Reliable Sources

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My initial reaction to the collapse of the Francis Scott Key Bridge was disbelief, I had just swiped open my phone, eyes adjusting after I rolled out of bed Tuesday morning, and saw the Daily Mail headline blazing on my Facebook news feed.  So immediately I Google “bridge collapse” and, sure enough, the highlighted results were full of similar headlines.  It must be true.

Since that moment there has been a flurry of speculation.  My first thought, of course, is was this deliberate?  Did the Russians do it?   But as I started to gather evidence, like the video showing the lights going out and puff of black smoke, mechanical failure was a plausible explanation.  That didn’t rule out some kind of sophisticated hacking attack, but then this isn’t a Tesla car or Hollywood fantasy where anything electronic can just be operated remotely through undisclosed magical means.

Theories are easy to create.  The hard part is to sift through the information pouring in and come up with something actually likely given probabilities and reliable sources.  A random guy online or old Larry at the parts counter isn’t trustworthy.  The corporate media is only slightly better, in that they at least get the general story right, yet are also politically motivated and basically parroting official sources or their ‘experts’ at a lower resolution.

What of these officials and experts?

I generally rate someone who has their own reputation on the line over someone who is spit balling and couldn’t change their own spark plugs.  Someone with credentials is a better choice for information given that they did put in the work to get their degree and prove their competence.  However, a PhD or government position doesn’t make a person honest or free of bias.  Those who get paid by the government are part of the political establishment and their partisan agenda should be assumed.

1) Professional Experience 

The sources that I trust are those who built a reputation outside of politics and within the industry—this is why I’ve subscribed to “What is Going on With Shipping?”  Later in the day of the collision and collapse of the bridge I found an established channel about maritime matters for explanation.  How do I know he’s credible?  His fluency is a start, he has the technical jargon and credibility with others who know shipping from first hand experience.  It is notable that nobody here is surprised that this incident could happen.  The details of his analysis give me confidence that the information is good.

Authority comes from having professional experience and a proven record.  When I picked my neck surgeon, for example, we had a conversation about his prior record and the procedure.  I sized him up.  He was articulate, empathetic, and had all the expected confidence of someone who could work a miracle of modern medicine.  He also was able to explain everything in terms that I could understand.  The trust I put in him paid off, my recovery was great and I’ve come back stronger than ever.  Licensing with charisma doesn’t mean someone is competent, but it definitely helps.

2) My Own Aptitude 

But my main tool for determining who to trust is based on my own aptitude.  I have a decent understanding of physics and spent my younger days curious about mechanical systems—and always needed to understand how they work.  I could turn a wrench.  I did my own diagnostics and repairs.  So when I do bring my car to the mechanic I’ve already done my homework. 

For example, when my car lost power right away I suspected the Ti-VCT system was to blame.  The engine then gave a code that supported this hypothesis and I took it to a local tire shop and inspection garage.  I told them exactly what to look for giving them a page of the diagnostics manual.  And yet, after having the car for a day or two (after changing the air filter and cleaning the MAF sensor) they concluded it could just be the car is old and losing compression.  Finally, after taking the time to look under the hood, I found the problem.  It was what I had been suspecting.  This time I took the vehicle to a real technician, a guy who with a reputation for good diagnosis, and he gave a beautiful technical explanation of what happens with a short in that system.  After an inexpensive repair I’ve had no issues since.

I’ve never worked in the engine room of a big cargo ship.  I know that they are huge and, despite involving the same principles, are on an entirely different scale.  For one, it takes a team to keep them running, this isn’t like your Toyota where you can simply turn the key, put it in drive and go.  No, they have a startup sequence and when I heard a play-by-play of the disaster unfolding, where the puff of black smoke was explained as being a fuel-air mixture imbalance when they were using a burst of compressed air to start the massive engine, I recalled hearing this being explained in a documentary and it all lined up with what I know about engines.  It is clear he was credible and therefore I felt the rest of his commentary had merit.  I’ll never trust the people who completely miss on the basics and then expect me to believe their conspiracy theories.

3) Most Plausible Explanation 

It could be the MV Dali crew were attacked by mind control aliens using the 5G cell phone network.  There’s no way to disprove this is not what happened.  However, it is not the most plausible explanation and certainly not the first stop (or last) of a reasonable analysis.  What is probable is the answer with the least amount of moving parts or crazy assumptions, which points currently in the direction that this was an accident waiting to happen or a matter of reasonable probabilities that needs no fanciful dreamt up explanation.

There are those times when fact is stranger than fiction.  But we should only go there if there is plain evidence of motives and the means.  Like when the Nord Stream pipeline exploded and prior to this the US President made a threat “We will bring an end to it.” It isn’t a big stretch to believe he had a hand in the sabotage.  The US Navy is one of the few in the world that have the capability of making this kind of attack, so that is a very plausible explanation.  It also wouldn’t just happen on its own or accidentally, so we do look for the potential connections.

Nothing is ever absolute.  We can’t know for certain.  But I’m going with the assessment of the professionals who don’t seem at all surprised that this could happen and can give an informative analysis.  I’ll weigh one of their opinions over ten thousand who claim that there’s something fishy or they feel it in their gut and who have never set foot in the bowels of a cargo ship.  The reliable sources are those with professional experience and are not tainted by ideologies or narratives that color their perspective of all events.

The Three Different Kinds Of Mechanics

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We tend to lump things together that shouldn’t be. In other words, there is plenty of diversity within categories and this is something true of those whom we call mechanics. And the significant difference in mechanics is analogous to other professions, which is where this essay will end up.

The other week my old reliable Ford Focus began to act up. I had traveled, with my family, to a company picnic and everything was fine on the way out. However, on the trip home there was something that was not right. The power delivery was rough when trying to accelerate but smooth enough while cruising and immediately my mind went to the trick this 2.0 L had up its sleeve.

The ‘Duratec 20‘ has Mazda DNA. It uses direct injection and variable valve timing (or Ti-VCT) to make 160 hp while still delivering decent fuel mileage. With a 12.1:1 compression ratio, it has a decent torquey feel for a 4-banger, and—paired up with a five-speed—it is fast enough to be fun.

And to the point that a week prior to this, on the way to church, a late 90s Honda Civic with a loud pipe did the customary flyby, and we just so happened to line up at the next red light. So, as was necessary, to the slight embarrassment of my wife and great amusement of my son, I do the hard launch. It bogged a bit, despite my loading up a bit prior to releasing the clutch, so I dumped it down completely, the tires chirped, I hit second hard and I was grinning a couple of car lengths ahead before they knew what had happened. Not an actual race, but I’m pretty sure I had the edge even if they were ready for me.

The engine light would eventually come on in the next day or two. And, sure enough, checking the code at AutoZone, it came up as a camshaft sensor. That was something I could handle. I swapped in the new part. But it didn’t fix the problem. I noticed that the negative battery terminal had some corrosion and, with the help of a cousin, we cleaned that. Still, no dice. The issue persisted.

Shop #1: The Inspection Garage

With the help of a mechanic friend of mine, who sent me the applicable page of the diagnostics manual, I determined that the problem was now beyond my shadetree abilities. It was potentially a crank sensor fault (that for some reason shows up as being the cam sensor) or involved some sort of wiring issue. I took it to the garage, within walking distance, which had given me a better deal for vehicle inspection than the dealer could offer.

I left them with the page of the manual. I returned to a vehicle with a drained battery and still acting up despite their efforts. They had cleaned the throttle body, changed the air filter, and not overcharged me for that service. However, the problem was not fixed, and the explanation he gave—that the car (with over 230,000 miles) was old and probably down on compression—did not satisfy me.

I had assumed that they had run down the diagnostics checklist, as I had basically told them to do, and that weekend decided to take a look again with the aid of a mechanically inclined brother-in-law at our family summer get-together. My sister has a 2016 Focus, which had corrected the wiring harness issue, and immediately, while looking at her engine bay, I noticed how the Ford had moved these wires from where they were on my own 2014.

So I took another look at that, I lifted the harness on my car where it was against the engine and, sure enough, I could see the cover was worn through and a little copper was shining. Uh-oh. With a small piece of electrical tape and a spirited tested drive, the diagnosis was clear—that was the problem and I would need to take it to a shop that was capable of following my instructions.

Shop #2: The Technician

After pricing my options, I decided on a garage that had helped me with another mystery issue years ago with my Jaguar XJR. Jake, the owner, was an expert at diagnostics and, in a conversation with Jason who he trained as his replacement, it was clear that this guy knew his stuff. Now, granted, in this case, I had already provided the diagnosis. However, I could tell that he understood the systems of the vehicle far better than the guy at the inspection garage.

This is the kind of mechanic you need when the issue is more than an alternator or something obvious that only needs to be removed and replaced. Anyone can turn a wrench. Quite a few can go down the diagnostics checklist and eventually find the solution. But the actual technician type is a different breed, he is the guy who writes the manual and can even feel what is going on after a short test drive. These are the Ken Miles, can-improve-what-already-is kind, who in different circumstances may have become an engineer or even a doctor.

The technicians are professionals. They have a high IQ and a wealth of knowledge. And it is about much more than having the correct certifications or a toolbox full of Snap-On tools. Some simply do not have the aptitude even if they went through years of training and others do. The technician could be working in the back alley of Manila or at the dealership down the road. There are different levels even within this group, but what sets them apart is their intuitions and ability to model the complex systems of a vehicle in their heads. He’s as smart as your cardiologist.

Shop #3: The Scam Artist

Years ago my brother took his Ford Tempo in for a routine inspection. This was his first car and basic transportation for a teenager. And only cost a few thousand dollars, which was basically all he could afford at the time. The tire shop is in the middle of town and looks decently professional. I think of this incident each time I see their advertising two decades later.

The bill he got was more than the value of the car. Apparently, they decided that every suspension part was out of tolerance and maybe they were technically correct, who knows?

What I do know is that my dad took severe issue with this and helped my brother negotiate a slightly better price for the work. Still, they soaked him for a huge amount of money and have lost our business since then. They were at the level of the inspection shop, or your local Walmart Auto Care Center, as far as their abilities and yet telling us with absolute conviction that the car was not safe to drive without the laundry list of parts with labor they installed without so much as a phone call to my brother.

Dealerships can overcharge. But usually, they are more reputable and not just replacing parts because they have you over the barrel and have a bonus to make. These are the types who would convince your grandma she needs the blinker fluid filled and muffler bearings replaced. They aren’t technicians (they would too be ashamed of themselves if they were) and are basically just swindlers with a wretch to use as part of the scheme. Their diagnosis is always something expensive.

What Kind Of ‘Mechanic’ Is Your Doctor?

This understanding of different types of mechanics applies to all professions. Not every college graduate with the right credentials is equally qualified. Some engineers are really good at the classroom stuff, they know the code and can be completely anal about largely irrelevant or unimportant details. Others really get what makes structure work, it is intuitive to them, and what they build is likely safer than the variety that dots all of the I’s and crosses all the T’s according to the IBC 2021.

Doctors come in many varieties as well. There are those types who get into things like cosmetics or reconstructive surgeries, chasing after the big bucks, and then there are the others who want to run a clinic or set up a family practice to help as many people as possible. The country ‘doc’ driving the F-150 is a different breed than the one with a BMW or Porsche. One is practicing medicine, and the other has a profitable business that requires some medical skills. And, in both cases, competency is not strictly a matter of gathering the right diploma or getting through the board requirements.

My own hunch is that most doctors are more like the inspection shop mechanic. They’re not out to screw you over and they also do good work for the most part. However, they got where they did because they were at least of slightly average intelligence and good at navigating the system. This doesn’t mean that they are actually doing the real number crunching of the diagnostics themselves. No, it means that they can match a list of symptoms with what they can find in the Merck manual and write a (barely legible) prescription. This could mean that they miss things, over-prescribe, or basically share in the same failures as the entire medical establishment.

So, how reliable is the system?

Well, I’m not sure.

When I read things like, Why Most Published Research Findings Are False, and how the Lancet published (then later retracted) studies that cautioned against the use of Hydroxychloroquine or how Ivermectin was skewered as being “horse dewormer” despite being an effective anti-viral medication, it seems that politics may be dictating the science. And we all know that politics is heavily influenced by cold hard cash. So, let’s think, who benefits from keeping these kinds of cheap widely available therapeutics from the market? There was an industry that made $90 billion from the pandemic and also has connections to the corporate media apparatus. Who knows how far this big money penetrates government agencies and impacts regulations or policies.

But I do know this has been said…

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as editor of The New England Journal of Medicine”

Marcia Angell, MD

And this…

“The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness”

Richard Horton, editor of The Lancet

I’m assuming these two would know a little about the current state of science and medicine.

So how does a doctor separate the wheat from the chaff?

It is not right that some see the failures of some as a reason to dismiss it all. Getting taken advantage of by one repair shop doesn’t make all mechanics crooks. Still, how does a patient know if their doctor is doing a high-level analysis of the evidence, is capable of critical thinking and going beyond the book, or if he’s just following the pack without doing any truly independent diagnostics? It really takes someone a bit removed from the profession, who doesn’t share their biases or bad remedies, to give the corrective treatment. Maybe a car mechanic turned doctor (the guy in the featured picture) would have some useful perspective on the topic?

Whatever the case, if we can’t trust everyone who is licensed by the state to inspect vehicles, we should be even more skeptical of those who want to put things into our bodies. They don’t even have to be bad or intend harm, it could simply be that they are asleep at the wheel, putting trust in institutions that have been compromised and corrupted. At the very least, the body is extremely complicated and even our most advanced methods are crude. We may not know that our modern versions of bloodletting are of negligible value or even harmful for another century or two. This is why we customers, the patients, should never be pressured one way or another even if the science is supposedly settled.

Yes, even those at the top of the profession today may be tomorrow’s quacks…

Note the “slow poison” written on the mixing device.

A Mixed Bag of Medical Results

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Part of my personal myth is that I was a “miracle baby,” spared from a very early demise by the medical intervention of nurses and physicians, including my uncle Elam, a pediatrician, who hand pumped air into my lungs while being transported to Geisinger Medical Center.  

I had been born premature, suffered from a condition called Hyaline Membrane Disease due to my underdeveloped lungs, suffered a collapsed lung due to my hard breathing, and likely would have died without the advanced care that I received.  I was a fighter, for sure, but my survival would depend on the skilled intervention of medical professionals.

My mother would tell me that story and also use it to remind me that God had a special purpose for my life.  But what she didn’t tell me, until much later, is that my early trauma was actually caused by her doctor who induced labor. 

Oopsies.

My Medical Family

My mother had aspired to be a nurse.  Even worked in a nursing home prior to marrying my dad.  But life, including my sister and your’s truly, changed her plans. 

However, as often is the case, these dreams of parents are sometimes fulfilled by the next generation and sometimes double.  Both of my sisters are employed in the medical field and eventually even my mom found her way into a doctor’s office before eventually playing an instrumental role in the opening of Compassion Parochial Clinic.

My own role in all of this was to be my eldest sister Olivia’s first patient.  Using her Fisher Price Medical Bag, she would check and treat my various imaginary ailments, and had her mind set on being a pediatrician like her well-respected uncle.  And, after graduating high school, then acquiring a biology degree, she continued her education at Albert Einstein College of Medicine on Bronx, NY.

In fact, l feel that I may deserve a partial credit for having attended a lecture on the heart.  Although, I may have missed the second half due to a terrible bout of drowsiness and was not the only one sleeping.  Although, as a courtesy, I will not say whether or not my sister had succumbed.

Anyhow, my younger sister Lilian also picked a medical career, eventually became an RN, continued her education, and is now working on her licensing as a midwife.  Her passion is welcoming babies into the world and is someone with a personality well suited for the job.

All of that to say that this exposure causes me to have deep respect those in this profession.  One way to get on my bad list very quickly is to suggest that those in the medical field are only in it for the money and would deliberately keep people sick to cash in.  Sure, there are bad eggs in every profession, some terrible doctors, but my sisters (like many of their colleagues) are there to help people get well.

That said, having family in medicine also removes some of the aura.  My sisters are far more qualified to give opinions on medical issues than I am and yet they also are still human. 

Doctors make mistakes, they’re fallible like the rest of us, with blindspots and bias.  Plus they’re used to having totally ignorant people, who “did their own research,” challenge them on things they’ve spent years of their life studying, and can become tired of answering these inane statements—appear arrogant.

Physician: “Heal Thyself…”

People have very high expectations in regards to modern medicine.  We’re supposed to go to the doctor and be completely healed. 

But the reality is quite different from that.  Once you get past the buzzing technology and laboratory developed chemical cures, the sterile well lit halls of institutions, our actual abilities are still quite primitive.  Science may have given us better bandaid solutions than were available to our ancestors, yet there really aren’t that many miracles to be had.

My own expectations have lowered considerably after two injuries requiring expert examinations.  

The first, diagnosed as Degenerative Disc Disease, brought me to the office of the renowned neurosurgeon, Dr. Rajjoub.  I had terrible pain, loss of strength and feeling on my right side, my neck was really bad from what my family doctor saw on the MRI.  My parents, after we waited what seemed hours, finally were escorted into the examination room and were full of anticipation.

Having done our own research, knowing the seriousness of my injury, it was quite certain that I would be under the knife soon.  They would open things up, remove the bad, and fix me up better than new!  

The physician strode into the room.  He looked over the charts and images with intensity and then, without hesitation, “physical therapy” and started to turn towards the door.  Stunned, my mom, speaking for the three of us, our mouths agape, “Wait, what?!?”  It was as if he just told a blind man to rub mud in his eyes and was simply going to leave.  He explained further, telling us about the risks of the procedures, how my neck movement would be limited after, and restated his recommendation.

Dr. Rajjoub was right.  After weeks of therapy and further exercise at home, I was able to regain feeling and the use of my right arm.  Sure, I occasionally have painful flare ups and may need the surgery some day, but the doctor had given me the right answer even if it was not the one that I wanted to hear at the time.  Modern medicine has advanced, yet it is our body that still does most of the healing.

A Comical Contradiction

After tearing my ACL I met with an orthopedic surgeon to discuss the options available.  Still active, I expressed my desire to get back in the game and he responded by recommending surgery.  They grafted a part of my hamstring tendon in where the ACL had been and I spent the next few months becoming good friends with Rob and Bob at Keystone Care Physical Therapy and impressing the old folks there with my vertical leap.

Unfortunately, after a year of intense rehab, I was playing basketball and reinjured the repaired knee.  So I went back to the orthopedic surgeon for a consultation and his advice?  He suggested that maybe I slow down a bit, that I was no spring chicken anymore (a paraphrase) and should probably avoid strenuous activities.  Excuse me?!?  I had thought I went through the surgery and physical therapy so that I could actually use the limb, right???

But that’s typical of a doctor’s advice.  He was trying to minimize the risk of my reinjuring my knee, to cover his own butt, and could I really expect him to say anything otherwise?  To tell me to go full throttle again?  I can understand why he would urge my caution.  And still I can’t deny being disappointed.  My thought had been that this surgery would allow me to pick up where I had left off and instead I got a cease and desist notice.

The Undiagnosed Nightmare

I’ve reconnected with an old school friend.  I rode the bus with him for many years and we shared a first name. 

It is quite astounding, actually, how we got reconnected.  That being a story for another time.  But one thing memorable about this old classmate is how he was always complaining about pain in his feet.  At a younger age I had thought of him as being weak or a whiner.  He had been diagnosed as being flat-footed.  

However, it was a little clearer that there was something more seriously wrong when, in middle school, a fall, after a playful shove in the hall, resulted in a broken hip.

Anyhow, at our one-on-one reunion he would let me in on his the true source of his suffering and something that the medical professionals had missed.  Something that doctors had initially told him was all in his head, that the genetic department of an area research hospital refused to even test,  turned out to be Fabry’s Disease, a rare genetic disorder where the body is unable to produce a particular enzyme, which means the body is unable digest certain proteins, and is a death sentence if not properly treated.

He had gone through hell.  A breeze on his skin felt like torture.  They had treated him with addictive painkillers that basically turned him into a junkie.  And his proper diagnosis came from an uncle who read a story about someone with similar symptoms, a revelation that prompted my friend to demand the diagnostic tests for the genetic disorder and only then did he finally receive the necessary treatment.  The medical system had both failed and saved him.

The Miracle Hoped For…

Then there’s my cousin Uriah.  Nothing, not the most advanced treatment in the world, could save him.  The prognosis was never good, Synovial Sarcoma, but I held on to the hope that some new cure might come along, some miracle might happen, and he would survive.

It was hard to watch.  First after one round of him taking poison, called chemotherapy and the only thing that will keep the corrupted human cells called cancer from growing, they decided that he would need to sacrifice his leg.  This Uriah and his family did everything they could, he received top notch medical care at Walter Reed and elsewhere.  But there was not much that could be done for him.

The limitations of modern medicine is a bitter pill.  And those seeking ‘alternatives’ do not fare any better if diagnosed with an aggressive form of cancer.  I know many strong-willed individuals, in partial denial of the graveness of their condition, who traveled to places like Mexico for some kind of breakthrough treatment and suffered the same fate.  Better technology may come along soon and yet disease and death is as natural as health and life.

There is a myth, popular in some circles, that if a person eats right and exercises they will be rewarded with long life.  Uriah was one of the most fit and disciplined people I know, there was nothing he could have done better, he was dealt a bad card.

Having Correct Expectations

We see the headlines, “The third-leading cause of death most doctors don’t want you to know about,” discussing medical mistakes, like this one:

“In 2002 James lost his 19-year-old son after he collapsed while running. He had been diagnosed with a heart arrhythmia by a cardiologist a few weeks prior and was released from the hospital with instructions not to drive for 24 hours.

“His death certificate said he died of a heart arrhythmia,” he said, but my son really died as a result of “uninformed, careless, and unethical care by cardiologists.” He explained: “If you have a patient with heart arrhythmias of a certain level and low potassium, you need to replace the potassium, and they did not. And they didn’t tell him he shouldn’t go back to running.” Communication errors, he said, are “unfortunately very common.”

What is left out of this story is that a century ago he would have simply died from the arrhythmia. 

In fact, only half a century ago my great-grandfather died, a middle-aged man, of a heart attack because there were no surgeries widely available. 

So, truly, modern medicine is a victim of it’s own success, things have improved so much from the time when many people died of many diseases, even at a young age, that we now expect perfection.  Our ancestors, not too long ago, would have no treatment options, whereas we demand answers when the treatment fails.

Those who expect too much will be the most sorely disappointed.  Those who expect to be saved from suffering by science will some day be faced with a harsh reality and, likewise, those who believe that there’s a cure for cancer being withheld are equally delusional.  This idea that we have complete control, that there should somehow be a cure for everything, is a product of our success in medicine and also ignorance of what this success actually means.  

Sure, some of us, like my grandpa, may have died on multiple occasions had it not been for medical advancements like Penicillin, prostrate surgery and pacemakers.  But, even now, with the great progress we’ve made, we’re still all eventually going to wear out.  Our bodies have a shelf life and all the intervention in the world isn’t going to do much to change that.  Eat healthy, exercise enough, avoid getting hit by a truck, and you might see eighty years, maybe more if you have good genetics.  But we won’t live forever.

So, before we become too critical, rather than only dwell on the failures, we should look at the advancement and appreciate the success.  Results will always be a mixed bag, even those who have received the very best care, men like Steve Jobs, do not live forever nor will you.  Even Lazarus, brought back to life by Jesus, eventually died.  And my friend, the one with the missed diagnosis, would long ago have joined Lazarus had it not been for modern medicine.