The call came from one of my attendings at night during my cardiology fellowship. It had a touch of the black humor that medical persons don’t like to admit bubbles up to the surface from time to time.
“You know Dr. Shock, the guy on TV? He’s being transferred. He’s having a big infarct and is in cardiogenic shock.”
I was at home. I quickly pulled myself together and got into my car to drive to the hospital. During the drive I reflected on the call.
Of course I knew who Dr. Shock was. He was a staple on local Philadelphia UHF television. Back in the 1960s and 70s, before cable TV with its hundreds of channels, there was just broadcast TV. In Philadelphia I still remember the channels: 3 (NBC), 6 (ABC), 10 (CBS), and 12 (PBS). However, beyond this VHF set of channels there was also UHF TV. Instead of the usual rabbit-ears antenna, these channels used a circular antenna. They also tended to be fuzzy and staticky. The shows were low budget and local, but well worth watching after school as a kid growing up in the Philadelphia suburbs. Local TV personality Wee Willie Webber introduced me to Ultraman and 8th Man on his show. Sally Starr presented Popeye cartoons and Three Stooges shorts. Dr. Shock hosted Horror Theater while prancing around in a Dracula get-up and presented old black and white monster movies. He was a funny, silly host, defusing the scariness of the movies in a tongue-in-cheek manner that later hosts, like Elivra, Mistress of the Dark, and Joel and Mike in Mystery Science Theater 3000 would come to perfect. So, yeah, I certainly knew who Dr. Shock was.
When I saw him in the hospital, I myself was shocked. This was a young looking man. Without his makeup, he didn’t at all resemble TV’s Dr. Shock. I found out his real name was Joseph Zawislak. He was just 42 years old. He was in the CCU with a big MI and low blood pressure. He shook my hand and was polite, dignified, and deferential. “Do what you can, Doc.” I had been directed by my attending to place a Swan-Ganz catheter.
This was 1979. I was a first year cardiology fellow. There wasn’t a whole lot we could do for someone in cardiogenic shock from a big myocardial infaction back then. It was the dawn of the thrombolytic and angioplasty age and those treatments were not readily available. Infact size limitation was all the rage, using nitrates, balloon pumps, and various magic potions. Practically speaking though, a large infarct with cardiogenic shock was usually a death sentence.
So it was that poor Dr. Shock arrested that night and couldn’t be resuscitated. Now, almost 40 years later, after so many forgotten patient interactions, I still remember him and that night clearly.
If annoying 21st century TV prescription drug ads were run as annoying 1950s TV ads (and taking into consideration 1950s morals and censorship).
Here is a pdf version of this post formatted as a screenplay, if you’d prefer (it looks nicer).
“The George Burns and Gracie Allen Show.” Theme music begins.
HARRY VON ZELL (V.O)
The George Burns and Gracie Allen Show,
ADVERTISING FILM SNIPPET.
Zoom in on floating box of Vialis tablets, as if resting on a gray table, light source from left. Box is tilted at 45 degree angle, pointing upward. Music swells.
HARRY (V.O.) (CONT’D)
Presented by Eli Pfeltzer, the makers of many fine prescription drug products, including VIALIS, the miracle pill for men.
“Eli Pfeltzer, Makers of VIALIS, the MIRACLE PILL for MEN.”
INT. THEATER STAGE – DAY
Announcer Harry Von Zell is standing center stage in front of a live studio audience. Curtain is down and is behind Harry. Audience applause swells and terminates. Music fades and stops.
Looks at watch.
Our curtain’s about to go up on George and Gracie, but first I want to let you in on a little secret. You’ve seen George get flustered at Gracie on many an occasion, and maybe you’ve asked yourself the question, “what keeps them together?”
Well, I’m not going to answer that directly. George already has fired me three times this month.
But instead I am going to tell you a story, a story about two women who meet while out shopping. Two old friends who haven’t seen each other for a while and need to catch up on what’s going on in their lives. Here they are, at the department store coffee shop.
(indicates to audience to watch film screen to left)
INT. DEPARTMENT STORE COFFEE SHOP – AFTERNOON
Two women, Betty and Marge, middle-aged, dressed nicely, wearing modern clothes, gloves, and flowery hats are seated opposite each other. They are drinking coffee.
(putting down her cup)
Oh, Marge, Fred and I are so happy together. My life is wonderful. He’s such an amazing man. He constantly brings me home flowers and candy. Gosh, he’s such an old-fashioned Romeo. He makes me feel like, well, like a real woman.
Marge starts sobbing uncontrollably.
I can’t begin to describe…
(she stops talking, suddenly observing Marge’s reaction to her words)
Oh my goodness! Marge! What’s the matter?
Marge brings herself under control.
(still sobbing a little)
Oh, Betty, don’t get me wrong. I am so happy for you and Fred. It’s just, it’s just…
I wish I could say the same about my Alfred. I don’t know what’s happened to him. It’s like all the romance has vanished from our marriage. He’s just not the man I married.
Betty reaches over and pats Marge’s shoulder to console her.
Oh Marge, I completely understand. In fact, Fred and I were having the same problems not too long ago. Then we learned about VIALIS.
Yes, VIALIS. It’s the new prescription drug from the Eli Pfeltzer company. It’s specially made just for men.
How’s it work?
It improves the circulation of the blood. As men get older, they get tired blood. It really gets them down.
How does improving the circulation help?
Here try these.
(she pulls out a box of VIALIS)
If they work, just have Alfred ask his doctor for more.
(looking at the box, turning it over)
Well, I guess I’m ready to try anything.
“A Month Later…” Brief interlude music
And now our two old friends meet again at the same department store, a month later. Let’s see how Marge is doing.
INT. DEPARTMENT STORE COUNTER – AFTERNOON
Marge and Betty encounter one another for the first time in month. Attire similar but not identical to former meeting.
You look happier than the last time I saw you.
I am. Alfred’s blood circulation is so much better, thanks to you and VIALIS. It made a big difference. And I can tell you, when his circulation got better, mine did too!
Oh, and more good news. I’m expecting!
My goodness, that’s wonderful. How many is it now?
It will be my tenth. I’m so happy!
(she pulls out the box of VIALIS from her purse and holds it up to the camera)
I think all wives should tell their husbands about VIALIS, don’t you? It really is the MIRACLE PILL for MEN.
INT. THEATER STAGE
Audience applause. Harry again stands center stage before the curtain.
I too want to applaud these two modern wives who are willing to do the right thing for their husbands. We all know that often it’s the wife who needs to take the initiative in looking after the health of her husband. Lord knows, it’s the last thing we men think about.
Uh-oh, curtain’s going up. It’s time for George and Gracie.
Audience applause. Harry exits stage left. Curtain rises.
EXT. OUTSIDE OF GEORGE AND GRACIE’S HOUSE – DAY
George is sitting on porch, smoking a cigar. Gracie enters from inside the house.
When I was working I never watched daytime TV. Even now I don’t watch much TV, usually just some news shows. Nevertheless recently I had occasion to watch some daytime television and I happened on the Maury Povich Show. Disobeying my better instincts to change the channel, I spent some time watching it, and the similar show that followed, the Steve Wilkos Show. I found both shows disturbing but oddly fascinating, probably the same mixture of emotions that kept the Roman peasants coming back to the Circus Maximus to watch people being torn apart by lions. Here on TV I was watching peoples’ lives being torn apart in a horrifying if less bloody fashion. Though I was disgusted with myself for watching, it was hard to turn it off.
If you are not familiar with the concept of these shows, it is rather simple. There is a woman, her child, and a boyfriend or spouse. The paternity of the child is in question. Rather than attempt to answer this question in private with DNA testing, the involved parties come on TV where they tell their stories and usually end up yelling at each other, accompanied by whoops, cheers and jeers from the studio audience. The moderator, Maury or Steve (Jerry Springer I believe was the first to have this kind of show) asks questions and makes some token attempt to keep the “contestants” in line, though a few thrown chairs and bleeped-out cuss words are par for the course and add to the drama. Finally the truth is revealed, both by the results of lie detector tests that the warring parties have taken before the show, and ultimately by the DNA test. At that point the man who thinks he is the father of the child finds out either he really is, or that his wife cheated on him and the kid isn’t his. There are variants on this theme, such as the freeloader who doesn’t want to support a child but finds out it is his kid after all, or the black couple with the light-skinned baby who everyone knows can’t be from the husband but the husband refuses to believe it until the DNA results come in. After the denouement there is a lot of crying or screaming or both. And then on to the next story.
Is this exploitative? Is the Pope Catholic? I did not watch long enough to prove this, but from what I watched and what I have read these shows have on poorly educated, low-income, often black couples who behave in a way that reinforces all the negative stereotypes we have of poor uneducated people. I don’t know why they come on the show. Sure they get a free DNA test, but at the cost of exposing the most private secrets of their lives to the world. The fact that they are willing to do this makes their participation even sader and more pathetic. But worse by far are the people who created the show and decided to exploit them in this way.
Back in the 1950s when I was growing up there was a show called Queen for A Day. Women would come on the show and tell stories about how they had lost all their money or had a handicapped child and couldn’t afford medical treatment. Using an applause meter, the audience would vote on which story was most pathetic. The winner was dressed in a royal robe and received her prize, often something like a washer-dryer. An awful concept for a show, but no worse than what’s on daytime TV now.
After Maury’s show was over, the nearly identical Steve Wilkos Show came on. A couple was introduced. Two young black people, who had a son 5 years old. I’m not sure if they were married, but I think they were and it’s easier to write their story as if they were. In any case they had been together for over 5 years and the man considered the son his. But he wasn’t sure. The wife, at about the time the child was conceived, had gone to a party where she claimed she was drugged and raped. She said she awoke in the hospital the next day not remembering anything and was told she had cocaine and Ecstacy in her blood. She did not press charges. The husband was concerned that the child was not really his. He said he loved his son but really wanted to know if he was his and whether his wife was telling the truth. As usual on the show, the two spent some time hurling accusations back and forth to the delight of the studio audience, and it looked like there wasn’t going to be much holding this relationship together if the DNA test didn’t come back the right way.
After a dramatic build-up (and several commercials), the results of the testing were delivered in a sealed envelope. The lie detector results were first. The woman had been telling the truth when she said she had awakened in the hospital with positive drug tests the morning after the party. But she had lied about being involuntarily drugged and raped. She had taken the drugs voluntarily and had “hooked up” with a guy at the party voluntarily. As the woman started breaking down on being confronted with these facts, the host, Steve Wilkos, read the results of the DNA testing. The man who had been with this woman for over 5 years and had served as a father to her son, was indeed NOT (emphasis per the show) the biological father of the child.
This sent the wife running in tears backstage. But the husband, who had every reason to be disappointed and angry, did the unexpected thing. He ran after his spouse, followed by the cameras. He hugged his wife and comforted her, repeating “we’ll work it out. We’ll work it out.” And all the time the camera focussed in on this most private, human, touching moment.
I turned off the TV, feeling guilty at witnessing such a private moment, but at the same time uplifted by the capacity of humans to forgive, to love. I guess this is the essence and attraction of reality television. While exposing a lot of the bad side of humanity, it occasionally surprises us by showing us the good lying at the core of some people. But it’s strong stuff, even gut-wrenching, and fundamentally voyeuristic. Not my cup of tea.
I’ve been backing off from social media recently. For someone who writes a blog as well as publishing medical apps this may appear to be a risky tactic. In truth this retreat has not been completely voluntary. Something known as “real life” has been seeking my attention and gotten in the way of my online life interactions.
My fascination with social media has always fallen into the “love-hate” category. Maybe “addiction” is a more apropos word than fascination. Social media addiction has supplanted the previous generation of technological addiction, television. Probably a similar fascination or addiction existed when radio was the dominant medium, but I don’t go back that far. The first reaction to television was amazement: “wow, there are moving pictures on the screen.” It didn’t matter that there were only 3 channels in black and white (later expanded slightly by adding fuzzy, low-budget local programs on UHF). Nightly TV viewing became a dominant part of American life in the 50s and 60s. With cable, the number of channels rose, but the signal to noise ratio decreased. TV viewing, passive and mindless to begin with, only got more passive and more mindless. Yet the TV addiction, once begun, could not be shaken, at least not until a stronger drug/soporific became available. I’m afraid that stronger drug is social media on the Internet.
Just as voices decried the huge number of hours that the average American sat in front of the TV set in the past, so too some voices have expressed concern over the tightening grip of social media. There is a lot of good that social media does. It brings together geographically separated folks of similar interests. It is much more active than watching television: people text, message, tweet, post, and blog. But by the same token it is much more seductive — and more readily available, now that everyone carries a smart-phone. Despite social media’s mostly bland and not terribly informative content, withdrawal is difficult. There is anxiety about missing interesting tweets or Facebook posts. By nature of the sheer volume of social media output, the occasional stuff that you might be interested in gets buried in the background noise of cat and baby pictures. So you end up either checking your Twitter or Facebook feed several times a day or living in fear.
Yet somehow the world went on before this torrent of social media posts, and we were none the poorer for its absence or at least living in blissful ignorance of what we were missing. It depresses me to see people walking down the street with their faces buried in their phones, or seemingly talking to the thin air, ignoring what is going on around them; or two people at lunch, staring down at their phones, not talking to each other. How social is social media if it actually decreases our sociability with each other in real life? I am not a Luddite and I don’t want social media to go away completely. Maybe just sometimes. Let’s not lose the delight of person to person conversations over dinner or lunch. Taking a break from social media, whether due to life events, being out in the middle of the ocean somewhere away from WiFi, or just voluntarily chosen, can be a refreshing, mind-clearing act. And the real world has a higher pixel density than your iPhone screen. Take a look!
I am rereading George Orwell’s 1984. The first time I read it was in the 1960s. Reading it again I wonder if he shouldn’t have titled it 2014. The book is closer to reality now than it ever was. No, we don’t have a dictator named Big Brother looming over us. But the ubiquitous electronic surveillance that the book describes has come to pass. In Britain there is one video surveillance camera for every 11 people. In the United States the National Security Agency (NSA) has been reauthorized by a secret FISA court to continue recording “meta-data” on all cell phone calls within the country. It has been revealed that the NSA has been recording all voice calls (including those of Americans traveling or living abroad) in at least one foreign country and has plans to expand the program. On the corporate front, Google scans my Gmail and search history and presents me with targeted ads. I voluntarily disclose personal information on Facebook and Twitter. The IRS knows all about my finances. My medical records are all digitized and stored in computer servers. My photos and documents are somewhere in “The Cloud” which sounds better than the reality: on some hard drive on some web server in a location unknown to me, tended by strangers. My life has been encoded into ones and zeros stored on computers scattered across the globe, and everyone wants a piece of the action. We have all allowed this situation to develop haplessly, many even welcoming these changes as a necessary response to the attacks of 9/11/2001. The government was able to take advantage of the fear engendered by these attacks to chip away at our Fourth Amendment rights to protection from unwarranted search and seizure of property. As Orwell says, from the point of view of our masters, IGNORANCE IS STRENGTH.
The Heartbleed Bug is a reminder of our vulnerability. He who lives by the sword dies by the sword. Software is powerful but it is also fragile. We have put all our information into one basket, and, to mix metaphors, Heartbleed revealed it is a leaky basket indeed. There are bad guys out there who want our data. My website gets attacked daily with brute force attempts to log in by guessing my password. I know this because my security software automatically notifies me and blocks the attacking site. My site has been successfully hacked in the past. It is a constant battle keeping one step ahead of the attackers. If you run the program Wireshark which inspects data packets arriving to your computer from the Internet, you can see that brute force password attacks are happening all the time. And if this happens to a minor target like my website, then more important sites are even more heavily bombarded. With results. Witness the Target credit card breach.
Now that all our private medical data has been or is being transferred to electronic form due to government mandates in the US, how safe is it from attack? I think you know the answer. Unlike Heartbleed which was a vulnerability in an open source implementation of the SSL protocol, medical electronic health record (EHR) systems provided by EPIC, Allscripts, Cerner, and others are proprietary systems, with closed-source software, not open to review by outside experts. The Heartbleed code, being open source, was readily reviewable by anyone, and despite this the flaw in the code was not picked up for two years. Are there flaws in the coding of EHR systems? As all software has bugs, the answer is undoubtedly yes. Could a large medical information breach happen akin to the Target credit card breach? Certainly.
It is frightening to consider the economic value of the medical information that these various private EHR companies are sitting on. Wouldn’t a potential employer want to know about your history of depression? Wouldn’t the drug companies love to know what’s in these database files? Targeted drug ads, anyone? After being sent home from the hospital following a myocardial infarction, will my Google search page include ads for the latest anti-platelet drug? There are plenty of companies who would pay a lot of money for this kind of information. Could your EHR company sell your data? Not legally, at least not now. But the data could be stolen and sold. And, given how the US has become more and more ruled by corporate interests, I wouldn’t be surprised if the selling of your private medical information does become legal some day. You did read that EULA thoroughly before clicking on the OK button when you signed into your doctor’s office, didn’t you?
In the 1960s television series, The Prisoner, Patrick McGoohan proclaims “I am not a number, I am a free man!” Like the book 1984, quite prophetic. Even the tiny video cameras of the 1998 movie “The Truman Show” have come true with cell phone cameras everywhere. We are a nation of voyeurs and exhibitionists, watching our reality shows and posting everything about ourselves on Facebook. Giving up our privacy is partly self-inflicted but also the result of data collection by Big Brother in the form of government and big business. In 1949, when 1984 was published, the technology didn’t exist to implement the invasion of privacy he envisioned. In 2014 that technology is here and the genie is out of the bottle.
The only thing more annoying than TV commercials is TV drug commercials. Nowadays the two have become virtually synonymous Whatever happened to commercials for Tide or the Ginzu knife? Now it’s one mind-numbing Cialis, Pristiq, or Lyrica commercial after another. There’s the commercial with the doctor standing in his white coat out in public next to a giant mirror, not saying a word as people walk up to him. That guy should be arrested. There is the glowing nocturnal butterfly, flying from house to house, presumably flying into the head through your ears while you sleep, to eat your brain. There are sad people who suddenly have drug-induced happiness. There are COPDers, accompanied by elephants. There’s the guy who doesn’t have to make the turn off to the Protime Clinic because he’s on Xarelto, and can go fishing instead. All the commercials have high production values, but many, like the doctor and the mirror, just seem weird. Each commercial follows the same pattern:
Part I: The cheerful narrator sets up the problem and then introduces the drug-based solution. No commercial gets to the point quicker than the Cialis commercial. The awkward, non sequitur intro goes something like this: “It’s the little things she does, you never get tired of. But your erectile dysfunction? That may be a matter of blood flow.” (I tried to google the exact text, but, have you ever tried to search for anything with the word Cialis in it? I warn you, don’t try it.)
Part II: The same narrator reads the list of side-effects, in the same cheerful but somewhat more pressured tone of voice, having only 30 seconds to get them all in (“…stop taking Cialis and seek medical attention if you have an erection lasting more than four hours…” or “…in rare cases Happy Drug X may cause death, suicide, liver failure, kidney failure, and so forth and so on…” or “…if your pregnant wife accidentally mistakes your Axiron for deodorant your baby will be born with two heads…”).
Direct to consumer prescription drug advertising was approved by the FDA in 1997 and is only legal in two countries in the world: the USA and New Zealand. Proponents of these ads argue that they should be permitted by First Amendment free speech and that they are useful to raise public awareness of diseases and their treatment. Opponents argue that this is wasteful spending, adding to the cost of these drugs, and that the ads create pressure on physicians to prescribe drugs they wouldn’t otherwise prescribe. The ads encourage the viewer to self-diagnose conditions like insomnia, restless leg syndrome, or “Low-T”, leading to unnecessary drug treatment of naturally occurring conditions. And, as the commercials warn us in that cheerful, friendly voice, there are some risks associated with these drugs. Even though the $4.8 billion dollars the drug industry spent (in 2008) on direct to consumer advertising is considered trivial compared to the total cost of health care (and is much less than the money spent on direct to physician marketing — which should be another blog post), clearly these ads work for the industry, or they wouldn’t bother spending the money.
I would love to make a policy of not using drugs that are advertised on TV, but the practice is universal, and some of the drugs, like the new anticoagulants are actually useful. I would be cheating my patients if I did that. With Congress being the representative of industry rather than of the people, it is unlikely direct to consumer drug advertising will ever change. Maybe if US physicians united to protest these commercials, then… Whoa! What I am thinking. Physicians in this country actually uniting to accomplish something? Sadly, I will undoubtedly be reminded of the perils of four hour erections for the rest of my life.
I’ve been going through the Season 4 Voyage to the Bottom of the Sea DVDs. The first half of this season has some memorable episodes, although the second half degenerates into typical “monster of the week” episodes before the show’s final oblivion at the end of this season. Watching the shows again brings me back to my teenage years of the 1960s and I have truly enjoyed the experience. Here are some screenshots from the episodes “Man of Many Faces.” This episode recalls the glory days of the first two seasons and counterbalances some of the more forgettable episodes. The episode is more notable for its drama and off-Seaview locations than special effects shots, but these screenshots indicate that even in season 4 some new effects shots were made.
I installed WordPress Jetpack recently. Among other features, it tracks traffic to individual blog posts. It’s interesting that of all the topics I’ve blogged about, this is the most popular post. There is not doubt that the special effects of that old series, especially the surface shots, hold up very well even by today’s standards. A 17 foot submarine model photographed while being towed in a lake has an element of realism that even computer graphics can’t match. It is no accident that the movies comprising The Lord of the Rings largely eschewed computer graphics and used models for most of their special effects.
No particular connection, but seeing the passing of Elizabeth Taylor brought back to mind how much I admired (ok, was in love with) her when I was young and watched her in movies such as Giant. For those who are only familiar with the aged version of the lady, these photos show her in her prime. See what I mean?
I’ve posted before about the DVD releases of the 60s TV series, Voyage to the Bottom of the Sea. Although without a doubt the first 2 seasons (especially the black and white first season) were the best, there is something great or at least nostalgic to the true Voyage fan in all of the shows. Fox DVD released the first 3 seasons fairly quickly (each season divided between 2 DVD sets), but then a long period of time passed without any word of the fourth season release. Fans began to panic. This thread speculating on the release of the fourth season was created. Ah the agony and ecstasy of the fans, the rise and fall of hope that Fox would finish the job they had started years ago! The desperate emails to Fox from the fans, the disheartening silence from Fox in return! Finally in March of 2009, the first half of season 4 was released. Despite being within a half a season of completing the series, it did not appear to be a sure thing that the final half of season 4 would ever be released. Speculation again ran rampant on the above mentioned thread. The economy crashed. DVD sales dropped. There seemed little hope that the last DVD set would ever be released. Fox was silent, but no doubt badgered by the legions of Voyage fans who emailed, called and wrote them. Well the fan effort paid off! Unbelievably, the last DVD set is due for release on January 11. You can pre-order from Amazon. Highly recommended for baby-boomers who grew up with the show. For others, you might start with season 1. Very good non-CGI special effects, as well as good acting from Richard Basehart and David Hedison in spite of some silly plots.