Vital Signs Are Vital: How We Learned To Measure Blood Pressure.

Posted on | April 1, 2025 | No Comments

Mike Magee

It has been estimated that a medical student learns approximately 15,000 new words during the four years of training. One of those words is sphygmomanometer. the fancy term for a blood pressure monitor. The word is derived from the  Greek σφυγμός sphygmos “pulse”, plus the scientific term manometer (from French manomètre).

While medical students are quick to memorize and learn to use the words and tools that are part of their trade, few fully appreciate the centuries long efforts, to advance incremental insights, discoveries, and engineering feats that go into these discoveries.

Most students are familiar with the name William Harvey. Without modern tools, he deduced from inference rather than direct observation that blood was pumped by a four chamber heart through a “double circulation system” directed first to the lungs and back via a “closed system” and then out again to the brain and bodily organs. In 1628, he published all of the above in an epic volume, De Motu Cordis.

Far fewer know much about Stephen Hales, who in 1733, at the age of 56, is credited with discovering the concept of “blood pressure.” A century later, the German physiologist, Johannes Müller,  boldly proclaimed that Hales “discovery of the blood pressure was more important than the (Harvey) discovery of blood.”

Modern day cardiologists seem to agree. Back in 2014, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure reported that “With every 20 mm Hg increase in systolic or 10 mm Hg increase in diastolic blood pressure, there is a doubling risk of mortality from both ischemic heart disease and stroke.”

But comparisons are toxic. No need to diminish Harvey who correctly estimated human blood volume (10 pints or 5 liters), the number of heart contractions, the amount of blood ejected with each beat, and the fact that blood was continuously recirculated – and did this all 400 years ago. But how to measure the function, and connect those measurements to an amazingly significant clinical condition like hypertension, is a remarkable tale that spanned two centuries and required international scientific cooperation.

Harvey was born in 1578 and died in 1657, twenty years before the birth of his fellow Englishman, Stephen Hales. Hales was a clergyman whose obsessive and intrusive fascination with probing the natural sciences drew sarcasm and criticism from the likes of classical scholar and sometimes friend, Thomas Twinning. He penned a memorable insult laced poem in Hales’ honor titled “The Boat of Hales.”

“Green Teddington’s serene retreat
For Philosophic studies meet,
Where the good Pastor Stephen Hales
Weighed moisture in a pair of scales,
To lingering death put Mares and Dogs,
And stripped the Skins from living Frogs,
Nature, he loved, her Works intent
To search or sometimes to torment.”

The torment line may be well justified in light of Hales own 1733 account of his historic first ever mention of the measurement of arterial blood pressure, illustrated and self-described here:

“In December I caused a mare to be tied down alive on her back; she was fourteen hands high, and about fourteen years of age; had a fistula of her withers, was neither very lean nor yet lusty; having laid open the left crural artery about three inches from her belly, I inserted into it a brass pipe whose bore was one sixth of an inch in diameter … I fixed a glass tube of nearly the same diameter which was nine feet in length: then untying the ligature of the artery, the blood rose in the tube 8 feet 3 inches perpendicular above the level of the left ventricle of the heart; … when it was at its full height it would rise and fall at and after each pulse 2, 3, or 4 inches.”

Having established the existence of “blood pressure,” the world would wait nearly another century to gain access to a reliable tool for measurement. That advance came from the hands of French physician-physicist, Jean Léonard Marie Poiseuille. He was born in 1799, amidst the flames of the French Revolution. In 1828, as a doctoral candidate, his dissertation on the use of a mercury manometer, attached to an anticoagulant laced cannula, in lab animal vessels as small as 2 mm in diameter, yielded measurable, and reproducible arterial pressure readings, earning him a gold medal from the Royal Academy of Medicine.

Carl Ludwig, a 31-year old German professor of physiology, next decided Poseuille needed a permanent and transportable record. His solution in 1847 was to attach a float with a writing pen to the open mercury column. As the mercury rose, the pen scratched out a reading on a revolving smoked drum. 

But direct arterial puncture was impractical and invasive. By 1955, scientists had surmised that applying external counter pressure to an artery could obliterate the pulse below the obstruction, and that measuring the pressure generated by an obstructing external rubber ball would essentially reveal the blood pressure generated by a contracting heart – the systolic pressure.

In 1881, an Austrian physician named Karl Samuel Ritter von Basch created an elaborate portable machine that included a manometer capable of measuring the internal water pressure inside an inflatable rubber ball applied at the wrist to the radial artery. The pressure necessary to eliminate the pulse below was roughly the peak pressure of the column of blood when the heart contracted. Eight years later, the French physician, Pierre Carle Édouard Potain, replaced the water with air for compression. 

By 1896, blood flow was appreciated as a series of waves that peaked when the heart contracted, and fell as the heart relaxed. The wrist compressing rubber rubber cup was replaced by an air filled cuff wrapped around the upper arm which constricted the larger brachial artery. A Russian surgeon, N.C. Korotkoff,  in 1905, suggested that doctors listen to the waves rather than feel for the pulse. The sounds he described became known as Korotkoff sounds.

As described in a 1941 translation of the Russian paper and illustrated here by wikipedia, Korotkoff wrote, “On the basis of this observation, the speaker came to the conclusion that a perfectly constricted artery under normal conditions, does not emit any sounds…The sleeve is put on the middle third of the arm; the pressure in this sleeve rises rapidly until the circulation below this sleeve stops completely. At first there are no sounds whatsoever. As the mercury in the manometer drops to a certain height, there appears the first short or faint tones, the appearance of which indicates that part of the pulse wave of the blood stream has passed under the sleeve…Finally all sounds disappear. The time of disappearance of the sounds indicated the free passage or flow of the blood stream… Consequently, the reading of the manometer at this time corresponds to the minimum (diastolic) blood pressure.”

It is easy to forget, in an age of semiconductors, photocells and strain gauges, that progress in understanding the human circulatory system took centuries to acquire, and international cooperation. When Covid hit, homes that could acquired Home Blood Pressure Monitors and Pulse Oximeters that attached to an index finger and delivered oxygen saturation of blood and pulse with no delay. For a little more, you can access a Portable ECG monitor  in the comfort of your own home. 

We  appear to have entered a new era, one where a U.S. president and his enablers are fast at work dismantling American scientific capacity and cooperative, AI-laced, international science discovery capacity. The timing couldn’t be worse, since increasingly, we patients are expected to enthusiastically participate as both providers and recipients of our own health care.

Do You Know Your Blood Type?

Posted on | March 24, 2025 | 2 Comments

Mike Magee

Medical Science has made remarkable progress over the past 100 years, fueled by basic scientific discoveries, advances in medical technology, improved diagnostic testing, and public health programming to support, inform, and empower patients.

Progress has been sequential, with each new discovery and advance building on those preceding it. These have combined to lengthen lifespan in the U.S. by 70% since 1900. If one were to make a list of the top 10 medical advances in the 20th century, there would be a wealth of candidates, and great debate over which to include. But one candidate for certain would be safe and effective blood transfusions.

In the middle of the 20th century, most Americans knew their blood type. It was one of the earliest pieces of medical data shared with patients. Some of us may still have it enshrined on a Red Cross donor card, or remember learning it in preparation for surgery, as part of obstetrical care, or during hospitalization.

Nowadays, we know a great deal more, data-wise, about ourselves and can refresh our memories by accessing electronic health records. But, surprisingly, blood type is often absent. 

Both my wife and I once knew our blood type, but were no longer certain. And blood type is not something you want to get partly right. For victims of major trauma, obstetrical patients, patients undergoing chemotherapy, and aging patients with chronic anemia, blood transfusions remain common.

Unlike the past, you don’t need a doctor’s appointment to learn your blood type. My wife and I purchased a self-testing double kit on Amazon for $18.99. My result, A+, is enshrined on the home test card above, delivered in 10 painless minutes. How this was made possible however is part of  a complex history  that reaches back more than four centuries.

Over 7 million Americans donate blood each year in the United States. Worldwide the number rises to some 120 million donors annually. Together Americans contribute over 12 million units of blood each year. Every two seconds, an American receives a blood transfusion in a hospital, outpatient care unit, or home setting. Each day 30,000 units of whole blood or packed red blood cells, 6000 units of platelets, and 6000 units of plasma are transfused. 

For hospital patients over 64, blood transfusion is the second most common hospital procedure. 16% of recipients are in critical care units, 11% in surgical operative suites, 13% in emergency departments, 13% in outpatient units (most in the service of cancer patients), and 1.5% associated with OB-Gyn procedures including 1 out of every 83 deliveries. 

Hemorrhage is the most common cause of death in 1 to 40 year olds. In the first hour after arrival at a trauma center, 25% require a transfusion and 3% of victims require more than 10 units of blood. Gun violence is the largest net consumer of blood. Compared to victims of motor vehicle accidents, falls, or non-gun assaults, gun victims consume 10 times more blood, and are 14 times more likely to die in a trauma facility. Massive transfusions themselves carry a significant risk of consumption of clotting factors, acidosis, and hypothermia.

These are the major facts. But how did we arrive at this point in time. Where did the knowledge come from? When did we understand the human circulatory system, and the components and functions of blood itself?  Who came up with the idea of transferring blood from one person to another, and how did we learn to do that safely? And who created “blood banks” and why?

An abbreviated history would have to begin with William Harvey who was born on April 1, 1578 in Folkestone, England, and had the good fortune of having the town’s mayor as his father. In his youth, he was described as a “humorous but extremely precise man” who loved coffee and combing his hair in public. He was privileged, curious and studious, a “dog on a pant’s leg” kind of guy when it came to understanding one thing in particular – the human circulation.

Without modern tools, he deduced from inference rather than direct observation (aided by observations and dissections of a wide range of fish and mammals) that blood was pumped by a four chamber heart through a “double circulation system” directed first to the lungs and back via a “closed system” and then out again to the brain and bodily organs. 

He correctly estimated human blood volume (10 pints or 5 liters), the number of heart contractions, the amount of blood ejected with each beat, and the fact that blood was continuously recirculated. He published all of the above in an epic volume, De Motu Cordis, in 1628. The only thing he didn’t nail down was the presence of tiny peripheral capillaries. That was added in 1660 by Marcello Malpighi who visualized the tiny channels in frog’s lungs.

All this occurred without an understanding of what blood was. It was only in 1658 that Dutch biologist Jan Swammerdam and his microscope described red blood cells.The notion of possible benefits of transfusions emerged within this same time frame. In 1667, someone tried infusing sheep blood into a sick 15-year old child. The child survived, but not for long. Other animals were attempted as well without success. Over many years other liquids were infused including human, goat, and cow milk, which yielded “adverse effects,” and led others to try saline as a blood substitute in 1884.

The problems with human to human transfusion were threefold. First, between collection form donor to delivery to recipient, the blood tended to clot. Second, there was no way of preserving non-contaminated blood for future use. And finally, the infused blood inexplicably often triggered life-threatening reactions.

Anti-coagulants, like sodium citrate, came into use at the turn of the century, addressing issue number one. The other two issues owe their resolutions in large part to an Austrian biologist named Karl Landsteiner. Through a series of experiments in 1901, he was able to recognize protein and carbohydrate appendages (or antigens) on red blood cell surfaces which were physiologically significant.  He defined the main blood antigen types – A, B, AB and O – and proved that success in human blood transfusion would rely in the future on correctly matching blood types of donors and recipients. In 1923, he and his family emigrated to the U.S. where he joined the Rockefeller Institute and defined the Rh Antigen (the + and – familiar to all on their blood types) in 1937. For his efforts, he received the Nobel Prize in Physiology.

Human to human blood transfusions, from healthy to wounded serviceman, proved life-saving in WW I. But the invention of “blood banks” would not arrive until 1937. Credit goes to Bernard Fantus, a physician and Director of Therapeutics at Cook County Hospital in Chicago. A year earlier, he had studied the use of preserved blood by the warring factions in the Spanish Revolution. He was convinced that collecting donated containers of blood, correctly typed and preserved, could be life saving for subsequent well-matched recipients. His daughter, Ruth, noting that the scheme of “donors” and future “lenders” resembled a bank, is credited with the label “blood bank.” 

In his first year of operation, Fantus’s “blood bank” averaged 70 transfusions a month. Techniques for separating and preserving red cells, plasma, and platelets evolved after that. And real life tragedies like the Texas City, Texas wharf fire of 1947 with mass injuries tested the system with 1,888 150cc units of pooled plasma administered to survivors of that disaster.

Additional breakthroughs came in response to the demands of WW II. Blood fractionation allowed albumin to be separated from plasma in 1940. Techniques to freeze-dry and package plasma for rapid reconstitution became essential to Navy and Army units in combat. 400cc glass bottles were finally replaced by durable and transportable plastic bags in 1947. And blood warming became the standard of care by 1963. By 1979, the shelf life of whole blood had been extended to 42 days through the use of.an anticoagulant preservative, CPDA-1 and refrigeration. Platelets are more susceptible to contamination and are generally preserved for only 7 days. The components preserved were also prescreened for a wide variety of infectious agents including HIV in 1985.

This brief history illustrates how complex and interwoven, hard-fought and critically important, are the advances in medical science. Empowered citizens  today are not only the beneficiaries of these discoveries, but contributors as well. The history of blood transfusion perfectly illustrates this point. If you don’t know your blood type, finding out is a useful starting point, and donating blood remains a remarkable act of good citizenship and a lasting contribution to the health of our nation.

Science as a Tool of Diplomacy. The Brief History of Balloon Angioplasty.

Posted on | March 17, 2025 | Comments Off on Science as a Tool of Diplomacy. The Brief History of Balloon Angioplasty.

Mike Magee

“Navigating Uncertainty: The recently announced limitation from the NIH on grants is an example that will significantly reduce essential funding for research at Emory.” 
Gregory L. Fenes, President, Emory University, March 5, 2025

In 1900, the U.S. life expectancy was 47 years. Between maternal deaths in child birth and infectious diseases, it is no wonder that cardiovascular disease (barely understood at the time) was an afterthought. But by 1930, as life expectancy approached 60 years, Americans stood up and took notice. They were literally dropping dead on softball fields of heart attacks.

Remarkably, despite scientific advances, nearly 1 million Americans ( 931,578) died of heart disease in 2024. That is 28% of the 3,279,857 deaths last year.

The main cause of a heart attack, as every high school student knows today, is blockage of one or more of the three main coronary arteries – each 5 to 10 centimeters long and four millimeters wide. But at the turn of the century, experts didn’t have a clue. When James Herrick first suggested blockage of the coronaries as a cause of “heart seizures” in 1912, the suggestion was met with disbelief. Seven years later, in 1919, the clinical findings for “myocardial infarction” were confirmed and now correlated with ECG abnormalities for the first time.

Scientists for some time had been aware of the anatomy of the human heart, but it wasn’t until 1929 that they actually were able to see it in action. That was when a 24-year old German medical intern in training named Werner Forssmann came up with the idea of threading a ureteral catheter through a vein in the arm into his heart. 

  Werner Forssman in action

His superiors refused permission for the experiment. But with junior accomplices, including an enamored nurse, and a radiologist in training, he secretly catheterized his own heart and injected dye revealing for the first time a live 4-chamber heart.  Werner Forssmann’s “reckless action” was eventually rewarded with the 1956 Nobel Prize in Medicine.  Another two years would pass before the dynamic  Mason Sones, Cleveland Clinic’s director of cardiovascular disease, successfully (if inadvertently) imaged the coronary arteries themselves without inducing a heart attack in his 26-year old patient with rheumatic heart disease.

But it was the American head of all Allied Forces in World War II, turned President of the United States, Dwight D.Eisenhower,  who arguably had the greatest impact on the world focus on this “public enemy #1.” His seven heart attacks, in full public view, have been credited with increasing public awareness of the condition which finally claimed his life in1969. 

Cardiac catheterization soon became a relatively standard affair. Not surprisingly, less than a decade later, on September 16, 1977, anther young East German physician, Andreas Gruntzig, performed the first ballon angioplasty, but not without a bit of drama. 

Dr. Gruntzig had moved to Zurich, Switzerland in pursuit of this new, non-invasive technique for opening blocked arteries. But first, he had to manufacture his own catheters. He tested them out on dogs in 1976, and excitedly shared his positive results in November that year at the 49th Scientific Session of the American Heart Association in Miami Beach.

Poster Session, Miami Beach, 1976

He returned to Zurich that year expecting swift approval to perform the procedure on a human candidate. But a year later, the Switzerland Board had still not given him a green light to use his newly improved double lumen catheter. Instead he had been invited by Dr. Richard Myler at the San Francisco Heart Institute to perform the first ever balloon coronary artery angioplasty on a wake patient. 

Gruntzig arrived in May, 1977, with equipment in hand. He was able to successfully dilate the arteries of several anesthetized patients who were undergoing open heart coronary bypass surgery. But sadly, after two weeks on hold there, no appropriate candidates had emerged for a minimally invasive balloon angioplasty in a non-anesthetized heart attack patient. 

In the meantime, a 38-year-old insurance salesman, Adolf Bachmann, with severe coronary artery stenosis, angina, and ECG changes had surfaced in Zurich. With verbal assurances that he might proceed, Gruntzig rushed back to Zurich. The landmark procedure at Zurich University Hospital went off without a hitch, and the rest is history.

Within a few years, Gruntzig accepted a professorship at Emory University and relocated with his family. He was welcomed as the Director of Interventional Cardiovascular Medicine. 

As the Frontiers in Cardiovascular Medicine reported in 2014: “Unlike Switzerland, the United States immediately realized Grüntzig’s capacity and potential to advance cardiovascular medicine. Grüntzig was classified as a ‘national treasure’ by the authorities in 1980; however, he was never granted United States citizenship. Emory University had just received a donation of 105 million USD from the Coca-Cola Foundation (an amount which in 2014 would equal approximately 250 million USD), one of the biggest research grants ever given to an academic institution, which allowed the hospital to expand on treatment of coronary artery disease using balloon angioplasty technology.”

Gruntzig’s star rose quickly in Atlanta. His combination of showmanship, technical expertise, looks and communication skills drew an immediate response. Historians saw him as a personification of the American dream. As they recounted, “The first annual course in Atlanta was held in February 1981. More than 200 cardiologists from around the world came to see the brilliant teacher in action. The course lasted 3 and 1/2 days with one live teaching case per half day and, with each subsequent course, the momentum for angioplasty increased.”

According to Emory records, “In less than 5  years at Emory, Grüntzig performed more than 3,000 PTCA procedures, without losing a single patient.” Remarkably, after 10 symptom free years, Gruntzig’s original patient, Adolf Bachmann, allowed interventional cardiologists from Emory to re-catheterize him on September 16, 1987, the 10-year anniversary of his original procedure. The formal report documented that the artery remained open, and the patient was symptom free.

As this brief history well illustrates, science has historically been a collaborative and shared affair on the world stage. In an age where Trump simultaneously is disassembling America’s scientific discovery capabilities, undermining historic cooperation between nations, and leaving international public health initiatives in shambles, it useful to remember that institutions like Emory have well understood that science requires international cooperation, and not only has the power to heal individuals, but also is a critical tool of diplomacy.

Video: Andreas Gruntzig (in his own words).

Echoes of Apartheid: The Case for Tesla Divestiture

Posted on | March 6, 2025 | 4 Comments

Join the “Tesla Divestiture” Movement

Send this link to all your friends and contacts.
Speak up! Push back!
___________________________________________________

Mike Magee

For aging Boomers, it is impossible not to hear echoes of Apartheid re-emerging with force 3/4 of a century after the battle for social justice here and in far away lands was fully engaged. The Musk assault, disguised as “efficiency” is little more than stealing money from the poor to give to the rich, and widens an already extraordinary income gap.

The assault is large enough to draw condemnation from a dying Pope Francis, forced to remind Trump, Musk and their enablers of the historic Jesus and the tenets of Liberation Theology.

Our college years in the 1960’s were accompanied by chaos and crisis, and guided by fundamental Judeo-Christian values. My college, the Jesuit-led Le Moyne College, was activist to its core. The movement was championed by two priests, brothers Daniel and Philip Berrigan. With the assassinations of JFK, his brother Robert, and MLK;  LBJ’s Great Society legislative battles; the Civil Rights movement;  and the Vietnam War,  America was literally on fire at the time. 

It was during this decade as well that a largely student-driven movement emerged to oppose Apartheid in South Africa and rapidly spread worldwide. A seminal feature of that movement was mass education and demonstrations with a goal of creating economic pressure on the leaders of South Africa by divestiture of all stocks and investments that benefited the nation.

Elon Musk, born and bred in Pretoria, South Africa on June 28, 1971, is more than a little familiar with that history. In fact, Silicon Valley, where Musk would eventually accumulate his massive wealth, is also the home to Stanford University, a site of great importance to the Apartheid movement and the battle for human justice. More on that in  a moment.

The economic battle against Apartheid would be waged unabated for over two decades, reaching a head on college campuses in the late 1970s. The explosive growth of protests followed the Soweto Uprising, a notorious event in the Soweto Township outside Johannesburg in June, 1976. South African police opened fire on children demonstrating. The riots that followed lead to a stream of horrendous killings including the murder of the South African Student Association leader, Steve Biko, while in custody.

But it was a sit-in, staged by Stanford students to protest Apartheid, that redefined the struggle by focusing on the use of university divestiture to deliver an “economic punch” to the ruling minority.  

A decision made by the Stanford Board to oppose a Ford Motor Company stockholder’s proposal to withdraw operations from South Africa provided the trigger. Stanford at the time held 93,950 shares of Ford Stock. In response to the inaction, the Stanford students launched a sit-in (captured by the Stanford Daily student newspaper below) inside the Old Student Union Building at 1 P.M. on Monday, May 9, 1977. When they wouldn’t leave five hours later, 294 students and faculty were arrested including the daughter of the U.S, Secretary of Labor, Jill Ann Marshall.

Six months later, after repeated demonstrations and disruptions on campus, the Board issued a statement that each of their trustees held a “deep aversion to the practice of apartheid”, and adopted a “South Africa-related ethical investment policy.” Still it took until 1985 for the university to “create formal investment policies that explicitly set out guidelines for investing in South Africa-related companies.”

The weight of the world’s economic-induced isolation did eventually prevail. Nelson Mandela was freed after 27 years of imprisonment, and soon united in his efforts with President F.W. de Klerk to achieve universal suffrage. Together they shared the 1993 Nobel Peace Prize. And a  free election followed one year later.

Many of us today, in our 70s and 80s, once again feel the familiar strains of suppression and oppression in the behavior and actions of Musk, as he toggles emotionally between South Africa, the Silicon Valley, and Washington. 

Violence is once again in the air, along with intense greed, cruelty, subjugation, and the targeting of the economically oppressed majority. Oligarchal and super-aggressive, sadly there is nothing new here. Musk’s child-like behavior obsesses on a “super-hero” world and visions of Mars as he ravages the inhabitants of Mother Earth.

Given his life origins and path, might he too respond to intensive economic isolation? And this time it is not Ford, but Tesla, that is front and center.

Musk owns 13% of Tesla stock (valued at $120B on March 6, and down to $104B since this campaign began)) which accounts for roughly 1/3 of his total wealth. His profiteering with Trump is obvious, visible, and accelerating. A Tesla Divestiture could be  the most likely way to “deliver us from evil” as it did with South African apartheid on April 27, 1994.

Want to help? 3 easy steps and then one more.

1. Trade it in. If you own a Tesla, trade it in for another brand now.

2. Check – Do you or  your organization own Tesla stock in any form?

3. If yes, organize a teach-in, to explain Divestiture (as in SA Apartheid), its’ purpose and utility.

4. Circulate and post an online petition to ask your organization to divest of all Tesla holdings.

. . . and one more, Copy and Share this post with all your contacts. 

Trump and Vance: We Need to Finish This Drama and Undress These Actors.

Posted on | February 26, 2025 | 2 Comments

Mike Magee

“Chance made the situation; genius profited from it,’ says history. But what is chance? What is genius?”  
                          Leo Tolstoy from “War and Peace”, 1867.

Trump and Vance wasted little time embarrassing America today. Following the game plan of  “Professional Wrestling” they did their best to bully and emasculate Ukraine’s President Zelensky, who is twice as smart and many times more courageous than the two combined.

They succeeded only in leaving many more questions than answers. Is Trump and Vance using Zelensky as a shield, easily discarded after taking deadly fire from Putin?  Are Trump and Vance capable of holding Musk in check, with his commanding wealth, or is he now the de facto play maker for the nation? Will Americans press “return to sender” in the midterm election to avoid further disgraces for our nation?

It has become increasingly difficult to differentiate what is Trump/Vance and what is Republican. The President and Vice-President are now clearly joined at the hip, a modern day version of Napoleon who Leo Tolstoy described in “War and Peace” 158 years ago. And like Napoleon, they have an army of supplicants determined to follow their leaders with the same conviction as the French army whose fate was to stall in the freezing grounds of Mother Russia and be consumed by epidemic typhus and trench fever.

Consider Tolstoy’s reflections, and judge yourself which apply to Trump and Vance, and are fast at work repeating history.

First, their rise . . . 

On The Rise To Power  

“Seizing power requires that the old . . . is destroyed; old customs and traditions are obliterated; step by step a group of a new size is produced, along with new customs and traditions, and that man is prepared who is to stand at the head of the future movement and bear upon himself all the responsibility for what is to be performed…A man without conviction, without customs, without traditions, without a name, not even a (military man or politician), seemingly by the strangest chances, moves among all the parties stirring up (hatreds), and, without attaching himself to any of them, is borne up to a conspicuous place.”

Early Success

“The ignorance of his associates, the weakness and insignificance of his opponents, the sincerity of his lies, and the brilliant and self-confident limitedness of this man moved him to the head…the reluctance of his adversaries to fight his childish boldness and self-confidence win him…glory…The disgrace he falls into…turns to his advantage. His attempts to change the path he is destined for fail…Several times he is on the brink of destruction and is saved each time in an unexpected way…the very ones who can destroy his glory, do not, for various diplomatic considerations…”

Fawning and Bowing to Power

“All people despite their former horror and loathing for his crimes, now recognize his power, the title he has given himself, and the ideal of greatness and glory, which to all of them seems beautiful and reasonable….One after another, they rush to demonstrate their non-entity to him….Not only is he great, but his ancestors, his brothers, his stepsons, his brothers-in-law are great. Everything is done to deprive him of the last powers of reason and prepare him for his terrible role. And when he is ready, the forces are ready as well.”

Turning a Blind Eye

“The ideal of glory and greatness which consists not only in considering that nothing that one does is bad, but in being proud of one’s every crime, ascribing some incomprehensible supernatural meaning to it – that ideal which is to guide this man and the people connected with him, is freely developed…His childishly imprudent, groundless and ignoble (actions)…leave his comrades in trouble…completely intoxicated by the successful crimes he has committed…he arrives for his role without any aim…(leading to) the decomposition of republican government…and his presence, clear of any (opposing) parties, can now only elevate him.”

Self-Adoration, Mobs, and Conspiracy

“He has no plan at all; he is afraid of everything…He alone, with his ideal of glory and greatness…with his insane self-adoration, with his boldness in crime, with his sincerity in lying – he alone can justify what is to be performed…He is drawn into a conspiracy, the purpose of which is the seizure of power, and the conspiracy is crowned with success….thereby convincing the mob more forcefully than by any other means that he has the right, because he has the power.”

Next, their fall . . .

The Spell is Broken by a Reversal of Chance

“But suddenly, instead of the chances and genius that up to now have led him so consistently through an unbroken series of successes to the appointed role, there appear a countless number of reverse chances….and instead of genius there appears an unexampled stupidity and baseness…”

The Final Act

“A countermovement is performed…And several years go by during which this man in solitude on his island, plays a pathetic comedy before himself, pettily intriguing and lying to justify his actions, when that justification is no longer needed, and showing to the whole world what it was that people took for strength while an unseen hand was guiding him…having finished the drama and undressed the actor(s).”

 

Shocking: The Story of the AED in 2025.

Posted on | February 21, 2025 | 2 Comments

Mike Magee

The leaders of America’s scientific community seem genuinely surprised by the actions of the past three weeks. They expected to be spared the wrath of Trump because they believed that “Americans of all political persuasions have respect for science and celebrate its breakthroughs.”

Maybe so. But that is an inadequate defense against a multi-pronged attack which includes purposefully selecting unqualified hostiles to key management positions; restricting scientists travel and communications; censuring scientific discourse; and clawing back promised funding for research projects already underway. This “knee-capping” has extended beyond our geographic boundaries with Trump’s vengeful withdrawal from the WHO and the Musk inspired elimination of USAID.

“This too will pass,” whisper Republicans behind closed doors. But even so, the nature of scientific discovery and implementation is a complex rebuild. This is because the path from innovation to invention to implementation is interdisciplinary and requires collaborative interfaces and multi-year problem solving. Not the least of the challenges is gaining access, trust, and cooperation from the general public which requires funding, public education, and community planning.

Take for example a life saving device that is increasingly ubiquitous – found everywhere these days from rural high school cafeterias to the International Space Station and everywhere in between – the Automated External Defibrillator or AED.

It is estimated that AED’s have the potential to save 1,700 American lives a year. Experts say that over 18,000 Americans have a life threatening cardiac arrest outside of a hospital with a shockable rhythm disturbance each year. But 90% don’t survive because access to an AED is delayed or not available. Without a correction in about ten minutes, you are likely to die. This means that the 6 pound AED has be where the patient is, the bystander has to know what to do with it, and there can be no delay.

Creating the modern day AED was a century long affair according to the  “Institute of Electrical and Electronics Engineers” or IEEE . That organization traces its own roots back to 1884 when electricity first sparked the imagination of our nation’s inventors. As they state, the IEEE has  “long been composed of engineers, scientists, and allied professionals. These include computer scientists, software developers, information technology professionals, physicists, medical doctors, and many others.”

Mark Kroll, is an electrical engineer and member of IEEE. He enjoys sharing his role and those of physicians and a range of science specialists in the AED creation story. His starting point is to remind listeners that in order for the AED to reach its potential, it had to be “idiot-proofed.”  

Without hesitation he labels the AED as “one of the greatest engineering success stories of the last few decades.” His reasoning is threefold:

1. “Efficacy of the waveform that delivers the electric shock.” 
2. “The innovative way that the unit’s energy is stored and delivered.”
3. “The AED’s overall ease of use.”

In the early 1900’s, Thomas Edison’s company, General Electric, was more than aware of the lethality of electric shock (electrocution). The switch from direct-current to alternating current transmission was accompanied by a disturbing increase in accidental electrocution deaths of their linemen. They turned to university experts (at institutions like Johns Hopkins) to get to the bottom of it. While experimenting with dogs, they noticed that a second shock sometimes brought the electrocuted dogs back to life. 

In 1921, a Hopkins medical student, Claude Beck, took notice. Beck went on to train in surgery at Yale and Harvard under Harvey Cushing, and in 1926 accepted a position as the first Research Fellow in Surgery at Case Western Reserve University in Cleveland, Ohio. Beck would eventually transition from General Surgery to Neurosurgery and then to Cardiac Surgery, but always wandered back to the lab to support his primary interest, applied research. In the 1930’s he began to pick up where the Hopkins researchers had laid off, doing a series of animal experiments, applying AC current directly to laboratory animals’ exposed hearts and measuring the effects. 

He created the first rudimentary defibrillator in the process consisting of “a transformer to isolate the animal from the 110-volt ac wall supply, a variable resistor to limit the current to a heart-safe value, and two metal tablespoons with wooden handles to deliver the jolt to the exposed heart.” A decade later, while operating on a 14-year-old’s heart, the child’s heart began to beat wildly and stopped. In an act of desperation, he rushed his machine from his lab to the OR and shocked the boy’s heart. When the first shock didn’t work, he repeated it and  successfully brought him back to life.

By 1965, local Heart Associations had begun training citizens in closed chest massage for heart attack victims, and the first “portable” defibrillators were utilized with limited success. Much of the reason why was their lack of portability (they weighed 70 kg or 154 pounds) and the machine required two operators – one to apply the “clothes-iron” size paddles, and the other to conduct and interpret an electrocardiogram to assure the victim actually had an arrhythmia, and hadn’t simply fainted or suffered a seizure.

Still, a few were saved, enough to encourage the physicists and engineers to innovate refinements that would make the invention capable of mass introduction. These included;

1. In 1980, biomedical engineers replaced the bulky paddles with flexible adhesive patches lined with a metal chloride gel.
2. The patches reduced skin contact resistance from 150 ohms to 75 ohms, which allowed for a lower voltage shock. This meant that the defibrillators could be built with higher-density electrolytic capacitors and miniaturized semiconductor switches lowering the weight to 20mg or 44 pounds.
3. The patches also simultaneously delivered an ECG allowing the machine to be operated by just one individual.

Over the next two decades, further advances in understanding the generation of a functional modern biphasic wave form, creation of software to automatically detect the target arrhythmia and time the delivery of the shock to the exact 100 millisecond moment when it would be most effective, and the creation of algorithms to get around a range of complicators (for example, what if the victim has a pacemaker).

 

Nowadays the AED is portable, increasingly accessible, and affordable. The HeartStart model by Philips is available on Amazon Prime for $1,723.63. It weighs only 6 pounds with dimensions about the size of a lunchbox (10.5 x 9.5 x 5.75 inches). So as not to confuse consumer operators under stress, there is only one button – and it delivers the shock. The on-off button was removed a few years ago. Now the machine turns itself on when the case is opened. The machine then guides with verbal commands. With patches attached, the machine automatically does a 3-second diagnosis, repeating the process 3 times. Only if 2 of the 3 tests positively identify an arrhythmia is the machine approved to shock.

And yet, for all the progress, the work in converting from invention to innovation to implementation still has a long way to go. And the actions of Trump and Musk, in undermining the communication and funding between multi-disciplinary scientists and their institutions not only complicates. It is potentially deadly.

What lines of AED investigation have been disrupted?

1. Data gathering: Each time an AED device is used in the field, the data gathered is transferred to ongoing research databases to measure effectiveness and guide refinements. These efforts require federal funding.
2. The expansions of these devices to schools, churches, airports, and the public square; and the training of citizens to confidently employ the devices without delay is a massive challenge, currently utilizing a combination of federal and state employees and non-profit organizations. Many of these individuals and organizations are on Musk’s chopping block.
3. Advances in AED design have demonstrated that CPR chest compression, while awaiting AED arrival, not only moves blood out of the heart but also moves air through the lungs. But responders delivering CPR routinely tire and are less effective after 60 seconds. Current research into next generation AED’s suggests that “complex, lower-voltage waveforms (100 to 200 V) that are delivered once or twice per second and cause strong chest constrictions” could eventually replace human administered CPR, and convert arrhythmias as well.

Will Mark Kroll and his medical science collaborators carry the day? He remains optimistic. He says:

“Indeed, we may now be on the cusp of a wave of medical automation that allows ordinary individu­als to intervene constructively when other people’s lives are at stake. The AED, we think, serves as an important case study for how to fit sophisticated life-saving medical electronics into health care and rehabilitation outside of hospitals. Advances in portable and easy-to-use equipment, home-based therapy, remote health monitoring, and telemedicine may one day allow patients to avoid long, expensive, and emotionally draining hospital visits.”

Is Musk Writing His Own Super-Hero Story?

Posted on | February 17, 2025 | 4 Comments

Mike Magee

A lot can happen in the blink of an eye. You can lose everything. Your name, your reputation. But they can be replaced… by determination, strength, empathy, faith… A renewed sense of how blessed you are just to be alive. To have people who love you, care for you, but that only happens if you don’t leave before the miracle. When you realize that tomorrow is a new day. That tomorrow brings hope, and hope is where we find redemption.

Wally West (The Flash), September, 2011

________________________________________________________

Susan Kirtley PhD is the Director of Comic Studies at Portland State University. She says that comics “inspire many of us to believe in ourselves and our visions for the future, despite any naysayers. It’s not necessary to have a superpower to be a superhero, but rather faith and commitment.” 

Elon Musk clearly shares her religious zeal and is a true believer. His outfits alone deserve graphic novel treatment. Eight years before he showed up in the Oval Office in a long length, villain inspired, black overcoat hunched over with four year old “X” on his shoulder as he decimated the employee ranks of the federal government, he said, “I read all the comics I could buy or that they let me read in the bookstore before chasing me away.”

Aaron Day Lewis, author of “American Comics, Literary Theory, and Religion,” draws straight lines between 1980’s comic heroes and their stark attitudes on good vs. evil, science fiction, societal calamity, and visions of afterlife. The heroes are often “cutting-edge inventors and futurists” or “vigilante billionaires” that morph into “genius detectives…I have to imagine Musk absorbed this idea that there’s this heroism to being smart and innovative… Maybe that inspired him to envision himself as a potential superhero, to write his own superhero story.””

In comic world, science and science fiction confidently blend and blur. In ranking the most powerful super heroes of all time, comic book aficionado Maverick Heart (aka aeromaxxx 777)  lists “Flash” as the clear winner, stating “Not only does he have super-speed, but once he reaches terminal velocity, he has shown other incredible powers. During an attempt to measure his top speed, he strained every muscle in his body to run at about 10 Roemers, which is 10 times the speed of light.”

“Roemers?” That’s a reference to Ole Roemer (1644-1710), a Danish uber-scientist, whose seminal discovery of the “speed of light” was celebrated on his 340th anniversary in 2016 with the Google doodle above. Details aside (the Earth’s timing of orbits around our sun were measured against Jupiter moon Io’s orbit around the distant planet), he detected a discrepancy in the measurements of the eclipses which amounted to 11 minutes. He attributed the lag to a speed of light he calculated to be 140,000 miles per second, not infinite as was commonly thought at the time.

Ole was the Elon of his day – tutoring France’s King Louis XIV eldest son one day, serving as Denmark’s royal mathematician the next, and still finding time to meddle in politics – getting himself appointed judicial magistrate, tax collector, chief of police, and mayor of Copenhagen. He was apparently as quick as Elon to downsize the manning table, reportedly firing the entire police force because “their morale was too low.” Not long on empathy, he was also known to target “beggars, poor people, unemployed, and prostitutes” – and not in a good way.

He was also science mentor of choice for up-and-comers in physics, astronomy, and natural philosophy. And that is why Daniel Gabriel Fahrenheit (1686-1736), a 22 year old equally ambitious scientist and instrument maker sought him out in 1708, two years before Ole’s demise and burial in the Copenhagen Cathedral. 

The road that led to that meeting however was bumpy. At age 15, Fahrenheit  lost both his parents to an accidental mushroom poisoning. His guardian then arranged a four-year merchant trade apprenticeship in Amsterdam. But when he completed the program at the age of 20 in 1706, he escaped an agreed upon further commitment with the Dutch East India company and his guardians sought an arrest warrant. When he arrived at Mayor Romer’s doorstep two years later, he was seeking business guidance and a pardon from further legal action. He achieved both. 

Ole Romer explained that there was currently intense interest in high quality instruments that could measure temperature. For nearly a century, everyone from Galileo to Huygens to Halley had been working on it. He himself had invented one in 1676 while convalescing from a broken leg, but there was great room for technical improvements.

 The challenges were threefold – physical construction, the creation of a standard measurement scale, and reproducible accuracy. He spent the next four years refining his glass blowing skills, discovered that mercury was a more reliable reference liquid than alcohol, and realized he could improve on Romer’s scale – which he did, renaming it the Fahrenheit scale in 1717 in a publication, Acta Editorum.

The famous scale was pegged on three different reference points. The first was the point at which a mixture of ice, water and salt reached equilibrium, which he identified as 0 degrees. The second was the temperature at which ice was just beginning to form on still water. This would be 32 degrees. And the final measure was the temperature when the thermometer was placed under the arm or in the mouth. This became 96 degrees. The span between 0 and 96 allowed Fahrenheit to create a dozen divisions with each subdivided into 8 parts. (12 X 8 = 96)

Fahrenheit thermometers were well-crafted and popular in their day. Their success carried  the Fahrenheit scale into two centuries of dominance. But in his day, the unpatented invention did not make him rich. He died at age 50, a virtual pauper. In September of 1736, he was granted a “fourth-class funeral of one who is classified as destitute” at the the Cloister or Monastery Church.

Just two decades later, in 1745, another scientist name  Anders Celsius arrived on the scene with a new scale. It would be a slow-burn, taking approximately two centuries to officially supersede the Fahrenheit scale everywhere in the world except (not surprisingly) the United States. Built on a scale of 0 to 100, the Celsius scale is also called the centigrade scale.

American scientific hubris has forced America’s math students to memorize conversion formulas and engage in what management guru, Tom Peters, would call unnecessary “non-real work.”

A down and dirty one: F -30 /2 = C.

Or more accurately: (F-32)/1.8 = C

In the meantime, comic book fantasists with a taste for standard-fare wild tales can purchase the “Trump Trading Card – Assassination Attempt- Gem 10 Graded – Trump Collectible Card” on Amazon Prime with a  17% discount for $19.99. 

But for you Trump voters with an unhealthy taste for the supernatural and unknown, Elon is more likely the “Ole” unlikely to disappoint. As Jeffrey J. Kripal, Professor of Religion, Rice University, and reviewer of “American Comics, Literary Theory, and Religion” wrote, “We are not who we think we are. Like the superheroes themselves, we each have a secret identity (or identities). The conscious ego or unitary self is a useful construction, but also an illusion.”

Professor Kripal does leave us with some hope for redemption, with futures not yet fully determined or decided.  In fact, these comic circumstances may unveil “super-selves that can become an important part of a new soul-making practice that will result in future selves and future stories in which to live and flourish. Our afterlives… are constantly being rewritten, redrawn, and seen anew. By us, as super.”

In God we pray. Amen

keep looking »

"Available Everywhere Now"
"Code Blue INDEX online"

 

  Ralph Snyderman
Prospective Health Blog
BIOGRAPHY   Meredith Magee Donnelly
Homegrown Friends
BIOGRAPHY   Eric Dishman
NIH Precision Medicine
BIOGRAPHY   Barbara Ficarra
Health in 30
BIOGRAPHY   William L. (Larry) Minnix, Jr.
Larry's Letters
BIOGRAPHY     Eric Dishman
Precision Medicine, Euthanasia, Abortion, Communism, Trillions of Dollars, Losing Freedom, and Town Hall Mobs BIOGRAPHY   Michael Millenson
Yearning for Universal Coverage Is Not Universal
BIOGRAPHY

 

 

 

 

Search

Search