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The problem with consumers

Sneezer

This post was considerably delayed, first due to the urgent need to publicize “Struck by Orca” and then by successive authorial waves of random health events (specifically J00[1], 2 separate bouts of A09.9[2], and in the middle, a nasty encounter with W00[3]). Now I am more or less healthy and ready to post about consumers.

On November 13, I concluded my post about patients by saying:
“So if patient is historically and socioculturally loaded, what else can we call them? Pat Mastors lists some alternatives: consumer, partner, person. Dr Hem, in Norway, overlaps in saying user,consumer, customer.”

Consumer, as an alternative to patient, has been around for quite a long time. Its origins are fundamentally economic; a consumer is a person engaged in a transaction who is not a producer. The Oxford English Dictionary entry shows you how old this usage is:

“consumer, n.” [OED Online. September 2013. Oxford University Press. 14 October 2013.]
2. A person who uses up a commodity; a purchaser of goods or services, a customer. Freq. opposed to producer.

1692 J. Locke Some Considerations Lowering Interest 20 Money may be considered as in the hands of the Consumer, under which Name I here reckon the Merchant who buys the Commodity, when made, to export.
1725 D. Defoe Compl. Eng. Tradesman I. Introd. 5 By the retailer to the last consumer.
1757 J. Harris Ess. Money & Coins 37 All men are in some degree consumers of foreign commodities.
1860 R. W. Emerson Wealth in Conduct of Life (U.K. ed.) 75 Every man is a consumer, and ought to be a producer.
1897 Sears, Roebuck Catal. No. 104. 1 (heading) Consumers guide.
1923 H. Kyrk Theory of Consumption v. 112 Consumers are influenced by other forces than those set in motion by the merchants who have goods to sell.
1933 Planning 1 vii. 5 Retail outlets..where improvements can be tried out and consumer reactions tested.
1970 Which? June 163/1 Manufacturers and consumers do not have identical points of view.
2001 Amer. Jrnl. Philol. 122 270 One continues to wish that the Clarendon Press would put its clothbound books a bit more within the reach of the individual consumer.

So much for economics. How long has consumer been applied to a client of healthcare services? The health context is the tricky part. There are just too many ways to express it. Some historians attribute the term to the late 1930s, when the ancestor of today’s Kaiser Permanente network was formed by workers for the Kaiser shipyards in California. (For a pocket history of Kaiser, see here).
This was the first HMO (health maintenance organization) and the term consumer was used precisely because the organization enabled purchase of healthcare services prior to need, that is, prior to being a patient.

Thus from the beginning, consumers and patients were not synonymous. In fact, consumer had to be coined precisely because patient implied “a person in a relationship with a healthcare provider or system for the purpose of receiving care” and thus was not the appropriate word.

The phrase consumer health is easier to trace. Every so often I search digitized newspaper content for it. This can never be the whole story, because different commercial vendors provide access to different newspapers and different years. Newspaper Archive currently has the largest suite of possible newspapers, however. The oldest reference I find to consumer health comes from the Middletown (NY) Times Herald of September 12, 1937—contemporaneous with Kaiser. It was used in a story about promoting the dairy industry:

“Each particular phase of the program aims to high-light the various steps in milk production and handling, the sanitary precautions taken, and the benefit in consumer health resulting from increasing the milk content of the ordinary diet.”

Then there’s Google NGrams, which covers books that Google knows about, 1800 through 2000. The phrase Consumer health is comparatively modern (1933) next to the term consumer, which appears — context unknown — as early as 1800.

A number of studies have been published that investigate how patients feel about being called consumers or anything else. These are mostly British and mostly studies of pregnant women. (A finding that I believe is worth a small study of its own). And the results are:

100 UK pregnant women, 15-50 years old: “Mother-to-be” and “Pregnant women” preferred. Batra N, Lilford RJ. Not clients, not consumers and definitely not maternants.Eur J Obstet Gynecol Reprod Biol. 1996 Feb;64(2):197-9. PubMed PMID: 8820002.

446 Cornish mothers, median age 28. Most popular: “Patient”. Least popular: “Client”, “consumer”, and “customer.” Byrne DL, Asmussen T, Freeman JM. Descriptive terms for women attending antenatal clinics: mother knows best? BJOG. 2000 Oct;107(10):1233-6. PubMed PMID:11028573.

200 UK mothers, age not provided in abstract. Most popular: “Patient”. “Least popular: “Client”, “consumer”, “customer.” Baskett TF. What women want: don’t call us clients,and we prefer female doctors. J Obstet Gynaecol Can. 2002 Jul;24(7):572-4. PubMed PMID: 12196849.

Review of 80 published studies of mental health services published in the English language; no actual humans involved (except in the research and writing, presumably). Preferred terms in published studies: “Client”, “patient”. Dickens G, Picchioni M. A systematic review of the terms used to refer to people who use mental health services: user perspectives. Int J Soc Psychiatry. 2012 Mar;58(2):115-22. doi: 10.1177/0020764010392066. Epub 2011 Feb 21. Review. PubMed PMID: 21339236.

As a word, consumer is demonstrably problematic. For example, the animation at the top of this post features a Sneezing Person. I am not a healthcare professional, nor do I play one on TV, but I feel safe in stating that this gentleman has a cold, an allergy, or a photic sneeze reflex. Is he a patient? No. From the photographic evidence, we know nothing about his access to healthcare. We know more about his access to movies. For all we know, he subscribes to a religion that prohibits him from visiting a healthcare professional. So what the heck IS he? We have to call him something. Is consumer accurate if he is not buying anything? (Besides a movie ticket?) Consumer, as inadequate a term as it may be, may be all we have.

Personally and professionally, I believe that consumers are not necessarily patients and should not be equated with patients, particularly in the healthcare information-seeking and informatics worlds. Conflating consumer with patient obscures some important differences. A high-school student doing research on cancer for a term paper is a consumer; his grandmother undergoing chemotherapy is a patient; both individuals will be in need of accurate, authoritative, health information, but how that information is provided to them really ought to differ. Because virtually all consumers are future patients, or will be caring for/living with/supporting patients, enabling consumers to access health information is critically important. Let’s just call them what they want to be called: Sneezing People.

—————
[1] “Acute nasopharyngitis.”
[2] “Gastroenteritis and colitis of infectious and unspecified origin”
[3] “Fall on same level involving ice and snow.”

Photo credit: “A series of animated GIFs excerpted by Okkult Motion Pictures from Coughs and Sneezes, a curious and amusing propaganda film from post war era on the dangers presented by… sneezing!” From the marvelous Public Domain Review. http://publicdomainreview.org/2013/07/09/coughs-and-sneezes-1945/.

King Charles, Struck by Orca, and the ICD

King_Charles_II_(Lely) Many, many thanks to FB friend Caroline Meikle, an alert SLIS grad and veteran of my Health Information Systems class, for sharing the news about Struck by Orca with me. It’s a volume of artworks illustrating the International Classification of Diseases, v. 10 – ICD-10 for short. How can a classification system have illustrations, you ask? Read on.

You have all encountered the ICD system if you live in a country that is part of the World Health Organization, or WHO, and have gone anywhere near a health-related process which needed to be counted by someone – whether or not the service cost you any money. Because the ICD is a product of the World Health Organization, it is not a commercial product and requires no licensing. For this reason, health information systems vendors used to brag that they built it into your system for free. To this, informed medical informatics professionals responded: “Big whoop.”

On your doctor or hospital bill in the US, if you are unfortunate enough to be admitted to the hospital with the plague, your ICD-10 code probably looks like this:

A20.9 Plague unspecified

“Unspecified”, which was “NOS” in ICD-9, is an all-purpose means of denoting “a concept for which a code does not yet exist.” In the example given above, this code would be used for a case of plague that was recognized as a more specific type –the specific types recognized by the system have codes:

A20.0 Bubonic plague
A20.2 Pneumonic plague

All classification systems must have a “park it here for now until we have something better” space. Why? Because knowledge is constantly evolving faster than shared language can express. However, these spaces must be raided regularly to develop new codes, or else the classification system will become encased in concrete and will be unusable. Hence the paradox of controlled vocabularies: Always a bit behind reality; constantly under revision.

For some years, my informal method of assessing classification codes in health information systems was to do a search for Astrocytoma. This is a specific type of brain neoplasm (=cancer). Until ICD version 10, the closest available term for this diagnosis was Miscellaneous Brain Neoplasm: NOS. Not very helpful if you are looking for astrocytomas! The cheaper systems vendors didn’t bother to build in other vocabularies, and stopped at ICD-9, because it was free; so the absence of an astrocytoma code was a negative sign for the health of the information system.

WHO nations use the ICD to produce disease statistics. This has been going on for centuries [See here for a good pocket history; initially, because the country’s leaders needed to be informed about the health (or not) of the nation. (The origin of “statistics”, of course, is “the state.”) John Graunt, an English haberdasher (1620-1674) is important to epidemiology and public health because he is the father of the mortality table: he tried to create a system showing deaths from the Bubonic Plague. For this work, King Charles II made him a member of the Royal Society, although according to Wikipedia this did not prevent him from dying in poverty because he chose to convert to Catholicism at the wrong historical moment. You can see excerpts from John Graunt’s work here; it must be an authoritative source because the site maintainer labels it “the official John Graunt Site of the 1996 Olympic Games.”

Later on, nations began to compare themselves to each other by using statistics. This effort was systematized by French statistician Jacques Bertillon (whose younger brother Alphonse invented the criminological use of fingerprints – what interesting conversations they must have had over dinner). Over time, through and despite world wars, these statistics assumed standard formats and grew into the ICD we know today and its family of context-aware modifications — such as the ICD-CM, used for billing in places like physician’s offices, which knows about diagnoses as well as causes of death. ICD-10 was finished in 1992. It is considerably more complex in the ~25 WHO countries that use it for reimbursement purposes; 110 WHO countries use it for purely statistical purposes. For this reason, the United States of America has been moving at an absolutely glacial pace (ICD-10 launched here in October 2013) while in parts of Europe ICD 11 is in beta.

Because the causes of human disaster are infinitely varied, there are some really, really odd codes. Among them:

• R46.1. Bizarre personal appearance
• Z62.891. Sibling rivalry
• X52. Prolonged stay in weightless environment
• V96.00XS. Unspecified balloon accident injuring occupant, sequela

And my personal favorite:

Y92.253. Opera house as the place of occurrence of the external cause

According to the publisher’s website, Struck By Orca is a book of “more than 60 pages, illustrating dozens of artists’ visual interpretations of their favorite ICD-10 codes. Artists include healthcare professionals, entrepreneurs, and professional artists.” I always like it when the artists include artists—this gives me a feeling of confidence. But it is much more important that the artists include healthcare professionals, who really understand the subject matter almost as well as their patients do. Look at the unhealthy art yourself at:

http://icd10illustrated.com/

Portrait credit: Peter Lely [Public domain], via Wikimedia Commons.

The problem with patients

1234929_10153173963320487_1299285971_nA recent guest column in my favorite medical blog, KevinMD, was written by patient advocate and former medical reporter Pat Mastors. She blogs here. Her column, “We need a new word for patient”, is all about the terminology – specifically, terminology used to refer to people partnering with healthcare professionals to discuss their health problems. You can find the KevinMD column here.

People partnering with healthcare professionals. Hmmm. I could call them PPHP, for short, but this is far too close to the acronym for my personal favorite example of medical terminology – pseudopseudohypoparathyroidism – also called PPHP for short. That’s almost as confusing as the name of the disease. So I’ll just call people partnering with healthcare professionals to discuss their health problems patients for the moment. Which would not be cool with Pat Mastors.

What’s wrong with patient? A recent editorial by the marvelously named Dr. Hem, in a Norwegian medical journal, sums up the usual criticism this way [English language version on site]: “Others have pointed out that the concept of patient is historically charged. Previously, the treatment of patients was characterised by paternalism – an omniscient, imperious doctor and a passive, obedient patient; the archetype of a power disequilibrium.”

Pat Mastors similarly argues: “Why is “patient” not le mot juste? Because it means “one that is acted upon” (Merriam-Webster), and its origin means “one who suffers” (I don’t know about you, but my friends would not describe me that way.)” And the Norwegian Dr. Hem goes on in the same vein: “The current ideal is the knowledgeable and active expert patient who imposes requirements on his/her doctor … It can be claimed that the new patient role is so different from the old one that the concept of patient should be done away with altogether …”

Sociolinguistics 101: Language has power. We have seen a similar evolution in discussing what patients do. In the “old” model referenced by Dr Hem, patients always did what their doctors told them. If they did not, they were “bad patients”. “Bad” is a little crude, though, so they were described as noncompliant. Over time, an attempt was made to move towards a participatory model of care, and terminology moved along with it. Adherence, as in “adherence to treatment”, became the favored word. At least, in theory. Has that solved the terminology problem? Not according to JM Bissonnette, who in 2008 published a concept analysis of the terms adherence, nonadherence, and treatment refusal as found in the literature of medicine, nursing and allied health. In 114 papers, “no distinct differentiation” was found between adherence and compliance. The synonymy is apparently complete. But Bissonnette still takes the field(s) to task for adopting a healthcare-professional-centric view: “No definition of adherence exists that reflects a patient-centred approach, the dynamic nature of adherence behaviour and the power imbalance implied by these terms.”

Physicians – and nurses – are damned if they do and damned if they don’t, by Bissonnette’s logic. In my humble opinion, this is because there will always be a power imbalance in situations where one party to a conversation knows something the other one doesn’t. As a person who did not drive an automobile until the age of 35, I am mildly clueless about cars, and if Jiffy Lube Guy suggests that my car has a cracked veeblefetzer and requires major surgery, I am very likely to believe him. That’s a power imbalance. It does not mean I feel particularly inferior to Jiffy Lube Guy in a cosmic sense. But he’s totally in control of that conversation. That’s fine. That’s why I brought him my car in the first place.

It may not be obvious that power imbalance in healthcare communication cuts both ways. As readers of this blog know, I am fascinated by symptom expressions – verbal or text-based, as in my PatientsLikeMe paper.

Why? Because this is the part of the healthcare conversation in which the patient is in complete control. No care can actually take place until the patient has revealed why they are seeking treatment. In fact, in my exhaustive review of 19th-century medical records, I found the physician catchphrase “What brings you here today?” expressed in documents as old as 1888. It’s the healthcare conversation starter because without a response to that question, the physician is completely stymied. Not only is this catchphrase a conversation starter, but it’s a very long-lived piece of the medical record – paper and electronic – and, after a brief incarnation as “presenting complaint”, lives on today as ‘History of Present Illness’.

So if patient is historically and socioculturally loaded, what else can we call them? Pat Mastors lists some alternatives: consumer, partner, person. Dr Hem, in Norway, overlaps in saying user,consumer, customer. More on these alternatives in my next post. In the meantime, be patient.

References cited

Bissonnette JM. Adherence: a concept analysis. J Adv Nurs. 2008 Sep;63(6):634-43. doi: 10.1111/j.1365-2648.2008.04745.x. Review. PubMed PMID: 18808585

Hem E. Patient, client, user or customer? Tidsskr Nor Laegeforen. 2013 Apr 23;133(8):821. doi: 10.4045/tidsskr.13.0527. English, Norwegian. PubMed PMID:23612085.

Smith CA, Wicks PJ. PatientsLikeMe: Consumer health vocabulary as a folksonomy. AMIA Annu Symp Proc. 2008 Nov 6:682-6. PubMed PMID: 18999004; PubMed Central PMCID: PMC2656083

Doctor, is it hot flashes, or am I going through menopause?

Hot FlashesAmy Dickinson, my favorite advice columnist since the death of Abby, Ann and Ask Beth, had an interesting exchange with a reader on October 15. The reader took issue with Amy’s previous advice issued on September 30. To quote:

“Dear Amy … I assure you it is not appropriate to tell your students that you are “menopausal”. This sort of thing should never be disclosed in the classroom. –Also a Teacher.”

Amy’s response raised my eyebrows:

“Dear Teacher: I didn’t suggest “The Teach” should say she was “menopausal” – only that she was having a “hot flash”.”

Here’s what Amy actually wrote on September 30: “Let’s say you have a sudden hot flash in fifth-period calculus. You can say, “Sorry, class, I’m having a hot flash. Let me fan myself and take a drink of water and it should go away in a minute. Whew! Any students who are sufficiently fascinated can very easily do an Internet search to discover what’s going on and the reason behind it. Soon enough this will become just another aspect of the natural and quirky progression of your day.”

Amy has pointed out a great truth of the age, which is that people can avoid giving out Too Much Information (TMI) by using a short casual throwaway reference that listeners can explore in more depth at their leisure on the World Wide Web. If the listeners are high school students, they are likely to do this exploring long before they get home. In fact, if the listeners are anything like my graduate students, they are exploring the minute the teacher has finished her sentence.

There are at least three things that fascinate me about Amy’s exchanges. All naturally involve medical terminology and consumer health vocabulary.

(1) What high school student does not know that “hot flash” is absolutely synonymous with “menopause?” Under what rock has that student been living?
(2) How long has “hot flash” been a synonym for “menopause?”
(3) Why should saying “hot flash” be any better than saying “menopause” to a class full of high school students?

Answering question #1 would require copious amounts of federal funding, which seems unlikely at the present point in history. So I’m ignoring that one. Questions #2 and #3 are more answerable. Here are the answers.

How long … “Hot flash” is revealed by the Oxford English Dictionary to date from 1610. Sort of. It is first recorded in a play by John Fletcher (as in “Knight of the Burning Pestle”). This play title is just as much of a double entendre as it sounds; this play turned me on to the delights of consumer health vocabulary long before I thought to formally research it).

But the “hot flash” described by Fletcher does not resemble menopause much: “Farre from me are these Hot flashes bred from wanton heat and ease, I haue forgot what loue and louing meant.” Wanton heat and ease sounds like the opposite of menopause. The next entry in the OED isn’t much better: “They continued wandring too and fro for the space of two days, hearing loud Shrieks and Groans, and now and then felt hot Flashes, which so amazed them, that they wished they had never ventured in.” [Fortunatus, 1682]. Fortunatus got the shrieks and groans right, but “amazed?” I don’t think so. In fact, the first reference I find to a menopausal hot flash, or at least a female hot flash, dates from 1907, when the Perry (Iowa) Chief reported that “Such warning symptoms as..hot flashes, headaches..and dizziness are promptly heeded by intelligent women who are approaching this period of life.” Now we’re talking.

Hot flash vs. menopause: Amy Dickinson’s advice reminds me of one argument about consumer health vocabulary and why we need it. This argument proposes that people are more comfortable with informal speech when it comes to descriptions of sexually themed and/or potentially stigmatizing body parts or bodily activities. This phenomenon has actually been studied by medical researchers.

I published a whole paper about consumers use of very informal terms — obscenities — for health concepts, back in 2007. If you are 18 or older, you can read it here: “Nursery, gutter, or anatomy class”. This paper got standing room only attendance at the American Medical Informatics Association where it was presented. Some members of the audience came up to me afterwards and told me great anecdotes about obscenities they’d encountered in their clinical and/or IT practice, none of which are printable. This paper has been cited in places as diverse as a medical informatics textbook..

And a blog by an artist and arts educator. Two more different communities of readers you could not expect to find.

… which tells me I am on to something. But what? More research is needed. Maybe I should Ask Amy.

***
Readers of Elfshot can see the original letter, and response from Amy Dickinson, on Amy’s blog here. This is where I got the graphic, too. Her response is on the Chicago Tribune page here.

Oxford English Dictionary citation: “hot flash, n.”. OED Online. September 2013. Oxford University Press. 17 October 2013 .

Dynamite and word-coining

Little Willie 1911 Trawling the Web a while ago, I ran into a website full of Little Willie jokes. These are a venerable form of sick humor dating back to at least 1904; they made a brief comeback in the 1960s all over the world. You can find way too many of them at the wonderful website Ruthless Rhymes. Warning: This site is hazardous to the preconceptions of those who think the late 19th and early 20th centuries were a More Innocent Time.

Today’s post features an interesting medical Little Willie from 1906 demonstrating the principle of eponymy. Eponyms are terms derived from names of people or places, and they are quite common in medicine, which, as a science, likes to commemorate discoverers of things. One of my favorite research topics is Dr. John Benjamin Murphy (1857-1916), a famously controversial Chicago surgeon. He was a native of Appleton, Wisconsin, practiced for a long time in Chicago, was much more popular in Europe than he was at home, but is buried in Calvary Cemetery in Evanston, IL, a beautiful showplace of monuments that my husband and I visited often when we lived in a hovel around the corner from 1991 to 1992.[1]

Murphy has been commemorated by the American College of Surgeons with a splendiferous auditorium. On Halloween 2013, I’ll be giving a paper about my Biographical Subjects in that very auditorium, which is weirdly cool because Murphy may very well have been an influence on my Biographical Subjects’ careers. At the very least, Murphy took out their nephew’s appendix in the late 1890s.

Among other things, Murphy was an early champion of the appendectomy. Enroute, he lent his name to clinical signs as well as surgical devices:

Murphy’s sign
Murphy drip
Murphy’s button
Murphy’s punch
Murphy’s test

and shared the credit for:

Murphy-Lane bone skid

[From http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1183442/.]

Spot the eponym in the following Little Willie:

Willie fetched his grandpa, kind,
(Chloroform he couldn’t find)
Blew him up with dynamite–
Willie was an Oslerite.

[from the Princeton Tiger; Published in the Los Angeles Herald, March 11, 1906 under the article title “Vicious College Humor”]

The eponym “Oslerite” is used to convey the idea that Willie follows the philosophy of Dr. Osler. This works much better if you know who Dr. Osler was. This explanation appears at Ruthless Rhymes:

“Professor William Osler (1849 – 1919) is well known in the field of gerontology for the speech he gave when leaving Hopkins to become the Regius Professor of Medicine at Oxford. His speech “The Fixed Period”, given on 22 February 1905, included some controversial words about old age. Osler, who had a well-developed humorous side to his character, was in his mid-fifties when he gave the speech and in it he mentioned Anthony Trollope’s The Fixed Period (1882), which envisaged a College where men retired at 67 and after a contemplative period of a year were ‘peacefully extinguished’ by chloroform. He claimed that, “the effective, moving, vitalizing work of the world is done between the ages of twenty-five and forty” and it was downhill from then on. Osler’s speech was covered by the popular press which headlined their reports with “Osler recommends chloroform at sixty”.’

All of which goes to show that the problem of media miscommunication and attention-getting headlines is a lot older than we 21st-century netizens tend to remember.

*******

[1] Sort of kidding about the hovel.

Bad habits and political excitement

Thanks to an archivist colleague, Vicki Tobias, at the University of Wisconsin-Madison for sharing this: Reasons for Admission It cites the Trans-Allegheny Lunatic Asylum without further details. However, I can attest to the truthfulness of these Reasons for Admission based on the research I’ve done into historic medical records and U.S. census mortality data.

These old-fashioned expressions have multiple functions in historic medical documentation. As you can see in the Trans-Allegheny graphic, some Reasons for Admission are clinical labels (“Asthma”, “Brain Fever”, “Female Disease”) while others are mini- medical histories (“Shooting of Daughter”, “Decoyed Into the Army”) and a subset of the second category attempts to assign blame (“Snuff Eating for 2 Years”, “Parents were Cousins”). Given space, humans tend to tell stories; I found similar repurposing of medical “forms” in my PatientsLikeMe study.

I am fascinated by historic medical expressions like these because they represent pure thought completely untrammeled by formal medical terminological systems. This is not pure *physician* thought, either: like the mortality data I’ve collected from US Census records, these expressions are sometimes the product of a dialogue between physician and family member, with the physician turning into a transcriptionist to capture the information (just as they do today). We can even picture the conversation: “What brought your wife here, Mr Smith?” “She’s been grieving ever since the death of her sons in the war.” Or alternately: “Novel reading. It’s that dadblamed novel reading. I blame it on the public library.”

There *were* no formal medical terminological systems that were shared across institutions prior to 1958. While individual hospitals have for centuries developed their own internal problem lists and taught them to trainee physicians, these were not formally *shared* lists, and once Newbie Physician left the hospital where he interned, he was likely to have to learn a new list. This process works fine until Hospital A has to share data with Hospital B; at that point, they need to agree on what diseases are — a struggle we continue to live with in the 21st century.

My personal favorite historic term? From the US census: “Ran away with the cars.” That turned out to be a man who died in a railroad accident (“the cars” means “railroad” at a certain point in human history).

Auto-brewery syndrome: Name it and claim it

Snippet via Google News tells me about a new diagnosis, ‘Auto-brewery Syndrome’ in which a man intoxicated himself without drinking any alcohol. This is an interesting story to me, a non-alcohol-drinking person, for several reasons. 1. The authors implicate medical terminology, thus making themselves subject to comment on my blog, by stating that this syndrome is “difficult to research since it goes by several other names.” Well, yes, but for heaven’s sake, that’s no excuse. Most things in medicine have dozens of other names. This is why we needed a Unified Medical Language System. 2. This article appeared in an open access and fancy-sounding journal from “Scientific Research Publishing” which itself appears on Jeffrey Bealls’ important Predatory Publishers list. SRP certainly looks problematic to me. They claim to be indexed in several “world-class” databases, including Web of Knowledge and PubMed, but the WOK “indexing” is in fact citations appearing in other journals — the journal itself is not indexed — and PubMed reports exactly one record from this journal which is an author submission to PubMed Central. PubMed Central would accept author submissions from an 8th grade Zumba class if the Zumba teacher had federal funding. Not the same as indexing, folks! 3. The additional names are kinda fun, I have to admit. “Auto-brewery syndrome” is also called “Drunkenness Disease” and “Endogenous Ethanol Fermentation.” But the authors’ frank admission that “Most of the articles published on this syndrome are anecdotal” makes me distrust their work. I like my articles to have actual data in them. Panola Community College needs to support its faculty better, or, conversely, give them more to do.

White House Blues

White House Blues

[with chords for those who would like to try this at home]

D
Zolgotz, cruel man
D G D
He shot poor McKinley with a handkerchief on his hand
A7 G
In Buffalo, in Buffalo
Zolgotz, you done him wrong
You shot poor McKinley when he was walkin’ along
In Buffalo, in Buffalo

The pistol fired then McKinley he did fall
The doctor says “McKinley, I can’t find the ball”
In Buffalo, in Buffalo

They sent for the doctor, the doctor come
He come in a-chargin’, he come in a-runnin’
In Buffalo, in Buffalo

He saddled his horse and he swung on his rein
And he trotted the horse till he outrun the train
To Buffalo, to Buffalo

Forty-four boxes all trimmed in braid
A sixteen-wheeled driver, boys, it couldn’t make the grade
To Buffalo, to Buffalo
Forty-four boxes trimmed in lace
Take him back to the baggage, boys, where I can’t see his face
In Buffalo, in Buffalo

Mrs. Mckinley took a trip, and she took it out west
Where she couldn’t hear the people talk about McKinley’s death
In Buffalo, in Buffalo

The engine whistled down the line
A-blowing every station – McKinley was a-dying
In Buffalo, in Buffalo

Seventeen coaches all trimmed in black
Took McKinley to the graveyard but never brought him back
To Buffalo, to Buffalo

Seventeen coaches all trimmed in black
Took Roosevelt to the White House but never brought him back
To Buffalo, to Buffalo
SPOKEN: That was Theodore Roosevelt

(2)

McKinley he hollered, McKinley he squalled
The doctor said “McKinley, I can’t find that ball”
From Buffalo to Washington

Roosevelt in the White House, he’s doin’ his best
McKinley in the graveyard, he’s takin’ his rest
He’s gone a long old time

Hush up little children, now don’t you fret
You’ll draw a pension at your papa’s death
From Buffalo to Washington

Roosevelt in the White House, drinkin’ out of a silver cup
McKinley in the graveyard, he never wakes up
He’s gone a long, long time
Ain’t but the one thing that grieves my mind
That is to die and leave my poor wife behind
I’m gone a long old time
Standing at the station, just lookin’ at the time
See by it you’re running by half-past nine
From Buffalo to Washington

Pay in the train, she’s just on time
She’ll run a thousand miles from eight o’clock till nine
From Buffalo to Washington

Yonder comes the train, she’s comin’ down the line
Throwin’ them a station message, McKinley’s a-dyin’
It’s hard times, hard times

Look a-here, you rascal, you see what you’ve done
You shot my husband with that Ivor Johnstone gun
Carry him back to Washington
The doc told the horse, he tore down the rein
Said to that horse, “You’ve got to outrun this train
From Buffalo to Washington”

Doctor came a-running, taked off his specs
Said “Mr. McKinley, better cash in your checks
You’re bound to die, bound to die”

From The Mudcat Cafe, “White House Blues
SOURCE: Bob Pfeffer
SOURCE’S SOURCE: (1) Bascom Lamar Lunsford, RECORD: “Songs and Ballads of American History and of the Assassination of
Presidents” (Library of Congress)
(2) Charlie Poole, RECORD:
COMMENTS: BLL titled it “Zolgotz”; he heard Willard Randolph sing it in about 1923. c.f. also A. Lomax “FS of North America”

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Relationships

When I was a young boy
Said put away those young boy ways
Now that I’m gettin’ older
So much older
I love all those young boy days
With a girl like you
With a girl like you
Lord knows there are things we can do, baby
Just me and you
Come on and make it hurt

CHORUS: Hurt so good
Come on baby, make it hurt so good
Sometimes love don’t feel like it should
You make it hurt so good

Don’t have to be so exciting
Just tryin’ to give myself
A little bit of fun, yeah
You always look so invitin’
You ain’t as green as you are young
Hey baby, its you
Come on, girl, now, its you
Sink your teeth right through my bones, baby
Let’s see what we can do
Come on and make it hurt

..

I ain’t talkin’ no big deals
I ain’t made no plans myself
I ain’t talkin’ no high heels
Maybe we could walk around
All day long
Walk around
All day long

John Mellencamp, “Hurts So Good”
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