Monthly Archives: January 2009

Not LF Guild

“Write what you know”

Sorry it’s been so long. Warcraft has taken up most, if not all, of my waking hours during the Xmas break and now work is cutting into my precious WoW time leaving me very little time to devote to blogging. You can see the bind I’m in!
But fear not, Mojo is back for this third official Nerdgasm X entry. No more Warcraft distractions. The topic of this entry: Warcraft.

For those of you who do not play the online phenomenon that is World of Warcraft, allow me to break it down for you. You create a character (a “toon”, in game lingo) and play as that character inside a vast in-game world along with the thousands of other people on your server (there are hundreds of servers or in game lingo “realms”). Occasionally, the missions you have to accomplish in-game (“quests”) require more than one player to accomplish. These “group quests” usually have the best rewards that scale with the difficulty of the task. To facilitate forming groups the in-game players have the option of creating or joining a “guild” which is made up of several other players who are dedicated to helping the other members of the guild if required. Ideally, the help can be for more than just quests as well. Most toons have in-game professions to craft gear and weapons (usually the best quality ones) to share amongst their guild-mates for low prices or free. They can also give advice on in-game matters such as what gear is best for what class. Some guilds have become so close over time as to offer advice on real life issues that may be going on. Essentially, a guild is a network of friends with whom you play WoW. Each server has dozens of guilds that are all different from each other. At the very least, it is people to talk to as you play. At the most, a guild is a group dedicated to bettering themselves in-game and doing the most difficult content.

It’s no surprise then that the vast majority of players opt to join guilds. So why, as the title of this article suggests, am I defending the idea of NOT joining a guild? Well faithful reader, because recent events have left me guild-less and I like it! I have looked for articles on the web that share this point of view but have been woefully disappointed. I submit, therefore, the following argument. Allow me to explain, as is the custom of my people, in list-form.

1. A guild will help you do group quests: Ideally, if you require assistance doing something difficult, the currently online guildmates will drop what they are doing and travel great distances to assist you. This is the ideal situation, but far from reality. The other people playing have their own set of priorities that are too time-consuming to drop at a second’s notice. The world of the World of Warcraft is HUGE. Blizzard (the company that runs it) charges a monthly fee for playing this game and so to increase their profit, made doing ANYTHING in-game take forever. Dedicating yourself to a goal is usually a large commitment so when someone asks you to stop doing that thing and come help you with something the usual reaction is to politely refuse and explain that you are too busy. In my time in guilds I have been guilty of this and so has everyone else… at the same time. This means frustration for the poor soul looking for help and means he/she has to resort to finding other players who may be doing that same quest or who are at least in the area and are very nice. The other alternative is to abandon that quest and opt for something easier (and thus obtain a significantly scaled down reward).

2. A guild will share resources: This is true, but also to a point. The way the professions work in WoW is that you must have materials or “mats” to create useful or usable items. The mats are generally obtained through long, drawn-out sessions dedicated to obtaining them (“grinding”) or by purchasing them from other players via the in-game eBay-like, Auction House. Since the in-game currency (gold) is very valuable for just about every facet of the game, most people get very greedy if they know their product is in demand and so the mats cost a fortune. This means that to obtain the materials necessary to create an item for yourself or a guild-mate, a lot of time and effort needs to be expended for very little personal gain. Not surprisingly then, only the lower quality or easy to get materials/items are available from guild-mates leaving you no choice but to either purchase the materials or the item yourself costing you the proverbial arm and a leg.

3. Guilds offer advice for your class/role: Despite it’s “cartoony” appearance and relatively simply UI, WoW is a complicated game. In the game, each “class” has a very specific role to fill within group level quests. A healer (like me), for example, must be counted on to replenish the health of their group to the point needed to counteract the damage being done to them by the enemy monsters. A hunter (like Kim) must be able to damage the enemy monsters to the maximum extent possible. To do this effectively or to the maximum extent possible, a player will require gear/armor/weapons that have the required boosts to the required statistic. He/she will also have to develop a feel for what spell/ability works best in which situation. They will also have to study each enemy encounter to anticipate or more easily adapt to the encounter thus preventing costly failure (both in terms of time and gold). This list is not exhaustive. The point is that learning how best to play your class requires real research. This is not an issue for casual players, but most people like to know they are pulling their weight in group activities. Having a network of people to assist you in this research is fantastic so you’d think a guild would be great. This is, in reality, usually not the case. Most guild-mates are simply reading websites/forums that you yourself have direct access to or, worse yet, are giving you BAD advice based on their own anecdotal evidence/experience. This was the case with my most recent guild: Too often I received bad advice from guild officers that directly contradicted my own extensive (I’m obsessed with this game remember?) research. Not being the laid back type, I immediately contradicted the officers which earned me a reputation as a trouble-maker.

4. The guild provides a group of people to talk to while questing: Yes, but is it always things you want to talk about? 90% of the conversation had on guild-chat will be game related but other discussions may include things you find offensive or ridiculous.

Although in THEORY, guilds are useful, fun and beneficial for your in-game experience, the vast majority of the time you will still find yourself resorting to non-guild related help for many of the objectives you have leaving you, like myself, wondering what the point of a guild really is. In addition to the contradictions noted above, the guild also brings with it things like “guild drama” where two people in the same guild argue openly about things resulting in friction or tension. You may also encounter “bossiness” or even direct orders from guild officers/leaders that may conflict with your own needs or desires or is otherwise undesired. You may then be punished or demoted by guild leaders for failure to follow these directives or for any number of frivolous reasons. Remember that some of the “leaders” of your guild may be, in real life, very immature people who simply want a power trip. To be fair, that’s pretty rare, but it can happen.

So what is a dedicated WoW-addict like myself doing without a guild? Well, to be frank (and also Mojo), anything I want. Maybe it’s because of my highly-demanded role or because of my extreme good luck with working on my own (or bad luck with guilds) but I have been enjoying all facets of the game to a fulfilling extent combined with the zero-pressure of worrying about guild-mates or the hassle of “guild commi
tments” that interfere with what I want to do and when. I have established a good rapport with several other people in the game and, when needed, can rely on them to ask me to join their groups for mutually shared goals. Without worrying about spending resources on guild-mates or giving up time/services for free, I am making profits much more easily and faster than before and if I require professional products, I may merely turn to the Auction House or the endless number of players who offer their services to anyone willing to part with a little gold. I no longer have to waste my time by politely asking the guild for help first (as is expected) then waiting for the polite refusal before I resort to the actual useful people who are advertising their services and availability to everyone. It just simplifies everything so much more.

In conclusion, perhaps I have been just that unlucky with guilds but after 8 steady months and 5 separate guilds and the same problems surfacing, over and over again, I am anxious to see how the next few weeks will play out with my new “no guild” diet. In addition to the in-game experiences noted above, since I have become guild-less I am being flooded with solicitations for join various guilds (it’s not a compliment, they just want numbers). Maybe one will manage to entice me enough to make me change my mind.

Not bloody likely.

MOJO

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When Penn & Teller got it wrong…

I love the show Bullshit. I love Penn & Teller. They are biased, to be sure. They fully admit it. And just because I like them doesn’t mean I have to agree with everything they say all the time. And just because I disagree with them (vehemently in this case) doesn’t mean I’ll stop liking them. They are great.

However… In the episode “Disability” (Season 5, Episode 7), they really screwed up big time.

In the first 2 minutes, as always the introduce their point: Laws enforcing adjustments so that handicapped people can get around are government intrusions and are annoying for the rest of us; therefore they are Bullshit. While Penn is talking, a muscular man in a cambered, lumbar back wheelchair (read: he obviously has exceptional trunk stability as this is an athletic-build chair) is wheeling around beside him and easily clears several obstacles.

I can see where they are going with this, and it’s so far from sensible it’s amazing they can even say their point with a straight face. Are they seriously so deluded that they think this is an accurate representation of the average wheelchair user? If so, that makes them ignorant. If not, that makes them disingenuous. And when they are ignorant and/or disingenuous in a way that marginalizes people for no reason other than they don’t like laws (specifically, The American Disabilities Act – ADA) forcing people to “be compassionate”, I get testy.

Their main beef is with the ADA, not actual disabled people. But the ADA is in place to protect these very people. Let’s face it. If there were no laws forcing public places to put in ramps and handled (as opposed to rounded) doorknobs, would a lot of them? No! That was the problem that made the law necessary in the first place. If we had any forethought for anyone other than those perfectly stable in their bipedality, we wouldn’t build buildings the way we do with lips on the bottoms of doorways and stairs into buildings. Disabled people aren’t new, we’re just starting to care. Which we should have done a long time ago, and then we wouldn’t even be in a position where people felt they needed to demand/make a law.

P&T then of course provide a few examples of disabled people who are perfectly adapted to their disability and hate the ADA too. I don’t like that word sometimes – disability. If you are functionally able to go about your daily business in an adapted way, are you really “disabled”? So do you even count in the point P&T are trying to make? Anyway… And then there are examples of obvious silliness such as braille on a drive through sign, as if those examples negate the entire premise that we should be more universally accessible as a society. And then there are examples of “poor souls”, boo hoo, who have to spend a few bucks on door knobs that aren’t stupid – the nerve!

Many people with disabilities have limits other than just wheels strapped to their ass. While their legs don’t work they may have comorbidities (or primary disabilities) such as trunk weakness, poor fine motor control, inability to pronate/supinate the forearm, inability to maintain midline gaze/head, inability to maintain posture, poor hearing/eyesight/tactile sensation, etc. All of which can make navigating a world with steps, narrow doors, round handles, etc a little much to bear. Also, wheelchairs tend to have a lot of gear on them and are heavy to cart around.

As medical science advances, so does people’s survivability with inevitable consequences such as reduced mobility and other issues. Some people are “lucky” enough to be athletic and have no problem with wheelchair mobility after, say, a spinal cord injury around the thoracic level. But many people in wheelchairs have problems like muscular dystrophy, cerebral palsy, MA, ALS, stroke, cervical spinal injuries, etc. and can’t get by that easily. Ignoring these people was an ethical issue that was not adequately addressed until there was a law.

We need to get it through our thick skulls that we should be building accessible in the first place. Does the curb need to be 6 inches off the ground even at the corner? No. So ramp it. Why have a tiny step into a building? Is it necessary to the function of the building? No. So get rid of it. Do we need round doorknobs, or can we use handles and automated buttons? No, and yes. So use them instead. What’s the big deal? They work just the same. Is it really that annoying to park in the space right next to the handicapped space if the space is empty? Get over yourselves. It’s 5 feet. While it may seem silly, you try and wheel yourself to and from the grocery store parking lot in the snow, weaving your way through cars looming over you as they whiz by and see how hard you have it for parking a mere 5-10 extra feet away. Seriously. Not to mention, regular parking spaces are too small for most adapted cars. So people in wheelchairs can park there, but they can’t get out. [I have a whole other issue regarding the safety and placement of these spaces, but that’s a topic for another time.]

Sure it may be annoying to change buildings to be accessible, but isn’t it “annoying” (to say the LEAST) to not be able to leave your house, as handicapped people once did, because you can’t get in anywhere? Do handicapped people not have the right to go where they please like the rest of us. While I agree that the ADA may not be set up in the best way, and there should be some sort of financial help in some cases (ex: small businesses), overall I think it does more good than harm. There are people who would take advantage, and situations that ruin it for everyone, but that’s what amendments are for. That’s what politics are for.

Now onto the most ridiculous example of the whole show. What is “accessible”? Apparently all accessibility it stupid because the law didn’t pick doors wide enough for an iron lung to get through and because low-cognition people can park in handicapped spaces. Are you fucking serious? Sure, ADA isn’t perfect for EVERYONE the way it’s currently written. But even though it isn’t perfect, that’s no reason to scrap all accessibility laws and declare them silly. Who the hell are P&T to judge what levels of disabled aren’t disabled enough to “deserve” a parking space?

It’s easy to be annoyed with these things when there’s nothing wrong with you.

This entire episode is extremist libertarian knee-jerking. P&T are more pissed off that the government has made a law forcing people to “be nice” than the concept of the law. While there are components of the ADA that could use clarification, the concept that every place is accessible to as many people as possible is one with which I think we all should be involved. If we won’t take that leap for each other, then someone should make us. The government stepped up. Deal with it.

Maybe it’s because I’m a dirty Canadian “socialist”, but I’d rather see “ugly” ramps (a stupid argument), wider doors, functional handles on those doors, and be slightly “inconvenienced” in the parking lot than have people stuck in the houses not able to go anywhere because we were being financially, spatially, or temporally selfish.

Video Of The Week – "Check Mates"

Too hilarious to comment:

Bad news: Khan died


Imdb reports that Ricardo Mantalban passed away on Wednesday.

The Shat reportedly commented: “KHAAAAAAAAAAAAAAAAAN!”

UPDATE – Baby Hitler

Remember those two brilliant individuals who named their kids after white supremacists? Well they lost their kids to child protective services (well the US equivalent anyway). However, I’m not sure that in the eyes of the law a name will constitute abuse or negligence so they may not be removed for long. However, it appears their home has racist paraphernalia so who knows. I’ll update if I hear anything else.

Fucktards.

UPDATE: See Skepchick‘s take.

Google page ranks = fail because of CAM

I am a student [in a health profession]. I have a patient with a subluxation of the shoulder. In stroke patients, this is a common ailment in the affected arm, as the weight of the arm is hanging without muscular support due to paralysis/weakness. We’re giving this patient daily movement therapy to increase range of motion, but eventually this patient will have to be discharged and will be on their own (although with family members who will be trained as well). In effect, this patient will be in charge of their own therapy other than outpatient or home visits for professional therapy. So in order to provide something for this patient to help them do some stretching etc on their own, I go to Google with the search “treatment shoulder subluxation” and the first page I get is this.

A CAM page.

Sigh.

This particular piece of sketchy treatment is called “prolotherapy“. And for something Wikipedia describes as having “conflicting evidence about its effectiveness”, the website should probably not be saying things like: “Prolotherapy offers the most curative results in treating chronic pain” [emphasis added] and “Nearly all pain conditions can be successfully treated with Prolotherapy” following a pack of lies about other treatments for pain. Let’s examine these statements shall we?

1. Traditional modern medical treatment for shoulder subluxation or instability involves rotator cuff strengthening exercises, specifically of the supraspinatus muscle, which is the primary muscle responsible for the external rotation of the shoulder. Although rotator cuff strengthening exercises help strengthen shoulder muscles, they usually do not cure the underlying problem, ligament laxity, and, thus, do not alleviate the chronic pain that people with this condition may experience.

First, the term “traditional medicine” is already condescending and sets a tone that what they have to offer is more innovative and cutting-edge. Well, the fact is: evidence is evidence. If you have it, your treatment wins. If you don’t, I’m not using it on a patient when I have other methods that are evidence-based. If there’s no evidence either way, I’ll try something low risk, but in this case there are effective evidence-based alternatives. So, fail.

Second, ligament laxity is symptom not an “underlying cause”. The cause of a subluxed shoulder is usually paralysis or injury. Furthermore, the pain they are describing is usually associated with bursitis, with the gleno-humeral joint being compressed, stretched, or twisted oddly due to improper movements with the humeral head out of position (a result of subluxation). So their description is a little misleading.

Third, I think they are describing the wrong muscle. While supraspinatus is involved in rotator cuff stability, it is actually an abductor of the shoulder, not an external rotator. External rotators are deltoid, infraspinatus, and teres minor. Unless they are referring to abduction as external rotation, which is just bizarre. Also, therapy works on all the shoulder muscles, not just the one on top of your scapula.

All that aside, I would not recommend an invasive treatment for shoulder subluxation unless a patient is not responding to non-invasive treatments and precautions.

2. Another standard practice of modern medicine is to inject steroids or to prescribe anti-inflammatory medications. However, in the long run, these treatments do more damage than good. Although cortisone shots and anti-inflammatory drugs have been shown to produce short-term pain benefit, both result in long-term loss of function and even more chronic pain by actually inhibiting the healing process of soft tissues and accelerating cartilage degeneration. Plus, long-term use of these drugs can lead to other sources of chronic pain, allergies and leaky gut syndrome.

No. This uncited statement is dubious at best. The “risks” of these treatments are typically the same as with any injection: infection, temporary discomfort at the injection site, damage caused by improper injection, and allergic reaction. Their statement that these treatments worsen symptoms is false. As for so-called “leaky gut syndrome“, that’s a partially made-up CAM ailment, so draw your own conclusion (hint: it’s theoretical nebulousness not deserving of such absolute statements against effective treatments).

3. When all else fails, patients who experience chronic pain as a result of shoulder subluxation may be referred to a surgeon. Unfortunately, surgery often makes the problem worse. Surgeons will use x-ray technology as a diagnostic tool, which does not always properly diagnose the pain source.

Wow. So you could go to a surgeon, but they’ll bust you up. So, good luck!

Where do I even start… Surgery is a last resort, not because it’s ineffective, but because it’s 1) invasive (read: risky) and 2) expensive. While true that X-rays do not often catch the problem (for example, soft tissue damage), such damage can be imaged through other methods such as MRI and ultrasound. So that statement is misleading and disingenuous. Finally, surgeons don’t just cut people up for the sake of it because they aren’t sure and they might as well try something. They perform surgeries when surgery is indicated on a case by case basis.

4. A better approach is to strengthen the ligamentous and shoulder capsular structures with Prolotherapy. In fact, shoulder subluxation or instability is one of the easiest conditions to treat with Prolotherapy.

Better? Really? Let’s see. This therapy involves deliberately irritating a part of the body to increase the body’s defenses in that area to accelerate the rate of tissue repair. Now while there may be something to this, the jury (i.e., rigorous peer review) is still out on the effectiveness of this treatment – a Cochrane review of 4 available studies showed conflicting results – and the possibility of effectiveness absolutely does not justify misleading people about other available therapies.

Also, an injection to affect a ligament would have to be very specific because they are frigging tiny, relatively speaking. There is a great possibility that this process would be activated (if it works) in surrounding tissues which may actually compound the problem. For example: since prolotherapy evidence is mostly back pain research, I would encourage extreme caution in using it for shoulder pain particularly in stroke patients where spasticity is a common post-stroke ailment.

Chronic pain is most commonly due to either to cartilage deterioration, tendon weakness or ligament weakness, as is the case with shoulder subluxation.

Again they are sort of describing symptoms as though they are causes. I’ll clarify. Shoulder subluxation (the problem) is defined by weakened tendons, ligaments, and muscles (the symptoms). This is usually painful. Subluxation is due to trauma, stroke, or previous injuries (the causes).

This basic lack of clarity does not bode well for me taking them at all seriously (although they lost that privilege several ignorant sentences ago).

The safest and most effective natural medicine treatment for repairing tendon, ligament and cartilage damage is Prolotherapy. In simple terms, Prolotherapy stimulates the body to repair painful areas. It does so by inducing a mild inflammatory reaction in the weakened ligaments and cartilage. Since the body heals by inflammation, Prolotherapy stimulates healing.

In theory. Get some more evidence and then you can make such bold statements. Safest? Most effective? MOST? Funny how that never came up in my schooling…or any journals I’ve looked at…or any reputable medical websites I’ve consulted… I would think that the treatment that is MOST effective would have been mentioned, I dunno, EVER.

Prolotherapy offers the most curative results in treating chronic pain. It effectively eliminates pain because it attacks the source: the fibro-osseous junction, an area rich in sensory nerves. What’s more, the tissue strengthening and pain relief stimulated by Prolotherapy is permanent!

Most curative…see above for my thoughts on their undeserving “most” statements.

Nearly all pain conditions can be successfully treated with Prolotherapy, including:
Osteoarthritis, Tendonitis, Migraines, Sports Injuries, Loose Joints (Hypermobility), Fibromyalgia, RSD Pain, Temporomandibular Joint Syndrome (TMJ), Sciatica, Herniated Discs, Degenerated Discs, Degenerated Joints, Chondromalacia Patellae, Osgood-Schlatter Disease, Carpal Tunnel Syndrome, Ligament Sprains, Plantar Fasciitis…and Back, Hip, Neck, Shoulder, Knee, Elbow, Foot, Ankle, Hand, Wrist, Finger and Toe Pain

This is a CAM favorite. “Our treatment is clearly better because it treats everything under the sun.” Except for a few things I noticed that don’t belong: Carpal Tunnel Syndrome and TMJ (to name just 2). If the effect is to tighten tendons and ligaments, this treatment would worsen Carpal Tunnel Syndrome by further compressing the nerve and worsen TMJ by further tightening the joint. So, I say WTF to that.

To read how a young athlete with shoulder pain benefited from Prolotherapy, click here.

I find it telling that, rather than provide a list of peer-reviewed references to support their statements, they link to an case report of one 13 year-old girl.

The treatment regimens suggested here are based on the experience Caring Medical. They do not apply to every case or condition. A person using these recommendations without the aid of a personal physician does so at their own risk. This information is provided for informational purposes only. It is essential to have your condition evaluated by your own personal physician.

There is is. “We can get away with saying all of the above, misleading you into thinking this is a great therapy and therefore priming you to evaluate information on it in a positive way, because – hey – we’re just providing harmless information. It’s your responsibility to listen to a doctor.”

That’s really good advice, actually. Go to a doctor.

But what about people like me who are looking up information for a patient in order to devise a treatment? It annoys me to no end that I have to sift through this garbage to get to information of any substance. CAM hurts people by wasting my time as a health care practitioner.

If prolotherapy has weight to it, fine, but websites like this are not being honest about its true nature. They don’t say “this a new treatment that is currently gathering evidence that might work for you and here are our sources so far”, they say “traditional treatments will hurt you so you should do this”. They say all of the bad things (and sometimes they are completely made up) about “traditional” treatments, and all of the good things (also sometimes completely made up) about their therapy. Evidence? What’s that?

That is wrong. WRONG. W-R-O-N-G. Sweet merciful crap, I can’t emphasize enough how WRONG that is. And it comes up first on a Google search for the problem.

Thank you CAM, you just wasted my time and reduced my focus on a patient. Congratulations, assholes.

Let’s play Johnny Carson

*Holds envelope up to head.*

– Stand on mailbox so no one can click on it.
– Stand on flightmaster so no one can click on them.
– Kill all the NPCs in a lowbie area so they can’t turn in their quests.

*Opens envelope.* Scroll over between ().

(Name three things that the Alliance do to be dicks.)