Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Drug Shortages Affect Those Still in the Dark Ages – Furosemide


Also posted over at Paramedicine 101 and at Research Blogging.

Go check out the excellent material at both sites.

In the current JEMS, there is an embarrassing article. Drug Shortage Possible in N.Y.

It seems that the drugs that people are worried about are lidocaine, furosemide, 50% dextrose, and epinephrine 1:10,000 preloaded syringes. Here, I will discuss furosemide.

Furosemide is not appropriate for EMS patients, because there are more appropriate drugs, more appropriate other treatments, and it is too often given to patients who have pneumonia.

Fluid accumulation in the lungs associated with APE, until recently, was attributed to excess accumulation of total body fluid. Accordingly, treatment of APE was aimed at removing excess fluid from the lungs by promoting massive diuresis. However, this explanation for APE could not reconcile the fact that APE typically occurs during early morning hours when fluid intake is minimal. The current explanation is that APE results from fluid redistribution within the body whereby a part of the intravascular volume is redistributed to the lungs as a consequence of increased intravascular pressure as outlined above.13 Primary objectives for the treatment of acute CHF are to reduce pulmonary capillary pressure, to redistribute pulmonary fluid, and to improve forward flow.12,13 These may be achieved by reducing LV preload and afterload, providing ventilatory and inotropic supports, and identifying and treating the underlying etiology of the syndrome (Table 3). It should be recognized that these treatment measures are intended for APE patients who are normotensive or hypertensive and not those who are hypotensive. The latter comprises cardiogenic shock secondary to severe LV systolic dysfunction; treatment of these critically ill patients is beyond the scope of this review.[1]

That is a big paragraph, but there is a lot of information in there. Enough to convince us that we should not be using furosemide to treat an acute onset/exacerbation of heart failure.

In the chart below, before furosemide in treatment there are plenty of other treatments. Notice that only oxygen comes before NTG (NiTroGlycerin) and the more severe the symptoms, the more NTG is given.

Mild symptoms – One 0.4 mg NTG spray/tab – repeated every 4 to 5 minutes.

Moderate symptoms – High-dose NTG, which is explained below.

Severe symptoms – Two to five 0.4 mg sprays/tabs at a time – repeated every 3 to 5 minutes.

But, but, but, but, but, . . . . . we can only give a maximum of 3 NTG – ever.

Then you need to get a better medical director, because your medical director has you killing patients.

Am I being too subtle?

Another treatment that is very effective is CPAP (Continuous Positive Airway Pressure) which is a BLS (Basic Life Support) skill, except where medical directors like to kill patients. When using CPAP (a form of NIPPV – Non-Invasive Positive Pressure Ventilation), NTG paste can be applied. Do not be shy with the paste, because nothing is absorbed well through the skin when the skin is pale. Pale means a lack of circulation. Also, since the appropriate dose is much more than standard NTG dosing, there is not much reason to hold back.

I disagree about the placement of CPAP at the bottom. CPAP should be started right away. This was published in 2003, so it is kind of old and conservative.

You call that NTG use conservative?!?!?

I do. I have given dozens of NTG in a period of 10 to 20 minutes and never had a patient experience any adverse effects while in my care or at the hospital. I have written elsewhere about the superstitious way we approach NTG.

Furosemide is in there, but only if the patient has peripheral edema. If there is no peripheral edema, is fluid overload the problem? That is a fluid redistribution problem. There is fluid in the wrong place, but that does not mean that the whole body is overloaded with fluid or that putting a bunch of fluid in the bladder is going to make things better. Moving fluid to the bladder does not mean that we are removing it from the lungs any more than we are removing fluid from anywhere else.

Click on the chart to make it bigger. I know I can’t read any of it at this size. This is from the same paper as the paragraph above.

Well, that is just one paper. Nobody else would be so irresponsible as to recommend such large doses of NTG.

Then let’s read about what they do in the ED (Emergency Department).

Most patients who experience CPE, however, do not have ECG evidence of an acute dysrhythmia or AMI. Treatment should therefore be aimed at redistributing the excessive pulmonary interstitial fluid into the systemic circulation, which improves alveolar oxygen-carbon dioxide exchange and hypoxia; therefore, pharmacologic agents that provide preload reduction and afterload reduction should be administered. In some cases, inotropic support is required also.[2]

What drugs do we use to provide preload reduction and afterload reduction?

The most effective and rapidly-acting preload-reducing medication is nitroglycerin (NTG) [21–25]. Multiple studies have demonstrated the superiority of NTG over furosemide [21,24,26–28] and morphine sulfate [28–30] for preload reduction, symptomatic improvement, and safety. NTG can be administered in sublingual, IV, or transdermal form, although the transdermal absorption can be erratic in the patient in extremis. NTG also has the benefit of a short half-life; therefore, if the patient develops a precipitous fall in blood pressure (generally uncommon in CPE {Cardiogenic Pulmonary Edema} patients), the blood pressure should return to previous values within 5 to 10 minutes of discontinuation of administration.[2]

But what about the dose?

In one study [26], 3 mg IV boluses of NTG were administered every 5 minutes to patients who had developed CPE, a dose equivalent to a 600 mg/min infusion. This protocol was found to be safe, well-tolerated, and effective for these patients and associated with reduced need for mechanical ventilation and more rapid resolution of symptoms. Standard anti-anginal dosages of sublingual NTG with which most physicians are comfortable (ie, 400 µg every 5 minutes), has the bioequivalence of an IV NTG infusion of 60 to 80 µg/min. Physicians should, therefore, be comfortable with the safety of even higher dosages of NTG for patients who experience CPE and usually present in a hyper-adrenergic state with moderately-to-severely elevated blood pressures.[2]

That is 7 1/2 times to 10 times the standard dose of NTG – with no problems.

Maybe that maximum of 3 NTG is something that should be ignored. The AHA (American Heart Association) seems to be ignoring it. Just try to find a limit on NTG administration in the current ACLS, which is from 2005.

These papers are available in PDF format, so you can print them out and hand them to your medical director and/or to the other doctors in the ED.

These are important papers. Both are review articles. One is written for EMS, while the other is written for the ED.

If you are feeling aggressive, maybe you can write on the bottom, Call me about improving the protocols we use to treat our patients.

There is one problem with this. This will lead to fewer intubations.

The best intubation is the intubation that is prevented by excellent patient care.


[1] Prehospital therapy for acute congestive heart failure: state of the art.
Mosesso VN Jr, Dunford J, Blackwell T, Griswell JK.
Prehosp Emerg Care. 2003 Jan-Mar;7(1):13-23. Review.
PMID: 12540139 [PubMed – indexed for MEDLINE]

Free Full Text PDF

[2] Modern management of cardiogenic pulmonary edema.
Mattu A, Martinez JP, Kelly BS.
Emerg Med Clin North Am. 2005 Nov;23(4):1105-25. Review.
PMID: 16199340 [PubMed – indexed for MEDLINE]

Free Full Text PDF

Mosesso VN Jr, Dunford J, Blackwell T, & Griswell JK (2003). Prehospital therapy for acute congestive heart failure: state of the art. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 7 (1), 13-23 PMID: 12540139

Mattu A, Martinez JP, & Kelly BS (2005). Modern management of cardiogenic pulmonary edema. Emergency medicine clinics of North America, 23 (4), 1105-25 PMID: 16199340


Andrew Wakefield and Cognitive Dissonance.

He made up a syndrome.

He performed unnecessary and risky medical procedures on children.

He received hundreds of thousands of pounds from lawyers for a study to look for that imaginary syndrome, because the imaginary syndrome could make the lawyers a lot of money.

He was horribly incompetent in his research methods.

He lied about what he did.

He sued Brian Deer, the investigative reporter who uncovered most of the fraud. He had to withdraw the law suit and pay the expenses of Brian Deer.

In 2004, when they became aware of the fraud, 10 of the 13 authors of the study had their names removed from that study.

On January 28, 2010, a little over a week ago, The General Medical Council released its verdict.

The Fitness to Practise Panel has heard this case under The General Medical Council Preliminary Proceedings Committee and Professional Conduct Committee (Procedure) Rules Order of Council 1988. It has considered which, if any of the facts not admitted by Dr Andrew Wakefield, Professor John Walker-Smith and Dr (now Professor) Simon Murch have been found proved and then went on to consider whether such facts found proved together with those admitted, would be insufficient to support a finding of serious professional misconduct.[1]

The Panel has accepted in full the advice of the Legal Assessor as to the approach to be taken. The three doctors have nothing to prove, the burden of proof is on the GMC throughout. If the Panel were not sure beyond reasonable doubt, the sub-head of charge was found not proved in favour of the doctor, in accordance with the criminal, as opposed to the civil, standard of proof.[1]

A lot of findings of Admitted and found proved.

A lot of findings of Found proved.

The occasional finding of Found not proved.

A lot of irresponsible – Found proved.

A lot of dishonest – Found proved.

Some crazy people are still defending Andrew Wakefield.

You would have to be crazy to defend that fraud.

Or dishonest and irresponsible.

These people have convinced themselves that vaccines cause autism, even though research has repeatedly shown no connection.

So, in order to protect themselves from having to admit that they endangered their children and other children, they need to defend this, even though Andrew Wakefield has admitted some of the fraud and a court has determined that he is guilty of a lot more.

When people should admit that they made a mistake, some will actually become even more defensive of their clearly mistaken position.

A clear case of cognitive dissonance.[2]

If you wish to read about the research that has been done on autism and vaccines, there are scores of studies.[3] Studies paid for by many different organizations – governments, universities, non-profit groups, and even drug companies. They don’t find any connection between vaccines and autism.

Andrew Wakefield was receiving hundreds of thousands of pounds from lawyers to show a connection. Is it surprising that he did?

Andrew Wakefield was working on a vaccine to compete with the MMR vaccine, so he has another reason he might benefit financially from making false accusations about the MMR.

Andrew Wakefield has shown that he is willing to subject children to risky procedures for no benefit to the children, as long as he makes his money.

There has been a lot written by others on the topic. In the comments the anti-vaccinationists will try all sorts of misleading approaches. Some will claim that they are not anti-vaccinationists, but that they only want safe vaccines.

Vaccines are safe.

How much safer could vaccines be?

There are a some examples in response to Dear Jenny McCarthy . . . at A Day In The Life Of An Ambulance Driver. Another is at Asshole doctor responsible for false MMR/autism claim gets his at Cranky Epistles.

In The martyrdom of St. Andy at Respectful Insolence, there is far more detail about the dishonest and irresponsible conspiracy to link autism and vaccines. A listing of a lot of posts on this topic, even some defending the fraud, can be found in On The Lancet’s Retraction of Wakefield’s 1998 Paper Alleging A Connection Between the MMR Vaccine and Autism at I Speak of Dreams.

The unfortunate thing is that Andrew Wakefield is still making over a quarter of a million dollars a year to spread his lies for Thoughtful House, an anti-vaccination organization in Texas. When it comes to Andrew Wakefield, follow the money – he does. He came to the US, but he is not a doctor in the US.

If you know of Andrew Wakefield pretending to be a doctor, call the police.

And vaccinate your children for their sake.

More information is available at Brian Deer’s website.


^ 1 Fitness to Practice Panel Hearing
UK General Medical Council
January 28, 2010
Free Full Text

^ 2 Cognitive dissonance

^ 3 Vaccines and Autism
Science-Based Medicine


Shaggy Comments on Some Research Podcasting Comments

In the comments to Some Research Podcasting Comments, Shaggy wrote,

I am beginning to think our definition of “why” in the educational arena is not the same. If it is, I will just conclude that either one of us is off our rocker. Explaining the importance of a certain treatment modality as well as anything else is considered very important as motivational.

Perhaps that is part of the problem with attaching questionable explanations to the results of research that was not designed to answer these questions.

Should we be more concerned with motivation, than with accuracy?

I could come up with many possible explanations for why something is happening. I would rather say, I don’t know.

Science is much better at showing what does not work, than what does work.

Science is much better at showing what does work, than at explaining why something works.

This was very important when I did occupational safety and health training for the Safety Council in Pa. as the “why” was part of Bloom’s three types of learning, and fell under the affective nicely. Why should you wear PPE?

Because people who do not wear PPE (Personal Protective Equipment) are over-represented in the morbidity and mortality statistics.

Why are safe work practices important?

Because going home to one’s family is more likely, when one follows these safe work practices.

Why is quick and continuous CPR necessary?

Research shows that without quick and continuous CPR, the resuscitation rate is significantly lower.

Maybe it is due to direct compression of the heart. Maybe it is due to increased intrathoracic pressure. Maybe it is due to a rebound effect after compressing the chest. Maybe it is due to some combination of these mechanisms. Maybe it is due to some other mechanism. Maybe it is due to a combination of some other mechanism and one or more of these mechanisms.

What do we need to know?

We need to know that quick and continuous CPR does work.

We do not need to make up stories that will likely be, at best significantly modified, and at worst completely discarded. Do we need to make up these stories just to motivate people to provide good treatment?

Maybe we will know what the mechanism is in a decade. Maybe in two decades. Right now, I think we are just spinning fairy tales to impress others with how smart we think we are. Or has there been research that conclusively shows the complete mechanism for CPR?

Regardless, the important point is that quick and continuous CPR works. How quick and continuous CPR works is not important in deciding whether we should provide quick and continuous CPR.

If you think these questions shouldn’t be answered, I may tend to think you finally went off the ledge.

How did I get on the ledge?

Why was I on the ledge?

How can I know if I fell off the ledge, if I don’t know the answers to the mechanism of my arriving on the ledge?

Then there is the question of whether I was actually on the ledge at all. Last thing I remember, I was nailed to a perch. Nice fish, the perch.

Maybe I just wasn’t motivated to stay on the ledge.

If you think we are talking about two different things, then perhaps you need to clarify for the intellectually challenged like myself.

I think we are talking about the same thing.

I think that we disagree.

On the other hand, I am confident that almost everyone agrees with you.

We need to become much more comfortable with uncertainty.

Narrative Fallacy –

Narrative Fallacy I

How did this happen? – Research

Narrative Fallacy II

CAST and Narrative Fallacy

C A S T and Narrative Fallacy comment from Shaggy

Some Research Podcasting Comments

Shaggy Comments on Some Research Podcasting Comments.

Spine Immobilization in Penetrating Trauma: More Harm Than Good?

EMS EdUCast – Journal Club 2: Episode 43

Education Problems, Autism, and Vaccines


Some Research Podcasting Comments

This Eve of Christmas Eve both EMS Garage and EMS EduCast.

I Hate People: EMS Garage Episode 67, which is really much more cheerful than it sounds – and it comes with beer recommendations. One warning is that everybody seemed to be having connection problems, so we couldn’t always hear each other. this led to people talking over each other more than usual and pauses, where nobody is talking since they think someone else is still talking. these problems are minor, but do pop up occasionally. Steve Whitehead of The EMT Spot even brings a surreal dimension to the show with mime podcasting.


Understanding EMS Research: Episode 42, which may have helped to provide some understanding of research. The problem is that there is far too much to the topic to be covered in one episode. This was expected to be a brief, year end episode. A brief episode? With me on it? What were they thinking?

The other problem is believing that research can be covered effectively and briefly.

A couple of points. I point out that I think that we should start EMS education with research. Only after the students understand research, should we move on to assessment and treatment.

The big disagreement was when we were discussing some of the old discarded EMS myths, which unfortunately have not been discarded everywhere. The old rule of thumb about what pressure is indicated by what pulses, that I wrote about in A Radial Pulse Means a Pressure of At Least . . . ., where I describe the research from the BMJ from 2000[1] (not 2001 as I stated on the show). There was a bit of discussion of this and somebody mentioned relying on heart rate as an indicator of blood loss. I pointed out that beta blockers and abdominal trauma are two of the confounders of this approach.

The abdominal trauma is something that I will have to do a post on, and I do not have the studies in front of me, but there have been several papers written about surgical patients losing significant amounts of blood, but not becoming tachycardic to indicate the blood loss. Some abdominal surgery patients even became bradycardic with significant blood loss. this is an important problem, because relying on heart rate alone would did cause the continuing uncontrolled bleeding in some of these patients to be missed.

This is something important that we need to be aware of. There are many things that may mislead us in our assessments. The more that we are aware of these confounders, the less likely we are to miss a significant problem. While part of the debate was about whether this happens in the majority of abdominal trauma (it probably does not), this approach is completely irrelevant to developing an awareness of a potentially significant problem. We stress over spinal cord injuries, while the incidence of spinal cord injuries is probably much lower than the incidence of exsanguination due to abdominal trauma that is unrecognized because there is no significant rise in heart rate. The outcome may be more likely to be fatal, as well.

Anyway, my biggest disagreement was when somebody started, based on less information than I already wrote, to try to figure out why this is happening. This is a bad idea.

Why is not important!

When we started to discuss this, that this may be due to vagal stimulus, someone stated that this is just a hypothesis for a study. I don’t have any problem with using that as the hypothesis for a study, but we were not designing a study. We were providing information for educators to use to teach students.

This is exactly where medical myths come from.

The students do not need to know why something works, only that it may work. To suggest anything more than that is suggesting that we know a lot more than we do know.

It is important to know as much about the limitations of our assessments.

It is not important to know why, until after we have a lot of information to support that idea.

Look at where the EMS myths started from. Somebody started explaining why something was happening, or maybe they were only wondering about the cause. Educators got a hold of the idea, and rather than say, I don’t know why, some gave an explanation that was repeated enough to become a myth. A myth that is almost impossible to get rid of, because people want certainty.

Certainty is nice, but it is a problem.

The only certainty in medicine is that we do not know as much as we think we know.

When we start taking explanations for granted, we find that somebody read too much into an observation, or a bunch of observations, or read too much into a study, or a bunch of studies.

This is the same thing that leads the general public to distrust science. We have research that provides limited information, but somebody decides to explain that limited information. If you want to bet on something that is almost a sure thing, here is what you should do.

Bet that the explanation is wrong.

This does not mean that the science was bad, or that the science was wrong, or that the study was not done well, et cetera. It means that somebody took a look at some science and decided to create some fiction, because they assume that they know what they are doing.

The safe bet certain bet is that the explanation is wrong.

The certainty in science and medicine is that our explanations will be wrong. These erroneous explanations will create distrust of science and medicine. these will not be the fault of the researchers, but of those explaining the research.

When we create explanations, we create a narrative – a story. We should start out with, Once upon a time . . . , or something similar, but we don’t. I have discussed this problem with narrative fallacy further in the links listed below. I will write about this more, because this is important.

I do not mean to put down anyone on the show. This is a problem that is almost universal. One of the reasons that it is so common, is that it is natural for us to explain things with stories. When life was simpler, that may have been effective. When the life of someone else is in our hands, we need to be better than that.

Narrative Fallacy –

Narrative Fallacy I

How did this happen? – Research

Narrative Fallacy II

CAST and Narrative Fallacy

C A S T and Narrative Fallacy comment from Shaggy

Some Research Podcasting Comments

Shaggy Comments on Some Research Podcasting Comments.

Spine Immobilization in Penetrating Trauma: More Harm Than Good?

EMS EdUCast – Journal Club 2: Episode 43

Education Problems, Autism, and Vaccines


[1] Accuracy of the advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral, and radial pulses: observational study.
Deakin CD, Low JL.
BMJ. 2000 Sep 16;321(7262):673-4. No abstract available.
PMID: 10987771 [PubMed – indexed for MEDLINE]

Free Full Text . . . . Free PDF

Prepublication History of Manuscript


Magic Sirens Prevent Ambulance Drivers From Hitting Things

FireGeezer writes[1] about a news article claiming that sirens prevent accidents.[2] Since I just wrote about Friday the 13th and 2012, why not give this non sequitur some abuse, too.

Sirens probably are important in getting the attention of other drivers. As cars become better at keeping out sound and the power of radios sound systems increases, it becomes harder to get the attention of other drivers.

Adding the sirens should help to get the attention of those drivers.

If I am driving an ambulance I am supposed to proceed when it is safe, not drive with reckless abandon.

Sirens have absolutely nothing to do with accidents.

Accidents are due to driver errors. Sirens do not decrease driver errors.

Greg Friese also wrote about this, at Everyday EMS Tips, in Tips to Reduce Intersection Collisions.

In the video, the medic being interviewed in the side view mirror states that they believe that the magic siren has made most of the difference. As a side note, they should get better mirrors than these ineffectively paired ones, which look as if someone wanted a two-level effect with a little path running down the middle.

My recommendation, and I know this sounds crazy, but my recommendation is better driver training. If their drivers are pulling in front of cars that are still moving, the siren should do a better job of getting the attention of the other driver. However, the real fault is with the driver of the ambulance not waiting for the car to stop.

The magic siren is not a cure for incompetent ambulance drivers.

We need to expect that the drivers of the other vehicles are incompetent. They are distracted and unaccustomed to emergency driving. We need to be prepared for them to do the wrong every time. We should expect that.

But the driver of the car didn’t stop!

Then don’t pull in front of the driver. I can wait. If it is such an emergency, that I have to get there as fast as possible, I will get there sooner if I do not crash into another vehicle. If I do not understand that, then I don’t belong behind the wheel of an emergency vehicle.

Ambulance crashes are almost always the fault of the driver of the ambulance. A new magic siren will not change that.

I suppose that their method of dealing with morbidly obese plus sized patients is not to send more people to help lift, but to document the weight as being within their acceptable levels for just one crew. Place the responsibility on the crew to recruit as many neighbors as they can to help, but deny that help is needed. My kind of place to work. 🙂

I know what we should do. We’ll install rocket launchers on the ambulances. If the driver of the ambulance blows up a few cars, the other cars will immediately drive off the road in an attempt to avoid being blown up. Or, maybe they will just get out of the car and leave it blocking the road. Perhaps they will stop driving anywhere near an ambulance station or a hospital. Of course, there may be more ambulance vs. ambulance crashes, but the rocket launcher of the quicker draw should be able to prevent those accidents. It will be like shooting at the broadside of an ambulance a barn, or the front, or the back, or maybe just wiring the ignition switch to the fuse on one of the rockets. Ambulances might not even have to wait for trains any more. This could be living in an EMSA Paradise.


^ 1 “Howler” Credited With Lower Accident Rate

^ 2 New sirens cut ambulance crashes in Okla.


T G I Friday the 13th

This is the third Friday the 13th of this year.[1] Numerologists and other superstitious people probably will attach some meaning to that. There is none. For many people, Friday is the end of the work week. For that reason it may be different from other days – more drinking and other celebratory behaviors that do not mix well with driving, digestion, consciousness, et cetera. For me on the other hand, Friday is the beginning of my work week. It is not the beginning of my pay week, just the beginning of several days of consecutive work. The beginning and end of the calendar week are arbitrary.

For similar reasons, calendars begin and end at points that are largely arbitrary. there is no predictive value beyond the expected astronomical events – solstices, planetary motion, and such.

Full moons, 13ths, Fridays, . . . do not predict luck, or anything else. Fridays do result in more drinking and thus more accidents and general stupidity, but that has to do with the end of the typical work week falling on Friday, not with anything more than that.

This does not stop a bunch of people from believing that the end of an old calendar, from a civilization that has little current presence, is predicting the end of that civilization, the world, or whatever.

Arguments supporting this dating are drawn from a mixture of archaeoastronomical speculation,[3] alternative interpretations of mythology,[4] numerological constructions, and alleged prophecies from extraterrestrial beings.[5][2]

Translated into English, that means that they are all anti-science people. People who do not understand reality. Although, I love the use of alleged to describe the ET prophecies. If they hadn’t thrown that in there I might have considered this to be a fact.

But, What if they are right?

Maybe they are right. The simple way to find out is to look at the other otherwise unforeseeable events predicted by the same method.

And the calendar predicts . . . nothing. surprise.

What about Nostradamus? Did he have anything to say about 2012?

Nothing there, either. Not that one should be used to contradict the other, since both are examples of fairy tale reasoning.

For anyone planning to commit suicide because you believe the world is ending, psychiatric help is available. However, if you do decide to provide a graphic demonstration of your stupidity kill yourself, put me in your will. That is Rouge Medic Rogue Medic. It’s not as if you expect that anyone else will get any of this stuff and I did recommend psychiatric help, so I am trying to help. Maybe I should set up a tip jar thingie with pdfs of wills already filled out except for the name of the sucker gullible fool dearly not-yet-departed.

What this really needs is a Mystery Science Theater 3,000 2012 version. Maybe this will be as unintentionally comic as The Day After Tomorrow or 10,000 BC. Here is a link to a review of 10,000 BC by Lawdog. Maybe he will do something nice for 2012 if he is feeling masochistic and desperate for blog fodder. If you like explosions and are turned off by thinking, this may be just the movie for you. Hmm. Maybe I should have started with that. Reach out to a whole different audience of semi-literate reader. Oh well, too late now.

If you want to watch an apocalyptic film, waiting for The Road is probably a much better idea. Cannibalism for Thanksgiving. That probably makes more sense than you will find in all of 2012.

Happy Friday the 13th.


^ 1 Friday the 13th

^ 2 2012 phenomenon