Re: ASK THE MINESHAFT: troll terrible health decision?

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Is it possible that the same sorts of alternative medicine people with the bits of woo about the essential oils curing cancer are also the ones who diagnosed him with cancer? And that's why there are no details about the cancer? Optimistically, maybe he's only being defrauded, not steered away from needed treatment. This is assuming the essential oils are for the cancer and the HIV treatment continues to follow the mainstream medicine model.


Posted by: Moby Hick | Link to this comment | 10- 7-13 10:17 AM
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My take on treating cancer with woo is that it satisfies twothree needs.

1. It allows the person with cancer to hope for a miracle.
2. It gives them the sense that cancer is manipulable by them.
3. Not only is it manipulable, but they can fit it into a purity context (of diet, of discipline, of regimen).
4. An almost fanatical devotion to the pope.

People really really want those things. Telling him to give up those things in favor of mainstream medicine isn't going to go well. The most I'd try for is to get him to do both mainstream medicine and the woo.

Also, mainstream medicine can really suck and not help for long. If it won't do much anyway, he may be making a considered choice to die faster. I'd respect that, if it were what he was really choosing.


Posted by: Megan | Link to this comment | 10- 7-13 10:18 AM
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1) You do not have the power to cure your friend. If your friend gets proper treatment and suffers because of it and dies, it is not your fault. If your friend fails to get proper treatment and suffers because of it and dies, it is not your fault.

Be careful not to confuse the things you have preferences about with the things you have power over.

2) You should at the very least make sure your friend knows that someone, whom they know personally, thinks it would be a good idea to do the conventional allopathic cancer treatment. It can make a big difference to have even one person in one's life express a different opinion.

3) If you think your friend will be convinced by arguments, then try arguments. If you think your friend will be convinced by guilt-tripping then try guilt-tripping. If you think something will probably make things worse, then don't do it, even if it would look like "helping" from the outside.

4) (I am least certain about this one, take it as a strong opinion held weakly, i.e. if you think I'm wrong then I probably am.) Unless they're considering a really unusual "alternative" modality, it's probably not worth the effort to argue against it. Most alternative medicine is not very harmful, and if it doesn't cost a fortune and makes your friend feel taken care of, then that's a genuine good. Don't get sucked into that kind of argument if you can help it. Just argue for the evidence-supported therapy.


Posted by: Benquo | Link to this comment | 10- 7-13 10:19 AM
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I am pretty sure the cancer diagnosis came from real doctors -- he had hinted at it before, and in the post about alternative treatments had talked about how he would have to tell his doctors he was noncompliant with their treatment plan.


Posted by: EBM | Link to this comment | 10- 7-13 10:20 AM
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So much for optimism. Sorry about your friend.


Posted by: Moby Hick | Link to this comment | 10- 7-13 10:21 AM
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I also wonder if giving up alcohol isn't the sticking point with the prescribed treatment.


Posted by: EBM | Link to this comment | 10- 7-13 10:21 AM
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2.last is definitely possible.


Posted by: EBM | Link to this comment | 10- 7-13 10:23 AM
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6 suggests that you find out whether, and if so make sure your friend understands that, partial compliance is better than no compliance.


Posted by: Benquo | Link to this comment | 10- 7-13 10:23 AM
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Yeah, 2.last is also a good point. If - but only if - your friend has made an informed rational choice to forgo treatment, then you should respect and support that.


Posted by: Benquo | Link to this comment | 10- 7-13 10:24 AM
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3.4 makes sense to me. Really, if I weren't closer than it sounds as if you are, I wouldn't say anything because I'd figure I had no hope of being effective. But if I were going to say anything, "If you've looked into [alternative regime] and it seems convincing to you, you should totally go ahead with it, as long as you do [conventional regime] as well," seems like the likeliest to be listened to.


Posted by: LizardBreath | Link to this comment | 10- 7-13 10:26 AM
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It is also worth nothing that it would not be terribly surprised if the whole thing was a way to get attention/rile people up. As I say in the post, he is very self-dramatizing, and a lot of his Facebook is posts about how he's losing friends so he must be doing something right, and so on. A lot of the rest is horoscopes.


Posted by: EBM | Link to this comment | 10- 7-13 10:26 AM
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10 is right, I think. But it sounds as if you don't actually share a conceptual language on these questions, so discretion may be the better part of valor.


Posted by: chris y | Link to this comment | 10- 7-13 10:30 AM
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You might want to engage with him to make sure he is communicating well with his doctors, i.e., make sure he's getting enough information about his diagnosis, different options for treatment, and any *uncertainty* about what the doctors know. Cancer is complicated, and often a patient has to be proactive to get all the needed information.


Posted by: torrey pine | Link to this comment | 10- 7-13 10:32 AM
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What about private messaging him and asking what kind of cancer it is? That would be helpful to know and would give you a sense of whether or not he's open to discourse, without making him defensive or anything.


Posted by: heebie-geebie | Link to this comment | 10- 7-13 10:37 AM
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12: There's a lot of space between "You are doing it WRONG, you should do it MY WAY INSTEAD, you are BAD and you should FEEL BAD", and "I just wanted to make sure you knew that I think conventional treatment modalities are also worth considering."

13 seems right too - offering to listen and help before opining seems like not only a good way to help on its own, but also a way to gain credibility and trust.


Posted by: Benquo | Link to this comment | 10- 7-13 10:38 AM
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3 generally, and 3.4 in particular, seem to me like very good advice.

A real world example: My kid's pediatrician is a totally rational, good allopathic doctor who has somehow built a large practice amongst people who go in for alternative medicine nonsense for their kids. Obviously, this is a lucrative business move for the pediatrician, but it's also not insane as medical advice given the world we live in. Basically, her strategy is to pooh-pooh almost nothing, and (based on the patient) to prescribe some kind of minor, usually fairly inexpensive herbal remedy in addition to (but never as a replacement for) whatever standard evidence-based practice she'd prescribe anyway. I personally find even the mere evocation of herbal woo in a medical context incredibly aggravating and annoying, so I confronted the pediatrician about it, and her explanation was basically "sure, there's no more than a placebo effect, but the placebo effect is real and so is the psychological benefit to the parents and kids who believe in this stuff, so there is a real benefit, and it's not my job to be the evidence based medicine crusader." Fair enough.

Also, many standard cancer treatments are super super horrible. I mean, I think, generally better than not doing them, but really truly horrible. It is possible to make a completely rational decision not to undergo chemo and take a flyer on some herbal nonsense, although not if your theory is that the herbal nonsense actually has a better chance of being effective.


Posted by: Robert Halford | Link to this comment | 10- 7-13 10:40 AM
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16: The midwives I had my kids with were a very Western medicine, hospital-affiliated, conventional experience. But there was a very funny moment when I was on a group tour of the hospital birthing center with a bunch of other pregnant couples, and one woman asked the terrifyingly efficient Czech midwife about herbal remedies, and got back: "Ve do not usually recommend the use of herbs. [Pause. Big grin] But vhen eet is necessary? Ve have zat knowledge."

I was instantly convinced that she was not only a Certified Nurse Midwife, but a highly skilled witch. Which, to be clear, I was fine with.


Posted by: LizardBreath | Link to this comment | 10- 7-13 10:47 AM
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Just to complicate the picture more, I should mention that this guy is sort of self-consciously crazy, but may actually also be crazy; he talked in one of his previous statuses (which alluded to ongoing hospitalization) about having been in the psych ward last spring. He was crazy in the "that guy is craaaaazy", goth-who-is-fun-to-party-with sort of way when I last spent any real time with him (which was twenty years ago) but it's entirely possible that things have gone in a more serious direction.

It's also possible, if I haven't made this clear, that he's fucking with people in a hard-to-understand and quite mean spirited way, although none of his previous statuses particularly seem to reflect him engaging in that kind of thing.


Posted by: EBM | Link to this comment | 10- 7-13 10:52 AM
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18 -- All the more reason to take 3.1 very seriously.


Posted by: Robert Halford | Link to this comment | 10- 7-13 10:55 AM
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Lot of good advice above. It seems to me that if you're going to do anything at all, it should amount to a pretty serious escalation of the relationship: definitely an email, or even a phone call, rather than engaging in FB banter. If it's a step too far to move the relationship in this direction -- and given the time that has passed and the nature of this fellow, it very well may be -- then probably the right answer is to hide him on FB.


Posted by: CharleyCarp | Link to this comment | 10- 7-13 10:57 AM
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The person I know in my approximate age range who by any objective measure is the smartest* has a weirdly strong belief in the efficacy of traditional east Asian herbal remedies. He is not himself from east Asia. I find it really weird; his arguments amount to "it would be really arrogant to privilege the relatively recent knowledge of science over millennia of accumulated tests", which doesn't sound at all convincing to me. Also, it isn't clear why he singles out traditional medicine from a particular geographic region.

* Of course, objective measures of intelligence don't really exist. But most successful by far, in terms of output produced, in a competitive intellectual field (like, I think there is zero ambiguity, which is strange, because there would be twenty-odd contenders for second most successful).


Posted by: essear | Link to this comment | 10- 7-13 11:01 AM
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People are frustratingly immune to having their beliefs altered by evidence, no matter how rational they seem, I guess is what I'm getting at.


Posted by: essear | Link to this comment | 10- 7-13 11:03 AM
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You could mention Steve Jobs as the go-to example of treating cancer with woo, and then, at the end, regretting having done sol.


Posted by: Spike | Link to this comment | 10- 7-13 11:13 AM
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sol = so.


Posted by: Spike | Link to this comment | 10- 7-13 11:13 AM
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re: 21

There tends to be a lot of Chinese language scientific papers on the efficacy [or lack thereof] of TCM formulae, so, being fair, it's orders of magnitude more robustly based on evidence than most herbal 'woo'. That said, the methodology used in those papers isn't the traditional Western methodology, so it's hard to get a really accurate sense of how effective they are. There's also a very long and rich intellectual tradition underpinning it.*

I had a summer job once working for a pharma company that were trying to bring a TCM formula to market, and who were doing the full range of Western testing phases, so I learned a lot of largely useless knowledge about TCM medicines and how they are tested in China, and here.

There's quite good evidence for the efficacy of some TCM medicines. I still wouldn't put my trust in TCM in general, though, as there's no evidence at all for some others, and some are known to be actively harmful or dangerous.

* not that I believe that that tradition is 'true' in any important sense.


Posted by: nattarGcM ttaM | Link to this comment | 10- 7-13 11:13 AM
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My friend's interlocutors recommended what appears to be very strong hash oil, which seems likely to be a couple of orders of magnitude less robustly evidence-based than even standard woo.


Posted by: EBM | Link to this comment | 10- 7-13 11:17 AM
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"Ve do not usually recommend the use of herbs. [Pause. Big grin] But vhen eet is necessary? Ve have zat knowledge."

She was talking about weed, right?


Posted by: Flippanter | Link to this comment | 10- 7-13 11:20 AM
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This is a fun graphic on supplements.


Posted by: beamish | Link to this comment | 10- 7-13 11:22 AM
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Herbal medicines basically can't be tested the way we normally test medicines, because a precise formulation can't be worked out to the satisfaction of regulators. Some of them certainly work.


Posted by: Cryptic ned | Link to this comment | 10- 7-13 11:26 AM
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And some of them are highly toxic. You pays your money and you takes your choice.


Posted by: chris y | Link to this comment | 10- 7-13 11:28 AM
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re: 29

The company I worked for had put a ton of money and expertise into that. Which, I think, is why they got bought by a bigger company. Lots of sophisticated assaying methods, very precise tracking of source ingredients, and a lot of other methods combined. Quite a lot of clever statistical stuff, too. The methods were designed in partnership with one of the big London science universities, and produced quite a few journal papers. Basically their methods were their only intellectual property, as the formulations themselves were old and widely used.


Posted by: nattarGcM ttaM | Link to this comment | 10- 7-13 11:36 AM
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Herbal medicines basically can't be tested the way we normally test medicines, because a precise formulation can't be worked out to the satisfaction of regulators.

What distinguishes herbal medicines from, say, paclitaxel (back when it came from the yew tree)? Not that I'm arguing for herbal medicine in general, but it seems that past a certain level of refinement herbal medicine effectively becomes Western medicine, and I'm wondering what that level is.


Posted by: Minivet | Link to this comment | 10- 7-13 11:46 AM
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28 looks significantly different today from the last time I looked at it. I'm not sure whether that's a vote in its favor or a vote against.


Posted by: lurid keyaki | Link to this comment | 10- 7-13 11:49 AM
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When you identify exactly one molecule that is having the observed effect, herbal medicine becomes Western medicine. If it's a mixture of many molecules, who knows.


Posted by: Cryptic ned | Link to this comment | 10- 7-13 11:49 AM
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re: 34

That was their unique selling point. They'd done a ton of work on assays that were specifically designed for medicines with multiple herbal ingredients, with potentially dozens of synergistic active molecules. The science sounded pretty solid to me [as I said, it was being run in partnership with a major bio-chem and/or pharmacology dept] but I'm not a pharmacologist. They weren't working miracles, they were just trying to establish consistency from batch to batch, so that the clinical trials data they were producing would be meaningful.


Posted by: nattarGcM ttaM | Link to this comment | 10- 7-13 12:07 PM
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26: I just last week heard a long story from a guy whose father's colon cancer treatment included the hash oil (and something or other mushrooms). Something was working, so they all agreed that he should keep doing everything he was doing.


Posted by: Megan | Link to this comment | 10- 7-13 12:44 PM
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30:

I had a sleep medicine fellow tell me stuff about valerian having okay studies behind it. Then my PCP told me he didn't know what he was talking about and said some stuff about whatever kind of agonist it was... benadryl ... etc. lack of purity... no good studies..(Wait, from me, benadryl is bad for you? Well, there's some association, no causation mind you, with dementia)

*But what stuck in my mind was that she had done some research herself on women who reported using herbal remedies, and, at least in the U.S., they have significantly higher rates of lead in their blood which probably won't hurt them too much but could hurt any kids they have.

So, I'm a little nervous about offering herbal remedies to kids and seeing them as harmless.


Posted by: Bostoniangirl | Link to this comment | 10- 7-13 12:47 PM
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32: Right, red yeast rice extract contains statins. One of those statins is in an FDA approved drug.


Posted by: | Link to this comment | 10- 7-13 12:50 PM
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38 was I.


Posted by: Bostoniangirl | Link to this comment | 10- 7-13 12:51 PM
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32: I like digoxin as an example better than paclitaxel because it has a narrow therapeutic index and still varies pretty widely by lot.(Obviously, pharma assays and corrects for this in formulated pills.) Aspirin vs willow bark is another good one, since it was used for pain relief.
31/34/35: ttaM is exactly right about the work that goes into pulling out the synergies in herbal medicines. My opinion is that once you ID active ingredients and their therapeutic concentrations and validate efficacy through a double-blind study, it's no longer an herbal remedy. Some work; some don't. It is a badly neglected area of research because it is difficult and expensive to fish out a supposedly bioactive compound from a complex tree bark tea.


Posted by: ydnew | Link to this comment | 10- 7-13 1:06 PM
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Of course he should say something, regardless of if their really friends, just consider the upside vs. the downside.


Posted by: David the Unfogged Commenter | Link to this comment | 10- 7-13 3:55 PM
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In 1992, around 29000 rubber ducks fell off a cargo ship in the Pacific Ocean, this is where they made landfall.


Posted by: Robert Halford | Link to this comment | 10- 7-13 4:01 PM
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This is where they made landfall.


Posted by: | Link to this comment | 10- 7-13 4:03 PM
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Today, still wanted by the government, they survive as soldiers of fortune.

If you have a problem - If no one else can help - and if you can find them -


Posted by: Robert Halford | Link to this comment | 10- 7-13 4:05 PM
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44 was great and I watched too much shitty tv as a kid.


Posted by: Moby Hick | Link to this comment | 10- 7-13 4:17 PM
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You guys are the best.


Posted by: troll | Link to this comment | 10- 7-13 4:28 PM
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If you're talking about the movie, I never saw it but it may be the best reminder of how Hollywood has lost all desire to try original material.


Posted by: Moby Hick | Link to this comment | 10- 7-13 4:33 PM
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I thought the rubber duckies all stayed together -- like anchovies, maybe, to fend off predators? -- and was hugely disappointed to find that 43 was not a picture of all 29,000 of them making landfall. I AM DISAPPOINTED, HALFORD! DO NOT MISLEAD ME, WHEN IT COMES TO RUBBER DUCKIES, AGAIN!


Posted by: Von Wafer | Link to this comment | 10- 7-13 4:46 PM
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Coincidentally, a friend of mine was just whining on FB about how the high-woo treatment regimen she has decided on to treat her (legitimate, very serious) medical condition will not be covered by Obamacare, and should she do a Kickstarter? I did not respond, because she is one of those people who interprets even the smallest criticism as outrageous persecution. Which goes some ways towards explaining why she is banned from a local private college campus after having her FB posts investigated by their security firm.

Personally, whenever I feel the slightest twinge of illness coming on, I drink a quart of Laetrile and dance widdershins around Hubert H. Humphrey's grave under a new moon.


Posted by: Natilo Paennim | Link to this comment | 10- 7-13 4:49 PM
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Lots of us don't have access to Hubert Humphrey's grave, Nat. What are we supposed to do? Stay sick and die? God, you're such an unfeeling dick.


Posted by: Von Wafer | Link to this comment | 10- 7-13 4:56 PM
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That's the third time "widdershins" has come up this week. Twice here, once in my Lord Peter novel.


Posted by: Moby Hick | Link to this comment | 10- 7-13 5:03 PM
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51: That would be the Plate o'Widdershins phenomenon.


Posted by: Turgid Jacobian | Link to this comment | 10- 7-13 5:13 PM
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Also not covered by Obamacare.


Posted by: apostropher | Link to this comment | 10- 7-13 5:20 PM
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Because the Death Panels can't spell it.


Posted by: Moby Hick | Link to this comment | 10- 7-13 5:35 PM
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where did we find this pleasant new fellow?


Posted by: text | Link to this comment | 10- 7-13 6:12 PM
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Not new. Not a fellow. Don't worry about it.


Posted by: Moby Hick | Link to this comment | 10- 7-13 6:13 PM
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The writing style should be familiar, text.


Posted by: parsimon | Link to this comment | 10- 7-13 6:14 PM
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44: in my mind your comment was riddled with bullet holes.


Posted by: oudemia | Link to this comment | 10- 7-13 6:16 PM
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I think I'm worse than the median commenter here at identifying people by writing style.


Posted by: essear | Link to this comment | 10- 7-13 7:41 PM
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Man, I acknowledge that thus may be a knee-jerk reaction if mine. But I couldn't help but read "giving up drinking to start the treatment" followed by "decided treatment was bullshit" and think maybe someone is having a hard time with the giving up drinking thing.


Posted by: Di Kotimy | Link to this comment | 10- 7-13 7:42 PM
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And now zipping through the thread... The flamboyantly craaazzzyy prototype is familiar as well. Reading through that filter, I'd be skeptical the medical drama is even real.


Posted by: Di Kotimy | Link to this comment | 10- 7-13 7:46 PM
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I know, I know. I'm a horrible person.


Posted by: Di Kotimy | Link to this comment | 10- 7-13 7:47 PM
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The BEST!


Posted by: troll | Link to this comment | 10- 7-13 11:37 PM
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she had done some research herself on women who reported using herbal remedies, and, at least in the U.S., they have significantly higher rates of lead in their blood

Wow. Impressive. All those herbs grown in urban areas, maybe?

hugely disappointed to find that 43 was not a picture of all 29,000 of them making landfall.

An Omaha Beach of Cute.


Posted by: ajay | Link to this comment | 10- 8-13 3:16 AM
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64: Now I'm imaging a version of Saving Private Ryan where the landing craft are the giant rubber duckies that seem to be all the rage.


Posted by: JP Stormcrow | Link to this comment | 10- 8-13 3:29 AM
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64: Mostly pills from the healthfood stores. There's a big problem with quality control in the supplement business--vitamins and minerals in addition to chinese herbs.


Posted by: Bostoniangirl | Link to this comment | 10- 8-13 3:30 AM
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Speaking of movies, went to see Gravity at an IMAX theater last night. My reaction: definitely mixed and heading downward the more I think* about it, companion was more positive. Ed Harris as the voice of Houston was the nicest touch.

*One of those "not thinking about it advised" movies.


Posted by: JP Stormcrow | Link to this comment | 10- 8-13 3:33 AM
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64: Here's the abstract. Apparently, it doesn't affect men as much.


Posted by: Bostoniangirl | Link to this comment | 10- 8-13 3:41 AM
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||

Will one of the physicists out there explain why Englert and Higgs rather than some of the other three or four people we are assured made crucial contributions to this work?

|>


Posted by: chris y | Link to this comment | 10- 8-13 4:07 AM
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69: The real answer has got to be the opaque politics of the Nobel committee.


Posted by: Walt Someguy | Link to this comment | 10- 8-13 4:15 AM
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64: Now I'm imaging a version of Saving Private Ryan where the landing craft are the giant rubber duckies that seem to be all the rage.

So, Batman Returns.


Posted by: Ginger Yellow | Link to this comment | 10- 8-13 4:42 AM
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Speaking of movies, went to see Gravity at an IMAX theater last night. My reaction: definitely mixed and heading downward the more I think* about it, companion was more positive. Ed Harris as the voice of Houston was the nicest touch.

Can you elaborate (in a non-spoilery way)? Physics aside, I've heard nothing but good buzz about it.


Posted by: | Link to this comment | 10- 8-13 4:44 AM
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72: One persistent trope in the details of how the dramatic plot elements played out. Basically the same story arc could have been followed without a certain kind of cliched Hollywood dramatic overstatement that bugs the hell out of me (YMMV). Example from another movie that suffered a bit from it--in The Fellowship of the Ring the thing in the water outside the entrance to Moria wasn't allowed to just grab Frodo and start dragging him in was in the book (and which done right would have been terrifying) but instead had to pick him up and fling him around. Gravity had all the tension and claustrophobia and whatnot that it needed without them laying it on so freaking thick.


Posted by: JP Stormcrow | Link to this comment | 10- 8-13 4:57 AM
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was s/b as


Posted by: JP Stormcrow | Link to this comment | 10- 8-13 5:01 AM
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a version of Saving Private Ryan where the landing craft are the giant rubber duckies

Related:

IN THE GRIM FUTURE OF HELLO KITTY THERE IS ONLY WAR


Posted by: ajay | Link to this comment | 10- 8-13 5:13 AM
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65: Quack and Yellow Quack and Yellow Quack and Yellow Quack and Yellow


Posted by: Cryptic ned | Link to this comment | 10- 8-13 5:18 AM
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69 the other three or four people we are assured made crucial contributions

Partly the problem is that none of them was "crucial", since they all did exactly the same thing. Anderson was really first, but he already has a Nobel prize, and he burned his bridges with the particle physics community by campaigning against the SSC. Beyond that, I guess they just went by publication dates.


Posted by: essear | Link to this comment | 10- 8-13 5:23 AM
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Lots of people have problems with the Statistical Society of Canada.


Posted by: Moby Hick | Link to this comment | 10- 8-13 5:26 AM
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Because they insist on using Maple?


Posted by: Awl | Link to this comment | 10- 8-13 5:54 AM
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If you like the map about the rubber ducks from the cargo ship, you should read the book about them, which is called, no lie, Moby Duck. I haven't read it myself, yet, but friends of mine who have recommend highly.


Posted by: Mme. Merle | Link to this comment | 10- 8-13 5:59 AM
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65, 75: That kind of incongruity was somewhat captured in this Bill Mauldin cartoon. "This is Fragrant Flower Advance. Gimme yer goddamn number. "


Posted by: JP Stormcrow | Link to this comment | 10- 8-13 6:06 AM
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Piratical statisticians, by contrast, refuse to use anything but R.


Posted by: ajay | Link to this comment | 10- 8-13 6:08 AM
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No, sometimes we also use SAS.


Posted by: opinionated pirate statistician | Link to this comment | 10- 8-13 6:34 AM
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77. Thanks.


Posted by: chris y | Link to this comment | 10- 8-13 6:54 AM
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|| Is this thread too early for a hijack-the-thread ATM? I need free legal advice. I'm on the board of a nonprofit. This charity gets lots of community involvement and volunteer labor. One volunteer who is a CPA had several years ago been volunteering heavy hours doing the bookkeeping for the organization, but then she became disillusioned with organization (which she thought was drifting away from its proper mission). She wasn't totally disillusioned though, and she agreed to begin doing the work on a paid basis. Everyone on the board (which I was not on at the time) understood that her compensation would be a below-market fixed annual stipend. (Except one person on the board, who is no longer on the board and is also close friends with this accountant/volunteer, who says she thought it was supposed to be billed at the accountant's normal hourly rate.) Anyway, here we are 2 years later, this accountant/volunteer has resigned (having become further disillusioned), and she's just dumped on us invoices for the last two years worth of work for her bookkeeping services, which are all significantly above the amounts we had budgeted for these services. (They are about double what was budgeted. She's been preparing our books and closed the books last year and delivered quarterly financial statements showing accrued accounting expenses for this year all in line with our budget (which she also helped prepare). She says she previously had no basis to accrue any more than that on our books, because she hadn't previously submitted her invoices.) FWIW, she's been providing terrible, sloppy, late, unresponsive work this whole time, which we only tolerated because we're strapped for cash and we thought she was being paid well under market.

I've been asked to write a letter to her explaining why we think she should go pound sand. (More technically, explaining why we think she's lucky we're offering to pay her what we had already budgeted (and no more), and if there wasn't residual goodwill in the organization from her volunteer days, we probably wouldn't be willing to pay her a dime. (The problems with her work product were really egregious, to an extent that is only now coming to light.) We've already told this to her in person, but she rejected the offer, and we were too gentle, and she walked away from the meeting thinking we were just trying to stiff her.

I initially drafted a letter to her but not with her as the target audience--I was really writing for a potential judge and or jury if this ever got to that stage. (Which, she's explosive and irrational, and really wants attention and validation on this, so it might.) But... looking at what I've drafted (which I haven't yet sent), I'm worried that's she's going to read it and blow up. That may be unavoidable even if I softpedal... see above about explosive and irrational. But, delivering an especially pointed letter that calls into question her professional capability and her work product seems like a potential disaster... see above about explosive and irrational. She could do a lot of damage to the organization in the community if she spread misleading information about us shortchanging a service provider. Of course, that damage may be unavoidable at this point... see above about explosive and irrational.

This is all probably way too abstract for anyone to offer any useful advice. Mostly I'm just feeling fraught about this letter and so I'm typing words here in this comment box to help ease my anxiety. But if anyone has useful advice, please let me know. |>


Posted by: OBAMA | Link to this comment | 10- 8-13 9:20 AM
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You can't be the person who closes the books and claim you didn't know about invoices that weren't submitted because you were the person to submit them. Or at least I don't think you should be able to and be taken seriously.


Posted by: Moby Hick | Link to this comment | 10- 8-13 9:24 AM
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You need to fight explosive and irrational with explosive and irrational. Are you in a position to shut down the entire U.S. government until she goes away?


Posted by: Moby Hick | Link to this comment | 10- 8-13 9:27 AM
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That is, are you on the board of the Heritage Foundation.


Posted by: Moby Hick | Link to this comment | 10- 8-13 9:27 AM
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87: Negotiate using things over which you have control.


Posted by: JP Stormcrow | Link to this comment | 10- 8-13 9:31 AM
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85: I'm curious as to roughly what the overcharges would be as a % of the overall yearly budget. Just trying to dimension the problem. Because I have no underlying principles about such things, my response would almost be entirely scaled to the materiality of the financial consequences.


Posted by: JP Stormcrow | Link to this comment | 10- 8-13 9:35 AM
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85: (I am not your lawyer and this is not legal advice). My instinct is that the lousiness of her work product isn't really here nor there -- that is, if you'd agreed to pay her market rates, the quality of her work product wouldn't really come into into it unless it was so terrible it didn't really count as doing the work.

Can you focus the letter on the interactions that made everyone believe in the 'below-market fixed annual stipend'? Even if there's nothing in writing from when the agreement was arrived at, surely you've paid her at least once over the last two years, and she took the money without reacting to it as an underpayment. I'd concentrate on that, and on talking about the initial agreement, even if you have to be talking about what people remember rather than anything in writing.

On the quality of her work, I wouldn't get into details. Mostly, I'd just avoid saying it was satisfactory, and maybe a sentence about how the organization didn't have budget for market rate services, and would have expected an entirely different level of service if it had been paying for services at the market rate.


Posted by: LizardBreath | Link to this comment | 10- 8-13 9:39 AM
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90: very small.

91.a: some of the lousiness of her work product consisted of errors that cost the organization real money. (E.g., accounting for A/R as paid even when it was not paid, in cases where enough time has elapsed that we can't now seek payment.)

91.b: She has not been paid anything at all over the last two years. Nor had she submitted any invoices until very recently. Everyone assumed she had been paid (the proper amount), since she did all the books and wrote all the checks.


Posted by: OBAMA | Link to this comment | 10- 8-13 9:50 AM
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Well, fuck. There goes anonymity. Oh well.


Posted by: read | Link to this comment | 10- 8-13 9:50 AM
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By the way, these are not the racists.


Posted by: read | Link to this comment | 10- 8-13 9:51 AM
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Just as a general rule, aren't you supposed to have two people write the checks and not let anybody write checks to themselves?


Posted by: Moby Hick | Link to this comment | 10- 8-13 9:52 AM
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Would you like me to re-anonymize them?


Posted by: apostropher | Link to this comment | 10- 8-13 9:54 AM
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Do the racists have better fiscal controls?


Posted by: Moby Hick | Link to this comment | 10- 8-13 9:54 AM
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She's been preparing our books and closed the books last year and delivered quarterly financial statements showing accrued accounting expenses for this year all in line with our budget (which she also helped prepare). She says she previously had no basis to accrue any more than that on our books, because she hadn't previously submitted her invoices.)

What Moby said about this. I'm not an accountant, and am working off sketchy memories of Accounting for Lawyers in law school, but 'accrual' means you put it on the books when the expense is incurred, and you make your best estimate if you don't know exactly what you're ultimately going to have to pay. If she was doing the books, then they're a statement by her of what she believed your accounting expense was for that year.


Posted by: LizardBreath | Link to this comment | 10- 8-13 9:58 AM
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She's been preparing our books and closed the books last year and delivered quarterly financial statements showing accrued accounting expenses for this year all in line with our budget (which she also helped prepare). She says she previously had no basis to accrue any more than that on our books, because she hadn't previously submitted her invoices.)

What Moby said about this. I'm not an accountant, and am working off sketchy memories of Accounting for Lawyers in law school, but 'accrual' means you put it on the books when the expense is incurred, and you make your best estimate if you don't know exactly what you're ultimately going to have to pay. If she was doing the books, then they're a statement by her of what she believed your accounting expense was for that year. I'd bring that up in the letter.


Posted by: LizardBreath | Link to this comment | 10- 8-13 9:58 AM
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The funny thing is that I had a strong opinion on whose problem this was, and was dead wrong about it.


Posted by: LizardBreath | Link to this comment | 10- 8-13 10:00 AM
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Me too.


Posted by: apostropher | Link to this comment | 10- 8-13 10:01 AM
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I had only a weak opinion, but I was right.


Posted by: Moby Hick | Link to this comment | 10- 8-13 10:10 AM
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96: not that big an issue, but thanks.

The issue with 91 and 98/99 (which was my original instinct, and my original response) is that we've already said all that, and none of it has any effect. She just thinks she's owed more. And the truth is, if it really was only a misunderstanding about the billing arrangement, we'd probably be inclined just to pay her and be done with it. So the thought was that maybe it's time to stop pulling punches, and explain both why we're really frustrated and why we don't think we owe her a dime, much less twice what we'd budgeted to pay her. Maybe that's a mistake.


Posted by: OBAMA | Link to this comment | 10- 8-13 10:13 AM
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Yeah, that's accrual (comes up a lot for me). I'd ascribe her putting those below-market payments in the budgets as evidence of her only expecting those payments at the time, though I have no idea how much it means legally.


Posted by: Minivet | Link to this comment | 10- 8-13 10:15 AM
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Nobody will ever put me on a board, but my wife keeps getting put on them. Society doesn't get me.


Posted by: Moby Hick | Link to this comment | 10- 8-13 10:20 AM
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Or society does get me and decided it doesn't need a board member who spends meetings looking at his cell phone.


Posted by: Moby Hick | Link to this comment | 10- 8-13 10:24 AM
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I was on a board once!


Posted by: OPINIONATED JESUS | Link to this comment | 10- 8-13 10:26 AM
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Did you have a written retention agreement with this person saying that you'd pay her market rates? If so, it's tougher if not based on what you've written here I'd feel pretty confident that it's OK to tell her to pound sand. Unless you don't want to piss her off for other reasons. Almost certainly, the fact question that matters for the law is pretty simple: what was your deal? Her reviewing books that had her accruing bills at a lower rate strikes me as pretty conclusive evidence that she understood she'd only be getting the accrued rates, absent a written contract or strong evidence the other way.

Also, isn't there a lawyer on your board?


Posted by: Robert Halford | Link to this comment | 10- 8-13 10:30 AM
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No, no written agreement saying anything whatsoever.

I said I was looking for legal advice, but I wasn't actually looking for "what is the law?" legal advice as much as "does it make tactical sense to throw pie in this person's face, or should we refrain from doing that?" legal advice. Because: I'm generally not inclined to throw pie, but maybe it makes sense here.


Posted by: OBAMA | Link to this comment | 10- 8-13 10:45 AM
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My gut advice (not your lawyer! don't actually know the facts!) would be to pay her outstanding bills (if any) at the accrued rate, together with a short and curt, but polite, letter that explains that shr has been paid at the agreed and accrued rate and she has now been paid in full and that you will not be paying her anything anymore, ever, and that this concludes the matter.


Posted by: Robert Halford | Link to this comment | 10- 8-13 10:52 AM
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I don't think throwing pie makes any sense. Ideally, she goes away with the money you budgeted to pay her with. Raising the emotional temperature won't help with that.

I think your next step is to offer to pay her the budgeted amount in exchange for her agreement that it constitutes payment in full (repeating the 'accrual' argument for why that's all you owe her), and then see what she does next.


Posted by: LizardBreath | Link to this comment | 10- 8-13 10:52 AM
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You could throw Boston Cream Pie, which I'm informed is actually cake.


Posted by: Moby Hick | Link to this comment | 10- 8-13 10:56 AM
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What happened to "You need to fight explosive and irrational with explosive and irrational"?

110: I would be very uncomfortable just paying the full amount without some assurance that it's going to make the issue go away. I think we'd at least need her agreement that the check constitutes full payment, no?


Posted by: OBAMA | Link to this comment | 10- 8-13 11:01 AM
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Nevermind everyone. This is boring, and is my issue. I'll sort it out.


Posted by: Bill Ayers | Link to this comment | 10- 8-13 11:04 AM
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Damn, unanonymous again. I'm terrible at this. Oh well.


Posted by: OBAMA | Link to this comment | 10- 8-13 11:05 AM
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I'm unclear what the fear is exactly. Do you just want to minimize this pain in the ass issue, or is their a realistic fear of litigation?


Posted by: Robert Halford | Link to this comment | 10- 8-13 11:08 AM
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85.3 to 116.


Posted by: Moby Hick | Link to this comment | 10- 8-13 11:16 AM
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116: It's 100% about minimizing this pain in the ass issue including the fact that I think it's more likely than not she'll file a claim in local low-dollar district court district court precisely in order to be a pain in the ass about the issue.


Posted by: Bill Ayers | Link to this comment | 10- 8-13 11:17 AM
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If your theory of the case is that the absolute minimum you'd pay her is the accrued amount, I might just pay the accrued amount with the message that it's been paid in full. That way she can rant and rave but you can just keep explaining that she's already been paid; if not, she's got a justifiable position that she needs to get something and the issue drags on. Relevant factors include the amount of money at stake, whether you think she's likely to pay hourly for a lawyer or get one on contingency, and whether the organization has some lawyer who can do at least minimal letter-writing type lawyering for free or low cost.


Posted by: Robert Halford | Link to this comment | 10- 8-13 11:17 AM
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Fuck you, you stupid browser! Good think I'm not spilling any real secrets. Christ.


Posted by: OBAMA | Link to this comment | 10- 8-13 11:18 AM
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Also, subsumed in those other issues, what your assessment is of her cash flow situation right now. Does she really really need the money now? If so the balance weighs towards paying her nothing without a final settlement agreement.


Posted by: Robert Halford | Link to this comment | 10- 8-13 11:20 AM
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If your theory of the case is that the absolute minimummaximum you'd pay her is the accrued amount

That's my theory of the case.


Posted by: OBAMA | Link to this comment | 10- 8-13 11:21 AM
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Is this the same charity board that was super racist about nominating at most one black person?


Posted by: heebie-geebie | Link to this comment | 10- 8-13 11:35 AM
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123, see 94.


Posted by: peep | Link to this comment | 10- 8-13 11:38 AM
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122 -- well, depending on the factors listed above, if you have a plausible justification for some definite sum less than the accrued amount, you may want to just go ahead and pay her some lesser (but justifiable) amount now. In any case, sending a long letter is unlikely to help the situation much -- either pay her and tell her to fuck off, or don't pay her and try to sit down for some kind of negotiation.


Posted by: Robert Halford | Link to this comment | 10- 8-13 11:44 AM
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If this is the ATM thread, I have one.

Hawaiian Punch had her first piano lesson. Hawaii is a prickly child in a lot of ways. I'm looking for some language to tell other adults the following: "I don't personally care if you piss her off - she has to learn to navigate the world. But if you'd like some techniques for not pissing her off, here's what works..."

I don't want to come across like they have to indulge her prickliness. She'll be fine either way. But maybe the other adult would like to have access to the information, especially in a lesson setting. My fear is that no matter what disclaimer I provide, it will come across like I'm saying "Do this. Don't do that. Don't piss off my kid."


Posted by: heebie-geebie | Link to this comment | 10- 8-13 11:48 AM
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She's too young for piano lessons, isn't she? I thought it was about 7, at the earliest.


Posted by: urple | Link to this comment | 10- 8-13 11:49 AM
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Nah, I think I started at 4, too. She's 4 1/2. Anyway, she did totally fine on the musical end of things.

But she cannot stand when adults chuckle at her - she interprets it that they're laughing at her (which sometimes they are, sometimes not.) And other things like that.


Posted by: heebie-geebie | Link to this comment | 10- 8-13 11:51 AM
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A template.


Posted by: Moby Hick | Link to this comment | 10- 8-13 11:52 AM
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McSweeney's understands me.


Posted by: heebie-geebie | Link to this comment | 10- 8-13 11:56 AM
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Good think I'm not spilling any real secrets.

If that's what you think, you have another thing coming.


Posted by: jms | Link to this comment | 10- 8-13 11:59 AM
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The silence is leading me to believe that I'm actually an obnoxious parent and I should just let everyone interact regularly.


Posted by: heebie-geebie | Link to this comment | 10- 8-13 12:12 PM
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132: Actually I think --"I don't personally care if you piss her off - she has to learn to navigate the world. But if you'd like some techniques for not pissing her off, here's what works..." -- is a fine thing to tell a piano teacher or other such.


Posted by: peep | Link to this comment | 10- 8-13 12:15 PM
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I kinda think you need to have the prickly encounter happen and then give after-the-fact advice for avoiding it in the future, rather than preemptive advice, speaking as someone else with a prickly kid.


Posted by: Robert Halford | Link to this comment | 10- 8-13 12:15 PM
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That's funny. Yesterday afternoon I wrote the same thing. The email I sent was:

http://www.mcsweeneys.net/articles/its-decorative-gourd-season-motherfuckers
He understands me.

Posted by: Megan | Link to this comment | 10- 8-13 12:16 PM
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I doubt there's any way to deliver the message the way you want at the current time. In a few weeks you could ask the teacher how things going, and if the teacher brings something up then you can give some tips.


Posted by: Unfoggetarian: "Pause endlessly, then go in." (9) | Link to this comment | 10- 8-13 12:17 PM
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I can do 134. When it comes up, is it a communication I can deliver over email? Or do I need to actually talk with the person?


Posted by: heebie-geebie | Link to this comment | 10- 8-13 12:19 PM
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My fear is that no matter what disclaimer I provide, it will come across like I'm saying "Do this. Don't do that. Don't piss off my kid."

This is the sort of thing that I'd do, with the appropriate disclaimer, but only if I did it in front of the kid. That way everybody, including my child, would know that I was describing the peculiarities of the child.

It's possible, however, that I'm not a very good parent. If your kids are too sensitive to criticism, they're not getting enough of it, is what I say.


Posted by: politicalfootball | Link to this comment | 10- 8-13 12:19 PM
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I have to teach, but will check in after.


Posted by: heebie-geebie | Link to this comment | 10- 8-13 12:24 PM
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139: Don't mention numbers! That makes my kid angry!


Posted by: peep | Link to this comment | 10- 8-13 12:25 PM
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137: I wouldn't bother if you're not doing it in person. This is the sort of communication that's only going to be effective if you've got a bit of a rapport going with the other person.

Actually, come to think, you know what I might do? Tell the teacher "HP's a little prickly sometimes -- if she's being difficult for you, tell me about it and I'll work on it with her." That puts you in the teacher's corner to begin with. At that point, either the teacher handles it and you don't worry, or the teacher will come to you with some moderately specific information on the bad interactions as the teacher perceives them, and you can communicate how you think HP is getting set off.


Posted by: LizardBreath | Link to this comment | 10- 8-13 12:27 PM
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110 is basically what we did awhile ago at my job when a contractor invoiced us (a nonprofit) for some work that was significantly in excess of what they actually did. We had not previously discussed a fee, and the contractor had not actually done any work, and didn't have a written contract, so was in a fairly shaky position, but had threatened to badmouth us in the community, as, indeed, OBAMA's accountant has threatened to do. We sent the contractor 20 or 30% of what was requested, with a note that said, basically "if you deposit this check, you are agreeing to it being the full amount of your compensation". Check got deposited and we were all set. Still rankled, especially because then we started hearing about how this contractor had pulled similar shit with other organizations all over town.


Posted by: William Howard Taft | Link to this comment | 10- 8-13 12:29 PM
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The only problem with 141.2 (which I've tried before) is that it kind of sets an expectation for the adult that he/she is dealing with a "difficult" child, which can itself be a problem. But still not necessarily a bad idea depending on teacher/situation.


Posted by: Robert Halford | Link to this comment | 10- 8-13 12:34 PM
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I would think a piano teacher who worked with four-year-olds would be very much interested in quietly pulling the parents aside to check what does and doesn't work with their kid, to save their nominally piano teaching selves some hassle down the line. Shows what I know!


Posted by: Sifu Tweety | Link to this comment | 10- 8-13 12:51 PM
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"Hi, this is my kid. She's kind of prickly, but you don't have to make any special accommodations for her. Just watch out for the red spine here, because that one's poisonous."


Posted by: torrey pine | Link to this comment | 10- 8-13 12:54 PM
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"Also, throwing her into the turbid Amazon will make her uncurl, and then you can scoop her out with your paw."


Posted by: LizardBreath | Link to this comment | 10- 8-13 12:56 PM
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126: For a countervailing view: I'm a cranky, impatient childless person, Heebie, and I'd totally be sympathetic if you gave me that kind of warning in advance. Maybe it's because the particular things you'd be advising against are so cute? (Not that they make me want to laugh at Hawaii or anything). If you were saying something like, "you might want to know that she doesn't do well with rules or criticism or whatever," that might prompt a little more secret skepticism, although I'd still appreciate the advance warning so I could plan my approach to both of you. And planning the approach seems key: I can see the argument for waiting until the prickliness emerges, but why risk starting off on the wrong foot?


Posted by: Mme. Merle | Link to this comment | 10- 8-13 12:56 PM
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"Don't ever say no to her! Don't ever tell her that anything she does is less than stupendous! Also, she may hit you when she's frustrated, but it doesn't really hurt that much."


Posted by: peep | Link to this comment | 10- 8-13 1:04 PM
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"Whatever you do, don't disrespect her. ARE YOU DISRESPECTING HER?"


Posted by: Robert Halford | Link to this comment | 10- 8-13 1:13 PM
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Is it even possible to sit a four-year-old at a piano without them being prickly? I was 58 before I ever willingly practiced a musical instrument.


Posted by: Moby Hick | Link to this comment | 10- 8-13 1:32 PM
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150: Is this future Moby commenting?


Posted by: peep | Link to this comment | 10- 8-13 1:34 PM
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No, but he sent me an email. Apparently, he forgot his PIN so I had to set him straight. I guess I lose my concentration before I reach 60.


Posted by: Moby Hick | Link to this comment | 10- 8-13 1:35 PM
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If your kids are too sensitive to criticism, they're not getting enough of it, is what I say.

She is very sensitive to criticism indeed! Especially from people outside of the nuclear family. A lot of her perfectionism is about appearing perfect to the outside world, and anticipating what they'll want from her before they ask for it.

Piano lessons will obviously push this button a thousand times over, because it's hard and frustrating and she can't possibly anticipate the next step, nor go without making mistakes. I'm wildly curious to see how she responds.

During the lesson, she concentrated intensely for the entire lesson, and I could see her stiffen every time she made a mistake. Also, she kept her fingers in her mouth any time she wasn't playing, and there was a ton of slobber on the keyboard by the time she was done. The instructor was very gracious and enthusiastic.


Posted by: heebie-geebie | Link to this comment | 10- 8-13 1:43 PM
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and there was a ton of slobber on the keyboard by the time she was done

That's fine. They just pick up the piano and put it in the bin for toys that need sanitized.


Posted by: Moby Hick | Link to this comment | 10- 8-13 1:48 PM
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153: Reminds me a little of my little sister. Ever since she was verbal she was an incredible perfectionist. So every night when she practiced the piano there was screaming that would have woken the dead, had any of them been sleeping in our hourse.

Now she's in her mid 20s, a genuinely exceptionally talented musician and composer, and doesn't scream very much when she has trouble learning a piece. So there's hope for Hawaiian Punch!


Posted by: Benquo | Link to this comment | 10- 8-13 2:36 PM
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*in our house


Posted by: Benquo | Link to this comment | 10- 8-13 2:36 PM
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And she looks great while licking a hammer.


Posted by: Moby Hick | Link to this comment | 10- 8-13 2:43 PM
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I swear I read somewhere that praising kids for effort and perseverance rather than accomplishment is a good way to combat the tendency toward perfectionism.


Posted by: Di Kotimy | Link to this comment | 10- 8-13 4:42 PM
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As another impatient childless person, I second Mme. Merle at 147.


Posted by: Jackmormon | Link to this comment | 10- 8-13 4:57 PM
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161: The finding you're thinking of was that praising innate ability rather than effort tends to cause excess fear of failure, which obviously interferes with learning. (This Po Bronson piece about the phenomenon occasioned a lot of online discussion a few years ago, including, IIRC, some here.)


Posted by: lambchop | Link to this comment | 10- 8-13 5:38 PM
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Yep. That's what I was thinking of! Thanks lambchop!


Posted by: Di Kotimy | Link to this comment | 10- 8-13 8:14 PM
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I threw pie.


Posted by: OBAMA | Link to this comment | 10- 9-13 12:20 PM
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Great. Did it work?


Posted by: Moby Hick | Link to this comment | 10- 9-13 12:36 PM
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