@VoodooV
when i use the term "extreme nasty" i am not referring to a civil war but rather the american public finally reaching its boiling point.

it started bubbling with the tea party,and if people recall it was NOT the rabid christian rightwing fascist group it is today.
they had real grievances and rightly so.

but they got co-opted by private monies.

then occupy blew up and they too had real grievances and since the power elites could not co-opt them like the tea party they were systematically shut down by targeted governmental edict.

thanks Obama.

for years the poor and working poor were disenfranchised,made irrelevant in a political system that only used them as talking points to garner sympathy during an election cycle.

but now the middle class are finding themselves falling into the ranks of poor and working poor and ALL have been made irrelevant and inconsequential.

the american public has been kept in a constant state of fear for over 25 years.
fear of brown people.
fear of losing their job.
losing their house.
hell they even fear their own neighbors!

while the beautiful and poetic nationalism of american exceptionalism and ingenuity sound great,most americans are aware its all bullshit.
the political system is corrupt and sick on its own hubris and greed.

the american public know that this government no longer serves their interest.just look at the data.time and time again the public has a strong opinion on a subject and yet our elected officials vote to serve their masters.
war in iraq? americans shouted NO!
bank bail out? resounding NO!
the examples over the past (especially the past 15 yrs) are staggering.

so while i admire your optimism in still using the political system to enact positive change.i just dont see it ever becoming a reality.
mainly because the system is rigged and not in our favor.

so that leaves only ONE option:take to the streets.
refuse to go to work.
keep your purchases to a minimum and trade with each other.
refuse to feed the beast.
clog it with bodies.
clog the streets..halt business from operating properly.

but avoid violence.

thats what the state uses and to give it reason to engage in violence will only serve to beget more violence.

make those in power afraid.
remind them who they really work for and that if they dont the whole fucking thing is gonna come crashing down.

its the only real option i see and if it comes to pass you will see those who wield power do so..and it will be very nasty.

see:the labor movement
see:civil rights
see:anti-war
see:woman sufferages

Haven't watched, but I'm going to predict at least one really boring segment that focuses on the controversy over violence in video games. I wish it were not so, but every single video games history I've ever seen has screeched to a halt in at least one part to rehash something that has little to do with the actual games and more to do with media hype and political opportunism.

I never purchase animals from breeders or shops, because I view their ilk as unethical in the face of the thousands of animals that ALREADY EXIST and DIE every year.

Stupid humans and their penchant for declaring one set of genetic qualities as better than another. A dog is a dog. A cat is a cat. Save the ones that need saving and halt your superfluous breeding to make money off of selective assholes.

I've owned a beautiful russian blue, orange tabby, dalmatian mix, german shepard, and austrailian cattle dog that I purchased from the pound. Pretty cheap, I did a good deed, and they ended up being some of the greatest companions of my life.

Seriously, stop breeding animals for so-called "pure" breeds. It's sickening. Actual lovers of animals and all things cuddly, think about this fact and stop doublethinking yourself into believing you're an animal lover. You're NOT. You love the idea of something cute that you believe is superior to another something that is less cute. And that line of thinking most certainly does not qualify you for anything other than a cretin.

Ooh-Rah Marine Aviation!

My grandfather was a crew chief in the Air Force for decades.
One of my favorite stories that he told was of the first time an AV-8A (original British Harrier, before US adopted them) landed at his base for a demonstration. He, along with everyone else on the flightline, watched in awe as it gently slowed to a halt mid-air, before decending to the runway. It apparently about gave them all a heart attack for fear of a stall.


*quality

@ghark
@notarobot

I recall news reporting just prior to military intervention in Libya was suggesting that Gaddafi's forces were approaching Benghazi and there were expectations of massacre if they were to reach it.

Wikipedia for what it's worth:

http://en.wikipedia.org/wiki/2011_military_intervention_in_Libya

"9 March 2011: The head of the Libyan National Transitional Council, Mustafa Abdul Jalil, "pleaded for the international community to move quickly to impose a no-fly zone over Libya, declaring that any delay would result in more casualties".[38] Three days later, he stated that if pro-Gaddafi forces reached Benghazi, then they would kill "half a million" people. He stated, "If there is no no-fly zone imposed on Gaddafi's regime, and his ships are not checked, we will have a catastrophe in Libya."[39]"

"17 March 2011: The UN Security Council, acting under the authority of Chapter VII of the UN Charter, approved a no-fly zone by a vote of ten in favour, zero against, and five abstentions, via United Nations Security Council Resolution 1973. The five abstentions were: Brazil, Russia, India, China, and Germany.[49][50][51][60][61] Less than twenty-four hours later, Libya announced that it would halt all military operations in response to the UN Security Council resolution.[62][63]"

To me it's one or the other...either it's justifiable violence or it's crazy to think it's justifiable violence. To me, using violence to answer an obvious accident is just plain crazy.
I watched in full screen and could not see the head touch ground, and never once noticed the child putting it's hands up to it's head, which would be the normal reaction if it's head were hurt. I mentioned it was not bleeding to indicate there didn't seem to be even a superficial skin wound, not to indicate that no blood means no injury.
Well, I indicated race because they were of different races, and sex because they were different sexes, and age because they were different ages, and for some reason it seems you expected different levels of responsibility from them. Perhaps it was not for any of these reasons, but I think they all come into play in your apparent theory that have differing levels of responsibility for their own actions, certainly sex seems to for most people.
Somehow my first post in this thread disappeared, I explained there that I thought they had about a 60/40 split with the larger responsibility going to the adult skater because NEITHER was looking where they were going, perhaps even 70/30. My point is that the child was not looking where it was running either, and was not being supervised by anyone that was watching out either, and it bears SOME responsibility. It could just as easily been hit by a bicycle that likely would have had every right to be there the way it ran diagonally across the open area, and I feel the reaction would have been identical.
I am not surprised that the law is different in many places. In many states, if someone assaults you and you have something in your hands, you may use it to defend yourself. It wouldn't be 'bringing in a weapon' because you had it in hand when attacked. If you pick something up, it would likely be different. In almost every state, if the attacker is still moving towards you (as she was at the end) you may use whatever force needed to stop the attack. In some states, it seems you may arm yourself before being touched and use deadly force to stop the advance if you fear attack. Once the attack/advance is halted, I think that all changes almost everywhere.
On a moral basis, my feeling is if they sucker punch you in the face, you should get one free shot back at them, even if they turn and run. I'm not sexist or ageist and try to not be racist, so none of those things should enter into who hit who.
edit: and you are correct, I just guessed the skater was white based on his appearance, accent, and the fact that he's skating. I may well be wrong about that (and many other things).

The officer needs to be charged and convicted of perjury.
All police involved need an official complaint on their permanent record to halt any advancement in their career, one from the judge would be GREAT! I'm just guessing, but I bet if they skip the next court date, they'll all have a warrant out for their arrest, how great would that be!
I'm just sad he could only sue for $2000, I think treble damages is warranted in this situation, and it should come out of the officers pay/pension.

I think the point is that it's not just water from a hose. Title says isn't after an f-16 crash. That could mean anything from a fireball exploding into a million pieces and needing putting out to a gear up landing where it skidded to a halt with no other issues. The latter wouldn't need water praying around but would need fire crews to be attending and suited up for a long time. I get the impression it's something like the latter and the water is all sweat.

Nice.

☝☝☝
Rational eh?

Criminals polluting the world's food production and distribution with a cadre of lawmakers and lawyers poised to give the beast a free-pass for the foreseeable future?

In March of this year, complicit cunt Obama signed H.R. 933, ‘Consolidated and Further Continuing Appropriations Act, 2013’-Missouri Senator Joe Blunt (R) worked with Monsanto to craft the language of a 78-page section of the bill which effectively protects biotech companies from judicial scrutiny should any notable public health risks arise as the result of GMOs. -IB Times’ Connor Sheets adds, “choosing to sign a bill that effectively bars federal courts from being able to halt the sale or planting of GMO or GE crops and seeds, no matter what health consequences from the consumption of these products may come to light in the future.”

Their army of lawyers-as formidable as any of Walmart's punk-ass legal teams, work constantly to keep information out of the public scrutiny while cementing the future experimentation on humans with their tweaks to the staple food sources of the planet's food. Over-reacting??

How does one "rationally oppose" the calculated acts of criminals who not only make the laws, but stack the odds in their favor by buying those who mold the legal system in their favor?

Go educate yourself. Perhaps start with a short list of GMO crops used in just about everything??
http://www.disabled-world.com/fitness/gm-foods.php

Then check out the cases Monsanto has brought to trial against a never-ending list of farmers who have tried to take on the beast when their livelihoods were destroyed by opening their mouths....

Anyone with common-sense and a worthless high-school diploma who hasn't been drinking the Kool-Aid their entire lives should be able to see that the fucking emperor is clothed in a human flesh tuxedo....

There are things that are not accepted by all but that just have to be tolerated as the alternatives are way worse. On abortion that means providing access to safe abortion cause if you don't, theyäll happen anyway.. And what then.. when a mother dies from illegal abortion, doesn't that mean we lost two lives instead of one. Personally don't consider fetus living, i'm teetering on whther it's the amount of brain capacity, heart pumping or is it simply the point when a child can be brought out of womb and it has some level of survivability, i don't know. That is not the point.

One things that is not discussed here is THE point of her talk: prevent the unwanted pregnancies in the first place. That doesn't mean abstinence but condoms, pills, counseling, info and abstinence (i do believe that not all youngsters should be having sex, abstinence is the BEST choice for those early year, no doubt in that. But instead of giving all single people, young, old or between, only ONE choice, and if that fails you have failed your life, why not give them access to the second best and so on.. Religion....

Keep religion out of this and just look at things in neutral manner. Some don't like gay sex but have no problem with gay marriage, just like some don't like carrots but have no problem other eating it.Banning either will not make them go away, if carrots were made illegal, people would still eat and grow them. So get out of that shell and try to look the big picture, ten try to look at things from the perspective of people who are actually going thru with it (most pro-lifers never had to do abortion, they have no clue on what's going on that persons head who makes such a choice; they have zero sympathy and are essentially sociopaths when dealing with this issue. No understanding, no caring, just pure judgement..

Plus human society has changed, we live healthier lives and longer so it only makes sense to have some variety when people want to procreate. The best possible time, place, resources, partner.. when all that falls in place wouldn't you think that is the best time to bring new people in? Not when your time is spent trying to gather those things, having a kid then might just slow that progress to a halt and we have yet another generation living in poverty and diminished options in life (we are talking USA here, where you have very limited social mobility, basically the more equal society, the less there are reasons for abortions... Most abortion occur simply because the mother can not provide a good life to a new human. More equal societies tend to take care of the societys main building blocks a lot better.

Sigh, its not a federal courts job to stop health issues in food, its the FDA. The EPA is responsible for any environmental problems they cause. This really does nothing.

Edit: also federal courts can't halt sale, they can be sued for damages if they make a seed that hurts you.

Discarded posts don't show up in the front page listing. I will have to make siftbot halt if you try to quality a discard posts.

I'm going to make a special exception and manually make this queued so it will show up.

Entropy is a son of a bitch.......and so are the people trying to sell this as something other than what it is, garbage.

If this was real, you would expect to see this engine accelerate uncontrollably.
Instead, it reaches a peak speed and stops accelerating. This speed will be determined by the potential energy given to the rotating wheel, from the distance drop of the magnet.

Once it reaches the fastest that potential energy can push it, the system reaches equilibrium. If you try and take the slightest bit of energy out of this system, it will grind to a halt.

http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=all

One October afternoon three years ago while I was visiting my parents, my mother made a request I dreaded and longed to fulfill. She had just poured me a cup of Earl Grey from her Japanese iron teapot, shaped like a little pumpkin; outside, two cardinals splashed in the birdbath in the weak Connecticut sunlight. Her white hair was gathered at the nape of her neck, and her voice was low. “Please help me get Jeff’s pacemaker turned off,” she said, using my father’s first name. I nodded, and my heart knocked.
Related

Upstairs, my 85-year-old father, Jeffrey, a retired Wesleyan University professor who suffered from dementia, lay napping in what was once their shared bedroom. Sewn into a hump of skin and muscle below his right clavicle was the pacemaker that helped his heart outlive his brain. The size of a pocket watch, it had kept his heart beating rhythmically for nearly five years. Its battery was expected to last five more.

After tea, I knew, my mother would help him from his narrow bed with its mattress encased in waterproof plastic. She would take him to the toilet, change his diaper and lead him tottering to the couch, where he would sit mutely for hours, pretending to read Joyce Carol Oates, the book falling in his lap as he stared out the window.

I don’t like describing what dementia did to my father — and indirectly to my mother — without telling you first that my parents loved each other, and I loved them. That my mother, Valerie, could stain a deck and sew an evening dress from a photo in Vogue and thought of my father as her best friend. That my father had never given up easily on anything.

Born in South Africa, he lost his left arm in World War II, but built floor-to-ceiling bookcases for our living room; earned a Ph.D. from Oxford; coached rugby; and with my two brothers as crew, sailed his beloved Rhodes 19 on Long Island Sound. When I was a child, he woke me, chortling, with his gloss on a verse from “The Rubaiyat of Omar Khayyam”: “Awake, my little one! Before life’s liquor in its cup be dry!” At bedtime he tucked me in, quoting “Hamlet” : “May flights of angels sing thee to thy rest!”

Now I would look at him and think of Anton Chekhov, who died of tuberculosis in 1904. “Whenever there is someone in a family who has long been ill, and hopelessly ill,” he wrote, “there come painful moments when all timidly, secretly, at the bottom of their hearts long for his death.” A century later, my mother and I had come to long for the machine in my father’s chest to fail.

Until 2001, my two brothers and I — all living in California — assumed that our parents would enjoy long, robust old ages capped by some brief, undefined final illness. Thanks to their own healthful habits and a panoply of medical advances — vaccines, antibiotics, airport defibrillators, 911 networks and the like — they weren’t likely to die prematurely of the pneumonias, influenzas and heart attacks that decimated previous generations. They walked every day. My mother practiced yoga. My father was writing a history of his birthplace, a small South African town.

In short, they were seemingly among the lucky ones for whom the American medical system, despite its fragmentation, inequity and waste, works quite well. Medicare and supplemental insurance paid for their specialists and their trusted Middletown internist, the lean, bespectacled Robert Fales, who, like them, was skeptical of medical overdoing. “I bonded with your parents, and you don’t bond with everybody,” he once told me. “It’s easier to understand someone if they just tell it like it is from their heart and their soul.”

They were also stoics and religious agnostics. They signed living wills and durable power-of-attorney documents for health care. My mother, who watched friends die slowly of cancer, had an underlined copy of the Hemlock Society’s “Final Exit” in her bookcase. Even so, I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims.

Things took their first unexpected turn on Nov. 13, 2001, when my father — then 79, pacemakerless and seemingly healthy — collapsed on my parents’ kitchen floor in Middletown, making burbling sounds. He had suffered a stroke.

He came home six weeks later permanently incapable of completing a sentence. But as I’ve said, he didn’t give up easily, and he doggedly learned again how to fasten his belt; to peck out sentences on his computer; to walk alone, one foot dragging, to the university pool for water aerobics. He never again put on a shirt without help or looked at the book he had been writing. One day he haltingly told my mother, “I don’t know who I am anymore.”

His stroke devastated two lives. The day before, my mother was an upper-middle-class housewife who practiced calligraphy in her spare time. Afterward, she was one of tens of millions of people in America, most of them women, who help care for an older family member.

Their numbers grow each day. Thanks to advanced medical technologies, elderly people now survive repeated health crises that once killed them, and so the “oldest old” have become the nation’s most rapidly growing age group. Nearly a third of Americans over 85 have dementia (a condition whose prevalence rises in direct relationship to longevity). Half need help with at least one practical, life-sustaining activity, like getting dressed or making breakfast. Even though a capable woman was hired to give my dad showers, my 77-year-old mother found herself on duty more than 80 hours a week. Her blood pressure rose and her weight fell. On a routine visit to Dr. Fales, she burst into tears. She was put on sleeping pills and antidepressants.

My father said he came to believe that she would have been better off if he had died. “She’d have weeped the weep of a widow,” he told me in his garbled, poststroke speech, on a walk we took together in the fall of 2002. “And then she would have been all right.” It was hard to tell which of them was suffering more.

As we shuffled through the fallen leaves that day, I thought of my father’s father, Ernest Butler. He was 79 when he died in 1965, before pacemakers, implanted cardiac defibrillators, stents and replacement heart valves routinely staved off death among the very old. After completing some long-unfinished chairs, he cleaned his woodshop, had a heart attack and died two days later in a plain hospital bed. As I held my dad’s soft, mottled hand, I vainly wished him a similar merciful death.

A few days before Christmas that year, after a vigorous session of water exercises, my father developed a painful inguinal (intestinal) hernia. My mother took him to Fales, who sent them to a local surgeon, who sent them to a cardiologist for a preoperative clearance. After an electrocardiogram recorded my father’s slow heartbeat — a longstanding and symptomless condition not uncommon in the very old — the cardiologist, John Rogan, refused to clear my dad for surgery unless he received a pacemaker.

Without the device, Dr. Rogan told me later, my father could have died from cardiac arrest during surgery or perhaps within a few months. It was the second time Rogan had seen my father. The first time, about a year before, he recommended the device for the same slow heartbeat. That time, my then-competent and prestroke father expressed extreme reluctance, on the advice of Fales, who considered it overtreatment.

My father’s medical conservatism, I have since learned, is not unusual. According to an analysis by the Dartmouth Atlas medical-research group, patients are far more likely than their doctors to reject aggressive treatments when fully informed of pros, cons and alternatives — information, one study suggests, that nearly half of patients say they don’t get. And although many doctors assume that people want to extend their lives, many do not. In a 1997 study in The Journal of the American Geriatrics Society, 30 percent of seriously ill people surveyed in a hospital said they would “rather die” than live permanently in a nursing home. In a 2008 study in The Journal of the American College of Cardiology, 28 percent of patients with advanced heart failure said they would trade one day of excellent health for another two years in their current state.

When Rogan suggested the pacemaker for the second time, my father was too stroke-damaged to discuss, and perhaps even to weigh, his trade­offs. The decision fell to my mother — anxious to relieve my father’s pain, exhausted with caregiving, deferential to doctors and no expert on high-tech medicine. She said yes. One of the most important medical decisions of my father’s life was over in minutes. Dr. Fales was notified by fax.

Fales loved my parents, knew their suffering close at hand, continued to oppose a pacemaker and wasn’t alarmed by death. If he had had the chance to sit down with my parents, he could have explained that the pacemaker’s battery would last 10 years and asked whether my father wanted to live to be 89 in his nearly mute and dependent state. He could have discussed the option of using a temporary external pacemaker that, I later learned, could have seen my dad safely through surgery. But my mother never consulted Fales. And the system would have effectively penalized him if she had. Medicare would have paid him a standard office-visit rate of $54 for what would undoubtedly have been a long meeting — and nothing for phone calls to work out a plan with Rogan and the surgeon.

Medicare has made minor improvements since then, and in the House version of the health care reform bill debated last year, much better payments for such conversations were included. But after the provision was distorted as reimbursement for “death panels,” it was dropped. In my father’s case, there was only a brief informed-consent process, covering the boilerplate risks of minor surgery, handled by the general surgeon.

I believe that my father’s doctors did their best within a compartmentalized and time-pressured medical system. But in the absence of any other guiding hand, there is no doubt that economics helped shape the wider context in which doctors made decisions. Had we been at the Mayo Clinic — where doctors are salaried, medical records are electronically organized and care is coordinated by a single doctor — things might have turned out differently. But Middletown is part of the fee-for-service medical economy. Doctors peddle their wares on a piecework basis; communication among them is haphazard; thinking is often short term; nobody makes money when medical interventions are declined; and nobody is in charge except the marketplace.

And so on Jan. 2, 2003, at Middlesex Hospital, the surgeon implanted my father’s pacemaker using local anesthetic. Medicare paid him $461 and the hospital a flat fee of about $12,000, of which an estimated $7,500 went to St. Jude Medical, the maker of the device. The hernia was fixed a few days later.

It was a case study in what primary-care doctors have long bemoaned: that Medicare rewards doctors far better for doing procedures than for assessing whether they should be done at all. The incentives for overtreatment continue, said Dr. Ted Epperly, the board chairman of the American Academy of Family Physicians, because those who profit from them — specialists, hospitals, drug companies and the medical-device manufacturers — spend money lobbying Congress and the public to keep it that way.

Last year, doctors, hospitals, drug companies, medical-equipment manufacturers and other medical professionals spent $545 million on lobbying, according to the Center for Responsive Politics. This may help explain why researchers estimate that 20 to 30 percent of Medicare’s $510 billion budget goes for unnecessary tests and treatment. Why cost-containment received short shrift in health care reform. Why physicians like Fales net an average of $173,000 a year, while noninvasive cardiologists like Rogan net about $419,000.

The system rewarded nobody for saying “no” or even “wait” — not even my frugal, intelligent, Consumer-Reports-reading mother. Medicare and supplemental insurance covered almost every penny of my father’s pacemaker. My mother was given more government-mandated consumer information when she bought a new Camry a year later.

And so my father’s electronically managed heart — now requiring frequent monitoring, paid by Medicare — became part of the $24 billion worldwide cardiac-device industry and an indirect subsidizer of the fiscal health of American hospitals. The profit margins that manufacturers earn on cardiac devices is close to 30 percent. Cardiac procedures and diagnostics generate about 20 percent of hospital revenues and 30 percent of profits.

Shortly after New Year’s 2003, my mother belatedly called and told me about the operations, which went off without a hitch. She didn’t call earlier, she said, because she didn’t want to worry me. My heart sank, but I said nothing. It is one thing to silently hope that your beloved father’s heart might fail. It is another to actively abet his death.

The pacemaker bought my parents two years of limbo, two of purgatory and two of hell. At first they soldiered on, with my father no better and no worse. My mother reread Jon Kabat-Zinn’s “Full Catastrophe Living,” bought a self-help book on patience and rose each morning to meditate.

In 2005, the age-related degeneration that had slowed my father’s heart attacked his eyes, lungs, bladder and bowels. Clots as narrow as a single human hair lodged in tiny blood vessels in his brain, killing clusters of neurons by depriving them of oxygen. Long partly deaf, he began losing his sight to wet macular degeneration, requiring ocular injections that cost nearly $2,000 each. A few months later, he forgot his way home from the university pool. He grew incontinent. He was collapsing physically, like an ancient, shored-up house.

In the summer of 2006, he fell in the driveway and suffered a brain hemorrhage. Not long afterward, he spent a full weekend compulsively brushing and rebrushing his teeth. “The Jeff I married . . . is no longer the same person,” my mother wrote in the journal a social worker had suggested she keep. “My life is in ruins. This is horrible, and I have lasted for five years.” His pacemaker kept on ticking.

When bioethicists debate life-extending technologies, the effects on people like my mother rarely enter the calculus. But a 2007 Ohio State University study of the DNA of family caregivers of people with Alzheimer’s disease showed that the ends of their chromosomes, called telomeres, had degraded enough to reflect a four-to-eight-year shortening of lifespan. By that reckoning, every year that the pacemaker gave my irreparably damaged father took from my then-vigorous mother an equal year.

When my mother was upset, she meditated or cleaned house. When I was upset, I Googled. In 2006, I discovered that pacemakers could be deactivated without surgery. Nurses, doctors and even device salesmen had done so, usually at deathbeds. A white ceramic device, like a TV remote and shaped like the wands that children use to blow bubbles, could be placed around the hump on my father’s chest. Press a few buttons and the electrical pulses that ran down the leads to his heart would slow until they were no longer effective. My father’s heart, I learned, would probably not stop. It would just return to its old, slow rhythm. If he was lucky, he might suffer cardiac arrest and die within weeks, perhaps in his sleep. If he was unlucky, he might linger painfully for months while his lagging heart failed to suffuse his vital organs with sufficient oxygenated blood.

If we did nothing, his pacemaker would not stop for years. Like the tireless charmed brooms in Disney’s “Fantasia,” it would prompt my father’s heart to beat after he became too demented to speak, sit up or eat. It would keep his heart pulsing after he drew his last breath. If he was buried, it would send signals to his dead heart in the coffin. If he was cremated, it would have to be cut from his chest first, to prevent it from exploding and damaging the walls or hurting an attendant.

On the Internet, I discovered that the pacemaker — somewhat like the ventilator, defibrillator and feeding tube — was first an exotic, stopgap device, used to carry a handful of patients through a brief medical crisis. Then it morphed into a battery-powered, implantable and routine treatment. When Medicare approved the pacemaker for reimbursement in 1966, the market exploded. Today pacemakers are implanted annually in more than 400,000 Americans, about 80 percent of whom are over 65. According to calculations by the Dartmouth Atlas research group using Medicare data, nearly a fifth of new recipients who receive pacemakers annually — 76,000 — are over 80. The typical patient with a cardiac device today is an elderly person suffering from at least one other severe chronic illness.

Over the years, as technology has improved, the battery life of these devices lengthened. The list of heart conditions for which they are recommended has grown. In 1984, the treatment guidelines from the American College of Cardiology declared that pacemakers were strongly recommended as “indicated” or mildly approved as “reasonable” for 56 heart conditions and “not indicated” for 31 more. By 2008, the list for which they were strongly or mildly recommended expanded to 88, with most of the increase in the lukewarm “reasonable” category.

The research backing the expansion of diagnoses was weak. Over all, only 5 percent of the positive recommendations were supported by research from multiple double-blind randomized studies, the gold standard of evidence-based medicine. And 58 percent were based on no studies at all, only a “consensus of expert opinion.” Of the 17 cardiologists who wrote the 2008 guidelines, 11 received financing from cardiac-device makers or worked at institutions receiving it. Seven, due to the extent of their financial connections, were recused from voting on the guidelines they helped write.

This pattern — a paucity of scientific support and a plethora of industry connections — holds across almost all cardiac treatments, according to the cardiologist Pierluigi Tricoci of Duke University’s Clinical Research Institute. Last year in The Journal of the American Medical Association, Tricoci and his co-authors wrote that only 11 percent of 2,700 widely used cardiac-treatment guidelines were based on that gold standard. Most were based only on expert opinion.

Experts are as vulnerable to conflicts of interest as researchers are, the authors warned, because “expert clinicians are also those who are likely to receive honoraria, speakers bureau [fees], consulting fees or research support from industry.” They called the current cardiac-research agenda “strongly influenced by industry’s natural desire to introduce new products.”

Perhaps it’s no surprise that I also discovered others puzzling over cardiologists who recommended pacemakers for relatives with advanced dementia. “78-year-old mother-in-law has dementia; severe short-term memory issues,” read an Internet post by “soninlaw” on Elderhope.com, a caregivers’ site, in 2007. “On a routine trip to her cardiologist, doctor decides she needs a pacemaker. . . . Anyone have a similar encounter?”

By the summer of 2007, my dad had forgotten the purpose of a dinner napkin and had to be coached to remove his slippers before he tried to put on his shoes. After a lifetime of promoting my father’s health, my mother reversed course. On a routine visit, she asked Rogan to deactivate the pacemaker. “It was hard,” she later told me. “I was doing for Jeff what I would have wanted Jeff to do for me.” Rogan soon made it clear he was morally opposed. “It would have been like putting a pillow over your father’s head,” he later told me.

Not long afterward, my mother declined additional medical tests and refused to put my father on a new anti-dementia drug and a blood thinner with troublesome side effects. “I take responsibility for whatever,” she wrote in her journal that summer. “Enough of all this overkill! It’s killing me! Talk about quality of life — what about mine?”

Then came the autumn day when she asked for my help, and I said yes. I told myself that we were simply trying to undo a terrible medical mistake. I reminded myself that my dad had rejected a pacemaker when his faculties were intact. I imagined, as a bioethicist had suggested, having a 15-minute conversation with my independent, predementia father in which I saw him shaking his head in horror over any further extension of what was not a “life,” but a prolonged and attenuated dying. None of it helped. I knew that once he died, I would dream of him and miss his mute, loving smiles. I wanted to melt into the arms of the father I once had and ask him to handle this. Instead, I felt as if I were signing on as his executioner and that I had no choice.

Over the next five months, my mother and I learned many things. We were told, by the Hemlock Society’s successor, Compassion and Choices, that as my father’s medical proxy, my mother had the legal right to ask for the withdrawal of any treatment and that the pacemaker was, in theory at least, a form of medical treatment. We learned that although my father’s living will requested no life support if he were comatose or dying, it said nothing about dementia and did not define a pacemaker as life support. We learned that if we called 911, emergency medical technicians would not honor my father’s do-not-resuscitate order unless he wore a state-issued orange hospital bracelet. We also learned that no cardiology association had given its members clear guidance on when, or whether, deactivating pacemakers was ethical.

(Last month that changed. The Heart Rhythm Society and the American Heart Association issued guidelines declaring that patients or their legal surrogates have the moral and legal right to request the withdrawal of any medical treatment, including an implanted cardiac device. It said that deactivating a pacemaker was neither euthanasia nor assisted suicide, and that a doctor could not be compelled to do so in violation of his moral values. In such cases, it continued, doctors “cannot abandon the patient but should involve a colleague who is willing to carry out the procedure.” This came, of course, too late for us.)

In the spring of 2008, things got even worse. My father took to roaring like a lion at his caregivers. At home in California, I searched the Internet for a sympathetic cardiologist and a caregiver to put my Dad to bed at night. My frayed mother began to shout at him, and their nighttime scenes were heartbreaking and frightening. An Alzheimer’s Association support-group leader suggested that my brothers and I fly out together and institutionalize my father. This leader did not know my mother’s formidable will and had never heard her speak about her wedding vows or her love.

Meanwhile my father drifted into what nurses call “the dwindles”: not sick enough to qualify for hospice care, but sick enough to never get better. He fell repeatedly at night and my mother could not pick him up. Finally, he was weak enough to qualify for palliative care, and a team of nurses and social workers visited the house. His chest grew wheezy. My mother did not request antibiotics. In mid-April 2008, he was taken by ambulance to Middlesex Hospital’s hospice wing, suffering from pneumonia.

Pneumonia was once called “the old man’s friend” for its promise of an easy death. That’s not what I saw when I flew in. On morphine, unreachable, his eyes shut, my beloved father was breathing as hard and regularly as a machine.

My mother sat holding his hand, weeping and begging for forgiveness for her impatience. She sat by him in agony. She beseeched his doctors and nurses to increase his morphine dose and to turn off the pacemaker. It was a weekend, and the doctor on call at Rogan’s cardiology practice refused authorization, saying that my father “might die immediately.” And so came five days of hard labor. My mother and I stayed by him in shifts, while his breathing became increasingly ragged and his feet slowly started to turn blue. I began drafting an appeal to the hospital ethics committee. My brothers flew in.

On a Tuesday afternoon, with my mother at his side, my father stopped breathing. A hospice nurse hung a blue light on the outside of his hospital door. Inside his chest, his pacemaker was still quietly pulsing.

After his memorial service in the Wesleyan University chapel, I carried a box from the crematory into the woods of an old convent where he and I often walked. It was late April, overcast and cold. By the side of a stream, I opened the box, scooped out a handful of ashes and threw them into the swirling water. There were some curious spiraled metal wires, perhaps the leads of his pacemaker, mixed with the white dust and pieces of bone.

A year later, I took my mother to meet a heart surgeon in a windowless treatment room at Brigham and Women’s Hospital in Boston. She was 84, with two leaking heart valves. Her cardiologist had recommended open-heart surgery, and I was hoping to find a less invasive approach. When the surgeon asked us why we were there, my mother said, “To ask questions.” She was no longer a trusting and deferential patient. Like me, she no longer saw doctors — perhaps with the exception of Fales — as healers or her fiduciaries. They were now skilled technicians with their own agendas. But I couldn’t help feeling that something precious — our old faith in a doctor’s calling, perhaps, or in a healing that is more than a financial transaction or a reflexive fixing of broken parts — had been lost.

The surgeon was forthright: without open-heart surgery, there was a 50-50 chance my mother would die within two years. If she survived the operation, she would probably live to be 90. And the risks? He shrugged. Months of recovery. A 5 percent chance of stroke. Some possibility, he acknowledged at my prompting, of postoperative cognitive decline. (More than half of heart-bypass patients suffer at least a 20 percent reduction in mental function.) My mother lifted her trouser leg to reveal an anklet of orange plastic: her do-not-resuscitate bracelet. The doctor recoiled. No, he would not operate with that bracelet in place. It would not be fair to his team. She would be revived if she collapsed. “If I have a stroke,” my mother said, nearly in tears, “I want you to let me go.” What about a minor stroke, he said — a little weakness on one side?

I kept my mouth shut. I was there to get her the information she needed and to support whatever decision she made. If she emerged from surgery intellectually damaged, I would bring her to a nursing home in California and try to care for her the way she had cared for my father at such cost to her own health. The thought terrified me.

The doctor sent her up a floor for an echocardiogram. A half-hour later, my mother came back to the waiting room and put on her black coat. “No,” she said brightly, with the clarity of purpose she had shown when she asked me to have the pacemaker deactivated. “I will not do it.”

She spent the spring and summer arranging house repairs, thinning out my father’s bookcases and throwing out the files he collected so lovingly for the book he never finished writing. She told someone that she didn’t want to leave a mess for her kids. Her chest pain worsened, and her breathlessness grew severe. “I’m aching to garden,” she wrote in her journal. “But so it goes. ACCEPT ACCEPT ACCEPT.”

Last August, she had a heart attack and returned home under hospice care. One evening a month later, another heart attack. One of my brothers followed her ambulance to the hospice wing where we had sat for days by my father’s bed. The next morning, she took off her silver earrings and told the nurses she wanted to stop eating and drinking, that she wanted to die and never go home. Death came to her an hour later, while my brother was on the phone to me in California — almost as mercifully as it had come to my paternal grandfather. She was continent and lucid to her end.

A week later, at the same crematory near Long Island Sound, my brothers and I watched through a plate-glass window as a cardboard box containing her body, dressed in a scarlet silk ao dai she had sewn herself, slid into the flames. The next day, the undertaker delivered a plastic box to the house where, for 45 of their 61 years together, my parents had loved and looked after each other, humanly and imperfectly. There were no bits of metal mixed with the fine white powder and the small pieces of her bones.

Katy Butler lives in Mill Valley, Calif., and teaches memoir writing at the Esalen Institute in Big Sur.

I'm far from saying don't get involved; only that appealing to government through existing democratic channels is not going to change much. "Please change your ways, pretty please" isn't going to cut it any more.

This isn't a war between the rich and the poor; it's a war between man and the virtual machine we insist on running. It isn't a conspiracy controlled by the few, it's en emergent behaviour perpetuated by the many.

There are those who are more guilty than the rest - where most of us are pedalling the wheels, they are actively strapping on rocket engines for their own gain; but targeting the rich will only get us so far.

If you look at different subjects - genetics, game theory and economics you can see from all of them that a population or economy will always carry the selfish. No more than the population will tolerate, and no less than they will suffer.

I believe we should accept that, and not focus on futile attempts at eliminating the selfish, but at the more realistic task of reducing the opportunity for corruption by them.

We are all responsible.

Each and every one of us that works for, or works with a corporation is contributing to the problem. It's a nonsensical system and it's ripe for corruption, yet we do it to ourselves.

Imagine a mechanical godzilla tearing through a city, causing death and mayhem; crushing schools, burning homes and squashing people in it's path; the city dwellers fleeing and screaming in terror. Imagine that monster of destruction suddenly grinding to a halt; foot steps are heard, a door cranks open.

Who steps out? Is it Mitt Romney? No it's your neighbour Larry; he's clocking off and now it's your shift.>> ^packo:

if you stand back and say "I don't get involved, politics are too dirty"... you are failing yourself, your future, your children, your children's future, your country, and your country's future... you are the OPPOSITE of patriotic, and can only consider yourself a citizen in the form of the burden you place upon others