A View Of The DOMA Decision

Dalai's Note: A close friend of mine, who happens to be gay and in a committed relationship, sent me this note on the recent Supreme Court decisions. I couldn't have said it better myself:

I think DOMA was a bad law and needed to go, but I am not fond of the concept of "gay marriage'. I think it's a bottom up solution for a problem that needs to be considered from the top down.

They are seeking marriage as a way to participate in the same "civil" benefits. Marriage, to me, is a religious concept and belongs to the churches/synagogues... and I won't get into the historical ownership of women that it was at one time.

What I would prefer is a complete disengagement of civil and corporate benefits from the religious concept of "marriage'. I don't think anyone should "benefit" in a civil/corporate sense, because they are in any particular type of relationship.

Our current "benefits" system is predicated on the older notions that women did not work, and were therefore "dependent". Thus health insurance, VA/military and social security benefits, you name it, etc, were set up with the idea of "taking care of the woman". We tried to equalize it for both men and women, as women entered the workplace, but the term "spouse", is the root of the problem. This set up established the notion that there had to be some sort of real or perceived sexual relationship between two people in order to purchase a product (such as insurance), or direct a benefit.

Beyond my death, I can utilize a will as an instrument to direct my property, my home and my money to anyone I choose, even my dog, if I wanted to. We ought to be able to do that in life. For anyone, for any reason. It should not be that different.

I think we would all be better off with the concept of Reciprocal Beneficiary. If I want to buy insurance for my partner, my brother, or my friend, or my Aunt Gertrude, all that should be required is that I name them as "reciprocal beneficiary", and pay the required/established cost. I shouldn't have to have a "marriage" license to purchase a product. If I want to direct benefits of any sort, to anyone, all that should be required is a contract/power of attorney or some power already inherent in the concept of Reciprocal Beneficiary, to be utilized as the appropriate legal instrument.

The government has no business moderating the personal lives of anyone. Nor should any corporation care what anyone's relationship status may be. (i.e. health insurance)

I think this would give everyone, on both sides of the issue, what they want, without the added perceived threat to those that are more conservative, that society is "falling apart". I think we are setting up a slippery slope and setting an uncomfortable precedent. Furthermore, I do not think citizenship should be so easily conferred upon someone just because they sign a paper and get married at the courthouse, as an example of civil benefit.

Instead of equalizing the opportunity for citizenship in this manner for homosexual partners via “gay marriage”, I think it should be eliminated completely, for all.

DOMA never considered Eastern European mail order brides as a threat to traditional marriage... Perhaps it should have. I do. Or rather, I consider it opening your bedroom door to the government.

I have heard of instances of government overreach in these types of cases where some government official recognizes that a particular marriage is one of convenience and orders it nullified. By what criteria did they make that decision? Lack of sexual relations? Time spent together? How was the determination made, that it was “merely” a marriage created simply for the benefits conferred, or if the couple, was truly in love? A bureaucrat decided this? Who’s to say?

Do we really want the government deciding how much love it takes to make a marriage? Who will decide for you that your personal relationship with someone is real vs. sham? Do we really want this?

I do not believe that the government should inhibit, discriminate against, nor protect or promote any particular class of citizen, any longer.

There are many churches or synagogues that will or were already performing marriage ceremonies for gay and lesbian couples if they are truly seeking consecration in a more liturgical or social sense. It is a nice thing. That isn't at issue, really. I can appreciate the notion of standing before your friends and family and making that commitment. It has social and cultural value. However, I fully support the religious institutions' rights to decide for themselves who they will and won't bond in whatever they consider to be sacred and holy matrimony.

I actually think the definition of marriage, or the defining attributes changed about 150 years or so ago. Marrying for love was not a common concept. Marriage was about alliances, politics, ownership and children. Only recently do most folks see it is a personal, loving commitment in any way. How many wives did some folks in the old testament have?

I firmly believe that everyone, and I mean EVERYONE, should have equal rights. My problem with the whole campaign, beyond my assumption that some have an agenda beyond simple equality, is that it attempts to change a definition (marriage = one man + one woman) that has been with us for thousands of years. A matter of syntax, really. But we cannot and we must not discriminate. Period. If there is some religious price to pay, that is between the individual and G-d. I'm not perfect, either, as Mrs. Dalai constantly reminds me.

And that's all I have to say about that.

Nuclear Death

A very sad tale from the Wall Street Journal:

Equipment Collapses, Killing Patient

By TAMER EL-GHOBASHY and CHRISTOPHER WEAVERA patient at a veteran's hospital in the Bronx was killed Wednesday when a large piece of diagnostic equipment fell on him in what experts called a rare accident.

The 66-year-old victim was undergoing a procedure using a gamma camera at the James J. Peters VA Medical Center when the apparatus apparently collapsed and crushed him, officials said.

In a statement, a spokesman for the medical center said the camera was installed in 2006 and was maintained by its manufacturer. "This is a very tragic and unusual event and the details are still unfolding," said Jim Connell, a hospital spokesman.

He declined to identify the patient, citing privacy laws.

According to the New York Fire Department, a 911 call for an ambulance came from the hospital on West Kingsbridge Road at about 12:30 p.m. on Wednesday, but was quickly called off. A spokeswoman for the New York City Medical Examiner said an autopsy hadn't yet been completed and that the victim hasn't been formally identified by next of kin.

An official with knowledge of the matter said the camera was a Infinia Hawkeye 4 model, manufactured by General Electric Co. The Hawkeye line is one of the largest on the market and can weigh more than 5,000 pounds.

Mr. Connell said the camera had been used in diagnostic procedures "without incident."

"Our first concern is for our veteran patient and for their family," Mr. Connell said in the statement. " We are in the midst of conducting an investigation and when we have a conclusive report, we will provide more information."

GE Healthcare learned of the incident from the VA, and a company "team has responded and is supporting the ongoing investigation," said Benjamin Fox, a GE spokesman. He didn't respond to questions about whether the company had seen similar failures elsewhere.

Nuclear-medicine physicians use gamma cameras to scan organs such as the lungs and kidneys, and other tissue deep in the body. Doctors inject patients with radioactive fluids; the gamma camera tracks the location of those drugs within the anatomy by collecting radiation they emit from inside the body. By contrast, X-rays fire radiation at the body from the outside to create images. Virtually all major hospitals use gamma cameras, which are a staple of nuclear medicine departments, said Jamie Dildy, an analyst for MD Buyline, a health-care equipment and technology research firm. New models, manufactured by the health-care units of Siemens AG, General Electric and Philips Electronics NV, typically cost between $300,000 and $800,000, she said.

Gamma cameras, which have been in use since the 1960s, consist of large panels of crystal that convert the rays to light. The rest of the device takes a digital picture of the light, not unlike a traditional camera.

The panels, which are often designed to rotate around a prone patient, are generally insulated with thick layers of lead that focus the gamma rays. They weigh "hundreds and hundreds of pounds," said William Spies, a professor of radiology at Northwestern University Feinberg School of Medicine.

But accidents are unusual. "I've been doing nuclear medicine since 1974," Dr. Spies said. "I remember one other incident where a gamma camera fell on a patient." Even that was a long time ago, he said.

I certainly send my condolences to the family of the victim.

I haven't seen any photos of the actual accident site, but here is GE's stock photo of the Infinia Hawkeye 4:

I'm wondering just what they mean by "collapsed"...did one of the acquisition heads work loose from its mountings and fall? Was there undue fatigue in some of the fastening hardware? Did the whole darn gantry tip over?

I can't help but be reminded of the on-line argument I had over emergency CD-ROM's and viruses. It was stated (not by me): "If it were to infect an unprotected computer in a nuclear medicine camera gantry, it could lead to crushing and killing a patient, so you should think long and hard before you boldly insert any outside data into your workstation." I certainly DO NOT think this is what happened here.

I guess we will have to wait for more information.

In the meantime, it might be wise to kick the side of any similar device before getting into it.

ADDENDUM

My good friend Hussein from Kuwait found the FDA recall notice:

 http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfres/res.cfm?id=116030

Product:  GE Healthcare Quasar Nuclear Medicine System, Hawkeye Option and Hawkeye 4 Option for Dual-Head Variable Angle Gamma Camera. Nuclear Medicine imaging systems. Recall includes all Infinia systems, all configurations.

Reason for Recall: Accelerated fatigue of the lateral axis motion subsystem of the Infinia Computed Emission Tomography System could result in mechanical failure causing the detector to slide; may impact patient and operators.

Sounds like this is a pretty wide recall. Time for new cameras all around!

ADDENDUM 2

It was pointed out to me by the editors of AuntMinnie that the date of the recall was:

 

Date Posted	April 10, 2013

 Uh oh......

NEWS FLASH! TeraRecon Drops Taylor!

Earlier this week, the Board of Directors of TeraRecon has decided to take a new direction, releasing longtime President Robert Taylor, Ph.D., according to several of my sources with a few of Tera's larger customers.

Dr. Taylor's bio on the TeraRecon site has been purged, but here is the cached version:

Robert Taylor, Ph.D. President and Chief Executive OfficerChairman Dr. Taylor joined TeraRecon in February 2001 with the responsibility for creating and developing the Company’s advanced visualization business in the global market. He received both his B.Sc. (1990) and his Ph.D. (1996) in physics from Imperial College of Science, Technology and Medicine, London, England. From 1999 to 2001, Dr. Taylor served as chief executive officer and director of publicly-traded AccuImage Diagnostics Corp., which was later acquired by Merge Healthcare, Inc. Dr. Taylor currently serves as Chairman, President and Chief Executive Officer (CEO) of TeraRecon, Inc. He has over 15 years of experience with advanced software and technology development and commercialization in a broad range of settings, from advanced clinical applications to distributed healthcare systems.

I'm rather in shock over this...I've met Dr. Taylor on several occasions, and I'm quite convinced his leadership helped make the product line what it is today. As you probably know, we chose TeraRecon over a number of other advanced-imaging vendors after a side-by-side comparison. We have been very pleased with our choice. It integrates quite well with our Agfa PACS, and it is user friendly.  Of course, there has been a learning curve as you would expect with a tool this powerful. Eventually, I'll get around to publishing some of the spectacular images my partners are producing daily.

Such is life in big companies, I guess. I haven't heard directly from Dr. Taylor as yet, but I'm sure he will land on his feet and find another pursuit worthy of his attention. I'll be glad to supply a letter of reference.

No word at this point as to Dr. Taylor's successor.

THIS Is What Happens When Patients Have Access To Their Reports

From Aunt Minnie's European Division:

June 5, 2013 -- Earlier this year, two radiologists were physically attacked as they worked in their hospital in Belgium. One of them tells Frances Rylands-Monk, associate editor ofAuntMinnieEurope.com, about the frightening ordeal, and talks about the lessons for clinical radiologists who are in ever closer contact with patients.
The day had started off like any other. I was steadily working through my morning's reports when my secretary came to tell me that two men were waiting outside to talk to me about an x-ray report I had done. My secretary thought they seemed odd, agitated even. It's not routine, but it's not unusual for me to occasionally discuss images with patients, so I asked her to show them in.

The two Caucasian men entered but refused to sit or take off their gloves, and rejected my offer of a coffee. One of them presented me with a neck x-ray he had undergone three days earlier with a technician and my corresponding report, which stated that the image was "normal." They disagreed with what I had written, were convinced that there was "electric wiring" in the neck cavity, and wanted me to look again and change my report accordingly.

I took a second look, but the x-ray showed nothing strange. I told them I couldn't change the report, as it wouldn't be true. They became angry, moved about my office, shouting and waving their arms, so I got up on the pretext of finding a colleague with whom I could consult about the image. In truth, at that point I felt I needed backup to help me reason with the patient and his companion, and calm them both down. I found another colleague quickly and brought him back to my office. He also looked at the x-ray and told the men we couldn't write about visualizing electrical wire in the neck if it wasn't there.


Radiologists must be vigilant when they talk to patients, and when they feel at risk, discussion should take place in open spaces..

At that point, one of the men said, "You have 10 minutes to change the report, or you will end up like Jesus Christ."

My colleague again refused.

"OK, five minutes," the man insisted.

When my colleague once more told him it wasn't possible, the larger man grabbed him by the neck, pushed him back onto my desk and held him there while the smaller man produced large nails and a hammer from his bag. I ran from my office to find help and was back seconds later, followed by x-ray personnel, and the police were called. By this time, the men had placed a nail on my colleague's hand and had wounded him by partly driving it in, but they ran out when we came in the room, knocking over patients and throwing expensive equipment and computers to the floor as they fled the department. When the police arrived 10 or so minutes later, we were able to provide clear descriptions of the men and identify them from security videos. They were quickly caught in a nearby street and taken into custody.

Get to know your security protocolsThe experience left my colleague traumatized and myself shaken. As radiologists, traditionally away from first-line contact with patients, an unprovoked attack such as this was completely unforeseen -- and unprepared for! It struck me that neither I nor my colleague knew the correct protocol for contacting our own hospital security, or at what point this action should have been taken, if indeed such security protocols even existed in the first place.

Radiologists are being encouraged to become increasingly more clinical, involved with patients at each stage of the diagnostic and therapeutic process; therefore, I wonder if such attacks will become more commonplace as they have in accident and emergency units. Either way, it now seems important for hospital personnel, particularly those working in isolated conditions or late at night (including radiology department staff), to know what to do in this particular emergency. For a hospital that theoretically had security procedures in place, and in which corridors are fitted with closed-circuit TV cameras, it is surprising that this incident happened in the first place. On the plus side, the staff across the entire hospital now knows what they should do when threatened.

Following the incident, our hospital management together with the radiologists decided that unless dealing with an elderly or clearly infirm patient who wouldn't be capable of an attack, one-to-one discussion of images should take place in a public space such as the reporting area (in our hospital an open-plan section of the department where other staff are always present), and not in closed spaces such as personal offices. Second, radiology staff working at night, early in the mornings, or late evenings were issued with special telephones that included a "panic button" that would immediately summon hospital security in dangerous situations.

'Delusional and paranoid'The police psychologist who evaluated our assailants in custody told us later the men were highly intelligent but delusional and paranoid. They had thought Belgian Intelligence had planted wires in one of them for surveillance purposes, and our "refusal to see" these wires on the x-ray meant we were evidently part of the conspiracy. They were committed to a secure hospital for treatment for an indefinite amount of time.

In a way, we were lucky this incident happened during the middle of the day and not at night when there would have been nobody at hand to call. We were also "lucky" that our attackers were carrying a hammer and nails, rather than a knife or a gun. The police were convinced that had this been the case, we would be dead men.

Radiology departments aren't the closed impenetrable places they once appeared to be. It is good to be patient-focused, but with this comes an element of risk. Radiologists must be vigilant when they talk to patients. With those whom radiologists feel at risk, discussion should take place in open spaces, while maintaining a degree of privacy where possible. Both management and staff should ensure security protocols aren't just known in theory, but that they work in practice and that drills are taken seriously. A panic button phone system is a good idea for any hospital, but even without such a mechanism, radiologists should know their hospital's protocol: who to call, how, and when.


Copyright © 2013 AuntMinnieEurope.com
Last Updated hh 6/4/2013 12:52:25 PM

OK, this is an extreme case. Still, allowing patients who don't understand what it is they are reading to peruse their charts is a VERY BAD idea. You won't convince me otherwise. Hopefully, none of my victims are lurking out there with a weapon. Or a hammer and some nails...

"The Patient Wants To Talk To You, Doctor..."A Manifesto About Image Sharing

There are those who go into radiology because they don't want to have much interaction with patients, but fortunately they are few and far between. Personally, I do like to talk with the patients. Really. But frankly, I'm glad the opportunities are limited, because I don't think I have what it takes to handle a painful exchange, such as having to tell someone they or a loved one has cancer. My mental health is far better served by talking to the PACS monitor. It only rarely talks back.

Many actually dread hearing from those we study, and here is one reason why:  there is a new phenomenon out there, patients reading their own reports. I have written on Sermo.com (sorry, physicians only) and AuntMinnie.com about what happens when angry patients get hold of this information. Keep in mind that ObamaCare mandates that patients have an electronic portal to their entire record, so we are only going to see more conflict and carnage as patients try to digest material that we have spent a lifetime learning to understand.

With all that in mind...

The other day, one of my nuclear techs walked into my office and told me a patient, whose PET/CT I had interpreted a week or so before, wanted to meet with me. She had read my report, and needed to tell me about some things I hadn't mentioned. I assumed the worst, and prepared myself for the inevitable confrontation with a belligerent, angry, under-educated, over-medicated, entitled member of the Me-First Society. How wrong I was.

The patient was ushered into my office, with my Chief Tech in attendance. I reviewed the patient's scan with her, starting with the very basics ("A PET scan looks for areas that are using sugar more actively than other areas...") I then showed her the area of concern on the scan and suggested how this might be further evaluated. Rather than becoming angry, she seemed more and more relieved, and ultimately even tearful. But she was quite correct: I did NOT have the full story, not by a long shot.

To keep it short and simple, this patient had been worked up extensively in the past for an unusual malignancy. She was felt to be cured (and I still think she is).  For whatever reason, she had stopped seeing her oncologist, and was now treated by her primary care physician. She had recently experienced some back pain, which led to an MRI, which showed some odd findings, which led to the PET/CT, which led to my stating that she had a different finding which was probably benign, but would need another MRI of a different area to prove this.

With me so far? So was the patient.

Who proceeded to tell me that she had had three prior PET/CT's at the local outpatient facility.

Putting it all together in retrospect, the funny findings on the lumbar MRI (that maybe she needed) which prompted the PET/CT had been there for years, and were benign. But now, the patient has gone through a PET/CT she really didn't need, and will have another MRI that she really doesn't need to prove that the artifact on the PET/CT she really didn't need is indeed an artifact.

I have railed for years and years about the need to accommodate the "portable patient," and in fact one of my old AuntMinnie.com articles from 2005 deals with this phenomenon:

Of the thousand daily frustrations I experience as a radiologist, perhaps the most painful is that of the "portable patient." You see, patients migrate from hospital to hospital, from clinic to clinic, and from office to office. They may be searching for a second opinion, a superspecialist, someone who will give them the particular answer they seek (some want to hear good news, some prefer bad news), convenience, drugs, or some combination of the above.

As often as not, they acquire a mountain of imaging studies along the way. When asked why they had a particular study at a particular site, the answer is invariably, "My doctor told me to have it there."

I've introduced you to a portable patient in the paragraphs above, and you can see what happened to her BECAUSE no one knew about the examinations she had already undergone. She was irradiated, magnetized (probably less of a problem) and scared to death (arguably more damaging than radiation) because we have no way to connect the dots of her various studies.

Well, that isn't quite true. We DO have ways. We just aren't using them. My earlier articles, in their naivete, have proposed something akin to an RHIO, a Regional Health Information Organization, which could serve as a repository for images no matter where they were obtained. You might think the Affordable Care Act mandates this in some form, but it really just pushes for electronic records, and the Meaningful Abuse provisions are simply there to bribe physicians to make their systems receptive to data pillaging by Washington. But I digress.

The state of Maine has an image archive that serves as a repository for the studies of all its residents according to the ACR. Maine might be unique:

Most states would have difficulty implementing a statewide image archive because many providers are proprietary when it comes to patient data. But Maine is uniquely situated to make it work. That’s because when HealthInfoNet was founded in 2006, the state’s four primary health-care organizations agreed not to compete over data, Rogow says. “There’s a lot of respect among members,” he says. “We’ve been able to keep everyone on board with exchanging their data, [in spite of the fact that] it’s a voluntary structure.”

Maine is also well-suited for the program because of its size. The state is geographically large but has only 1.3 million residents and 38 hospitals, which makes coordinating a statewide exchange more manageable than in heavily populated states like California and Texas.

But still, the Maine experience provides proof of concept. This CAN be done. Many years ago, when our old AGFA PACS needed replacing, I suggested to the IT types that the three hospital systems in our average town in the South combine efforts to create a single city-wide PACS to serve all three hospitals and particularly all their patients. I was told by the illustrious CIO that we couldn't even think of working with one of the other hospitals because it was "suing us" (which wasn't quite a lie...they were challenging a CON application.) Millions of dollars and patient welfare down the toilet over C-suite egos.

There were and are other approaches. As an alternative to a central repository, connecting one PACS to another isn't that hard. The best way to do this, and fulfill all HIPAA requirements in the process, is to use an image-sharing system such as lifeIMAGE (my personal favorite by a mile).

Don't even bother to suggest that CD-ROMs solve anything.  They don't. They get lost, they get broken, they don't always load, the patient may forget to bring the disk, or the original imaging site may forget to send it, and darn, they're closed today... At one of the centers we staff, the clinicians come at me at least twice a day, every day, with an outside CD. After three years, I finally was able to convince the powers-that-be to load the damn things into PACS and merge the data with local exams. But the clinicians don't want to bother with waiting for the disks to load...they want results NOW. In my opinion, CD's aren't even worthy of being drink coasters, given that huge hole in the middle. 

My daughter Dolly, now a 4th year medical student, suggests that the patients themselves have some responsibility to inform us about prior exams, as my patient above actually did, though after the fact. For better or worse, that is not going to work in most cases, and we all know why. Hold the patient responsible? In an ideal world, maybe. But it won't happen in my lifetime. And it's next to impossible for an overworked primary-care doc to know about every examination that has been ordered by the patient's army of physicians. To pervert the old saying, too many docs spoil the patient.

The Portable Patient is a problem with solutions, which are not necessarily cheap. Still, they are necessary. 

Here's where I'm going to anger a lot of people, and that is of course why you like to read my rantings. But, the following is something that needs to be said, and I'm going to say it.

Given that:

• Not knowing that the patient has had prior studies leads to unnecessary imaging,
• Unnecessary imaging may expose the patient to unnecessary radiation, and unnecessary costs and anxiety,
• Unnecessary radiation is bad for you, as is anxiety,
• We have ways to share prior studies,

It stands to reason that today, in the 21st Century, shirking our responsibilities to the patient in this aspect of medical imaging is MALPRACTICE. Yes, I used the M word. But that's exactly what it is. We are not doing what we should, and what we must, for patient care. It is high time to apply technology that has been around a long time to unify patients' records, imaging and otherwise. 

We are harming our patients out of ignorance, out of hubris (why would they go to any doctor/hospital/clinic other than me/mine?), out of greed (I get the revenue if I repeat the study!)  This is completely unacceptable.

Let's all DO something about it. Talk to the rads, the IT folks, the clinicians. The time has come to fix this very fixable problem.

And don't be afraid to talk to the patients. You might be one someday.

Naughty Curiosity!!!

It seems that Curiosity, the Mars rover, thought no one was looking, so....

Adding A Trackpad, or (Jail)Breaking iBad

As a reward for surviving his operation in 2010, we gave Dalai, Jr. one of the original iPads. He never really took to it, preferring his laptop instead. Even so, in  those heady, early days of the iPad, I was quite certain it would become THE radiology accessory, as seen in this cartoon which I made even before the iPad was released, and then this one after it was out. Later, I wrote an early review of the radiology viewing software then available. Some of my comments in that piece were rather prescient, especially those concerning the eventual increase in screen-resolution.

My son's iPad ultimately languished in a drawer for several years. On a lark, I dusted it off and used it for a teleprompter with the proper app (dvPrompter), which worked very well. It occurred to me that perhaps it was time to revisit the iPad, and maybe even pop for the iPad 4, with the Retina Display I had correctly predicted, and the Lightning connector which I had not foreseen.

The closing paragraphs of my software review referenced Apple's potential to redefine the PC world (in the more generic sense), with tablets taking over from laptops and desktops. This hasn't quite happened. It is rather ironic that Microsoft itself ran with the idea...right into a brick wall. The Latest and Greatest Windows, version 8, tries to add a touch interface and some flashy graphics to the venerable GUI. But it isn't selling, as noted by Yuval Rosenberg in the Fiscal Times:

Windows 8, meanwhile, hasn’t won over consumers since being launched in October, accelerating the popular shift away from PCs. Microsoft looks to have a flop on its hands – and one that, despite Ballmer’s talk of devices and services, remains very much at the heart of the company’s strategy. "At this point, unfortunately, it seems clear that the Windows 8 launch not only failed to provide a positive boost to the PC market, but appears to have slowed the market," IDC’s Bob O'Donnell said in releasing the quarterly data. IDC’s data doesn’t include tablets or the new wave of laptop-tablet hybrids, so the slump in Windows-based computing may be slightly less pronounced than its figures show, but rival tracking firm Gartner found an 11.2 percent decline in year-over-year PC shipments so Windows 8 clearly hasn’t helped turn the tide.

The new operating system, designed to enable touch screens, has failed to win over users accustomed to the old user interface, or UI. Plus, PCs with touchscreens are still expensive compared to tablets. "While some consumers appreciate the new form factors and touch capabilities of Windows 8, the radical changes to the UI, removal of the familiar Start button, and the costs associated with touch have made PCs a less attractive alternative to dedicated tablets and other competitive devices,” O’Donnell said. “Microsoft will have to make some very tough decisions moving forward if it wants to help reinvigorate the PC market."

And therein lies the problem. I came to the conclusion independently, but CNet's Scott Stein stated it better than I could in a 2012 article, "Why My iPad Can't Replace My Laptop:  It's The Trackpad":

Adding a keyboard to an iPad, like the Logitech/Zagg Keyboard Case for iPad 2, solves the problem of text entry. That's great for when you have to write a long essay, or are working on a chunk of your Great American Novel, or just want to jot down some notes. It's not so great when you have to edit a document, or create a blog post with embedded links, or do simultaneous Web research and writing. To do anything more than text entry and a few other commands, you'll have to reach up and touch the iPad's screen, which isn't exactly ergonomic or time-efficient when you have the iPad propped up and a keyboard attached. In fact, it's downright awkward.

This is why touch-screen laptops haven't taken off. No one wants to touch a screen while typing on a keyboard. I want a trackpad when I work, or even a mouse. Touching the screen makes no sense in "laptop" mode. I'd rather use the iPad as a straight-up tablet, which brings me back full circle and defeats the purpose of the keyboard.

So, the key to high-level iPad happiness is a keyboard and a pointing device. Several keyboard cases exist, and work well. There are all sorts of Bluetooth trackpads out there as well, but they don't work with the iPad as yet...because they aren't supported by the IOS (operating system). But, there is a way...

You've probably heard of jail-breaking an Apple product, and I won't bore you with the details. Suffice it to say that with the proper software, one can take control of one's iPod, iPad, or iPhone, freeing it from the shackles of the iTunes store, not to mention the Kupertino Kops and their vision of exactly how your interface should behave. In my research, I found that there IS software to allow the use of a Bluetooth mouse or trackpad with an iDevice...IF it's jailbroken.

Legal opinions in the past few years have declared that it is not illegal to jailbreak the Apple progeny, (but it is of course illegal to then download software for free that should be paid). If you jailbreak, you will void Apple's warranty, but, well, my old iPad 1 is waaaaaay out of warranty...

So I did the deed. I jailbroke my son's iPad.

Once processed, the only initial change to be seen is the appearance of a new app named Cydia, which one could think of as the iTunes Store of a jailbroken, parallel universe, or perhaps a Bizarro world (any Superman fans out there?) Navigating Cydia is an experience somewhat less refined than browsing the iTunes store. The interface is cruder, and not for the faint of heart. To be honest, I felt sort of dirty being there, like wandering through an Earth-Fare and being the only customer without Birkenstocks. But it works, and once you get the hang of it, there is a tremendous amount of stuff that will transform your iWhatever into something the late Steve Jobs would probably haunt you over if he could.

Aside from the various downsides of not being able to upgrade to the latest IOS until the mad geniuses out there upgrade their jailbreaking software, and losing the warranty, there isn't too much of a downside. BUT, if you were expecting everything to be free, you would be sadly mistaken.  So...I have yet to spend the $5 for the Bluetooth software. But I will. Eventually.

What I envisioned is a keyboard case for the iPad with a trackpad built in, something like this:

The Crux "Loaded" clamshell iPad case, prototype pictured above, was to have transformed your iPad into a mini-laptop for the small fee of $250. But for whatever reason, Crux seems to have dropped the project. Probably because the small fee of $250 was a little steep for the purpose. Add the cost of a souped-up iPad and you've about hit the $1,000 minimum price of an 11" MacBook Air:

15, 13, and 11 inch Macs, image courtesy Anandtech.com

Personally, I'm thinking the Air would be the better choice after all. I wonder if you can jailbreak an Air...

In the meantime, the Android world does have trackpadded options; Stein cites this Asus Transformer:

Credit: Scott Stein, Josh Miller/CNET

While the radiology apps for Android is not yet as numerous as for IOS, some do exist, and in fact Calgary Scientific's ResolutionMD is the first to receive clearance from the FDA for diagnostic reads.

In the meantime, I'm just going to wait for the iPad 5, before making any purchase decisions.  The '5 is said to be thinner and more powerful then ever before. I wish I could say that about myself...

The Final Four And Other Unfairness

While I'm not that much of a sports fan, Mrs. Dalai and I bid successfully on tickets for the Final Four offered by one of our favorite charities, Camperships For Nebagamon, and so we got to tick one more item off of our bucket list. (Still to come, not necessarily in order: Superbowl, college and professional baseball World Series, visits to Giza and the pyramids, Angor Wat, the Terra Cotta Soldiers in China, African Safari, Paris, Scotland, Ireland. And while I've been to Israel, Hawaii, and Australia, Mrs. Dalai hasn't, so our shared list includes these spots as well.)

Courtesy Kevin B. Cox, www.sbnation.com

I won't begin to analyze the Final Four semi-final and final games, as most any one of you out there could do a far better job of it than I. Still, we thought Michigan had a stronger performance against Syracuse than Louisville did against Wichita State, and we were a little surprised by the outcome of the final game. While we had no dog in the fight, as USC (our USC, not that usurper in California) has never made it into the Final Four, we did favor Louisville out of sympathy for the injured Kevin Ware.

There is nothing like seeing a sport played at the highest levels, even for someone like me who doesn't really appreciate the finer points of the game. I was somewhat surprised that the President, who is a very big fan of the game, didn't show for the finals. Mr. Obama does get all the nuances, I'm sure. But everyone understands this: there will be a winner and there will be a loser in each and every game. And no one seems to have much of a problem with that. It is accepted that in competition, the outcome is determined by some magical melange of luck, skill, timing, phase of the moon (the tides might affect the spin of the ball, you know), and Heaven knows what else. The Wolverines, while disappointed, haven't been quoted as saying that the Cardinals had some unfair advantage. Rick Snyder, the Governor of Michigan, who sat about 20 seats away from us, isn't calling Greg Fischer, the Mayor of Louisville, to chastise him over the loss, and request an equalization of the points scored.

Clearly, we all understand the concept of winning and losing, and the implied fairness therein. But somehow that feeling doesn't seem to translate into real life, which is essentially a series of competitions that pit one of us against another in some form or fashion. I had to compete with other applicants to get into college, then medical school, then residency, then to find a job. You could say I "won" these clashes, and others lost. My salary might therefore be higher than someone else's. The general feeling, at least among approximately 53% of the population, give or take a percent, is that somehow this is not fair, and my largess must be equalized. I must be forced to pay my fair share, although no one has bothered to define what my fair share really is, not to mention what makes this fair in the least. Fair has become the purview of the majority, and as the old saying goes, democracy lasts until the public realizes it can vote itself stuff from the public coffers. Which the public expects to be filled by the "winners" of society giving back points (I mean money) that was earned, well, fairly.

Was it fair that Louisville beat Michigan? From my vantage-point in section 116, about 40 rows up, I think so. But there are those who attribute the win to bad calls such as the foul called on the block pictured above. If we go there, however, we have to postulate some sort of bias on the part of the officials; otherwise, it's rather safe to assume an equal number of bad calls for each team. And maybe that is the origin of the fairness thing. All men (and women) are created equal, but the second we draw our first breath, that equality diverges into a zillion different directions. The outcomes of our various endeavors simply cannot be equal, and this angers a lot of people. It just isn't fair, they cry. But I say this: it wouldn't be at all fair to FORCE equality where it doesn't belong. Someone who is smarter and/or more clever than I am deserves to make more money and have more toys than I do. It's that simple. And that trickles down to those who had the luck to be born to those with those skills, in my humble opinion. Again, it is NOT the job of the government to equalize the outcome, only to remove impediments to the success of anyone and everyone with the ability to achieve it.

Congratulations to the Louisville Cardinals, who played hard and deserved their win and title, even with the unfair loss of Kevin Ware. I guess to be fair, Michigan's Trey Burke should have volunteered to have his leg broken as well, eh? That would have leveled the playing field... Fair is fair, after all.

Did You Ever Wonder...

Mark down Thursday, May 23, on your calendars...that's the date of the next AuntMinnie.com Virtual Conference, and your favorite Doctor Dalai of PACS will have a supporting roll:

"Did You Ever Wonder...Some Musings On What Radiologists REALLY Want Out Of PACS"

Dr. Sam Friedman, the self-proclaimed "Dalai Lama of PACS" shares his (occasionally tongue-in-cheek) views on PACS and how it works (or doesn't) in the hands of the average radiologist. Developed by visionaries and co-opted by Information Technology, PACS had great potential to revolutionize the daily grind of the radiologist, but can just as easily thwart any attempt at efficiency. It would be nice if those who wrote the software actually asked what PACS should do. Did you ever wonder just what that is? The next few moments should cast some light on this mostly-ignored subject.

I hope you will find the entire conference, and my presentation in particular, interesting and informative. I do, however, need your help. Please contact me at doctordalai(AT)gmail.com, and let me know what YOU think! What does your PACS do that you like, and what features do you detest? If you could make your own PACS interface, what would it include? All ideas will be read, and the best will be rewarded with a free mention on this very blog!

Seriously, I would be very grateful for your thoughts on PACS. send them to me at

doctordalai(AT)gmail.com

Thank you!!!!

Merge Re-Refinances

While it's not yet up on Merge's website, the company has sent out a press release to those of us on their  email list announcing a new "Tender Offer" and "Consent Solicitation". Here it is:

Merge Healthcare Announces Tender Offer and Consent Solicitation for 11.75% Senior Secured Notes Due 2015

CHICAGO, April 2, 2013 (GLOBE NEWSWIRE) -- Merge Healthcare Incorporated (Nasdaq:MRGE), a leading provider of clinical systems and innovations that seek to transform healthcare, today announced that it has commenced a cash tender offer (the "Tender Offer") for any and all of its $252,000,000 outstanding aggregate principal amount of 11.75% Senior Secured Notes due 2015 (CUSIP Nos. 589499AB8 and 589499AA0) (the "Notes"). The purpose of the Tender Offer is to improve Merge's financial position by refinancing its indebtedness outstanding under the Notes at a lower interest rate.

In connection with the Tender Offer, Merge is soliciting consents (the "Consent Solicitation") to effect certain proposed amendments to the Notes and the indenture governing the Notes (the "Indenture") that would eliminate substantially all of the restrictive covenants and certain events of default contained therein, would release all of the collateral securing the Notes, would shorten the minimum redemption notice period required for Merge to redeem Notes from thirty days to three business days prior to the redemption date, and would modify certain other related provisions contained in the Indenture. The Tender Offer and Consent Solicitation are being made pursuant to an Offer to Purchase and Consent Solicitation Statement dated April 2, 2013 (the "Offer to Purchase"), which more fully sets forth the terms and conditions of the Tender Offer and Consent Solicitation.

{snip}

As described in the Offer to Purchase, the "Total Consideration" for each $1,000 principal amount of Notes validly tendered and related consents delivered at or prior to 5:00 p.m., New York City Time, on April 15, 2013 (such date and time, as the same may be extended, the "Consent Expiration Time") and accepted for purchase will be $1,066.96 per $1,000 principal amount of such Notes, which includes a consent payment of $30.00 per $1,000 principal amount of such Notes (the "Consent Payment").

{snip}

The Tender Offer and Consent Solicitation are conditioned upon, among other things, (a) the receipt of tendered Notes from the holders of at least two-thirds of the aggregate principal amount of the outstanding Notes (excluding any Notes owned by Merge or any of its affiliates), (b) receipt of funds from certain refinancing transactions, on terms and conditions acceptable to Merge, in an amount sufficient to enable Merge to purchase the tendered Notes, make the Consent Payments and pay related costs and expenses, and (c) certain other general conditions, each of which is described in more detail in the Offer to Purchase...

Now, I'm no financial genius, as my wife the accountant will tell you. But adding up the numbers, it looks like Merge is offering 6.7% on the purchase of the note, but then taking back 3% in "consent payment" thus yielding 3.7%. But the holders of Merge's debt were to be paid over 11% when the $200 million + in notes were originally tendered in 2010. They might not be very happy about the lower rates.

I'm a firm believer in refinancing, having done so on my home loan several times over the years to take advantage of prevailing interest rates. But I have to be a little worried about this consent business. One could read this as ways to get out of the note's provisions...that couldn't possibly be the case, now could it?

Oh, well.  It was suggested to me years ago that GE was funding Merge's purchase of AMICAS to piss me off, a thought I dismissed at the time. Now that GE has finally come up with a usable GUI, their Universal Viewer, one wonders if they might decide to just squash Merge/AMICAS out of existence altogether. But I'm being paranoid, right? While Merge is a scrappy company run by savvy people, no one ever got fired for picking GE.  Just sayin'...    ;-{)}

The Apple Of My iEye: iVision

With all the hype about Google Glass and Pebble watches, it would appear that Apple has been left far behind in the innovation game. Nothing of this caliber seems to be coming from the magical workshops of Cupertino.

Until today, that is. Secret documents leaked from Apple's headquarters indicate something quite revolutionary, a product that will firmly plant Apple back at the top of the heap for years to come.

If it were up to me, I would want something that would encompass everything I want and need to do during the day into one neat package. It seems that Steve Job's ghost has heard me, and the result is to be called iVision.

PatentlyApple.com, a site that monitors Apple patents, strangely enough, documents some of the technology behind the new miracle:

This image from the patent application shows us the optical projection approach to delivering images to both eyes. The technology can be modified such that the screen transparency can be modified, and thus the display can either be projected over reality, or seen as the exclusive image, creating a virtual-reality experience for 3D movies, games, and the like.

Processing for this first version will have to be off-board, as the power and communication ability required for this ambitious product is too great to be contained in any headset that might possibly be acceptable to Apple's hipster customers. Thus, a souped up iPhone, tentatively labeled the iPhone5V, will connect to iVision via Bluetooth. Control will be via an advanced version of Siri that actually recognizes your commands.

It is, of course, the superimposition of virtual on top of real that will be iVision's big selling point. Various functions will be controllable by iPhone5V apps. Pedestrians and tourists will of course want the site-labeling that Google Glass already offers, and certainly iVision will outdo this:

I'm assuming that the iPlace app will have extended capabilities, perhaps connecting with the appropriate databases to provide local information:

iVision will have tremendous applications in the medical realm. A virtual display of PACS, called iPACS, assuming Apple can buy back that trademark, will free us from our workstations. For the surgeons, iOperate will provide step-by-step assistance:

The most exciting app of all, to those (over 18 years old, please) with no lives, will be iStrip:

Simulation courtesy of oskarlewis.com

What? You were expecting more of a surface view? We'll have to adjust the settings....

Of course, Apple won't stop with iVision. The logical progression of all this is something more personal, more internal...iSight!

Image courtesy cnet.com

Based on the ground-breaking work on artificial vision at MIT, iSight will indeed be an implanted optic replacement, able to interface directly with the user's brain, bypassing Siri. Expect a version for early (and brave) adopters sometime in 2015.

Oh, yes...I completely forgot to show you the iVision wearable device.  Here it is!

This glimpse of the future is available only on this particular day. Have a good one.

Takedown Breakdown

My previous post about a page takedown due to a supposed DMCA (Digital Millenium Copyright Act) violation attracted a comment:

I am going through the appeal process regagrding D360 threats myself. My hosting provider did lock down my entire site and I am working to get it back up. D360 contacted me and I responded immediately and removed the state map images for the U.S. that one of my researchers found through Google Images, and in our rush to complete a project last Fall 2012, it went without proper review as to the origins of those maps. An honest error on our part, admittedly, but these asshats are in this to suit people and are not interested in simple resolutions. I have had my site at godsownparty(dot)com for over 5 years without ever experiencing this type of aggressive attack over an unintentional error. When my site returns...guess who I am writing about?

And this comment attracted another comment (which was posted three times as the author, whom I would have thought was quite web-facile, had trouble understanding Blogger.com's controls):

This Anonymous person's name is Leah and she's pretty upset at her website begin down. Destination360 filed a DMCA complaint on her website because they took 3 maps on 3 separate articles. Example: http://www.destination360.com/maps/arizona-map.gif Its pretty clear there's a copyright and who owns it right? Her webhost was pretty heavy handed in their response but we have no control over that. She's now posting nasty anonymous comments on our Google+ acct. Why not just take responsbility for your actions and move on? Because its the internet and people can be anonymous.

To which I answered, in comment form:

Dear Local Trips/Destination360: Thank you so much for sending the same comment three times. I guess it never hurts to be certain you were heard, but you do apparently believe in taking responsibilities for your actions... When you file a DMCA complaint, as you seem to enjoy doing quite often, it causes undue havoc and pain upon people who were really not trying to harm you. In my case, I credited your photo to your site. Had you left it alone, you might have generated additional business, as the Hunter post is one of my most popular. The credited link could have drawn in more people to your site. And even if you don't want additional traffic to your illustrious site, you COULD have simply contacted me and asked nicely for me to take down the image. I would have done so, but had I refused, it would THEN be the proper course of action to file the DMCA. With your petty behavior, you now inspire people like me and Leah to let others know, and not only do you not gain any traffic, you lose potential customers and viewers. Is it worth that? And by the way, as noted in the post, I've found duplicates of your photos and your copy elsewhere...who stole what from whom?

To which Dan Taylor, the principle (and I have to admit superb photographer of Destination360.com) answered:

Dalai, Obviously that wasn't the intention to post multiple times, feel free to delete extras if you care. The commenting confirmation on this has something to be desired. I cannot comment on your specific instance regarding DMCA but we're fine with someone filing a DMCA on Destination360 we hire all our writers and content is run through copyscape so our work is vetted. Thanks for allowing us rebuttal on this issue.

And I responded:

Here's a rebuttal for you...why are you at Destination 360 being such BUTTS about this? WHY couldn't you simply contact me, which you can see is quite easy to do, and ask NICELY for me to remove the image in question? WHY did you feel it necessary to go straight to a DMCA filing? DO you possibly grasp that this just works against you in the end? Probably not.

Dan has the last word to this point:

Sorry but in order to process DMCA's you must follow certain procedures. Most people taking images are doing it for profit "traffic theft". On occasion innocent users get caught in this. Its impossible to determine who this is without significant work on our part. So the only way we can effectively and legally process these is to send to the website user email adddress and webhost. In the case of the Leah incident she had her whois hidden as private so we had no way. We sent 5 emails over the course of one month. I doubt you will understand our position but if you were in our shoes you might. In all fairness you say easily contact you. In looking at http://doctordalai.blogspot.com/ I cannot find anyway to contact you on this blog. I must go back to my dayjob. Cheers! 

Well, Dan, old friend, you really should consider putting in that "significant work", as you might be taking away the livelihood of others. My blog exists mostly for my own amusement, but other people actually depend on theirs for a living. I notice Destination360.com produces something under $200/day in advertising, which may or may not be enough to keep you in Nikon D800's without your day job. "Leah's" site isn't back up even yet, so I don't know if this is something that generates food-money for her or not. Would you be at all sorry for your actions if it did? Was her goal actually traffic theft? Mine certainly wasn't. If by that term you mean using the photos in question to divert web traffic from your site to mine, well, I guess that practice does exist.  However, I seriously doubt it represents the majority of people who use your photos, ESPECIALLY those who do so and give you credit for them as I did. With the crediting link, YOU, Dan, and your illustrious site, get FREE advertising. The "Doctor Hunter" post was one of my most popular. I used the photo of the hunter to represent my friend the hunting doctor, and it had nothing to do with anything on D360.com. Nothing but upside for D360 to just leave it and me alone.

There's a punch line here...the photo in question wasn't taken by Dan or anyone else associated with Destination360.com...it was a STOCK PHOTO from iStockphoto.com.  So I bought the rights to use it myself, and it's back up on the Doctor Hunter post:

Order Summary
File: #1162020
XSmall
Standard License (Included) Order number: 19731992

Please save this invoice/receipt as a record of your purchase.



iStockphoto LP, Suite 200 - 1240 20th Ave SE
Calgary, Alberta T2G 1M8 Canada

Now, isn't that interesting? How did they know my use of the photo was not kosher? Well, I made it easy for them by posting the credit right there by the picture. It's also possible to check the source of a download by examining the EXIF data of the photo. In this case, the version I borrowed from D360 mentions their website, and that from iStock contains their info, and that is perhaps another way to search. (I will of course assume that D360 licensed this picture either from iStock or in another legal manner.)

It's pretty clear that my friend Dan is trolling the 'net looking for photos (and maybe text) that match the content of Destination360.com, without bothering to find out the origin of the material. To be fair, I had not properly obtained permission to use the photo in question (which I have now), and in MY case, D360 truly did have the right to file the DMCA action. BUT, this isn't always the case with Dan and company, as he himself admits above, and some others like "Leah" will suffer. Others have had similar amusing experiences as this blog post and attached comments will illustrate:

My frustration at GoDaddy has gone to a whole other level this week.

I used to be a loyal GoDaddy customer from day 1. I hosted over a hundred websites, including 3 dedicated and 2 virtual servers, had all my domains through there all purchases through my reseller account which was also doing very well. Needless to say I feel I am a pretty reliable source to be giving a GoDaddy review.

Over the last 2 years, my loyalty to GoDaddy has been steadily dwindling. It wasn’t the customer support that was steadily getting worse, or the constant mistakes in billing….it wasn’t even the malware attacks that prayed on server vulnerabilities, infecting over 87 of my wordpress sites that they stubbornly insisted to the bitter end, wasn’t their fault.

But the nail in the coffin for me, was finding out that GoDaddy does not enforce their own terms to protect our servers, and that anyone with an email has the power to take your server down.

Scary right? Its the truth and here is what happened.

Recently one of our Dedicated Servers was suspended because of a Copyright Complaint. No notice, no warning…nothing. One minute its up and the next its down.

There is no way to contact the Copyright department by phone. You can only contact them through email. And they are the only one with the power to restore your server. You are supposed to receive an email notifying you as to why the server was taken down but since most of us with dedicated servers also host our emails on the server, that did not happen in our case.
So we had to send them a request by email to find out why our server was suspended and they took their sweet time responding. Nearly 5 hours later we got an email with a complaint that was attached from www.Destination360.com who claimed an image we had on the site was theirs and they swore under penalty of perjury to that fact. They provided a link of the image on their own site, and then one that showed it on our site. That was it.

Our first issue was to get the server restored. And in order for us to do that we had to follow this list of things which included swearing under penalty of perjury that we would remove the image immediately. I found that interesting considering you can’t remove the image when the server is down. We responded with the things they asked us for, and told them we would remove the image as soon as they put the server back up. But we kept getting rejected with an auto response referring us to the terms and instructions. I just continued to submit the same response and the 4th time it was accepted. FINALLY, After 12 hours of being down and waiting for responses, we were told we would be restored. But it didn’t happen and when we called to see why, we found out they went home and we would have to wait until the next morning!

Eventually they got the server back up. Total down time, 20 hours, just long enough to lose traffic from a breaking news story linked to on drudge, affect the sites ranking and lose advertisers.

I decided to now look into this situation that caused all this which was the copyright violation claim. Imagine my surprise when I searched the image in question on tineye.com, to find out that the image was in fact owned by IStock photo. Further research showed we had a license for it.

So why was Destination360.com filing complaints about images they don’t own? And how was this claim validated by GoDaddy? Can anyone claim copyright infringement and just take down a website? Does GoDaddy just yank your website, no questions asked?

It seems so, how else could this have happened when clearly the accuser did not own the image and could not have provided proof of such.

SO the questions is, does GoDaddy just automatically suspend service when they get complaints and then sort out the details later? Because that seemed to me like a very dangerous power to give to someone who wants to take a site down. There had to be something that prevents false claims or malicious intent.

I called an talked to a manager named Chris to ask this very question. Chris assured me that although they wont make the decision who is right and who is wrong when the complaints are received, they do make them follow a strict complaint submission protocol and will verify the complaint before they suspend. They admit they take action swiftly but they do not just suspend all sites that get complaints arbitrarily.

I checked out the rules for submitting a copyright complaint. To my surprise, the complaint that Desintation360 provided did not provide the necessary information to have a valid complaint according to the terms of GoDaddy.

So how was that claim aloud to pass as valid? Can anyone just lie and say we stole their image and take our server down?

But even more surprising is that they do NOT ask you to provide proof of some kind of documentation of the actual copyright when making a complain. Which means if someone has malicious intent, all they have to do is swear that they believe you have violated their copyright (even if no such copyright exists) by using something of theirs on your website, and GoDaddy will suspend the website. No questions asked.

I contacted ISTOCK who immediately called me, concerned and provided us with proof for GoDaddy, that we were within our rights to use that image. My goal was to not only show GoDaddy the claim was not valid but to show we had the right to put the image back up.

I immediately emailed that to GoDaddy the license and letter from ISTOCK, along with several requests for a manager to review this situation. I was very concerned that our server was not safe, and wanted to know why the complaint was allowed to be escalated to server suspension and how they thwart malicious intent, if they are not asking for any kind of proof. Chris the manager said they do look into these things first. But clearly that didn’t happen here. So what happened?

I expected someone to email me back. But we got nothing but automated responses containing instructions on how to get our server back up which proved they were clearly not even reading our emails considering the site had already been back up for 2 days.

When I finally did get a response from someone named Michelle, she asked me why the image was still up when we promised to remove it. That concerned me again considering it wasn’t up and hadn’t been for 2 days. But even worse was that we had provided our license for the image and should have been able to put it back up anyway. SO no one was even looking at our emails and documentation. GoDaddy didn’t care that we were wrongly accused.

Hey wait, aren’t they supposed to be on our side?

After providing her with a link to the images 404, and again asking how we can document with GoDaddy that this claim was not valid and did not comply to their terms and asking to be allowed to republish the image, she responded asking us file a counter claim.

So we did. She responded to tell us that the server would need to be suspended until the court date.

Wait….court date? What court date? I thought we were just providing you with information about why the complaint was not valid so we could put the image back up and not get in trouble for it. Apparently there is NO way to do this. There is no way to disprove a bogus claims with GoDaddy and NO way to hold someone accountable for false claims under penalty of perjury without taking them to court. And the best part is that godaddy supports you through this process by taking your server down until it is resolved, something that is not mentioned in their terms.

In the end, we never got a call or email responding to our concerns, nothing assuring us it wouldn’t happen again, nothing explaining the situation, nothing acknowledging the proof we had the rights to the image, nothing assuring us that they do look into claims before yanking servers and sites. Just Nothing.

Oh and I emailed Destination360 several times to tell them about their mistake and how it affected our website. Guess what I got from them? Yep. Nothing.

So what does all this mean to you? It means your GoDaddy server and website is vulnerable. And until GoDaddy decides to listen to its customers and better protect them, this is not going to change anytime soon.

I certainly don’t intend in staying around to find out.

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Reply

June 26, 2012 at 3:42 pm


I, too have had the same issue with this malicious company Godaddy. On the 25th of this month, June 2012 they took my site down after they received the same complaint of a copyright violation from the same company destination360.com They simply emailed Godaddy and said we stole one of the photos from their site. We did not steal anything, as the photo was licensed by Istock. Godaddy never contacted us and just immediately took our site and hosting down. After they did they emailed us. And by violating our contract with them, Godaddy, they ruined our online business.

I will look into filing a lawsuit against Godaddy and against destination360.com for libelous and false claims.

Godaddy must actually believe they are too big to fail…they are wrong. Once a company reaches success, like GM and thousands of other companies, they treat their customers like dumb ignorant cash-cows.

Reply

June 26, 2012 at 4:14 pm


Email me and I can give you the name of the manager at ISTOCK who has been dealing with Destination360 already about this issue. ISTOCK is NOT happy as it harasses their customers and I am sure they will be concerned to hear this is still occurring. I will be sure to email my contact there and let her know.

You have a valid reason to pursue legal action as in order for them to take down your server, they have to swear under penalty of perjury and since they have done it more than once and have already been warned about it, it is not longer something they can claim is an oversight. I am happy to provide you with details of our situation for your court case if it helps.

Reply

May 21, 2012 at 4:36 pm

http://www.destination360.com had our site removed for using an image of a windmill we had a legal license from istock to use! It was a huge problem for us and took us nearly a week to resolve. Worse yet, we also could not put the image back up as godaddy did not seem to care that we had a license, and said they would take our site down if we put the image up. So we paid for a license we can’t use. Your site is about godaddy, but it seems to me the real problem is istock! In other words, if you buy an istock license you are at risk from a company who has decided they own images that they don’t and will have your site taken down? Your article is a year old, it is unacceptable that istock has not fixed this issue. They need to take action against Destination360. Suspend their account!

I don’t understand what Destinantion360 has to gain by doing this? Do they really think that they own these images??

Dan, buddy, pal, mate, friend...THIS is what your blind shotgunning accomplishes. For every real case of "traffic theft" you eliminate, you cause a boatload of grief for several more innocents.

Not that you really care, but IF you and Destination360.com want to be a good citizens of the web, Cease and Desist from your belligerent practices outlined above. Yes, it is your right to pursue those who actually ARE trying to steal your customers (although I'll bet you don't get much revenue from the vast majority of those viewers who might be so enticed anyway), but you should have the common courtesy to find out BEFORE you go, ummm, gunning for them. You are doing nothing more than turning away potential visitors to your site. You are firing a shotgun into a crowd which you think might contain someone who ripped you off. This is not the way to win friends and influence people. Not at all. In fact, Dan, you posted something on your own forum about "besstpicturesof.com" which I won't reproduce as you might get upset. The gist of the post was that "image scrapers" are trolling for your content and using it as an easy source of revenue. Really, Dan? Are the dozens of little piss-ant blogs out there that you have prosecuted (under pain of perjury) REALLY using your content for revenue? Certainly, a site that DOES do this deserves the full weight of your wrath, the rest of them, the rest of us, probably not.

Since you are quite concerned with Internet piracy, as we all should be, by the way, you might be glad one of your images was lifted to be used in a talk about...Internet piracy.  The image of the Mexican Caribbean is yours. Have fun prosecuting the Hong Kong police.

There are a lot of sites dedicated to travel beyond D360.com. I'll be visiting those, and not yours. I urge my readers to do the same. THIS is what your behavior brings you, Dan. Yes, mine is a small blog with few readers. But they have friends, and the friends have friends...

Next time, send the perpetrator an email, a common courtesy which you didn't afford me. Most of us out there will do the right thing. Unlike those who indiscriminately file DMCA notices.

Dalai Speaks! No One Falls Asleep!

I had the honor of speaking to the South Carolina Radiological Society Annual Meeting yesterday. Clearly, the organizers wanted to intersperse some entertainment and low-brow amusement into the schedule of academic presentations, and I was more than happy to oblige.

My talk was a revamped version of what I said at RANZCR in 2010, updated appropriately to reflect the few areas of improvement I've seen since then.

Because the presentation computer was a Dell running Windows Vista (I guess someone actually bought a copy), two video clips that were supposed to be part of my PowerPoints didn't work. So, if anyone who attended the meeting actually was motivated to check them out, here they are...

The Scope of the Project

This fanciful piece is inspired by the rigidity of the IT mentality...

Dalai's PACS Fix

This is how I would handle some of the PACS problems I encounter...if I could.

Now here's something that will shock the pants off of some out there.  After my talk, I was approached by one of the participants who asked me if I had time for "some advice".  I naturally assumed he was going to tell me how awful a speaker I was (I used my old iPad 1 for a teleprompter). But no, on the contrary, he thanked me for the talk, and proceeded to ask which of a restricted list of PACS vendors he should consider. Here's the shock...WITHIN the constraints under which he was operating, I felt the best choice was.....

Wait for it.....

Agfa.

You're welcome.

Lessons From Steubenville

Dalai's Note:  It seems that Dalai, Jr., has discovered the cathartic effects of writing, especially after a brutal Chem exam! Here is is latest, and I agree with every word....

The light shining through your window hits your face, and you instinctively open your eyes. Big mistake. The drinks from the night before have taken a toll on your body, and the hangover is hitting you like a massive freight train carrying twenty cars of nausea, headache, and dehydration. You hear a buzzing, and see your phone is lighting up with 1, 2, 5, 10 new text messages. You read everything from “R u ok?” to “I CNT BELIEVE U DID THT U WHORE!” You wonder what everyone’s talking about, but realize that you don’t know because you don’t remember anything from last night. Something about a party…some drinks…a car ride… and then nothing.

The next Monday at school, you’re ignored by all your friends, who call you a liar and a slut. You’re still not sure why. That is until someone waves the pictures in your face. Suddenly it becomes clear. You’re afraid to say anything, because after all, you’re the one who got drunk. You’re the one who didn’t stay in control of yourself. It’s your fault. Not those guys. They didn’t mean any harm, they were just messing around. It’s how guys are, everyone knows that.

Eventually though, you confide the truth in someone, and accusations are made. Even though the boys are put in prison, you’re publicly shamed and faulted for being unconscious. For drinking too much. For letting yourself be raped. You’re told on the national stage that you should have kept better control. That you were asking for it. That you have no right to press charges. All your fears are coming true, and you wish you had never said anything at all. Because after all, it is your fault. Right?

As I’m sure we’ve all heard by now, two high school football players in Steubenville, Ohio were accused of raping an unconscious sixteen year old girl at a party last August. There are several pictures of the two boys digitally penetrating the helpless, passed out young woman, but for some reason the world, and especially the mainstream media, has continued to try to protect them. At first, the entire incident was nearly swept under the rug by local officials who didn’t want to see the local high school’s star players kept out of the game. Later, once the guilty verdict was handed down earlier this week, the world cried out for the “two young men [who] had such promising young futures" (CNN), instead of rejoicing in the fact that two criminals had been brought to justice.

So what does that say about us as a nation? First and foremost, the amount of victim blaming that has occurred over the course of this trial has been, frankly, sickening. Yes, the survivor of this heinous—but all too common—crime should not have drunk as much as she did. Yes, she should have kept better control over herself and her actions. But does that give someone the right to do whatever he wants to her as she is passed out and probably in need of medical attention? I am ashamed to live in a country that so clearly thinks along these lines.

If you think that this girl is to blame for getting herself into the situation, then you could not be more wrong. Yes, we are responsible for our actions, regardless of whether we are drunk or high or sober, but does that mean that those around us are allowed to suspend their accountability and human decency simply because it’s our fault for getting drunk? No. In fact, situations like that are where our kindness is supposed to shine through. Instead of videotaping their buddies, those bystanders should have been calling an ambulance, the police, or at the very least keeping those two animals away from her.

You may question my use of that word to describe Trent Mays and Ma'Lik Richmond, but that’s exactly what they behaved like that evening. Sure, you can say that they were drunk as well, but then again, aren’t we responsible for what we do when we’re drunk? No, these boys acted with no regard for the humanity or well being of their victim. They saw something they wanted and took it. They’d been taught their entire lives that they could have everything they could possibly desire as long as they were good at throwing, catching, and hitting a couple strips of leather.

I grew up in a small Southern town, where high school football was overshadowed only by college football and church, but mostly college football. During my high school years, I served a stint on the school’s Honor Council, the committee of students tasked with trying cases of cheating on campus. In my second trial ever, we were brought what should have been a very cut and dry case. A student was caught with a cheat sheet during an exam, and the teacher turned him in. Under most circumstances, our recommended punishment, a one day suspension, would have been carried out immediately that Friday. There was one small problem, though. The defendant was not any ordinary student. He was the quarterback of the football team, with no real second string replacement. With the biggest game of the season coming up on Friday, the defendant was let off with a slap on the wrist and one early morning detention the next week.


Is this fair? No, but not just to those around this student. This young man was taught his entire life that he could do no wrong and that all his messes would be cleaned up for him, simply because he was an athlete. Yes, those students who actually work for their grades had been cheated, but they at least know how to function as ordinary human beings. When they go out into the world, they will know how to take responsibility for their actions and take care of themselves. I don’t think I can say the same of the quarterback. While his peers learned early on that their actions have consequences, he will one day have to realize this truth the hard way, much like Mays and Richmond did. He is not the one we should crucify for this travesty of school hall justice.

So who is to blame?

In short, everyone. You, me, the media, politicians, everyone is at fault. We have developed and sustained a society that teaches its youngest generation so many warped lessons. Girls are taught not to dress provocatively because it’s asking to be raped. Boys are taught to worship athletes, musicians (if you can call rappers musicians), and movie stars who sexually and physically abuse women, take illegal drugs, and routinely act as if they are above the law.

You may be thinking to yourself, “I don’t respect those people, and I certainly wouldn’t want my kids to do so, either.” Then do something about it. Sit your kids down and tell them that no matter how famous or rich or attractive they may or may not become, they are still and will always be human beings. Don’t show your boys how to hold a bat, teach them to hold themselves accountable for their actions. Take your daughters to a self-defense class, don’t tell her that she is a helpless victim. Your son deserves to know how to act as a functioning member of society, and your daughter deserves to be able to go to a party without fear.

Fortunately, a good majority of parents already do those things. However, there are still plenty of parents that need to wake up to reality themselves. These patterns in our society have taken root because plenty of people believe that their sons or daughters will grow up to be the next Peyton Manning or Beyonce. Sadly though, all these parents are doing is setting their children up to be the next Mays or Ma’Lik, so engrossed in themselves and their own wants that they harm those around them with their selfishness and lying.

Lipitor of the Soul: One Man's Response to Society's Heart Problems

Dalai's Note:  My son, Dalai, Jr., offers this response to my recent post...

Recently, my father, Doctor Dalai, wrote an article entitled “Atherosclerosis of the Soul” in which he describes “a thickening, a coarsening of whatever it is that makes us, well, us.” As a Freshman at BigBucks University, a medium sized research institution in the Midwest known for its rigorous Pre Med curriculum, I have both witnessed and experienced this phenomenon first hand. I have seen behavior that those removed from the situation would call soulless, robotic, and callous. I have watched myself and my fellow students push ourselves well beyond our breaking points with sleep deprivation, overloaded schedules, and extracurriculars. I have seen and, in many cases dealt with myself, depression, doubt, and even suicidal thoughts brought on by upcoming tests, returned grades, and vast, intangible plans for the future.

At the beginning of the semester, I studied for five or more hours a day, slept maybe four hours a night, and had an A+ GPA. I also hated every second of it. The draining hours spent in the library only reminded me that I had plenty of time to take care of my grades, but not myself. I ate terribly, saw my non-premed friends little, and kept up with the bare minimum of hygiene. Showering became an extra alarm clock to wake me up in the morning instead of a way to smell presentable.

After my first round of tests, I found myself sitting on one of the highest GPA’s on campus, with 3 A’s and a B+. But instead of the satisfaction that I had expected to follow from my success, I felt hollow and numb. I had the grades, but they meant nothing to me since they had come at the sacrifice of “whatever it is that makes us, well, us.” Staring at my 69 (a B+ on a test where the mean was in the low fifties), I realized that I had to take better care of myself. I knew that I needed to make a change, or I would explode. The problem, though, was I had no idea where to start. In high school, I had sports and other extracurriculars to keep me sane, but adding another activity to my already packed schedule would have only made things worse for me. Instead, I examined my daily routine and decided that I would focus on reshaping that to meet my needs. I started by forcing myself to sleep more each night, putting my work down by 3:00 AM and waking up no earlier than 9:00 AM. The benefits were tremendous, physically, but not mentally. I still felt overwhelmed by everything going on, resorting to shutting myself in the library all day to avoid dealing with the stress of anything beyond schoolwork. I let my already flimsy social life crumble as I simply could not handle the drama, effort, and emotional drain of being a good friend. Physically, I was never better, but my atherosclerosis of the soul was nearing terminal stage.

Almost a month of living in this empty, inhuman state left me depressed and unsure of my direction in life. I needed a change, and I needed it fast, so I began where I did with my first change. Looking over my day, I tried to find parts that I could make relaxing and peaceful. Studying was already my drug, laundry was too much of a hassle, and showering simply existed as a means to a socially acceptable end. Plenty of friends (though I’m not sure that’s the right word) offered me numerous drugs as a way of “chillaxing,” but I was far too afraid of losing my precious grades—the only prizes I really had left—to even consider taking their offers. Eventually, I remembered an article I had read years before about traditional straight shaving and its supposed meditative quality. Being in college with a minor allowance, I decided to make the fifteen dollar investment and tried it out.

Put quite simply, the results were incredible. Not only did I have the satisfaction of fighting against a steep learning curve, I had a beautiful—well, beautifully smooth anyway—final product to show for it. Unlike my classwork, I could feel my success in my hands and had immediate feedback for where I was doing well and where I needed to improve. I got to spend twenty or thirty minutes a day simply working with my hands and focusing on nothing but blade angle, pressure, and technique. My skin felt BBS—baby’s butt smooth for those of you outside the culture—all day and stayed hydrated and toned despite the bitter winters we get here.

I want to be clear that I do not think that everyone should partake in this hobby—especially those of you who shave areas more sensitive than your face. No, straight shaving is not the answer for everyone, or frankly, barely anyone. It worked for me, but only because it gave me the ability to wake up to reality. Our quick-fix, throwaway society leaves us doing things as speedily and efficiently as possible. We get more done faster, but often at the expense of our results or physical and mental well being. We slap some goo on our face, drag a disposable multi-bladed contraption across it, and run out the door for our jobs. Yes, we may be razor burnt and cut up, but that doesn’t matter as we get to our work a minute earlier so that we can read our scans, take our depositions, or crunch our data that much faster. It doesn’t matter to us if we miss a detail here or there, as is bound to happen with such a mindset, regardless of who we harm in the process. After all, we did the best we could, and if that isn’t good enough, then it’s not our fault. Therein lies the true horror of atherosclerosis of the soul. There is no responsibility and no ownership of mistakes. Not only are we hardened against everything that goes on around us, but we are totally untouched by our contribution to that torrid state of affairs.

So what can we do?

How do we snap out of it?

I don’t know. I struggle with my soul-plaque as much as the next person, even though I can now recognize it for what it is. But in the end, it’s true: the first step is admitting you have a problem.

An atherosclerotic patient has two choices: treat their disease and improve their lifestyle, or accept the possibility of total blockage and eventual death that can result. It’s easy to take pills and undergo bypasses; it’s hard to run every day and eat healthily. But in the end, it’s the long term effort that will make the difference and beat the disease, not the quick fix. Unfortunately, people have found a third option that’s even more detrimental than the second. Instead of accepting the disease for what it is and dealing with it, they have buried their heads in the sand and are indifferent to and oblivious of its existence.

As a society, maybe it’s time we realized that and decided on a change, but I don’t think that will be anytime soon. The simple truth is, it’s easy to be isolated and numb, and the vast majority of people want what’s easy. Until people wake up and decide that our humanity is worth working for, we have no choice but to wait for the heart attack.