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artsy-moonwalker · 4 years ago

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Would you go into more details about your OC’s backstories?? They all look so cool 😆

I would love to! Thank you so much for this question :)

I'm going to focus distinctly on their childhood for these descriptions.

(mentions of drug addiciton, war, and violence)

Before I get into their backstories, it is important to address their environmental situation for context.

In their childhood, there was a civil war going on within America. This is a fictional war, of course, taking place in the early 2000s. Lenis, Everest, Flint, and Darryon all have their parts to play, and the war affects the four in different ways. While Lenis, Everest, and Flint are trying to escape war from their hometown and cross the country, Darryon and his siblings are attending shelters and risk their lives trying to help in any way they can.

So now that we have some context of their biggest childhood dilemma, let's get into the four individually. I won't go into complete detail to avoid any spoilers I'd like to share later on, but I will dive into their personalities and importance. I don't know how long this post will be, but I'll try to keep it as short as I can.

Lenis, 13 years old - tall, blond, a bit tan, a distinct scar on his left jaw, brown eyes

Lenis lives in a small town in Ohio. It's a bit run down, and his house is in bad shape. Considering his family is lower class, he doesn't have much money to spend, and he gets by with what he has. He lives with his two strict parents, him being an only child. But he takes care of a stray cat that lives in a forest behind his home that he calls "Otter." Whenever he tries to get the cat to stay in the house, his parents don't allow it. They can't exactly afford to take care of an animal, especially when they have to pay for his monthly medication and doctor visits.

He has a bone condition where his bones are incredibly fragile. He can't walk for very long, and running is even worse on him. It doesn't take a lot of force to break a bone either, and he's had to visit the doctor numerous times for fractures and snaps. So he has a medication that helps him not feel the aching as much, and allows him to walk or run for a time. He is in no way a strong person. His physical strength is constantly challenged and he feels like a burden to those he loves whenever they have to make sacrifices to just to help him. Especially when it comes to his best friend, Everest.

He is always being protected by Everest. He's taken multiple punches for him, he has to carry him sometimes, he can't do a lot of outdoor activities with him due to how easy it is to get injured. Lenis hates this. He hates being held back and he hates that his best friend has to be held back too because of it. He often tells Everest that he can do things himself, but that ends with him getting hurt more than not.

Lenis really is a grateful and humble soul. He tries to find the good in every situation no matter how painful it can be. This is especially apparent for his friends. If anything is troubling them, he will do what he can to get them through it. His optimism was a lot more prominent when he was a child, though. After escaping war, he finds it difficult to find the good in bad situations. But that doesn't mean he won't try to. It's safe to say the light in his eyes are faded as he grew older.

Everest, 13 years old - short, red head, blue eyes

This is Lenis' best friend, that's how everyone at his school titles him. Because he is constantly by his side more than he is alone. He knew Lenis since he was a toddler due to their mothers being friends, and ever since then, Lenis would nickname him "Evvy." Everest was always like a brother to him. He was incredibly protective and would often put Lenis before him.

Emotions and Everest don't exactly work well together. He tends to be reserved. Cold and bitter, even. If he's showing any extreme emotion, it tends to be anger or frustration. But he has a soft spot for Lenis. He's really one of the only people around him that can make him smile. Other than his mom, of course, who he lives with down the street from Lenis. His mother was pregnant before he left home; his father having left after a short and abrupt divorce. Little information was given to him about why that occurred. But his mom was happier, and that's what he wanted. He was never close with his father anyway.

Everest knows that his protectiveness over his friends, especially Lenis, can be a fault at times. He's gotten hurt many times due to it, both mentally and physically. And it isn't even because his friends are defenseless. He knows they can protect themselves if they need to, but he cannot help himself. He can't let them get hurt if he can stop it. He speaks bluntly, and his words may go over a few lines, or he may be prone to starting arguments, but he is incredibly selfless. He means well in every action he takes despite all of that.

Flint, 12 years old - short, black buzz cut, large dark eyes

Flint is a troubled child to say the least. He's callous towards others, he seems to only care about himself, and he isn't afraid to use force and threaten violence. He was Lenis' biggest bully after ending his friendship with him in a desperate fit to steal his pain medicine. Yes, Lenis and him were friends before that. And Flint truly wanted to continue the friendship, but he needed those pills. Lenis wasn't going to just give them to him. So he had to resort to violence, thus harming Lenis, and regretting it later.

It's easy to think that maybe Flint had a drug addiction, and stole Lenis' pills because of that. But that isn't the case at all. It wasn't because of an addiction, it was for a much deeper reason.

His younger sister, Penny, was facing a horrible sickness that was going to kill her if she didn't get the right treatments. His mother, being constantly intoxicated with alcohol, spent all of her money on things she didn't need. So she couldn't afford Penny to have any treatment at all. Flint, who has been basically raising his little sister, decided to take matters into his own hands, and find any possible way to make her feel better. Even if it meant harming Lenis for some pills.

Flint loves his sister more than anyone. Or loved, at least. She unfortunately didn't make it long after the pain medicine incident.

He wants to be good, he really does. But Flint is difficult to get along with. Especially with Everest. Much like the red head, Flint has a short temper, and they always fight with each other. But also like Everest, he has a soft spot for Lenis (he is sort of like the peacemaker of the group). Flint is incredibly emotional, and he always says what's on his mind, even if they're not so nice things. He feels regretful for a lot of things, though. He's trying to be a better person, and befriending Lenis again is something he is determined to do.

Darryon, 12 years old - Average height, black curly hair, dark eyes, has an intense burn scar along his face

Darryon lives in California with his siblings, and only his siblings. His parents died in a car crash while they were on their way home from a relative's house. The war was breaking out, and they were caught up in it at the worst possible time. Darryon's oldest brother was a soldier in the war, and his oldest sister was her younger siblings' guardian while he was gone. He has five siblings, not counting himself. Three girls and two boys. And he is very close with each of them, especially his oldest sister, Carlitha. She followed shelters, and he did the same. For a long time, she was concerned for his wellbeing considering just how dangerous a job like this was. They were always venturing in war zones and had to face many hardships. But even at a young age, Darryon wanted to be part of something bigger than himself. His parents' death were a big motivator in his efforts, and he found that helping others get through the war was an effective coping mechanism.

He didn't go through these hardships without consequences, though. On one occasion, a shelter he was attending got bombed, and he was caught in the flames, leaving the brutal burn marks you see on him now. These marks filled the mouths of the other kids at his school when he tried going back. But how can anyone go back to a normal life after that? Luckily he had a good group of friends to back him up during his good and hard nights.

He has a very distinct sense of humor, and finds it easy to entertain himself when no one is around. Some of the kids at his school think he's weird because of his behavior at times. He talks to himself out loud, he has a funny laugh, he has a few imaginary friends (one stays with him even in his adulthood), etc. But he embraces those things more than anything, and his friends don't care, so why should he?

When he isn't helping at a shelter, he finds time for himself or his family. For example, he's very fascinated with nature, and enjoys drawing what he sees around him in a sketchbook. He's pretty good at it too. What started as drawings of birds or gardens soon turned into drawings of burnt landscapes and debris of towns. He liked to draw the people he would meet in shelters as well, and he kept every drawing, not knowing if that person survived after they parted ways or not.

Darryon's story does collide with the others at some point. He and his sister go to great lengths around the country, of course they're going to befriend Lenis, Everest, and Flint at some point, and it will certainly stay that way.

If you read this far, thank you! I really hope this little introduction to them has intrigued you, and if not, that's okay too :) I want to share more about them later on, and I plan to write out chapters to get the full story soon as well. I've been working on this story for more than a year now in private, and I'm really having fun, so I'm excited to share it with you. Thank you again!

#war story #lenis dosh #everest howsare #flint dean #darryon clifton #penny dean #carlitha clifton

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paint-lady · 4 years ago

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hey, if you don't mind, i want your advice: i'm going to be running a chronicle set in chicago (i am using the chicago by night 5e book) for players who are new to vampire for the most part in a few days and i can't For The Life of Me to come up with an interesting chronicle hook (yeah i have read the hooks in the book). any ideas/suggestions/general advice?

Hiya! I could talk your ears off on how I write my chronicles- so hopefully I have taken all my processes and reduced it down to a lovely World of Darkness jam.

Here are two good hooks I just came up with- feel free to use them! The third is what I got for my first chronicle, and I just think its a narrative that works very well for new players.

>Option 1: Guilty Until Proven Innocent ”Chicago is a series of paradoxes and transitions, of ever changing paradigms and whimsy,” (CbN 47). Have your coterie be newbies to the city. Ask why they have come to Chicago. Power? A new start? Perhaps this is a political arrangement between the clan of one city with another. Whatever their reason, they have arrived right when a Primogen vanishes- and guess who is first on the suspect list? The fresh faces on the streets >:) The coterie, having barely settled, has to suddenly prove their innocence. And finding evidence lets them uncover something much more sinister....

This one is ideal for new players as it sets everyone on an equal footing. Even if they create a character that has been a vampire for 50+ years and has amassed several dots of influence, herd, status- whatever, they are still new to the city. And being new means you have to start all over again. (This may be frustrating to a player that invested all those points at character creation- but it is on you as the ST to make sure they have opportunities to use those dots and on them as a player to think cleverly.)

Starting the tale off with defending their innocence is actually a very engaging questline. It effectively sets the stage for the political powerhouses. It lets new players know there are rules- and those in power are watching. It also sets the consequences for failure. Understand that the Camarilla probably isnt going to outright kill the coterie if they fail- always make the punishment just harsh and grueling enough to make final death feel like a mercy. Failure isn’t the end of the story.

For new players- I would be lenient with the time it takes for them to find evidence. But within reason. Think like your Prince and Seneschal. Do you really want this coterie running around for a full week, unsupervised, making more messes? No. You don’t. (You might wanna send an npc with them to watch and keep em out of trouble. Your npc is also able to vouch for them.)

This story lends itself to be a Camarilla Chronicle very easily. You can go Anarch, but an Anarch leader suddenly vanishing and blaming the newbies is much more quickly going to end with blood spilled. Thank your local sweeper.

> Option 2: Containment Breach Blacksite 24 (Loresheet on page 264) was temporarily occupied by Operation Firstlight. It has now been transformed into a medical research facility. While most kindred of Chicago know of Blacksite 24, they have zero clue what happens inside other than bad news for them- the less they know the safer they are. The chronicle opens with a car crash. The captured soon-to-be coterie was in transit to this feared medical facility. The crash did kill the driver and the agent in charge of transporting them. The crash did not fully break their restraints, but it did enough damage that first responders are freaking out. They are all at hunger 3. The chronicle is a hunt. The coterie should have some knowledge of what had happened to them and how lucky they are to have escaped. Operatives are already on their way to recapture them. They must hide in this city- and do their best to survive and stay out of sight.

The point of this story is to invoke dread. I highly recommend one player either being a thin-blood (or an npc) with the Daydrinker merit, or a player to have a ghoul. If they decide to not have a daywatch, they increase their chance of being found.

This story also sets up a feeling of desperation. They would be willing to take shelter from anyone- anyone. Eventually the other kindred will catch on that these guys are on the run from something. Any sane kindred would toss them out to protect themselves. A compassionate kindred who takes them in will suffer the final death as a compassionate fool- or join them in captivity.

This story lends itself to be an Anarch Chronicle much more easily. This is the time the Camarilla will likely be a bit more paranoid and bloody. While they might not outright kill the coterie- they will send them somewhere that is a death trap. They wont dirty their hands with this. After all, you do not want any evidence to fall into the hands of the SI if you hired the hit.

This story is ideal for newbies without background merits. No allies, no influence, no herd. Let them take more mythic merits such as bloodhound and unbondable (Consider finding some from V20 too! There are some really awesome supernatural merits!). These powers would certainly be more fascinating for a medical team to study- not how many instagram followers they have. This kind of story also lets your players feel more powerful- but out of the loop. It lends itself to them forging alliances and getting caught in one-sided favors a lot more quickly.

The challenging aspect of this story is that is starts with a masquerade breach. New players may not know how to handle such a blatant breach and thats okay. I would let the crash slide- and the Camarilla in the background handles it. Breaches after the crash need to be handled with proper consequences.

> Option 3: New Blood This is what my storyteller did to me and my first time players (and its also very close to the plot of CoNY). We were shovelheads. Embraced to make a huge mess for the Camarilla and die quick deaths. We were all thin-bloods. The last thing the pcs remember is the sweet rush of ecstasy washing over them, before clawing out of the earth and driven mad by an insatiable hunger. The thrill of the hunt, and the sweet, warm blood on their tongue, nothing was going to be better. All three will awake next to each other, surrounded by the corpses they drank dry in their frenzy. What a way to play the name game! The players have three nights were they figure out their new condition or coverup their tracks (if they think to do it). They contend with their hunger and hatred of sunlight, wrestle with accidentally drinking their family member dry. After three nights, the Scourge comes knocking. Rather than outright killed, they are dragged to Elysium. For some reason, they are adopted by an upstanding member of the Camarilla- or the Prince orders a political rival care for them (hoping they fail). The players are the errand childer of this kindred, and slowly they figure out what they have been gathering through all these errands....

This one lets the characters all have the moments where they discover their disciplines and powers- and bestial tendencies. It naturally flows to allow players to slowly discover the rules and mechanics as well. All players must play fledglings for this tale.

This story is much more a personal tale than a political one. Eventually politics makes its way in...but it does not have to be a focus.

This story has less of a hook and more of a “Figure it Out” survival mode until the errands begin. The story is how the character’s react to their condition. It very quickly lends itself to a narrative of finding your own path in the night, rather than mindlessly obeying.

So here are a few questions that I ask myself when crafting a chronicle story:

1. What kind of story do you want to tell? Not asking for a plot hook, I’m asking for a general concept. Is it a tale of good triumphing over evil? (Not necessarily a wrong answer, but if you wanna play good guys...vampire is not the best game for that). Is this a chase? Is this a race against time?

2. How do you want your story to make your players feel? Do you want to tell a story that invokes as much dread as possible in your players? Do you want them to feel ultra powerful? Vampire is both a power fantasy and a dread inducing game- it can do both.

3. If you don’t know what kind of story you want to tell, switch gears to worldbuilding. CbN has so many NPCs with the rumors already written for you. Its your setting, perhaps switch two rumors around with prominent NPCs. Decide which ones are true in your setting- Maybe Primogen Annabell did kill her predecessor. Perhaps the Lasombra are attempting to infiltrate the Camarilla as everyone fears- but no one is able to prove it or stop it. Deciding what is true, false, and undetermined usually blossoms into hooks and stories worth investigating.

4. What is a historical event of the city that the Vampires would have endured/ scars would have remained? For example, in my chronicle set in Richmond, the tale of the Richmond Vampire is true. Depending on who you ask, it is the Camarilla’s best or sloppiest cover up. Have the chronicle coincide with the events and the coterie live through them. No one said this must take place in 2021- you can do 2015, 2008, -hell go back the 1990s. Its actually super fun if you set your chronicle in the 90s and your Malkavian is using phrases from 2020.

5. One of my things I do when writing scenes and moments is play Dread by myself. Dread is a role playing game played with jenga. There are no dice rolls, if you want to attempt something, you have to pull pieces from the tower. If the tower falls, you die. If there is a moment where I really really really dont want to pull from the tower, though the reward for succeeding is so so sweet- I keep the moment. If its really easy to shrug and go eh, I can live without performing that action- go back and rewrite it. If you have no incentive to pull from the tower, why would they?

6. Examine your player’s desires and ambitions- and do not neglect them in your chronicle. The plot wont magically allow all of them to achieve their ambitions. However, provide opportunities for them through the plot. Its on them to strive for what their character wants- its on you to make them struggle but have the path to get there. For example, if a player wants to become a Baron, provide a political opening. Perhaps then by announcing their power, they have made a bigger name for themselves and it has become harder to hide. Perhaps by doing this, the kindred they owe a favor is suddenly much more vocal about it.

Here are some suggestions for handling new players:

> You are going to have to handhold them through some things. New players to vtm won’t be able to see the cascading political web and how the consequences of their actions will ripple into waves. I like to use Wits+Insight and call it Common Sense. Common Sense was a merit in V20- and damn is it WONDERFUL. All they need is just 1 success (they can take half) to have you explain how whatever plan they just thought of is actually a TERRIBLE idea.

> Do your RPG consent list. Know what is safe to discuss and what is off the table. I highly recommend utilizing something my Storyteller used for my first chronicle, and subsequently I use for all my ttrpgs now: Invoking the Veil. The metaphor is that you are slowly lessening the intensity of a scene- as if raising the opacity or looking through layers of fabric. Eventually, there is too much fabric and you can no longer see the scene. If something is too intense, the ST or the player may announce they are invoking the veil. Reduce the scene by lowering music, speaking in third person, or avoiding heavy descriptors. You can reduce it further to just dice rolls. Role play stops, and the consequences of the scene are solely dictated by the dice. Or fade to black. If a player is repeatedly fading to black on something- ask to talk to them about it. Clearly something is too intense and they are not having as much fun as they can. Debriefing after a session is also a good idea. Do something silly! Share and check all the memes in the discord chat. Its important to make sure you and your players know that at the end of the night- its all just a game.

> I find the sabbat and new players don’t tend to mix well. You may absolutely still use the sabbat in your chronicle! But the dogma and philosophical ideals of the sabbat can be offputting and downright upsetting to a first time player. You may absolutely build to it- that’s what I did to my players. And in the moment of the truth, they chose to cling to humanity.

> The taking half mechanic is your friend! V5 says players may announce how many dice they are rolling- and if the dividend is greater than the DC- they auto succeed. This streamlines play. Of course, you as the Storyteller may say this is a roll they are not allowed to take half on. Usually these are contested rolls (combat).

> The three turns and out rule keeps combat intense but not too lengthy. It actually streamlines encounters super super well.

> My ST used a phrase, “The quickest way to kill Cthulhu is to give it a healthbar.” If Methuselahs and Elders are involved in your game- avoid giving them stat blocks. This cultivates a conflict that new players must find a way to overcome without brute force combat. It makes them think critically and defy these super old antagonists through narrative means. This also gets the notion out of your and their heads, “if they die, its over.” Its never that easy. Never.

#steph answers questions #thanks for asking!#vtm #vampire the masquerade #vamp tag #storyteller vibes #ghostravens

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greater-than-the-sword · 4 years ago

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Hey I respect you and your opinion so I’d like to ask this if that’s okay.

I am worried about not getting the vaccine because places like India are like going up in flames because of COVID, and in the US it seems like it has largely decreased because of the vaccine. It seems like if I was in India I’d get it no question; like choosing not to get it is a first world problem type thing. I’m mainly worried about infecting others if I get sick. (I’m less worried about potential side effects down the road.)

Am I missing something? Like I feel like all I see is sources lauding the vaccine for saving us all, and like nothing else. I’m genuinely curious I’m not trying to be antagonistic. God bless!!

I appreciate your questions on this. This is a sort of long-answer question that needs a lot of background to understand why people are where they are.

For me, I come from a place of long-term distrust for both the government and the medical establishment.

Distrust for the government because we know that humans are power-hungry, power corrupts, and absolute power corrupts absolutely.

Distrust for the medical establishment due to family history and the corroborating testimony of hundreds of others who know hundreds of others in concentric, outward-reaching circles of testimony about medical incompetence and abuse. I feel like at a certain point anecdotes have meaning beyond anecdotal evidence, and indeed it is not for no reason that “anecdotal evidence” is the first step in the scientific method.

I am not saying science isn’t real and I’m not saying that all doctors are bad people or whatever I’m about to be accused of.

Actually, I think people, individuals, and their families, need to lean very heavily on data and learn about data interpretation. Who are you allowing to interpret data for you? Scientific studies are real, but who are you allowing to tell you what they mean and what you should do about it?

If you can’t interpret data, find an individual you know and trust who can interpret data. Not a news organization. Not a celebrity. And certainly not a governmental department.

The reason we have these differences is because of who people trust with their data interpretation.

Covid is a disease with a 99.7 survival rate, last I checked (not being sarcastic, I really mean last I checked). We haven’t always known that about Covid, but now we do, and I think society should revert to treating Covid the way we have historically treated other diseases with a 99.7 percent survival rate. It was never worth it to wreck society like we have, even if the ratio had turned out to be worse. I think what we’ve done showcases dramatic cowardice.

At the same time it’s my distrust for the institutions that are promoting the Covid vaccine that makes me hesitant about it. It’s also the conditions under which the vaccine emerged: tight deadlines, cutthroat politics, high pressure. The individuals that funded its development are not people I trust. And what I dislike more than all of that is a culture that normalizes social pressure to get a medical intervention. I think people’s medical decisions should be 100% their personal informed choice with their consent.

Now, are things different in India? I don’t know, but a couple things come to mind: 1) I don’t live there, so it doesn’t matter 2) if our government in “the land of the free” is shady, who can say India’s government is not shady? They have their own political issues, and this virus is nothing if not politicized.

Additionally, what may seem to be a first world problem is less so than you think. Unethical testing of vaccines on people living in third world countries is a big problem and part of the reason for my hesitancy, in fact. I don’t want those people to be subjected to that anymore than I want to be subjected to it myself.

It’s a kind of worldview, I think, and I realize it’s hard to understand jumping in at this time.

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senadimell · 5 years ago

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If you've got time to share, I'd love to hear more about your thoughts around Snape and Lupin.

@deathdaydungeon, here you are!

After a conversation with @frederick-the-great, I’ve been thinking about Lupin, Snape, and what they say about morality in HP. I’m not talking about the troublesome white hats, black hats morality, but am instead looking at from this angle: Lupin is nice and well-liked, but often lacks a backbone, whereas Snape is mean and disliked, but incredibly brave. Which is more important? I find Harry’s last sacrifice to be a useful point by which we measure their impact.

Lupin and Snape useful to compare on several important fronts.

As foils for each others’ teaching methods

The way they deal with social disadvantage

Their connections to Harry’s father and how they pass on James’ legacy

1) They both teach at Hogwarts, and are foils for each other in many ways. Snape is mean and takes away points. He’s seen as selfish. His classes are hard and unpleasant for Harry. He’s mean to Neville, and rather than encouraging him, mocks him and belittles him, which just adds to the overall disaster of Neville’s poor self-esteem mixing badly with potions class.

However, even Umbridge admits that Snape’s teaching methods work, and she’s working for Fudge who doesn’t like Death Eaters and has been defied by Snape in GoF, so we know he’s effective for a lot of people, if not Neville.

Yet, for all that, Snape saves Harry’s life multiple times. On top of that, Snape wants to keep the fact that he saved Harry’s life a secret.

“Very well. Very Well. But never--Never tell, Dumbledore! This must be between us! Swear it, I cannot bear...especially Potter’s son...I want your word!

My word, Severus, that I will never reveal the best of you? Dumbledore sighed, looking down into Snape’s ferocious, anguished face. “If you insist...”

DH 679, The Prince’s Tale

Conversely, Lupin is nice and rewards points. He’s seen as generous. His classes are fun and interesting for Harry. He’s kind to Neville, and expresses confidence in him that leads him to succeed and do well. That confidence is a huge part of Neville’s character development. I doubt he’d grow into the resistance leader in DH if not for the many times teachers expressed confidence in him, like Dumbledore in PS, Lupin in PoA, Fake!Moody in GoF, and Harry in OotP. Harry certainly approves of his methods:

“You’re the best Defense Against the Dark Arts teacher we’ve ever had!” said Harry. “Don’t go!”

PoA 424, Owl Post Again

However, it’s worth noticing that Hermione does worse on his exam than we ever see. She fails the Boggart test, and she and Harry were the only two people not permitted to experience the Boggart in class. Lupin’s teaching methods aren’t foolproof. Despite that, he’s overall seen as a nice guy and good teacher.

Yet Lupin endangers Harry’s life. The secrets he keeps are dangerous: his secret to keep is that he’s a werewolf and actively endangered three students lives with his negligence, as well as the fact that he hid a secret about a believed and convicted mass murderer to save face with Dumbledore.

“That was still really dangerous! Running around in the dark with a werewolf! What if you’d given the others the slip, and bitten somebody?”

“A thought that still haunts me,” Lupin said heavily. “And there were near misses, many of them. We laughed about them afterwards. We were young, thoughtless--carried away with out own cleverness.

“I sometimes felt guilty about betraying Dumbledore’s trust, of course....he had admitted me to Hogwarts when no other headmasters would have done so, and he had no idea I was breaking the rules he had set down for my own and others’ safety. He never knew I had led three fellow students into becoming Animagi illegally. But I always managed to forget my guilty feelings every time we sat down to plan our next month’s adventure. And I haven’t changed...

Lupin’s face had hardened, and there was self-disgust in his voice. “All this year I have been battling with myself, wondering whether I should tell Dumbledore that Sirius was an Animagus. But I didn’t do it. Why? Because I was too cowardly. It would have meant admitting that I’d betrayed his tryst while I was at school, admitting that I’d led others along with me...and Dumbledore’s trust has meant everything to me. He let me into Hogwarts as a boy, and he gave me a job when I have been shunned all my adult life, unable to find paid work because of what I am. And so I convinced myself that Sirius was getting into the school using Dark Arts he learned from Voldemort, that being an Animagus had nothing to do with it...so in a way, Snape’s been right about me all along.”

PoA 355, Moony, Wormtail, Padfoot, and Prongs

Plan is emphasized because those trips that ended in “near misses” weren’t some impulsive romp. They were planned and coordinated in advance.

“I just saw Hagrid,” said Harry. “And he said you’d resigned. It’s not true, is it?”

“I’m afraid it is, said Lupin. He stared opening his desk drawers and taking out the contents.

“Why?” said Harry. The Ministry of Magic don’t think you were helping Sirius, do they?”

Lupin crossed to the door and closed it behind Harry.

“No. Professor Dumbledore managed to convince Fudge that I was trying to save your lives.” He sighed. “That was the final straw for Severus. I think* the loss of the Order of Merlin hit him hard. So he--er--accidentally let slip that I am a werewolf this morning at breakfast.”

“You’re not leaving because of that!” said Harry.

Lupin smiled wryly.

“This time tomorrow, the owls will start arriving from parents ....They will not want a werewolf teaching their children, Harry. And after last night, I see their point. I could have bitten any of you...That must never happen again.

“You’re the best Defense Against the Dark Arts teacher we’ve ever had!” said Harry. “Don’t go!”

PoA 424, Owl Post Again

What strikes me about this conversation is how Lupin shifts the blame around. This doesn’t start with an admission of guilt. He’s not leaving because the parents are right. He’s not leaving because he’s seen how dangerous he can be, or because he owns up to making an incredibly dangerous decision. He’s leaving because Snape forced his hand. If Snape didn’t do that, he would do the same thing he’s always been doing: sweeping his misdoing under the rug and promising himself privately that he’s going to change, but never doing it.

It’s always someone else’s fault for Lupin. That’s a neat tie in to the next point of comparison:

2. Lupin and Snape both experience marginalization in wizarding society, but in very different ways. Lupin faces socio-legal** marginalization and Snape faces socio-economic marginalization.

Lupin’s a werewolf. We see how prejudice affects his life, from his inability to find a job and his worn out clothes to his people-pleasing nature. He’s always acting nice and harmless. He does nothing to play into the condemning stereotypes he’s faced since childhood. Despite that, he still can’t find a job. Nobody will hire him, and people are scared to interact with him. From the way he talks about werewolves, it’s implied that this prejudice is held blindly across Wizarding society. Both Ron and Hermione are horrified to learn Lupin’s a werewolf. *** Later on, he’s legally limited in the kinds of jobs he holds and the kind of magic he’s allowed to perform. Lupin has no control over his transformations, and did not choose his condition.

Lupin’s not really wrong when pities himself. The odds really are stacked against him when he’s treated as if he’s a wolf 24/7, not just a few predictable times a month. His prospects are honestly awful.

The problem is, his condition is dangerous. Thus, the issue of victim blaming is particularly thorny for Lupin. He can’t just accept that he’s a monster for something he has no say over, and yet he can’t escape the fact that sometimes he is monstrous for reasons out of his control. He feels guilty for the people he could have hurt, but also seems to resent that people blame him for something that’s not his fault. The problem is that he carries that lack of accountability into spheres where he should be accountable, like not taking his medication and endangering children because of it.

Snape’s story is very different. He is poor in both the wizard and muggle worlds, and half-blooded, and was sorted into Slytherin as a child. He doesn’t have one condition against him, but checks boxes that make it hard for any one side to accept him. He’s too impure and poor to survive on his own for the Slytherin, but is a Slytherin with Death Eater friends and housemates interested in dark magic, which means he’s never going to fit in with the Order of the Phoenix crowd, especially when some of its members torment him at school. ****4

This essay makes a convincing point that the wizarding world is not a meritocracy, and that people like Snape need powerful patronage to advance if they don’t have the money to support themselves.

I don’t consider the sorting a proper choice. I know Harry does, but I’m of the opinion that at age 11, very few people have been taught how to analyze different perspectives and make an informed decision. Most 11-year-olds are trained to obey their parents and accept their family’s ideology. Harry’s choice rests on very little evidence--most of what he knows is what Hagrid told him, and that he doesn’t want to be sorted into Voldemort’s house along with Draco Malfoy, someone who reminds him of Dudley. I don’t think Snape was very informed either (I’d love to know why), because he doesn’t realize why it Lily wouldn’t be sorted into Slytherin.

“You’d better be in Slytherin,” said Snape, encouraged that she had brightened a little. DH 671, The Prince’s Tale

Either the pureblood rhetoric just wasn’t strong in those days, or his mother didn’t tell him about that.

...“Where are you heading, if you’ve got the choice?”

James lifted an invisible sword.

“’Gryffindor, where dwell the brave at heart!’ Like my dad.”

Snape made a small, disparaging noise. James turned on him.

“Got a problem with that?”

“No,” said Snape, though his slight sneer said otherwise. “If you’d rather be brawny than brainy--”

DH 671-2, The Prince’s Tale

It seems that most people just follow familial preferences. As to why Snape wants to be in Ravenclaw over Slytherin, my preferred interpretation is that he had a family legacy, knew that Slytherin rewarded the ambitious and clever, and that Slughorn, the head of Slytherin house, had a knack for making the kind of connections that a poor, clever boy would need to succeed.

Nevertheless, once Snape was in Slytherin, the odds were stacked against him. The house in that era was full of people who would later be Death Eaters. “Dark Magic” wasn’t frowned upon among his housemates, and siding with Voldemort wasn’t yet widely acknowledged as a transgression by wider society.

“No, no, but believe me, [Sirius’ parents] thought Voldemort had the right idea, they were all for the purification of the wizarding race, getting rid of Muggle-borns and having pure-bloods in charge. They weren’t alone either, there were quite a few people, before Voldemort showed his true colors, who thought he had the right idea about things.…” OotP 112

Additionally, people like Bellatrix were in the years above him, and given how Fred and George acted with younger students, I think it’s highly likely younger students had to find a place in the hierarchy or be the target of ‘pranks.’ He was a halfblood, after all, and dirt poor.

Snape knew these people. He ate with them, slept with them, and went to class with them. It is so much easier to understand and befriend someone you spend time with. I’d say that most people who subscribe to problematic ideologies aren’t just awful to be around all the time, or else these movements wouldn’t gain any traction. They’re likely funny and nice to be around if you’re not on their bad side.

In addition to strong peer pressure to befriend the people who would be death eaters, he was also bullied four to one. His bullies received protection from the headmaster when he was nearly killed or permanently maimed. They were popular and well liked.

The best analogy I’ve heard to describe Snape's Hogwarts situation is that he’s a kid in a rough neighborhood who joins the local gang. It provides protection and the hope of social mobility, and from his perspective, the other gang fights just as dirty (his treatment by the marauders). He doesn’t stop to think that the system is flawed, or that the gang’s very existence indicates the failure of authority and threatens its members. He just sees himself as a kid with nothing who needs help with protection and advancement. We know that Voldemort hasn’t shown his true colors, and it’s possible he showed different faces to different people.

‘Now, yer mum an’ dad were as good a witch an’ wizard as I ever knew. Head Boy an’ Girl at Hogwarts in their day! Suppose the myst’ry is why You-Know-Who never tried to get ’em on his side before ... probably knew they were too close ter Dumbledore ter want anythin’ ter do with the Dark Side.

‘Maybe he thought he could persuade ’em ... maybe he just wanted ’em outta the way. All anyone knows is, he turned up in the village where you was all living, on Hallowe’en ten years ago. You was just a year old. He came ter yer house an’ – an’ –’ (“The Keeper of the Keys”)

Dumbledore’s cited as the reason they turned him down, not their blood status. I think there’s evidence that the wholesale anti-muggleborn campaign wasn’t a huge part of the first wizarding war, and wasn’t implemented until the second, even if there was anti-muggle propaganda. (Muggle=/=muggleborn). It’s implied that Tobias is abusive and that Snape hates him for what he did to him and his mother; it’s implied that faced class prejudice by the muggles around him as well:

“I know who you are. You’re that Snape boy! They live down Spinner’s End by the river,” she told Lily, and it was evident from her tone that she considered the address a poor recommendation.

DH 665, The Prince’s Tale

When you read stories about people who are able to escape cycles of gang violence and poverty, there’s almost always someone who lifts them out. There’s someone who pushes them, or extends a hand, or believes in them. There are community outreach programs, or churches, or an English teacher that pushed them to do better and try out for a scholarship. That person is usually someone who knows what it’s like and knows how hard it is to get out.

Snape doesn’t seem to get that support anywhere. Slughorn doesn’t seem to notice him, for whatever reason. Lily doesn’t approve of his friends, but also doesn’t understand at all what the pull is--that it’s hard to swim against the current of what everyone else is saying, despite the fact that she feels the same pressure to end her friendship with Snape.

“… thought we were supposed to be friends?” Snape was saying. “Best friends?” “We are, Sev, but I don’t like some of the people you’re hanging round with! I’m sorry, but I detest Every and Mulciber! Mulciber! What do you see in him, Sev, he’s creepy! D’you know what he tried to do to Marry Macdonald the other day?”

DH 673, The Prince’s Tale

In the very same conversation, the fact that Snape is not allowed to share what happened to him with Lupin and the werewolf incident means that Lily will never be able to understand what Snape is facing: That the leader of the good guys makes excuses for and protects people who recklessly endanger the lives of others.

“And you’re being really ungrateful. I heard what happened the other night. You went sneaking down that tunnel by the Whomping Wollow, and James Potter saved you from whatever’s down there--”

Snape’s whole face contorted and he spluttered, “Saved? Saved? You think he was playing the hero? He was saving his neck and his friends’ too!...”

DH 674, The Prince’s Tale

Later in the year after SWM, she tells Snape this:

“None of my friends can understand why I even talk to you.”

DH 675 The Prince’s Tale

She expects him to reject all of his classmates and stand against the tide, despite the fact that she knows how hard it is to do that and can’t comprehend why he sticks with his classmates. She expects him to be grateful to James Potter as if what he did was altruistic, because the Headmaster swore Snape to secrecy and he keeps his promises, despite the fact that someone else was spreading the story. (The fact that she says she heard it instead of talking about it like its common knowledge implies that she heard it from a friend, so our friends the Marauders likely weren’t keeping their lips zipped even if Snape was.)

I don’t say this to shift the blame away from Snape to Lily in regards to Snape joining the Death Eaters. I just want to point out that Lily wasn't someone who could help him break the cycle. He didn’t squander some chance she offered him. She just wasn’t enough to break him out--not empathetic, motivated, or well-informed enough. (I think the fact that they were peers plays a big role in that).

Ultimately, Snape did choose to join the Death Eaters. He did yield to peer pressure. He did obey his assignment and report the prophecy to Voldemort. He spent his youth yielding, following the path in front of him, and choosing what was probably the easier choice: stick with your group, find powerful friends, do what they want, and don’t ask too many questions about their methods. That’s what makes his decision to betray Voldemort so powerful to me.

Here’s part of the passage when Snape betrays Voldemort:

...The adult Snape was panting, turning on the spot, his wand gripped tightly in his hand, waiting for something or for someone...His fear infected Harry too, even though he knew that he could not be harmed, and he looked over his shoulder wondering what it was that Snape was waiting for--

Then a sliding, jagged jet of white light flew through the air. Harry thought of lightning, but Snape had dropped to his knees and his wand had flown out of his hand.

“Don’t kill me!”

DH 676, The Prince’s Tale

He was terrified. He knew he was caught between the world’s two most powerful wizards, but it was worth it if he could save his childhood friend.

Then when Lily dies:

“Her son lives. He has her eyes, precisely her eyes. You remember the share and color of Lily Evans’s eyes, I am sure?”

“DON’T!” bellowed Snape. “Gone...dead...”

“Is this remorse, Severus?”

“I wish..I wish I were dead....”

“And what use would that be to anyone?” said Dumbledore coldly.

DH 678, The Prince’s Tale

Whatever motivation Snape had before is gone. A person’s life who is not his own is worth more than his own, and he’s drowning in guilt. From now on, Snape works to be useful in saving Harry’s life, and later many lives, at risk of death. His choices are a black mark on his record, likely making it difficult for him to get a job when he’s been tried as a Death Eater, and all of his wizarding connections are Death Eaters or their associates. He has no money or influence. Dumbledore hires him.

So Lupin has a single ailment and faces constant social and legal discrimination. He constantly tries to undermine people’s expectations about werewolves by being mild, but unfortunately is too afraid of rejection and its consequences to stand up against bad behavior or take full responsibility for his failings. He has friends who support him, but do it by engaging in risky behavior. He does not stop them. Perhaps he fears exposure and expulsion. Perhaps he just likes belonging for once. Either way, he does not come clean until forced to.

Snape is different; instead of facing outright rejection, he’s from a poor background and grows up surrounded by peers who join something somewhere between a gang and a cult while being bullied by people groomed by a rival organization. The headmaster of his school supports the rival organization and swears him to secrecy about an incident when they endangered his life, sending the message that his life is worthless. That same group continues to publicly bully him. He continues down this path until he realizes that it endangers something he cares about, and makes a decision that puts him at risk of being killed by the two most powerful wizards alive. He changes course.

Snape seems to view his problems as challenges facing him, whereas Lupin sees his problems as part of who he is, and not something he can change. Lupin seems to accept what happens to him in a fatalist kind of way. He sees what happens as inevitable and somewhat out of his control, whereas Snape never seems to blame his circumstances for him becoming a death eater, even though they clearly limited his options. I think that attitude matters. However, because Lupin’s facing a fictional magical malady, it’s difficult to fully blame him for that attitude.

Both Lupin and Snape have to react to powerful societal pressure that makes it difficult for them to succeed. Comparing them is apples and oranges at best, because their circumstances were so different. I don’t think you can judge either’s morality based on group identity, though.

3. Finally, they both act as a window on James: who he was, and what he means to Harry, who never knew him. That means in some way, they help pass on his parental legacy to orphaned Harry.

Hogwarts is Harry’s home, which means that the teachers are more than just teachers, but play a symbolic parental role in his life.

Hogwarts was the first and best home he had known. He and Voldemort and Snape, the abandoned boys, had all found home here.

DH 697, The Forest Again

You can’t understand Harry without realizing what he lacks: a loving home and living parents. He’s always looking into the past to find his parents, and is saddled with a legacy he struggles to understand--why did he live, who were his parents, and what does he need to do now?

Lupin and Snape also share a connection with Harry that goes beyond a normal teacher-student relationship, unlike McGonagall or Flitwick. Snape and Lupin are more personally connected to Harry than the other professors because they know Harry’s parents and went to school with them. I will mostly focus on James from here on out since we know so little about Lily personally and Harry mostly tries to emulate or avoid his father’s behavior and legacy.

They’re also the last people who knew James to survive, and they die almost at the same time. They’re the only teachers apart from Dumbledore who give Harry private lessons. More importantly, these lessons are all tied thematically to Harry’s past. Harry’s experience with dementors and the patronus charm are his first re-encounter with his parents and his past.

Terrible though it was to hear his parents’ last moments replayed inside his head, these are the only times Harry had heard their voices since he was a very small child. But he’d never be able to produce a proper patronus if he half wanted to hear his parents again.

PoA 243, The Patronus

In the end of PoA, Harry sees himself and mistakenly thinks it’s his father.

“Come on!” he muttered, staring about. “Where are you? Dad, come on--”

But no one came. Harry raised his head to look atet he circle of dementors across the lake. One of them was lowering its hood. It was time for the rescuer to appear--but no one was coming to help this time--

And then it hit him--he understood. He hadn’t seen his father--he had seen himself--

Harry flung himself out from behind the bush and pulled out his want.

“EXPECTO PATRONUM!” he yelled.

PoA 411, Hermione’s Secret

So the patronus itself is linked up with Harry’s past, and his coming-of-age. He doesn’t rely on others to save him, but must do it himself. (Though Harry’s never really trusted the adults to save him.) It’s interesting to note that Harry actually learns the Patronus charm under Lupin’s tutelage.

On the other hand, Snape introduces Harry to the unpleasant side of his father’s legacy. Through Snape, we see that James wasn’t just a little cocky, but a bully.

“Apologize to Evans!” James roared at Snape, his wand pointed threateningly at him. “I don't want you to make him apologize,” Lily shouted, rounding on James. “You're as bad as he is.” “What?” yelped James. “I'd NEVER call you a--you-know-what!” “Messing up your hair because you think it looks cool to look like you've just got off your broomstick, showing off with that stupid Snitch, walking down corridors and hexing anyone who annoys you just because you can--I'm surprised your broomstick can get off the ground with that fat head on it. You make me SICK.” She turned on her heel and hurried away.

....

He had no desire at all to return to Gryffindor Tower so early, nor to tell Ron and Hermione what he had just seen. What was making Harry feel so horrified and unhappy was not being shouted at or having jars thrown at him; it was that he knew how it felt to be humiliated in the middle of a circle of onlookers, knew exactly how Snape had felt as his father had taunted him, and that judging from what he had just seen, his father had been every bit as arrogant as Snape had always told him. OotP, Snape’s Worst Memory, emphasis added

It’s interesting note that Harry fails to learn Occlumency from Snape. (In fact, we never see Harry use magical skills he learned from Snape apart from Expelliarmus, which is...important). At the same time, he gains an important perspective.

You can’t have James without this part of him. However kind James was to Lupin, however brave James was when he saved his wife, he was neither kind nor brave when he bullied Snape. It’s uncomfortable and awkward, but it’s important.

When he had finished, neither Sirius nor Lupin spoke for a moment. Then Lupin said quietly, “I wouldn’t like you to judge your father on what you saw there, Harry. He was only fifteen —”

“I’m fifteen!” said Harry heatedly.

OotP

Harry rejects the idea that actively bullying someone is just folly of youth. He knows what it’s like to be disenfranchised. Regardless of what Snape and James’ relationship was, he didn’t deserve that kind of humiliation. And Lupin watched, and defends him. Harry has to grapple with that.

Ultimately, Snape and Lupin do more than just connect him to his past. They also teach him his two signature spells, Expelliarmus and Expecto Patronum. One saves his soul, and one saves his life and frees the wizarding world from Voldemort because of Voldemort’s fractured soul.

Snape and Lupin as moral counterpoints

How do we evaluate this:

“I’d never have believed this,” Harry said. “The man who taught me to fight dementors--a coward.”*****5

DH 213, The Bribe

and this?

“Albus Severus, you were named for two headmasters of Hogwarts. One of them was a Slytherin and he was probably the bravest man I ever knew.

DH 758, Seventeen years later

Ultimately, I don’t think it’s really that useful to pit two people with different backgrounds against each other. At the same time, they represent two different halves of a question: when it comes down to it, should we try to be kind or brave? I don’t think you have to pick one, but when pursuing the two, there are bound to be moments of conflict.

I always come back to the lyrics to Last Midnight from Sondheim’s Into the Woods.******6

You're so nice You're not good You're not bad You're just nice I'm not good I'm not nice I'm just right I'm the witch You're the world

Snape doesn’t care about being nice. I think this is where most non-Snape fans start pulling out the pitchforks and torches. Snape isn’t nice, and he’s not nice to kids. He’s not nurturing.*******7 He’s abrasive, allergic to coddling, and petty when he can get away with it. In fact, most of the people he’s ‘nice’ to are significantly more powerful than him, or someone he needs to be on good terms with.

Lupin is nice. He’s mild. He’s often kind. However, he often picks being liked over standing up for something.

What does that result in? He doesn’t stand up for Snape. The bullying continues and keeps Snape firmly on his path. He wins the respect of the Gryffindors with the Snape Boggart incident but loses whatever credibility he had to tell Snape to ‘put their past behind him.’

On the other hand, Neville’s bravery in DH was nurtured by Lupin’s confidence. Neville kept hope alive and led a rebellion. Lupin is one of the few adults that Harry fully respects and trusts up until the Grimmauld place confrontation. (He likes Hagrid and Molly, but doesn’t necessarily trust them to make decisions in their best interest, while he usually respects Lupin’s judgement). Harry loves him, and it’s because he loved him and watched him die that he needs to act and fight back against Voldemort.

Ultimately, Harry’s relationship with James and the adults who pass on his legacy is one of the most important symbolic relationships in the book. The thematic resolution of the series is Harry’s act of sacrificial love.

He did not know what to feel, except shock at the way Snape had been killed, and the reason for which it had been done....

...He could not bear to look at any of the other bodies, to see who else had died for him. He could not bear to join the Weasleys, could not look into their eyes, when if he had given himself up in the first place, Fred might never had died...

He turned away and ran up the marble staircase. Lupin, Tongs...He yearned not to feel....He wished he could rip out his heart, his innards, everything that was screaming inside of him.

To escape into someone else’s head would be a blessed relief....Nothing that even Snape had left him could be worse than his own thoughts.

DH 660-662, The Prince’s Tale

He rushes to the headmaster’s office to escape into Snape's memories. His memories convince Harry that sacrificing himself is the expedient thing to do, and he heads to the Forbidden Forest. To enable is last sacrifice, he uses the Resurrection stone to witness his parents and his father’s friends. Their combined testimony is enough to ameliorate his personal fears about following through with this final act.

Lupin and Snape leave entirely different legacies behind. Lupin encourages and inspires. As an authority figure, he gives people like Neville space to grow and his compassion towards Harry gives him the strength to face his demons. Harry’s decision in DH to die must have something to do with the kindness he was shown, and the sacrifices people who loved him made for him, of which Lupin is a part. Despite what he saw in Princes’ Tale, Snape wasn’t one of the people who’d make an appearance with the Resurrection stone.

Yet Snape sacrificed his life for Harry and the wizarding world, entities that Snape didn’t seem to like and that certainly weren’t kind to him. His form of bravery is about endurance, tenacity, and willingness to do what is right even when you hate your allies and no one else is going to credit you for what you do. And that’s very Harry. Even if he hates Draco, he’s not about to let him die if he can help it. Harry has much more in common with Snape than Lupin, I think.

Since this is about souls, let’s return to the Patronus charm. Snape’s not the kind of person who typically inspires that kind of emotion required to cast a Patronus in others, at least from what we see in Harry’s perspective. Yet because he has experienced that love, he can cast it and shows Harry what needs to be done. Snape enables Harry to dive under the ice. Lupin’s the kind of person who can inspire a patronus, but isn’t the one to make the sacrifice play until after Harry confronts him about his duty to his family. Ultimately, though, they both sacrifice themselves in the Battle of Hogwarts.

* Ever since I realized how blatantly tangential Order of Merlin must be to Snape’s character motivation, that line has frustrated me to no end. There’s no way frothing-at-the-mouth PoA Snape just really coveted that Order of Merlin. He’s often petty, yeah, but if Lupin believes it’s just about that and has nothing to do with Snape’s real conviction about how dangerous Lupin’s actions were, he’s deluding himself. I hate that he passes it on to his students.

**Yes, I am making up words today. Lupin’s faces prejudice and discrimination on a social level enforced by increasingly powerful discriminatory laws.

*** It’s worth noting that if we take every book as equally valid canon, then there’s either widespread ignorance towards lycanthropy, as Lockhart convinces everyone he was able to “cure” the Wagga-Wagga werewolf, and as teenage Horcrux!Riddle said Hagrid raised werewolf cubs under his bed, or else lycanthropy is actually a wide range of conditions under a wolfy umbrella ranging from treatable to incurable. Lupin is our primary source for lycanthropy: he’s the one who tells us about Greyback, for example. If we hold the first two books as equally valid, then perhaps we only know about Lupin’s particular type of condition. That’s the Watsonian analysis, anyways.

****4 These footnotes are getting ridiculous. Basically, there’s no consensus on what Dark Magic is, and on what basis it’s Evil. This essay goes into things that are labelled as curses. I’m inclined to believe that the vast majority of Dark Magic is just Magic We Don’t Like for Reasons.

The definition of what is and isn't considered Dark Magic is never explained: often it just seems to mean "a curse I don't approve of". Even "curse" has never been satisfactorily defined, but we can certainly say that not all curses are regarded as evil, since some appear to be on the Hogwarts curriculum, and are certainly performed without censure.

*****5 While I paired the quotes at the top of this section together for dramatic effect, it’d be a shame not to look at the context of the Lupin fight.

“I thought you’d say [that your mission was top secret],” said Lupin, looking disappointed. But I might still be of some use to you. You know what I am and what I can do. I could come with you to provide protection. There would be no need to tell me exactly what you were up to. Harry hesitated. It was a very tempting offer.

Hermione then asks about Tonks.

“I’m pretty sure my father would have wanted to know why you aren’t sticking with your own kid, actually”... ...“I’d never have believed this,” Harry said. “The man who taught me to fight dementors--a coward.”

...“Parents shouldn’t leave their kids unless--unless they’ve got to.”

...“I know I shouldn’t have called him a coward.”“No, you shouldn’t,” said Ron at once. “But he’s acting like one. “ “All the same...” said Hermione.

“I know,” said Harry. “But if it makes him go back to Tonks, it’ll be worth it, won’t it?”

He could not keep the plea out of his voice. Hermione looked sympathetic, Ron uncertain. Harry looked down at his feet, thinking of his father. Would James have backed Harry in what he had said to Lupin, or would he have bene angry at how his son had treated his old friend?

DH 213, The Bribe

Harry feels personally betrayed that someone who has a family and child would abandon them. Here he is unyielding and accusing to someone he cares about in the hopes that they re-evaluate what matters. It’s a rather Snape-like tactic, actually. Or else a Dumbledore one.

I love the dialogue in this scene, but have some major issues with how Harry’s internalization drops out the window for shock value. JKR does the same thing when has Harry pull the Veritaserum trick in HBP. I don’t like it.

******6 The witch and Snape aren’t perfect analogues, since she’s decidedly more amoral in my opinion, but they’re both contractually-motivated characters whose humanity is shown by their (platonic/familial) love for a more “innocent” character and the guilt at the innocent character’s sacrificial death. Guilt doesn’t lead the witch to do anything productive, and for Snape it does, which is where they diverge on the character path.

*******7 Draco may be an exception to this. However, watching Snape struggle to build rapport with Draco in HBP leads me to think that while Snape’s been on Draco’s side, he’s still not “nurturing,” or in other words, good at cultivating trust and encouraging the strong and wholesome parts of someone’s personality to grow.

#hp meta #snape #pro snape #severus snape #remus lupin #i haven't figured out how to make this appear above the cut...

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sideblogformindtrash · 5 years ago

Text

A PLANT GUIDE TO ALTERNATIVE FOOD SOURCES/PLANT BASED MEDICINE/POISONOUS HERBS

FOR WHEN YOU ARE A 15th CENTURY PEASANT AND GOING TO THE DOCTOR WILL KILL YOU BECAUSE NO ONE HAS WASHED THEIR HANDS IN A MONTH.

This post ended up huge.

DISCLAIMER CAUSE I DON’T WANT ANYONE TO GET SICK BECAUSE THEY ATE BAD LEAF:

Natural medicine is a fascinating topic and it carries a rich history of survival, culture and human history.

It is also a valuable source of insight for traditional medicine – it is often by searching the traditional, plant or nature based solutions and researching the active compounds on them that regular medicine can be crafted. These sciences are allies, they aren’t enemies, and the end goal is, always, to save lives.

HOWEVER it is NOT a replacement for traditional medicine. Traditional medicine works on isolating and amplifying components that are proven to be the source of the healing properties of plants and other things, both increasing the chances of obtaining a result and reducing the collateral effects, as well as monitoring people on a close and safe environment were any side-effects particular to that individual, caused by other pre-existent conditions, can be taken in consideration and dealt with by professionals. Dosage is also a very important factor that has to be considered. Doctors are equipped to deal with that. Everything can be a poison in excess.

By this, I mean to say if you go around using this info to justify selling mlm essential oils or being antivaxx I’ll personally haunt you once I’m dead. Natural medicine can be an interesting addition to conventional treatments if used responsibly, but it is not a replacement and is not to be used if you have no clue what you are doing. Please don’t go outside to eat random leaves and don’t trust random moms on facebook, their ‘research’ is far less than what I did for a tumblr post :’)

I can’t stress this enough: this is intended as a writing resource and not to be used in real life or as a guide. Don’t eat/use plants you don’t know. Please don’t. I’m also not a medical professional, I’m a plant nerd :)

And – a lot of this comes from oral traditions passed on by family. So shoutout to my grandma. Most of it is stuff you should be able to verify with a quick google search and I expent the day doing just that as well as gathering more info; I can link more trustworthy sources than Wikipedia if someone is interested, but they are mostly not in English.

ALSO, as a note: Popular plant names are NOT RELIABLE and vary greatly among regions, besides, they often are used to refer to a great number of species of the same genus; when in doubt always check the scientific name of the plant as that is standardized globally and taxonomists work hard to keep it concise.

Go to the doctor if you are sick please please please please please please please please please please please please please please :)

And just one more little note: I live in South America, that’s the flora I’m most familiar with. I know very little about European and Oceanic flora; but I reckon a lot of these might be similar to Asia and North America since a bunch of these plants are invasive species originated from Asia that have adapted well and spread around the continent.

Ok, first part is medicine second part is poison.

Some general info:

TO MAKE A BALM: You’d need some sort of animal fat or vaselin + a triturated mix of the correct plant parts and bee wax. Fat needs to be melted first, then you’d add the plant mix and lastly the bee wax; it needs to be constantly mixed until it gets the balm consistency and then filtered.

HOW TO MAKE A POULTICE: It’s basically just the mashed ingredients + something to make it slightly moisty; it largely depends on what it is exactly but it could be water, milk, coconut oil or animal fat. The paste is to be spread over a warm wet cloth and wrapped around the wound.

ON TEAS: A lot of the time you will need the fresh plant leaves and not the dried versions they sell on little sacks; Or they might both work, but likely to different things. Different parts of the plant might have different effects.

ACTIVATED CHARCOAL: It’s the go-to emergency poison retardant. It has the characteristic of being an adsorptive; this means other particles tend to cling to its surface and later be expelled with it. It can cause vomiting and nausea. Regular charcoal has been used historically for the same reasons. Eating the charcoal may interfere with other medications the person might be on.

A Few Non-Conventional Edible Plants and Medicinal Herbs:

-Pereskia aculetea: Popular names are lemonvine; blade-apple cactus; leaf cactus; rose cactus; fruits, flowers and leaves are edible and has high-nutritional value. Depending on how it’s prepared, the leaves taste somewhat like fish. The flowers are sweet, and can be used in baking cakes and pies. They have sharp thorns on the fruits and branches. It is a good emergency food-source as it causes a fulfilling sensation and can be consumed raw.

Tea made with the leaves is good for the intestinal flora. It is anti-inflamation and helps ulcers heal. Can be used externally if the leaves are triturated and mashed into a paste. The fruit is anti-oxidant;

Stanchys byzantina + some others of the genus: Known as Lamb’s ear. It’s cute and fluffy. It also tastes like fish if fried on butter. Making tea with the leaves can help with cough and throat irritation. Helps with stomachache and indigestion.

-Mentha sp. – MINT! Everyone loves mint. It smells nice and is fresh. It helps with colds and is effective against parasites such as giardia and amebas. The tea has to be made with fresh leaves for it to be effective, not dried ones.

-Arnica sp. – NOT EDIBLE AND CAN BE TOXIC IF INGESTED. Small amounts can be used as a spicy however is not recommended. However, it’s a very good topical painkiller; can be used as a balm, a poultice or on lack of other options, making a strong tea and infusing a clean piece of cloth on it then applying to the sore muscles can work.

-Calendula sp. – It’s edible but not exactly tasty, a little spice I’d say. A balm can be made from it that is very good on cuts and bruises.

-Begonia cucullata – Known as wax begonia. It’s all edible, but calcium rich so should be avoided by someone with kidney problems.

-Portulaca oleracea – The Poultice is good against acne and insect stings; helps with inflammation and tea can be used against intestinal parasites. Slightly cooked leafs can help with burns (1º degree burns, don’t apply on anything worse). The seeds are specially good against parasites. Leaves, flowers and seeds are edible.

-Conyza canadensis / bonariensis – The Horseweed. Leaves are edible. They taste spicy-ish. Can help treat hemorrhoids and diarrhea.

-Echinodorus grandiflorus: This one is common of wetlands and water proximity. The crushed rhizomes can be put over the skin to alleviate rashes and hernias. Tea made with the fresh leaves is a diuretic and laxative; is also good against throat inflammations. Cold tea can help with skin conditions as well. Leaves are very bitter, the rhizome is somewhat sweet.

-Hedychium coronarium: White-ginger-lily or garland flower; It is common on wetlands or near water sources. The rhizomes and flowers are edible (leaves aren’t), flowers usually consumed as sort of a jam and the rhizomes as flowers. Helps with throat inflammations and pain. Oil made from this plant can be slightly sedative.

-Cymbopogum winterianus: Citronella; or Lemon Grass. NOT EDIBLE. It’s super sticky to the touch, makes your hands sticky too and very easy to get cuts from it because the leaf blades are somewhat sharp. A poultice of the leaves can be used on cuts, but the better use for it is as a natural repellent. Mosquitoes and other insects hate this plant. Just by having it planted somewhere near is very unlikely they’ll approach; candles can be made from it and incenses too.

- Pampinella anisum – Commonly known as aniseed and actually easy to find as dried leaves or the seeds. The dry leaves tea help with cold and throat swelling. Poultices and the essencial oil can be good as a relaxant; Tea made from fresh leaves is good for insomnia, nausea and stomachache. Tea made with the seeds can be used against intestinal parasites; breathing the vapor helps clean a constipated nose.

-Plantago major – Probably the most common one on this list and one of the best. Called great plantain or broadleaf plantain. Leaves are diuretics; help against inflammations and help soothe stomachaches and diarrhea. Everything but the roots are edible. Tea helps with cold.

-Ilex paraguaiensis – Yerba-mate or just matte. Has a very good nutritional value. People drink the dried leaves tea like water in Brazil and it’s very good for cooking sweets. It is slightly stimulant(high caffeine teor) and highly antioxidant. The fruits and leaves are nutrient rich; can be good on fighting anemia; has some effect against caries inducing bacteria and is effective against certain types of fungi; it only grows in forested areas because it is very sensitive to sunlight.

-Xanthosoma sagittifolium – Arrowleaf Elephant’s Ear. Rhyzomes, leaves and haste are edible BUT ONLY IF COOKED. Tastes similar to spinach. When they are raw, they have oxalic acid and are somewhat toxic. Is somewhat good against fever. A fried leaf can be used as a wrap over burns.

-Hibiscus sabidariffa - Slightly sour tasted tea made from the leaves; have a diuretic effect. Can be used as a natural pigment on other foods.

-Pistia stratiores – Water lettuce. It looks like a lettuce and it floats. Can be consumed as a juice, infusion or used as a poultice on hernias. HOWEVER I’d recommend never using any found on nature. Floating plants are being studied as having absorbent qualities and helping filter toxins and heavy metals from water, so much so they can make part of sewage treatment.

Dangerous/Poisonous Plants:

General treatment idea: A very generic idea of how poisoning is treated would be the administration of activated charcoal and a gastrointestinal wash depending on how long ago has been the ingestion. Mucosa can be treated/washed with products like egg whites, milk and olive oil in small quantities. Eyes are washed with water and saline. Most poison’s don’t have antidotes, so everything else would be treating the specific symptons. Catheterization may be needed on cases where the urinal tract is paralyzed because it’s important to keep the person hydrated. Laxatives may also be used in cases where it is safe. Everything largely varies with the specifics of each compound. On many of them inducing vomit might be worse.

PLANTS:

Brugmansia spps.: Known as Angel Trumphet; Angel’s Tears or Snowy Angel’s Trumpet. This plant likes high-humidity, so in a dry climate, it might indicate proximity to water sources. The in-nature form of this plant is highly toxic; every part of it being leaves, flowers trunk or roots. Seeds and leaves are specially dangerous. Can induce a trance-like and delusional estate as well as induce visual and auditory hallucinations; can cause paralysis of smooth muscles, confusion, dry mouth, pupil dilation and paralysis of the eyes. Can lead to death; severity varying depending on part of the plant ingested as well as the age of the plant and hydration state. They start from 15 to 30 minutes after ingestion.

Euphorbia milii.: Known as Christ’s Thorn; Crown of Thorns or Christ Crown. Honestly this one’s strength is the aesthetic. It has thicc thorns, pretty red flowers and I’m pleading you all to put it on a Whumpee’s head. It’s a moderate poison compared to the others; Inside the whole plant there is a white latex substance that is toxic. It causes skin and mucosa irritation. It can cause severe stomach-ache. Can lead to blindness if non-treated eye contact occur. If ingested, can cause severe stomach-ache and ulcers. The latex is very sticky to the touch.

Dieffenbachia spp: Similar to the one above without the fun thorns.

Zantedeschia aethiopica: The Calla Lily. In contact with mucosa’s it causes swelling and irritations; feelings of burn, nausea, vomit and diarrhea; difficulty swallowing and can cause death by asphyxiation due to internal swelling of the digestive system that in turns compresses the pharynx. ALSO: This is not exactly widespread knowledge I think, but this plant is hallucinogen and like 2-3 years ago the tea has been used as kind of a drug around here. However, this plant does not work as other popular recreational hallucinogens; it causes damage to the central nervous system and even if used just once, the user might never recover from it. What I heard from people who did try it, is that the hallucinations tend to be really bad and on the negative side.

Cicuta maculata – If you want to be dramatic and die like Socrates I guess. Its poison was used for execution in ancient Greece.

Calladium spp. – It’s ALSO called Elephant’s ear. See what I mean by common names not being reliable? Irritation, pain and swelling of tissues. All parts of the plant are poisonous. If ingested can lead to death due to swelling of throat/tongue.

‘Curare’ – this is actually not just one plant, but a mixture of several made into poison for darts and arrows. The Strynchnos and Chondodendron genus are the most important. It was used for hunting, but considered bad practice on war. Causes paralysis of the external body and some of the main internal systems killing the prey by asphyxiation. The person responsible for producing the poison was very likely to die due to being exposed to toxic fumes, because it was needed to cook the tree-barks during two to three days. Someone hit by the poison can survive if artificial respiratory methods are available until the poison-effect passes.

Potatoes – I’m not even going to elaborate on this one but raw and green potatoes = bad; however cultivated potatoes are way less toxic than the wild variations and the most poisonous plant parts are the leaves;

Aesculus hippocastanum – A horse chestnut seed, bark, flower and nut can cause poisoning when consumed raw. Causes muscle twitching, weakness, loss of coordination; vomiting; kidney problems and stupor. It slows the formation of blood cloths and might worsen the condition of hemorrhagic wounds.

Agave sp. – The flowers are edible and the saps can be used for an alcoholic beverage. But the saps cause pain and burning in contact with the skin; it will also start to develop blisters soon after the exposure. The healed skin tends to remain sensitive and have reoccurring itchy for years after the contact. Ingesting the saps might be fatal.

Anemonoides nermorosa – Wood anemone. All parts of the plant contain protoanemonim, it can cause irritation and burning sensation to skin; ulceras on the mouth; vomiting blood and nausea.

OK that should be it for today, but it isn’t even the surface. If anyone wants to expand or correct something on this, I encourage you to do so. Just don’t eat the leaf. Please don’t.

Not all but some of the sources (again, not english): here; here; here; here; here; here; one that IS in english and a shoutout for wikipedia cause why the hell not and one to my grandma who is a lovely lady who hates just about everything in the world.

#whump writing #whump scenario #whump writing resource #whump #im ded

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thanksjro · 5 years ago

Text

More Than Meets the Eye #18- Rung Psychologically Tortures a Man with Poor Snack Management

So, Swerve’s having a less than stellar day, and for once it isn’t linked to his deep-rooted sense of self-loathing.

Good thing he already emptied those stills, otherwise this would be just the hugest mess.

Thanks to some off-panel Whirl shenanigans that took place prior to this storyline, Swerve had Brainstorm put in a few security measures. Of course, Brainstorm being Brainstorm, never does weaponry in any half-measures.

Still, it isn’t quite enough. Looks like Swerve’s going to have to break out the big guns for this guy.

There’s a lot going on here, so let’s break it down.

On the character side of things, it would appear that Swerve is a merciful god of robot booze, as he’s not yet banned anyone from his small business, even when he probably ought to- Fort Max I get, and Whirl has the whole “is also an Autobot” thing going on, but Cyclonus has actively attempted to murder Swerve in the past, and also is the closest thing to a Decepticon they’ve got on the ship at any given time.

On the weaponry side of things, it would seem that Swerve having blown his face clean off his skull back in issue #12 got back to Brainstorm, who- because he’s married to his career and loves a project- immediately got to work on a gun that Swerve could actually handle with his funky little cartoon-man hands. Of course, that doesn’t mean Swerve’s going to get away with his dignity intact, oh heavens no! This thing has a literal smiley face slapped on the front of it. Well, you know what they say: it’s Nerf or Nothing.

Swerve blasts a hole in the Legislator with his silly, silly gun, and the bar is saved from further destruction.

I like to imagine that Brainstorm recorded that victory line himself, because he wants to support his friends, in his own, bizarre way.

Things are looking rough for the rest of the Lost Light, as the Legislators have completely flooded the ship with their forces, as the crew do their best to fight them off. Blaster’s had his titty compartment blasted open. Huffer is screaming. The medics have taken to violence. Skids has broken out the brass knuckles and is making god-awful math puns. The Legislators are still coming, without any end in sight. It’s a real shitshow.

Over on Luna 1, it would appear that Ratchet immediately passed out after seeing Pharma, which is a fair response to seeing someone who’s supposed to be very much dead, I think. Pharma calls Lockdown, they have a bit of banter, and then the scene moves on to whatever Cyclonus and Whirl are doing.

Because these two are the only ones on the away team who can actually fly, they’ve broken off from the rest. Whirl’s getting antsy, and decides he’s gonna fight something. Cyclonus, though he does mention that Rodimus told them not to do exactly what Whirl is suggesting, seems to agree with this line of thought.

Speaking of Rodimus, him and the rest of the gang are zipping around on those M.A.R.B.s, though it appears as if some of the passengers have switched drivers. Rung’s over with Chromedome now, holding on to him for dear life. Maybe they’re having an impromptu grief counseling session as they run from danger. Tailgate’s with Rodimus, and he’s just pointed out that Ratchet got left behind. Rodimus can’t deal with that right now, though, and decides that they need to get away from all these gotdang Decepticons and then figure out their next step.

Then he’s distracted by the literal lineup of dead Titans just hanging out on the moon.

Luna 1’s kinda fucked up.

Cutting back to our framing device- nope, still haven’t gotten caught up with the present yet- Ambus asks what Rodimus did next. Well, a lot happened. A lot. Chromedome jumped out of his therapy session with Rung and transforms into his alt, which I want to say is the only time he’ll do it in MTMTE. Whirl and Cyclonus are faffing about in the sky, more or less toying with the Decepticons following them. Rodimus wants to pull another Fantastic Voyage, much to Tailgate’s horror.

Rodimus zooms into the first crack he sees, but doesn’t manage to lose his attackers. Tailgate provides commentary, as Rodimus wraps the little guy around his neck like a cape, leaps from the M.A.R.B., and does some super sick gymnastics, hanging from a pipe jutting out of the ceiling as the guys who were chasing them run into… well, I assume each other, but it’s not terribly clear.

Crisis avoided, Rodimus drops down, transforming as he does. Tailgate goes with him, because gravity is still a thing on the moon, and we get a reminder that he’s only got a couple days left to live. Unfortunately, it would appear he’ll be spending his final days rotting in a prison cell, as Lockdown shows up with everyone else in handcuffs, forcing Rodimus to come quietly. Everyone seems very put out by this whole situation, especially Brainstorm. He’s downright furious, probably because he got captured by the guy with a fish butt on his head.

Oh, the indignity of it all!

Then again, maybe he’s just focused on working up the cajones to ask just what the hell is going on on this super weird moon. Lockdown obviously isn’t a bad enough dude to be running this operation- we saw what happened the last time he went against someone who actually had the time to plan something out- so our away team has deduced that there’s someone higher up on the food chain here. Also, there’s the whole issue of money clearly being a major factor in all this.

That sort of tech doesn’t just fall out of the sky.

As they’re being walked down this corridor of tension building, Chromedome spies Ultra Magnus in an adjoining hallway. He calls to him, but is very solidly ignored. But there’s no time to worry about Magnus being a rude shit, because it’s time for character reveals!

There’s an interesting little detail about Tyrest’s character, which is a little hard to see given the layout of the art for this page, but here it is, on the end of his staff:

Now, I know that the Autobot badge was appropriated from a symbol meant to represent Primus, but that was millions of years ago. So much for being a neutral party, huh Tyrest?

Rodimus is real peeved about being chased, shot at, arrested, and held against his will, and fully intends to give Tyrest a piece of his mind. Tyrest isn’t interested, however, telling him to shove a sock in it, or be “held in contempt.” While this is happening, Perceptor and Brainstorm have noticed the positively humongous and positively ancient space bridge that Tyrest just has lying around in this room.

Oh no, this is about the baby field from last issue, isn’t it? Brainstorm’s going to jail for infant arson.

Rodimus greatly dislikes this whole situation, and expresses himself through the art of verbal abuse. Smash cut to them back in the cell, Ambus not seeming terribly impressed with how Rodimus handled himself with Tyrest.

The tale is finished, we know where we were. Now how to move forward?

Chromedome asks for a bit more information on our new friend, because the whole “Ambus” thing is throwing him off, and with good reason: how do you tell your late husband’s ex that you had to blow up your mutual partner to keep him from being eaten by a lippy bastard? But this isn’t the illustrious Dominus Ambus- this is MINIMUS Ambus, the lesser known brother. Chromedome/Dominus isn’t completely taken off the table, however, as Minimus uses some awkward phrases that seems to tell me Dominus isn’t confirmed dead.

Rung wants to know what Minimus’ whole deal is, seeing as he’s also in prison with the lot of them. Minimus explains that he’d been moving a shipment of energon derivatives, when Tyrest had arrested him for having traces of space cocaine in his goods.

Was taking his eye really necessary, Tyrest?

Minimus was placed into custody years ago, and has been awaiting trial this whole time. Not exactly sure why, seeing as this moon isn’t exactly off the chain populated. Maybe Tyrest’s just been busy doing things that are absolutely NOT nefarious in any form or fashion whatsoever.

Minimus mentions that he’s lost his Autobot badge, and Rung offers to let him borrow his own- which we’ve never seen him wear because it’s apparently too big for him- but Minimus would rather he wear it himself.

Tailgate doesn’t take to this bit of information about the appeals system very well, seeing as he’s not got years to wait around. He’s beginning to panic, not trusting Cyclonus and Whirl to break them out, and starts needling the others to do something. Brainstorm reveals that his briefcase, which he’s had this entire time, as he always does, has an attention deflector built into it, making it effectively invisible to Tyrest and his goons. Rung feels a certain kinship with the briefcase in that moment.

Imagine walking up to a widower and saying “Hey there, honeybunches, how about submitting to that crippling addiction your late spouse begged you to quit so we can bust out of prison?”

Of course, Tailgate’s only told Cyclonus about his condition, so no one’s exactly raring to go busting out, since they’ve assumed everyone present is effectively immortal.

Over on another part of the moon, Ratchet’s finally waking up from his stress-induced nap to find Pharma channeling his inner Jigsaw. Ratchet gives him some constructive criticism on his new hands, but Pharma’s kind of over listening to whatever Ratchet thinks.

Oh, I hope it’s one of those gag gifts where you open it and get hit in the face with a pie. Those are always a laugh.

Back on the Lost Light, Swerve is looking for his very best friend in the whole wide world. I really hope the feeling is mutual, because there’s no way Swerve would survive that sort of rejection.

The doors to the oil reservoir open, looking like the elevator scene from The Shining, and we see what’s become of our dear, dear Skidsy.

Skids is pretty sure all this Legislator nonsense is because of him, and he’s not about to let people die for his sorry butt today, no siree. He’s gonna save the day.

Then again, this is about where Star Saber pops into existence behind him and stabs him through the spine, so maybe not.

Behold, a bastard!

Star Saber in the IDW run is well-known as being a witch-hunting zealot who can and will commit acts of violence over any perceived slight against Primus he identifies in any given living creature. This is a stark removal from his original character, who is so pure-hearted, kind, and generous, he literally adopted an orphan to raise as his own son. So, what exactly happened here?

TMUK happened.

Back in the days before Roberts was a professional scriptwriter, back before IDW had the license for Transformers, the members of the TMUK fan group decided that Victory’s Star Saber was going to be evil. Why isn’t exactly clear, only that it was a decision that was made not by Roberts on his lonesome, but more as a collaborative effort. Of course, this Star Saber isn’t a one-to-one copy of the TMUK Star Saber- that guy was much more conniving and, uh, Hitler-y, than what we have here.

Getting back to the story, Swerve tries to save/avenge Skids, firing with his custom gun, only to miss every single shot.

Looks like there’s going to need to be a rework on the My First Blaster.

Swerve gets beaned over the head with the butt of Star Saber’s sword for his troubles, his visor shattering in the process. Damn, sure hope he’s got a reading prescription, and not anything he’ll actually need to see.

Back over on the moon, Ratchet’s pretty uninterested in playing Pharma’s little game. It’s just as well though, because, as it turns out, Pharma’s an impatient guy. Must be an absolute nightmare during the holiday season and birthdays. He throws open the box, revealing what’s inside.

THAT IS NOT PIE.

But we saw Ratchet’s face over on the other side of the room. How can he be in two places at once? Well, here’s the thing about Transformers…

They’re pretty darn hard to kill.

Back in the cell, Rung’s doing his part as a member of the away team by passing out snacks. Tailgate reveals his awful garbage disposal mouth. We get the down-low on Tyrest.

Once upon a time, Tyrest was an engineer. Then the war happened, shit got crazy, and suddenly he was organizing exoduses and peace talks with genocidal maniacs, and got appointed Chief Justice by the space pope himself.

Rodimus comes over to get in on the little snack party Rung and Tailgate are having, mentioning the Aequitas Trials- the very ones that were recorded onto Ironfist’s brain back in Last Stand of the Wreckers. Minimus comes over, warning Rodimus to keep hush-hush about those, since they’re top secret and all. Kind of a weird thing for you to do, Minimus. Hell, why do YOU know about these super secret trials, Mr. Nobody Trader Guy? Those were after Dominus disappeared, so it’s not like you had an in through your cool older brother.

Rodimus gives everyone the skinny on the trials, despite Minimus being weird about the whole thing.

Perceptor knows all this already, but I suppose it’s possible Rodimus is the only son of a gun who isn’t subscribed to Wreckers: Declassified and isn’t aware of Perceptor’s whole deal.

Minimus moves the topic over to the crew of the Lost Light, latching on to Skids specifically the moment he’s mentioned. Rung does his due diligence and offers Minimus a ride on the snack train. Minimus declines, Rung insists, and the box of space pocky is dropped on the floor.

Minimus goes to help Rung pick up the snacks, as Rung actively hinders the clean up effort.

Minimus is two seconds from snapping Rung’s scrawny little wrist like a toothpick if he doesn’t quit it. Luckily Rodimus is there to break up this positively bizarre situation. And then things get really weird.

Rung’s been watching Minimus since they got here, noticing things that were very familiar- speech patterns, mannerisms, tone, inflection, OCD behaviors, things like that. Once he developed enough of a hunch, Rung started intentionally antagonizing him by making a mess and putting his Autobot badge on in a way that isn’t up to standards. Why would he do this? Why would he want to cause an outburst in someone he just met?

Well, the thing is, he hasn’t just met Minimus Ambus. He’s actually been serving under him for the last year.

That’s a rather dark use of your doctorate, Rung, forcing a man to reveal his true identity by poking at his mental health until he was about to snap your neck over some candy. You did it so well, too.

Maybe you were on Kimia for more than just psych evals. What was your career officially called again? Psyops specialist is what they have listed on the Wiki. Truth be told, I don’t even know what that entails. Let’s look it up, shall we?

...I guess therapy is his side gig?

So either Roberts meant something else entirely, or Rung is actually super fucking scary.

#transformers #jro #mtmte #remain in light #issue 18 #maccadam #Hannzreads #text post #long post #overthinking about robots #incoming analysis #comic script writing

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didanawisgi · 4 years ago

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Medicine’s Fundamentalists

The randomized control trial controversy: Why one size doesn’t fit all and why we need observational studies, case histories, and even anecdotes if we are to have personalized medicine

BY NORMAN DOIDGE

AUGUST 14, 2020

If the study was not randomized, we would suggest that you stop reading it and go on to the next article. —Quote from Evidence-Based Medicine: How to Practice and Teach EBM

Why is it we increasingly hear that we can only know that a new treatment is useful if we have a large randomized control trial, or “RCT,” that has positive results? Why is it so commonly said that individual case histories are “mere anecdotes” and count for nothing, even if a patient, who has had a chronic disease, suddenly gets better with a new treatment after all others failed for years—an assertion that seems, to many people, to run counter to common sense?

Indeed, some version of the statement, “only randomized control trials are useful” has become boilerplate during the COVID-19 crisis. It is uttered as though it is self-evidently the mainstream medical position. When other kinds of studies come out, we are told they are “flawed,” or “fatally flawed,” if not RCTs (especially if the commentator doesn’t like the result; if they like the result, not so often). The implication is that the RCT is the sole reliable methodological machine that can uncover truths in medicine, or expose untruths. But if this is so self-evident, why then, do major medical journals continue to publish other study designs, and often praise them as good studies, and why do medical schools teach other methods?

They do because, as extraordinary an invention as the RCT is, RCTs are not superior in all situations, and are inferior in many. The assertion that “only the RCTs matter” is not the mainstream position in practice, and if it ever was, it is fading fast, because, increasingly, the limits of RCTs are being more clearly understood. Here is Thomas R. Frieden, M.D., former head of the CDC, writing in the New England Journal of Medicine, in 2017, in an article on the kind of thinking about evidence that normally goes into public health policy now:

Although randomized, controlled trials (RCTs) have long been presumed to be the ideal source for data on the effects of treatment, other methods of obtaining evidence for decisive action are receiving increased interest, prompting new approaches to leverage the strengths and overcome the limitations of different data sources. In this article, I describe the use of RCTs and alternative (and sometimes superior) data sources from the vantage point of public health, illustrate key limitations of RCTs, and suggest ways to improve the use of multiple data sources for health decision making. … Despite their strengths, RCTs have substantial limitations.

That, in fact, is the “mainstream” position now, and it is a case where the mainstream position makes very good sense. The head of the CDC is about as “mainstream” as it gets.

The idea that “only RCTs can decide,” is still the defining attitude, though, of what I shall describe as the RCT fundamentalist. By fundamentalist I here mean someone evincing an unwavering attachment to a set of beliefs and a kind of literal mindedness that lacks nuance—and that, in this case, sees the RCT as the sole source of objective truth in medicine (as fundamentalists often see their own core belief). Like many a fundamentalist, this often involves posing as a purveyor of the authoritative position, but in fact their position may not be. As well, the core belief is repeated, like a catechism, at times ad nauseum, and contrasting beliefs are treated like heresies. What the RCT fundamentalist is peddling is not a scientific attitude, but rather forcing a tool, the RCT, which was designed for a particular kind of problem to become the only tool we use. In this case, RCT is best understood as standing not for Randomized Control Trials, but rather “Rigidly Constrained Thinking” (a phrase coined by the statistician David Streiner in the 1990s).

Studies ask questions. Understanding the question, and its context, is always essential in determining what kind of study, or tool, to use to answer those questions. In the “RCT controversy,” to coin a phrase, neither side is dismissive of the virtues of the RCT; but one side, the fundamentalists, are dismissive of the virtues of other studies, for reasons to be explained. The RCT fundamentalist is the classic case of the person who has a hammer, and thinks that everything must therefore be a nail. The nonfundamentalist position is that RCTs are a precious addition to the researcher’s toolkit, but just because you have a wonderful new hammer doesn’t mean you should throw out your electric drill, screwdriver, or saw.

So let’s begin with a quick review of the rationale for the “randomized” control trial, and their very real strengths, as originally understood. It’s best illustrated by what happens without randomization.

Say you want to assess the impact of a drug or other treatment on an illness. Before the invention of RCTs, scientists might take a group of people with the illness, and give them the drug, and then find another group of people, with the same illness, say, at another hospital, who didn’t get the drug, and then compare the outcome, and observe which group did better. These are called “observational studies,” and they come in different versions.

But scientists soon realized that these results would only be meaningful if those two groups were well matched in terms of illness severity and on a number of other factors that affect the unfolding of the illness.

If the two groups were different, it would be impossible to tell if the group that did better did so because of the medication, or perhaps because of something about that group that gave it an advantage and better outcome. For instance, we know that age is a huge risk factor for COVID-19 death, probably because the immune system declines as we age, and the elderly often already have other illnesses to contend with, even before COVID-19 afflicts them. Say one group was, on average, 60 years old, and all the members got the drug, and the other group was on average 75 years old, and they were the ones that didn’t get the drug. Say that when results were analyzed and compared, they showed the younger group had a higher survival rate.

A naive researcher might think that he or she was measuring “the power of the medication to protect patients from COVID-19 death” but may actually have also been measuring the relative role of youth, in protecting the patients. Scientists soon concluded there was a flaw in that design, because we do not know, with any reasonable degree of confidence, whether the better outcomes were due to age or the medication.

Age, here, is considered a “confounding factor.” It is called a confounding factor, because it causes confusion, because age can also influence the outcome of the study in the group as a whole. Other confounding factors we know about in COVID-19 now include how advanced the illness is at the time of the study, diabetes, obesity, heart disease, and probably the person’s vitamin D levels. But there could easily be, and probably are, many other confounding factors we don’t know, as of yet. There are even potential confounding factors that we suspect play a role, but are not quite certain about: the person’s general physical fitness, the ventilation in their home, and so on.

This is where randomization is helpful. In a randomized control trial, one takes a sufficiently large group of patients and randomly assigns them to either the treatment group, or the nontreatment (“placebo” or sugar pill) control group, for instance. Efforts are made to make sure that apart from the treatment, everything else remains the same in the lives of the two groups. It is hoped that by randomly assigning this large number of patients to either the treatment or nontreatment condition, that each of the confounding factors will have an equal chance of appearing in both groups—the factors we know, such as age, but also mysterious ones we don’t yet understand. While observational studies can, with some effort, match at least some confounding factors we do understand in a “group matched design” (and, for instance, make sure both groups are the same age, or disease severity), what they can’t do is match confounding factors we don’t understand. It is here, that RCTs are generally thought to have an advantage.

With such a good technique as RCTs, one might wonder, why do we ever bother with observational studies?

There are a number of situations in medicine in which observational studies are obviously superior to randomized control trials (RCTs), such as when we want to identify the risk factors for an illness. If we suspected that using crack cocaine was bad for the developing brains of children, it would not be acceptable to do an RCT (which would take a large group of kids, and randomly prescribe half of them crack cocaine and the other half a placebo and then see which group did better on tests of brain function). We would instead follow kids who had previously taken crack, and those who never had, in an observational study, and see which group did better. All studies ask questions, and exist in a context, and the moral context is relevant to the choice of the tool you use to answer the question. That is Hippocrates 101: Do no harm.

Now, you might say that a study of risk factors is very different from the study of a treatment. But it is not that different. There can be very similar moral and even methodological issues.

In the 1980s, quite suddenly, clinicians became aware that infants were dying, in large numbers, in their cribs, for reasons that couldn’t be explained, and a new disorder was discovered, sudden infant death syndrome, or SIDS, or “crib death.” Some people wondered if parents were murdering their children, or if it was infectious, and many theories abounded. A large observational study was done in New Zealand that observed and compared factors in the lives of the infants who died and those who didn’t. The study showed that the infants who died were frequently put to sleep on their tummies. It was “just” an observation. But on that basis alone, it was suggested that having infants sleep on their backs might be helpful, and that parents should avoid putting their infants on their fronts in their cribs. Lo and behold, the rates of infant death radically diminished—not completely, but radically. No sane caring person said: “We should really do an RCT, rule out confounding factors, and settle this with greater certainty, once and for all: All we have to do is randomly assign half the kids to be put to bed on their tummies and the other half on their backs.” That would have been unconscionable. The evidence provided by the observational study was good enough.

Again, all studies have a context and are a means to answering questions. The pressing question with SIDS was not: How can we have absolute certainty about all the causes of SIDS? It was: How can we save infant lives, as soon as possible? In this case, the observational study answered it well.

The SIDS story is a case where we can see how close, in moral terms, a study of risk factors and a study of a new treatment can be in a case where the treatment might be lifesaving. Putting children on their tummies is a risk factorfor SIDS. Putting them on their backs is a treatment for it. The moral issue of not harming research subjects by subjecting them to a likely risk is clear.

Similarly, withholding the most promising treatment we have for a lethal illness is also a moral matter. That is precisely the position taken by the French researchers who thought that hydroxychloroquine plus azithromycin was the most promising treatment known for seriously ill COVID-19 patients, and who argued that doing an RCT (which meant withholding the drug from half the patients) was unconscionable. RCT fundamentalists called their study “flawed” and “sloppy,” implying it had a weak methodology. The French researchers responded, in effect saying, we are physicians first; these people are coming to us to help them survive a lethal illness, not to be research subjects. We can’t randomize them and say to half, sorry, this isn’t your lucky day today, you are in the nontreatment group.

There are other advantages to observational studies in assessing new treatments. They are generally lower in cost than RCTs, and can often be started more quickly, and published more rapidly, which helps when information is needed urgently, as in a novel pandemic when little is understood about the illness. (RCTs, in part because of the moral issues, take longer to get ethics approval.) Observational studies are also easier to conduct at a time when patients are dying in high numbers, and hospital staff is overwhelmed, trying to keep people alive. They can involve looking back in time, to make use of observations in the medical chart. In such cases, it is crucial that the initial observations about how patients responded to the medications and treatments that the staff had on hand is documented, in as systematic as way as is possible, because there might be clues and nuggets as to what worked.

Exclusion Criteria: Do RCTs Study Real-World Patients?

But there are also problems at the conceptual heart of the RCT. Often the RCT design sees “confounding factors” not simply as something that has to be balanced between the treatment and no-treatment groups by randomization, but eliminated at the outset. For a variety of reasons, includinga wish to make interpretation of final results more certain, they aggressively eliminate known confounding factors before the study starts, by not letting patients with certain confounding factors get into the study in the first place. They do this by often having a lot of what are called “exclusion criteria,” i.e., reasons to exclude or disqualify people from entering the study.

Thus, RCTs for depression typically study patients who only have depression and no other mental disorders, which might be confounding factors. So, they usually study people who are depressed but who are not also alcoholic, not on illicit drugs, and who don’t have personality disorders. They also tend to exclude people who are actively suicidal (because if they are, they might not complete the expensive study, and some people think it is unethical to give a placebo to a person in acute risk of killing themselves). There are many other reasons given for different exclusions, such as a known allergy to a medication in the study.

But here’s the problem. These exclusions often add up until many, maybe even most, real-world depressives get excluded from such a study. So, the study sample is not representative of real-world patients. Yet this undermines the whole purpose of a research study “sample” in the first place, which is to test a small number of people (which is economical to do), and then extrapolate from them on to the rest of the population. As well, many studies of depression and drugs end up looking at people who are about as depressed as a college student who just got a B+ and not an A on a term paper. This is why many medications (or short-term therapies) end up doing well in short-term studies, but the patients relapse.

If you are a drug company (which pay for most of these studies) and you’re testing your new drug, exclusion criteria can be made to work in favor of making your drug appear more powerful than it really is, if sicker patients are eliminated. (This is a good trick, especially if your goal of making money from the drug is your first priority.)

This isn’t a matter of conjecture. This question of whether RCTs, in general, are made up of representative samples has been studied. An important review of RCTs found that 71.2% were not representative of what patients are actually like in real-world clinical practice, and many of the patients studied were less sick than real-world patients. That, combined with the fact that many of the so-called finest RCTs, in the most respected and cited journals, can’t be replicated 35% of the time when their raw data is turned over to another group that is asked to reconfirm the findings, shows that in practice they are far from perfect. That finding—that something as simple as the reanalysis of the numbers and measurements in the study can’t be replicated—doesn’t even begin to deal with other potential problems in the studies: Did the author ask the right questions, collect appropriate data, have reliable tests, diagnose patients properly, use the proper medication dose, for long enough, and were their enough patients in it? And did they, as do so many RCTs, exclude the most typical and the sickest patients?

Note, other study designs also have exclusion criteria, but they often are less problematic than in RCTs for reasons to be explained below.

The Gold Standard and the Hierarchy of Evidence

So, why is it we also hear that “RCTs are the gold standard,” and the highest form of evidence in the “hierarchy of evidence,” with observational studies beneath them, and case histories, at the bottom, and anecdotes beneath contempt?

There are several main reasons.

The first you just learned. It had been believed that RCTs were a completely reliable way to study a treatment given to a small sample of people in a population, see how they did, and then one could extrapolate those findings to the larger population. But that was just an assumption, and now that we have learned the patients studied are too often atypical, we have to be very careful about generalizing from an RCT. This embarrassment is a fairly recent finding that has yet to be taken fully into account by those who say RCTs are the gold standard.

The second reason has to do with the fundamentalists relying on outdated science, which argued that RCTs are more reliable in their quantitative estimates of how effective treatments are because they randomize and rule out confounding factors.

But a scientist who wanted to know if RCTs, as a group, were universally better and more reliable than observational studies at truth-finding would actually study the question scientifically, and not just assert it. And, in the 1980s, Chalmers and others did just that, examining studies from the 1960s and 1970s. They found that in the cases where both RCTs and observational studies had been done on the same treatment, the observational studies yielded positive results 56% of the time, whereas blinded RCTs did so only 30% of the time. It thus seemed that observational studies probably exaggerated how effective new treatments were.

Three other reviews of comparisons of observational and RCT study outcomes showed this same difference, and so researchers concluded that RCTs really were likely better at detecting an investigator’s bias for the treatment being studied, and hence more reliable. Since many scientific studies of drugs were paid for by drug companies that manufactured those drugs, it was not a surprise that the studies would have biases. These reviews formed much of the basis for RCT fundamentalism.

Just because an RCT is performed and published is no reason to assume it doesn’t exaggerate efficacy.

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But here’s the problem: These were reviews of studies that were done in the 1960s and 1970s. Once the observational study researchers became aware of the problem, they upped their game, and improved safeguards.

In 2000, new reviews comparing the results from hundreds of RCTs and observational studies in medicine that had been conducted in the 1990s were conducted by scientists from Yale and Iowa College of Medicine. They found that the tendency of observational studies to suggest better results in treatments had now disappeared. They now got similar results to RCTs. This was an important finding, but it has not been sufficiently integrated into the medical curriculum.

There is another reason we hear about RCTs. As RCTs became the type of study favored by regulatory bodies to test new drugs, they rose to prominence, and drug companies upped their game and learned many ingenious ways to make RCTs exaggerate the effectiveness of the drugs they are testing.

Entire books have been written on this subject, an excellent one being Ben Goldacre’s Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients.Since, to bring a drug to market requires only two RCTs showing the drug works, these techniques include doing many studies but not publishing the ones that don’t show good results. But there are sneakier techniques than making whole studies with negative outcomes go missing. There are ways to publish studies but hide embarrassing data; publish the good data in well-known journals and the negative findings in obscure journals; not study short-term side effects; almost never study, or ask about, long-term side effects; or play with measuring scales, so that patients appear to achieve statistically meaningful benefits which make no clinical difference. If you do a study that gives you a bad outcome on your key measure, don’t report that, just find some small outcome that was in your favor and retroactively change the goal of the study, to report that benefit and that alone. Make researchers and subjects sign gag clauses and nondisclosures. Have the drug companies ghostwrite the papers, make up the tables, and get academics, who never see the raw data sign them. This is routine.

The list goes on, and those tricks have often been used, successfully, to gain approval for drugs. Becoming very familiar with these ruses can save lives, because in a pandemic, new drugs will earn Big Pharma billions because the illness is so widespread, and they have a large playbook to draw from. Once two RCTs are selected from the many done to take the drug forward, the propaganda campaign begins, and as Goldacre shows, drug companies spend twice as much on marketing as they do on research. So, to repeat, just because an RCT is performed and published is no reason to assume it doesn’t exaggerate efficacy.

One group of studies, though, that don’t often play by these corrupt rules are RCTs done on already generic drugs, because they are off-patent, and there is really very little money to be made in them. In these cases, when a drug company has a generic rival to what might be a big money maker, there are ways of making that generic look bad. If the generic takes four weeks to work, test your drug against it, in a three-week study (the placebo effect for your drug won’t have worn off yet). If a vitamin is threatening your drug, test your drug against it, but use the cheapest version, in a dose that is too low. It’s an RCT, that’s all that matters.

Despite all this, advocates of RCTs still teach that, all else being equal, RCTs are always more reliable, and teach this by cherry-picking well-known cases where RCTs were superior to observational studies, and ignore cases where observational studies have been superior, or at least the better tool for the situation. They take the blunt position that “RCTs are better than observational studies,” and not, the more reasonable, accurate, and moderate, “All else being equal, in many, but not all situations, RCTs are better than observational studies.”

The phrase, “all else being equal,” is crucial, because so often all else is not equal. Simply repeating “RCTs are the gold standard of evidence-based medicine” implies to the naive listener that if it is an RCT then it must be a good study, and reliable, and replicable. It leaves out that most studies have many steps in them, and even if they have a randomization component, they can be badly designed in a step or two, and then lead to misinformation. Then there is the very uncomfortable fact that, so often, RCTs can’t even be replicated, and so often contradict each other, as anyone who has followed RCTs done on their own medical condition often sadly finds out. A lot of this turns out to be because they have many steps, and because Big Pharma is so adept now at gaming the system. Like gold, they turn out to be valuable but also malleable. A lot of the problem is that patients differ far more than these studies concede, and these complexities are not well addressed in the study design.

The Hierarchy-of-Evidence Notion Does Harm, Even to RCTs

One of the peculiar things about current evidence-based medicine’s love affair with its “hierarchy of evidence” is that it is still proceeding along, ignoring the implications of the scientifically documented replication crisis. True, the fact there is a replication crisis is now widely taught, and known about, but to the fundamentalists, it is as though that “crisis” doesn’t require that they reexamine basic assumptions. The replication crisis is compartmentalized off from business as usual and replaced with RCT hubris.

The irony is that the beauty of the RCT is that it’s a technique designed to neutralize the effects of confounding factors that we don’t understand on a study’s outcome, and thus it begins in epistemological humility. The RCT, as a discovery, is one of humanity’s wonderful epistemological achievements, a kind of statistical Socrates, which finds that wisdom begins with the idea, “whatever I do not know, I do not even suppose I know” (Apology, 21d).

But that beautiful idea, captured by a fundamentalist movement, has been turned on its head. The way the RCT fundamentalist demeans other study designs is to judge all those designs by the very real strengths of RCTs. This exaggeration is implicit in the tiresome language they use to discuss them: The RCTs are the “gold standard,” i.e., against which all else is measured, and the true source of value. Can these other designs equal the RCT in eliminating confounders? No. So, they are inferior. This works, as long as one pretends there are no epistemological limitations on RCTs. The problem with that attitude is, it virtually guarantees that the RCT design will not be improved, alas, because improved RCTs would benefit everyone. In fact, RCTs would be most quickly improved if the fundamentalists thought more carefully about the benefits of other studies, and tried to incorporate them, or work alongside them in a more sophisticated way. That is another way of saying we need the “all available evidence” approach.

The Case History and Anecdotes

Also disturbing, and, odd, actually, is the belittling of the case history as a mode of making discoveries, or what it has to offer science as a form of evidence. In neurology, for instance, it was the individual cases, such as the case of Phineas Gage, that taught us about the frontal lobes, and the case of H.M., that taught us about the role of memory, two of the most important discoveries ever made in brain science.

Here’s how the belittlement goes. “Case histories are anecdotes, and the plural of anecdote is not data, it is just lots of anecdotes.”

First of all, case histories are not anecdotes. An anecdote, in a medical text, is usually several sentences, at most a paragraph, stripped of many essential details, usually to make a single point, such as “a 50-year-old woman presented with X disease, and was treated with Y medication, for 10 days, and Figure 7 shows her before and after X-rays, and the dramatic improvement.” In that sense, an anecdote is actually the opposite of a case history, which depends on a multiplicity of concrete, vivid details.

A case history (particularly in classic neurology or psychiatry) can run for many pages. It is so elaborated because it understands, as the Canadian physician William Osler pointed out: “The good physician treats the disease; the great physician treats the patient who has the disease.” And who that patient is—their strengths, weaknesses, their other illnesses, other medications, emotional supports, diet, exercise habits, bad habits, genetics, previous treatment histories, all factor into the result. To practice good medicine, you must take it all into account, understanding that the patient is not any one of these details, but a whole who is more than the sum of the parts. Thus, true patient-centered medicine necessarily aspires toward a holistic approach. So, a case history is a concrete portrait of a real person, not an anecdote; and it is vivid, and the furthest thing possible from an abstract data set.

A typical RCT describes several data points about hundreds of patients. A typical case history describes perhaps hundreds of data points about a single patient. It’s not inferior, it’s different. The case history is, in fact, a technology, albeit an old one, set in language (another invention, we forget) and its structure (what is included in the case history, such as descriptions of the patient’s symptoms, objective signs, their subjective experiences, detailed life history, what makes the illness better, what worse, etc.) was developed over centuries.

Even anecdotes have their place. We often hear methodologists say, when a physician claims he or she gave a patient a particular medication, or supplement, or treatments, and they got better, “that that proves nothing. It is just an anecdote.” The problem is in the word “just.” Something doesn’t become meaningless, or a nonevent because a scientist adds the word “just” before it. That word really says nothing about the anecdote and a lot about the speaker’s preference for large number sets.

But anecdotes are very meaningful, too, and not just when lives are changed by a new treatment for the first time. This dismissive indifference to anecdotes turns out to be very convenient, for instance, for drug companies. If you are a physician, and you give a patient who had perfectly good balance an antibiotic, like gentamicin, and she suddenly loses all sense of balance because it injured her balance apparatus, the drug maker can say that is “just” an anecdote. It doesn’t count. And in fact, it is a fairly rare event. But it is by just such anecdotes that we learn of side effects, in part because (as I said above) most RCTs for new drugs don’t ask about those kinds of things, because they don’t want to hear the answer.

If we are to be honest, evidence-based medicine is, in large part, still aspirational. It is an ideal.

That’s why the approach I take—and I think most trained physicians with any amount of experience and investment in their patients’ well-being also take—might be called the all-available-evidence approach. This means, one has to get to know each of the study designs, their strengths, and their weaknesses, and then put it all together with what one is seeing, with one’s own eyes, and hearing from the particular patient who is seeking your care. There are no shortcuts.

One of the implications of this approach in the current COVID-19 situation is that we cannot simply, as so many are insisting, rely only on the long-awaited RCTs to decide how to treat COVID-19. That is because physicians in the end don’t treat illnesses, they treat patients with illnesses, and these patients differ.

The RCTs that are on the way may recommend, in the end, one medication as “best” for COVID-19. What does that mean? That it is best for everyone? No, just that in a large group, it helped more people than other approaches.

That information—which medication is best for most people, is very useful if you are in charge of public health for a poor country and can only afford one medication. Then you want the one that will help most people.

But if you are ordering for a community that has sufficient funds for a variety of medications, you are interested in a different question: What do I need on hand to cover as many sick people as possible, and not just those who benefit from medication X which helps most, but not all people? Even if a medication helps, say, only 10% of people, those will be lives saved, and it should be on hand. A medication that helped so few might not even have been studied, but if the others failed, it should be tried.

A physician on the frontline wants, and needs, access to those medications. He or she asks, “What if my patient is allergic to the medication that helps most people? Then, what others might I try?” Or, “What if the recommended medication is one that interacts negatively with a medication that my patient needs to stay alive for their non-COVID-19 condition?”

There are so many different combinations and permutations of such problems—and hardly any of them are ever studied—that only the physician who knows the patient has even a chance of making an informed decision. They are the kinds of things that arise on physician chat lines, that ask questions to 1,000 online peers like, “I have a patient with heart disease, on A, B, and C meds, and kidney disease on D, who was allergic to the COVID-19 med E. Has anyone tried med F, and if so, given their kidney function, should I halve the dose?”

Evidence-based medicine hasn’t studied some of the most basic treatments with RCTs or observational studies, never mind these kinds of individual complexities. So, the most prudent option is to allow the professional who knows the patient to have as much flexibility as possible and access to as many medications as possible. If we are to be honest, evidence-based medicine is, in large part, still aspirational. It is an ideal. Clinicians need latitude, and patients assume they have it. But now the RCT fundamentalists are using the absence of RCTs for some drugs to restrict access to them. They have gone too far. This is epistemological hubris, at the expense of lives, and brings to mind the old adage, “Absence of evidence is not evidence of absence.” As long as we’ve not got the best studies for all conceivable permutations, medicine will remain both an art and a science.

So, does conceding as much and giving the clinician latitude mean I don’t believe in science?

“Believe,” you say?

That is not a scientific word. Science is a tool. I don’t worship tools. Rather, I try to find the right one for the job. Or, for a complex task, which is usually the case in medicine—especially since we are all different, and all complex—the right ones, plural.

#medicine #fav #print this off later #family medicine #internal medicine #philosophy #science #covid-19 #sars-cov-2 #covid-19 vaccine

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butterfly-winx · 5 years ago

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Zenith

- Do you know about Zenith? No? I mean you own a computer so you must. I hear the whole planet is covered in one large city.

- Zenith lives up to its name, as it is regarded to be the home to the height technological development in the Magic Universe. It houses the more universities, research institutes and engineering testing fields on its tiny surface than Magics and Earth combined.

- Though it is true that the planetoid is covered with a seemingly uniform cityscape, there are patches of untended ground peeking through, mainly the polar seas. Antitheva and Bitheva may only classify as large lakes elsewhere, but they are perfectly fit for a small planet of Zenith’s size. They even help populations of merfolk at some point in time.

- The overwhelming amount of construction covering the planet’s surface has long become its vice. With no reflective surfaces left and with machinery forced to operate day and night to fuel the latest technological advancements, the whole planet has become a singular heat trap. The seas were boiling and the air was unbreathably hot. What got research going however was the failing performance of their heavy duty machinery, screws sweating and bending out of shape, lasers blinking tired and unfocused. They devised a plan to cool down the surface of the planet by releasing agents to shield them from the thermal effects of solar rays, and achieved the impossible. Zenith’s climate has since then settled on a comfortable average of 250 K.

- The seas froze over and the merpeople disappeared - or maybe they did already during the boiling phase, out of their luck living off already dead fish. Urban development was given final approval and the last patches of earth disappeared from sight, buried under the striving for more.

- Despite its aforementioned properties, Zenith is no monolith and it would be amiss to describe it as such. Zeniths countries and cultures are diverse, only connected by their burning need for advancement and their fight against the cold. They have a spectrum of governance forms in the different countries ranging from democracy, constitutional monarchy to representative republic and in some cases even direct democracy of people.

- As cities cover all of the planet, it is difficult to determine where individual settlements in a country begin and end. Country borders are the only demarcations, each government shielding itself with force fields, trenches or physical walls from imagined spies and malevolence.

- Techna’s home of Haikar is in a country that still tries to honour the memory of the separate settlements that have melded together. So Haikar is not a separate town as much as it is just a borough with its own town governance, and is considered to be the capital of Transjordan.

- Other Zenith country names with capitals where applicable: Tribilisi (Kandu), Gorgan, Nuzul (Xihat), Tbaku, Navyol, Urzghar

- Most of these countries don’t get along with each other too well. As is understandable, seeing as they are very culturally diverse. Each wants to be the best though and their most bitterly fought battles are usually over patent rights and the tenure of well-respected scientists. As banal as these reasons seem, as brutal are their methods of mutual sabotage to keep the leading edge.

- Transjordan unfortunately is quite small and has many neighbours, so their paranoia and battle readiness is markedly large even on planet. Growing up, Techna went through disaster and terror awareness training regularly, to the point where they could probably recite what to do in case you found a car bomb better than they could explain a simple recipe.

- Oh and are recipes important! As clean edged people think the inhabitants of Transjordan are, there is nothing minimalist about their food choices. They love combining spices and textures and always serve feasts with generosity rivalling Eraklyon’s. Deserts usually have some sort of fruits, nuts AND some preserve in them, the combinations endless.

- While it is true that for the most part, cultures on Zenith value a simple approach to things. If it can be done in a few words, why waste a sentence on it? Bureaucracy is usually a two-click-formula affair, their whole lives are condensed on a sigle digital display ID, shopping comes to you at home. Hell even marriages are just an affair of simple form signing.

- But food is where they really go full ham. It is not seen as frivolous to waste 10 eggs on a cake, because what you are doing creating nutrition and enjoyment. It is simply reasonable and efficient to go to the max when you do that and create an absolute delicacy you can gorge yourself on in one slice or less.

- So if they are so into feasting and enjoying things with purpose, what gives Zenithians such a bad name? Well, it is just that. People of Transjordan for example, like to enjoy things with purpose. They don’t really care much for music or theatre, they are just activities to air your brain out. They will import off-world made products, but there isn’t a lot of room for cultural arts on Zenith because they channel their passion elsewhere.

- Yes you heard right, Zenithinas have passion galore. They just, in the Universe's most efficient move, channel that passion into the work they already do. The majority of scientific discoveries have been made because somebody cared enough to look deep into a topic and push further, because previous answers were unsatisfactory. Children are coached to find something that inspires this level of devotion in them and have extensive education and support networks to get them there.

- On the topic of children: most of them aren’t the genetic descendants of their parents, rather a random selection from the common gene pool. The public gene pool is a hotly debated topic, but a long established structure of procreation that only the very wealthy have the option to contest. (There is a way to gain approval to sire an own baby from just the genes of two people, but it is extremely costly.)

In some research some time ago it was determined that for the optimal survival of people on the planet, genetic relation to the parents raising the child was not only suboptimal, but actively detrimental to overall population survival. In this “more civilised” approach, parents apply for a baby who is conceived and birthed in bioreactors. This way no people who can conceive are put through undue stress and the public gene pool babies also carry less hereditary health conditions. It is supposedly a win-win situation, yet it leaves a sour taste in most people’s mouth. No wonder less and less Zenithians plan families if that is the process they have to do it by.

- As straightforward as they are, Zenithians often struggle when communicating with people from other planets and not only because of arising cultural differences. Sure any Zenithian would blush and pale when forced into a situation dealing with overly expressive Solarians, but in any other regular case, the Universal Translation Spell is not on their side either. Jordan is a very logical and to the point language and the floralitiy of other languages is impossible to be transferred to it. The UTS instead produces blocky, difficult to parse translations that often leave Techna confused to the intentions of others.

- It is of course evident that the main industry of the planet is electronics production and R&D. Companies on Zenith produce all manners of gadgets, but they are best in creating refrigeration technology (ironic, right?), astronomic instruments, self-propulsion transportation (vehicles) and medical diagnostic tools and applications. The associated application programming industry is also booming with server houses the size of smaller cities. It is no surprise that Zenith’s electricity consumption is through the roof with such a vital sector to support.

- Before their trade for electricity with Solaria, Zenithian people used static electricity discharges to harvest energy. Their planet being covered with one gigantic city didn’t leave much space for utilising the natural resources of their planet. All the mineral ore having been exhausted, no major flowing waters left and stranded with miserable and cold weather the options for energy sources were limited. What they had however was tall buildings and thunderstorms, so they used lightning harvesters for ages.

- With the storm and snow clouds obscuring the sky most days, Zenith is quite dark. The cities illuminate themselves, kind of like year round festive ornamentation.

- Spirituality is an interesting topic on planet that everyone you ask will have a different answer for. Major parts of Tribilisi and Urzghar for example believe in machine assisted immortality. They see machines as superior to biological matter and work towards the unfallability and omniscience of artificial intelligence in which part of their conscience will be able to rest after death. The predominant belief in Transjordan that Techna grew up with is that after death, there is nothing. Based on the theory of energy conservation, what one doesn’t use and convert into heat will be redistributed into the rest of the world. It is selfish to think one could hold on to any energy after death.

- Most people also don’t care for magic. Sure some magic users crop up among them here and there, but they most likely remain untrained. This is why Techna chose a school off planet to pursue their passion and why they weren’t claimed as a Guardian fairy of Zenith after they graduated. (Since this position doesn’t exist.)

- Almost all things on the planet are solved non-magically accordingly. Their transport systems are unparalleled with some regions using small-distance whole structure replication, aka honest to god matter teleportation. The frozen over seas are also fully utilised with air cushion containerships cruising the flat expanse. Along a certain longitude Zenith also sports a unique feature: the longitudinal crust train. A four meter wide segment of the planet, as if cut out of the surrounding cityscape, moves on straight rails around the whole circumference of the planet. It is the fastest mode of civilian transport available.

- They need all the good transportation and radio transmission they can get - by the way, the Universe Wide Web is also a Zenithian invention, who would have thought - as with their living space limited, Zenithian countries have spilled over onto nearby moons, essentially colonising and terraforming those.

- So, you see, Zenith and either of its countries aren’t by far as boring as one might think on the first glance and most of them certainly don’t shy back from showing emotion.

#winx club #winx club zenith #zenith #just to clarify: zenith is the planet transjordan the country and haikar the city techna is from #repost because tagging didn't work with the last one #the bonus points for finding which town names I derived the Zenithian countries from is still on #butterfly fic #worldbuilding

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slowlymadeart · 6 years ago

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[Image 1 Description: A Crowd of people, all colored blue, with the label "Interneters" on them. To the left of the crowd a young man stands out. He is a repeat character. We'll call him "The Interneter." He has dark brown skin, short light blue dread-locks. He wears a burgundy colored hoodie, a dark teal V-neck shirt, and dark bluish-grey jeans. The Interneter says "You never told us what a "Spoonie" is."

To the middle right is Rachel, we can only see to the bottom of her shirt for now. (She has pale white skin, short and messy blonde hair, teal shirt with ferns printed on each side, Maroon shorts, light cyan thigh-high stocking with cut outs of leaves on them, maroon shoes). Rachel, smiling wearily, looking right at us, holding her index finger up:"Well, you could just google it. But hey, what the heck? Why pass up an opportunity to be the first person who tells you what it means?"

We see Rachel again on the lower left side, smiling while raising an eyebrow, holding her left hand to her face, and her right hand out towards us: "Ya ready?"

The crowd lines the bottom of the image. The Interneter stands in the middle, with a speech bubble above "Yes." and a speech bubble to his bottom right, "That's why we asked."]

[Image 2 Description: There is a lavender square at the top of this image, on it is the text: "Spoonie" comes from a disability metaphor first described in a 2003 essay by christine miserandino called "The Spoon Theory" in which she tells the story of trying to explain to a friend what it feels like to have lupus, using spoons as visual representation of her daily energy. She actually handed her friend a bouquet of spoons and said: "

Below Christine, a white woman with long brunette hair, a white headband, purple dress shirt and jeans, holds out a sparkling bouquet of spoons saying "Here you go".

Below this we see her down on one knee. To her right her friend, female, brown skin, long braided dark brunette hair with a reddish tint, blue over-all dress, and teal leggings, sits on a stool holding the spoons Christine handed her.

"You have Lupus." Christine says, to which her friend nervously responds "Haha, whaaat?...... Please explain."]

[Image 3 Description: Another lander square fills the top of this image, on it is a quote from Christine's Essay, "Most people start the day with unlimited amounts of possibilities- energy to do whatever they desire...for the most part, they do not need to worry about the effects of their actions...I wanted something for her to actually hold, for me to then take away. If I was in control of taking away the spoons, then she would know what it feels like to have something else being in control."

Below Christine sits alone, her legs "criss-cross". She is smiling at us and holds a giant spoon. Around her are little blurbs in purple text, "Might actually own a giant spoon" "Has done awesome advocacy work" "Read more at butyoudontlooksick.com (if you want to)"]

[Image 4 Description: a chart titled "How Spoon Theory Works". A single spoon equals a unit of energy that a person can use safely. On the left is "spoon cost per activities" on the right is icons to show the activities.

1 spoon; Getting out of bed, taking medications, changing clothes. 2 spoons; Watching a tv show, a microwavable meal, using the internet.3 spoons; Enagaing in a small activity like art, cleaning something, making a meal that required stove or oven.4 spoons; Taking a shower, leaving your home, socializing.

Narration text: Why use it? I'll let this quote by a doctor who was originally using buckets of water (???) with patients explain. "Using analogies and/or metaphors...can help clinicians and patients' loved ones get a better understanding of the impact of specific activities on a patient." (John Hopkins Neurologist Scott Newsome, DO, on the topic of "Spoon Theory")]

[Image 5 Description: The Interneter is looking worried, sweating. He says to Rachel,

"Oh wait, so I have major depression disorder, insomnia, and ADHD. During my last episode, I was barely able to make it to one class a day, and maybe get one meal. My insomnia felt uncontrollable. I ran out of mental brain power for my classes, but I still attempted as much class work as I could, even if my brain couldn't fully show up. Don't get me wrong- I still tried, so hard. Even if I was too depressed to feel things like 'normal' I still wanted to be embracing my college life. I feel like spoon theory would have really helped me in times like those. Especially since I haven't found an antidepressant that works on me yet. I know it's not like what you go through, like chronic physical illness. I wouldn't want to make less of your experience or appropriate this term. I'm just wondering if-"

Rachel, looking calm, finding The Interneter endearing and smiling slightly, "Your experiences are just as valid and the level of impact your depression has absolutely qualifies you as a spoonie."]

[Image 6 Description: Narration text "Today a spoonie is someone with a condition that causes limited amounts of physical and/or cognitive energy, such as chronic illness, mental illness, or disability. It's also used by neurodivergents who deal with persistent energy limitations."

Below sits 4 girls all smiling, waving, and looking at us, left to right; The first girl has an average frame, tan skin, long navy blue hair, a maroon hat, faded pink pants, a blue/purple/lavender striped shirt, and cutting scar on her arms. Second girl is Kitt, she was in another comic, she has a plus sized frame, dark brown skin, shoulder length curly/dark brown hair. she wears a teal dress with white strips, a waist long blue jacket, blue shoes, her left left is a purple prosthetic. Third girl, she is Asian, very light but still tan skin, with black hair in cut in a pixie style. She has on a white sweat shirt that has lavender sleeves and a salmon color at the bottom, in the center is the rainbow infinity sign for neurodivergence. She has on mint pants and wear white and salmon colored sneakers. On the floor below them sits Rachel.

Narrative text "Not all of us are literally measuring out energy in terms of spoons, but having such a metaphor is extremely helpful."]

[Image 7 Description: Narrative text "Spoon Theory embraces acknowledgment of a condition's control, which is weirdly liberating because this reminds a person:"

Girl number 3 is on the right is whispering to The Interneter "Lack of control isn't proof of personal weakness. You don't have to beat yourself up for experiencing your condition."

"I know that. . ." the interneter says shyly, blushing and smiling.

"Do you though?" Rachel says from the left.

Below her is girl number one. "Do u? I've been doing this for 13 years and even I forget sometimes."]

[Image 8 Description: Narrative text "For young people in particular, spoonie is the first word a person may use when starting to rewrite what their life with their condition could look like."

The Interneter lays flat on his bed, we see him from the side looking hopeful "Having to live life this way isn't easy, but I want to make it work."

Below we see he is centered on his bed holding 1 spoon, "especially since I'm still having that episode of depression." On the right side his words continue "I didn't say anything because I was afraid of messing up the flow of the comic."]

[Image 9 Description: Narrative text "Spoons can be a silly thing to associate with possibly not having enough energy to manage basic survival activities, which is one reason some don't bother using the term at all. Still, it's easier to say,"

A woman, standing in the center of the image with a long purple dress, short brunette hair, and a purple walking cane, holds a hand to her chest smiling "I'm a spoonie!"

To her left is a large man all in red, hand on his hips smiling, "My own experiences of feeling tired helps me empathize with you. You make me feel validated."

To her right is a little girl colored pink "Spoons are good!"

Next to her is a woman in maroon "Such a cute and positive take!"

At the bottom of the image narrative text says "Rather than bring folk's moods down with-"]

[Image 10 description: "My body is disabled! Living an existence with a condition that is unpredictable and invisible sometimes breaks my brain! Please don't shut me out until I'm "Fixed". Just respect my limits." Rachel says, now in the center of the people instead of the purple-dressed spoonie. She sits in her wheelchair with legs up, holding her arms out, her expression is crying yet smiling.

The large man to her left has his arms folded, now very uneasy "How do I tell apart your "disability" from excuses, self pity, and faking stuff? And who sits in a wheelchair like that?"

On the right the little pink girl is crying, her maroon mother bending down to hold her. "Isn't "Disabled" bad?" the girl ask.

Her mother responding "Nothing we need to worry about, sweetie. There are plenty of programs that think of the disabled so we don't have to."

Narrative text, "Yes. Spoonie can at times feel detached just enough from harsh reality to ease people's discomforts."]

[Image 11 Description: Narrative text:” Perhaps detached enough for misguided normies to think,”

A young woman standing in the center with one hand on her hip and one raised with her index finger pointed upwards says "Hey! I feel like I have limited energy to! I like this "spoons" idea. It will help me be mindful and proactive with my energy! I'm a spoonie now!"

She is white woman with tanned skin, long bleach blonde hair in a pony-tail, wearing grey yoga pants and a green tang top. On her tang top are the words "Has no condition is just human".

To her left Girl number 3, Kitt, and Rachel are huddled looking at the woman. “Don't-” says girl number 3. "Oh no, wait-" says Kitt. "You're not one now, but hey, you'll be one of us eventually. No need to rush." says Rachel.

On the left is a young hipster male all in orange "You're just a product of obsessive online health trends." He calls out.

Narrative text "Let's hope it doesn't turn into the 'snuggie' of disability lingo.]

[Image 12 description: Narrative Text: "Now, being disabled by a condition, especially it's fatigue aspect, doesn't mix well with the 'hyper-productive' narrative that today's society puts out."

A Pinkish-maroon leg with the words 'society that doesn't fully realize the systemic harm of it's ableism' on it, kicks a stick figure of the Interneter high up into the air in a Team Rocket fashion.

"Looks like having problems with my human body is causing me to be considered less of a human agaaiinn!!!" The interneter says, surrounded by anime sparkles.

Narrative Text "Still, being active, productive, and accepted by some form of community, lay the foundations for self-confidence and a sense of worth. Contributing online is one way even the most debilitated amount us have managed a version of that foundation."]

[Image 13 Description: Narrative text: "Disabled communities are sources of support, love, guidance, and empowerment built upon collaboration, inclusion, and knowledge. They help bring together people with a willingness to listen, because they all know the value in feeling heard."

Two horizontal rows of a diverse group of people with disabilities, drawn to show them all in bed, all interacting with each other like the would if the were together in person. Below each person is an awareness ribbon to indicate the condition(s)they have.

From left to right, top row; A young woman with very dark brown skin, black hair in a bun, is looking concerned and reaching for a young man in the row below her. He is black with slightly lighter skin, very short hair, a 5 o'clock shadow, wearing glasses. He is reach towards her with is left arm, his right arm is curled due to his medical condition. Next in the top row, a Young woman with curly brown hair, tan skin, glasses, and cutting parts on her arms is smiling and being handed a book by a young white male with Downs-Syndrome, he hair short light brown hair and glasses. A young woman with tan skin, glasses, wearing a hijab, has a pink prosthetic arm holding a piece of paper, and is using her other arm to hold hands with the person she is smiling/talking with- a thin non-binary with short blue pixie hair and braces on her elbows and right arm. This person is also holding a piece of paper, eyes shut from laughing, with happy tears coming from their eyes.

Bottom row; Next to the young man with dark skin, is a plus-sized woman with white skin, her hair is deep violet in a pixie cut. She is holding a yellow ribbon, looking concerned and speaking a "?" as she taps the should of the girl next to her. This girl is Asian with black hair in a short ponytail, she looks back at the woman with the ribbon, her arms are on the back of the next woman, whom she is comforting. This woman has medium dark skin, half her head is shaved, the other is short navy blue dreadlocks. She is curled up and crying, below her is a yellow ribbon next to a purple one. The young man on her left has his left arm around her, and has a sympathetic expression, talking with the woman to try and provide comforting. He has tan skin and short curly brown hair, with short curly brown facial hair.

Narrative text: "Spoonies are just one part of this collective, their efforts displaying that a condition's control isn't proof of weakness, as if can exist even along side massive amounts of inner strength."]

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