Musings of a Cancer Doctor

Wide-ranging views and perspective from George W. Sledge, Jr., MD

Monday, January 9, 2012

On Junk Mail: Cliquez ici

In my idle moments, when my spirits are down, I look at the Junk E-mail folder in Microsoft Outlook. It never fails to give me pleasure. Let me share a week’s worth of the highlights with you.


First, the real:

·    Honest advertisements for a bunch of courses, including “Business Writing for Results”; a “CRA & CRC Beginner” course; a course on “Employee Internet Policies on Campus: Legal Solutions for Your School”; an invite to the “4th International Conference on Drug Discovery and Therapy” in Dubai; and to Bio-IT World in Boston (Dubai sounds warmer); Microsoft Excel Basics, an “Event Planning Workshop” at the Caribbean Cove Hotel in Indianapolis (right off of I-465: I have driven by it on many an occasion); “Auditing Techniques for  Clinical Research Professionals” in Boston; an online course on “Why Your First 2 Weeks Matter So Much: Strategies for New Faculty “ (been there, done that, too old to change). Not much in the way of CME credits, best as I can tell, so I’ll continue going to Chicago for the ASCO Annual Meeting, and to San Antonio for the Breast Cancer Symposium.


·    A real job offer for a practice in the Rocky Mountains. I have no interest in moving there, but it is kind of them to think of me. We all want to be wanted.


·    An actual email from an old friend somehow filtered out as junk by Outlook. I am glad I saw it. I once sent several angry emails to someone I thought was ignoring me, only to discover that the email filter had decided she was not to be trusted. Who knows, maybe Outlook has better judgment than I do, but it made me look kind of foolish at the time. I suspect I have missed other notes from people I care about, perhaps inadvertently creating enemies through faux disdain.


Second, under the general category of personal improvement:


·    Multiple (4) male enhancement/enlargement advertisements that will make me the “Love Guru” (as if I wasn’t already) and “scare off the competition” using “a pill that is like no other” that will “leave a long-lasting impression” on women everywhere.

·    Something from France entitled “Faites des rencontres Chaudes !!” which Google Translate tells me means, “make dating girls!!” All I need to do is “cliquez ici”. Cliquez ici: I like that.  So much classier sounding than “Click here” when you want to make dating girls.

·    My Facebook account was apparently deactivated due to multiple CSRF attacks, but I can reactivate with a “tool free” (really, “tool free”--I kid you not) phone call to 996 312 973 006. Doesn’t look like any tool free number I have ever called: it has enough digits to be located on Neptune. A CSRF attack, by the way, “forces an end user to execute unwanted actions on a web application in which he/she is currently authenticated,” according to the Open Web Application Security Project. Having been forced to execute unwanted actions in the past, I want to avoid CSRF attacks with all my heart.


Third, multiple opportunities to improve my finances:


·    Mr. N.B. of the IMF, in South Africa is now handling my finances, replacing “All Governmental and Non-Governmental prostates”. Mr. B is quite persistent, as I have received several missives from him, but I think I’ll just mind my own Non-Governmental prostate.

·    Mr. C.A. of the Realm Finance Bank in London notified me that a Mr. Michael and his wife and three children tragically died in an auto accident on Rodney Road, Portsmouth, Hants, and left a total of 2,345,000 Great British Pounds money behind, which he is willing to help me “repatriate”.

·    Interestingly enough, Mr. L.W. of the Zenith Bank PLC also writes to tell me that “Mr. Michael, his wife, and his three children were involved in a drastic car accident along Sagamu/Lagos Express Road” and left another account valued at “USD 15, 345,000.00”, which he and I can share. Poor Mr. Michael: not only did he have to watch his family die twice (in England and Nigeria), he also suffered the indignity of dealing with so many dishonest bankers. You would think his name was “American Economy” the way these vultures have picked over his carcass.

·    Mrs. M.O. informs me of $24,000,000 in bank boxes inside a security vault in New York; I’ll get 20% for helping them “clear out this consignment.” Personally I think I deserve considerably more than a 20% cut for clearing out a New York bank vault, so I’ll decline.

·    Mr. John Pedro of Madrid, Spain (though his email address, curiously enough, suggests that he lives in Australia) tells me that I have won the MEGA MILLIONS SUPER LOTTO PLUS & EMAIL SWEEPSTATKES to the tune of Nine Hundred And Seventy Thousand Euros as of “1st of diciember 2011.” Hurrah!

·    Mrs. J.M.R., the 87-year-old widow of the “Late Sir M.R., who died in a Plane crash on Monday the 7th of September 1998” wants to give me $3.5 million if I will only send her $120 “for the security keeping & intuity fee of the cheque so far.” Apparently she and Sir M began their successful life together as the result of an anonymous gift they received in their youth, and she wants to pay it forward. To me: how sweet.

·       Mr. A.R. offers me the compliments of the season and “Four Million Five Hundred Thousand United States Dollars,” which he contacted me about because I have the same last name as a deceased client. I better start calling around to see if my relatives are all OK. Sledge isn’t all that common a name.

·       Corporal S.M.M. of the army’s 3rd infantry division wants my “kind assistance to move the sum of Three million, two hundred thousand united states dollars to you.” Corporal M, who mysteriously adds that she is “an American soldier with Swiss background,” found this stash “in barrels at a farmhouse near one of Saddam's old palaces in Tikrit.” She wants me to keep it safe while she recovers from injuries received in service to her country. Trusting souls, those Swiss: explains all the banks.

·    Y.A., a lawyer based in London, England (though, curiously, with a Russian email address) wants my help in laundering money from the bank account of the “Late Muammar Gadaffis family, now they are dead.” It’s a dark cloud that has no silver lining, I guess, and I never cared much for old Muammar and his kin, so why not? Plus it will go well with my Saddam windfall.

·    A Mr. S.E. of the Federal High Court of Benin writes me that the Federal Republic of Benin’s Economic and Debt Reform Department will send me $5000 per day if I will only send him $55.  If I don’t get my first payment within two hours I am instructed to contact the FBI. As if that would ever be necessary: I have great and implicit faith in the Federal High Court of Benin.

·    Christine Lagarde, director of the International Monetary Fund, in affiliation with the World Bank, wants to compensate “all the people that have been scammed in any part of the world…to the sum of US$1,000,000 each.” All I have to do is send them my name, address, telephone number, sex, status, age and nationality. How wonderful! This renews my faith in bankers everywhere. I am uncertain, however, why Ms. Lagarde has a Saudi email address. Has the IMF moved?

·    The U.S Treasury Department's Office of Foreign Assets Control (OFAC), whose address is 1500 Pennsylvania Avenue, NW Washington, DC 20220 is releasing $15,500,000.00 to me. I can pick it up, believe it or not (and I do, I do!) via an ATM machine. I just need to send them $150.99 to get my ATM card. I looked it up: 1500 Pennsylvania Avenue truly is the U.S. Treasury Department’s address.  Which proves it must be real.

·    A cryptic note from China, all in Chinese ideograms, which no doubt informs me of a long-lost cousin who left me a few million dollars or wants me to attend a meeting there. Or maybe it is Chinese for “cliquez ici.” Who knows?


I always wonder who would be foolish enough to answer such emails. It must be a sufficiently large number of people to make it worth the emailing, particularly when email is essentially free and no one is likely to pursue a scammer to Saudi Arabia, Australia, Benin, Thailand, Russia or Iraq. The scam amounts ($35-$150) seem pretty small potatoes, until you imagine them being multiplied by the large number of greedy and foolish people in this world. The equally large number of desperately poor people with Internet access and poor English skills explains the quantity and content of the messages.


A Mr. Gary Thurek sent the very first email spam to 393 recipients on ARPANET (the predecessor of the modern web) in 1978. Mr. Thurek was the father of email spam, which now involves over seven trillion messages annually. Spam accounts for four of every five email messages sent today. The top producers of spam include (in order) Brazil, the United States, India, South Korea, Turkey, Vietnam, China, Poland, Russia, and Argentina. Why Brazil surpasses us is a mystery, which we need not pursue.


Before We Cast Stones…

It is easy to despise spammers, who rob us of our time, commit nefarious acts of fraud, and strike at us from a long distance.  But before we cast stones, let me ask how different all this is this from what occurs every day in medicine? The parallels seem endless to me.  Large numbers of poorly written articles flood the literature, library shelves groaning under their weight. Many of the articles, in turn, represent so-called “ghost management,, written by pharmaceutical companies to support marketing claims.


The studies themselves are often poorly powered, undersized, with no real scientific hypothesis and no chance of proving anything of value: CV polymerase that adds little to the sum total of human knowledge. I would like to believe that the fraud content is not quite as high as my junk mail folder, but we’ve got no lock on virtue, as recent scandals demonstrate.


But it is the sheer bulk of the literature that impresses, and depresses.  When I performed a PubMed search for “breast cancer” this morning, a mere 238,824 articles popped up on my screen.  I’m supposed to be an expert in this area, but I’d be astonished if I read more that 5% of the articles published every year in my field. And of course I want to read more than just breast cancer articles: real advances in medical knowledge often come from the periphery. If you lose your peripheral vision, you end up being blind-sided.


Pity the poor generalist who attempts to keep up with all of the advances in cancer medicine. Will the CME meetings offer assistance? My inbox (whether by snail mail or email) is routinely clogged with advertisements for a multitude of medical meetings, claiming to enhance my performance (as a physician, anyway) if I will only respond to their entreaties. If we decreased the number of medical meetings by 50%, would our patients really suffer? I suspect not. We may find out, as the pharmaceutical companies are backing away from supporting such meetings.


Modern medicine is clearly a spam-filled environment, and the problem is getting worse. We need knowledge, and free access to knowledge, but we particularly need knowledge that is authoritative, concise, and free of bias. Could Microsoft or Google or some equivalent create a spam filter for medical knowledge? Perhaps, but then I would likely miss that rare article that changes how I think about the disease, just as my current spam filter occasionally places emails from old friends into Outlook purgatory.


In the meantime, I’m going after Saddam’s barrels of money from Tikrit, Muammars’s bank account, my missing relative’s estate, my MEGA SUPER LOTTO PLUS winnings, my Treasury Department ATM card and the IMF’s compensation fund for scamming victims.  I’ll use the proceeds to found my own Internet company: Watch for the email, my long-lost friend. Cliquez ici!