Welcome to the Science Talk, the weekly podcast of Scientific American for the seven days starting July 26th. I am Steve Mirsky. This week on the podcast, we will hear more from James Bagian. He is a former astronaut and currently the director of the Department of Veterans Affairs National Center for Patient Safety. Last week, we talked about shuttle missions. This week, he will talk about patient safety. We will also test your knowledge about some recent science in the news. First though, we will hear from Kip Hodges. He was an M.I.T. geologist for 23 years before recently becoming the founding director of the new school of Earth and space exploration at Arizona State University. He is also the author of an article in the August issue of Scientific American called "Climate and the Evolution of Mountains". I called him at his office in Tempe.

Steve: Dr. Hodges, thanks for talking to us today.

Hodges: My pleasure.

Steve: You begin your article in the August issue of Scientific American with a story about you riding a horse in the Himalayas. What were you doing there and what were you doing there on a horse?

Hodges: (laughs). Well, I was working with one of my students in the--actually, what used to be the Kingdom of Mustang and still referred to as the Kingdom of Mustang, which is actually part of Nepal now, but it’s very near the Tibet border. I was trying to weigh the pros and cons of doing little extra field work or going back to Katmandu, and I finally decided that I could get a little extra field work in with my student if I figured out some fast way to get back down to the airport and so, I hired this horse from one of the local people.

Steve: You were told the horse won't go down that hill after noon.

Hodges: Yeah, pretty much, and I didn't really understand that at the outset. I thought, this as a pretty crazy thing, and then I realized that basically this horse, which is smart enough to realize that every afternoon an enormous wind came up in that canyon, and he just sort of shut down.

Steve: And how is that all related to the real big theme of the article--the relationship between weather and tectonics?

Hodges: Well, I just thought it was a fun place to start because the winds in that particular canyon are extremely strong and they are basically strong because of very high topographic gradient that--down from the Tibetan plateau--that's [a] certain average elevation and they were something over 4,000 meters down to the Indo-Gangetic plain. So, it's like falling off the edge of a table as you come from the Tibetan plateau down through the Himalayas and into the peninsular part of India, and as a consequence of that there are great many meteorological processes that sort of define what the local weather is like; and one of those things is that sort of either up or down canyon winds that are related to the heating of the Tibetan plateau during the day.

Steve: And your research there though has uncovered this very deep--literally deep--relationship.

Hodges: Certainly, it implies that, you know, we have known for a great many, many years now that whenever large mountain ranges like the Himalayas are built they have an impact on the local weather. They actually have the capacity of steering the local weather, but I think one of things that's really interesting and one of the motivations for writing this particular article is the fact that it may very well be a two-way street, one in which that microclimate wants to set up as the mountains begin to build has a feedback implication of exactly mechanically how the mountains grow through time; and of course it obviously has an impact on how the mountains waste away because of the erosion associated with very strong precipitation, in this case in particular associated with the Indian summer monsoon.

Steve: If you get a lot of rain, you are going to get that kind of erosion on the surface. We were talking about processes that are going on very deep underneath the surface too, right?

Hodges: Yeah, absolutely, I think one of the interesting ways to look at a mountain range is areas that have very high mountains also tend to have very thick continental crust; and in those particular places, the fact that the crust is substantially thicker than the crust on either side of it means that it's sort of out of equilibrium with its surroundings--that[out] of a mechanical equilibrium with its surroundings--and as a consequence of that, the mountain range has a tendency to want to spread laterally under its own way to essentially smooth out those differences in elevation and differences in crust thickness from the mountain range itself to the areas around it and the way that actually happens appears based on the research that we have done on a grown body of research that other folks have done actually appears to be controlled in part by literally what the microclimates are-- where it rains, where it doesn't rain--and in fact this erosion front along the southern flank of the Himalayas where there is very, very heavy rainfall seems to be an extremely efficient way of sort of removing that excess gravitational potential energy--the excess mass of the mountain range--and the critical question is how does material get to that erosion front? And one of the arguments that's made in this particular article, and in a lot of our research in general, is that there are deep structures--faults that go down into the middle part of the crust down several tens of kilometers--that actually help convey material to that erosion front.

Steve: The material down there is under so much pressure that it actually kind of flows.

Hodges: It's hot because, as we know, temperatures tend to increase with depth in the earth, and when you get down to those levels, the material is very hot and it behaves very much like what scientists refer to as a viscous fluid. And so, even though the rate at which it flows is extremely, extremely slow by our standards, by human standards, it flows nonetheless. So, over [a] million-year time scale it's capable of flowing just like toothpaste through a potty.

Steve: And it's flowing out to that front.

Hodges: Basically, the material moves toward that erosion front simply because that's the place that it's most efficiently removed from the system and this excess gravitational potential energy can be dissipated. The analogy that I use in the article has to do with the reservoir that's backed up behind a dam and if you, you know, if you have a breach in the dam, there is a tendency for the water to flow through the breach in the dam; and basically that tendency is exactly the same process. It's the tendency of the excess gravitational potential energy of the reservoir behind that dam being dissipated by flow of the water through the dam and downstream.

Steve: And one of the really neat things you talk about is that flow is also building the front back up, so the monsoon can never get over that mountain range.

Hodges: Right--we think that as that front builds up it also tends to act as a barrier to the storms. It's what the meteorologist refer to as an orographic barrier to the storms, so that as the monsoon rain storms sweep out of the Bay of Bengal and come toward the Himalayan front, they basically can't get up and over the Himalayas and to the north toward the Tibetan plateau. So, they trap there and they tend to squeeze out the moisture in the form of extremely high precipitation along the front. So, as long as you are building the front up you are actively trapping the storm systems that produce the monsoon rainfall. The monsoon rainfall then causes extreme erosion along that particular front and extreme erosion on the front then feeds back into, attracting more material to be brought to that particular position by the structures that project down into the middle crust of the Tibetan plateau. And of course that material comes back up, builds the front a little bit higher and the cycle starts all over again.

Steve: Really interesting. Is this the first example that you know of this kind of possible connection anywhere in the world?

Hodges: Well, people have made suggestions about these sorts of connections in other places,and I think the thing that's really special about the Himalayas of course is they are the highest mountain range in the world, and they do form a remarkable orographic boundary. The rate of rainfall in the Indian monsoon is extremely high and therefore, because that particular event has such an impact on erosion in this particular part of the world, it's a very easy place to study this phenomenon.

Steve: Dr. Hodges, thanks very much.

Hodges: You are very welcome. You take care.

Steve: Hodges' article "Climate and the Evolution of Mountains" is in the August Scientific American and on our Web site www.sciam.com. The Web site of his new school at Arizona State--the School of Earth and Space Exploration is www.sese.asu.edu. We'll be right back.

[Voiceover:] For breaking news about science and technology, visit www.sciam.com/newstoday.

Now it's time to play TOTALL.......Y BOGUS. Here are four science stories; only three are true. See if you know which story is TOTALL.......Y BOGUS.

Story number 1: Apollo 11 astronauts Neil Armstrong and Buzz Aldrin used a pen to replace a broken end of a circuit breaker, allowing them to takeoff from the moon.

Story number 2: A New York doctor doing surgery in El Salvador stopped operating to donate his matching rare-type blood to the patient.

Story number 3: A tomahawk cruise missile fell off a truck on the Interstate 95 about a mile from my house last week.

Story number 4: Researchers have found a drug that enhances athletic performance at high altitude--Viagra.

We will be back with the answer, but first, former astronaut Dr. James Bagian directs the Veterans Affairs National Center for Patient Safety. On last week's podcast, we talked about space stuff. I then asked him how he went from NASA to his current position.

Bagian: Actually, I went there first in 1998 to the department of Veterans Affairs with a hospital system--basically to look at how patient safety was being looked at and suggest possible techniques that I draft[ed] from my engineering background, my background at NASA, you know, being very familiar with various safety-type activities and what could be applied. And that was Dr. Chang who asked me to do that and subsequent to a panel I chaired; and the recommendations we made on some projects I did at that time--they decided they wanted to create a national frontier for patient safety and then recruited me and also offered me the position, which I took in the very beginning of 1999.

Steve: And then, in 1999, there was this kind of bombshell publication.

Bagian: That’s bombshell publication you're talking about is the Institute of Medicine report. One of the big things that people would--a lot of timeI hear all time, is that they propose that they thought about 98 to 44,000 people die in a year--[that] that was all medical error. Now, they made many recommendations, and I think that we, of course, really do a lot to make the healthcare community and the population pay attention to this; but we have done all, virtually everything that ha[s]ve been recommended that would be pertinent to our hospital system already and they had already been in place. So when we read it, it was really validating because we had identified this problem long before this report came out, and we were already taking some very specific measures to work our way in that direction. So, for us it was sort of ho-hum.

Steve: Can you briefly talk about what they identified as the problem for patient safety?

Bagian: They talked about medical error, and we didn’t really look at it that way. All We [all] said that was a sloppy way--or I personally thought it was a sloppy way--to look at it because it implies that many people, even today, erroneously look at it and say, Well people just make mistakes; if we get them to stop making mistakes we'll be okay. And it's not that simple because medicine and healthcare--as many industries [are]--is very complex, and [in terms of] safe[ty], [there] is seldom one single event or action that causes the problem; it's usually a whole chain of events. So, in fact we designed a system by which it's harder to get into a problem. And a good example I can give you is if you go back into the mid '80s, prior to that any automatic transmission car anywhere in the world--certainly in United States--all you had to do to take it out of park was to pull the gear selector from park to whichever gear you chose, reverse or drive.

Steve: Right, but now you must put your foot on the brake.

Bagian: Correct, and the other reason we looked at it that way [is] that's a real system solution. The reason we looked at it that way is that even if you want to learn about something to fix it, people have to tell you, yes they will discover it. And in some cases, errors people make, they don't know they made them because to know it's an error, you have to know what the proper way or a more optimal way to do it; and many times people think they are doing it the optimal way. On the other hand, we took a much different approach and we said the goal is not to prevent errors, but the factor. the goal in fact is to prevent harm to the patient.

Steve: Right, very important differentiation.

Bagian: Right. And we thought things--for instance, with a pacemaker, if we change that goal we found that one of our hospitals--[the] very next week, in fact, that we really had to strain, that they had an Intensive Care Unit pacemaker that would not function, an external pacemaker. We normally put the wire into your body that goes to the heart, and it's used for a temporary measure; and it had a message that came as just error 004 and it would not pace the patient. They got desperate. They said let's turn it off and on as people sometimes do with their computers, they just turn it off altogether and reboot; they try that, if [and] that didn't work, and fortunately one of the nurses came up and said, wait a minute, I think there's another device here not being used, let's get that. She brought it up, hooked it up with the same leads coming out of the patient, it showed no error message. It did pace the patient, the patient did fine. That was a close call. Now, knowing that this has happened before and they just said well this was broken, the other unit was broken, they sent the engineering to be, you know, fixed. Engineering will get a look at the manual, and sa[y],id "Oh, it's error in 004", despite ND just pull the battery out and then put it right back in.

Steve: The same battery.

Bagian: The same battery and this is because the memory as in some devices is always powered by the batter. The on/off switch doesn't affect that, and the only way to basically flush the memory is to do a hard power down, which [and the] only [way they] can do it is to remove the battery, and they would do this. It will only take them a few seconds, you know, it's just like your remote control for your TV, you know, took it off the fingernail, then pull off the battery, put it back in and then, they would send it back to the floor, the nurses would get it often in the same shift and prior to this they will say, wow, are those engineers just wizards. They fixed it so quickly. Well now, when this happened instead of thinking it broke[n] and obviously giving [it] to somebody else to fix, I said, why is this happening? And when they looked and the engineer told what they were doing, they go, this isn't right/ They called us and we got involved, plus the company; and the company's response basically was well, people just thought that they could just take that battery out, put it back and there would be no problem. We said, but they don't know that--and think about what would happen to the patient if in this case they didn't have a spare pacemaker, and it is the most widely used pacemaker worldwide for the previous eight years. So it wasn't like just a couple patients have been affected. So, they will really understand doing anything. We immediately labeled all pacemakers like that: If error 004, take the battery in and out. But we continued to work with them and they finally agreed to change their software so that couldn't happen anymore.

Steve: Right.

Bagian: Which is the resolution; by doing that nobody was really hurt in the particular instance they brought it to our attention. They can't get it fixed for everybody. So, let the ship rock for example. So, that's the kind of thing that we really worked towards to have mechanism[s] and tools we develop for people to be able to do a good systems analysis, create [an] environment where people aren't punished for reporting problems--because if you punish people for reporting a problem, they are unlikely to tell you.

Steve: The Web site of the National Center for Patient Safety is www.patientsafety.gov.

Now, it's time to see which story was TOTALL.......Y BOGUS. Let’s review the four stories.

Story number 1: Apollo 11 astronauts saved by a pen.

Story number 2: Surgeon donates blood in middle of operation.

Story number 3: Tomahawk cruise missile on I-95.

Story number 4: Viagra enhances athletic performance at high altitude.

Time's up.

Story number 4 is true. Viagra was found to improve athletic performance at the equivalent of high altitude according to a study published in a[the] Journal of Applied Physiology. The research was done with subjects riding stationery bicycles in low-oxygen conditions. Hopefully, they weren't wearing light-wear bike shorts.

Speaking of low oxygen, story number 1 is true. On the moon, in a story that's just being revealed after almost four decades, Aldrin and Armstrong jammed a pen into a hole to modify a broken circuit breaker. That's according to the British newspaper, the Daily Mirror. Ballpoint pens also work to open numerous kinds of bike locks and as all MASH viewers know, there is nothing like a ballpoint pen when you need to perform an emergency tracheotomy.

Speaking of emergency surgery, story number 2 is true. The Associated Press reports that a New York doctor recently was doing surgery on a boy with rare B-negative blood in El Salvador when the boy needed a transfusion. Dr. Sam Weinstein of Montefiore Medical Center in the Bronx is also B negative. So, he turned the scalpel over to his colleagues and donated blood on the spot.

And speaking of the Bronx, the story about a tomahawk cruise missile falling off a truck on Interstate 95 in the Bronx about a mile from my house is TOTALL.......Y BOGUS. Because what fell off the truck on I-95 in snail traffic for hours last Friday morning only looked exactly like a tomahawk cruise missile. The 3,000-pound tomahawk look-alike was a dud used to train Navy personnel to handle them, according to the New York Times. But it has a great impression of the real thing. A bomb squad detective said he got a call from a cop on the scene, who said, look I am not kidding, I got a cruise missile sitting in the middle of I-95. The detective also said that he had seen mortar shells, live grenades, and a torpedo washed up in the Rockaway[s], but that the phony tomahawk was the biggest. We'll be right back.

Rennie: Hi, I am John Rennie, editor in chief of Scientific American. Our magazine is now available in a digital edition. Not only does your Scientific American Digital subscription include the full contents of every new printed issue, it also entitles you to access our digital archives from 1993 to the present. For more information, visit www.sciamdigital.com.

Well that's it for this edition of the Scientific American podcast. Our email address is podcast@sciam.com and also remember that science news is updated daily on the Scientific American Web site www.sciam.com. For Science Talk, the podcast of Scientific American, I am Steve Mirsky. Thanks for clicking on us.