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Your medical records DO NOT belong to you. They should. but they don't. Intentionally or not, you're spreading propaganda. Medical records in the USA are NOT YOURS! Without question, the company that generates the data would own it.

Oops, I was slightly wrong. You *might* own your medical records... if you live in New Hampshire

Part of this may be due to antibiotics being used as a diagnostic tool and also because patient expectations may lead to antibiotic prescribing.

Anecdotally, my wife recently had an onset of acute bronchitis, which is, in most cases, a viral infection. Her doctor prescribed antibiotics "just in case" it was bacterial.

Most vasectomy techniques involve tying (ligating) or fulgurating (burning) both ends. The vas doesn't seem to burst, but there is a complication called "sperm granuloma" where leaking sperm (often happens) can cause inflammation (also often happens) which can cause pain (doesn't happen that often) and in rare circumstances recanalization of the vas.

Granted, it's been a while since I performed a vasectomy but I was trained to ligate and cauterize/fulgurate both ends. Surgical implantation of this switch sounds tricky: the vas is a slippery little thing, the canal narrow, and the human body doesn't always take kindly to the implantation of foreign material.

FWIW, most of the volume of ejaculate isn't sperm, but prostatic fluid. Vasectomized guys are shooting blanks, but it's not easy to distinguish between the blanks and live ammo without a microscope. Check out the grin on this urologist as he explains the same.

Pallative care just prolongs suffering. I saw my mother die slowly with metastasized cancer and an inoperable broken hip this way. While there were times when the pain medication helped, there were times when it was not that effective.

The fact of the matter is that end of life pain is hard to manage and is often undertreated.

http://www.aafp.org/afp/2001/1001/p1227.html

I'm contracting in the industry right now, and... The problem with e-records is draconian HIPAA requirements. Also all our systems have to be able to pass an audit by the FDA, meaning if I add a piece of javascript to check for numerics... re-validation! I'm not saying the government should back down, medical records need to be private, but they've got IT management and senior staff here trembling at the mention of their existence. Supposedly, it's kept the main production system from being update for the last couple of decades or so simply because nobody wants to take on the responsibility of potentially getting the business shut down... then again that's operations, and they can be a bit dirka dir, but it's definitely a problem from both sides of the fence.

Well, your "take" is incorrect.

http://www.aafp.org/afp/2006/0101/p83.html

If this guy was clinically unable to take responsibility, he should either be in a mental hospital, or in the care of guardians who don't allow him access to the Internet.

Should be indeed. If everyone with major depression, alcoholism, and the other important factors that contribute to suicide got help then we would see very, very few suicides.

http://www.aafp.org/afp/1999/0315/p1500.html

http://psycontent.metapress.com/content/ek8w74718q375804/br

"CPR is a very violent, lifesaving act. When done correctly it usually breaks ribs."

I'm not sure how I can cleverly say, "WTF." Unless the target is old/frail, breaking ribs will only happen if you are a sadist or caught up in the moment. If you get a chance to use CPR, calm down and relax... the target shouldn't end up like Evel Knieval after a failed jump.

What are the risks of CPR?
Pressing on the chest can cause a sore chest, broken ribs or a collapsed lung.

It's hard to be clever when you're simply contradicting people out of sheer ignorance.

A) Currently, the FDA has the power to regulate cigarettes.

It doesn't matter if it is not a new drug. The FDA controls things like: how much nicotine are you getting? How quickly? Is the delivery mechanism safe? Is the mechanism for delivery safe, repeatable, and reliable? Can they be tampered with? How consistent is the manufacturing - Ex: does the dosage vary from lot to lot?

B) FYI: e-cigarettes are sold at mall kiosks.

Sam's Club will start offering pre-packaged EHR systems.

http://www.aafp.org/online/en/home/publications/news/news-now/practice-management/20090424sams-club-ehr.html

Because Human life isn't valued in economic terms, not yet anyway. By your judgment, everything up to and including genocide would be perfectly justified as long as the balance sheet came out positive.

There is no line where the unthinkable becomes OK. If it's wrong for a million people to be killed for a reason, then it's also wrong for 1 person to be killed.

According to this http://www.aafp.org/afp/20000815/825.html diagnosis is usually done at 16 weeks at the earliest. That puts the baby squarely in the 2nd trimester, and squarely into the gray zone as to whether the baby is an individual with rights. So we are definitely not talking about "a bunch of cells".

What prevents a government plan from having copays, and unreimbursed treatments and prescription drugs? In any case, for the vast majority of people, the opportunity cost of going to the doctor is a sufficient cost to prevent them from pursuing excessive care.

Hypochondriacs aside, investments in health care pay diminishing returns implying a concave utility function wrt medicine. So intuitively it seems it shouldn't be that hard to design a system which controls costs.

re: your proposal. I see why it's appealing. From expected utility theory we know that the benefit of insurance is that it protects us from unlikely outcomes that could be costly. But it's only economical to insure yourself against risks, not known expenses.

Here's an issue with your proposal. We have known for quite some time that preventative care is the most economical way of treating illness. This is the "routine low-cost treatment" that you reasonably expect people to afford by themselves. But at the same time you've introduced a moral hazard which discourages people from living a healthy lifestyle and pursuing preventative care by insuring them treatment against catastrophic illness.

In your proposed plan people have to pay out of pocket to get the polio vaccine, but if they actually get Polio then the government will pay for them to be on a ventilator for the rest of their life. This seems backwards to me. It's a lot cheaper to immunize people for free but tell that that if they skip the vaccination and get polio then they are on their own.

If you were convinced that giving out vaccines for free significantly reduced health care costs, would you be in favor of doing so?

Our current national health care system, aka "give the emergency room a fake name", shares the incentive structure of your proposal. Because preventative care is expensive and the ER is free, many people use the ER for primary care. This abuse of the emergency room is hugely inefficient; it is both expensive and provides poor quality care. If we incentivize preventative care then we can improve health and reduce total health care expenditure.

Whoops, there's no edit button...Your grandfather is probably on beta-blockers for heart disease or high blood pressure (or tremor), not anxiety. Still, they're relatively safe, with a proven decrease in mortality after heart attacks. Propanolol's a good drug, in fact if it piques your interest I'd suggest reading the wikipedia article on it or maybe the AAFP's stuff. --pent

Omeprazole (aka Prilosec) alone won't cure ulcers, but in combination with antibiotics it can. In the US, except for OTC antibiotic ointments, antibiotics in anything require a prescription.

To quote wikipedia:
"Use in Helicobacter pylori eradication

Omeprazole is combined with the antibiotics clarithromycin and amoxicillin (or metronidazole in penicillin-hypersensitive patients) in the one week eradication triple therapy for Helicobacter pylori. Infection by H. pylori is the causative factor in the majority of peptic and duodenal ulcers."

Also see "Management of Helicobacter pylori Infection" ( http://www.aafp.org/afp/20020401/1327.html )

And no, I'm not a medical doctor, but I did stay at a Holiday Inn Express last night...

"The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."

For starters, there is the ongoing medical marijuana debate. A bunch of states currently allow for the use of medical marijuana in their state. Federal law still has marijuana in the Schedule I category which means it has no medical use, so feds arrest users.
Medical marijuana is an easy one, as so many medical organizations support it.

The current drug czar also uses federal funds to campaign and lobby against drug laws reform at the state level.

The federal government also recently passed a spending bill which "would take away federal grants from local and state transportation authorities that allow citizens to run advertising on buses, trains, or subways in support of reforming our nation's drug laws".

Here is a quote from an article regarding assisted suicide, and the federal government's attempts to stop it by invoking drug laws: "Ashcroft... invoked the federal Controlled Substances Act, a law aimed at drug traffickers, and threatened to use it against physicians who prescribe drugs to help patients end their lives."

There are many other arguments to stop the drug war of course.. our constitution gives us the right to freedom of speech, which presupposes freedom of thought. Many drugs allow us to change how we think, so they should not be banned by the government. The Center for Cognitive Liberty and Ethics makes this argument, which I personally find quite compelling.

I'm glad you asked this question, and hope I have given you some ideas to think about.

No they would never introduce something like that in the states!

As a medical student myself, I am selfishly glad that the ACGME has adopted an 80 hour week recommendation, as there seems to be evidence that shifts of even 12+ hours are detrimental to patient care. (Note that the link is for nursing. Current recommendations for medical residents have a 30-hour-straight limit).

On the other hand, you are entirely correct that certain specialty residency programs have been having trouble meeting the 80 hour guideline. Indeed, residents feel pressured to lie about work hours, since their program losing accredidation would hurt their own prospects as well.

Finally, please note that even 80 hour recommendations have officially been extended to 88 hours for some programs, such as many neurosurgery residencies. Imagine if your boss explicitly told a theoretical programming/IT governing body that 80 hours a week, averaged over 4 weeks, simply wasn't enough time. I hope this gives pause to those who love to complain about long hours spent programming.

Also, if you could cite me a study that says definitively that alcohol is physically addictive, please do.

I'm not sure why that's important, but here is a journal article concerning withdrawal from heavy alcohol use.

But you're right, perhaps I shouldn't generalize--not all alcoholics are wife beaters. But how many alcoholics would I have to meet for you to say that my experience isn't "too narrow"?

A properly randomized sample of about 100 would probably be adequate at the 80% confidence level. The method of properly getting that sample is rather difficult though. It is estimated that about 10% of the population is susceptible to alcoholism, but many of those who are susceptible will have chosen not to drink. You'll likely have to interview about 2000 people, ask a battery of questions to both them and a significant other to determine if they are alcoholic and if so are they more abusive than the non-alcoholics.

And finally, no I've never experienced what addiction is like, though if alcohol were actually physically addictive, I and many of my friends should be junkies by now. But we aren't, because we have common sense.

It has nothing to do with common sense. About 90% of the general population is not prone to alcoholism. The number varies among different ethnic groups. If you chose your friends at random, we'd expect to see 1 in 10 of them have issues with alcoholism. However, unless you are very unusual you don't choose your friends at random.

Coincidentally you do see similar things even for hard drugs. If the entire population of the country were given a hit of crack, most of them would not turn in to junkies. There is something different about those who will become junkies and we don't yet understand exactly what. Whatever it is, it is not simple and is an active area of research.

Episodes of delirium tremens have a mortality rate of 1 to 5 percent.

And yet, cyanide is found in cyanoacrilic adhesives, which were developed (IIRC) for the military in Vietnam to instantly bond flesh back together on nasty chest wounds, to stop bleeding.

Using Adhesives for Laceration Repair During Sports Events

They mean instantly, btw. Some "Zap-A-Gap" almost bound my fingertips together with brief passing touch.

http://www.aafp.org/afp/20010301/883.html

My understanding is that - although smoking is a risk factor for the condition - Barrett's esophagus is most frequently associated with Gastroesophageal Reflux Disease (GERD).

So really, Barrett's is not among the "effects of being [a] longtime smoker," but rather a condition that many people with GERD develop that is associated with a greatly increased risk of developing throat cancer later. So lowering the number of people who smoke really wouldn't decrease the need for this test.

First, I'm not sure how you can be ready to run in 5 minutes. 5 minutes to change, sure. but what about the 5-10 minutes of stretching and warmup? You do stretch and warmup properly, don't you?

Stretching before and after running is a great way to waste time and injure yourself. More and more research is coming to the conclusion that stretching does not reduce injuries, esp. for limited momement sports such as running. It was a tough mental barrier to overcome after years of stretching before exercise, but after 1 marathon with stretching and 2 w/o stretching during training, I can see that there is really no difference.

Note that I'm not saying stretching is a necessarily waste of time - if I was a hockey goalie or a gymnast I'd probably thing differently. I'm also not saying to skip a warm up - start slow (walk even) for the first 5-10 minutes to get your muscles into gear.

If you want improved flexibility, then go for it, but do it right. Learn yoga. But don't stretch cold muscles for 5 minutes before a run - you're just asking for trouble.

I think this is a very good example of someone pulling a story out of his a**. There are 6 insures listed for emergency room malpractice insurance in Nevada. That's one less than the number listed for Texas with a set of "written by the insurance industry itself" limits on lawsuits.
And California, with one of the better insurance company oversight systems also has 6. Many states only have two or so providers. So what have the "reforms" got to do with anything. See Malpractice Insurance Providers by State. The company named (American Physicians Insurance) is listed there as only doing business in Texas. So Dr. Gondy is going to have to work in Texas, or so it seems.... And of course Texas has the highest homeowner and automobile insurance rates in the country, so she had better not plan on living in the state or buying a car there....

Another view is presented in Malpractice Rates Whitepaper. It appears that malpractice caps in California did not prevent them from having the highest insurance rates in the country (a 450% increase in the 13 years following their tort "reform"). That lead directly to Proposition 103, controlling the insurance companies directly and imposing a 20% rate reduction. Notice those insurance companies keep doing business in California because they MAKE MONEY doing so.

By the way, this directly contradicts your assertion that "the rate of growth in protected states is lower than that of unprotected states." But it does not keep the ACEP web site from asserting that MICRA has "lowered" rates 6% since 1988, forgetting to mention that from the passage of MICRA in 1975 to California's forced rollback of insurance rates in 1988, rates went up 450%. See the Q & A titled Was MICRA effective?.

And note that in Connecticut a "physician owned" insurance provider is jacking rates up 30% after a 20% increase in the same period that California rates dropped 6%: American Academy of Family Physicians "challenges".

Finally, I can't find any information anywhere about what rates really are other than urban legends about $300,000/year premiums. Doesn't that strike you as interesting, too?

Nitpicking note--germs are not allergens, and bubble-boy syndrome (severe combined immune deficiency--SCID, IIRC) is a result of a person's inability to produce and maintain a healthy population of immune cells. Allergic reactions typically look and feel like a severe overreaction by the immune system--something that you would never see from a bubble-boy sufferer.

It means that every piece of anything chemically processed that you have in your home slowly breaks down over time, and gives off noxious chemicals. Everything from formaldehyde to radon.

Nit number two. Radon exposure in the home is never the result of chemically processed materials breaking down in the home. Radon gas is formed by the nuclear decay of natural radioisotopes in soil. (Since natural clays are used to make bricks, there may be slightly higher radiation levels in brick buildings, as well.)

Most of us dont notice, but it apparently makes some people _very_ sick. Couple this with todays "need" to make homes virtually air tight, and you have a place that makes reactive people really, really sick.

The airtight buildings of today do concentrate allergens while often simultaneously drying out mucous membranes that would normally keep these nasties out of our lungs, "Sick Building Syndrome" (SBS) may result. Often, the cause of SBS can be traced to one or two contaminants in the environment--moulds in the air system, formaldehyde releases from fresh carpet adhesives, and so forth.

"Multiple Chemical Sensitivity" (MCS) is a disorder characterized by extreme sensitivity to multiple environmental toxins. MCS is still far from being recognized by the medical establishment at large. Here is a good, balanced summary from the American Academy of Family Physicians. Of particular note is the fact that the AMA, the American College of Physicians, the International Society of Regulatory Toxicology and Pharmacology, and American Academy of Allergy and Immunology have rejected MCS as an organic illness--but then, they could be wrong.

"[MCS] has been rejected as an established organic disease by the American Academy of Allergy and Immunology, the American Medical Association, the California Medical Association, the American College of Physicians, and the International Society of Regulatory Toxicology and Pharmacology. It may be the only ailment in existence in which the patient defines both the cause and the manifestations of his own condition. Despite this, it has achieved credibility in workmen's [sic] compensation claims, tort liability, and regulatory actions."

"No evidence based on well-controlled clinical trials is available that supports a cause-and-effect relationship between exposure to very low levels of substances and the myriad symptoms reported by clinical ecologists to result from such exposure . . . . Until such accurate, reproducible, and well-controlled studies are available, the American Medical Association Council on Scientific Affairs believes that multiple chemical sensitivity should not be considered a recognized clinical syndrome."

"Review of the clinical ecology literature provides inadequate support for the beliefs and practices of clinical ecology. The existence of an environmental illness as presented in clinical ecology theory must be questioned because of the lack of a clinical definition. Diagnoses and treatments involve procedures of no proven efficacy."

You can start with this which explains the effects of THC on the memory and learning portions of the brain, and then move along to this which tells us (among other things) that marijuana use restricts blood flow to the brain. Then, if you're still with us, check out this. The fourth paragraph details lab experiments where it was found that giving THC to rats caused a loss of brain cells. If you have any further questions, post them here or check your favourite search engine.