Slashdot Mirror

before they start playing with DNA.
Modern medicine still can't get appendicitis right. Doctors look at unreliable scans to make life or death decisions...

https://psnet.ahrq.gov/webmm/c...
https://journalofethics.ama-as...
https://westjem.com/case-repor...

and my favorite

http://skepticalscalpel.blogsp...

Great job, guys. You can't even figure out a 19th century disease and now you want to play with the mechanics of life itself?

There is supporting evidence for your hypothesis:

http://journals.sagepub.com/do...

I think the explanation that high-achieving women tend to be proficient in both verbal and math abilities while men are more likely to be proficient primarily in math abilities is pretty compelling. It's possible that preference is the primary driver, but I'm not sure you can really separate preference and ability so cleanly.

Look at the gender breakdown of medical specialties here:

https://wire.ama-assn.org/educ...

Notice how men tend to gravitate toward roles that involve less human interaction? Surgery, Anesthesiology, Radiology. There's no shame in admitting that women might be simultaneously as good as men at Math, but better, or at least more likely to enjoy, roles that require high levels of verbal aptitude as well.

The AMA isn't a trade union (they don't negotiate pay and benefits for physicians, and only 25% of US physicians are members). The AMA contracts with the feds to develop a list of the relative values of chargeable medical procedures (which then get modified by insurance companies, who decided actual remuneration.

The AMA does come up with a code of ethics, but ensuring US physicians meet acceptable standards of competency is up to your state or territorial medical board, which are all quasi-governmental entities.

I enjoyed your comment about the "health insurance pigeon hole." I mean I get everyone hates health insurance, but what about the car insurance pigeon hole, and the fire insurance pigeon hole? The fundamental idea of insurance — spreading out risk — seems like a good one, and all insurance markets are regulated. It's a fascinating question if health insurance needs to be more regulated, or less, or simply standardized like they do in most other industrialized companies so it can be understood by mere mortals.

The AMA isn't a trade union (they don't negotiate pay and benefits for physicians, and only 25% of US physicians are members). The AMA contracts with the feds to develop a list of the relative values of chargeable medical procedures (which then get modified by insurance companies, who decided actual remuneration.

The AMA does come up with a code of ethics, but ensuring US physicians meet acceptable standards of competency is up to your state or territorial medical board, which are all quasi-governmental entities.

I enjoyed your comment about the "health insurance pigeon hole." I mean I get everyone hates health insurance, but what about the car insurance pigeon hole, and the fire insurance pigeon hole? The fundamental idea of insurance — spreading out risk — seems like a good one, and all insurance markets are regulated. It's a fascinating question if health insurance needs to be more regulated, or less, or simply standardized like they do in most other industrialized companies so it can be understood by mere mortals.

I don't think that women in subdivisions of Medicine are universally at gender parity as you assert. Look at the statistics for residents here:

https://wire.ama-assn.org/educ...

While many fields are close, There's a huge disparity in Gynecology (85%), Pediatrics (75%), and radiology (27%). Other subdivisions listed show lesser skew one way or the other, but it's still there.

In no way does this imply a difference in ability, but there absolutely appear to be different preferences at play.

https://wire.ama-assn.org/delivering-care/how-get-most-accurate-blood-pressure-measurement

What's nice is the AMA even tells you how much each nurse practitioner error can change the reading. Yes there are a lot of inaccurate home devices ... but I'd be shocked if most were off by the more than 100mmHg that a careless NP can cause when using more accurate equipment.

IT failures have increased by 129 per cent since Shared Services Canada took over tech support for the entire government five years ago. Not only that, the memo says, the duration of each outage has increased by 98 per cent. "Its 'one size fits all' IT shared services model has negatively impacted police operations, public and officer safety and the integrity of the criminal justice system," reads the memo.

But Single Payer eliminates redundancy, thus lowering the costs while improving the services. Does it not?

You originally stated "Last I checked, there wasn't any data showing that "spreading out" vaccinations either helped or hurt a damned thing." It took me mere seconds to find an article that unambiguously states that yes, the schedule matters, and parents delaying vaccinations in a misguided attempt to reduce risk to their child are achieving the exact opposite outcome. Further the only way you could describe as a "guess" that increasing the length of time a child is not vaccinated will increase their risk of disease is if you don't believe that vaccines are effective. As for the degree of parental control over vaccination I agree with the American Medical Association: nonmedical exemptions to immunization mandates should be barred.

That's nonsense. Immigrants have always been subject to inspections and requirements to fit societal standards. Storekeepers and others also freely practiced discrimination (Jews, Irish, Germans, Asians, etc.).

http://www.history.com/news/9-...
http://www.vox.com/policy-and-...
http://www.museumoffamilyhisto...
http://journalofethics.ama-ass...
http://cis.org/HistoryIdeologi...

I'm not saying I agree or disagree with either side on this debate. I'm saying that the setting of standards and rejecting immigrants who fail to meet those standards is well established in American history (sometimes with tragic consequences).

Here's an example. Suppose you smoke marijuana at some point. Your doctor asks you about that and mentions it on your medical record, because it's clearly health-related, significant and part of a good medical history.

20 years later, you have knee surgery and you're left with severe, intractable pain. The only thing that controls it is opioid drugs. Your doctor looks at your medical record and sees that you have a history of marijuana use. There are "risk scales" that define that as "drug abuse" (for example, the opioid guidelines of the Texas Medical Society). So instead of simply treating your pain with enough opioids to control the pain, your doctor makes you sign a "pain contract" which requires you to take regular drug tests, and has the provision that he can abandon you and expel you from his practice if you fail a drug test or violate any of the other provisions in the pain contract. Instead of controlling your pain down to 2 on a scale of 10, he only controls it down to 5 or 6 on a scale of 10, and leaves you to suffer in pain. These are the actual provisions of "pain contracts," and a history of marijuana use in your medical record can cause a doctor to define you as a drug abuser, and make it difficult or impossible for you to get drugs to control your pain.

http://journalofethics.ama-ass...
Veterans Health Administration Policy on Cannabis as an Adjunct to Pain Treatment with Opiates
Michael Krawitz
AMA Journal of Ethics.
June 2015, 17(6):558-561.

http://www.nytimes.com/2016/03...
Patients in Pain, and a Doctor Who Must Limit Drugs
By JAN HOFFMAN
New York Times
MARCH 16, 2016

Your medical record contains information about all kinds of aspects of your personal life.

For example, a good medical history would include information about your sexual practices. In some states, normal teenage sexual behavior would be a felony, and some anti-abortion prosecutors have subpoenaed medical records of teenage girls who got abortions, and women who had late-term abortions, in order to find somebody to prosecute. http://www.slate.com/articles/...

I would recommend that you never tell your doctor that you use marijuana.

That will usually go into your medical record, because it's part of your medical and social history.

Now with electronic medical records, anybody with access can do a text search for "marijuana" and find it.

The most obvious problem that I can identify is that years later, you might have a legitimate need for opioids.

For example, hip and knee replacements are very painful. In order to be successful, they require physical therapy, which is also very painful, and often can't be done right without opioids. (See Jane Brody's story in the New York Times about her own knee replacements.)

If your medical record mentions marijuana, that can set off some (unscientific) guidelines for using opioids, which require that you sign a "pain contract." You have to take (unnecessary and expensive) drug tests, with (unnecessary and expensive) doctors' visits, with lower doses than would be medically appropriate, and they can discontinue opioids if you test positive for marijuana. Normally it would be a violation of medical ethics to abandon a patient, but these pain contracts allow doctors to unethically abandon a patient if they violate some of these provisions.

The Veterans Administration just backed off on one of those pain contracts after a veteran sued them. But not everybody can afford a lawyer.

http://journalofethics.ama-ass...
Veterans Health Administration Policy on Cannabis as an Adjunct to Pain Treatment with Opiates
Michael Krawitz
AMA Journal of Ethics.
June 2015, 17(6):558-561.

If a doctor specifically asks about marijuana, I think a good answer would be, "You can't guarantee me that this information will be confidential, right?"

I don't need someone to hold my hand.

What makes you think programmers are better able to negotiate the labor market than physicians (AMA), lawyers (ABA), or other "knowledge workers" (AAUP)? Those groups - especially AMA and ABA - have done an exceptional job of legislating protection for native practitioners. In many cases, a lawyer isn't even allowed to practice across state lines, nevermind international boundaries. And the hoops for a foreign-trained physician? Even a US citizen trained outside the country (say, at SGU) faces extra regulatory scrutiny returning to the US. When the AMA started, any hack with a sharp knife could do surgery; now they're among the most protected classes of workers.

A lone wolf may be a fine programmer, but the market is a big game of prisoner's dilemma: the isolated, self-interest strategy loses.

Here ya go, AC.

http://www.ama-assn.org/ama/pu...
http://kff.org/other/state-ind...
http://scholarship.law.cornell...
http://www.americanbar.org/con...
https://docs.google.com/spread...
http://www.indiana.edu/~emsoc/...

I can only assume that you'll return the favor. :D

Being in "constant agony" is nowhere specified in the ethical guidelines as a defining criterion for a best-interests analysis. You're simply pulling that out of your ass.

Nope, I'm giving that as an (admittedly coarse and imperfect) definition for the very difficult concept "quality-of-life" (or rather, lack thereof). You might want to read up on that. It is one of the concepts on which the concept "medical futility" is based.

And you continue to conflate withdrawal of life-sustaining treatment with euthanasia. They are two completely different things.

There is a difference, but the line is already blurry from a legal point of view, and nearly nonexistent from an ethical point of view. You might be conflating ethics with law.

It's the patient who gets to decide what his or her level of suffering is, and whether or not it is reasonable to continue life-sustaining medical intervention.

Only within certain limits; these absolutes you seem to be reasoning in don't play well with reality. To give a more extreme example, if you are involved in an accident in which you lose your genitals, and end up in intensive care for a short while, with little acute pain and a prognosis of full recovery, you don't get to decide to die because you dread staying a virgin forever.

And yes, there is substantial precedent for this.

Wrong link? This is an article on "medical futility", and it does refer to "quality-of-life", as I asserted. It contains one precedent, which is largely in agreement with the conditions I had in mind. Admittedly, those conditions are a bit more elaborate than what I wrote in my post; I'm not here to write whole essays on "quality-of-life" and "medical futility", and you'll have to assume good faith. My main point is that there are narrow legal and ethical limits within which a patient is allowed to choose to die, and that the case in TFA is outside them for the time being.

It continues to amaze me how human beings refuse to view death as part of the natural process of life, much to their own and society's detriment.

You're setting up a big strawman here. Would it not be to society's detriment for the child in TFA to grow up without mother, or for the poster and all his family to lose a beloved one at the tender age of 28, hastily unplugged before anyone could know how well she would recover (in that respects, I advise you to read some of the posts further down this discussion, including my own). What if it would be your mother or sister, and I were the dick shouting "unplug her!" while you'd rather would like to first see her stabilize and get a solid prognosis on her recovery? Also, if a very poor person catches bacterial bronchitis and obtains antibiotics through medicaid, would you also say that's to "society's detriment" and they should "learn to view death as part of the natural process of life"? The fact that society steps up for those in trouble is what differentiates us from solitary animals. It only becomes a problem when the intervention is both futile and unwanted, which is why we have these laws and ethical guidelines. In other words, yes death is part of life and shouldn't be averted if there's no good reason to do so, but "good reason" is hard to define and subjective, and laws and ethical guidelines by nature play it safe as to not offend anyone. I think the current laws in the liberal jurisdictions I was talking about strike a good balance; what you're proposing could too easily lead to excesses and injustices. As "parts of life" go, death is a pretty irrevocable one... Here's some further food for thought. I can't say I agree with every last letter of it, but it's a good though-provoking read.

What part of "without being in constant agony" did you not understand?

Being in "constant agony" is nowhere specified in the ethical guidelines as a defining criterion for a best-interests analysis. You're simply pulling that out of your ass. And you continue to conflate withdrawal of life-sustaining treatment with euthanasia. They are two completely different things.

The basic standard, clearly articulated, is that the preferences of the patient are paramount. It's the patient who gets to decide what his or her level of suffering is, and whether or not it is reasonable to continue life-sustaining medical intervention. And yes, there is substantial precedent for this.

It continues to amaze me how human beings refuse to view death as part of the natural process of life, much to their own and society's detriment.

Forgot the link: http://www.ama-assn.org//ama/p...

There is not in any way "consensus" that "GMOs are safe"

Again the facts say otherwise.

The consensus is that they are safe.
American Medical Association
National Academy of Sciences
World Health Organization
Chief Scientific Advisor to the European Commission
Department of Agriculture
Food and Drug Administration
Environmental Protection Agency

Scientific consensus is that GMOs are safe.

Generci ingredient names are chosen by a scheme that isn't strongly related to the actual chemical name, though. Do some of them carry the systematic name too?

"administrative action or termination." ...OR termination? Every single one of them should have been fired at the least. If I looked up an ex girlfriend on the electronic medical record system I'm logged into right now, I would be subject to a $50,000 dollar fine and a year in prison even after being fired ( AMA HIPAA penalties page). This kind of abuse of access to privileged information similar to a HIPAA violation, except double illegal since most of the surveillance has no legal basis either.

My job as a doctor is not to lecture that patient or make fun of them, but to try to help them as much as I can with the tools I have at my disposal.

One of the tools a doctor has at their disposal is the lecture -- often dubbed "patient education". It has far fewer side effects than drugs or surgery.

OTOH, to give a good lecture, one must understand the subject. Most doctors know fsck-all about nutrition, or healthy lifestyles in general. An astounding 44 percent of male physicians are overweight. Maybe this bias is frustration at their own failures.

Don't be stupid.

Despite not agreeing totally with the start of this thread, there is _some_ validity to what was said: From Wikipedia (not my favorite source, mind you)

Principles of screening

World Health Organization guidelines were published in 1968, but are still applicable today.[2]

The condition should be an important health problem.

There should be a treatment for the condition.

Facilities for diagnosis and treatment should be available.

There should be a latent stage of the disease.

There should be a test or examination for the condition.

etc

A good screening test is one that provides a definitive answer. You DEFINITELY have AIDS / rabies / smallpox, for example. Whether you can treat/cure AIDS/rabies/smallpox? Well, that's something else entirely.

Actually, you are wrong here. There are very few tests in medicine that are "absolute answers". Every test has an error rate associated with it. We typically look at sensitivity (the chances of actually detecting the disease) and specificity (the chance of the positive test being the disease in question). This leads to the concepts of false-positives(you don't have the disease, but the test says you do) and false-negatives(you have the disease but we missed it). Going further down the statistical highway, when we include the incidence of the disease in the population and the probability that an individual has a disease...that yields positive or negative predictive values (the chances that a positive (or negative) test is indicative of existence (or absence) of disease in that person.

Let me be brief, and state no test is 100% sensitive nor 100% specific, and while you may approach 100% with PPV or NPV, the other cannot, therefore, be 100%.

As such the original article is very wrong in their claims:

says their new technology can diagnose Alzheimer's disease up to six years before symptoms appear with 100 percent accurac

The program analyzes patients' eye movements and time spent looking at familiar and new images and then generates a score. Kaplan said 100 percent of subjects who scored below 50 percent on the test have gone to receive an Alzheimer's diagnosis within six years, while none of those who scored above 67 have developed Alzheimer's.

I'm sorry, what is their prediction when the patient scores a 55?

But if you can't screen to provide a diagnosis, then you can't isolate symptoms, spot OTHER symptoms which may be masked by similar diseases that someone DOESN'T have (and only a screen will tell you that), or work out how to manage the condition, even if you can't treat it. Management might refer to, for example, being told not to share your blood with AIDS, or getting benefits and home-help for Alzheimer's, or even just "don't do this particular exercise / take this particular drug".

Er....I'm not sure _what_ you are trying to say here. But let me clarify: screening does not by definition provide a diagnosis....it mere raises the level of concern. Take the (very poorly chosen) example of breast cancer....mammography (which is starting to fall out of favor for screening) screening alerts the physician to the potential for a cancer. After mammography, typically we attempt to obtain a tissue diagnosis (biopsy) to "prove" a cancer. But even then, errors can still be made.

A good screening test has the following:

be capable of detecting a high proportion of disease in its preclinical state***

be safe to administer

Oh and while you are at it do something about malpractice tort reform - the major cause of excessive medical costs.

No matter how thin you slice it...

Life Expectancy at Birth by Race and Sex, 1930---2010

White Male, Born 1930, 58 Years
Black Male, Born 1930, 47 Years

White Male, Born 2010, 76 Years
Black Male, Born 2010, 72 Years

-----

US Census Data

US Population 1930, 122,775,046
US Population 2010, 308,745,538
US Population 2020, 337 million (est.)

"In 2019, when the last of the baby boomers (those born between 1949 and 1964) have reached age 55, nearly twenty-nine percent of the total United States population will be age 55 and older." Source: Government Accountability Office, "Older Workers: Demographic Trends Post Challenges for Employers and Workers," 2001

-----

The time isn't far off when we will have 100 million seniors to care for.

Then there is the problem of providing medical care to the poor of all ages. The politics of health care. Red and Blue.

Best and worst states on unmet health needs

The states with the highest percentages of residents who had unmet health care needs due to cost in 2010 were in the South, according to a new study.

Five highest

Mississippi: 26.0%
Texas: 25.3%
Florida: 25.1%
Louisiana: 23.9%
Georgia: 22.6%

Five lowest

North Dakota: 8.2%
Massachusetts: 8.7%
Hawaii: 9.7%
Iowa: 9.9%
Vermont: 10.5%

Source: ''Virtually Every State Experienced Deteriorating Access to Care for Adults over the Past Decade,'' Robert Wood Johnson Foundation

Nearly every state showed health access declines in 2010

Who could possibly be opposed to cheap, automated healthcare?

Doctors. Obviously.

People that can do math see Obamacare as infeasible given current practice and the number of practicing doctors. Doctors vociferously oppose delegating anything, however.

We're going to have to break the doctor monopoly in the US. The cost has gotten too high to indulge this exclusivity any longer. Automation, nurse practitioners, whatever. It's got to end. If there is anything good about Obamacare it is that this issue will be forced.

I don't wish to see Doctors punished, but the fact is that tens of millions of people are about to arrive in their offices with uncancel-able, no-lifetime-limit, fixed-rate Obamacare and a lifetime of accumulated, untreated damage. At the very least this is going to force a LOT of delegation.

Physics. It's a bitch.

the bleeding, oozing legions covering their faces.

Someone take that reporter out and provide clue-by-four education. It's "lesions". [grumble, "spik inglish, boah!"]

Phenol to cause lesions such as are described? Well, if you spray your face with 10% phenol-in-water you'll get lesions like that (this used to be a standard technique in early "aseptic" operating theatre practice - see Lister's work in the 1850s ; and this is why better techniques were developed.) Hippuric acid ... rings a bell, but I'd have to check ... sounds like horse piss to me. Sure enough "found in the urine of horses and other herbivores." (Wikipedia).

You know ... this being people complaining about water from private wells in an agricultural area ... I'd be wondering how good the management of horse (and other herbivore) piss and shit has been on those farms for the last century or so. Aquifer contamination can take a LONG time to show up.

The last time I was doing drilling on an aquifer in Britain (the South Downs Chalk, feeding London in a few thousand years : if you watch the horses on the big bend at Goodwood racecourse, you can see the oil wells on the hillside opposite), we had no concerns - none what so ever - about contaminating the aquifer. Regulations were that we could only drill with drinking water and (precisely) nothing else (until we got to the point of casing off the aquifer, when we were allowed to cement the casing in place). Then we had to verify that the casing was "tight" with a 1800psi/ 10 minutes pressure test, witnessed by representatives from the water board and local council and local residents. My input as a geologist was to confirm (by cuttings examination and interpretation of geophysical logs) that we were beyond the bottom of the aquifer. Then - next section of the well was drilled with a water-based mud (pH 11 : (inert) barytes powder, potassium chloride, ice-cream thickening agents, soap ; I don't normally bother to wear gloves, unless the safety officer is watching), cased and cemented a couple of hundred feet above the expected reservoir (again, my call) to provide a second pressure barrier (3000psi/10 minutes test) before displacing the well to use oil-based mud for the horizontal reservoir section (which I steered - it was short, only 3000-odd ft) because this was not a well that needed fracking.

That is "standard practice" in the oilfield - it's highly optimised to cut costs and risks. There are people who will cut cost further by cutting corners. For example, a job I was asked to comment upon (and which I use as an example when I'm teaching my juniors pore pressure engineering) was when an Indonesian oil company saved the cost of the intermediate casing string. The result was the "Lusi" mud volcano, which is still erupting today. with hundreds injured (by scalding mud) and thousands displaced, roads and railway lines damaged and closed or relocated ... I use it as an example of WHY we don't do that.

If there are wells in Pennsylvania which are constructed down to Indonesian standards and are leaking methane into aquifers as alleged, then I would suggest that America improve it's drilling regulation (and enforcement) to somewhere closer to the British and European model than the Indonesian model. But hey, that's your political problem.

hissing wells

? I haven't seen that allegation before. But, if that's methane leaking out of a fitting, then that is the drilling company's PROFIT going off into the atmosphere (never mind the potential hazard, think of the lost profit ! ) ; they want to know about that, yesterday, if not sooner. On the other hand, if it's a water-pumped seal (where you reduce the pressure across an active seal by

Greetings, Rockdoc. Yeah, it has been a while.

I was using "chemicals" in the vernacular. :-)

The issue that seems to plague fracking in the U.S. is that while the composition of the mud and support chemicals used is known, it frequently isn't shared.

It leads to issues like this: http://www.ama-assn.org/amednews/2012/08/27/gvl10827.htm

The general public thinks emotionally, not logically. Trying to tell them that things like gas pocket migration, hissing wells and the like occur naturally a certain percentage of the time means nothing to them. They start screaming cover-up, statistical relevance be damned.

The situation is changing here, though. Many States are passing laws requiring disclosure of ingredients so things like that article highlight will eventually be a thing of the past.

Yeah, back to the story. It was about enlarging zones used for hydrothermal power. Since there won't be any hydrocarbons to pump out, there won't be any to leak. Water goes in, steam comes out and turns the turbine.

The first thing I thought of was "yes, this looks expensive".

http://www.ama-assn.org/amednews/2012/11/19/bil21119.htm

64% of physicians hold no ownership stake in their practice. Which means they either work for a large physician group owned by a corporation or a hospital, or they work in a hospital. The reasons sited in that article are exactly the concerns mentioned in the comments here. Regulations and overhead are too much for the independent physician.

> LED accent lighting.... can be very dim, but provide enough light to act as a night light.
We used amber -- switched separately. Those (no blue) can be as bright as you want, including reading lights.

(The health issues are emerging in epidemiology statistics for use of blue-white light at nighttime)
http://articles.courant.com/2012-06-20/health/hc-light-dangerous-ama-0621-20120620_1_breast-cancer-light-pollution-ama-board-member
Adverse Health Effects of Nighttime Lighting
http://www.ama-assn.org/resources/doc/csaph/a12-csaph4-lightpollution-summary.pdf

What pedophiles need is help, especially when evidence proves that some pedophilic urges are caused by physical problems and can be cured by surgery.

So we're lobotomizing people again, eh? Just like they tried to "cure" homosexuals and other perceived "deviants" back in the 1950s.

I assume you are some right wing Christian anti-gay bigot? If not, you're just plain stupid.

Equating gays and paedophiles shows that you have no idea what you are talking about, and you probably don't even realise why it is so offensive.

What pedophiles need is help, especially when evidence proves that some pedophilic urges are caused by physical problems and can be cured by surgery.

So we're lobotomizing people again, eh? Just like they tried to "cure" homosexuals and other perceived "deviants" back in the 1950s.

It's possible that the free distribution of existing child porn over the internet is probably the best thing that could happen (short of a cure) re: the problem of pedophilia. With its ease of accessibility, supply becomes high, resulting in, one would guess, a reduced chance for someone afflicted with pedophilia to use actual children to satisfy his desires, much in the same way that "normal" internet porn may reduce the occurrence of rape.

What pedophiles need is help, especially when evidence proves that some pedophilic urges are caused by physical problems and can be cured by surgery . (I'm not saying all pedophilia has physical causes; it seems obvious that much of it is caused by psychological problems during adolescent development)

A friend of mine works in radiology research. He holds the same opinion.

I stayed at a Holiday Inn last night, and I wholeheartedly agree.

Okay, if you prefer:

http://radiology.rsna.org/content/259/1/6.extract
http://rpd.oxfordjournals.org/content/145/1/75
http://archinte.ama-assn.org/cgi/content/full/171/12/1129
http://www.propublica.org/article/scientists-cast-doubt-on-tsa-tests-of-full-body-scanners
http://www.sciencedirect.com/science/article/pii/S0267364908000708

Find me similar articles from professionals in the relevant fields and not associated with the TSA that say the opposite.

but in the end weight is just a matter of calories in vs calories out.

It's not ENTIRELY this, though this is a big part of it. The Journal of the American Medical Association recently published a study in which participants were fed an extra 1000 calories a day during an approximately 3 month period. One subgroup received 25 percent of daily calories as protein, one received 15 percent protein, and one group received five percent protein.

The kicker? All groups gained the same amount of fat. However: the normal and high protein groups actually increased lean body mass and increased resting energy expenditure. The low protein group did not gain any lean body mass nor increase their resting energy rate. Here's the link to the JAMA study (it's the highlights - there are many articles on the web discussing the study)

Can't decide if I agree or disagree. We are generally in the same insurance pools, it will generally save us money (and cut down on the societal awfulness of car crash deaths) if more people wore seat belts.

On the other hand, in the grand scheme of causes-and-numbers-of-death, it's just not that big a deal. The simple act of driving the car instead of walking, biking, or even just standing on a subway or bus (just plain sitting turns out to be bad for us) kills more people by far. One estimate of the risks and rewards of bicycling (crashes, vs health benefits) was 20 years of life gained for each year of life lost. Given that bicycles offer little protection from crashes other than their low speed, this suggests that lack of exercise is really bad for you, and that driving cars to excess is one reason for this lack. Another study found a 28% lower mortality rate for bicycle commuters even after adjusting for other cardiovascular risk factors.

Probably the best plan for saving lives would be mandatory helmet laws for car drivers and passengers. Head injuries from car crashes are a significant cause of death and disability, so this is not an outlandish thing to do. Australian researchers have even developed a prototype helmet for just this purpose that is less expensive and less cumbersome than your average motorcycle helmet. What makes this plan "best" is not that it is necessarily super-effective at reducing car deaths, but that encouraging just a fraction of car drivers to use some healthier form of transit will save many lives through their improved cardiovascular health (if we believe the 20:1 figure for bicycling rewards:risks, and assume that bicycles and cars have the same risk of crash death, diverting 5% to cycling would save about as many lives as are lost to car crashes in total. Similar ratios probably also apply for walking).

And yeah, I know this is an inflammatory proposal, that's why I included all the links to back up my argument.

Google "Jaundice", which can be a result of dumping too much blood into the kid.

That's the carp you hear from doctors who are unwilling to change the way they have always done things..
It's just that there is no study showing that. On the contrary. While there is no significant increase of jaundice, delayed clamping might lead to healthier babies a few months later and might give the baby a boost right after birth.

The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: a randomized, controlled trial.

Delayed Cord Clamping in Very Preterm Infants Reduces the Incidence of Intraventricular Hemorrhage and Late-Onset Sepsis: A Randomized, Controlled Trial

Late vs Early Clamping of the Umbilical Cord in Full-term Neonates

My suggestion:
read up on delayed cord clamping (decent sources, like parent-to-be-books from your local library written by MDs and maybe medical journals) and include it in your birth plan. With the money saved from cord blood banking buy something like this binary Infant Bodysuit

That's also the AMA's recommendation.

Experts don't think cigarette warning labels are effective:
Archives of pediatric and adolescent medicine

Did you consult any experts before making sweeping statements about what they believe?

abstract is here http://jama.ama-assn.org/content/307/7/685.abstract
story itself, paid for probably with tax dollars is paywalled
The abstract says that yes, at 3 days, amoxicillin and placebo similar, but there was a diff at day 6
Also, total number of patients studied is quite small - Typical Bull**** "MD" science - mds just don't know how to do science, and they constantly flood the literature with these worthless studies, so the net result is a negative, cause you have towaste brain power to not pay attention

However, what is of more interest is the hard to read format of the abstract, which is a deliberate format imposed by the medical journals; the use of statistics in parenthesis, eg quote, mean difference between groups of 0.03 [95% CI, 0.12 to 0.19]) and on day 10 (mean difference between groups of 0.01 [95% CI, 0.13 to 0.15]), but differed at day 7 favoring amoxicillin (mean difference between groups of 0.19 [95% CI, 0.024 to 0.35]).
makes the abstract almost impossible to read; this practice has been criticized, but the idiot mds of course don't listen.
Not only that, with the number of people in the study, if you know naything of the history of medical studies, to give CIs is just BS, crazy statistics for no reason other then to tget a publication or satisfy the wierdness of hte editors; everything that is wrong with academic medicine is in this abstract
sorry for rant

http://jama.ama-assn.org/content/307/7/685.short I can't tell if it's paywalled or not - it appears to be. Pubmed hasn't indexed it yet (not that they offer free articles from JAMA anyway).

An existing US Food and Drug Administration (FDA) mechanism for approving premarket generic drugs was identified and modified for the purpose of qualifying ARVs for use in PEPFAR programs. The process, FDA tentative approval, included expedited review that allowed the FDA to rapidly evaluate antiretroviral drugs from any manufacturer internationally, and to issue approval for use in PEPFAR programs if the ARVs met FDA standards of safety, efficacy, and manufacturing quality.

As a physician who spent one long autumn working in an AIDS clinic in Kampala prior to what the Ugandans called "the Bush program," and watching most of my affected patients be marked for certain death... and then celebrating along with them the long overdue arrival of lifesaving therapy with PEPFAR's implementation, I owe that frustrating Texan a debt of gratitude.

I have to wonder what meta-analyses you have been reading. Aside from the fact that meta-analysis is highly susceptible to agenda biases, there is also this meta-analysis. It concluded that SSRI's like Prozac, at least in the case of severe depression, were not only statistically significant, but reached the more stringent standard of clinical significance.

Eh, that's sounds pretty anecdotal, doesn't it? Coincidentally, I picked the following article as an example for my statistics class about a month ago: http://jama.ama-assn.org/content/304/13/1447.short

In short: Arizona set up a 5-year program to educate people in CCOPR (chest compression-only CPR). Comparing victims who got CPR from non-medical professional bystanders, to those who got CCOCPR, the latter had almost double the chance of surviving to discharge from a hospital (7.8% to 13.3%). However, when looking at multiple randomized trials for dispatcher-assisted CPR over the phone, there was no statistical difference between the techniques. (P-values 0.18, 0.09, and 0.16; p. 1452-3). The sociology factor is suggested, but it's at the bottom of the list:

"There are multiple reasons COCPR might have advantages over conventional CPR techniques. These include the rapid deterioration of forward blood flow that occurs during even brief disruptions of chest compressions,8,31 the long ramp-up time to return to adequate blood flow after resuming chest compressions, 8,31 the reduction of cardiac venous return with the use of positive pressure ventilation,32 the complexity of conventional CPR,21,33 the significant time required to perform the breaths,28,33,34 the critical importance of cerebral and coronary circulation during arrest,8,31,35,36 the reduced time required for emergency medical dispatchers to instruct a bystander over the telephone how to perform COCPR, 6 and the reluctance to perform mouth-to-mouth ventilation on strangers.25,26,28,37" [p. 1453]

In a similar, and equally amusing, vein, the 2008 Ig Nobel Prize for Medicine was awarded to a team of researchers for "demonstrating that high-priced fake medicine is more effective than low-priced fake medicine".

You don't have to inject the virus, you just have to inject gays users of crystal meth users. http://virtualmentor.ama-assn.org/2005/12/ccas3-0512.html.

" (look at small children to see rather obvious effects)."

pleases top spreading that myth. Sugar doesn't effect kids that way, its an observation bias.

Here is the abstract of one of the several studies:

http://jama.ama-assn.org/content/274/20/1617.abstract

"From 1998 through 2005, reported serious adverse drug events increased 2.6-fold from 34 966 to 89 842, and fatal adverse drug events increased 2.7-fold from 5519 to 15 107. Reported serious events increased 4 times faster than the total number of outpatient prescriptions during the period. In a subset of drugs with 500 or more cases reported in any year, drugs related to safety withdrawals accounted for 26% of reported events in that group in 1999, declining to less than 1% in 2005. For 13 new biotechnology products, reported serious events grew 15.8-fold, from 580 reported in 1998 to 9181 in 2005. The increase was influenced by relatively few drugs: 298 of the 1489 drugs identified (20%) accounted for 407 394 of the 467 809 events (87%)." This is from http://archinte.ama-assn.org/cgi/content/abstract/167/16/1752. Anyone notice that they are drugging us to death? The Public needs special protection. Sorry about the "Hate Speech"

I think you need to back this up with numbers. There's an awful lot of diseases-of-the-unfit that cycling makes less likely, to the point that in one Danish study, non-bicycle commuters were observed to have a 39% higher mortality rate. Could just be a coincidence, of course. In my own anecdotal case, riding a bicycle allows me to avoid various forms of medical care -- in my 20s, with a cranky knee, whose symptoms were relieved by cycling, the knee doctor offered the advice, "I can cut you open, or you can ride your bike, your choice." Now, it tends to relieve symptoms of arthritis in general (on those joints that get flexed-not-impacted by riding) as well as keeping my weight down and my blood chemistry in a good place (we've got before/after comparisons, it's pretty striking).

Your cost of food-production estimates are wildly overstated. This has been addressed by people like Pimentel, and if you avoid meat, you are probably doing okay. As a general rule, the cost of a food item sets an upper bound on the energy required to produce it. So for example, a gallon of milk costs about the same as a gallon of gasoline -- so it could not take more than a gallon of gasoline's worth of energy to produce that milk (this ignores taxes, etc, but round numbers). A gallon of 1% milk has enough energy to fuel a cyclist for about 150 miles -- 2% and whole milk, much more (the rule is 50kCal per mile). So the bicycle beats a car there, pretty easily.

It's also possible to do better -- oats, in particular, yield 5 kCal of food energy for every 1 kCal of fossil fuel input (units are a bear, I know), so that if you cook them carefully (not usually the case) you can get an effective mpg of 3000. Cooking them carelessly lowers that to 2000 or even 1000mpg.

And it's been a few months since I last saw Manhattan, but the guns must be carefully hidden, because I didn't see any, and it was bloody expensive, which normally suggests that people wish to be there, not the opposite.

Car crash deaths are not that big a deal. Lack of exercise is estimated to kill an order of magnitude more people. One study compared the health risk from not exercising (i.e., from driving cars to excess), to the crash risk for bicycles (not cars, bicycles), and found that riding bicycles saves about 10 years of expected lifespan for every year lost to bicycle crashes. Another study in Denmark found that the mortality rate was 39% higher for non-bicycle commuters, after correcting for risk factors.

So, seriously, it's old news, but if you think that the right way to think about safety is which car to drive, as opposed to whether to you should be driving, you're not looking at the big picture. If government officials were smart, they would ignore this pinheaded economist, and focus on ways to get people out of their cars and getting a bit more exercise.

I submitted this story a few months ago, but it wasn't picked up, so I guess now will be good time to recount the main facts:

A single scan is equal to 3-9 minutes of natural background radiation exposure and would raise the amount of radiation a person is exposed to on a 6-hour intercontinental flight by about 1%. As for cancer risk, 1 million people flying 10 times a week will have 4 additional cases of cancer (using current models of radiation-cancer association). This is compared to the 600 cases of cancer they will get from the flight itself and to the 400,00 cases these people will have over their lifetime.

I can't find the full article anymore (paywall), but the abstract is here. It is interesting to note that the authors also wrote this:

In medicine, we try to balance risks and benefits of everything we do, and thus while the risks are indeed exceedingly small, the scanners should not be deployed unless they provide benefit—improved national security and safety—and consideration of these issues is outside the scope of our expertise.

The article also points out that since TSA officials do not allow outside scrutiny of the actual radiation levels of the machines, we cannot know if they perform as intended or if they expose us to more radiation. But still, I think they are probably a lot safer than you would have thought.

Just because it's non-ionizing radiation doesn't mean it can't damage cells, or alter proteins. Otherwise a microwave oven wouldn't be able to cook stuff. Or people wouldn't have to be careful about radar exposure[1].

Damage cells enough and the odds of cancer go up.

The risks are probably not that high (compared to smoking and some toxins). But the phones often operate rather close to heads. And there are measurable effects ) http://jama.ama-assn.org/content/305/8/808.abstract ). So I'd keep my cellphone usage as low as possible. Maybe some people's brains can take it (or might even do better) but others might not fare so well.

[1] http://www.ncbi.nlm.nih.gov/pubmed/10926722

I've seen similar data to the reference the other replier posted. It's not very addictive, it is short-term non-toxic. Many other drugs, including many sold over the counter, if you overdose, you can easily die. I don't think there is even one death attributed to marijuana overdose (I did a little Googling to see if I could refute this, and turned up a bunch of zeroes and a parody). Long-term, if you smoke it, it's not optimal for your lungs, no, but the last person I saw smoking dope, smoked a pinhead's worth (modern dope is very strong) which is not very much smoke to inhale.

And you also have to be careful to distinguish between "use" and "abuse". Alcohol is not a "safe" drug, judged as an abusable drug (it is slightly addictive, it can kill you in overdose, it can trash your liver with long-term overconsumption), but moderate consumption is judged to be good for most people.

I'm also pretty skeptical of nanny-state arguments -- if you think it's okay to make me not smoke dope "for my own good", I think it's okay to force you to exercise four hours each work "for your own good". My (hypothetical) nanny-ism will result in many more lives saved than your (hypothetical) nanny-ism (need a reference? Here, bicycle commuting cuts mortality by 28%.)