Domain: ama-assn.org
Stories and comments across the archive that link to ama-assn.org.
Comments · 226
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Re:Right...
A higher rate of obesity in America does not necessarily make most Americans fat. Where'd you learn logic, America?
Correct in the Spock sense, not in the Joe Friday sense:
Q: How many adults age 20 and older are overweight or obese (Body Mass Index, or BMI, > 25)?
A: Over two-thirds of U.S. adults are overweight or obese.[4]
All adults: 68 percent
Women: 64.1 percent
Men: 72.3 percentThat's from an NIH page, and it references an AMA paper. I guess the fat vs. overweight distinction can be argued.
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Re:...liabilities
Tasers are a non-lethal general purpose alternative to going hand to hand with someone or shooting them. The chances of getting hurt, either the officer or the suspect, in a fist fight are much higher than when a taser is used.
Tell that to poor old Robert Dziekanski.
Wow. One famous Taser victim. Care for a larger sample size?
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Re:DEAR SONY
I see no problem whatsoever with suing when terms are found to be unreasonable after the fact. Once again, if you don't like terms, don't agree to them in the first place. Yes, clicking "OK" counts.
Not all licenses say the same thing at all. There are some licenses that are better, some that are worse, and some that are just plain weird. Licenses usually protect the interests and rights of the copyright holder, and it shouldn't be surprising that most companies have similar interests.
Now, IANAL, and this is certainly not legal advice, but if there's some term of a contract that's outright unreasonable, I'd say go ahead and break it. Don't complain when you get sued, but by all means, drag the contract through court and fight it out. Get that unreasonable term invalidated!
The "one part invalidated" clause protects the company against having the whole contract thrown out by a jurisdiction who finds some small part unacceptable. Usually, that protection is provided by legislation anyway, but it's not hard to imagine a jurisdiction's laws containing wording like "Any contract that requires X is invalid".
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Re:Mileage keeps dropping...
"Much of the world" prefers miles per gallon. I know how big my tank is. I know my car does 58 mpg (imperial). I know that the orange light comes on at about 1 imperial gallon remaining, therefore I know I have approximately 50 miles of normal driving before I run out of fuel. I also know that on a 10 gallon top up I can go roughly 500 miles. How does knowing that I can go 100km using 21.25 litres of fuel help me here?
I find a 1L/100km quote about as intuitive as the Office ribbon, but 235 miles per gallon makes an awful lot of sense - but then I'm used to miles per gallon.
At the end of the day, who cares ?
:)Your point about body temperature is great though! As you clearly know, the 37 Celsius came about by a scientist, using Celsius measurements, taking the temperatures of a large number of people and taking their mean. He rounded. This has since been converted, by morons, to 98.6 Fahrenheit, and gets quoted as definitive! http://jama.ama-assn.org/content/268/12/1578.abstract
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Re:Yay!
and stupidly short expiration dates [medscape.com] on medicines
First, that link requires registration. Yuck. Second, IIRC from Pharm School, expiration dates are legally mandated by the FDA to be when the active ingredient(s) degrade to 90% efficacy? Maybe I'm wrong on that one... or maybe it was just for prescription meds. But it's kind of important for dosing properly.
Well, it's complicated. (Long and winding article). Short answer:
- There are lots of rules and regulations
Baseline data comes from pilot studies during early manufacturing periods. Typically the testing does not go beyond six months. Various forms of regression analysis and environmental stress analyses are used in order to accelerate the process but the article seemed to imply that anything past the actual test time got into hand waving territory and, since it's in the interest of the pharmaceutical company to not push the date back, they don't.
Manufacturers are encouraged to redo testing as they get more experience with production methods. In a totally surprising move, they don't. It's time consuming and expensive.
Open the package and all bets are off.
The military did studies back in the mid 1960's that showed the expiration dates for most medications kept under carefully controlled conditions were much, much longer than printed on the label. What this means in a non military context is an open question.
As usual, we don't know jack.
Totally off topic from Apple's latest hiccup and the world's breathless analysis of same, but since I actually looked it up, here it is.
- There are lots of rules and regulations
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Re:The damage is already done
That article really pissed me off. I'd been reading about some of the studies they mention...
A study by the American Institute of Medicine concluded that a link between thiomersal in vaccines and neuro- developmental disorders --including autism - was 'biologically plausible'
Quite aside from the fact they didn't bother to identify the study, and only quoted two words from it, they didn't bother to mention that the AMA has since endorsed (DOC) the opposite.
In a related U.S. study, researchers found a 'statistically significant' association between thiomersal in vaccines and children with problems such as attention deficit disorder and speech and language learning delays.
Is there an extra page in the British version of Strunk & White that says you should never identify a study or quote more than two words?
How can they mention (I will not call it "cite") studies that are inconclusive on some aspects of a vaccine link, and fail to mention that every study which is rigorous enough to reach a conclusion has concluded there is no link?
Bastards.
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Re:The damage is already done
That article really pissed me off. I'd been reading about some of the studies they mention...
A study by the American Institute of Medicine concluded that a link between thiomersal in vaccines and neuro- developmental disorders --including autism - was 'biologically plausible'
Quite aside from the fact they didn't bother to identify the study, and only quoted two words from it, they didn't bother to mention that the AMA has since endorsed (DOC) the opposite.
In a related U.S. study, researchers found a 'statistically significant' association between thiomersal in vaccines and children with problems such as attention deficit disorder and speech and language learning delays.
Is there an extra page in the British version of Strunk & White that says you should never identify a study or quote more than two words?
How can they mention (I will not call it "cite") studies that are inconclusive on some aspects of a vaccine link, and fail to mention that every study which is rigorous enough to reach a conclusion has concluded there is no link?
Bastards.
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Re:Super
If you're wearing a seat and shoulder belt, the additional benefit of an airbag is not large. The alternative may be merely bruises from the belts.
It is if you hit something at 120km/h.
You also discount the role of incentives to get people to attend more careful to automobile maintenance, etc.
:-)Mechanical failures are not always caused by bad maintenance.
As far as actual measured death rates go, the safest vehicle on the road is a bicycle -- even after adjusting for other risk factors, non-bicycle commuters have a 39% higher mortality rate, says this study: http://archinte.ama-assn.org/cgi/content/full/160/11/1621.
I don't think that's a valid conclusion to be drawn from that study.
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Re:Super
If you're wearing a seat and shoulder belt, the additional benefit of an airbag is not large. The alternative may be merely bruises from the belts.
You also discount the role of incentives to get people to attend more careful to automobile maintenance, etc. :-)
As far as actual measured death rates go, the safest vehicle on the road is a bicycle -- even after adjusting for other risk factors, non-bicycle commuters have a 39% higher mortality rate, says this study: http://archinte.ama-assn.org/cgi/content/full/160/11/1621 . -
Re:Not just allergies
All you have to be is wrong once.
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Re:Evidence Based Medicine Movement
And to give a specific example of a well-studied off-label use of a drug:
Prochlorperazine (aka Compazine) has been used for decades to treat migraines, but it isn't approved by the FDA for this. There are lots of studies supporting this use, including randomized, double-control studies.
FDA approval for a new indication costs $12-15 million. When the marked for a drug is dominated by a cheap, low-margin generic version, there is simply no economic incentive to seek FDA approval for a new indication.
The same thing is about to happen with using ketamine to treat depression. Ketamine is cheap and long out of patent, and apparently it works wonders for depression. It is highly unlikely that any company will bother spending the money to get FDA approval for this indication.
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Re:For example
Exercise burns carbs and then fat. Trouble is, the carbs we take in our daily diet still outnumbers that which I burn from riding 10 miles each day.
Then you needed to eat fewer calories, and not just from carbs. Low carb diets work only when caloric intake decreases. (If you consume 3000 calories of fat and protein and burn 2000 calories, just what do you think happens to that other 1000 calories?)
In fact, people can lose weight on either low carb (preferable a vegetarian low carb, if one doesn't want to shorten one's lifespan, since a typical low carb/high protein diet has detrimental effects of coronary blood flow) or high carb diets. The problem is caloric intake, not the proportion of macronutrients in the diet. If carbs are to blame, why does Japan have one of the lowest obesity rates in the world and a diet still centered around rice? And why is that obesity rate increasing as the diet Westernizes and becomes less carb-centered? It's nothing to do with carbs versus protein or fats, it's serving size, sugar, and exercise patterns.
People seriously do not understand nutrition or how diet and exercise work.
Yes, and the belief in the effectiveness of low carb diets is just evidence of this.
Anyway, congratulations on decreasing your caloric intake and losing weight, even if it took belief in the effectiveness of pseudoscience to help you do it.
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Re:What the hell?
You could just as well call it "fruit sugar"
People do call fructose "fruit sugar", but the FDA does not allow HFCS to be called "fructose", since (as you point out) it isn't. Nor can it be labeled "sugar", which it is, due to the chemical processes involved (much like how you have to specify that fat is hydrogenated, even though it's still just fat).
HFCS use in foods has been declining, yet obesity continues to rise
...Citation needed, and here it is: HFCS use in food has declined about about 20% per capita, since the high point in 2002 (source, table 50). In fact, the use of caloric sweeteners has fallen by 15%, while obesity has increased by 15% in the same time period (source).
Of course, HFCS consumption still correlates positively with obesity on the individual level – just not directly. More HFCS generally implies more junk food.
If you think fructose is bad, stop eating fruit, [because] it's the sugar you'll find therein.
Oh, if only logic worked... The obsession with HFCS vs. fructose vs. cane sugar vs. honey is the same old fantasy of being able to eat all the crap you want as long as it's the right kind of crap.
Obesity as a biological problem was solved ages ago: consume less energy and/or expend more. Science will eventually solve the psychological problem that you can't eat that donut even though you really want to, but until then, wishing really hard won't make it come true. And trying does not help.
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Re:WOAH WOAH WOAH
This is so ridiculous I am undoing moderation to reply.
Congratulation. You wasted your mod points so you could expose your own ignorance.
You are also forgetting the burden illegal immigrants put on our welfare system. Since they often work for low wages and live below the poverty line they qualify for all sorts of benefits. In Wisconsin they get excellent health care (better than my current employment benefits and they pay nothing for it), housing assistance, heating assistance, food stamps, etc... all on the American taxpayer's dime.
Bullshit. With the exception of maybe the children of immigrants, illegal immigrants genreally do not qualify for any type of welfare, food stamps, or housing assistance. Regarding health care, studies have shown that illegal immigrants place a lower burden on our health care system than citizens of the same socioeconomic class. Here is a second study which came to the same conclusion. Here is a third. A fourth.
Interestingly it seems that these programs were tailored for illegal immigrants as you do not need a social security number to qualify--meaning you don't have to be paying taxes to get the benefits.
I've never heard of a state giving illegals welfare-type benefits. I'd love a link to these programs in Wisconsin you speak of. Got one?
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Re:Huh?
That's tasteless and misleading. Death is very rarely that immediate, especially in bicycle accidents. Furthermore, the guy driving the car probably has a higher risk of death in general -- it's been studied, non-cycling commuters have a higher (39%) mortality rate. The vividness of the bike-car crash tends to distract people from the fact that sitting (in the car) is much more risky, over time.
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Re:Alternate solution
The costs to you personally from not getting enough exercise probably dominate all of that. How much would you pay to not have a 39% higher chance of death? That's the cost of not getting exercise (specifically, of not riding your bicycle to work, according to this study). Problem is, choosing to get enough exercise takes time (takes much more time off a bike, but somehow people don't view it that way) and it takes time to get comfortable on a bike in traffic and it takes time to build the muscles and CV system to just hop on the bike and go and not care about the exertion. Balance that, against our Lake Wobegonesque optimism that we won't be the ones to get heart disease/diabetes/stroke/cancer, and that's how people stay in their Convenient Cars.
And obviously (or maybe not) the car companies don't want you to think about this, and the oil companies don't want you to think about this, and the drug companies don't want you to think about this (think of the cholesterol meds avoided, the diabetes meds avoided, even the erection meds avoided, because bad circulation is a lot of that). You're a revenue stream, so get back to work and continue consuming their stuff. It's good for the GDP. -
Re:Thank goodness:
Actually, I don't think this test is all that useful. According to the article, the test was validated for people with significant memory loss. Alzheimer's can really be diagnosed clinically in that group, so the test won't add all that much, and if it is from spinal fluid then it involves a painful and invasive lumbar puncture (spinal tap). I would say that this test is of academic interest, a step in the right direction towards finding a test that can be used early on. There is more interesting research into bloods tests which are less invasive.
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Re:Thank goodness:
That happens, but it is rare. But because of the potential numbers of people who would want the test, the difficulty of doing a lumbar puncture (spinal tap) on persons who have arthritis in the back (very common among us ancient folk), are of the supersized persuasion, or have other reasons to dissuade themselves, I don't think this is going to be the ultimate test.
Instead it will serve as a proxy to allow simpler tests to be developed. TFA also notes that PET scans are fairly accurate. These are available at many larger medical centers but are also pretty pricey and technically complex.
This is also not the first time that lumbar punctures for beta amyloid have been used to diagnose Alzheimer's. And finally, the abstract of the original article for your viewing pleasure. -
Re:Pass it to the Left
So you have a citation, then?
Logical fallacy: misdirection. This is irrelevant.
Agreed, I'm from Wisconsin just talking experience.
you are pushing an anti-cannabis agenda.
You are paranoid, I'm not against you sir. I push no agenda. It does however seem though you think the benefits of marijuana to people who do actually need it is a cure for them. It's not. Yes, it takes away pain, and helps in many ways that no other drug can. It is a miracle drug without a doubt. It is not a cure though. Making someone eat who normally would not only prevents other health issues, it doesn't solve the one causing them to not eat.
Legal recreational use will create unforeseen problems, while perhaps minor, it will not result in world peace. -
Re:Just feed them less
As Gary Taubes, author of "Good Calories, Bad Calories"...
Taubes is a scientific and journalistic fraud, who pushes nutritional pseudoscience and misrepresents the positions of people he interviews. See http://www.fumento.com/fat/reason.html and http://www.atkinsexposed.org/atkins/105/Center_for_Science_in_the_Public_Interest.htm.
A huge part of the problem these days is the massive consumption of carbohydrates.
No, in fact the bulk of your caloric intake should be complex carbohydrates. Now, highly refined carbs do make it easier to overeat -- as do fatty foods. But the bulk of our problem is very simple: we eat something on the order of 25% more calories now than we did three or four decades ago. When you're overeating by 500 calories a day, shuffling around the proportions of macronutrients is re-arranging the deck chairs on the Titanic.
Carbohydrates raise blood sugar, which raises insulin levels, which promotes fat storage, inhibits release of energy from fat tissue and promotes inflammation, associated with next to all our "western diseases" like heart disease, stroke, Alzheimer's, fibromyalgia and so on
Yeah, that's why you see so many fat Japanese people, all that rice. And why we've had all these "western diseases" for centuries, as we ate a grain-centered diet since, like, the beginning of human civilization.
Oh, wait a minute...obesity rates in Japan, where the typical diet gets about 55 to 60% of calories from carbs, are about 1/10 those of the U.S. -- but are rising as carb levels decrease and fat and protein levels increase.
And the fact that for most of human history[*] the majority of the human race has eaten a grain-centered high carbohydrate diet -- these "diseases of affluence" were awfully rare until the 20th century.
([*]To be taken literally: history starts with writing, which comes after the Neolithic revolution.)
And a high protein meal will also raise insulin levels -- good, since insulin is necessary for uptake of amino acids protein synthesis.. And people who are exercising lose weight and improve insulin response on high carb diets better than on high fat ones. And a high-complex carbohydrate diet will have you lose much more weight that a low-carb, high fat diet.
So, in summary: Taubes, full of shit; low carb diets, not backed by science.
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let's look at the researchI am extremely dubious that your anecdote is truthful. All the current research points to exactly the opposite of what you describe.
The study that provides the clearest counter-example to your anecdote was on mature human males and tested the effects of soy phytoestrogens on their sex hormone levels as well as a few other factors. The result showed no negative effect:Because changes in sex hormones have a much greater effect on infants because they are actively developing, there have been even more studies showing that soy forumula has no negative effect to sexual development:
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Re:Sounds good...
Based on a few papers I found and a few quick, back-of-the-envelope calculations, it should help at least 10.3% of the infected population and at best will help 96%. The huge amount of variability comes from not knowing much about superinfection in HIV. I'd also like to know what strains VRC01 and VRC02 specifically
/don't/ target; if the researchers are referring to HIV-1M, O, and N and HIV-2, then "over 90%" means 23/25 is covered, so I'm betting HIV-1N [see http://commons.wikimedia.org/wiki/File:HIV-SIV-phylogenetic-tree.svg ]---but, who knows.Anyway---for every 100 person-years, there will be a few HIV reinfections in HIV-positive individuals, sometimes by viruses of the same exact subtype, sometimes by viruses of differing subtypes. Sometimes the viruses are more virulent than the original infecting strain of HIV. The time elapsed since the original HIV infection does not seem to make an impact on the distribution of times of second HIV infections. (Yes, I know that sentence could use re-wording, but exactly how is eluding me atm.)
http://jama.ama-assn.org/cgi/content/full/292/10/1177 suggests 5.0 reinfections per 100 person-years (population size 78) in SoCal, http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.0030177 suggests 3.7% reinfections (population size 36) per 100 person-years in Kenya, and http://jvi.asm.org/cgi/content/full/79/16/10701?ijkey=30fccead91569e63031af4357a242da634620d52#SEC3 suggests 10.3 reinfections per 100 person-years (population size 20). A weighted average of these numbers, where the weights are the population sizes (not the best approach, but given the sparse amount of data found in the literature about this particular topic in general, it's better than no weighting, perhaps), comes out to 5.0 reinfections [reinfection or superinfection is very hard to define for HIV---see the methodology in the second article for more information about this] per 100 person-years. So if we look at http://en.wikipedia.org/wiki/File:HIV_time.png a timeline...If we assume the number of reinfections a year is simply the reinfection rate (5.0/100 to get per-year) multiplied by the HIV-positive population that year, and guess that none of the population in 1980 (where the timeline starts) was superinfected, we get 22.7 million in 2008. If the population in 1980 had all been superinfected, we get 30.0 million in 2008.
On the other hand, if we assume that only the increment in HIV-positive population is eligible for reinfection (a lousy assumption, but with how little is known, it's as good as any---actually, I'm partly going off of the notes in the introduction of the second article about the known information about reinfection rates), and just multiple the difference from year-to-year in the HIV-positive population by the reinfection rate, we get 1.31 million. (It would not make sense to include the 1980 population here, based on the assumption made.)We don't really know enough to guess, but we can probably assume there would be at least an easily noticeable impact. A 10% drop in HIV population would be very obvious---that's a few million people.
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Let's ask the AMADon't listen to me, just listen to the AMA instead; they're happy to admit their mistake (although they won't overtly admit the motivation behind it). Basically in the 1980s they wrongly predicted in 10-20yrs we'd have a surplus of hundreds of thousands of doctors and the market would crash (yeah, wouldn't that be horrible, to have too many doctors? I mean, horrible if you want to drive a Lexus and you're a doctor, I suppose...). Of course they got it wrong ("accidentally," I am sure) and overshot in the other direction and now we have a huge shortage. "Whoops." Unfortunate byproduct: ridiculous salaries (mostly for specialists). Not so unfortunate if you're a dermatologist, though.
Some quotes from the AMA themselves:
"Not a single allopathic medical school opened its doors during the 1980s and 1990s ... The surge in new medical schools is taking place as the Assn. of American Medical Colleges predicts a shortage of at least 125,000 physicians by 2025 ... But some experts on work-force issues say new schools are not enough. They say that without more federal funding for residency slots or changes in the doctor payment system, the schools are unlikely to avert an overall work-force shortage or address the undersupply of primary care physicians and general surgeons ... 1 in 3 active physicians is 55 or older."I think we can agree that it's unreasonable to have 99.999% of the applicants on one side of the line or the other, but beyond that? What about taking only the best 10%, or only the best 90%, would one of those be OK with you?
How about 98% rejection rate? From the AMA article above: "Many private medical schools have 5,000 or more applicants for a class of 100 students."
Again, I hope it comes across, I know something about this issue. I said "ostensibly qualified" and "more than half" in my OP because I didn't want to get into a big debate about the exact percentage of people who apply and are grossly underqualified and rejected versus the legit applicants who are rejected, but basically the former is not happening, since you need to take the MCATs (not easy) and complete the equivalent of a degree in Molecular Biology simply to even apply to med-school (and currently to be competitive you need hundreds of hours of volunteer work, professional medical experience such as EMT work, and even then it is often a crapshoot, I know many qualified applicants who have been rejected more than one year in a row). -
studies with "sham needles"
Chinese medicine has always included acupressure as an effective treatment. Indeed, it predates acupuncture -- not surprisingly, people noticed "it feels better if I press and rub here" before they thought, "hey, what if I stick a bamboo splinter into my skin so I can stimulate that point but free up my hands?" Pick up an acupuncture products catalog and you'll find a variety of "pellets" which can be taped to the skin to stimulate the points without puncturing the skin.
So at best, "sham" needles -- i.e., acupressure -- as a control for acupuncture is like using aspirin as a control while investigating a new painkiller.
The study that Yong (not "Tong") mentions also featured treatment via a set of points determined in advance by one therapist, and delivered by another. But when I see my acupuncturist (or even when I give a shiatsu treatment including the use of acupressure points), point selection is determined in part by the response to earlier points. So this is rather different than acupuncture as practiced by knowledgeable practitioners.
That study also excluded patients with previous acupuncture treatment for any condition; based on my experience, however, it seems that it takes some experience with acupuncture to learn how to give feedback to the practitioner, to recognize and report the de qi sensation, so the effectiveness of the treatment increases with experience. (Perhaps there is also something like the habituation required for a cannabis "high" at work here, with the patient learning to interpret and respond to new sensations.) And the study also excluded those with "specific causes of back pain", so would seem to likely include a high proportion of those whose complaints had a strong psychosomatic component, and so would be poorly suited to investigating the physiological mechanisms involved.
This is all too representative of the problems with much acupuncture research: what gets tested often has little to do with Chinese medicine as it is applied by knowledgeable practitioners.
Despite these problems, this study found that "Compared with usual care, individualized acupuncture, standardized acupuncture, and simulated acupuncture [i.e., acupressure] had beneficial and persisting effects on chronic back pain." Nor does the study's comparison of individualized acupuncture vs. standardized acupuncture justify Yong's claim that it did not matter where the needles were placed. It takes some twisting to interpret this study the way that Yong would like to.
And of course the placebo effect plays a role -- as it does in any treatment, including surgery. If my acupuncturist is doing nothing beyond triggering a placebo response in me, the results are still real, and what I pay her for the little show she puts on that lets whatever part of brain is responsible do its thing, is a bargain.
(My bias: I'm and NCCAOM Diplomate in Asian Bodywork Therapy; my practice is a small sideline to my computer geek day job.)
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Not the reason for Exam Room computers
Physicians need to start putting computers in exam rooms not because of Google-itis, but because we desperately need to start using electronic medical records.
An extraordinarily low percent of hospitals are using EMRs. Source: study by the New England Journal of Medicine, reported here in the American Medical Association:
http://www.ama-assn.org/amednews/2009/04/06/gvsc0406.htm
Forget Google-itis, how about having a system where if one doctor prescribes a medication, an alert immediately pops up warning the physician that this patient is also taking another medicine that will cause severe reactions if the two are taken together?
Imagine an industry that has extremely high-tech factory production equipment (Advance MRIs, Gamma Knife non-invasive surgical devices), but has the back office operations run entirely on post-it notes and shuffling paper back and forth on shopping carts. Get the systems in there to prevent dumb medical mistakes and improve cost efficiencies. Preventing Google-itis is a small amusing beneficial side effect.
Ben
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Re:Food?
He finally went on Atkins and was able to shed enough weight that he was able to start walking around the house, then around the block, etc until he was back down to near his original weight. It's one of the few instances where I'd advocate Atkins.
Even people with impaired glucose tolerance will lose weight on a caloricaly appropriate diet based on complex carbohydrates -- and in so doing, will avoid the negative health effects of a high protein Atkins-style diet.
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Re:Food?
Perhaps you should go tell the National Cattlemen's Beef Association to use fattier cuts of beef for their next study.
They picked lean cuts of red meat for their 1999 study ( http://archinte.ama-assn.org/cgi/content/full/159/12/1331 ).
Maybe you can teach them a thing or two.
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Re:The entire concept is mistaken
Actually, ecigarette makers are banned from advertising their products as smoking cessation devices. See here.
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Re:Of course
What a Bunch Of FUD....
If you're going to throw crap out there, you might want to trying providing links that back up your claims.
It was the same with airbags. Aside from unbelted passengers, airbags didn't improve safety. But Ralph Nader, knowing this, got up in front of Congress and lied in order to get airbags passed that would kill infants, while also working to prevent warning labels on them initially so that people wouldn't be scared of them. So we've had presidential candidates who worked very hard to pass regulations that killed babies by ejecting their heads out of the back of car windows while their bodies were still strapped into their car seats. Safety doesn't matter nearly as much as the appearance of safety. .Study after Study after Study have shown quite the opposite. In fact, there have even been papers that conclude that the media have skewed their reporting on the subject to basically fall in line with what you were spouting about above.
The point of an airbag is to cushion and slow the upper torso and head from striking hard objects that cause rapid deceleration of the body and head in collisions (super high G forces) which leads to injury and death. While the initial airbags had their faults, and have caused deaths when used both properly and improperly, they have saved far more lives than they have claimed.
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Re:They're going to do it anyway.
Now, let's look at your line of thought: American educators are going to be able to teach kids how to properly use contraception, in a way that they'll remember in the heat of the moment, and be able to recall from memory. Shit
... most kids can't read, and they've been taught reading since first grade!Actually, that's kind of the problem. It does seem to make sense. There's just the problem that every study done on whether it really does has pretty comprehensively proved it false. An example from the American Medical Association, with some useful footnotes to the more detailed studies, is here.
Comprehensive sex education does work. Contrary to what some people may think, the emphasis in that is most certainly not "Now go do it tonight, just make sure you use a condom!" The focus still is very much on waiting and why to do so (and in most programs I've looked at, this includes a discussion of the potential emotional issues). However, let's be realistic. If you put a bunch of kids in various stages of puberty together, some of them are going to have sex, no matter how much you tell them not to do it. That being the case, let's make sure they at least know how to do it in a much safer manner.
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Re:This bill is so wrong.
So then all laws requiring motor vehicle insurance are unconstitutional? That would be interesting.
The car insurance analogy is like comparing apples and oranges. First of all the government does not make you drive, but if you do drive you need insurance to have the privilege of using public roads. But to further tear up your argument. The government can revoke your license if you drive poorly, can the same be said for health care? Wouldn't that be like telling people who smoke that they can't go to the doctor anymore? Driving a car on public roads is a privilege that can be revoked. Living is not. Simply being born under this bill will require you buy something, and if progressives get a single payer plan, you will most likely buy from the government.
We spend 17% of our GDP on health care right now. Other nations get the same or better overall results spending less than half of this. Yes you might have to wait for some services but there is clearly huge inefficiencies in the current system, so much so that it is easy to argue that even a government run program would be better.
If you are diagnosed with a disease like cancer, time is your #1 enemy, and oftentimes it is how long it takes to get a CT scan or see an oncologist that makes the difference between life and death. So, you see, this is a really major issue. If you had a sucking chest wound would you want to wait more or less time? For that matter, if you had anything wrong with you, would you want to wait a longer time? You say there are huge inefficiencies in our system, but then fail to point out a single one. Here's a link that pretty much blows that whole argument out of the water though: Most Cancer Survival Rates in USA Better Than Europe and Canada. This is due to our better health care system. By the way, can you produce a list of high profile individuals that flew from the U.S. to the U.K. or Canada to receive medical treatment? Because they sure come here in droves! You also fail to point out how out health care system will compare when 1/3 of the doctors quit, and incentives (high pay) to practice medicine decrease.
Other nations get the same or better overall results
I'm going to have to call you on that one. Maybe you can point out another country that has a better medical system, since they are so numerous and all. Be nice if you provided a link. Something real too, I don't want to hear about how the U.K. has more coverage, even if they have to wait for 6 months for a CT scan. Coverage delayed is coverage denied.
it is easy to argue that even a government run program would be better.
I pointed out in my earlier post that medicare is the #1 denier of claims. I pointed out how medicare costs are rising almost 2x as fast as private insurance, And cost estimates were wildly underestimated (predicted $9b actual $67b). How does that jive with your argument that the government run program is better? We have the proof that it is not run better right there! Where is your proof that the government is going to be more effective? Seems like you just want to debate the points you think you have a shot at winning, or so you thought!.
There is quite a bit of evidence that the US has a huge and expensive overcapacity in exotic medical devices brought about by our current insurance system. We also clearly pay far more for the same drugs than people in other countries.
If there is quite a bit of evidence, I'm sure it wo
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This bill is so wrong.
Let me count the ways:
Constitutionality:
The constitution says people cannot be coerced into signing a contract. By anyone. If you don't like it amend the constitution, but you cannot just make up your own laws. That's called anarchy. So right there the bill is dead. But let me go on.
Common sense
The kings of inefficiency. The same people who spent so much of your social security and medicare money on things besides social security and medicare, to the point that the two programs have unfunded liabilities of over $100 trillion, are now going to, according to the bill, take 500B from medicare to pay for the new program and supposedly expand the roles of people on medicare and the new plan. Do some simple math! If you have a system that's already out of money, and you take more money from it to start a similar system, more than triple the number of people receiving benefits, it's going to cost more not less! You have to be insane if you think adding people to the government's dole will somehow lower costs as progressives claim. Keep in mind that in 1965 lawmakers predicted it would only cost 9$ billion by 1990, unfortuanly the real cost was $67 billion. But don't worry they were only off by A FACTTOR OF 7. I'm sure they are better and more trustworthy in making cost estimates today. Congress would never deceive us!
This bill causes lack of care (not coverage)
Sure the government will cover you for all preexisting conditions, there will just be no faciliteis or doctors to treat you! OH BUT YOU'RE COVERED!!! Tell it to the people in the UK or Canada who are waiting 6 months for a CT scan, where here in the U.S. it's unusual to wait for more than a few days. The New England Journal of Medicine estimates that a full 1/3 of doctors will "QUIT PRACTICING MEDICINE" if the bill passes, further eroding our resources. So ya, you're covered, but you're going to have to wait a few years for that liver transplant now. People other countries will no longer have a "capitalist health care system" to save them, unfortunately nether will we. We will have a government panel deciding who is worth said liver transplant and deciding who gets to live and die, instead of your doctor or a panel of your doctors. A healthy 19 yr/old kid, who hasn't put a dime into the system will be placed higher on the list than say a 60 yr/old man who has paid into the system his whole life. In essence the 60 yr/old man worked his whole life paying into a system that will deem him unworthy and spend his money on someone whom he has never met while he suffers and dies while younger "more economically viable" people will get treatment first. In the existing system, the same 60 yr/old man would be able to do whatever it takes for him to get his liver (insurance,debt,sell car/house etc.). While dems try and portray private insurers as evil for turning down procedures, drugs etc. keep in mind that the number 1 denier of care per capita is medicare! So there's another false argument made to try and pass this bill.
How much is too much?
People in this country continue to live longer and longer. This is attributable not to better diets or healthier living, but as a direct result of having invested such large sums of money into our health care system. I've heard 17% from democrats, decrying the amount. Dems say that our private insurance is increasing at too fast a rate (3%/yr) but they want to change us to a system that is similar to the unfunded medicare, but medicare is increasing at a rate much faste -
Re:Healthcare
something will make things worse
If you have evidence showing things will get "worse" that isn't based on anecdotes and an irrational fear of "socialism", then by all means present it. Unfortunately for you, there is plenty of evidence showing things will in fact get significantly better if we switched to a publicly run system. Paper after paper has been written showing real gains in efficiency that would save the average American thousands of dollars a year. But hey. don't let reality and facts get in the way of your gut beliefs.
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Re:IdeaThe emergence of antibiotic resistance on farms where livestock are routinely treated with antimicrobials has been well documented, but whether it poses a human health threat has been controversial. Now, a growing body of evidence suggests these "superbugs" of animal origin are being transmitted to humans. http://jama.ama-assn.org/cgi/content/extract/298/18/2125
Less than a minute with Google gives lots of references. These bugs come from farms and end up in people.
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Re:For our sake
First off, the lead author of the study, Andrew Wakefield, was not a pediatrician who specialized in the treatment of children, nor was he an immunologist, who specializes in studying and treating the immune system. He was a gastroenterologist, who was consulted over some digestive disorders.
Second, he based his research on a study of only 12 children whom he treated. Yes, you read that correctly. Twelve kids. Not 200, or 6,000, or 15,000. Twelve. And that was his sole study group. There was no control group with which to compare results.
Third, he collected blood specimens from random children whom he invited to his son's birthday party, and paid them 5 pounds each for their blood. He did not obtain informed consent from the kids or their parents, a major violation of medical ethics and research protocols.
Fourth, he accepted over 400,000 pounds in payment from a group of attorneys retained by parents groups to sue the pharmaceutical companies that manufacture vaccines.
Fifth, he now blames thimerosol and the minute levels of ethyl mercury it contained as causes of autism, but in his original paper, he never mentioned thimerosol or mercury, mainly because the MMR vaccine he was blaming for autism did not even contain thimerosol.
Is this enough? Or do you need more data? If so, check out http://archpsyc.ama-assn.org/cgi/content/full/65/1/19.
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Re:The debate is long from over.
Use PubMed to find scientific research in peer-reviewed journals. Here's the one I would immediately reference, as it was not funded by any pharmaceutical company, but by the State of California's Department of Public Health (your tax dollars at work): http://archpsyc.ama-assn.org/cgi/content/full/65/1/19. You can even contact the authors directly, if you have follow-up questions.
There are, however, many, many, many others. Again, use PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) instead of Google, as google ranks hits by popularity, not by scientific sources.
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Re:Great defence!
There are some specific cases where brain abnormality evidence seems like it would be very valuable to the defendant. This guy for instance. Initially pretty normal. Gradually develops increasingly problematic sexual misbehavior. Just before being sent to jail, goes to the ER with a headache and neurological symptoms. They MRI him and chop out a huge tumor pressing on his frontal lobe. Sexual misbehavior stops.
Some time later, it starts up again. They check, and the tumor has partially regrown. Tumor is again resected, and patient is again fine.
In a case like that, there seems to be a compelling argument to be made that the defendant's behavior is a medical problem rather than a criminal one(and a treatable medical problem, not an "well, enjoy the secure ward for the rest of your life" medical problem). If, though, your plea is basically "But, but, this MRI shows exactly the part of my brain that makes me a violent shitbag..." That seems fairly useless to you(though it might be helpful in the long term, if it helps us figure out how to stop producing people like you). Obviously, with sufficient scientific knowledge, it will be possible to identify the anatomic basis of your behavior. So what? -
Re:Well yes...
The prostate cancer stats aren't comparing the same thing.
http://www.factcheck.org/elections-2008/a_bogus_cancer_statistic.html
Wait times are real, but when you get the operation it's free so it's a trade off, but unlike what the right says the single-payer Canadian system will not let you wait until you die.
http://www.factcheck.org/2009/08/dying-on-a-wait-list/
neither will the nationalized UK system (right Dr. Hawking?)
http://www.factcheck.org/2009/08/how-to-not-prove-a-point/
Not that any of this really matters, the US is not adopting a Canadian or UK style system. The public option is a vague notion at the moment. We don't know what it will cover or even who it will cover. We'll have to wait and see. The big changes are regulation and allowing companies to compete nationally instead of state by state-The National Health Insurance Exchange. That is, break state monopolies by insurance companies (Hawaii and North Dakota only have one insurer available and other states, like New Hampshire, one company has almost 90% of market).
http://www.ama-assn.org/ama1/pub/upload/mm/368/compstudy_52006.pdf (Warning PDF)
The NHIX is the most important part so much so that the regulation may not even be necessary because with increased competition the company that gives better service and doesn't deny for preexisting conditions will/should get more business. However, I trust the insurance companies as much as I trust the cable/telco companies. The regulation should preempt the underhanded dealing to keep markets as they are and block out competition.
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Re:Mines a vodka and red bull...
I know it was used as an anesthetic at one time, but do they use it for that at all anymore?
The only thing I found was: "Cocaine and Phenylephrine Eye Drop Test for Parkinson Disease"
http://jama.ama-assn.org/cgi/content/full/293/8/932-b -
Re:Cut the f*cking Carbs
Adherence to a diet is more important than the type of diet as far as weight loss is concerned. It's not like calories from sugar (or protein or whatever) count any more than calories from anything else. "Glycemic index" also hasn't been found to have any effect if that's what you're getting at.
Blood sugar, unless you're diabetic, is rather unexciting. The insulin/glucagon system will keep blood sugar from dropping too low or getting too high. It's actually rather surprising, your body can maintain your blood glucose levels for something like 40 days without eating. Since it's quite adept at making glucose, not eating much sugar isn't going to lead to lower blood sugars levels. (Diabetics have to worry since this system doesn't work as well in them... leading to peaks and dips that are rather dangerous.)
Eating 875 g of sugar above what you need will generally cause you to gain a pound of body fat. The same is true of eating 875 g of protein or 389 g of fat. The only concern is that while there aren't really any essential sugars, cutting out an entire macronutrient class is unhealthy. Balanced diets are best, but anything you'll stick to will work. If low carbohydrates works for you, great. Just try to transition to something a little healthier eventually. -
Re:What's in it?
This is from a paper in the Journal of the AMA:
A total of 824 physicians (65%) completed the survey. Nearly all (93%) reported practicing defensive medicine. "Assurance behavior" such as ordering tests, performing diagnostic procedures, and referring patients for consultation, was very common (92%). Among practitioners of defensive medicine who detailed their most recent defensive act, 43% reported using imaging technology in clinically unnecessary circumstances. Avoidance of procedures and patients that were perceived to elevate the probability of litigation was also widespread. Forty-two percent of respondents reported that they had taken steps to restrict their practice in the previous 3 years, including eliminating procedures prone to complications, such as trauma surgery, and avoiding patients who had complex medical problems or were perceived as litigious. Defensive practice correlated strongly with respondents’ lack of confidence in their liability insurance and perceived burden of insurance premiums.
So it seems to me that there are quite a lot of unnecessary procedures, wasting a significant amount of money. With tort reform, fewer doctors would be inclined to practice defensive medicine, the term given to procedures performed to cover the doctor's ass instead of giving any benefit for the patient. More alarming to me, and an issue I hadn't encountered before now, is doctors' avoidance of risky procedures and patients with "complex medical problems." So yes, tort reform would have a meaningful, positive impact on medical care as a whole, far more of an impact than the "saving pennies" you originally stated.
It's a pity that what's actually good for the patient seems to come a distant third.
Agreed.
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Re:Captain TwatObvious
Dude, cherry picking articles that are convenient to preserve ignorant opinion won't get you far with me. Notice the stipulations of that article are exclusive, not inclusive.
I'm not on campus right now but I bet I could dig up a ton of primary published scientific literature with data to support the efficacy of Flu vaccines.
A quick dig with Google Scholar yielded this (if you wanna get to the 'answer' just go to the Conclusions section:
http://jama.ama-assn.org/cgi/content/abstract/281/10/908
http://content.nejm.org/cgi/content/abstract/331/12/778
http://74.125.155.132/scholar?q=cache:ASHZ--Eay88J:scholar.google.com/+flu+vaccine&hl=en
http://journals.lww.com/joem/Abstract/1997/05000/Cost_Effectiveness_of_the_Influenza_Vaccine_in_a.6.aspx (this only shows the abstract, but the last line of the abstract is a short version of the conclusion)
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And those are just from the first 10 results. I've informed you plenty; from here you can accept new information and begin to learn, or you can ignore it, use selective reading, and maintain ignorance. From here I assume you will become irrational so I will leave this conversation now.Fyi, light can degrade organic compounds, to include proteins. And while I do not claim to clearly understand the properties of influenza virus, I cannot, like you, purport absolution in an argument for the presence of miniscule anecdotal observation.
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Writing is a big problem!
Alzheimer's Disease is not only about memory. A recent article describes how certain cognive abilities, such as visuospatial skill, already start to decline three years before the first signs of memory imparement start to surface. My wife, who has been diagnosed with Alzheimer's Disease about three years ago, can no longer write, not even her own name. She cannot even sign. She still thinks that she can write her name, but when she tries, she fails. Even copying her name from an example, is very hard for her. She can still read, although lately I have noticed, she is also starting to have problems with that. However, she still does most of our shoppings. She goes shopping almost everyday and I tell her what to buy. But I should limit the number of items to about three, otherwise she is getting trouble. If its more than one or two items, I have to give her a shopping list. I give her the list in the morning, before I go to my office, and in most cases it is only during the day, that she goes shopping. Her short-time memory is very poor. She can tell you the same story within five minutes, or also often loses her keys or makes things 'disappear' in the house.
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Re:Gee whiz!
If the sugar pill with 0.00001% of some drug has the same effect as a plain old sugar pill, clearly you should just buy some damn sugar pills.
The problem is that the effectiveness of placebos actually goes up when you increase their price: "Commercial Features of Placebo and Therapeutic Efficacy".
Oddly enough, the expensive sugar pills do work bette -- as long as the patients know the price.
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There are randomized controlled trials
Randomized, controlled trials have shown the effectiveness of flu vaccines, contrary to the claims of the article. (Example: Wilde et al., "Effectiveness of Influenza Vaccine in Health Care Professionals.")
In addition, research into mortality reduction already takes into account comorbid conditions and age. (Example: Nordin et al., "Influenza Vaccine Effectiveness in Preventing Hospitalizations and Deaths in Persons 65 Years or Older in Minnesota, New York, and Oregon: Data from 3 Health Plans.")
The article is at best poorly researched and at worst intentional FUD.
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Re:How Many Separate Cases?
Trade organizations set standards, agree on best practices, and increase collaboration in the industry. For example, the American Medical Association writes assessments to evaluate physician performance in 266 common medical techniques. I think we can all agree competent doctors are a Good Thing.
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Re:It's not really homeopathic
I don't know where you are getting your "facts" from, but you should never use that source again. here is the AMA position on the use of placebos. As for your statement that all drugs are psychosomatic, that is just patently rediculous. Another poster had mentioned antibiotics, and cancer drugs. Then there are also blood thinners, such as aspirin, blood clotting agents, insulin, and a wide range. The one example you gave was an antidepressant. I would be surprised to see an antidepressant that worked without some neurochemistry explanation.
But you are right about one thing. Doctors do often give out placebos. THe AMA is against it, and it is against their code of conduct, because it "may undermine trust, compromise the patient-physician relationship, and result in medical harm to the patient."
Of course, they do say it is ok, if the patient knows he or she is, or may be, receiving a placebo, but they make it clear that this is not meant to be a substitute for medication.
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Selective Bias
A case study tells you nothing about prevalence in the community.
Your "1/4000" prevalence estimate dates back to 1960. You're going to have to do better than that. Especially because the prevalence of schizophrenia and schizophreniform disease in the community is around 1/100.
Vardy et al say The findings supported a model of LSD psychosis as a drug-induced schizophreniform reaction in persons vulnerable to both substance abuse and psychosis.. That is to say, among a vulnerable segment of the population, with disorders of GABA metabolism, many drugs can induce an above-average pseudo-delerium, and that these delerious states are indistinguishable from each other, and from schizophreniform disorders.
Soyka et al illustrate a high concordance between high dosages of alcohol and schizophrenia. Do we then assume, naively, that alcohol induces schizophrenia?
Soyka et plus al further indicate that schizophrenia and schizphreniform disease is associated with multifactorial drug use. LSD is not a primary or singular etiological agent here.
Goswami et al present a large body of evidence that people with schizophrenia or even family members with latent schizphreniform tendencies self medicate" in a manner usually considered polydrug abuse. Again, do you really think that the polydrugs are causing the GABA disarray in their cortexes?
To date, the only drugs that have been proven to induce schizophrenia in humans, and schizphrenia-like symptoms in lab animals, and to increase the symptoms of schizophrenia in people already afflicted with it are the NMDA receptor antagonists such as ketamine or PCP. These probably induce their chronic effects through an oxidative cascade. No similar mechanism has been presented, much less demonstrated, for any specific, putative effects of LSD on neural development.
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Re:Paedophiles
but it's difficult to persuade people that most paedophiles don't abuse children because of the existing conflation of terms.
Wikipedia manages to quote an article stating "We were unable to find any published reports indicating the prevalence of pedophilia among those who were either arrested for or convicted of child sexual abuse or the prevalence of pedophilia in the general population." for citation of the statement "The disorder is common among people who commit child sexual abuse."
It is a shame that most campaigners for other deviant opinions seem to either ignore or go out of their way to distance themselves from your own problems. On the surface that would seem to be a prudent move of self-interest.. but if you consider the bigger picture you realise that the war against ignorance is better fought on all fronts rather than picking and choosing battles. As long as people can justify the concept of thought crime in any form then they will be content to let governments run riot over other peoples rights.
Perhaps you could write a book, 'life at the thin end of the wedge'.
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Obama says swine flu not a cause for alarm
CNN reports that President Obama said Monday that the swine flu outbreak is a 'cause for concern and requires a heightened state of alert,' but is not a 'cause for alarm.' I for one agree with him. No one has died in the US from swine flu yet the media is portraying it as a major disaster. How is this any worse than the regular influenza that causes approximately 36,000 deaths and more than 200,000 hospitalizations every year in America?