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Last November 2005 I placed an engine online, for free, No Charge.. I could not patent it because if I had the government would have seized it and eaten it whole. None of you would have heard of it or me again. Which of course would possibly be considered a blessing I'm sure by a whole lot of doctors who feel that same way RIGHT NOW. I placed my Internet branding iron against the CDC and the AMA for allowing ongoing atrocities being worked against me {and the rest of Roanoke VA patients}. I don't just WRITE about what George Orwell's World is doing to us {processing us all through a meat grinder} because I know I am not the only one going through various kinds of AMA-approved doctor hell.

The United States Government talks a good line to us about how GREAT OUTER SPACE EXPLORATION & DISCOVERY IS GOING TO BE but here in George Orwell's REAL WORLD, Fact is they want Outer Space ruled by their {{our?}} Military. In all truthfulness, th

You should look up the study itself.
The whole point that they checked biomarkers to make sure that it wasn't a bias in the self reporting, and it wasn't.

Are you seriously trying to argue that because America has gone and done something stupid like set up a black hole in Guantanamo that it somehow makes the EU's system of secret evidence and anonymous witnesses a good legal system? They're both bad!

I will be the first to admit that America is a hippocracy. Just ask the AMA and the AHA. But that doesn't mean that the principles of fairness should be tossed aside when judging other legal systems.

I wonder how significant the results are,

and I'm too lazy to look for myself.

The abstract makes me think this was a poorly conducted study. Where's the control group that played no games? What if playing games reduces these thoughts in a way that varies based on the game? You could also have gotten this result by baselining the attitudes of the subjects before the experiment, but then you also might have lost all the interesting quotes like "Media violence exposure may play a role in the development of negative attitudes and behaviors related to health."

They did find that blood pressure tends to go up while playing games. In addition, those with exposure to home and community violence had a more sigificant blood pressure change with the violent game than with the other game. I think they might have just verified post-traumatic stress disorder.

Effects of Media Violence on Health-Related Outcomes Among Young Men

Sonya S. Brady, PhD; Karen A. Matthews, PhD
Arch Pediatr Adolesc Med. 2006;160:341-347.

Objective To test the effects of media violence exposure on blood pressure, negative affect, hostile social information processing, uncooperative behavior, and attitudes toward health risk behaviors among young men varying in lifetime violence exposure within the home and community.

Design Experimental laboratory study.

Setting University campus situated within an urban environment.

Participants One hundred male undergraduates aged 18 to 21 years.

Intervention Men who had previously reported differing amounts of lifetime home and community violence were randomly assigned to play The Simpsons: Hit and Run (low-violence condition) or Grand Theft Auto III (high-violence condition).

Main Outcome Measures Systolic and diastolic blood pressure; negative affect; hostile social information processing; uncooperative behavior; and permissive attitudes toward violence, alcohol use, marijuana use, and sexual activity without condom use.

Results Men randomly assigned to play Grand Theft Auto III exhibited greater increases in diastolic blood pressure from a baseline rest period to game play, greater negative affect, more permissive attitudes toward using alcohol and marijuana, and more uncooperative behavior in comparison with men randomly assigned to play The Simpsons. Only among participants with greater exposure to home and community violence, play of Grand Theft Auto III led to elevated systolic blood pressure in comparison with play of The Simpsons (mean, 13 vs 5 mm Hg).

Conclusions Media violence exposure may play a role in the development of negative attitudes and behaviors related to health. Although youth growing up in violent homes and communities may become more physiologically aroused by media violence exposure, all youth appear to be at risk for potentially negative outcomes.

Author Affiliations: University of Pittsburgh (Drs Brady and Matthews), Pittsburgh, Pa. Dr Brady is now a postdoctoral fellow in the Health Psychology Program at the University of California, San Francisco.

Article VI: A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.

Article IX: A physician shall support access to medical care for all people.

Article VI gives physicians a way out by allowing them to bow out of any non-emergency case. THe AMA's codified policies have a bit more to say

http://www.ama-assn.org/apps/pf_new/pf_online?f_n= browse&doc=policyfiles/HnE/E-2.095.HTM&&s_t=&st_p= &nth=1&prev_pol=policyfiles/HnE/E-1.02.HTM&nxt_pol =policyfiles/HnE/E-2.01.HTM&

Because society has an obligation to make access to an adequate level of health care available to all of its members regardless of ability to pay, physicians should contribute their expertise at a policy-making level to help achieve this goal. In determining whether particular procedures or treatments should be included in the adequate level of health care, the following ethical principles should be considered: (1) degree of benefit (the difference in outcome between treatment and no treatment), (2) likelihood of benefit, (3) duration of benefit, (4) cost, and (5) number of people who will benefit (referring to the fact that a treatment may benefit the patient and others who come into contact with the patient, as with a vaccination or antimicrobial drug). Ethical principles require that a just process be used to determine the adequate level of health care. To ensure justice, the process for determining the adequate level of health care should include the following considerations: (1) democratic decision making with broad public input at both the developmental and final approval stages, (2) monitoring for variations in care that cannot be explained on medical grounds with special attention to evidence of discriminatory impact on historically disadvantaged groups, and (3) adjustment of the adequate level over time to ensure continued and broad public acceptance. Because of the risk that inappropriate biases will influence the content of the basic benefits package, it may be desirable to avoid rigid or precise formulas to define the specific components of the basic benefits package. After applying the five ethical values listed above, it will be possible to designate some kinds of care as either clearly basic or clearly discretionary. However, for care that is not clearly basic or discretionary, seemingly objective formulas may result in choices that are inappropriately biased. For that care, therefore, it may be desirable to give equal consideration (eg, through a process of random selection) to the different kinds of care when deciding which will be included in the basic benefits package. The mechanism for providing an adequate level of health care should ensure that the health care benefits for the poor will not be eroded over time. (VII) Issued June 1994 based on the report "Ethical Issues in Health System Reform: The Provision of Adequate Health Care," adopted December 1993 (JAMA. 1994; 272: 1056-62).

In theory there is some mandate that a doctor must provide needed care regardless of cost, however the policy is not black and white so there are loopholes.

Article VI: A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.

Article IX: A physician shall support access to medical care for all people.

Article VI gives physicians a way out by allowing them to bow out of any non-emergency case. THe AMA's codified policies have a bit more to say

http://www.ama-assn.org/apps/pf_new/pf_online?f_n= browse&doc=policyfiles/HnE/E-2.095.HTM&&s_t=&st_p= &nth=1&prev_pol=policyfiles/HnE/E-1.02.HTM&nxt_pol =policyfiles/HnE/E-2.01.HTM&

Because society has an obligation to make access to an adequate level of health care available to all of its members regardless of ability to pay, physicians should contribute their expertise at a policy-making level to help achieve this goal. In determining whether particular procedures or treatments should be included in the adequate level of health care, the following ethical principles should be considered: (1) degree of benefit (the difference in outcome between treatment and no treatment), (2) likelihood of benefit, (3) duration of benefit, (4) cost, and (5) number of people who will benefit (referring to the fact that a treatment may benefit the patient and others who come into contact with the patient, as with a vaccination or antimicrobial drug). Ethical principles require that a just process be used to determine the adequate level of health care. To ensure justice, the process for determining the adequate level of health care should include the following considerations: (1) democratic decision making with broad public input at both the developmental and final approval stages, (2) monitoring for variations in care that cannot be explained on medical grounds with special attention to evidence of discriminatory impact on historically disadvantaged groups, and (3) adjustment of the adequate level over time to ensure continued and broad public acceptance. Because of the risk that inappropriate biases will influence the content of the basic benefits package, it may be desirable to avoid rigid or precise formulas to define the specific components of the basic benefits package. After applying the five ethical values listed above, it will be possible to designate some kinds of care as either clearly basic or clearly discretionary. However, for care that is not clearly basic or discretionary, seemingly objective formulas may result in choices that are inappropriately biased. For that care, therefore, it may be desirable to give equal consideration (eg, through a process of random selection) to the different kinds of care when deciding which will be included in the basic benefits package. The mechanism for providing an adequate level of health care should ensure that the health care benefits for the poor will not be eroded over time. (VII) Issued June 1994 based on the report "Ethical Issues in Health System Reform: The Provision of Adequate Health Care," adopted December 1993 (JAMA. 1994; 272: 1056-62).

In theory there is some mandate that a doctor must provide needed care regardless of cost, however the policy is not black and white so there are loopholes.

They already have....

Dear Mr. Kernablaha,

You are absolutely right. What were we thinking? The whole idea is rediculous. Thank you, Mr. Kenalbaha, for providing the insight that only a person with a "minimal knowledge of biology" could provide. Us here with postdoctoral degrees have been clearly wasting our efforts on nonsense. We'll send back our grants and ask that all our peer reviewed articles be retracted.

Sincerely,

Diana W. Bianchi, M.D.
Vice Chair for Research,
Floating Hospital for Children, Tufts University

I never said I'd want to change a gay person. I don't!

You said there was evidence that homosexuality (when defined as one's sexual preference) is caused rather than chosen. I agree. I find the evidence for biological predetermination (such as genetics) a little shaky, but I believe there is ample evidence that psychological and sociological issues can pre-dispose someone to homosexuality.

There was a study done linking brain chemistry to sexual preference, see Homosexuality may be issue of brain chemistry

It seems that sexual abuse (among many other factors), especially by a father at an early age, can pre-dispose someone to homosexuality. See for example Human sexual orientation. Archives of General Psychiatry

There are in fact gay men and women who desire not to be so, see Why Conservatives Should Embrace the Gay Gene Should we reject these people, telling them they were born gay and will always be that way? How insensitive of you!

But the question, which you are so ignorantly missing is, if a homosexual chooses not to sleep with the same sex, is he/she still homosexual?

Hey! I have an idea, why don't you talk to some real psychologists at a real university about what the prevailing scientific findings are about this?

You pal,
Brian

For those that still think that PCB stands for printed circuit board, or it may mean this, in this context it is "plasma kinetics of procarbazine" that appears to be an anti-cancer thing.

For me being a white boy, I wouldn't take something that was 100x more toxic in people over there. I'll stick to the stuff that isn't known to readily kill any human after determining that its OK (by the survival or death of others, right?!?).

No, I don't mean the stuff that they just put on TV ads like this. I'd take a risk of an STD (standard deviation) to get to know the author of this piece.

In my case, it's a little confused since I have a mild seizure disorder AND have been diagnosed bipolar as well. However, the treatment I'm on for those does seem to mitigate the negative side of Aspergers some. However, without a baseline fMRI and an on-meds fMRI (plus an expert in this field), I have no hard data on that. It could equally well be that the other stuff aggravated whatever the Asperger mechanism is.

The extensive research going on is excellent - I'm surprised it took so long for them to use fMRI, I would have thought that one obvious, although I've been told in the past by my own doctor that fMRI couldn't possibly show anything up. Clearly they were wrong on that. (* Gloat *)

Some more information for the obsessive:

• Neuroanatomical differences between Aspergers and Autism
  
• Home page for Asperger's Disorder, though how the disorder can type is something I don't know.
  
• Another quick intro but good if you don't have gigantic magnetic resonance imaging equiptment in the basement.
  
• Not sure if this is a dupe, but it goes in depth into the differences shown by fMRI.
  

Surely you allude to Alien Hand Syndrome (cf. a recent scholarly article)

Currently the AMA recomends 29 genetic tests on newborns and I read somewhere that there are around 90 genetic tests for newborns already out there. The idea is to make it easier to provide preventative health care to those predisposed to certain diseases. That's what doctors want. What insurance companies want is another issue entirely.

C|Net Integrates Oncology Viewer Into News Site

It gave me visions of a cross between goatse and JAMA.

that the Grandma is on Parkinson medication, which leads to computer game addiction?

Actually it was called:
"Association of Television Viewing During Childhood With Poor Educational Achievement"

BTW, I write tongue-in-cheek. See my commentary on these studies....

"Actually it was more likely to be drug prohibition that did it."

That argument would make more sense if the legal drugs in the US didn't kill more than the illegal ones.
Tobbaco use is the #1 cause of preventable deaths.
Alcohol use is preventable killer #3.

http://jama.ama-assn.org/cgi/content/abstract/291/ 10/1238?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&f ulltext=Actual+Causes+of+Death+in+the+United+State s%2C+2000&searchid=1117628499274_996&stored_search =&FIRSTINDEX=0&journalcode=jama

The JAMA article that describes this study is publically available. Linky, linky!

This reasoning is exactly why these systems are no longer widely used. There were quite a few documented instances where hepatitis B was transmitted through the use of contaminated jet injectors. For infection control purposes, it's a lot easier to use a disposable needle than sterilize an injector after every use.

I agree that it's important that people must be more responsible with their debt and consider their loans and purchases more carefully. The wording of the current bankruptcy reforms seem to indicate encouraging more personal responsibility. However, I believe it's geared toward improving the credit / bank industry profits.

Consider this article: http://www.ama-assn.org/amednews/2005/02/21/gvsc02 21.htm

Well over half of the US's bankrupcies in 2001 were a result of medical bills. Most alarming:

"The study found that while three-fifths of respondents who declared bankruptcy due to illness or injury had private health insurance when they got sick, one-third of them subsequently lost coverage, often because they had to stop working."

So it can be inferred that not all these people are entering bankruptcy due to gross irresponsibility. Similarly, people running small businesses or self-employed people might be doubly vulnerable in the case of a medical crisis.

"It's not suggesting women can't do math, it just says that they are not genetically apt to be good at it because of their gender."

Sorry to jump your shit here, but there is absolutely no genetic basis whatsoever for differences in mental performance between the sexes. Keep in mind that there are other non-genetic differences between the sexes (I'm not talking about child rearing here). For example, in the US and many other nations, males and females use segregated communal bathing facilities instead of integrated communal bathing. How could that non-genetic difference contribute to mental performance? The Connecticut Longitudinal Study showed that 90% of 3rd and 4th grade teachers are female. How would that change mental performance?

Don't forget the Nurture part of Nature vs Nurture.

Take a look at your doctor's handwriting the next time you get a prescription. If you can't figure it out, your pharmacist probably can't either.

Human oversight is having sufficient presence of mind to ask your doctor "What drug am I being prescribed? At what dosage? In what form?", remembering the answer, and comparing what your doc told you with what's on your prescription... and with your pharmacist gives you after reading your prescription. In at least one recent study, around 6% of prescriptions result in errors.

In the absence of that oversight, I'll take my chances with the robot.

not all doctors are liberal with pain killers for terminal patients, or patients that obviously *need* them.

for example

specifically, from the article:
This consensus statement is necessary based on the following facts:

* Undertreatment of pain is a serious problem in the United States, including pain among patients with chronic conditions and those who are critically ill or near death.
* Effective pain management is an integral and important aspect of quality medical care, and pain should be treated aggressively.
* For many patients, opioid analgesics--when used as recommended by established pain management guidelines--are the most effective way to treat their pain, and often the only treatment option that provides significant relief.
* Because opioids are one of several types of controlled substances that have potential for abuse, they are carefully regulated by the Drug Enforcement Administration and other state agencies. For example, a physician must be licensed by State medical authorities and registered with the DEA before prescribing a controlled substance.
* In spite of regulatory controls, drug abusers obtain these and other prescription medications by diverting them from legitimate channels in several ways, including fraud, theft, forged prescriptions, and via unscrupulous health professionals.

----

so while you may know "good" doctors who use every tool at their disposal in their practice, many, many, many people in the US do not.

Who said anything about gay sex being the main method. It used to be the main method. Now there are more women infected than men, and in the hardest hit parts of the world the spread of the epidemic is closely tied to widespread prostitution. In both cases the true factor is promiscuity, what has always been a risky factor with regards to disease but which has been lauded in popular culture for both sexes for the past 40 years or so. How many people you've had sex with is practically a metric for how manly (for men) or liberated (for women) you are these days.

I only made that statement to respond to a specific example in the prior post. I don't know the rates for the industrialized countries but I suspect that even if homosexuals still have a higher percent infected than heterosexuals, the larger numbers of heterosexuals could mean they have as many or more people actually infected - and AFAIK prostitution plays only a relatively small part in the spread of the disease here. When you look at who gets infected in America, what you mainly hear about is a lot of people who thought their partner(s) were safe and decided to skip the condom, and a bunch of people who like to fuck around but don't like condoms, and a lot of people who just can't bring themselves to make the mental and physical effort neccessary to practice safe sex. And even sex with a condom - or even without intercourse - is no guarantee.

Syphillis was indeed a major problem some years back. Not incidentally, it was at its most deadly when and where prostitution was common, in the cities in the late 1800s. Then we could cure it and aggressive tracking and treatment policies and changing social mores reduced it's significance to very little. And now we are seeing a resurgence of syphilis anyway, and AIDS is a major killer. It makes me wonder what's next. (I note in passing that it seems the more intimate the contact the more fatal the disase tends to be, but I don't have any data to back that up).

To be blunt, the idea that a social stigma and religous dogma against extramarital sex and particularly promiscuity is based purely on idealogical justifications is flat out wrong. They are almost certainly based primarily on the eminently practical notions of preventing the spread of disease and ensuring that fathers are both taking responsibility for their own children and not being tricked into doing so for others. Both of those unfortunate events can have been easily avoided with a little reason and responsibility, and yet history has shown time and again that given half the chance people will exercise neither. There is zero evidence that today is any different, and why not? Unbridled lust has always been louder than caution and reason. Ask yourself - how many times in your life have the rigid opinions of other people been the only thing stopping you from making a foolish decision? If you can't think of any, try remembering what it was like to be a teenager.

We may today regard rigid social constraints as something inimical to our pluralistic society, but cold reality is proving them to be vital components of our survival.

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

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

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

No, removing simply the word pain would render an inaccurate statement. The myth that marijuana smoking shrinks the brain, or causes toxic effects to the brain stems from several fundamentally flawed studies, and the temporary short term memory defecits users experience. The popular drug that is proven to cause brain damage and shrink the brain would be alcohol.

Don't get me wrong, there are plenty of reasons to avoid marijuana, especially because the common method of administration - smoking - is proven to be harmful. Still, spreading misinformation does nothing to alleviate the drug problems we face.

Proven brain damage from alcohol:
http://www.ama-assn.org/ama/pub/category/9416.html /

Debunking the marijuana-brain damage myth:
http://content.health.msn.com/content/article/70/8 0972.htm/

Compared to my workplace where 80 hour weeks are universally recognized as signs of laziness.

And to think before the changes we routinely worked 110-120/wk.

"No-one forcing them to work there." misses the point of the obvious non-monetary benefit to the allure of working there.

Enjoy.

Enjoy.

Isn't the existence of the gene prior art?

The existence in vitro, outside the human body of copies of the isolated gene by techniques like PCR is not prior art. Stories about people being sued for their own genome are nonsense because the patents cover isolated genes. Also the patent must include a substantial use for the gene, not just a description of the gene. That use is ALSO not prior art.

Here the story.

Maybe the person who posted this is just making the problem so complex, they can't find a reasonable solution?

I agree with the points you are making, but I don't think it is proper to use the term "3rd world countries".

Third world countries? Are those countries with corrupt elections, corrupt judges, and corrupt government leadership?

Is a third world country one of those that is always making war on its neighbors? (The U.S. government has bombed 24 countries since the Second World War. The last Brazilian aggression outside the country was in 1822, I'm told.)

When you say "third world country" you give an impression that the U.S. is superior in every way. That impression is false. In general, Brazilians are much happier than Americans. People in the U.S. use more legal drugs than those of any nation that has ever existed. The U.S. is the most obese country in the history of the world; eating when not hungry is an index of unhappiness.

A higher percentage of U.S. citizens go to prison or jail than any country in the entire history of the world. For example,

President George W. Bush DUI, 1st record of arrest
President George W. Bush DUI, 2nd record of arrest

Vice-President Dick Cheney DUI, record of 1st arrest
Vice-President Dick Cheney DUI, record of 2nd arrest

With the overreaction to HIPAA rules driving everyone to distraction, I doubt open source software is going to gain much traction in the U.S. What guarantee (from a manager's or director's point of view) is the software HIPAA compliant? What the hell does that mean, anyway? Buy it from a vendor and it's their fault if something goes wrong (again, from a manager's viewpoint), download it from the Internet and something goes wrong... important people are in trouble!

HIPAA madness has hit a major teaching hospital that will remain nameless. They're rolling out an expensive new HIPAA-compliant (certified! --of course) Health Information Management System. It's replacing an existing infrastructure that works perfectly, and is completely paid for (except for maintenance contracts). 400+ people have to be retrained on the new software, new hires have to learn both systems as they'll both be operating over the 2 month roll-out.

It's become almost trite to assume that many people in computing -- especially programmers -- are on the autistic spectrum. Usually this means Asperger's rather than "classic" Kanner autism, but in truth, it's not yet clear what bright-line (if any) separates the two conditions, and many studies have lumped Asperger and Kanner autistics together.

The lay distinction is that Asperger's is high-functioning autism, or autism without mental retardation, and in some cases of Asperger's even higher than average intelligence; but while there are more high-functioning individuals with Asperger's than Kanner's, high-functioning and low-functioning individuals with both syndromes exist. A diagnosis of Asperger's, unlike Kanner's does not include late speech or speech followed by a loss of speech, but both forms involve speech abnormalities of one sort or another, and both involve significant social impairment, related to an inability to "read" others' body language or (more so in Kanner's) an inability to conceive that others' perceptions differ from the autistic person's.

In nuerotypical (i.e., normal) brains, the part of the brain called the fusiform gyrus is activated to "read" another person's emotional state from the other's facial expression. In autistic persons (either Kanner or Asperger), the fusiform gyrus is not activated, with some studies showing autistic used parts of the brain used for object processing and others that each autistic individual uses a different brain areas to process facial emotional cues. High-functioning autistics generally explain that they process faces consciously, apparently as part of general problem solving.

Autistics are often seem as having less empathy or "flatter" emotions, although Temple Grandin, a high-functioning Kanner type autistic, reports that autistic have different emotions with the predominant emotion being a pervasive sense of fear. It is unclear whether this fear is the cause, effect, or just a
correlate of, the social impairments of autistic.

Autistics genenerally have special areas of interest which they obsess over, and this is in fact one required criteria for diagnosis.

Autism has only been included in the Diagnostic and Statistical Manual of Mental Disorders , the handbook of (American) psychiatry, since 1994, and so was apparently often mis-diagnosed (as depression, schizophrenia, or Pervasive Developmental Disorder) until recently; in many cases, the diagnosis of a child has led to a retroactive diagnoses (usual of Asperger's, as it's more "subtle") of one or both parents. Autism is one of the most strongly inherited neurological syndromes.

For more and more balanced information (I happened tonight to be browsing the journal articles that I cited, thus my emphasis on them) see (as usual) Wikipedia's article on autism.

To the submitter: do you know what form of autism you have?

A recent study published in the JAMA suggests that drinking many cups of coffee may reduce adult onset diabetes. The story is here: http://jama.ama-assn.org/cgi/content/abstract/291/ 10/1213

I guess you will discount this proof too, since you cannot get access to the full article without paying. I wonder, do you even realize the irony of your insistence on having FREE proof?

There is a disconnect in the system that makes this a very bad idea for physicians.

Health care is highly regulated in the U.S. Physicians can't control their overhead (malpractice insurance, front office staff) and can only control their income by seeing more patients an hour, as the prices are mostly fixed. Now, the portions of health care that aren't highly regulated are prescription drug costs and LAWSUITS.

Because the overhead is fixed, and price/visit is fixed (and has declined every year since 1992), the only way to make more money is to see more patients in the same amount of time. This exposes a physician to more risk because of number of people seen and less time/patient. Physicians are humans, and they will make mistakes, and it is extremely difficult to manage risk in an environment where the population is underserved, you're underpaid and overworked.

Now, add these mistakes to the legal system - a system that isn't regulated. A jury of 12 people too stupid to get out of jury duty hear arguments about complex medical cases. At this point, the physician is under extreme risk because, even if he practiced the standard of care and solid evidence based medicine, a good defense lawyer can win a jury over despite the facts/evidence: I.E. "Mrs. Jones expected to have a perfect child but because of the delay of delivery, the child has cerebral palsy and needs $$$ for health-care costs..."

Now, despite following standard of care, you as an INDIVIDUAL PHYSICIAN can lose everything you've made in one lawsuit. This leads to further escalations in health care costs, as test-ordering becomes the only mechanism a physician can minimize his risk. Plus, the system is designed to discourage quality improvement/assurance processes that are common in other areas of modern business, because the INDIVIDUAL PHYSICIAN IS PERSONABLY LIABLE for mistakes, even mistakes of the system.

Now, tell me, if every time you fscked up on your job you were liable to lose everything you ever made, would you point those things out to others? I assure you the answer is no.

It is unfortunate that the system has come to this, because most people are understanding and don't abuse the system. But the system is ripe for abuse, and it only takes a small number of people (think 1-2/500,000) getting windfall suits to send it out of control. That's less than SPAM responder rates, but with real negative consequences, not only for individual physicians, but communities that are losing access to health care because of upward spiraling malpractice rates.

I would like to see QI/QA implemented in medicine, but it's not going to happen until the risk for the individual practitioner is practically removed for reporting errors.

For further reading, I suggest this.

Most people going to med school these days are NOT primarily concerning with getting out of the hospital with a Mercedes. I graduated from Harvard college in 1997, and my classmates who DID want a Mercedes went into management consulting and investment banking, and have been making 6 figure salaries for 7 years now. Some of them are millionaires.
In contrast, your average medical student: lives in a tiny dorm/apartment throughout med school, takes out an average of $95,000 in loans, and when they finally graduate and do a residency, they make only $40,000 per year. (Subtract out loan payments.) When they do their fellowship to become a specialist, they will get paid about the same.
You are wrong about the timing: it's more than 10 years to become a specialist- at a minimum: 4 college, 4 med school, 3 residency, 3 fellowship= 14 years with negative or small salary.
And the training is grueling- if prisoners were forced to work as hard as residents, it would be ruled cruel and unusual. You can look at the new work-hour guidelines for residents that are supposed to IMPROVE the situation- 80 hours/week averaged over a month, work an average of 6 days a week, shifts can't be longer than 36 hours straight! Note that many programs are still working residents harder than that!
Even after finishing training and starting a successful practice, would you want to continue to work 60-70 hours per week, plus be woken up receiving phone calls from patients all night for the rest of your adult life? How about regularly being woken up to go into the hospital in the middle of the night when one of your patients has a heart attack?
Honestly, most doctors deserve to be paid more than what they are making. There are still a couple of specialties where doctors are RELATIVELY overpaid, but your average doctor deserves at least what he or she is making. There are plenty of valid criticisms of the medical profession, but doctors getting paid too much is not one of them. And to address the original topic, the contribution of doctor's fees to total healthcare expeditures in this country is miniscule. Some of it has do do with liability insurance and the high cost of hospitalizing patients with all of our expensive, modern technology.

Most people going to med school these days are NOT primarily concerning with getting out of the hospital with a Mercedes. I graduated from Harvard college in 1997, and my classmates who DID want a Mercedes went into management consulting and investment banking, and have been making 6 figure salaries for 7 years now. Some of them are millionaires.
In contrast, your average medical student: lives in a tiny dorm/apartment throughout med school, takes out an average of $95,000 in loans, and when they finally graduate and do a residency, they make only $40,000 per year. (Subtract out loan payments.) When they do their fellowship to become a specialist, they will get paid about the same.
You are wrong about the timing: it's more than 10 years to become a specialist- at a minimum: 4 college, 4 med school, 3 residency, 3 fellowship= 14 years with negative or small salary.
And the training is grueling- if prisoners were forced to work as hard as residents, it would be ruled cruel and unusual. You can look at the new work-hour guidelines for residents that are supposed to IMPROVE the situation- 80 hours/week averaged over a month, work an average of 6 days a week, shifts can't be longer than 36 hours straight! Note that many programs are still working residents harder than that!
Even after finishing training and starting a successful practice, would you want to continue to work 60-70 hours per week, plus be woken up receiving phone calls from patients all night for the rest of your adult life? How about regularly being woken up to go into the hospital in the middle of the night when one of your patients has a heart attack?
Honestly, most doctors deserve to be paid more than what they are making. There are still a couple of specialties where doctors are RELATIVELY overpaid, but your average doctor deserves at least what he or she is making. There are plenty of valid criticisms of the medical profession, but doctors getting paid too much is not one of them. And to address the original topic, the contribution of doctor's fees to total healthcare expeditures in this country is miniscule. Some of it has do do with liability insurance and the high cost of hospitalizing patients with all of our expensive, modern technology.

Sciam is a nice science enthusiast magazine. As is the nature of the publication, the article is light on details. The magazine a good tool to be introduced to new information, but I would prefer to read about some hard studies, such as in JAMA

(They do have this to say)

Something I feel compelled to point out, that is a common irritant in much I read (Yeah, I admit it. I try not to, but guilty of it too): You have a logical fallacy in your assertion that I'd say they're as objective as you get, unless of course you believe in some kind of "science-conspiracy".. (Check out Wikipedia logical fallacy

You make the assumption that one needs to believe in a "science conspiracy" in order to presume that the magazine is not "as objective as you get."
Bollocks. I don't believe in science conspiracy, yet I don't know the credentials of a particular journalist, so I can't assume that that particular journalist is completely objective or knowledgeable enough to report fully and accurately.

Having said that, I personally dislike polygraphing, I think it is intrusive, like a mental form of body cavity search.
Unfortunately, we don't live in a nice world, and sometimes the polygraph is a tempting, and if it IS accurate, then a useful tool. A problem of polygraphing is potential abuse. I hear of abuse stories a good deal. How many are true, how many are fabricated? I don't know.

• The capital cost of the EKG machine, amortized over the periods of time it is actually used.
  
• The ongoing service contract on it.
  
• The rent on the space you occupied during your visit, and the space occupied by all the people who helped make your visit happen.
  
• The salaries (and benefits) of the people who answer the phone, make your appointment, take you to the exam room.
  
• The time the dr spent reviewing your EKG and other records while not in your presence.
  
• The time the dr spent noting findings.
  
• The time and money the dr must spend on continuing education to keep up to date. (You really wouldn't want her to scrimp on this would you?)
  
• The (non-trivial) time taken by staff to pull your chart, perform billing, re-file the chart...
  
• Standard business insurance for things like fire, theft, general liability.
  
• Medical malpractice insurance.
  

Futher, the idea that corporations are evil is more BS.

If it was true monopoly laws would be thrown out, corporate taxes would be nullified, companies would have the right to vote, environmental protections would go away and corporations would be protected from lawsuits by the public.

Futher, the idea that corporations are evil is more BS.

Actually, I think I remember reading about a study that compared people who watched a lot of TV versus people who read a lot (UPDATE: I did read about a study. It was this one). The readers still weighed less. One possible reason? Ever tried munching on a bunch of food and reading at the same time? I have. It isn't easy. For those of you who haven't tried it, let me tell you that reading a borrowed library book and eating soup at the same time is a *very* bad idea. :-L

Also, book reading is *still* less sedentary. You're flipping pages, more of your brain is being used (and your brain uses energy). TV watching is possible the *least* calorie burning activity you can engage in. You burn more calories when you're asleep or standing than you do while watching TV.

Finally, don't forget that TV is constantly bombarding you with advertisements for food and drink. It's easy to be encouraged to eat or drink a lot while watching TV.

In about 80% of medical malpractice claims, no signs of negligent injury are shown, the study notes.

From this source (harvard university study).

Moreover:
In addition to not getting money to the right people, the current liability tort system also fails to deter negligent behavior, the report finds. Physicians or other health professionals who provide negligent treatment often aren't penalized, and physicians who have provided adequate care sometimes are punished, the study states.

Over the past five years, claims of medical malpractice have stayed relatively the same, however the amount of money paid per claim averages double what it has in the past.

Dot com bust? maybe a little, but we're talking about billions and billions of dollars, 1/3 of which goes to the lawyers..

Not like anyone's reading this anyway :)

The Members of the RIAA (lables) are the for-profit companies. The members are who really own the copyrights, IP and Artists.

Suing the RIAA for anti-trust would be like suing NORML for being the only real marijuana activist group or suing the American Medical Association (AMA) for being the primary association for doctors.

Professional and Trade Associations have become an intregal and pervasive part of our political landscape. It's a shame that most people don't even realize that they exist. Assocaitions are so pervasive that there's even a California Christmas Tree Association.

So yeah, socialism has overrun much of Europe, but on an average person basis, your average mainland Europeaner is happier than his/her American counterpart.

I hear this sort of thing alot, but then I see something like
this:

Hypertension Prevalence and Blood Pressure Levels in 6 European Countries, Canada, and the United States

Conclusions: Despite extensive research on geographic patterns of CVD, the 60% higher prevalence of hypertension in Europe compared with the United States and Canada has not been generally appreciated. The implication of this finding for national prevention strategies should be vigorously explored.

Despite "taking it easy", Europeans actually seem to lead more stressful lives.

So where does this idea come from that things are better over there?

• The NEJM site does indeed has free registration but, as of this morning, claims that the entire text is only available to subscribers.
• I will address some of the beginning comments first, then question 2, and then question 1.

So, does ECT work or not? If you are worried about rhetoric, I suggest you give evidence to backup your statements since you seem to be lacking in that area.

So far, I have made no statements as to the effectiveness of ECT. I am suspect of ECT's proponents. (further addressed below)

You don't seem to have any argument other than ECT should not be used because the pioneers of psychotherapy were actually trying to find ways to help severely mentally ill patients through desperate measures? I am telling you the facts. ECT is the MOST effective treatment for serious depression. You can go and refute every article I present but try finding one that disagrees with my statement, the statements from the psychiatrists referenced in the Atlantic article, and the NEJM article.

The studies that favorably show ECT's effectiveness have an interesting thing in common. They typically had one or more of the following people involved: Sackeim, Abrams, Fink, Weiner, Swartz, and Krystal. Abrams and Swartz co-founded Somatics, one of only two companies that manufacture and sell ECT devices. Fink, who wrote one of the few books on ECT is a consultant to Somatics and appears in their training videos. Sackeim, Weiner, and Krystal all have consulted for either or both Somatics and MECTA (the only other manufacturer of ECT machines), and had equipment donated to their studies by Somatics and/or MECTA. Weiner received grants from one or both of the companies.

Selected references for the above:

• http://www.healthyplace.com/Communities/Depression /ect/resources/jama/disnews.asp(I don't care for the tone of the commentary in this article, but their informational statements seem abave board.)
• http://www.omh.state.ny.us/omhweb/ect/(This lists the studies that were used to form NY's policies on ECT, note the names)
• http://www.ama-assn.org/sci-pubs/sci-news/2001/snr 0314.htm(the donation of equipment is mentioned in the editors note)

This leads to my answer to question 2.

Who is an independent source of information on ECT?...[let me also address a related point from Q1:]...You seems to have found yourself in a contradiction. You choose not to believe the psychiatrists because they use and advocate ECT. At the same time you would presumably believe psychiatrists that do not use ECT? If they do not use ECT wouldn't the natural presumption be that they are already biased against it? Whose testimony on this topic would you believe?

I don't believe I quoted any psychiatrists in my earlier responses, just sections of Daniel Smith's commentary. But, I admit that it amounts to the same thing. I'll clarify and narrow my position on practioners of psychiatry. Not all current psychiatrists practice their profession in the manner their predecessors did. I also don't think that ECT is a litmus test for a "trustworthy" psychiatrist. Especially considering updated techniques such as use of muscle relaxants and anesthesia during the procedure. Also, the guidelines for ensuring patient consent for using the treatment seem positive. These positive changes could only come about with the acknowledgment of past abuses and a commitment to not allowing such things to happen again. In light of this, all studies involving past abused techniques and the indviduals conducting the studies should be held to a higher standard. As shown above it seems that the main proponents of ECT have a vested

You may already have stood in such a line without knowing it. Many medical texts still use illustrations and diagrams from Pernkopf's Atlas (Atlas of Topographical and Applied Human Anatomy) to this day.

The Atlas is based on things learned during the commission of atrocities. Its author was a supporter of the regime responsible for those atrocities.

And yet, its contents have been used to save lives for 60 years, perhaps even including yours.

> For me the question is not *what* but who we're doing research on, and in the case of stem cell research, we've stepped over the line.

Do we throw out anatomy because it has benefited from what virtually the entire population of the planet agrees were war crimes performed on adult sentient beings?

If not, why should we throw out a technology that could lead to cure for Parkinson's, as well as the growth of replacement organs (possibly without an attached host body!) on the objections of a few religious fundamentalists ("life begins at conception / glob of undifferentiated cell has a soul" stage) or somewhat less-fundamental fundamentalists ("life begins when it looks cute / fetus" stage)?

It's not as easy a call as you might think, is it? :)

For the record (no point in bitching about bioethics unless you have the balls to make a stand - and while I disagree with your stand, I congratulate you on having one) I believe what Pernkopf did was grossly unethical, but I have no reservation and feel no guilt about being treated by doctors who learned from his work. I have no reservations about stem cell or fetal research. I see no contradiction between these two positions.

50 years from now, today's bioengineers may be looked upon as ignorant barbarians committing mass murder, or as the saviors of the human race. My position on bioengineering is the result of a moral choice, and I'm willing to accept any guilt on my conscience should I facts cause me to revisit it in the intervening half-century.