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Americans killed by guns in recorded history: 0

Is that like that philosopher who insisted that nobody was killed by a sword, they died from not avoiding the sword?

Here's a shock for you, guns do kill people.

On a side note, concealed carry warning and brandishing probably stops that many robberies, rapes and murders in a week...

Because...you must think that attempted robberies, rapes, and murders are so common that there are thousands a week! What kind of crime-ridden world of fear do you live in?

Americans killed by medical mistakes each year: about 250,000

And we've got a whole group of people arguing about that problem too!

Americans killed by antibiotic resistant bacteria each year: 23,000

Also discussed.

Clearly guns are not that big a threat unless you are an alt left fascist progressive looking to dominate and subjugate the American people.

Nope, guns are a big threat to the American people, what with deaths from toddlers with guns, whereas imaginary fears of alt-left fascist progressives looking to dominate and subjugate the American people aren't a threat at all, except so insofar as they lead right-wing pseudo-conservative trolls to instigate feigned outrage in America.

Every dictator in the last 100 years from Stalin to Mao on down the line disarmed their people first and then murdered millions of them.

Nope. In fact, many dictators armed their people, then told them to go forth and kill "not their people" because well, that's a great way for dictators to keep power.

You must not be familiar with history.

Guns are in fact inanimate objects controlled by their wielder, which is why every LEO in the country carries one.

Guns, are in fact, tools that ought to be regulated like many other tools, such as lawnmowers, chainsaws, pressure washers, and nail guns, and no, not every LEO in the country carries one. For example. And some shouldn't.

Any group that uses "gun deaths" are political shills with no interest in truth.

I wonder if you realize that group includes yourself.

Gun deaths usually include suicides (who just use different methods in gun free countries), criminals shot by police or citizens, and other justified shootings that are actually a good thing for society and end up saving lives.

Nope, actually, they're not using different methods, the suicide rates are often lower, self-defense and other justified shootings are excluded from the counts though actually...the number of such shootings is a problem, not even counting the various incidents.

Sorry, I know you don't want there to be any problem except not having enough bullets for all those dirty leftists who you hate with all you

Who says women don't also prefer to be served by female digital assistants? They seem to when it comes to doctors.

She should have been a con artist. I figured you'd be interested and would like to know that, in her professional opinion, they're suitable for use in such environments assuming they're not being kept in complete, sterile, isolation. I expect to know if they can be brought in and put on the network by the end of next week.

Ya know, for someone who isn't an Apple fan, you have probably purchased more Apple gear than the next TEN fanbois, LOL!!!

Your daughter may very well have a promising second-career as a con-artist; but in this particular case, she is right-on.

When the iPad first came out, I was looking into developing a disposable "bag" for just this sort of application. That idea went the way of all my good ideas, and was eventually replaced with another idea of mine for an iPad/tablet "sterilizer" chamber, that would use UV to disinfect one or more iPads/tablets. And of course, charging facilities would be provided, too for charging-while-disinfecting.

iPads are used in thousands of hospitals everyday. Even without the disinfection. In sterile environments, like an Operating Room, they tend to put them in plastic bags (a gallon-ziploc works fine), and yes, the touchscreen does work through the plastic bag. But on the regular "floors", they just treat iPads like a clipboard. No sterilization, no protective sheath/pouch, nothing.

I would say that iPads are probably fairly easy to keep relatively clean (cleaner than a computer keyboard and mouse!!!), simply because there really aren't many cracks and crevices for caked blood, etc, to congregate. The main issue is the Home button, because it gets pressed a zillion times a day, followed by the Sleep/Wake button. But a simple silicone-rubber "boot"-type case would probably work...

So you know shit about CPR, the results of it and the working of respirators. Why should we listen to you?

Sure - a "We" person, how cute - here you go, Mr. or Ms. "We":

http://www.radiolab.org/story/...
in there:

A chart of doctor responses from the Precursors Study:
http://www.wnyc.org/i/raw/1/Ga...

and from there:

http://www.kevinmd.com/blog/20...
Now we see a huge Japanese study of more than 400,000 people who experienced out-of-hospital cardiac arrest, published in the JAMA on March 21, 2012. Approximately 18% of those who were administered CPR and epinephrine did achieve spontaneous circulation but fewer than 5% survived 1 month and fewer than 2% survived 1 month with good or moderate cerebral performance.

Maybe you are watching too much TV?

http://well.blogs.nytimes.com/...

keep trying...

Besides, you do realize that your pharmacy sells your prescription information to mining companies

For the benefit of those who might wonder why companies such as Freeport-McMoRan would care that you picked up some Augmentin at the pharmacy, that's "data mining companies".

In fact my medical records folder comes home with me from my visits and does not even physically stay in his office.

No, it doesn't. At least in the US, the original stays in the office. You might get a copy but even here in Nuttville we're not crazy enough to let the patient have the canonical record.

Besides, you do realize that your pharmacy sells your prescription information to mining companies and that the states typically monitor any restricted drug with a system of your own?

The only way to stay perfectly anonymous is to get care out of the country or stay healthy.

Aren't most propellants for food/human use nitrous oxide? Then the answer would be 0.

Could be, but not for asthma inhalers.

You are correct. Thanks for the citation.

Kevin Pho wrote about this on his blog.

http://www.kevinmd.com/blog/20...
A virtual office visit for your cold is not a good idea
Kevin Pho, MD | Kevin's Take | February 10, 2013

But something is lost through these virtual connections. There is value to face-to-face interaction, where a provider talks to and examines a patient in person. For example, I’ve seen a patient convinced that he had a sinus infection only to find that he had a tumor inside his nose. Another complained of minor ear pain, but after examining her, I saw that it had spread to the point where she needed to be hospitalized for intravenous antibiotics. Both of these diagnoses would have been missed had I only treated them over the Internet.

Without the ability to talk to and examine patients in the exam room, many doctors play it safe and reflexively prescribe drugs, whether patients need them or not. A recent study from the Journal of the American Medical Association http://www.medpagetoday.com/Pr... found that patients who were treated through Internet-based virtual visits had higher antibiotic prescription rates for their sinus infections, compared to patients whom were seen in the office.

That's actually Archives of Internal Medicine (now JAMA IM).
"Physicians ordered fewer tests, but prescribed antibiotics more often, when they evaluated patients for sinusitis and urinary tract infections (UTIs) via Internet-based virtual office visits versus in-person visits, a study of four primary care practices showed," as MedPage Today put it. Mehrotra A, et al "A comparison of care at e-visits and physician offices visits for sinusitis and urinary tract infection" Arch Intern Med 2012; DOI :10.1001/2013/jamainternmed.305.

It's frustrating to see how they keep prescribing antibiotics for sinus infections. You can't do a quick strep test on Skype (not that a negative strep test will stop many inappropriate prescriptions for antibiotics). JAMA IM had 2 articles lately about patients who got inappropriate antibiotics for sinusitis, and went on to Clostridium difficile, one of them fatal. It's interesting to see the answers doctors give when you ask them, "Why are you giving me antibiotics for a viral infection?"

Oh, you wanted to know what I thought of the value of a physical examination. I told my doctor, "I want whatever the U.S. Preventive Services Task Force says I should have." I want him to follow the guidelines, whenever there are guidelines. You can't do a lot of the stuff in the guidelines over Skype.

I'm not sure that you can do much more on Skype than you can over the phone. And my doctor (and his covering doctors) are not willing to do much over the phone, I think not because of the money but because they don't feel confident diagnosing someone over the phone. I'd like to be able to discuss things over the phone, with the understanding that I'd follow up with an office visit when appropriate. But doctors don't do that.

Last time I went to the doctor, it was because some nurse on the phone told me that, based on my symptoms, I might have heart failure. (It was ridiculous.) So there you go: standard exam for heart failure. In addition to listening to my history, my doctor listened to my chest, observed my neck veins, and ordered blood and urine tests. You can't do that on Skype.

Skype sounds like a gimmick, which may be appropriate in rural Alaska or Africa, but not in developed countries. Typical American marketing: You can do something equally well with a simple, cheap phone call or a fancy hi-tech teleconference. Which do you do?

There were studies which found that telephone psychotherapy was as effective as in-person visits. I wouldn't be comfortable with that, but if they have good published evidence for it, I'll go along with it.

http://soylentnews.org/comment...
http://en.wikipedia.org/wiki/C...
http://www.damninteresting.com...
"Furthermore, both radiotherapy and chemotherapy have an immune-suppressing side-effect. Since both treatments kill the rapidly dividing cells of the immune system along with the rapidly dividing cancer cells, both can be used together if care is taken. But immune-stimulating Coley's Toxins work entirely differently, and their effect would be cancelled out if used at the same time as high-dose immunosuppressant chemo- or radiotherapy. It became an either/or situation-- and in the end, the fashionable new treatments won out over Coleyâ(TM)s fiddly reworking of an ancient 'natural' remedy. "

Some other suggestions by me here (primarily nutritional, but also on fasting helping with chemotherapy):
http://slashdot.org/comments.p...

More on mushrooms and preventing cancer as also mentioned:
http://articles.mercola.com/si...

It is hard to know who to trust in the cancer industry to find, as you suggest, the best individualized treatment. It's certainly true that people selling alternative products and books (including Furhman, mentioned in my other post) have a conflict of interest. In general, the entire field of oncology is also sadly full of conflict of interest because oncologists make so much money by doing treatments.
https://www.burtongoldberg.com...
"Here is a shocking fact you most likely did not know: Unlike other kinds of doctors, cancer doctors (oncologists) are allowed to profit from the sale of chemotherapy drugs. In fact, most of the annual income oncologists earn comes from the profit that they make from selling these highly toxic drugs to their patients."

And:
http://www.kevinmd.com/blog/20...
"And that is where oncologic decision making gets really messy. Because in the United States, at least, many oncologists make a good deal of their income selling drugs to their patients. ... Many oncologists vehemently deny being influenced by this financial conflict of interest. But such denials defy both logic and data. Oncologists would have to be superhuman not to be influenced, at least unconsciously, by such strong incentives. After all, there is often no single "best" way to treat any given tumor, and there's often good reason to believe that expensive new therapies might be better than older, cheaper treatments. In the face of such uncertainty, how could oncologists avoid being influenced by the knowledge that those promising expensive new treatments also help generate so much income?"

Integrative alternatives:
http://www.drweil.com/drw/u/PA...

Regardless of the future, I wish you the best in making the most of each day like this celebrity with cancer:
http://www.reuters.com/article...
http://www.people.com/people/a...
"Resolved to face her last days with courage and humor, "I don't think of dying," says the actress, 73, who previously battled lung cancer in 2009. "I think of being here now.""

Good luck!

http://www.kevinmd.com/blog/2013/12/give-pain-hope.html
Sometimes we give pain instead of hope
James C. Salwitz, MD
December 25, 2013

One of the most satisfying sports is to make ourselves feel better by degrading another. What better way to make up for our own inadequacy, then to shove someone else’s face in theirs? We see this at work, in our families, in politics and in almost every type of social interaction. Nonetheless, it is particularly painful and tragic when we project our own fear and frailty onto someone that is dealing with the consequences of disease and even death.

The plan has to cover it. The doctor doesn't have to administer it. That is the whole point. My personal experience with this issue was in August of this year.
Here is a story from December of last year.

It is a hypothesis that collecting more data will find a pattern that will predict heart failure earlier, and that will lead to earlier interventions.

They haven't demonstrated that it works.

In order to demonstrate it, they have to do a controlled trial. They have to use these data collection systems in a group of 5,000 patients, and use the usual methods in another 5,000 similar patients, and see if there's any difference in a meaningful outcome. Do the patients live any longer? Are they any less likely to get strokes?

Sometimes it works, sometimes it doesn't. The New England Journal of Medicine just published a report on the use of a high-tech surgical intervention -- implanting cardiac resynchronizing devices in a new subset of heart failure patients. http://www.nejm.org/doi/full/10.1056/NEJMoa1306687 It turned out the resynchronization patients had more deaths than the control group, and they stopped the study early. You don't know until you've done the randomized, controlled trial. That's the method of science, the experimental method. You take your brilliant ideas and put them to a test.

That's science. Everything else is bullshit.

There was a study of using an electronic medical record in a pediatric intensive care unit. The patients with the EMR had a higher death rate than the control patients. The doctors said that when they needed to write a prescription in a hurry, they would just take out their Rx pad and write it. When they needed to write it with the EMR, they had to sign in, go through screens, and find what they were looking for.

EMR replaced a simple, effective system -- paper and pen -- with a more difficult system. What's the point?

Read what doctors are actually saying about electronic medical records, http://www.kevinmd.com/blog/ http://www.nejm.org/

There are systems that actually make it easier to treat patients. As I understand it, the Veterans Affairs and Kaiser Permanente have systems that actually collect useful data. The Scandinavians have great useful databases. http://www.bmj.com/content/347/bmj.f5906 But a lot of the new systems, particularly the ones that are merely being installed because they're required and subsidized under new federal regulations, are driving doctors crazy. They complain that they have to log in, go through screens, fill out checklist after checklist, and wind up with records that go on for hundreds of pages that nobody ever looks at again. Traditionally, on paper, they were forced to write a concise narrative for their colleagues and themselves, of useful information that got to the point and helped them make a decision about what to do next. These poorly-designed EMRs stopped forcing doctors to think. It simply forced them to collect a lot of data. Data isn't information. Useless data is noise.

And maybe most of all, they complain that instead of looking at their patients, they're looking at a computer screen. If you have to tell somebody that he's going to die in 6 months if he doesn't stop smoking, you shouldn't be looking at your computer screen. Maybe there's an element of human communication that computer nerds don't appreciate.

In any computerized records, there's a tradeoff between how much data you collect, and how much time you have to spend entering data. You can spend an extra hour a day just entering more data. Is this pill a tablet or a capsule?

And more important than time, when you write a medical record, you should be filtering information for just the important information. Otherwise you're just adding noise to the record, and making it harder for the humans to spot patterns.

If you want to prevent heart failure, the basic job is to stop smoking, lose weight, and exercise. When patients get outside of certain well-understood parameters, you can give the

From Do we really have the world’s best cancer care? :

When [cancer] mortality rates are restricted only to patients under 65, the US loses its lead – we are right in the middle. Only when we compare mortality rates among patients over 65 do we excel among our peers. Why? Possibly because Medicare gives older Americans the health care access they lacked when younger.

This age breakdown suggests American medicine possibly offers the world’s best cancer care, but only to patients with access to that care.

Emphasis mine.

The reason we pay so much for health care is because the recipient doesn't know and/or doesn't care how much it costs, namely because they don't pay for it. Likewise, they don't shop around. So even though it is all privatized, there isn't really much of a free market system.

That's not true. There are countries with government-run insurance, like Canada and Germany, and government-run socialized medicine, like the UK, where patients don't know how much it costs, or care (except to the degree that a good citizen doesn't like to see tax money wasted), and they spend roughly half what we do.

Most of the difference is in the insurance system. For every $1 you pay in health insurance premiums, 15 cents of that right off the top goes to the insurance company (look up a health insurance company financial statement under "loss ratio"), and for every 85 cents that your doctor gets, another 15 cents goes for the administrative costs of dealing with the insurance companies. Another difference is in our use of expensive medicines (erythropoetin for kidney dialysis was Medicare's single most expensive drug, and the dialysis centers, which made a profit on it, were overusing it to the point that they were actually killing people with it), and high-tech equipment (such as CAT scans, which are so overused that they're causing a significant number of radiation-associated cancers). Specialists make around $300,000 a year. Malpractice is about 2% of the health care dollar, so there's no big savings there.

Patient choice has almost nothing to do with it. The doctor has to agree on a treatment (and the more expensive procedures they do, the more money they make). A doctor tells you, "You have to do this now or you can die." What choice do you have?

Here's an example of an unusually well-informed patient, a physician assistant himself, who got appendicitis, did his research, and wanted to be treated with antibiotics, rather than surgery (which can actually be safer):

http://www.kevinmd.com/blog/2013/09/77-percent-success-good-guy-insurance.html
A 77 percent success rate is good enough for a guy without insurance
Andrew T. Gray, PA-C
September 26, 2013

How many patients know enough to resist a doctor's sales pitch: "You have to do this immediately or you could die"?

Every doctor I've known (which admittedly isn't many) who has worked in a country with a nationalized health care system always talks about how it is problematic because as the end of the year approaches they have to stop caring for their patients because the money has run out. In addition to that, the pay is crap compared to here, which results in a brain drain (notice how when a foreign country needs the *best* care for a particular patient, they pay to have them shipped here for their operation. Always here. In the US resides the world's top centers for cancer, neurology, cardio, and numerous other medical disciplines, and this didn't happen by accident.)

Well, I've talked to a few doctors from the UK, Canada, Germany, Sweden, and a few other countries, and I've read the studies that compare their outcomes for standard indicators like infant mortality and life expectancy, and for common procedures like cancer and heart disease. Basically the outcomes in all the developed countries are about the same. I wouldn't disparage American medical research, but if you read the New England Journal of Medicine every week, as I do, you'll see that some of the most important studies are also done in Europe, Australia, and elsewhere, The American studies are often done to get an expensive new drug approved, but the foreign studies are often done to test whether a common treatment actually works (for example this week an Australian doctor wrote an article about whether IV fluids do more harm than good). We didn't discover the AIDS virus; Luc Montagnier of France did. We didn't discover s

But I um... thought... um.. it was good for.me to um..... have a what's the.word Jenny? A diet low is salt. I may not be smart, but I know what high blood pressure is...

Just a note that, according to my doctor, and many articles I've read, excessive salt in the diet is NOT a problem for many/most people, but only those sensitive to it. Good explanations can be found:

• Myth or Fact: Salt Increases Blood Pressure (Hint: It's myth)
• A low salt diet for high blood pressure: Where’s the evidence?
• UVA Study Finds Salt May Not Contribute To High Blood Pressure

Here's another doctor who made the same argument about testing for illegal drugs. Be sure to catch the distinction between screening tests and diagnostic tests.

http://www.kevinmd.com/blog/2013/07/drug-testing-considered-screening-tests.html
Should drug testing be considered screening tests?
Chris Rangel, MD | Conditions | July 12, 2013

... The problem of a false positive test is frequently encountered in the practice of medicine. Depending on the clinical circumstances and the nature of the initial test, follow up evaluation with more expensive and possibly more invasive testing is often required in order to verify the results. For example, an abnormality found on the chest x-ray of a smoker with a bad cough requires further evaluation. A CT scan of the chest, bronchoscopy, and even a needle biopsy to obtain a tissue sample for analysis are required before making a diagnosis of lung cancer and starting treatment.

However, the possibility of a false positive drug screen and the need for further testing and evaluation is rarely considered outside the context of clinical practice. Employers, school administrators, government agencies, and law enforcement can and do consider a positive drug test to be perfectly equivalent to an admission of illicit drug use. This frequently results in the administration of some form of punishment or corrective action being delivered without giving the accused the right to defend themselves in any way. Essentially, drug testing is an effective way to violate a person’s right to due process since most drug screening is managed by lay people in non-clinical roles who believe that drug testing is 100% reliable. But this would be the same absurdity as giving chemotherapy to the smoker with the abnormal chest x-ray without first trying to verify the diagnosis with further evaluation (due process).

The other problem comes from the mass drug testing of large numbers of people (either random or at the initial point of contact). The interpretation of the results of a medical test are never as simple as positive or negative. The statistical probability of a false positive or a false negative result must be considered in concert with the pretest probability....

Wrong. You'll pay several times more out of pocket than an insurance company would pay...

Wrong:

A recent article in the Los Angeles Times reported a CT scan of the abdomen costs about $2,400 for patients insured by Blue Shield of California, while the Los Alamitos (Calif.) Medical Center cash price is only $250... Another local California hospital charges insured patients $415 for blood tests that cost only $95 in cash.

Interesting link. The AAOS study was a podium session, not a peer-reviewed study. They merely asked the physicians whether they were performing the procedure as defensive medicine, but didn't confirm it. I'd like to know why a procedure would be useful as defensive medicine if it isn't useful for clinical management.

Of course these doctors or their practices are also getting paid for these MRIs. My hypothesis is that they're actually giving unnecessary MRIs just to make money out of it, and when challenged, they justify it by saying it's defensive medicine.

When somebody challenges a doctor on a useless procedure, it sounds a lot better if he says, "defensive medicine," than it does if he says, "I just do a lot of useless procedures because I make a lot of money out of them."

I'd like to see a study designed to tell the difference -- perhaps including a hospital where orthopedists and radiologists are on salary, and not paid by the procedure.

As KevinMD himself said, the costs of defensive medicine are probably overstated http://www.kevinmd.com/blog/2010/09/defensive-medicine-saves-money-physicians.html
Especially the claims made by Newt Gingrich's organization.

A citation:
http://www.kevinmd.com/blog/2011/02/defensive-medicine-accounts-20-mri-scans-xrays.html

I'm glad your local jail is well-staffed, although I don't know where it is. If it's a good program, it's unusual.

According to the Journal of the American Medical association, prison health care is bad around the country. One of the problems is that services are contracted out to a few big corporations, like Correctional Medical Services, which according to JAMA was providing incompetent care which led to many deaths. Another problem is sheer budget-cutting.

http://www.aaskolnick.com/jama/28oct98a.htm
http://www.aaskolnick.com/jama/28oct98b.htm
http://www.aaskolnick.com/jama/28oct98c.htm
http://www.aaskolnick.com/baddoc1.htm
http://www.aaskolnick.com/baddoc2.htm
http://www.aaskolnick.com/baddoc3.htm

That was the most comprehensive series. Here are some more recent stories:

http://www.slate.com/articles/news_and_politics/explainer/2009/03/jailhouse_doc.html
http://www.democracynow.org/2005/3/4/harsh_medicine_new_york_times_exposes
http://www.kevinmd.com/blog/2010/11/care-prison-healthcare.html

Parent said, "Prisoners receive better medical care than most Americans, and it's illegal to let them go untreated."

It's not true that prisoners receive better care than most Americans. If it is, I'd like to see the supporting data.

It may be illegal to let them go untreated. So it's illegal. Prisons do it all the time. Many organizations are suing prisons over health care, and often getting court orders. Sometimes the prisons respond to the court orders, and sometimes they don't.

If they get arbitrary 10% budget cuts, as they did in Texas, they couldn't improve their health care even if they wanted to.

Doctors are busy enough they don't need to do things just "to make more money."

Exactly! Damn those doctors and their $150,000+ medical school debt!

A generic is, by definition, a medication that has the same exact active component.

Binders and coatings can make a huge difference.

Often too, the "Generic" in the term most often used for these programs is an earlier formulation that's gone out of patent (see the revolving door "we changed it just enough to re-patent it" scam that so many drug companies come up with). Depending on how it's produced, the newly "generic" older formulation may have different effects for different individuals, or may have different effectiveness for different symptoms/diseases based on dosage timing or minor chemical differences.

I was astonished to discover today that the original study had a sample size of 12 ? Really n= 12 ? Even if the so called 'study' had been held to the highest standards of clinical data collection, no matter how good the data in humans looks at n = 12, it is still at total toss up on much larger sample size. I can not believe how foolish and a total clusterfuck of idiots the whole anti vaccine movement is. For the nutcases out there read this You are endangering all of our kids.

and as for "a reputable and verifiable source for everything you said."

So, you don't watch the news, Old people and young or "special" children are the number one customers.
http://media.www.dailyvidette.com/media/storage/paper420/news/2008/02/18/News/Nintendo.Wii.Used.For.Rehabilitation.Purposes.wiihab-3215373.shtml
http://www.kevinmd.com/blog/2007/02/nintendos-wii-in-nursing-home.html
http://www.foxnews.com/story/0,2933,260990,00.html
http://www.engadget.com/2007/02/23/nintendos-wii-a-hit-with-the-geriatric-set/
http://www.bellaonline.com/articles/art58580.asp
http://www.shortnews.com/start.cfm?id=65566
http://www.specialkids.com/my_weblog/2008/09/research-shows-rehabilitation-benefits-of-using-nintendo-wii.html
http://www.nypsystem.org/press/2008/04/st-marys-at-forefront-of-thera.html
https://www.mywii.com.au/NewsDetail.aspx?id=2150

http://www.kevinmd.com/blog/2007/06/sicko-and-hail -mary-medicine.html

This is an example, in Sicko, that Michael Moore play loose with facts.