Slashdot Mirror

Because when the false "vaccines causes autism" craze started in the 1980:ies the large amount of lawsuits in the US caused several large manufacturers planning to leave the US: https://www.nejm.org/doi/full/...

So the US government initiated the "National Vaccine Injury Compensation Program" instead where the manufacturers put money into a large fund that makes payouts to everyone claiming to have been injured by a vaccine.

And for your second claim, no the pharmacologists that tests wheather vaccines are safe or not are not he climatologists that make claims about Global Warning. And Science does not work that way anyway, there never existed any scientific evidence that Manhattan would be submerged by now. Whoever said that to you lied their pants off.

Better analogy would be Nazi cold exposure science.

Indeed. Much of what we know about reviving cold water drowning victims comes from research conducted by Nazis on prisoners.

Should we insist that these victims die instead, because the research was unethical? There are activists calling for exactly that. So the death of innocent people would be honored by ... deaths of additional innocent people.

The Dacau Hypothermia Experiments

Why is the organ transplant research any different?

What is the next step? Should we also throwout research from scientists that were unethical in the personal lives?

There is a very good argument as to why the labeling should not be required; the first is simply space. There are all sorts of things various interest groups might want on a label (was this picked by union labor, was it picked by an employer that uses e-Verify, what county was it from, what is the distance from the farm to processing center, and so on); if you allowed every group to force its requirements onto the label, you might simply run out of room. The second is First Amendment related. Labeling requirements are a form of compelled speech, which the courts generally frown upon unless given a good reason. Since no one has yet to show any actual harm from eating GMO foods, that puts a the burden of proof as to why it needs to be on the label on those desiring the labeling. Look at cigarette labeling for example; the standard Surgeon General's warnings have been ruled okay, but the courts shot down the FDA's attempts to force large, graphic warnings onto cigarette packages, in large part because the FDA couldn't prove that they were more effective than the smaller warnings. Here is an interesting article on that. https://www.nejm.org/doi/full/...

You might have missed the news on CD awhile back, ask your doctor if he/she knows what causes Crohn['s]

This is a very interesting article and they may be on to something, but it is far from the first time Crohn’s disease has been attributed to microbes. They make a good argument, but I don't think that this closes the case yet. They specifically note that this is for "Familial Crohn’s Disease" and not all cases are familial. This was also a study that only looked a 9 family, with an n of 20, so this is not a very large study, and these are likely geographically co-located (but they did not give a lot of data on that). I'll avoid a long history of the disease and just place the gentle reminder that correlation is not causation (and in medicine the level of evidence for proof is often much higher than in other sciences). A lot more research needs to go into this - but investigating the complex relations in the gut biome is probably going to yield some very good insights.

So I'll continue with my standard answer for Crohn's that "we still don't know for sure" - but we're getting closer.

It doesn't sound like anyone is denied effective treatment in the current system (unless they end up control in a clinical trial) so I'm not sure what the new bill is going to do other than potentially open the doors to snake oil sellers.

The bill protects doctors and pharmaceutical companies from liability for giving experimental treatments to terminally ill patients, which is one of the reasons drug companies don't want to give these out. Drug company liability has gone bonkers in the last few years - people are suing because chemotherapy drugs are causing their hair to fall out, and blood thinners are causing them to bleed more easily. It's insane.

As long as the doctors and patients are fully informed that the drug is experimental I don't see a problem with this.

Doesn't sound like that's a problem:

Finally, expanded-access programs could bring liability exposure. Litigation in this arena, however, has been limited to obtaining access rather than seeking redress of treatment-related harm. The lack of adverse-event lawsuits may reflect the willingness of such patients to assume risks as well as the adequacy of existing regulatory and manufacturer safeguards.

If we arm everybody, can we perpetually be together at an NRA conference? You see, when the NRA holds a conference, gun deaths decrease. No, really--you can read that science, too:
http://www.nejm.org/doi/full/10.1056/NEJMc1712773?query=TOC&

There was a memorable 1996 article in the New England Journal of Medicine examining transmission of drug resistant Mycobacterium tuberculosis by a passenger on a commercial airline flight.

http://www.nejm.org/doi/full/1...

Especially memorable is a seat map showing the index passenger's seat, and locations of others who showed positive TB skin tests.

I stated:

(In cattle country, USA feed stores all display tetracycline and amphicillin powder in open barrels with convenient scoops the size of garden trowels stuck in them for customers to purchase bulk antibiotics priced by the pound.)

Prompting Swave An deBwoner to exclaim:

Serious question: how is this allowed? These are prescription-only pharmaceuticals right? I can't just walk into a drugstore and pick up a bottle of either of these antibiotics without a prescription.

Is there some part of the law that controls access to these that explicitly exempts feed stores?

Large-animal veterinarians routinely write multiple-refill prescriptions for bulk-purchase antibiotics for livestock farmers and ranchers. Their local feed store keeps a copy of those prescriptions on file, so their customers can buy antibiotics in bulk without being inconvenienced by the need to hand over a new prescription form each time they visit. It's a "good ol' boy" thing.

Googling the question brings me to an article that states that pet stores routinely sell prescription antibiotics without prescription:

http://www.nejm.org/doi/full/10.1056/NEJM200207183470319

https://www.smithsonianmag.com/science-nature/here-are-reasons-you-shouldnt-take-fish-antibiotics-180964523/

I am amazed.

Pet antibiotics - and especially those for fish - are a different issue. As are pet vaccinations.

FWIW - with the exception of rabies vaccine, I administer all our dogs' vaccinations and innoculations myself, because DIY is MUCH less expensive than having a veterinarian do it ...

(In cattle country, USA feed stores all display tetracycline and amphicillin powder in open barrels with convenient scoops the size of garden trowels stuck in them for customers to purchase bulk antibiotics priced by the pound.)

Serious question: how is this allowed? These are prescription-only pharmaceuticals right? I can't just walk into a drugstore and pick up a bottle of either of these antibiotics without a prescription.

Is there some part of the law that controls access to these that explicitly exempts feed stores?

Googling the question brings me to an article that states that pet stores routinely sell prescription antibiotics without prescription:

http://www.nejm.org/doi/full/10.1056/NEJM200207183470319

https://www.smithsonianmag.com/science-nature/here-are-reasons-you-shouldnt-take-fish-antibiotics-180964523/

I am amazed.

Since you don't seem to be able to use the Google, I'll get you started,. https://phys.org/news/2015-09-... https://www.epa.gov/no2-pollut... http://www.nejm.org/doi/full/1...

Nice links--none of which show or even claim to show a correlation between Volkswagens specifically and the death rate.

Since you don't seem to be able to use the Google, I'll get you started,.
https://phys.org/news/2015-09-...
https://www.epa.gov/no2-pollut...
http://www.nejm.org/doi/full/1...

It sounds like the GP had Dupuytren's contracture, a common thickening of connective tissue in the palm, with a time course of years that can result in inability fo extend (unbend) one's fingers.

As a primary care physician, I don't think I've yet referred anyone for surgery for this (in 17 years) and instead have people do stretching exercises, but surgery may make sense in severe cases. Collagenase injections (the Xiaflex referred to above)looks like it may be useful for patients who don't do well with stretching, don't want surgery, and don't have severe contractures. It doesn't look totally benign (51% bruising, 37% bleeding, 1% tendon rupture, 0.5% permanent unrelenting pain syndrome) but less invasive than surgery. It looks pretty effective.

That said, I've learned when I do referrals, one needs to be careful of who one refers to. For some specialists, given that they use a hammer a lot, most patients may start looking like a nails. I think pretty much all of these specialists genuinely want to help people, but when you specialize in something there's a risk of tunnel vision. For example, when a patient with annoying (but maybe not disabling) back pain wants to see a specialist —depending on who one sends them to — they've got a good chance of getting surgery done. Most back surgery for common spine conditions isn't clearly better than waiting a year for most patients. It's hard to tell some people you don't want to see a fancy specialist for this: you'd be better off losing weight and exercising more.

That said, though I'm pretty proud of myself for encouraging patients to avoid even seeing a surgeon until I really think it will help, and avoiding brand name medications, and decrying expensive vitamins or supplements with little evidence of effectiveness, this article in the New England Journal of Medicine gave me pause. Sure, Gawande claims with some reasoning that a lot of medical procedures have little benefit, and a lot of money is wasted. But the research leading to those conclusions was somewhat cherry-picked, and there is other research that suggests that higher spending really does improve outcomes. The author notes that "perhaps the most accurate conclusions is that sometimes less is more, sometimes more is more, and often we just don't know." Like a lot of health policy (and a lot of life in general), the issues may be more complex than they first appear.

most medical professionals would find this deeply insulting

Yeah, they like to pretend they're doing good rather than being purely commercial about it. e.g.
http://abcnews.go.com/Health/p...
https://www.cbsnews.com/news/d...

Fancy a chance at surviving a serious head injury, especially if it may take months or years to recover? Don't sign up to being an organ donor: http://www.nejm.org/doi/full/1...

This court case appears to be still ongoing: https://nypost.com/2012/09/26/...

We cannot answer the first question because the manufacturers won't tell us.

Gee, if only there were a device you could use to measure the components of a vapor. And if only there were well known techniques for measuring a statistically relevant sample of e-cig vapors to get a general idea of what's in them.

Very cute, there. If you knew more about mass spectrometry you would likely know the statistical difficulties native to the method. However even if you were able to do absolute quantification of every component in a single sample, the e-cigarette market is so thoroughly un-regulated that there is no way to assert that sample as being representative of anything. A company can make a formula "ABC1" and sell it today that has a given mixture, and then sell a completely different formula "ABC1" tomorrow with all the same labels. On top of that there is no reason to expect that one company's "ABC1" is similar to their "ABC2", or that something called "ACB1" from another company is at all similar to either.

So I honestly have no data about the physics of how an e-cig works. However, I'd be very, very suprised if there are anywhere near the reactions going on in a battery powered e-cig versus combusting tobacco. If I were building an e-cig, I'd use the lowest power possible to vaporize the fluid.

One model is described at howstuffworks.com. This one they describe uses a heating element, which correlates well with verified reports of people being burned by them. It's not combustion, but it is high enough temperature to ionize the liquids so they can be inhaled.

But I'd be really, really surprised if any chemical reactions at all occur, let alone combustion or ionization. Do you have any reason to believe otherwise?

We've been able to observe chemical reactions between charged gas phase-ions for over half a century now. After all, what is an ion but a molecule with a non-zero charge? Anything with a non-zero charge will have a tendency to seek out another molecule to resolve that charge to zero.

I suspect you can count the number of detectable chemicals on your fingers and toes

That's making some pretty huge assumptions about the manufacturing process used by the companies selling the e-cigarette liquids (amongst other things).

The tittle had me excited because I thought they'd been studying the suicide risk of depressed people on anti-depressants vs. depressed people not on anti-depressants. There have been studies done, such as this one (open access, published in the journal of the Royal Society of Medicine) found that when selective serotonin and serotonin-norepinephrine reuptake inhibitors are given to adult healthy volunteers with no signs of a mental disorder, the suicide risk is doubled. Whether this doubling also occurs in depressed individuals is the real question, but this is hard to study ethically.

Anti-depressants are far more controversial than most people seem to think, and the medical field has slowly begun to admit it. Note that I'm not saying the study I mentioned or this study prove that their usage should be stopped, but at the very least they're clear indicators that more research is needed into their efficacy and potential alternatives.

Indeed you are right! Antidepressants are far more controversial than most people seem to think. The reasons some doctors in the medical community are beginning to admit it (embarrassingly after 20+ years) is that the data for their effectiveness is really thin. Essentially, they don't work outside of patients with (maybe) really severe depression, and even in those cases the effect is largely minimal.

What's worse, like all good/new things once the first bits of data started to show they "helped" (mood in many people is a fluctuating thing, you could argue they would have felt better in a few weeks anyway), the prescriptions started flowing, and it is now hard to reverse the expectations that one of the prior commenters note - pill to cure or treat depression. According to a 2015 study, more than two-thirds (69%) of those prescribed an antidepressant do not actually meet the criteria for the diagnosis of major depressive disorder.

It also shows the business of medicine - showing "statistically significant" results that may or may not contribute to clinical significance. Here's what I mean. For trials that examined depression that was mild to moderate in severity, the benefit was just 1.29 points on the 53-point Hamilton Depression Rating Scale (HDRS). The difference for trials that studied severe depression was 2.69 points on the HDRS. Previous researchers suggested/used a 3-point difference which corresponded to “no clinical change”—that is, neither a doctor nor a patient would notice that change. Other researchers showed that at least a 7-point difference was necessary for “minimal improvement.” As you see, many studies don't come close.Then there is publication bias. If you look closely you find that 49% of the total studies had negative results,

It is a mess. It is a problem. People who are clinically depressed and suffer depression need treatment, and they need effective medications that afford them a clinically significant improvement in their condition, not just statistically. This is true for all branches of medicine - I'm looking at you cardiology and oncology.

Why don't you google yourself you moron?

Citing a huffinton post article ... that is not even funny.

This is from 1943: http://www.nejm.org/doi/full/1...
This is more modern: https://en.wikipedia.org/wiki/...
This are show cases: http://nonutsmomsgroup.weebly....

In what damn dream world do you live? I hope you never have kids. Damn idiot.

Yes! These de-clawed HIV vectors are known more broadly as therapeutic lentivirus. The problem is still efficiency - you have to not only hit every infected cell, but CRISPR editing has to go off without a hitch in those cells. Then there's the issue of turning off the transgene you've just delivered before "off target" cuts can induce chromosomal aberrations that can lead to cancer.

This isn't the first time researchers have used gene editing to tackle HIV infection. There is a clinical trial involving adenovirus delivery of zinc finger nucleases (a prior generation gene editing technology) to patient-derived blood stem cells to inactivate CCR5, an essential HIV receptor, on the surface of immune cells. Importantly, these cells are removed from patients, edited in the lab and returned to the body. This ensures that all NEW blood cells will be HIV resistant, but is also not a total genomic clearance of latent provirus.

I agree that a combination of approaches will probably be required to inactivate latent provirus as well as slow disease transmission. Public health approaches like needle exchanges and safe sex education are probably just as important for eliminating this disease.

Gee, without a stent I would be dead since your coronary collapses and without it your heart dies.
So I guess I and other stent recipients are alive for some other reason such as __ fill in the blank.

__LUCK__

Unfortunately, a stent is often kind of a stopgap which can be used in some situations to attempt to avoid bypass surgery. Your cardiologist should have told you that stents are primarily inserted to provide symptomatic relief from angina and chest pain related to coronary artery disease and blocked arteries. Medical studies like this one have not shown that they actual reduce the rate of Myocardial Infarction (aka heart attacks).

Also, long term studies of stents show that 35-40% suffer restenosis (a bit better with a drug-eluting stent). The jury is out if a stent will actually save your life in the future or not relative to this risk.

DST is biologically absurd. Earth time is based on an approximately 24 hr day, with seasonal shifts in the length of the day/night cycle based on latitude. Biological organisms synchronize with this cycle (termed circadian entrainment). Trying to shift that cycle by 1 hour artificially twice a year is counterproductive and harmful.

http://www.nejm.org/doi/full/1...

It is time (pun intended) to stop this nonsense.

Apparently smokers do have higher medical costs per year than non-smokers (but lower costs over a lifetime because they die sooner). source source

I think the reason for this is that on average smoking causes more damage via heart disease and emphysema than via lung cancer.

They probably did. But since ALS damages brain cells, you likely have to re-calibrate. Looks like they were doing this in 2010 with less severely disabled people. I'm too lazy to look further back.

It's been proven over and over again that long-term smoking causes expensive end-of-life health problems

Oh, is it now?

You might want to stop spouting your 'alternative facts'.

If people stopped smoking, there would be a savings in health care costs, but only in the short term. Eventually, smoking cessation would lead to increased health care costs.

Although smoking cessation is desirable from a public health perspective, its consequences with respect to health care costs are still debated. Smokers have more disease than nonsmokers, but nonsmokers live longer and can incur more health costs at advanced ages. We analyzed health care costs for smokers and nonsmokers and estimated the economic consequences of smoking cessation.

And no I don't smoke and didn't vote for trump standard disclaimer.

I'm pretty sure techniques very similar to this have been available in France for more than a decade. So maybe the story should be that the slow U.S. regulatory process for medical procedures is a decade behind as opposed to framing it as brand new cutting-edge technology.

Not true. I follow French medical science -- everybody in medicine does. Much of their work is excellent, but they don't hide it. They talk about it at international conferences and publish their results in major journals. Like everything else in medicine, when the French come up with a good idea, the rest of the world picks it up.

For that matter, when a French scientist comes up with a good idea, graduate students all over the world want to study in his lab, just like French grad students want to study in other labs worldwide. So a lot of the cutting-edge work is by international teams. You can see that by searching Youtube for Dance Your PhD http://www.sciencemag.org/news...

Cancer immunology is a big field. Everybody's trying to make it work. Sometimes it works, sometimes it doesn't. Bone marrow transplants (actually blood cell transplants) are standard now for some leukemias, and fairly effective. This specific treatment has never been done before, not in France, or anywhere.

It's also not true that the European regulatory agencies approve drugs faster than the US FDA:

http://www.nejm.org/doi/full/1...
The 21st Century Cures Act â" Will It Take Us Back in Time?
Jerry Avorn and Aaron S. Kesselheim
N Engl J Med 2015; 372:2473-2475
June 25, 2015
DOI: 10.1056/NEJMp1506964

An underlying premise of the bill is the need to accelerate approval for new products, but this process is already quite efficient. A third of new drugs are currently approved on the basis of a single pivotal trial; the median size for all pivotal trials is just 760 patients. More than two thirds of new drugs are approved on the basis of studies lasting 6 months or less â" a potential problem for medications designed to be taken for a lifetime. Once the Food and Drug Administration (FDA) starts its review, it approves new medications about as quickly as any regulatory agency in the world, evaluating nearly all new drug applications within 6 to 10 months, an impressive turnaround for such complex assessments.

http://www.nejm.org/doi/full/1...

Mortality among Recent Purchasers of Handguns

Garen J. Wintemute, M.D., M.P.H., Carrie A. Parham, M.S., James Jay Beaumont, Ph.D., Mona Wright, M.P.H., and Christiana Drake, Ph.D.

N Engl J Med 1999; 341:1583-1589
November 18, 1999
DOI: 10.1056/NEJM199911183412106

        Background

        There continues to be considerable controversy over whether ownership of a handgun increases or decreases the risk of violent death.

        Methods

        We conducted a population-based cohort study to compare mortality among 238,292 persons who purchased a handgun in California in 1991 with that in the general adult population of the state. The observation period began with the date of handgun purchase (15 days after the purchase application) and ended on December 31, 1996. The standardized mortality ratio (the ratio of the number of deaths observed among handgun purchasers to the number expected on the basis of age- and sex-specific rates among adults in California) was the principal outcome measure.

        Results

        In the first year after the purchase of a handgun, suicide was the leading cause of death among handgun purchasers, accounting for 24.5 percent of all deaths and 51.9 percent of deaths among women 21 to 44 years old. The increased risk of suicide by any method among handgun purchasers (standardized mortality ratio, 4.31) was attributable entirely to an excess risk of suicide with a firearm (standardized mortality ratio, 7.12). In the first week after the purchase of a handgun, the rate of suicide by means of firearms among purchasers (644 per 100,000 person-years) was 57 times as high as the adjusted rate in the general population. Mortality from all causes during the first year after the purchase of a handgun was greater than expected for women (standardized mortality ratio, 1.09), and the entire increase was attributable to the excess number of suicides by means of a firearm. As compared with the general population, handgun purchasers remained at increased risk for suicide by firearm over the study period of up to six years, and the excess risk among women in this cohort (standardized mortality ratio, 15.50) remained greater than that among men (standardized mortality ratio, 3.23). The risk of death by homicide with a firearm was elevated among women (standardized mortality ratio at one year, 2.20; at six years, 2.01) but low among men (standardized mortality ratio at one year, 0.84; at six years, 0.79).

        Conclusions

        The purchase of a handgun is associated with a substantial increase in the risk of suicide by firearm and by any method. The increase in the risk of suicide by firearm is apparent within a week after the purchase of a handgun and persists for at least six years.

And then you could add that the life expectancy in Cuba is higher than the U.S., and the infant mortality is lower.

http://www.nejm.org/doi/full/1...
A Different Model -- Medical Care in Cuba
Edward W. Campion, M.D., and Stephen Morrissey, Ph.D.
N Engl J Med 2013; 368:297-299
January 24, 2013
DOI: 10.1056/NEJMp1215226

This highly structured, prevention-oriented system has produced positive results. Vaccination rates in Cuba are among the highest in the world. The life expectancy of 78 years from birth is virtually identical to that in the United States. The infant mortality rate in Cuba has fallen from more than 80 per 1000 live births in the 1950s to less than 5 per 1000 â" lower than the U.S. rate, although the maternal mortality rate remains well above those in developed countries and is in the middle of the range for Caribbean countries.3,4 Without doubt, the improved health outcomes are largely the result of improvements in nutrition and education, which address the social determinants of health. Cuba's literacy rate is 99%, and health education is part of the mandatory school curriculum. A recent national program to promote acceptance of men who have sex with men was designed in part to reduce rates of sexually transmitted disease and improve acceptance of and adherence to treatment. Cigarettes can no longer be obtained with monthly ration cards, and smoking rates have decreased, though local health teams say it remains difficult to get smokers to quit. Contraception is free and strongly encouraged. Abortion is legal but is seen as a failure of prevention.

There was an article in the New England Journal of Medicine back in 2003 that showed that the difference in spending between Canada and the US came down basically to the additional admin costs in the US:
http://www.nejm.org/doi/full/1...

In fact it's unbelievable how much the admin costs are. It's interesting looking at those numbers and the ones you quoted, which if accurate surely show costs are increasing far faster than the rate of inflation.

I work in a hospital, I can tell you the administration costs are ridiculous. There are many people walking around with hospital badges on that I want to ask, tell me your job in one sentence and if you can't your fired. There is WAY to much administration and it eats our healthcare dollars from the inside out.

There was an article in the New England Journal of Medicine back in 2003 that showed that the difference in spending between Canada and the US came down basically to the additional admin costs in the US:
http://www.nejm.org/doi/full/1...

In fact it's unbelievable how much the admin costs are. It's interesting looking at those numbers and the ones you quoted, which if accurate surely show costs are increasing far faster than the rate of inflation.

I read a while back that a surgeon accidentally got cancer from one of his surgical patients:

http://www.nejm.org/doi/full/1...

So, it appears that cancer can move between hosts in a mechanical fashion.

I found a nastier one a while back: guy has tapeworm, tapeworm has cancer, tapeworm spreads its cancer throughout the guy's body as it wriggles around.
Here's the story. One of the interesting things was that the tapeworm tumors had differently-sized cells, so they were easy to differentiate from the host's cells. Now, that's not exactly cancer being transmitted, insofar as it wasn't his cells that were turning cancerous, but they were growing/multiplying and helped cause his death. It's like being infected with some other animal's cancer.

I read a while back that a surgeon accidentally got cancer from one of his surgical patients:

http://www.nejm.org/doi/full/1...

So, it appears that cancer can move between hosts in a mechanical fashion.

Yeah, that was my intention: only cancers that are clonally transmissible, not other types of pathogens that are transmissible in the usual manner of viruses(do any bacteria or eukaryotic parasites do that sort of thing?) and often provoke the development of cancer in their host.

So far, the one that horrifies me the most is the case of the poor bastard who was parasitized by one or more tapeworms; but ultimately died when the tapeworm developed cancer and its cancer spread beyond the tapeworm and aggressively into his tissues. That's multiple levels of "people who thought that nature was red in tooth and claw were optimists". For the sake of my sound sleep, I'm pretending that that could only have happened because he was immunocompromised; and certainly represents no risk whatsoever to anyone else; because otherwise I'm going to have to start sleeping with a flamethrower under my pillow.

Gun Ownership as a Risk Factor for Homocide in the Home. They say 2.7 to 1. That's just the first I found with a Google search. And the fatal school shootings list is really obscenely frequent now.

Pardon me for getting exasperated, but I shouldn't really have to tell you to read the news! This stuff is right in front of you.

That's not true at all.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098594/

http://www.ncbi.nlm.nih.gov/pubmed/6066852/

http://www.nejm.org/doi/full/10.1056/NEJMsa021721#t=articleTop

If you're going to command the ridiculously high salaries that surgeons do, and charge the patient the ungodly sums that you do, you should do your job right or be prepared to make amends for not doing so. If that's not tolerable, go find another job where you're less likely to hurt people with your carelessness. Sheesh, the entitlement...

the cost of medicine today hasn't been driven in very large part by technological advances

Twenty seconds on google would have disabused you of this incorrect notion. Technology advances have played a HUGE role in the rapidly increasing cost of medical care. Don't take it from me, take it from The New England Journal of Medicine.

and technological advances clearly have drastically improved outcomes.

Often yes but not always. It's trivial to find cases where technology improvements have either minimal or no improvements in patient outcomes. Sometimes we use the expensive shiny new tool in ways that don't actually improve medical outcomes. Sometimes the tools are used more for medico-legal reasons than for actual patient safety. My wife is an MD and she has to do things all the time which are unnecessary for treatment but guard against potential lawsuits. She has to order tests which confirm what she already knew with 99.9%+ certainty just for the unlikely chance she is wrong. If a hospital buys a new MRI machine you can bet your ass they are going to find ways to keep it busy to recoup the cost. Often this means ordering unnecessary tests.

Doctor and Lawyer salaries are through the roof because those are two of very few jobs that can not be outsourced to a third world country. If Blue Cross could ship you to Haiti for a 40c an hour doctor you don't think they would?

Welcome to the "Global Economy". You have heard all about it I'm sure, and how great it is. A real Utopia where everyone benefits. Assuming of course you are already extremely wealthy, because the rest of the people are expendable. As long as a company can stay afloat using dirt cheap labor, they will. Zuckerberg won the lottery, nothing more. That is your shot to getting out of the cesspool we are creating by complacently watching the government be run by the same people profiteering.

History is cyclical, we have seen this all before. The same result will come eventually, because people never learn to learn from history.

Doctors are being outsourced:
http://www.nbcnews.com/id/6621...
http://www.nejm.org/doi/full/1...

Lawyers are being outsourced:
http://www.americanbar.org/pub...
http://www.economist.com/node/...

Doctor and lawyer salaries are not high because they can't be outsourced (they can), but because of the fucked up healthcare and legal systems in America.

Already seeing medical outsourcing: http://www.nejm.org/doi/full/1... .

Original paper, New England Journal of Medicine
http://www.nejm.org/doi/pdf/10...

You're saying that if I've been paying taxes all my life, and I have cancer and I could be cured for $50,000, but I don't have $50,000, the government should leave me to die, like that guy in the NEJM article http://www.nejm.org/doi/full/1...

Sounds good to me. Fuck off. I'm tired of the pretentious, entitled parasites who can be bought for an empty promise.

You sound like a parasite to me. You want the government to do things for you, but you don't want the government to do things for anybody else.

You're saying that if I've been paying taxes all my life, and I have cancer and I could be cured for $50,000, but I don't have $50,000, the government should leave me to die, like that guy in the NEJM article http://www.nejm.org/doi/full/1...

Sounds good to me. Fuck off. I'm tired of the pretentious, entitled parasites who can be bought for an empty promise.

If I pay taxes, it's my money too.

There's always some excuse why you deserve it. I don't buy that it is your money and I don't buy that you deserve expensive health care that you are unwilling to pay for yourself.

It certainly is my money. I pay taxes like everybody else, and I'm entitled to a share of what the government does with my money, according to the laws that my elected representatives passed.

You're saying that if I've been paying taxes all my life, and I have cancer and I could be cured for $50,000, but I don't have $50,000, the government should leave me to die, like that guy in the NEJM article http://www.nejm.org/doi/full/1...

I don't believe that and most American don't believe that. I don't think there's a developed country in the world where they believe that.

Hell, I was even there long enough to have experienced their health care system after I got a wisdom tooth removed in Helsinki. Cost me $25 (which the dentist wouldn't take because he said it had been a pleasure to practice English with me).

Just because it didn't cost you a lot doesn't mean it was cheap. Capitalism paid for that bit of social welfare.

It was cheap because the Finnish health care system costs half as much per capita as the US health care system.

While the Soviet Communism had many great accomplishments, I wouldn't praise their freedom of expression.

While US capitalism had many accomplishments, I wouldn't praise their health care system. It's the most expensive in the world. For those who can easily afford to spend $100,000 for a major illness, and have the skills to shop for health care, it's a good system, with outcomes as good as the other developed countries like Canada. For those who don't have that kind of money, they leave sick people to die. http://www.nejm.org/doi/full/1...

The major accomplishments of our health care system, like the new $100,000 a year drugs, are mostly the results of government grants to academic researchers, whose universities sell the rights to private companies.

I will acknowledge that for rare and hard-to-diagnose diseases, we do have some of the best medical centers in the world. People come from Canada and elsewhere to be treated at the National Institutes of Health campus -- oops! Socialized medicine.

And for treating soldiers with head wounds and missing limbs (of which we have so many from Iraq and Afghanistan) the US military and VA health care system is the best in the world -- oops! Socialized medicine.

Citation? The placebo effect has been shown to "work" on asthma as well. This means that asthmatics "treated" with sugar pills or sham acupuncture report feeling better than without such treatment. However, objective measurements of their breathing capacity don't change under such treatments. This is downright dangerous! It gives a false sense of security without actually changing the risk of life-threatening complications. http://www.nejm.org/doi/full/1...

This is unfortunately a very widespread misunderstanding, but placebos are not harmless, even if they "work". They are positively harmful in cases where better-than-placebo interventions exist for life-threatening conditions.

How about parents who smoke in the house? You can prove that by checking conicotine levels in the kid's urine.

Only once you've ruled out consumption of tomatoes and aubergine.

http://www.nejm.org/doi/full/1... The article this abc story is based on.

Let's assume per capita GDP is a meaningful measure of the country's economy. Another measure of the country's economy is the equality or distribution of income.

I'd rather live in a country with more equality of income, even if it had a lower per capita GDP. (And some economists argue that more equality would produce a higher per capita GDP.)

Since we can't compare alternative Americas, empirical examination of the data is the best evidence we have.

I'm saying that other industrial countries have higher minimum wages, greater equality, and still have high production and a pretty good quality of life.

The difference between a per capita GDP of $55,000 a year and $45,000 a year is not that dramatic. The difference between a country in which people are left to die of treatable diseases because they can't afford health care http://www.nejm.org/doi/full/1... and a country where everyone gets needed health care is dramatic.

I don't care about high unemployment, if you also have a German- or Scandinavian-style social safety net, so that unemployed people can still maintain a comfortable life. In Germany, unemployed workers are paid almost as much as they are when employed. Some of them take additional training during their down time. Some of them were go on vacation. That's fine with me. The economy doesn't collapse just because you have 10% of the workforce on the dole.

I had friends in California when Reagan was governor. They were able to go on welfare, get enough to live on, go to the California state university system free, and get a college degree. California got a lot more scientists and engineers just as Silicon Valley was developing. I think that's good.

The US does have a per capita GDP of about $10,000 more than Germany ($45,000 vs. $55,000). OK.

Suppose you had 2 countries:

Country A has a per capital GDP of $55,000, but the distribution is unequal.

If you divide the country into quintiles, people in each category are:

Bottom 1/5 $13,750 a year

Next 1/5 $27,500

Next 1/5 $55,000

Next 1/5 $110,000

Top 1/5 $220,000

(which is roughly the actual income distribution in the US.)

Country B has a GDP of $45,000. But there is more equality. The distribution is:

Bottom 1/3 $22,500

Middle 1/3 $45,000

Top 1/3 $90,000

Which would you prefer? In country A, you have 1 chance in 5 of being in third-world poverty. ($13,750 is the per capita GDP of China.)

I'd prefer country B. In country B, I'm guaranteed a comfortable life.

Of course other countries have higher GDP per capita http://en.wikipedia.org/wiki/L... All of the modern industrial countries are clustered in about the same range.

Besides, most of that $55,000 per year per capita GDP in the US doesn't go to me. It goes to people at the top of the income distribution, and since 1980 it's been going disproportionately to the people at the very top of the income distribution.

It's like the economist's joke: Bill Gates walks into a bar. The average income in that bar goes up to $100 million a year.

I realize that randomized, controlled trials in peer-reviewed journals may not be the whole, final truth, but this is a nice catalog of everything that you can argue over.

http://www.nejm.org/doi/full/1...
Myths, Presumptions, and Facts about Obesity
Krista Casazza, Kevin R. Fontaine, Arne Astrup, et al.
N Engl J Med 2013; 368:446-454. January 31, 2013. DOI: 10.1056/NEJMsa1208051 [FREE]

Results. We identified seven obesity-related myths concerning the effects of small sustained increases in energy intake or expenditure, establishment of realistic goals for weight loss, rapid weight loss, weight-loss readiness, physical-education classes, breast-feeding, and energy expended during sexual activity. We also identified six presumptions about the purported effects of regularly eating breakfast, early childhood experiences, eating fruits and vegetables, weight cycling, snacking, and the built (i.e., human-made) environment. Finally, we identified nine evidence-supported facts that are relevant for the formulation of sound public health, policy, or clinical recommendations.

Longer piece on same topic for different audience in the New England Journal of Medicine.

Here's the story. It's free text online. tldr: The government paid for the research and development, took all the risks, an academic researcher did all the work, a private company came along, took advantage of a naive scientist, and sold the test back to the taxpayers for 50 times what it actually cost.

(The New York Times just had a series on health care by Elisabeth Rosenthal which gave a dozen examples like this. Asthma inhalers cost about 20 to 50 times as much in the US as they do anywhere else. There are people who go to Europe once a year to buy a year's supply of drugs.)

http://www.nejm.org/doi/full/1...
Perspective
History of Medicine
Patenting the PKU Test — Federally Funded Research and Intellectual Property
Diane B. Paul, Ph.D., and Rachel A. Ankeny, Ph.D.
N Engl J Med 2013; 369:792-794
August 29, 2013
DOI: 10.1056/NEJMp1306755

In 1961, the U.S. Children's Bureau (USCB) embarked on a field trial of the test, requiring rapid production of kits to screen more than 400,000 babies. Guthrie, who had a cognitively impaired son and a niece with PKU, was involved in a parents' group, the National Association for Retarded Children (NARC). In consultation with the NARC, he decided that commercial production of test kits would be most efficient.

Guthrie favored the Ames Company, a division of Indiana-based Miles Laboratories, which marketed the earlier PKU tests. Although Guthrie assumed that the government would enter a contract with Ames, the company said it would manufacture the kits only if a patent were issued. In 1962, Guthrie filed a patent application in his own name and signed an exclusive licensing agreement with Miles, under which he would receive no royalties but 5% of net proceeds would be divided among the NARC Research Fund, the Association for Aid of Crippled Children, and the University of Buffalo Foundation (affiliated with the Buffalo Children's Hospital, Guthrie's employer). There was no pricing provision, an omission that Guthrie later deeply regretted.2

Miles, however, couldn't quickly produce test kits in the required quantity. So with financial support from the USCB, Guthrie rented a house in which to produce and assemble kits containing the materials necessary to perform and interpret 500 tests, at a cost of about $6 each. But when Guthrie visited the Ames Company in June 1963, he discovered that it planned to charge $262 for what were essentially the same kits. He was appalled, and when appeals to the company proved futile, he alerted USCB officials. They recommended that Miles not be granted exclusive commercial rights, in light of the large public expenditure on the test, the potential effect on states that planned to manufacture their own materials, and the steep price Miles planned to charge. Although the test had been developed with support from various organizations, the majority of the funds had come from the Public Health Service (PHS), which provided $251,700, and the USCB, which contributed $492,000 plus $250,000 through the states, chiefly for the trial. Given this federal funding, the surgeon general of the PHS determined that the invention belonged to the United States and abrogated the exclusive licensing agreement.

Do you not have children?

Yup -- we have a 4yo. The recommendation we received was to give her some small smears of peanut butter around the age of 1 now and then, and to simply watch for any negative reactions.

She had none, which of course doesn't prove anything in and of itself.

I should note that the results from the recent study aren't new. Here are a few papers worth checking out on the subject:

• Early consumption of peanuts in infancy is associated with a low prevalence of peanut allergy (2008 - an interesting study, although I will note it was apparently funded by the US National Peanut Board),
• Factors Associated with the Development of Peanut Allergy in Childhood(2003 - an interesting part of this article link is that it contains a tab to read all of the letters the journal received concerning this research. It's a useful read for you, as it shows how research is commented on, and potentially refined within the scientific community).

Interestingly, the above link does mention that the advice you received was common advice (at the time of publication in 2008) in the UK, Australia, and in the past in North America (so I don't disbelieve that you received this advice -- although "common" doesn't necessarily imply "supported by research").

Yaz