Slashdot Mirror

Here's the article I was thinking about. From the conclusion:

http://www.nejm.org/doi/full/1...
Artemisinin Resistance in Plasmodium falciparum Malaria
Arjen M. Dondorp, M.D., François Nosten, M.D., Poravuth Yi, M.D., et al.
N Engl J Med 2009; 361:455-467
July 30, 2009
DOI: 10.1056/NEJMoa0808859
[Free]

Chloroquine and sulfadoxine–pyrimethamine resistance in P. falciparum emerged in the late 1950s and 1960s on the Thai–Cambodian border and spread across Asia and then Africa, contributing to millions of deaths from malaria.28,29 Artemisinins have been available as monotherapies in western Cambodia for more than 30 years, in a variety of forms and doses, whereas in most countries (other than China, where they were discovered), they have been a relatively recent introduction.1 Despite the early implementation of an active malaria-control program by the Ministry of Health of Cambodia, including the introduction of artemisinin-based combination therapies in 2001, a recent survey showed that 78% of artemisinin use in western Cambodia consisted of monotherapy provided through the private sector.30 The extended period of often-suboptimal use, and the genetic background of parasites from this region,31 might have contributed to the emergence and subsequent spread of these new artemisinin-resistant parasites in western Cambodia. In contrast, artemisinin derivatives have been used almost exclusively in combination with mefloquine on the Thai–Burmese border, where parasitologic responses to artemisinins remain good, even after 15 years of intensive use.27 Measures for containment are now urgently needed to limit the spread of these parasites from western Cambodia and to prevent a major threat to current plans for eliminating malaria.

Cuba actually has one of the best health care systems in the world, for their income, and a pretty good system even without correcting for income. The New England Journal of Medicine had several articles about that. American doctors who go to Cuba rate them highly.

They sent their doctors to Sweden for training. The Cubans established their own medical school, Escuela Latinoamericana de Medicina (ELAM), which is the largest medical school in the world and trains doctors from Latin America and all over the world -- including the U.S. Tuition is free, and they cover all costs, for students who agree to practice in medically underserved areas (including parts of the U.S.) when they graduate.

Cuba has an infant mortality rate and life expectancy that compares favorably with the U.S., so they must be doing something right. The infant mortality and life expectancy is better than low-income parts of the U.S., like The Bronx, NY, or Louisville, KY, where people who can't afford to pay for health care are left to die after they spend all their money. http://www.nejm.org/doi/full/1... They learn how to practice medicine without regularly using expensive equipment like CAT scans, which are actually overused (sometimes causing more harm than good) in the U.S.

Cuban doctors have done some important medical research. For example, developed a couple of new vaccines for diseases of the undeveloped world, and they even supplied them to the U.S.

There isn't any brainwashing going on, anyone with kids knows that little boys look for ways to make weapons and take things apart on their own very early. Evolution didn't produce genders that are identical mentally, and that is fine. The problem is people looking to make everything 50/50 in every profession.

http://www.nejm.org/doi/full/1...
Discordant Sexual Identity in Some Genetic Males with Cloacal Exstrophy Assigned to Female Sex at Birth
William G. Reiner, M.D., and John P. Gearhart, M.D.
N Engl J Med 2004; 350:333-341
January 22, 2004
DOI: 10.1056/NEJMoa022236

I think this is the best evidence on socialization and gender. Boys were surgically converted to girls at birth, and raised as girls. They nonetheless identified as boys, and engaged in stereotypical male behavior, such as preferring war toys and rough-housing over domestic games and marriage fantasies.

http://www.nejm.org/doi/full/1...
Discordant Sexual Identity in Some Genetic Males with Cloacal Exstrophy Assigned to Female Sex at Birth
William G. Reiner, M.D., and John P. Gearhart, M.D.
N Engl J Med 2004; 350:333-341
January 22, 2004
DOI: 10.1056/NEJMoa022236
[FREE TEXT]

Background

Cloacal exstrophy is a rare, complex defect of the entire pelvis and its contents that occurs during embryogenesis and is associated with severe phallic inadequacy or phallic absence in genetic males. For about 25 years, neonatal assignment to female sex has been advocated for affected males to overcome the issue of phallic inadequacy, but data on outcome remain sparse.

Methods

We assessed all 16 genetic males in our cloacal-exstrophy clinic at the ages of 5 to 16 years. Fourteen underwent neonatal assignment to female sex socially, legally, and surgically; the parents of the remaining two refused to do so. Detailed questionnaires extensively evaluated the development of sexual role and identity, as defined by the subjects' persistent declarations of their sex.

Results

Eight of the 14 subjects assigned to female sex declared themselves male during the course of this study, whereas the 2 raised as males remained male. Subjects could be grouped according to their stated sexual identity. Five subjects were living as females; three were living with unclear sexual identity, although two of the three had declared themselves male; and eight were living as males, six of whom had reassigned themselves to male sex. All 16 subjects had moderate-to-marked interests and attitudes that were considered typical of males. Follow-up ranged from 34 to 98 months.

Conclusions

Routine neonatal assignment of genetic males to female sex because of severe phallic inadequacy can result in unpredictable sexual identification. Clinical interventions in such children should be reexamined in the light of these findings.

Thank you, that's a very interesting article. The letter of reply is also informative. Lest readers believe that the fact that nicotine is present in some vegetables may somehow compare to the serious dangers of smoking, he indicates that the calculations presented regarding an "environment with minimal smoke" described by the author of the article actually amounts to "the equivalent of 1 percent of the smoke from one puff of a cigarette", hardly what most of us would consider "low amounts of smoke in a room":

Finally, it has been well confirmed that the exposure to tobacco smoke indicated by a plasma concentration of 5 to 10 ng of cotinine per milliliter is of clear toxicologic importance,3 whereas there is no evidence that daily exposure to the equivalent of 1 percent of the smoke from one puff of a cigarette would be of toxicologic importance or could possibly confound assessment of environmental exposure.

http://www.nejm.org/doi/full/10.1056/NEJM199308053290619#t=letters

Interestingly, you're a bit right:
http://www.nejm.org/doi/full/1...

10 grams of eggplant equated to ingesting the same amount of nicotine you would absorb by being in a room with low amounts of smoke. Weird.

Of course, unless you like to snort eggplant, it's not going to do jack to the cilia in your lungs.

I can't believe anyone can be stupid enough to think cannabis is dangerous enough to merit criminalization.

What you can or cannot believe isn't important, the truth is that canabis can have a devastating effect on the developing teenage mind. Even if you don't consider that enough to warrant criminalization, that does not justify insulting those of us who do.

I wonder how you arrive at that "truth". Even the arch-enemy of cannabis, Nora Volkow, head of NIDA, admits that they can't prove it because association is not causation. http://www.nejm.org/doi/full/1... Or at least that's what she was forced to admit when the reviewers at the New England Journal of Medicine insisted she back everything up with published research.

Inhaling any smoke into your lungs can cause damage and long term health problems. Chronic cough, emphysema, and even lung cancer are all possible outcomes of smoking pot. it also raises your blood pressure and your heart rate, similar to smoking tobacco.

only the ignorant or misinformed deny it has any ill health effects.
its not that different from smoking tobacco.

It is ironic that somebody who posts this much ignorance and misinformation can accuse others of being ignorant and misinformed.

Even Nora Volkow, the head of NIDA, in her review article in the New England Journal of Medicine trying to defend the war on drugs, doesn't go that far. http://www.nejm.org/doi/full/1...

Just because tobacco causes chronic cough, emphysema, and lung cancer, that doesn't mean that anything you smoke has the same effect. That's like sympathetic magic.

Actually, when medical researchers tried to prove that cannabis caused those things, they failed. When you look at people who smoke marijuana, and compare them to people who don't, the marijuana smokers have no more chronic cough, empysema and lung cancer than non-marijuana smokers.

Look at it this way: If I chew tobacco, I'm more likely to get cancer of the jaw. But I can chew all the carrots I want, and I won't be more likely to get cancer. Obviously, there's something in tobacco that isn't found in carrots that causes cancer. And there's something in tobacco that isn't found in marijuana that causes cancer.

scholar.google.com if anybody's interested.

Effects of scheduled overtime on labor productivity - Abstract says 'no significant effect on productivity'
Productivity in manufacturing...: As hours/day dropped, they worked more days(of the year), so productivity remained about the same.
Scheduled Overtime and Labor Productivity: Quantitative Analysis: Productivity drops 10-15% for 50/60 hour work weeks.
Effect of Reducing Interns' Work Hours: Surprise, Surprise, NOT working medical interns for 24+ hours straight reduces serious medical errors by more than 50%.

... it's also their nutrition programs.

What a great euphemism for rationing.

Cuba has a relatively low income, and the boycott is responsible for much of that (that was the purpose of the boycott, remember?) That's the result of U.S. policy, not the failure of Cuban socialism. So you cut their food and then blame them for rationing food.

In other low-income countries, especially free-market countries like Guatamala, when people can't afford to buy the food or health care that they need to live, they just die. That even happens in the U.S., where people die from curable diseases all the time because they can't afford to pay for medical care http://www.nejm.org/doi/full/1...

However, unlike most other low-income countries, Cuba has distributed their scarce resources, like milk, to those in greatest need, particularly to pregnant women and children. Prenatal nutrition is a big factor in infant survival. The studies of the Dutch famine during WWII showed that. There are studies of animals. That's established medical science. So doctors would expect Cuban infant survival to be lower because they give pregnant women more food. And it is. Even the CIA agrees. It's not because they define infant mortality differently.

Once again, there are no studies that meet the standards of science (published in peer-reviewed journals, adjusted for any differences in definitions) that say that Cubans have a higher infant mortality than Americans. The "scientists" who made that claim (in the letters section of Science, for example ) can't support it with facts.

Low-income people in Cuba have better health care than low-income people in the U.S. That's the facts.

There are people who form their conclusions based on scientific facts and people who form their conclusions based on ideology. You are free to join whichever group you want.

The Lathe of Heaven.

Actually, that was exactly my thought (minus the dream) when I saw the abstract of this post. In fact an article published 9 Oct would doubtless have been written some time before that--although I suppose they might rush an article on this topic through, meaning it might have been written (and last updated) only slightly before that date.

I went to the NEJM, and the original article is in fact available: http://www.nejm.org/doi/full/1.... Oddly, down at the bottom it says "This article was published on May 7, 2014, and updated on May 22, 2014, at NEJM.org." I don't understand that, unless they re-published it in October. Worse, though, none of the quotes in the /. post actually appear in the NEJM article, although the general point of needing early(er) diagnosis does come up.

So I'm starting to smell s.t. fishy in this post. Where are the alleged quotes coming from?

The New England Journal of Medicine did a study of 599 articles and 1500 ratios between 2000 and 2005 and there conclusion was "Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not.". There have also been more recent studies that comes to similar conclusions.

As for your doctors advice, of course on a personal level it's generally cheaper to catch things early but that assumes you are actually going to develop something. For those that never do, or for those cases where advanced warning is of little benefit, cost-wise, those thousands of dollars of tests are effectively wasted money. The math is simple, [(cost of testing) x number in target population] - [(cost of treatment) x number of affected]

For prostate cancer, for example, it's been estimated only 1 in 1000 affected men will be saved by preventative screening. For the other 999, as well as those who never get prostate cancer, the early screening was essentially needless costs. Because of it's rate of growth, in most cases knowing early before symptoms arise, won't affect outcomes or treatments. Of course for that one man the preventative screening is a lifesaver, but on purely economic front, it's not cost-effective.

The drivers are black. It has nothing to do with speeding or infractions. Cops don't charge anyone for actually doing something wrong.

This has been proven much closer to the truth than you probably think. For example, in this study, black and white women were found to be equally likely to use drugs during pregnancy, but black were ten times more likely to be reported to police:

Among the 715 pregnant women we screened, the overall prevalence of a positive result on the toxicologic tests of urine was 14.8 percent; there was little difference in prevalence between the women seen at the public clinics (16.3 percent) and those seen at the private offices (13.1 percent). The frequency of a positive result was also similar among white women (15.4 percent) and black women (14.1 percent)...

During the six-month period in which we collected the urine samples, 133 women in Pinellas County were reported to health authorities after delivery for substance abuse during pregnancy. Despite the similar rates of substance abuse among black and white women in our study, black women were reported at approximately 10 times the rate for white women (P < 0.0001 ), and poor women were more likely than others to be reported.

(cite - note, this is the New England Journal of Medicine!)

Drug use and speeding are probably close parallels in that a tiny proportion of all violations of the law are prosecuted, so who gets punished depends more on whom society chooses to scrutinize than actual crime rates.

"Nevertheless, having a targeted treatment is often better than no treatment at all."

Perhaps, but I doubt there is any good evidence for this. Weak effects and noisy data don't mix well, we are probably taught all sorts of incorrect things based on spurious results. I would suggest getting away from these targeted treatments of at most limited benefit and work on figuring out how to turn aneuploidy as a drug target.

FDA approval typically requires randomized controlled trials, so when a treatment is available it has been tested at least against placebo (if that was the best available treatment at the moment of approval). That's why I say "better than no treatment". A drug that is not better than placebo usually does not make it past the approval stage (and if it does, approval can be quickly revoked, for example bevacizumab in breast cancer: http://www.nytimes.com/2011/11...)

What sort of evidence would you expect? For example, the study which established the targeted agent trastuzumab is available online: http://www.nejm.org/doi/full/1.... Bias and noise are unavoidable, but with my knowledge of statistics the result seems reasonably clear.

Anyway, with respect to your other comment, aneuploidy is not an obvious target but people are working on it and on drugs that interact with the mitotic machinery. Let's hope they will be successful.

Somewhat ironically, we finally seem to be making progress in the fight against cancer at the same time we are losing the fight against bacteria. Take tuberculosis, for example, there are only a few drugs left that work. In fact, the fda just approved a drug bedaquiline that would have failed its clinical trial had it been practically any other kind of drug. You see, people who were taking it were dying at an alarming rate. It was approved because we don't have any other weapons against multi-drug resistant TB.

In 2013 in the US more people died of antibiotic resistant bacteria than died of AIDS.

I have had similar experiences with pre-hypertension and having no real success lowering my blood pressure -- except with the DASH diet. Like you, after a fairly short time with DASH, my blood pressure became normal. However, if you read the studies behind DASH (rather than the pamphlet on the website) you will find that the diet is geared around the hypothesis that increasing potassium and magnesium is the mechanism for lowering blood pressure. The sodium reduction is just kind of stapled on. The original paper shows that the DASH diet tended to reduce blood pressure at all sodium levels (although it appeared to reduce it more with lower sodium intake). Unfortunately, I couldn't tell from the paper what sample sizes they were using and I have grown cautious about the statistical abilities of nutritional researchers. The published DASH pamphlet is also faulty (IMHO) as it does not follow the diet used in the studies. It has a *much* higher calcium intake. I suspect (but have no evidence to support my feeling) that the published pamphlet has been prepared with "input" from various special interest groups.

The original DASH paper is available here: http://www.nejm.org/doi/full/1...

There a some other papers available on the internet as well. I would read these and ignore the various other websites/books with information about DASH.

There was an article this week in the New England Journal of Medicine about a guy who tried a home fecal transplant, and wound up in the hospital. He gave himself cytomegalovirus, with very bad gastrointestinal symptoms.

He had a 7-year history of ulcerative colitis. The doctors made recommendations but he declined many of them. Instead, he gave himself a "home brew" fecal microbiota transplant. He used stool from his wife and 10-month-old child. Some people think that stool from children is more "pristine" than stool from adults, and doesn't need testing for infectious disease. Actually, children are a bad source of stool, because they get frequent viral infections, especially if they attend day care.

He finally started following doctors' recommendations and the ulcerative colitis and cytomegalovirus cleared up after a couple of weeks.

Fecal microbiota transplant actually works well for Clostridium difficile, with more than 90% effectiveness, which is great since C. difficile can be fatal and is often antibiotic-resistant. However, in the few studies with ulcerative colitis it didn't work too well and sometimes made it worse.

The article found two other cases of people who got infections from fecal transplant.

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

case records of the massachusetts general hospital
Case 25-2014 — A 37-Year-Old Man with Ulcerative Colitis and Bloody Diarrhea
Elizabeth L. Hohmann, M.D., Ashwin N. Ananthakrishnan, M.D., M.P.H., and Vikram Deshpande, M.D.
N Engl J Med 2014; 371:668-675
August 14, 2014DOI: 10.1056/NEJMcpc1400842

A 37-year-old man with ulcerative colitis was admitted to the hospital because of abdominal cramping, diarrhea, hematochezia, fever to a peak temperature of 38.8C, and drenching night sweats. Several weeks earlier, he had performed home fecal transplantation.

Last time I had somebody run a catheter (or whatever) into my heart, I was having a heart attack. Having the clot simply removed is worth a bit of risk. I wouldn't do it for fun (particularly since lying still while the groin incision healed enough for me to move was agonizing).

It sounds like you either got a thrombolytic like TPA, or you got a stent placed.

In principle, the doctor should be able to say, "In randomized controlled trials, when people in your situation are treated with this procedure, their survival rate is X, and when people are untreated, their survival rate is Y."

I haven't been following the literature carefully lately, but in my understanding there's a small but significant advantage to using a thrombolytic or a stent.

Cardiology has a lot of treatments with small but significant advantages. They add up to a large advantage. People with heart disease live a lot longer today than they did 50 years ago. The NEJM had a 200-year historical review, A Tale of Coronary Artery Disease and Myocardial Infarction, http://www.nejm.org/doi/full/1... [FREE] which had a nice table showing deaths from cardiovascular disease declining from 4/1,000 in 1950 to 1/1,000 in 2010.

I would estimate that it represents an increase in life expectancy of about 10-15 years. That's about equal to the life expectancy that cigarette smoking takes away.

So you had your heart attack at a good time. It's a good thing you waited.

Your hypothesis doesn't explain the available data

I know, I know, reusing the same data for everyone in this thread, but they all seem to be making the same argument that is strictly hypothetical, and doesn't account for real-world data.

None of these statistics take into account the rate of attempted suicides. That would certainly be a factor. Using a gun the first time you decide to try to kill yourself, you're much more likely to succeed because guns are so efficient. Taking pills or cutting yourself, or even driving your car into a tree, can land you in a hospital and the people around you realize you try to off yourself and you just might get the help you need to keep you from trying again.

"He said suicide rates tend to be higher in states with higher gun ownership — not because gun owners are more likely to suffer from depression, but because guns are faster and deadlier than other methods such as drugs, carbon monoxide or hanging. People are more likely to survive an attempted overdose or even a hanging than they are a gun-shot wound."

Also from the CDC: "There is one suicide for every 25 attempted suicides."

Your hypothesis doesn't explain the available data

I know, I know, reusing the same data for everyone in this thread, but they all seem to be making the same argument that is strictly hypothetical, and doesn't account for real-world data.

How about data to support the notion I'm presenting

Non-firearm suicides are pretty consistent with high and low gun ownership, but firearm assisted suicide goes waaaaaaaaaaay the fuck up.

Let's reinforce this with some related data:

here we go

Followed the chain of citations through this 2000 article to this 1986 journal entry. Briefly, and if I'm remembering my A-level Stats correctly, they found that there is no correlation between an adoptive parents BMI and the adoptee's BMI, there is a very strong correlation between biological mother and child, and a strong correlation between father and child.

When "rest and liquids" don't work, our ability to treat dehydration today is exceptional. We can also safely medicate for pain, reduce fever, and treat other complications very well.

You probably know as well as I do too, that anti-viral medication is rarely used because of the impact to mutation.

Our ability to treat dehydration didn't work too well in these 111 cases of PCR-confirmed influenza, which had a fatality rate of 27%. http://www.nejm.org/doi/full/1... When a patient is dying from influenza, they use anti-viral medication (and everything else they've got).

Nor did it help this 15-year-old Texas girl who died of H1N1. http://www.nejm.org/doi/full/1... This article says that in order for the CDC to count a case as influenza, it has to be diagnosed at least with a rapid diagnostic kit, and it says, as other articles do, that the CDC probably underestimates the number of influenza cases by applying this strict criteria.

I apologize that this article is apparently behind a paywall. But then, if you can't get to a NEJM article, how can you know the facts about influenza?

When "rest and liquids" don't work, our ability to treat dehydration today is exceptional. We can also safely medicate for pain, reduce fever, and treat other complications very well.

You probably know as well as I do too, that anti-viral medication is rarely used because of the impact to mutation.

Our ability to treat dehydration didn't work too well in these 111 cases of PCR-confirmed influenza, which had a fatality rate of 27%. http://www.nejm.org/doi/full/1... When a patient is dying from influenza, they use anti-viral medication (and everything else they've got).

Nor did it help this 15-year-old Texas girl who died of H1N1. http://www.nejm.org/doi/full/1... This article says that in order for the CDC to count a case as influenza, it has to be diagnosed at least with a rapid diagnostic kit, and it says, as other articles do, that the CDC probably underestimates the number of influenza cases by applying this strict criteria.

I apologize that this article is apparently behind a paywall. But then, if you can't get to a NEJM article, how can you know the facts about influenza?

Find me any new vaccines that have a double blind placebo study.
Here is three from a simple google search. http://jid.oxfordjournals.org/...
http://jid.oxfordjournals.org/...
http://www.nejm.org/doi/full/1...

Yes, some new vaccines have their performance compared to existing vaccines for the same drug. The existing vaccines have been compared to placebos already... No need to test for placebo performance as it already been confirmed that the established drug is better than placebo, what you really care about is if the new drug is even better or why bother with the new one.

Also find me some scientific studies that show and follow children who get multiple different combinations of vaccines over the course of 10-15 years.

http://cid.oxfordjournals.org/...
Check of the 15 sources on that paper. And a simple google search will give you way more than that...

Come on, if you're going to post something, at least be honest! The following quotes are from the abstract, which I think you'll find disagrees with your claims..

Kellerman's study said people were 2.7, not 23, times more likely to be killed.

After matching for four characteristics and controlling for the effects of five more, we found that the presence of one or more firearms in the home was strongly associated with an increased risk of homicide in the home (adjusted odds ratio, 2.7; 95 percent confidence interval, 1.6 to 4.4).

They only considered homicides within a home, not some random distance.

All homicides involving residents of King County or Shelby County that occurred between August 23, 1987, and August 23, 1992, and all homicides involving residents of Cuyahoga County that occurred between January 1, 1990, and August 23, 1992, were reviewed to identify those that took place in the home of the victim.

Revealed: secret plan to push'happy' pills
http://www.theguardian.com/soc...

Big Pharma Could Win International Price Monopoly, Unlimited Profits in 'Free Trade' Deal
http://www.huffingtonpost.com/...

US patent moves are 'profoundly bad' in leaked TPP treaty
http://www.theverge.com/2013/1...

The Trans-Pacific Partnership (TPP) is a proposed free trade agreement under negotiation between Australia, Brunei Darussalam, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, the United States and Vietnam. Leaked documents show the U.S. Trade Representative (USTR) is pressuring TPP countries to expand pharmaceutical monopoly protections and trade away access to medicines.
http://www.citizen.org/TPPA

The medical industry the third-leading cause of death in the United States; after heart disease and cancer.
http://en.wikipedia.org/wiki/I...

Big Pharma Shamelessly Shills Dangerous Bone Drugs You Don't Need
http://www.alternet.org/story/...

The H1N1 Swine Flu Pandemic: Manipulating the Data to Justify a Worldwide Public Health Emergency
http://www.globalresearch.ca/t...

"Somewhere in Rayong or Chon Buri on the coast of Thailand, a young woman may at this very moment be baring her arm for a shot of an experimental Aids vaccine that many of the leading scientists in the field say categorically has no hope at all of working.

She will be one of 16,000 volunteers recruited for the second large-scale Aids vaccine trial, a $119m exercise many scientists believe is a farce."
http://www.guardian.co.uk/scie...

Fraud has become so endemic in this country that it's woven its way into America’s DNA. 2). Big Pharma Fraud.
http://www.alternet.org/story/...

Drug Makers New Targets for U.S. Fraud Inquiries, Report Says
http://prescriptions.blogs.nyt...

Merck drew up a "hit list" of doctors that needed to be "neutralized" because they criticized the now banned drug Vioxx.
http://science.slashdot.org/st...

Merck invents its own journal to publish bogus research findings to promote it's own products.
http://blog.bioethics.net/2009...

Why Aren't These Fraudulent Papers Retracted?
http://truth-out.org/news/item...

Doubts about Johns Hopkins research have gone unanswered, scientist says
http://www.washingtonpost.com/...

A National Survey of Physician–Industry Relationships
http://www.nejm.org/doi/full/1...

he U.S. has an infant mortality rate that dwarfs comparable nations, as well as the highest teenage-pregnancy rate in the developed world, largely because of the politically-motivated unavailability of contraception in many areas."

Seriously? I don't know of anywhere in the US where contraception is not available. They sell rubbers at all drug stores and most every grocery store I've ever been to. I'm born and raised in the south of the US, and I've never seen anywhere that doesn't have multiple forms of contraception unavailable with or without a prescription. There are no cities I know of that ban them by law.

While condoms have useful purposes, they have a contraceptive failure rate of about 1% a year. A gynecologist at a medical school once told me that for women who absolutely must not get pregnant, she prescribes either the contraceptive loop or the hormone implants, both of which must be inserted by a doctor. Another reliable method is the pill, which must be prescribed by a doctor. The cheapest place to get this is usually a Planned Parenthood clinic. Otherwise it might cost $1-2,000

Throughout the South, politicians have been closing down Planned Parenthood clinics. Romney said that he will do anything he can to shut down Planned Parenthood. http://www.nydailynews.com/new...

They've also been trying to exclude contraceptives from health insurance under a religious exemption. http://www.nejm.org/doi/full/1...

I've also noticed that when I see a list of states with their incidence of sexually transmitted diseases, Mississippi and Alabama are usually at the top of the list.

The infant mortality and maternal mortality is pretty high in the U.S. in general and throughout the South in particular. Yes, Rolling Stone was correct.

Insurance is supposed to be there for EMERGENCIES, not to run you $10 copay for routine Dr. visits. That needs to be something you save and pay for, just like any other necessity of modern life, like utilities, food and gas.

That's one of those ideas that sounds good but doesn't work when you try them out in the real world. Most other developed countries have health care systems that pay 100% of costs (although non-American Slashdotters may be informative on that). Health insurance isn't car insurance.

The biggest problem is that once people have to pay for "routine" visits, they don't go on routine visits. Obviously you are one of those people who can afford to pay for a $200 doctor's visit out of pocket. Maybe half of Americans are in your category. The other half aren't. Doctors have no end of stories about people who didn't get routine care because they couldn't afford it, and wound up with preventable, fatal diseases. http://www.nejm.org/doi/full/1...

The other problem with "emergency" care is, "what is an emergency?" If I have to pay $100 for a doctor's visit myself, but my insurance pays for my $2,000 ER visit, I'm going to have a lot of emergencies. That actually was the problem in the Swiss health care system, which was mostly a catastrophic system which didn't kick in fully until you had passed a certain amount (It might have been $30,000). Once you reach $30,000, the insurance company has to pay for everything, 100%, so the doctors give them CAT scans, tests, specialist consultations, etc., and bill it all to the insurance company.

This is the type of policy and situation that is usually perfect for healthy younger folks that don't need tons of coverage for routine things.

Think about it. Any policy is perfect for healthy younger folks who never need coverage. The only people who need health insurance are the ones who get sick. If you develop multiple sclerosis or lupus, you can live a much more normal life if you can afford to get a lot of health care. There are drugs that can save your life and keep you out of a wheelchair for $50,000 a year.

I knew a young, libertarian Republican who had severe psoriasis, which put him in the hospital once or twice a year. The drugs he was taking were damaging his liver and kidneys. There were new, more effective, safer drugs -- but they cost $100,000 a year. What did he do? Government handouts. His wife was a government employee, and he was covered on her policy.

It has been upheld in US courts that even the minor fame from open-source authorship counts as economic gain (thus reinforcing the GPL's validity as being consequential).

I'd like to know the court citation. I did a quick Google search for "Arms Export Control Act open source software" and it looked like open source and anything else that was public domain was not subject to export restrictions.

http://oti.newamerica.net/blog...

http://www.mtu.edu/research/ad...

As to imports of scientific information, I read about that (I think) in Science, about how some American journals were refusing to accept papers from restricted countries. At least some lawyers argued that the regulations allowed the exchange of scientific information, the journals were wrong, and should start accepting papers.

I've seen submissions in the New England Journal of Medicine from Iran, usually short pieces in their "Images in Clinical Medicine" feature. http://www.ncbi.nlm.nih.gov/pu... http://www.nejm.org/doi/full/1... Iran has a pretty good health care system, with doctors trained in the UK.

Iraq used to have one of the best health care systems in the world. Some of the most bitter critics of Saddam Hussein were Iraqi doctors, and I used to read their articles in The Lancet and BMJ. After the war, some of them were treated worse by George W. Bush than they were by Saddam (as in blowing up hospitals).

If they couldn't publish their stuff in American medical journals, the British journals are happy to publish high-quality work.

You — and others — seem to have misconstrued my argument to mean, the government simply can not do anything. That's not, what I said. They can do it — just poorly.

it's rare for conservatives to change their minds based on the facts

Is not it a little early in the conversation for ad hominems?

I base this on several years of the Wall Street Journal comments page, until I gave up on them. And I read lots of conservative articles on health care policy. There are conservatives who change their minds based on the facts, but in my experience they are rare. William Buckley is dead. The WSJ editorial page has turned into a Pravda for the conservative wing of the Republican Party. Sic transit gloria mundi.

The military and Veterans Affairs medical centers give some of the best care in the world

Citation needed?

http://www.ncbi.nlm.nih.gov/pubmed/?term=%22Veterans'+Affairs%22

http://www.nejm.org/doi/full/10.1056/NEJMoa1007474

http://www.ncbi.nlm.nih.gov/pubmed/7979780

http://circ.ahajournals.org/content/86/1/121.abstract

http://circ.ahajournals.org/content/93/12/2128.abstract

In case you're not used to reading medical journal articles (and most people aren't), the point of these studies is that they took the medical conditions that they most frequently treated, and were responsible for the most deaths, like heart disease, high blood pressure, and kidney disease, where different doctors treated the same patients different ways, and they did randomized, controlled trials to see which treatments worked at all and which were better. They also did studies of different VA hospitals to see which hospitals had better and worse outcomes. They tried to improve the hospitals with worse outcomes, and if that didn't work, they shut the departments down.

If you go to any major medical conference, and go to the sessions on important diseases, you'll usually hear them talking about the "VA study." That's because in many medical specialties, the VA did the major, best-designed study to find out which treatments work and didn't work. There are a few private non-government organizations, like Kaiser-Permanente and Blue Cross/Blue Shield, who do the same thing, but (not to disparage them), the VA does a lot more of these studies.

The National Institutes of Health also does big studies like that. Of course, with the budget cuts, they can't do as many, and they're being forced right now to decide which important ongoing studies will have to go, as Science and Nature have been reporting.

Everybody who follows medical research knows this. If you say, the government can't do anything well, they'll know that you don't know anything about the reality in this important field.

And as for those complaints about the bad outcomes in VA hospitals -- those are the kind of thing that happen in any hospital. It's easier to find out what happens in the VA hospitals because of their internal accounting and disclosure policies. You'll notice that the story got that information from the government's own review. Try to get that same information from private hospitals. What matters is when doctors who know how to compare hospitals compare large numbers of patients, to see whether there are any statistically significant patterns. When they do that, the VA hospitals usually do well. And when they don't, they find out why and how to change it.

Ronald Reagan got his colon and prostate su

*Those* people (the young and working poor) are going right on Medicaid, or getting heavy subsidies.

To get Medicaid, you must make less than 133% of the poverty level, which is about $13,000/year. So they're not going on Medicaid unless they're really broke. If they have a chronic disease, they're going to be paying about $8,000 a year. Otherwise the young are subsidizing the system.

So, umm... still freeloading on the system. /me bangs head on desk...

When they had got exacerbations of conditions like asthma, couldn't breathe, went to the emergency room like the libertarians do, got oxygen, ran up a $4,000 bill, couldn't pay it, and went bankrupt, that would arguably be freeloading on the system.

Now under Obamacare/Romneycare/Heritagecare, the right-wing Democrats are forcing them to get insurance to pay for their ER trips. The Democrats (foolishly copying the Republicans) call that taking personal responsibility. You call that freeloading.

I know what the conservative solution is: Let them die. http://www.nejm.org/doi/full/10.1056/NEJMp1312793

Speaking for the American public, I can say: we don't want your solution.

This study was done on people with "no nutritional deficiencies". Yet vitamins are intended as supplements for people with nutritional deficiencies. As such, this study doesn't really show what it appears to be showing.

Vitamin deficiency diseases are generally third-world diseases. The population of the U.S. has very little vitamin deficiency. It's not as if doctors see scurvey or rickets when they go out into the community.

When Americans do have vitamin deficiency, it's usually because of a disease, hereditary or acquired. For example, alcoholics get vitamin B deficiency.

The New England Journal of Medicine had a case of rickets a few years ago, and the patient was a mentally retarded child who ate a diet entirely of Pop-Tarts.

Here's another one http://www.nejm.org/doi/full/10.1056/NEJMicm1205540 -- from the Ukraine. "In addition to a diet poor in vitamin D and calcium, the patient had a history of biliary dyskinesia, which may have contributed to poor absorption of fat-soluble vitamins, including vitamin D."

Here's another one http://www.nejm.org/doi/full/10.1056/NEJMcp1113996 Autoimmune gastritis (pernicious anemia) is the most common cause of severe [vitamin B12] deficiency.

One major cause of vitamin deficiency is people on fad diets. The macrobiotic diet was one of the worst for that. Sometimes people couldn't follow the macrobiotic diet themselves, but they had an infant that they kept on a "strict" macrobiotic diet (by feeding them not much more than brown rice), and in a few cases the child died.

There are some stupid articles, like this one http://www.ncbi.nlm.nih.gov/pubmed/21310306 that simply measured vitamin D blood levels, without consideration of whether they actually had clinical disease that made any difference to the patient's health. (It's like finding an elevated PSA or a lung spot that will never develop into cancer.) If you don't know how to read a journal article, you might misinterpret this to mean that there was a lot of vitamin D deficiency. But I can't find any studies that show clinical vitamin deficiency in Americans without specific diseases, since America was industrialized during WWII.

Here's an article by people who do understand the complexity of the problem http://www.nejm.org/doi/full/10.1056/NEJMcp1009570 and here's what they say:

Randomized, controlled trials of vitamin D supplementation have addressed its effects on skeletal outcomes, but most of these trials involved supplementation with both vitamin D and calcium, making it impossible to separate out the effects attributable specifically to vitamin D.

I just spent half an hour trying to find an article in a peer-reviewed journal that describes vitamin deficiency in a population in the U.S. where the deficiency isn't the result of a serious disease, and I can't find one.

The only time Americans need vitamin supplements is when they're diagnosed with a specific disease that causes a specific deficiency. In that case, they should get treated with vitamins under the supervision of an MD. You have to find out the cause of the deficiency and treat it. Otherwise you could die. This isn't the kind of thing you can self-treat with Google searches.

This study was done on people with "no nutritional deficiencies". Yet vitamins are intended as supplements for people with nutritional deficiencies. As such, this study doesn't really show what it appears to be showing.

Vitamin deficiency diseases are generally third-world diseases. The population of the U.S. has very little vitamin deficiency. It's not as if doctors see scurvey or rickets when they go out into the community.

When Americans do have vitamin deficiency, it's usually because of a disease, hereditary or acquired. For example, alcoholics get vitamin B deficiency.

The New England Journal of Medicine had a case of rickets a few years ago, and the patient was a mentally retarded child who ate a diet entirely of Pop-Tarts.

Here's another one http://www.nejm.org/doi/full/10.1056/NEJMicm1205540 -- from the Ukraine. "In addition to a diet poor in vitamin D and calcium, the patient had a history of biliary dyskinesia, which may have contributed to poor absorption of fat-soluble vitamins, including vitamin D."

Here's another one http://www.nejm.org/doi/full/10.1056/NEJMcp1113996 Autoimmune gastritis (pernicious anemia) is the most common cause of severe [vitamin B12] deficiency.

One major cause of vitamin deficiency is people on fad diets. The macrobiotic diet was one of the worst for that. Sometimes people couldn't follow the macrobiotic diet themselves, but they had an infant that they kept on a "strict" macrobiotic diet (by feeding them not much more than brown rice), and in a few cases the child died.

There are some stupid articles, like this one http://www.ncbi.nlm.nih.gov/pubmed/21310306 that simply measured vitamin D blood levels, without consideration of whether they actually had clinical disease that made any difference to the patient's health. (It's like finding an elevated PSA or a lung spot that will never develop into cancer.) If you don't know how to read a journal article, you might misinterpret this to mean that there was a lot of vitamin D deficiency. But I can't find any studies that show clinical vitamin deficiency in Americans without specific diseases, since America was industrialized during WWII.

Here's an article by people who do understand the complexity of the problem http://www.nejm.org/doi/full/10.1056/NEJMcp1009570 and here's what they say:

Randomized, controlled trials of vitamin D supplementation have addressed its effects on skeletal outcomes, but most of these trials involved supplementation with both vitamin D and calcium, making it impossible to separate out the effects attributable specifically to vitamin D.

I just spent half an hour trying to find an article in a peer-reviewed journal that describes vitamin deficiency in a population in the U.S. where the deficiency isn't the result of a serious disease, and I can't find one.

The only time Americans need vitamin supplements is when they're diagnosed with a specific disease that causes a specific deficiency. In that case, they should get treated with vitamins under the supervision of an MD. You have to find out the cause of the deficiency and treat it. Otherwise you could die. This isn't the kind of thing you can self-treat with Google searches.

This study was done on people with "no nutritional deficiencies". Yet vitamins are intended as supplements for people with nutritional deficiencies. As such, this study doesn't really show what it appears to be showing.

Vitamin deficiency diseases are generally third-world diseases. The population of the U.S. has very little vitamin deficiency. It's not as if doctors see scurvey or rickets when they go out into the community.

When Americans do have vitamin deficiency, it's usually because of a disease, hereditary or acquired. For example, alcoholics get vitamin B deficiency.

The New England Journal of Medicine had a case of rickets a few years ago, and the patient was a mentally retarded child who ate a diet entirely of Pop-Tarts.

Here's another one http://www.nejm.org/doi/full/10.1056/NEJMicm1205540 -- from the Ukraine. "In addition to a diet poor in vitamin D and calcium, the patient had a history of biliary dyskinesia, which may have contributed to poor absorption of fat-soluble vitamins, including vitamin D."

Here's another one http://www.nejm.org/doi/full/10.1056/NEJMcp1113996 Autoimmune gastritis (pernicious anemia) is the most common cause of severe [vitamin B12] deficiency.

One major cause of vitamin deficiency is people on fad diets. The macrobiotic diet was one of the worst for that. Sometimes people couldn't follow the macrobiotic diet themselves, but they had an infant that they kept on a "strict" macrobiotic diet (by feeding them not much more than brown rice), and in a few cases the child died.

There are some stupid articles, like this one http://www.ncbi.nlm.nih.gov/pubmed/21310306 that simply measured vitamin D blood levels, without consideration of whether they actually had clinical disease that made any difference to the patient's health. (It's like finding an elevated PSA or a lung spot that will never develop into cancer.) If you don't know how to read a journal article, you might misinterpret this to mean that there was a lot of vitamin D deficiency. But I can't find any studies that show clinical vitamin deficiency in Americans without specific diseases, since America was industrialized during WWII.

Here's an article by people who do understand the complexity of the problem http://www.nejm.org/doi/full/10.1056/NEJMcp1009570 and here's what they say:

Randomized, controlled trials of vitamin D supplementation have addressed its effects on skeletal outcomes, but most of these trials involved supplementation with both vitamin D and calcium, making it impossible to separate out the effects attributable specifically to vitamin D.

I just spent half an hour trying to find an article in a peer-reviewed journal that describes vitamin deficiency in a population in the U.S. where the deficiency isn't the result of a serious disease, and I can't find one.

The only time Americans need vitamin supplements is when they're diagnosed with a specific disease that causes a specific deficiency. In that case, they should get treated with vitamins under the supervision of an MD. You have to find out the cause of the deficiency and treat it. Otherwise you could die. This isn't the kind of thing you can self-treat with Google searches.

For 10 cents a day, I'll take the risk that I'm wasting my money. It's cheap insurance, and there might even be a benefit.

You might want to consider that there might be a significant risk of harm too.

Slight negative effect on lung cancer survival for high doses of Vitamin A.
Increase risk of all-cause mortality for high doses of Vitamin E.
Significant increase in mortality from gastrointestinal cancers from high doses of antioxidants, A & E in particular.

"There were people who were vaccinated that got this disease, but to blame it on the un-vaccinated, we excluded all those who did not get their vaccinations when we said so"

That, uh, is not what they're saying. It's implied from their statement that some people were vaccinated on time and still got the disease, yes. Clearly the vaccine is not 100% effective. We know this. But they're highlighting the fact that people who were not vaccinated are overrepresented in the infected group, a fact that is true and interesting.

They have no scientific data to prove that there are certain times that EVERY individual must be vaccinated - there are many medical reasons for why one would delay certain vaccinations.

That statement is not making the value judgement you are attributing to it. There could be a million reasons to not get vaccinated. It could be a horrible idea to get vaccinated. They're not doing any of the persecution you're imagining. They're just saying that people who didn't get vaccinated (a smaller group) makes up a disproportionate number of people who got infected.

Additionally, they have no studies to show that delaying vaccination has an increased risk of infection from the diseases

Measles vaccines are well studied. There are studies that prove the efficacy of the vaccine, and also studies that tell us how long vaccines take to start working. There's also studies on the effect of vaccination programs that are widely followed. Here - http://www.nejm.org/doi/pdf/10.1056/NEJM199411243312101 - is an article from the New England Journal of Medicine talking about how the vaccine effectively eliminated measles in Finland.

Of course there are negatives to vaccines, sure, but the vast majority of resistance to them is based on misunderstandings and ignorance of science. There's also a feeling that opting out has no negative consequences; this is dangerous, and something that becomes exponentially more dangerous the more people that buy into it. It's like people deciding not to vote. It's pretty much meaningless in small numbers, but it could become a real issue if too many people stopped at once.

One last question... just one*.

Is psychology evidence-driven, or belief-driven?

(*) This isn't just me asking. Here's a quote from the The New England Journal of Medicine article:

Evidence-based medicine is valuable to the extent that the evidence base is complete and unbiased. Selective publication of clinical trials — and the outcomes within those trials — can lead to unrealistic estimates of drug effectiveness and alter the apparent risk–benefit ratio.

(**) Also, I have no meaningful training in science or statistics. If you want, you can win the argument by pointing this out in your response.

Read this book: Why zebras don't get ulcers. It explains how stress influences our life, and how complex the system works that tries to regulate this. It shows that it all works beautifully, for people living in the wild, but the system is not so good for us.

This book won't give you the solution to depression, but it will show that the body uses many methods to accomplish several things, like redirecting sources when in danger or in rest. There is not one solution - any solution will have side effects, and this goes for the solutions of the body as well.

The original model held that psychotherapy could cure depression. Talk to your analyst once a week and after years of treatment you got better.

Then it was discovered that low norepinephrine caused depression, and tricyclics fixed that and cured depression.

Then it was discovered that low serotonin caused depression, and SSRIs fixed that and cured depression.

Then it was discovered that low dopamine caused depression, and MAOIs fixed that and cured depression.

And recently, the The New England Journal of Medicine reported depression meds have no effect.

One last question... just one*.

Is psychology evidence-driven, or belief-driven?

(*) This isn't just me asking. Here's a quote from the The New England Journal of Medicine article:

Evidence-based medicine is valuable to the extent that the evidence base is complete and unbiased. Selective publication of clinical trials — and the outcomes within those trials — can lead to unrealistic estimates of drug effectiveness and alter the apparent risk–benefit ratio.

(**) Also, I have no meaningful training in science or statistics. If you want, you can win the argument by pointing this out in your response.

The healthcare in the US is second to none.

Or according to the NEJM, second to 36, when you look at actual results. http://www.nejm.org/doi/full/10.1056/NEJMp0910064

Saying US healthcare is the best, is a bit like saying India has the best housing on earth, and pointing to the mansions and palaces of Mumbai as evidence, while ignoring the slums.
(BTW, India also has excellent healthcare, if you can afford it. )
  Quality healthcare is more widely available in the US, but the system is still incredibly inefficient compared to other developed countries.

Me Me Me Me!!!!!

If you want to force me to pay for someone else, then sack-up and raise my taxes for that purpose - Medicare/Medicaid already exist for this exact function. Don't hide it behind "healthcare" and then systematically damage everyone's quality of healthcare in the process (which this little law will indeed do...)

Obama didn't sack-up and raise taxes for health care because, after extensive discussions with the Republicans, he concluded that the Republicans would never agree to it. He therefore had to lie and call it something else. The alternative was even worse http://www.nejm.org/doi/full/10.1056/NEJMp1312793 In state after state, Republican legislatures won't pay taxes for Medicaid, and the conservative Democrats aren't much better. What do you think "Taxed Enough Already" means?

A lot of liberal Democrats thought that if Obama stood up and fought the Republicans, he could have gotten a single-payer system like Canada. Too bad. The Canadian system costs about half as much for about the same outcomes. So you're going to have to pay twice as much, in premiums and taxes, for a ridiculous Republican-designed system. Too bad.

Otherwise, your first sentence shows an idiotic, greedy, and rapacious attitude towards things that are quite simply not yours.

Adam Smith said that those who have received a greater benefit from society have an obligation to contribute a proportionally greater part of their income to the costs of running that society -- in other words, progressive taxation. You benefited from society. Now pay up. I'm sorry you're not convinced that it's the right thing to do. But it's the law.

Let's look at the latest issue of the world's premier medical journal*, the New England Journal of Medicine. Where do their authors come from? The U.S., Korea, Germany, Belgium, Canada, Spain, France, the U.K.....

Gee, despite what the Pharmaceutical Researchers and Manufacturers of America told you, lots of people all around the world do medical research.

For another way to look at it, count the Nobel laureates in medicine http://www.nobelprize.org/nobel_prizes/medicine/laureates/

Bottom line: While the U.S. does a lot of medical research, we're actually not an island of civilization in a world of barbarian freeloaders. There are other societies around the world where scientists (and their governments) put a lot of effort into not only practical but basic scientific research, and come up with important medical developments, like, oh, uh, penicillin and, uh, the structure of DNA. Science is a worldwide enterprise, and everybody pulls their share. Imagine that, there are kids in Europe who are studying Darwin and Newton just like we do. And even in Japan https://en.wikipedia.org/wiki/Akira_Endo_(biochemist) and China https://en.wikipedia.org/wiki/Artemesinin#History

http://www.nejm.org/doi/full/10.1056/NEJMoa1306494
A Phase 2 Trial of Ponatinib in Philadelphia Chromosome–Positive Leukemias
J.E. Cortes and Others
Address reprint requests to Dr. Cortes at the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, or at jcortes@mdanderson.org.
The authors' affiliations are as follows: the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (J.E.C., H.K.); Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.); H. Lee Moffitt Cancer Center, Tampa, FL (J.P.-I.); Charité–Universitätsmedizin Berlin, Berlin (P.C.), III. Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim (M.C.M.), and Abteilung Hämatologie und Onkologie, Universitätsklinikum Jena, Jena (A.H.) — all in Germany;

http://www.nejm.org/doi/full/10.1056/NEJMoa1301064
Intrarenal Resistive Index after Renal Transplantation
M. Naesens and Others
From the Departments of Nephrology and Renal Transplantation (M.N., L.H., K.C., D.K., P.E., B.B., B.S., B.M., H.J., C.M., K.D.V., Y.V.), Pathology (E.L.), Radiology (L.D.W., F.C., R.O.), and Abdominal Transplant Surgery (J.P., D.M.), University Hospitals Leuven, and the Departments of Microbiology and Immunology (M.N., K.C., D.K., P.E., B.B., B.S., B.M., J.P., D.M., K.D.V., Y.V.) and Imaging and Pathology (E.L., L.D.W., F.C., R.O.), KU Leuven — both in Leuven, Belgium.

http://www.nejm.org/doi/full/10.1056/NEJMoa1215541
Dolutegravir plus Abacavir–Lamivudine for the Treatment of HIV-1 Infection
S.L. Walmsley and Others
From the University Health Network, Toronto (S.L.W.); Hospital Clinico Universitario, Santiago de Compostela (A.A.), and Hospital General de Elche and Universidad Miguel Hernández, Alicante (F.G.) — both in Spain; Centre Hospitalier Universitaire Saint-Pierre, Brussels (N.C.); Dr. Victor Babes Infectious and Tropical Diseases Hospital, Bucharest, Romania (D.D.); Medizinisches Versorgungszentrum Karlsplatz HIV Research and Clinical Care Center, Munich, Germany (A.E.); Centre Hospitalier Régional d'Orléans, Orléans, France (L.H.); Antiviral Therapy Unit, Ospedali Riuniti, Bergamo, Italy (F.M.); University of Nebraska Medical Center, Omaha (U.S.); GlaxoSmithKline, Stockley Park, United Kingdom (C.G.); and GlaxoSmithKline, Research Triangle Park, NC (K.P., B.W., S.M., G.N.).

Let's look at the latest issue of the world's premier medical journal*, the New England Journal of Medicine. Where do their authors come from? The U.S., Korea, Germany, Belgium, Canada, Spain, France, the U.K.....

Gee, despite what the Pharmaceutical Researchers and Manufacturers of America told you, lots of people all around the world do medical research.

For another way to look at it, count the Nobel laureates in medicine http://www.nobelprize.org/nobel_prizes/medicine/laureates/

Bottom line: While the U.S. does a lot of medical research, we're actually not an island of civilization in a world of barbarian freeloaders. There are other societies around the world where scientists (and their governments) put a lot of effort into not only practical but basic scientific research, and come up with important medical developments, like, oh, uh, penicillin and, uh, the structure of DNA. Science is a worldwide enterprise, and everybody pulls their share. Imagine that, there are kids in Europe who are studying Darwin and Newton just like we do. And even in Japan https://en.wikipedia.org/wiki/Akira_Endo_(biochemist) and China https://en.wikipedia.org/wiki/Artemesinin#History

http://www.nejm.org/doi/full/10.1056/NEJMoa1306494
A Phase 2 Trial of Ponatinib in Philadelphia Chromosome–Positive Leukemias
J.E. Cortes and Others
Address reprint requests to Dr. Cortes at the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, or at jcortes@mdanderson.org.
The authors' affiliations are as follows: the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (J.E.C., H.K.); Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.); H. Lee Moffitt Cancer Center, Tampa, FL (J.P.-I.); Charité–Universitätsmedizin Berlin, Berlin (P.C.), III. Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim (M.C.M.), and Abteilung Hämatologie und Onkologie, Universitätsklinikum Jena, Jena (A.H.) — all in Germany;

http://www.nejm.org/doi/full/10.1056/NEJMoa1301064
Intrarenal Resistive Index after Renal Transplantation
M. Naesens and Others
From the Departments of Nephrology and Renal Transplantation (M.N., L.H., K.C., D.K., P.E., B.B., B.S., B.M., H.J., C.M., K.D.V., Y.V.), Pathology (E.L.), Radiology (L.D.W., F.C., R.O.), and Abdominal Transplant Surgery (J.P., D.M.), University Hospitals Leuven, and the Departments of Microbiology and Immunology (M.N., K.C., D.K., P.E., B.B., B.S., B.M., J.P., D.M., K.D.V., Y.V.) and Imaging and Pathology (E.L., L.D.W., F.C., R.O.), KU Leuven — both in Leuven, Belgium.

http://www.nejm.org/doi/full/10.1056/NEJMoa1215541
Dolutegravir plus Abacavir–Lamivudine for the Treatment of HIV-1 Infection
S.L. Walmsley and Others
From the University Health Network, Toronto (S.L.W.); Hospital Clinico Universitario, Santiago de Compostela (A.A.), and Hospital General de Elche and Universidad Miguel Hernández, Alicante (F.G.) — both in Spain; Centre Hospitalier Universitaire Saint-Pierre, Brussels (N.C.); Dr. Victor Babes Infectious and Tropical Diseases Hospital, Bucharest, Romania (D.D.); Medizinisches Versorgungszentrum Karlsplatz HIV Research and Clinical Care Center, Munich, Germany (A.E.); Centre Hospitalier Régional d'Orléans, Orléans, France (L.H.); Antiviral Therapy Unit, Ospedali Riuniti, Bergamo, Italy (F.M.); University of Nebraska Medical Center, Omaha (U.S.); GlaxoSmithKline, Stockley Park, United Kingdom (C.G.); and GlaxoSmithKline, Research Triangle Park, NC (K.P., B.W., S.M., G.N.).

Let's look at the latest issue of the world's premier medical journal*, the New England Journal of Medicine. Where do their authors come from? The U.S., Korea, Germany, Belgium, Canada, Spain, France, the U.K.....

Gee, despite what the Pharmaceutical Researchers and Manufacturers of America told you, lots of people all around the world do medical research.

For another way to look at it, count the Nobel laureates in medicine http://www.nobelprize.org/nobel_prizes/medicine/laureates/

Bottom line: While the U.S. does a lot of medical research, we're actually not an island of civilization in a world of barbarian freeloaders. There are other societies around the world where scientists (and their governments) put a lot of effort into not only practical but basic scientific research, and come up with important medical developments, like, oh, uh, penicillin and, uh, the structure of DNA. Science is a worldwide enterprise, and everybody pulls their share. Imagine that, there are kids in Europe who are studying Darwin and Newton just like we do. And even in Japan https://en.wikipedia.org/wiki/Akira_Endo_(biochemist) and China https://en.wikipedia.org/wiki/Artemesinin#History

http://www.nejm.org/doi/full/10.1056/NEJMoa1306494
A Phase 2 Trial of Ponatinib in Philadelphia Chromosome–Positive Leukemias
J.E. Cortes and Others
Address reprint requests to Dr. Cortes at the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, or at jcortes@mdanderson.org.
The authors' affiliations are as follows: the Department of Leukemia, University of Texas M.D. Anderson Cancer Center, Houston (J.E.C., H.K.); Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea (D.-W.K.); H. Lee Moffitt Cancer Center, Tampa, FL (J.P.-I.); Charité–Universitätsmedizin Berlin, Berlin (P.C.), III. Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim (M.C.M.), and Abteilung Hämatologie und Onkologie, Universitätsklinikum Jena, Jena (A.H.) — all in Germany;

http://www.nejm.org/doi/full/10.1056/NEJMoa1301064
Intrarenal Resistive Index after Renal Transplantation
M. Naesens and Others
From the Departments of Nephrology and Renal Transplantation (M.N., L.H., K.C., D.K., P.E., B.B., B.S., B.M., H.J., C.M., K.D.V., Y.V.), Pathology (E.L.), Radiology (L.D.W., F.C., R.O.), and Abdominal Transplant Surgery (J.P., D.M.), University Hospitals Leuven, and the Departments of Microbiology and Immunology (M.N., K.C., D.K., P.E., B.B., B.S., B.M., J.P., D.M., K.D.V., Y.V.) and Imaging and Pathology (E.L., L.D.W., F.C., R.O.), KU Leuven — both in Leuven, Belgium.

http://www.nejm.org/doi/full/10.1056/NEJMoa1215541
Dolutegravir plus Abacavir–Lamivudine for the Treatment of HIV-1 Infection
S.L. Walmsley and Others
From the University Health Network, Toronto (S.L.W.); Hospital Clinico Universitario, Santiago de Compostela (A.A.), and Hospital General de Elche and Universidad Miguel Hernández, Alicante (F.G.) — both in Spain; Centre Hospitalier Universitaire Saint-Pierre, Brussels (N.C.); Dr. Victor Babes Infectious and Tropical Diseases Hospital, Bucharest, Romania (D.D.); Medizinisches Versorgungszentrum Karlsplatz HIV Research and Clinical Care Center, Munich, Germany (A.E.); Centre Hospitalier Régional d'Orléans, Orléans, France (L.H.); Antiviral Therapy Unit, Ospedali Riuniti, Bergamo, Italy (F.M.); University of Nebraska Medical Center, Omaha (U.S.); GlaxoSmithKline, Stockley Park, United Kingdom (C.G.); and GlaxoSmithKline, Research Triangle Park, NC (K.P., B.W., S.M., G.N.).

The reason the law is so complex is that American health policy is made not by a process of examining the options rationally and picking out the best ones, but by a process of political compromise,

If we looked around the world for health care systems that are working (in terms of price, quality and service), we would probably pick something like the Canadian single payer system.

Instead, we had to accommodate every powerful interest group, campaign contributor, and free-market ideologue. Why do we need a private insurance industry? We don't, they just have a good lobby.

The free market health care system doesn't work unless you're willing to let people die when they can't afford health care. http://www.nejm.org/doi/full/10.1056/NEJMp1312793 So how do the right-wingers get out of that? They come up with a system of subsidies (which they call tax refunds). In order to figure out who "deserves" to get what subsidy, they have to examine every applicant's income, expenses, and circumstances and apply arbitrary formulas.

Because it incorporates tax payments and other grants, you have a system which is as complicated as the entire tax system and a welfare application combined.

Then you have to please these economic theorists who believe (despite 40 years of evidence) that if people have to pay co-payments, they'll be wiser medical consumers. So you've just made a simple system complex. Then you have to provide "choice" of silver, gold, platinum and lead policies, so you have to do the same thing four times over.

By the time you've finished compromising with every interest group, you have an enormously complicated health care financing system, which may not even be precisely designed or logically consistent. So when you try to write code, you have to go back and clarify the policy that you're implementing in code.

Compare that to the Canadian system: You hand your Canadian Medicare card to the receptionist, and she swipes it. The government pays for it.

OK ... so what are my liberal friends willing to surrender in return? It's got to be something near and dear to their hearts. :)

Right now the conservatives have cut food stamps, and they want to eliminate it entirely.

Food stamps are one of the most effective welfare programs we have, supported until recently by Democrats and Republicans alike.

Without food stamps, we'd be back to third world hunger like we were in the 1930s, with people stealing bread and children with rickets.

Is that a realistic compromise? Can I in good conscience bargain away food stamps and let people go hungry again?

I don't believe in false balance. Both sides aren't equally wrong. When you ask the Republicans what they want on health policy, they say, "Abandon Obamacare and leave the free market in its place." I can't go back to that. This is the free market. http://www.nejm.org/doi/full/10.1056/NEJMp1312793 Obamacare was already a compromise with the Republicans, modeled on Romneycare and the Heritage Foundation plan. Obama gave them everything they wanted, and they were still against it. How can you negotiate with people like that?

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

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

It's not such a great idea to remove personal accountability. When nobody cares about being healthy because "someone else" will pay the bill, then nobody will be healthy, and the amount of money required to pay the bill every year will exceed all of our production (although we already do not produce enough to pay our bills).

This has been disproven by 40 years of research, starting with the Rand Health Insurance Experiment http://en.wikipedia.org/wiki/RAND_Health_Insurance_Experiment and confirmed with studies by insurance companies and big corporations that self-insure their employees. The reason people believe it, when the data contradicts it, is that they're following an irrational free-market ideology. The rich conservatives figure that they can easily afford copayments themselves, and they can save money by not having to pay for the poor. It's a way of making the poor pay more for worse health care. Copayments result in worse health outcomes, and higher health costs. Companies have tried copayments and gone back when it wound up costing more. In health care, the free market fails, and we know the reasons why. If a doctor tells you to go to the hospital immediately because you could die, you can't start researching it on the Internet and comparing prices. If you want to discourage people from spending money on needless health care, you should put pressure on the doctors, who actually make the big purchasing decisions. That's what they do in countries like Canada and England, that spend half as much as we do. This is part of the Republican war on science. They try a free-market solution, it doesn't work, and instead of accepting failure, they ignore the facts and make excuses.

The Rand study was a controlled study that randomly divided people into different groups, with different levels of copay among them. That's the strongest evidence you can get.

The goal of the Rand study was to find out whether people who must pay copayments would be more likely to use appropriate treatments, and less likely to use inappropriate treatments.

-- The people with copayments were less likely to use inappropriate treatments, but they were also less likely to use appropriate treatments -- like drugs to control blood pressure, asthma, diabetes, etc. As a result, they wound up in the hospital more.

-- With copayments, people with asthma would save $100 by not taking their asthma controller medication, have an asthma crisis, go to the emergency room, and run up a $1,000 hospital bill that they couldn't afford to pay anyway.

The Rand study didn't have the statistical power to tell whether people with higher copayments were more likely to die, but they did find that the secondary outcomes like high blood pressure and high blood sugar were worse.

Studies of copayments have been done ever since, by insurance companies and big employers that were looking for ways to save money. They consistently found that copayments cost them more money in the long run.

-- Copayments raised costs. http://www.nejm.org/doi/full/10.1056/NEJMsa0904533 Increased Ambulatory Care Copayments and Hospitalizations among the Elderly. People made worse health care decisions.

-- When Medicare managed care companies imposed a small copayment for mammograms -- in over-65yo women, one group in which mammograms are cost-effective -- the rate of mammograms went down significantly. http://www.nejm.org/doi/full/10.1056/NEJMsa070929 Effect of Cost Sharing on Screening Mammography in Medicare Health Plans

-- IBM tried a copayment scheme with their employees. It wound up costing them more money, so they dropped it.

The reason it doesn't work is that the free market doesn't work in health care. The Nobel prize-winning economist Kenneth Arrow explained why in an article seve