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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

http://www.nejm.org/doi/full/10.1056/NEJMoa1306742
Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus
N Engl J Med 2013; 369:407-416 August 1, 2013DOI: 10.1056/NEJMoa1306742

Free, no paywall.

Good diagram here.
http://www.nejm.org/action/showImage?doi=10.1056%2FNEJMoa1306742&iid=f02

http://www.nejm.org/doi/full/10.1056/NEJMoa1306742
Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus
N Engl J Med 2013; 369:407-416 August 1, 2013DOI: 10.1056/NEJMoa1306742

Free, no paywall.

Good diagram here.
http://www.nejm.org/action/showImage?doi=10.1056%2FNEJMoa1306742&iid=f02

I don't know where you get all this BS. Most doctors work for themselves or for a small group of doctors

How about The New England Journal of Medicine? How about NPR? How about the doctor I am married to? Hospitals hire huge numbers of doctors and the rate has been increasing in recent years dramatically.

Every time I've been to a hospital (and everyone I've ever known has), I got multiple bills, one being from the hospital, and one being from the doctor.

That has precisely nothing to do with how the doctor is compensated for his/her take home pay. While it is possible that they two are independent (there are lots of independent doctor's offices), a great many practices are actually fully owned subsidiaries of hospital systems. Just because you are not in the main hospital does not mean the hospital does not own the practice. If you look you'll often see that an outpatient clinic or seemingly independent surgery center is actually affiliated with one of the major hospital systems in your area. Hospitals have been on a buying spree for the last decade. Bills for medical care are commonly not integrated. The mere fact that you received multiple bills means very little by itself. Hospital systems also are the largest category of employer for new doctors. Just because you have some limited personal experience with a few practices doesn't mean anything regarding who actually employs doctors.

Doctors DO NOT work for hospitals.

Like hell they don't. 1 in 6 works directly for a hospital and over half work for so called integrated delivery systems which is basically the hospital's wider network. Effectively captured business or subsidiary businesses. There has been a 75% rise in the number of doctors employed directly by hospitals since 2000.

Surgeons and lawyers are very different professions: they own their own businesses, they're their own bosses, and they make a ton of money

You are a quite incorrect. Better pick another example to compare to if you want your argument to hold any water.

Most doctors do not own their own business and many aren't even paid all that well especially considering the hours required. The majority work for hospitals and thus are employed by someone else. The amount of money they make varies greatly by specialty. General practitioners as a rule do not actually make particularly high salaries. The lowest paid GPs have salaries of less than $90K per year with the mean somewhere around $175K. And they typically work 60-80 hours weeks to get that salary. Specialists tend to do better (though not always) and academic positions pay significantly worse than private practice as a rule of thumb. I'm married to an MD and she is not a business owner.

I don't know about lawyers quite as well but the data I've seen says about 20% are self employed. Lots of lawyers work for large law firms and most of them that do so are not partners.

! yep

We already know that's the case for antibiotics. And we know plants compete with one another by suppressing competitors' growth.

Seems to me Thomas's comment is intended to add a loophole -- "we created this cDNA and patented it, so we have the patent, so if you claim you found the exact same thing out there in nature somewhere, it must be you stole it from us." Betcha.

http://www.nejm.org/doi/full/10.1056/NEJMp1215093
The Future of Antibiotics and Resistance
Brad Spellberg, M.D., John G. Bartlett, M.D., and David N. Gilbert, M.D.
N Engl J Med 2013; 368:299-302January 24, 2013DOI: 10.1056/NEJMp1215093
----------------
"... after billions of years of evolution, microbes have most likely invented antibiotics against every biochemical target that can be attacked — and, of necessity, developed resistance mechanisms to protect all those biochemical targets. Indeed, widespread antibiotic resistance was recently discovered among bacteria found in underground caves that had been geologically isolated from the surface of the planet for 4 million years.2 Remarkably, resistance was found even to synthetic antibiotics that did not exist on earth until the 20th century. These results underscore a critical reality: antibiotic resistance already exists, widely disseminated in nature, to drugs we have not yet invented.

"Thus, from the microbial perspective, all antibiotic targets are “old” targets...."
-----------------

This "it can't happen to me" mentality is how highschool kids live their lives. Eventually you grow up and realize it CAN happen to you.

I couldn't agree more. Your belief that firearms make you safer is based purely on a "it cant happen to me" attitude. You are gambling against the odds, assuming that your outcomes will be better, without applying facts and real world statistics.

Oh, and you're also incorrect about suicide.

A bunch of citations in Wikipedia's section about it.

Quoth http://www.nejm.org/doi/full/10.1056/NEJM199702133360701#t=articleResults:

We observed no safety advantage to hands-free as compared with hand-held telephones. This finding was not explained by imbalances in the subjects' age, education, socioeconomic status, or other demographic characteristics. Nor can it be explained by suggesting that those with units that leave the hands free do more driving. One possibility is that motor vehicle collisions result from a driver's limitations with regard to attention rather than dexterity. Regardless of the explanation, our data do not support the policy followed in some countries of restricting hand-held cellular telephones but not those that leave the hands free.

Don't be stupid.

Despite not agreeing totally with the start of this thread, there is _some_ validity to what was said: From Wikipedia (not my favorite source, mind you)

Principles of screening

World Health Organization guidelines were published in 1968, but are still applicable today.[2]

The condition should be an important health problem.

There should be a treatment for the condition.

Facilities for diagnosis and treatment should be available.

There should be a latent stage of the disease.

There should be a test or examination for the condition.

etc

A good screening test is one that provides a definitive answer. You DEFINITELY have AIDS / rabies / smallpox, for example. Whether you can treat/cure AIDS/rabies/smallpox? Well, that's something else entirely.

Actually, you are wrong here. There are very few tests in medicine that are "absolute answers". Every test has an error rate associated with it. We typically look at sensitivity (the chances of actually detecting the disease) and specificity (the chance of the positive test being the disease in question). This leads to the concepts of false-positives(you don't have the disease, but the test says you do) and false-negatives(you have the disease but we missed it). Going further down the statistical highway, when we include the incidence of the disease in the population and the probability that an individual has a disease...that yields positive or negative predictive values (the chances that a positive (or negative) test is indicative of existence (or absence) of disease in that person.

Let me be brief, and state no test is 100% sensitive nor 100% specific, and while you may approach 100% with PPV or NPV, the other cannot, therefore, be 100%.

As such the original article is very wrong in their claims:

says their new technology can diagnose Alzheimer's disease up to six years before symptoms appear with 100 percent accurac

The program analyzes patients' eye movements and time spent looking at familiar and new images and then generates a score. Kaplan said 100 percent of subjects who scored below 50 percent on the test have gone to receive an Alzheimer's diagnosis within six years, while none of those who scored above 67 have developed Alzheimer's.

I'm sorry, what is their prediction when the patient scores a 55?

But if you can't screen to provide a diagnosis, then you can't isolate symptoms, spot OTHER symptoms which may be masked by similar diseases that someone DOESN'T have (and only a screen will tell you that), or work out how to manage the condition, even if you can't treat it. Management might refer to, for example, being told not to share your blood with AIDS, or getting benefits and home-help for Alzheimer's, or even just "don't do this particular exercise / take this particular drug".

Er....I'm not sure _what_ you are trying to say here. But let me clarify: screening does not by definition provide a diagnosis....it mere raises the level of concern. Take the (very poorly chosen) example of breast cancer....mammography (which is starting to fall out of favor for screening) screening alerts the physician to the potential for a cancer. After mammography, typically we attempt to obtain a tissue diagnosis (biopsy) to "prove" a cancer. But even then, errors can still be made.

A good screening test has the following:

be capable of detecting a high proportion of disease in its preclinical state***

be safe to administer

Don't be stupid.

Despite not agreeing totally with the start of this thread, there is _some_ validity to what was said: From Wikipedia (not my favorite source, mind you)

Principles of screening

World Health Organization guidelines were published in 1968, but are still applicable today.[2]

The condition should be an important health problem.

There should be a treatment for the condition.

Facilities for diagnosis and treatment should be available.

There should be a latent stage of the disease.

There should be a test or examination for the condition.

etc

A good screening test is one that provides a definitive answer. You DEFINITELY have AIDS / rabies / smallpox, for example. Whether you can treat/cure AIDS/rabies/smallpox? Well, that's something else entirely.

Actually, you are wrong here. There are very few tests in medicine that are "absolute answers". Every test has an error rate associated with it. We typically look at sensitivity (the chances of actually detecting the disease) and specificity (the chance of the positive test being the disease in question). This leads to the concepts of false-positives(you don't have the disease, but the test says you do) and false-negatives(you have the disease but we missed it). Going further down the statistical highway, when we include the incidence of the disease in the population and the probability that an individual has a disease...that yields positive or negative predictive values (the chances that a positive (or negative) test is indicative of existence (or absence) of disease in that person.

Let me be brief, and state no test is 100% sensitive nor 100% specific, and while you may approach 100% with PPV or NPV, the other cannot, therefore, be 100%.

As such the original article is very wrong in their claims:

says their new technology can diagnose Alzheimer's disease up to six years before symptoms appear with 100 percent accurac

The program analyzes patients' eye movements and time spent looking at familiar and new images and then generates a score. Kaplan said 100 percent of subjects who scored below 50 percent on the test have gone to receive an Alzheimer's diagnosis within six years, while none of those who scored above 67 have developed Alzheimer's.

I'm sorry, what is their prediction when the patient scores a 55?

But if you can't screen to provide a diagnosis, then you can't isolate symptoms, spot OTHER symptoms which may be masked by similar diseases that someone DOESN'T have (and only a screen will tell you that), or work out how to manage the condition, even if you can't treat it. Management might refer to, for example, being told not to share your blood with AIDS, or getting benefits and home-help for Alzheimer's, or even just "don't do this particular exercise / take this particular drug".

Er....I'm not sure _what_ you are trying to say here. But let me clarify: screening does not by definition provide a diagnosis....it mere raises the level of concern. Take the (very poorly chosen) example of breast cancer....mammography (which is starting to fall out of favor for screening) screening alerts the physician to the potential for a cancer. After mammography, typically we attempt to obtain a tissue diagnosis (biopsy) to "prove" a cancer. But even then, errors can still be made.

A good screening test has the following:

be capable of detecting a high proportion of disease in its preclinical state***

be safe to administer

Take a look at figure 1 from this article. The article you quote concentrates on one type of accident. Taking all types of accidents together show fewer deaths.

That's the kind of story I'd like to see a link to, but let's assume it's true.

If your grandmother has a gun in her house, she's more likely to use it to kill herself, or another innocent party, as she is to use it to defend herself.

http://www.nytimes.com/2013/01/02/opinion/at-the-er-bearing-witness-to-gun-violence.html
At the E.R., Bearing Witness to Gun Violence
By DAVID H. NEWMAN
Published: January 1, 2013
I do not know exactly what measures should be taken to reduce gun violence like this. But I know that most homicides and suicides in America are carried out with guns. Research suggests that homes with a gun are two to three times more likely to experience a firearm death than homes without guns, and that members of the household are 18 times more likely to be the victim than intruders.
Emergency rooms are themselves volatile environments, not immune to violence. Over the last decade, a quarter of gun crimes in American E.R.’s were committed with guns wrested from armed guards.

http://aje.oxfordjournals.org/content/160/10/929.long
Guns in the Home and Risk of a Violent Death in the Home: Findings from a National Study
Linda L. Dahlberg, Robin M. Ikeda and Marcie-jo Kresnow
Those persons with guns in the home were at greater risk than those without guns in the home of dying from a homicide in the home (adjusted odds ratio = 1.9, 95% confidence interval: 1.1, 3.4).
The risk of dying from a suicide in the home was greater for males in homes with guns than for males without guns in the home (adjusted odds ratio = 10.4, 95% confidence interval: 5.8, 18.9). regardless of storage practice, type of gun, or number of firearms in the home, having a gun in the home was associated with an increased risk of firearm homicide and firearm suicide in the home.

http://www.nejm.org/doi/full/10.1056/NEJM199310073291506
Gun Ownership as a Risk Factor for Homicide in the Home
Arthur L. Kellermann, Frederick P. Rivara, Norman B. Rushforth, Joyce G. Banton, Donald T. Reay, Jerry T. Francisco, Ana B. Locci, Janice Prodzinski, Bela B. Hackman, and Grant Somes
N Engl J Med 1993; 329:1084-1091
October 7, 1993
DOI: 10.1056/NEJM199310073291506
Rather than confer protection, guns kept in the home are associated with an increase in the risk of homicide by a family member or intimate acquaintance.

http://www.ncbi.nlm.nih.gov/pubmed/3713749
N Engl J Med. 1986 Jun 12;314(24):1557-60.
Protection or peril? An analysis of firearm-related deaths in the home.
Kellermann AL, Reay DT.
Only 2 of these 398 deaths (0.5 percent) involved an intruder shot during attempted entry. Seven persons (1.8 percent) were killed in self-defense. For every case of self-protection homicide involving a firearm kept in the home, there were 1.3 accidental deaths, 4.6 criminal homicides, and 37 suicides involving firearms. Hand-guns were used in 70.5 percent of these deaths.

http://www.annemergmed.com/article/S0196-0644(12)01408-4/abstract
Annals of Emergency Medicine
Volume 60, Issue 6 , Pages 790-798.e1, December 2012
Hospital-Based Shootings in the United States: 2000 to 2011
Gabor D. Kelen, Christina L. Catlett, Joshua G. Kubit, Yu-Hsiang Hsieh
In 23% of shootings within the ED, the weapon was a security officer's gun taken by the perpetrator.

There has been a revival of ECT for severe, incurable depression, especially with the risk of suicide, and it's always with the consent of the patient. The problem is, it's always associated with memory loss. The recent treatments have less memory loss than the older treatments, but if you have ECT, you're going to lose long-term memories.

http://www.nejm.org/doi/full/10.1056/NEJMct075234
Clinical Therapeutics
Electroconvulsive Therapy for Depression
Sarah H. Lisanby, M.D.
N Engl J Med 2007; 357:1939-1945
November 8, 2007
DOI: 10.1056/NEJMct075234

I don't want this in the hands of the same people who made Vioxx, Thalidomide or Lipitor.

Hey, one of these, Thalidomide to be exact, is a bad example. Insufficient clinical trials leading to careless administration in pregnant women (who very often didn't even know they were pregnant) caused the deplorable results. That aside, the drug is very safe and effective.

The argument is devolved to a binary straw-man: a "pro/con" proposition - to the end of stifling nuanced inquiry and actual understanding.

Mary Shelly wasn't anti-science when she wrote "Frankenstein".

Goethe wasn't "anti-science" when he wrote "The Sorcerer's Apprentice". If you aren't immediately familiar with the fable, it is worth revisiting. The story concerns the casual nature of hubris, particularly in the domain of technical insight.

There is a very real delusional aspect to a culture that uses scientific method in an atomised scope and then applies one technical outcome in a pervasive manner.

The operative phrase here is: "knows enough to be dangerous." Another such is "unintended consequences".

Let us quote from the article, and allow the unintended consequences aspect to unfold its manifest possibilities in our imaginations:

The negative sides, however, are very substantial. Cytomegalovirus doesn't normally cause symptoms in healthy people, but it tends to be active in very young babies and among those with immune defects, where it can cause serious complications. Herpes viruses cause unpleasant symptoms as well.

I don't want this in the hands of the same people who made Vioxx, Thalidomide or Lipitor.

Actually, the BBC gave a link to the NEJM article. What have they done with those 5 patients since then?

http://www.nejm.org/doi/full/10.1056/NEJMoa0905370
Willful Modulation of Brain Activity in Disorders of Consciousness
Martin M. Monti, Ph.D., Audrey Vanhaudenhuyse, M.Sc., Martin R. Coleman, Ph.D., Melanie Boly, M.D., John D. Pickard, F.R.C.S., F.Med.Sci., Luaba Tshibanda, M.D., Adrian M. Owen, Ph.D., and Steven Laureys, M.D., Ph.D.
N Engl J Med 2010; 362:579-589
February 18, 2010
DOI: 10.1056/NEJMoa0905370

Results

Of the 54 patients enrolled in the study, 5 were able to willfully modulate their brain activity. In three of these patients, additional bedside testing revealed some sign of awareness, but in the other two patients, no voluntary behavior could be detected by means of clinical assessment. One patient was able to use our technique to answer yes or no to questions during functional MRI; however, it remained impossible to establish any form of communication at the bedside.

Conclusions

These results show that a small proportion of patients in a vegetative or minimally conscious state have brain activation reflecting some awareness and cognition. Careful clinical examination will result in reclassification of the state of consciousness in some of these patients. This technique may be useful in establishing basic communication with patients who appear to be unresponsive.

Yes, smokers are cheaper to care for in the long run:

http://www.nejm.org/doi/full/10.1056/NEJM199710093371506

There's more than one study which has shown this. Discouragement of smoking is based on politics rather than sound policy.

The NRA doesn't want to make it legal to shoot people.

Bullshit. The NRA is one of the most prominent backers of the Stand Your Ground laws:

http://www.prwatch.org/news/2012/07/11628/studies-show-more-people-shot-death-%E2%80%9Cstand-your-ground%E2%80%9D-laws

They sell insurance intended to protect you from any financial ramifications of shooting people, and make sure that you have the lawyers you need to protect you from legal ramifications:

http://www.indecisionforever.com/blog/2012/06/14/nra-sells-insurance-covering-legal-costs-of-shooting-people

The NRA routinely champions gun ownership as a means of self-defense, despite the well demonstrated fact that gun ownership makes you (and your family) less safe:

http://www.nejm.org/doi/full/10.1056/NEJM199310073291506

There are some real reasons to own guns, but the NRA is a bunch of howling vigilantes. They not only want to make it legal to shoot people, they want to make it easy.

SARS went from zero to 900 deaths very quickly.

In an eight month period 900 people died of SARS. In an average year during the same period 167,000 to 333, 000 die from the common seasonal flue.

900 deaths were the beginning tail of the curve. We didn't have an epidemic because of an aggressive international effort led by WHO to stop it, by isolating patients. That effort led to the deaths of many doctors and nurses, of whom Carlo Urbani was only the most prominent. It's impossible to prove that the outbreak would have spread with an exponential increase, but the judgment of the doctors who were managing it was that it was highly likely, and they believed it strongly enough that they were willing to risk and give their lives to stop it. There was a good chance of a worldwide outbreak of a viral disease with 10% mortality, and they stopped it.

This is an example of how using technical terms such as pandemic can blow things out of proportion. TB is not a new disease and neither is resistant TB. In the US the incidence of resistant TB is declining. In the last year reported there were 103 cases of resistant TB in the US. And no "outbreaks" of resistant TB.

The problem with Florida is that the Republican governor and legislature just closed down the very hospital they need to treat TB at a time when XDR is emerging as a real threat.

Prove this statement. How does closing down a 50 bed hospital have a major impact on an outbreak.

I don't know what burden of evidence you would demand to prove it, but WHO says that one part of the strategy is, "strengthening health care systems and primary care services". Florida's policies of cutting health care budgets and privatizing services are doing the opposite. The underlying problem is that health care in the U.S. is driven by politics, not rational policies, and while the Democrats are pretty bad, the Republicans are the worst offenders.

You also need to justify the statement that "XDR is emerging as a real threat" when the actual numbers say something completely different. Show me how it is an emerging threat in North America.

According to my reading of NEJM and Science, XDR is appearing in many parts of the world in which TB is treated inadequately, such as Russia, and when it appears, it often can't be treated at all, the TB progresses and the patient often dies.

As the NEJM says, the only way to deal with MDR and XDR strains is prevention.

I think you have very much oversimplified NEJM's position of XDR-TB. Here is an actual quote from a NEJM article;

All evidence suggests that XDR tuberculosis reflects a failure to implement the measures recommended in the WHO's Stop TB Strategy.5 This strategy emphasizes expanding high-quality DOTS programs, addressing HIV-associated tuberculosis and drug resistance, strengthening health care systems and primary care services, encouraging all providers to follow good practices, empowering patients and communities to improve health, and enabling and promoting research.

Prevention is only one part of the above strategy.

The relevant part is:

strengthening health care systems and primary care services

The Republican policies are weakening health care systems and primary care services, particularly among the TB-vulnerable populations.

Many of them have latent disease, which means they feel OK but are transmitting TB

Here is an example where your information is completely incorrect. Here is a quote from the CDC fact sheet'

Persons with latent TB infection are not infe

SARS went from zero to 900 deaths very quickly.

In an eight month period 900 people died of SARS. In an average year during the same period 167,000 to 333, 000 die from the common seasonal flue. This is an example of how using technical terms such as pandemic can blow things out of proportion. TB is not a new disease and neither is resistant TB. In the US the incidence of resistant TB is declining. In the last year reported there were 103 cases of resistant TB in the US. And no "outbreaks" of resistant TB.

The problem with Florida is that the Republican governor and legislature just closed down the very hospital they need to treat TB at a time when XDR is emerging as a real threat.

Prove this statement. How does closing down a 50 bed hospital have a major impact on an outbreak. You also need to justify the statement that "XDR is emerging as a real threat" when the actual numbers say something completely different. Show me how it is an emerging threat in North America.

As the NEJM says, the only way to deal with MDR and XDR strains is prevention.

I think you have very much oversimplified NEJM's position of XDR-TB. Here is an actual quote from a NEJM article;

All evidence suggests that XDR tuberculosis reflects a failure to implement the measures recommended in the WHO's Stop TB Strategy.5 This strategy emphasizes expanding high-quality DOTS programs, addressing HIV-associated tuberculosis and drug resistance, strengthening health care systems and primary care services, encouraging all providers to follow good practices, empowering patients and communities to improve health, and enabling and promoting research.

Prevention is only one part of the above strategy.

Many of them have latent disease, which means they feel OK but are transmitting TB

Here is an example where your information is completely incorrect. Here is a quote from the CDC fact sheet'

Persons with latent TB infection are not infectious and cannot spread TB infection to others.

Please get your fact straight.

Science magazine had even more pessimistic articles about XDR.

Care to cite any of these "science magazines"?

They sent a reporter to the former USSR, where they have no functioning health system

I believe there is a "functioning health care system" in North America so any comparison with the former USSR are invalid.

According to TFA, they're putting up TB patients in motels!

TB has a contagious stage and an non-contagious stage. The thing is that many people do not take their medication during the non-contagious stage and need to be watched. Putting up non-contagious patients who need to complete the second part of their treatment in hotels so proper medication can be ensured is not a bad thing. Many are homeless and all they need to have done is be fed and given medications at regular intervals. One does not need a hospital bed to do that. In cases of people with homes this would be done in their homes. I would much rather see a $50/day hotel used than a $3000/day hospital bed that could be used by an acute patient.

The numbers are not important. What's important is the emergence of multi-drug resistant (MDR) and extremely-drug resistant (XDR) strains. MDR strains are difficult to treat. Some doctors say that XDR strains can be treated with great difficulty and expense, but I've read of cases of XDR that doctors couldn't treat at all.

So fear mongering about a crisis that may never happen and is not happening now is more important that real facts and figures. This just plays into the hands of drug companies who w

The numbers are not important. What's important is the emergence of multi-drug resistant (MDR) and extremely-drug resistant (XDR) strains. MDR strains are difficult to treat. Some doctors say that XDR strains can be treated with great difficulty and expense, but I've read of cases of XDR that doctors couldn't treat at all.

Here's where I get my information from:

http://www.nejm.org/doi/full/10.1056/NEJMra0908076
Review Article
Current Concepts
MDR Tuberculosis — Critical Steps for Prevention and Control
Eva Nathanson, M.Sc., Paul Nunn, F.R.C.P., Mukund Uplekar, M.D., Katherine Floyd, Ph.D., Ernesto Jaramillo, M.D., Ph.D., Knut Lönnroth, M.D., Ph.D., Diana Weil, M.Sc., and Mario Raviglione, M.D.
N Engl J Med 2010; 363:1050-1058
September 9, 2010

Actually, we've had people flying in aircraft for years, and that caused major outbreaks of many infectious diseases. AIDS Patient Zero, don't forget, was an airline steward. SARS was spread by airline passengers. Like a lot of infectious diseases, SARS went from zero to 900 deaths very quickly. (The movie Contagion was pretty accurate, according to the reviews in the science magazines.) People are flying into the US every day from third world countries, and a lot of them have MDR and XDR TB. http://www.nejm.org/doi/full/10.1056/NEJMcp1005750

As the NEJM says, the only way to deal with MDR and XDR strains is prevention. It's difficult (sometimes impossible) and expensive to treat MDR and XDR. Patients don't like to take the drugs for good reason -- isoniazid and rifamycin have serious and sometimes dangerous side effects, particularly liver damage, which is dangerous for patients with HCV or alcoholism. Many of them have latent disease, which means they feel OK but are transmitting TB. They don't want to take a drug for 6 months that makes them sick.

Science magazine had even more pessimistic articles about XDR. They sent a reporter to the former USSR, where they have no functioning health system and herd TB patients, AIDS patients, and drug addicts into the world's largest prison system (the largest after ours). They had XDR patients they couldn't treat even when they had the drugs.

The problem with Florida is that the Republican governor and legislature just closed down the very hospital they need to treat TB at a time when XDR is emerging as a real threat. They're privatizing health care, like the Russians and Chinese did (with disastrous results, and their antibiotic-resistant infections are threatening us). According to TFA, they're putting up TB patients in motels!

And you can't just treat people for their TB, you have to provide comprehensive health care. Which the Republicans are also cutting back.

This country is spending more money to fight Hollywood-fantasy bioweapons attacks than we're spending to fight real, documented, extremely dangerous diseases. There was a new bioweapons "sniffer" that cost I think $100 million, and turned out to be useless because of its false alarms. Who needs Al Qaeda when you've got the Republicans?

The numbers are not important. What's important is the emergence of multi-drug resistant (MDR) and extremely-drug resistant (XDR) strains. MDR strains are difficult to treat. Some doctors say that XDR strains can be treated with great difficulty and expense, but I've read of cases of XDR that doctors couldn't treat at all.

Here's where I get my information from:

http://www.nejm.org/doi/full/10.1056/NEJMra0908076
Review Article
Current Concepts
MDR Tuberculosis — Critical Steps for Prevention and Control
Eva Nathanson, M.Sc., Paul Nunn, F.R.C.P., Mukund Uplekar, M.D., Katherine Floyd, Ph.D., Ernesto Jaramillo, M.D., Ph.D., Knut Lönnroth, M.D., Ph.D., Diana Weil, M.Sc., and Mario Raviglione, M.D.
N Engl J Med 2010; 363:1050-1058
September 9, 2010

Actually, we've had people flying in aircraft for years, and that caused major outbreaks of many infectious diseases. AIDS Patient Zero, don't forget, was an airline steward. SARS was spread by airline passengers. Like a lot of infectious diseases, SARS went from zero to 900 deaths very quickly. (The movie Contagion was pretty accurate, according to the reviews in the science magazines.) People are flying into the US every day from third world countries, and a lot of them have MDR and XDR TB. http://www.nejm.org/doi/full/10.1056/NEJMcp1005750

As the NEJM says, the only way to deal with MDR and XDR strains is prevention. It's difficult (sometimes impossible) and expensive to treat MDR and XDR. Patients don't like to take the drugs for good reason -- isoniazid and rifamycin have serious and sometimes dangerous side effects, particularly liver damage, which is dangerous for patients with HCV or alcoholism. Many of them have latent disease, which means they feel OK but are transmitting TB. They don't want to take a drug for 6 months that makes them sick.

Science magazine had even more pessimistic articles about XDR. They sent a reporter to the former USSR, where they have no functioning health system and herd TB patients, AIDS patients, and drug addicts into the world's largest prison system (the largest after ours). They had XDR patients they couldn't treat even when they had the drugs.

The problem with Florida is that the Republican governor and legislature just closed down the very hospital they need to treat TB at a time when XDR is emerging as a real threat. They're privatizing health care, like the Russians and Chinese did (with disastrous results, and their antibiotic-resistant infections are threatening us). According to TFA, they're putting up TB patients in motels!

And you can't just treat people for their TB, you have to provide comprehensive health care. Which the Republicans are also cutting back.

This country is spending more money to fight Hollywood-fantasy bioweapons attacks than we're spending to fight real, documented, extremely dangerous diseases. There was a new bioweapons "sniffer" that cost I think $100 million, and turned out to be useless because of its false alarms. Who needs Al Qaeda when you've got the Republicans?

Indeed, your genetic makeup is as important as lifestyle, maybe even moreso.

I wouldn't go overboard; genetics is important, but lifestyle is as important or even more so. The three most common causes of premature death in the United States: tobacco, sedentary lifestyle/poor diet, and alcohol.

I've been thin all my life except when I was on Paxil and gained 40 pounds. When I got off the Paxil it just came off, not only did I never diet, it was an effort to keep some of the weight I'd gained on.

A friend of mine was a construction worker, so he got plenty of excersize and was by no means overweight. Yet he died three years ago at age 42 from a sudden heart attack. Niether my lack of obesity or his heart attack were from lifestyle.

If your grandparents all died of heart disease before age 60, you're not likely to live to be 70 no matter how healthy your lifestyle.

Let me amend that; if all your grandparents all died of heart disease before age 60, you're likely to have coronary artery disease and will need to be treated, or you're not likely to live to be 70. Medical sciences, especially in cardiology, has advanced significantly since your grandparents' time. (And even in the last 10 years.)

http://www.nejm.org/doi/full/10.1056/NEJMp1113618 The Irrelevance of the Broccoli Argument against the Insurance Mandate Einer Elhauge, J.D. N Engl J Med 2012; 366:e1January 5, 2012

Others argue that the Constitution's framers could not possibly have envisioned a congressional power to force purchases. However, in 1790, the first Congress, which was packed with framers, required all ship owners to provide medical insurance for seamen; in 1798, Congress also required seamen to buy hospital insurance for themselves. In 1792, Congress enacted a law mandating that all able-bodied citizens obtain a firearm. This history negates any claim that forcing the purchase of insurance or other products is unprecedented or contrary to any possible intention of the framers.

Interesting. Did this include seamen who only sailed the ocean within their own state, or did it apply only to seamen who sailed the ocean between states and/or between the US and other countries?

Was requirement for the purchase of firearms a mandate to promote the firearms business or was it perhaps related to the national defense?

http://www.nejm.org/doi/full/10.1056/NEJMp1113618
The Irrelevance of the Broccoli Argument against the Insurance Mandate
Einer Elhauge, J.D.
N Engl J Med 2012; 366:e1January 5, 2012

Others argue that the Constitution's framers could not possibly have envisioned a congressional power to force purchases. However, in 1790, the first Congress, which was packed with framers, required all ship owners to provide medical insurance for seamen; in 1798, Congress also required seamen to buy hospital insurance for themselves. In 1792, Congress enacted a law mandating that all able-bodied citizens obtain a firearm. This history negates any claim that forcing the purchase of insurance or other products is unprecedented or contrary to any possible intention of the framers.

Girls are told from infancy that people such as themselves like pink, and that people such as themselves don't like math, and that females who do like math and computers, or who (horrors) take an interest in asserting their rights, are dreary unnatural creatures who don't get invited to parties. "Interest" in a subject isn't an innate immutable quality in a child. It reflects the child's training.

That's a testable hypothesis. There was a natural experiment in which, because of a birth defect, boys were surgically and medically converted to girls, and brought up as girls from infancy. It was a failure. They were brought up as girls in every possible way, by parents who were told by doctors that their children were girls, and parents who were committed to bringing them up as girls. But from birth, they expressed male preferences in toys and play (such as rougher play and favoring toy weapons). This was in contrast to their sisters, who were brought up the same environment by the same parent, but engaged in typical female behavior. As a result of this study, sex conversion surgery for boys with bladder exstrophy has been discredited and abandoned.

There's an environmental component and a genetic component. But the genetic component is clearly strong and sometimes overcomes the environmental component.

Read this article and tell me if you still think it's all environment.

http://www.nejm.org/doi/full/10.1056/NEJMoa022236 [free]

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; 350:333-341January 22, 2004

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. ...

The parents of all 14 subjects assigned to female sex stated that they had reared their child as a female. Twelve of these subjects have sisters: parents described equivalent child-rearing approaches and attitudes toward the subjects and their sisters. However, parents described a moderate-to-pronounced unfolding of male-typical behaviors and attitudes over time in these subjects — but not in their sisters. Parents reported that the subjects typically resisted attempts to encourage play with female-typical toys or with female playmates or to behave as parents thought typical girls might be

Health effects are not a red herring at all. There have been cases of GMO food causing allergy problems. For instance, here is an article from the New England Journal of Medicine showing the effects of transgenic soybeans created by Pioneer Hi-Bred which contain a gene from the brazil nut. You don't even need to read the article; just look at the image of the allergic reaction caused by skin-prick testing of extracts from the GMO bean on a person who is allergic to brazil nuts.

And hell, some of Monsanto's corn is registered and patented as a pesticide! There was a recent article here which puts the blame for colony collapse disorder squarely on the use of HFCS from Monsanto corn to feed bees--the trace amounts of pesticide in the corn syrup are enough to make the bees get lost while foraging. This particular pesticide appears harmless to humans; it's been used since the '30s, but it is an illustration of how unintended consequences come into play.

What GMO essentially means is that you have no idea what kinds of genes are in your food, and you will continue to have no idea unless you have an allergic reaction. That's not great, but there could also be long-term effects that will remain unknown for years or decades--a little bit like the radiation craze before we realized it promotes cancer. And there could also be secondary effects: round-up ready crops are meant to be sprayed, and they're going to get hit with a lot more herbicides than non-GMO crops. The use of these crops has been widespread for under a decade. I think it makes sense to remain cautious on the health front as well.

The monoculture is almost certainly the larger issue, and my intention is not to detract from it. I have heard that something like 97% of the varieties of food we grew in the 19th century are now extinct. There are less than 10 kinds of potatoes widely grown, down from 500, and these kinds of numbers are seen across the board. That's not a good idea.

The fat, carbohydrate, and cholesterol theories of atherosclerosis are all BULLSHIT. Atherosclerosis is caused by chronic INFLAMMATION of the arteries.

Just a few years ago, a Canadian study using baseball stats (because they tracked handiness closely) concluded that lefties were far more likely to die, ( http://www.nejm.org/doi/full/10.1056/NEJM199110033251412) this was later shown to have suffered a seemingly paradoxical sampling error (not controlling adequately for those that didn't die). Then there was another study that concluded that left-handedness was likely the result of anoxia in the womb ( http://www.sciencedirect.com/science/article/pii/002839327390050X). It was discounted for similar sampling error problems. Neurological "wiring error"; perhaps a mutation with few consequences; advantages in the mathematical world (presumably via having a screwy mindset); Language disadvantages; Language *advantages*; high proportion of left-handed (possibly suppressed) American presidents http://www.anythingleft-handed.co.uk/presidents.html (Clinton, Bush, Obama ... ). So... run a elaborate predator/prey model applied to sports and see an advantage for the 10% that are different; sounds like rediscovery of Perato distribution to me, http://en.wikipedia.org/wiki/Pareto_distribution I'm just not convinced that there's been a proper scientific approach to this issue to date, and until then i'm still stuck with a twisted spine in most college classrooms.

While flu vaccines with adjuvants have been used in Europe over the last few years, I am not aware of any vaccines with adjuvants licensed or used in the United States in several decades (including intramuscular and nasal vaccines). See N Engl J Med. 2010;363(21):2036, http://www.nejm.org/doi/full/10.1056/NEJMra1002842. This is regrettable, as increased complication rates appeared to be minimal or none (on the order of increased redness at the injection site for some patients), and vaccines with adjuvants seem to be a lot more effective. The reason vaccines with adjuvants aren't available in the US is because of concerns of safety, not all of which are well-informed.

Why pay all the premiums when you can just sign up when you're diagnosed and get everything paid for.

That's no different than the current situation when people wait until they need emergency treatment, then don't pay for it. SOMEONE still pays for it.

Of course, the premiums would have to rise to the point that it doesn't make sense to bother buying insurance even then. Then, NO ONE will have insurance, so we'll have to do something, and single payer is something, so we'll have to do that.

Single payer isn't the only way to address the cost of health care, and it has a lot of problems too. A lot of people just don't want the government to have that kind of power. Imagine if instead of giving everybody Social Security checks, the government never sent you money but let you select products and services from a catalog that they controlled. That would be insane, and that's what single payer health care does -- even less because you'll have to demonstrate need for the product or service.

Why is single payer better than, say, a voucher? That would make it exactly like SS.

Then the next step is controlling the cost of health care. Guess what, spreading around the burden with this individual mandate, or by having single payer with universal coverage, does not automatically lower costs. In fact either approach would probably cause health care costs to skyrocket since there's more money in the system, and absolutely nothing being done to control costs. (Or do you really think the Democrats will start rationing health care for women, minorities, the poor, the elderly, children, etc in order to save money? Hah!)

But the thing is, everything that will realistically control costs (not rationing since that will not happen) can be done *without* universal coverage. Number one thing: increase the supply of doctors. Does that need universal coverage? No. Allow imports of drugs. Does that require universal coverage? No. Tort reform (though I don't support that): No universal coverage needed.

Name one thing that requires universal coverage to noticeably lower total cost of health care. And don't bother naming universal preventive care before citing conclusive evidence that it does in fact noticeably lower cost, because the New England Journal of Medicine says "Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not."

By not making the individual mandate severable, they seem to have unnecessarily risked the possibility that the entire law will be stricken, resulting in an opportunity for sanity to prevail.

That doesn't make sense. The people who failed to make it severable are the same people who want single-payer care, so if that's really the grand plan why are you calling it an unnecessary risk?

Researchers have determined that the risk zone for driver airbags is the first 2 to 3 inches (5 to 8 cm) of inflation. So, placing yourself 10 inches (25 cm) from your driver airbag gives you a clear margin of safety. Measure this distance from the center of the steering wheel to your breastbone.

Or, http://www.nejm.org/doi/full/10.1056/NEJM199807093390219:

A limitation of our study is that the new regulation defines the safe distance as 10 in. (25 cm) from the breastbone to the steering wheel.

or, http://www.wikihow.com/Adjust-Seating-to-the-Proper-Position-While-Driving

Distance from the wheel: There should be a minimal clearance of 10" (and preferably 30cm) between the center of the steering hub and the base of the breastbone (sternum). It should also not be further away that 45cm.

For me and my height, that results in *almost* (but not completely) straight arms in addition to being able to control the pedals properly - not too straight or bent - either is problematic in an accident. Other pages document an ideal arm bend of 120 degrees.

It remains to be shown how realistically close to human this mouse model can possibly be.

One remembers that a few years ago http://www.nejm.org/doi/full/10.1056/NEJMp068082 (New England Journal of Medicine), a candidate antibody-type medicament from TeGenero produced severe toxicity in the first (and only) volunteers who received it, though previous animal trials had seemed to give a green light to take it forward to humans. Although the initial test animals there were not altered as in the way now proposed, clearly limits exist for the degree of alteration that can be achieved.

-wb-

Here's what's going on in alternative medicine in Australia. Unfortunately this article is behind a paywall, so I'll give you an excerpt. (It helps to understand that when you give a lung x-ray, you have a good chance of finding spots that nobody can really interpret, that usually turn out to be harmless.)

http://www.nejm.org/doi/full/10.1056/NEJMp1110812
What's the Alternative? The Worldwide Web of Integrative Medicine
Ranjana Srivastava, F.R.A.C.P.
Department of Medical Oncology, Monash Medical Centre, Melbourne, VIC, Australia.
N Engl J Med 2012; 366:783-785 March 1, 2012

Out of curiosity, an impressionable woman in her 30s attends an integrative medicine exhibition; having recently had a child, she's been sleep-deprived and wants to investigate natural remedies. At the seminar, she wins a door prize — a blood test that promises to diagnose cancer. She was considering getting a blood test anyway and seizes this opportunity for a more comprehensive workup. After all, you can't be too careful about avoiding cancer.

Weeks later, she receives a call from an apologetic but alarmed stranger telling her she has advanced cancer.

“How do you know?” she gasps.

“Your blood test is positive for circulating tumor cells.”

“What does that mean?” she cries.

He sends her a three-page report and tells her to seek immediate help. She spends a nail-biting week awaiting an appointment with the recommended integrative health expert.

Glancing at the report, the expert declares, “You have advanced non–small-cell lung cancer. You need treatment now.” The woman is petrified: Has her teenage smoking habit come back to haunt her?

“Are you sure?” she asks.

“Absolutely. There are circulating tumor cells in your blood.”

Tears streaming down her face, the woman asks, “What now?”

The practitioner prescribes a 12-week course of intravenous vitamin C, at a cost of $6,000, paid up front. Without further discussion, an appointment is made.

[Gets a CT scan, which shows 2 2mm nodules. They could be lung cancer.]

The hunt for a rapid cure brings the woman to my office. Relating her story, she shifts between self-assurance and sheepishness. “I know you find this incredible, but I need your help. I am dying of cancer.”

“There's no evidence of cancer,” I reply, seeking to reassure her.

Instead, her tone sharpens: “But I have circulating tumor cells! How can you say that?”

Incredulous, I try to explain too many things. The blood test is a long way from being validated for clinical use. It was unscrupulous even to offer it. Does it make sense to her that it was sent to an unheard-of overseas laboratory for processing? Why did no one recommend that she see an oncologist?

[Demands a PET scan. PET scan clear, the 2 nodules on the CT have disappeared. Probably transient foci of inflammation. Srivastava tells her, "There is no cancer." Woman still insists she has lung cancer. Demands to see a surgeon. Surgeon refuses to see her.]

Yes, you are correct, Canadian health care costs half as much as U.S. health care, and the outcomes of the Canadian system are at least as good -- possibly better. This has been demonstrated repeatedly in scientifically rigorous comparisons in peer-reviewed journals.

http://www.openmedicine.ca/article/view/8/1

A systematic review of studies comparing health outcomes in Canada and the United States

Gordon H Guyatt, PJ Devereaux, Joel Lexchin, et al.

Background: Differences in medical care in the United States compared with Canada, including greater reliance on private funding and for-profit delivery, as well as markedly higher expenditures, may result in different health outcomes.

Objectives: To systematically review studies comparing health outcomes in the United States and Canada among patients treated for similar underlying medical conditions.

Methods: We identified studies comparing health outcomes of patients in Canada and the United States by searching multiple bibliographic databases and resources. We masked study results before determining study eligibility. We abstracted study characteristics, including methodological quality and generalizability.

Results: We identified 38 studies comparing populations of patients in Canada and the United States. Studies addressed diverse problems, including cancer, coronary artery disease, chronic medical illnesses and surgical procedures. Of 10 studies that included extensive statistical adjustment and enrolled broad populations, 5 favoured Canada, 2 favoured the United States, and 3 showed equivalent or mixed results. Of 28 studies that failed one of these criteria, 9 favoured Canada, 3 favoured the United States, and 16 showed equivalent or mixed results. Overall, results for mortality favoured Canada (relative risk 0.95, 95% confidence interval 0.92-0.98, p= 0.002) but were very heterogeneous, and we failed to find convincing explanations for this heterogeneity. The only condition in which results consistently favoured one country was end-stage renal disease, in which Canadian patients fared better.

Interpretation: Available studies suggest that health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent. ....

The United States also spends far more on health care, i.e., approximately 15% of its gross domestic product versus about 10% in Canada. In 2003, Americans spent an estimated US$5,635 per capita on health care, while Canadians spent US$3,003.

http://www.nejm.org/doi/full/10.1056/NEJMsa022033

Costs of Health Care Administration in the United States and Canada

Steffie Woolhandler, M.D., M.P.H., Terry Campbell, M.H.A., and David U. Himmelstein, M.D.

N Engl J Med 2003; 349:768-775 August 21, 2003

Results

In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers' administrative costs were far lower in Canada.

If I were a doctor, I couldn't imagine making a blanket statement that everyone would want the same thing.

This was discussed in the latest New England Journal of Medicine.

http://www.nejm.org/doi/full/10.1056/NEJMp1109283

For some decisions, there is one clearly superior path, and patient preferences play little or no role — a fractured hip needs repair, acute appendicitis necessitates surgery, and bacterial meningitis requires antibiotics. For most medical decisions, however, more than one reasonable path forward exists (including the option of doing nothing, when appropriate), and different paths entail different combinations of possible therapeutic effects and side effects. Decisions about therapy for early-stage breast cancer or prostate cancer, lipid-lowering medication for the primary prevention of coronary heart disease, and genetic and cancer screening tests are good examples. In such cases, patient involvement in decision making adds substantial value.

> FWIW, I'd say yes, you appear to be confused.

Unfortunately, you can't (freely) administer one of the standard medical tests for that (or even the newest competing test) --- all because of the influence of copyright law. Perhaps, yes, this is the age of where the Pirate Parties' platforms progressively produce politically pleasing positions.

If you're interested in reading more about the topic:
http://www.nejm.org/doi/full/10.1056/NEJM199306173282418

How's the New England Journal of Medicine for you? http://www.nejm.org/doi/full/10.1056/NEJMp078187

Reference 4 is a review article that covers the (imaginary) link between autism and thiomersal.

The thiomersol-autism thing was entirely manufactured by a (former) physician in the UK who it was found violated ethical guidelines, falsified his results and had a vested interest in the outcome (he was involved with a company offering a vaccine alternative). The scientific evidence is clear - if you don't get your kids vaccinated you are needlessly endangering them. Along with everyone else.

As for your tobacco reference, scientific studies did NOT find that tobacco was safe. Tobacco companies insisted it was, for years, but they did not have scientific evidence backing them up. In fact, the reason they had to defend themselves was because scientific studies were showing that tobacco is in fact dangerous.

But hey, if you want to protect your kids from toxic elements you'd better check into the chlorine thing. We're CONSTANTLY ingesting chlorine! (Note: if you cut chlorine out of your kids' diet they'll die. Fairly quickly)

Except the Constitution explicitly gives congress the power to collect taxes.

The funny thing is that the "individual mandate" is actually structured as an income tax ($695/year or 2.5% of income, whichever is greater) -- having health insurance merely exempts you from the tax. There are no special criminal penalties for not having insurance. See this article for more details.

It is not at all clear that it has the power to "mandate that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die".

Well, if you're a minor, you'll be covered by Medicaid. If you're a senior, you'll be covered by Medicare. So it's more accurate to say the government is "giving a tax exemption to people between the ages of 18 and 65, if they buy an expensive product from private insurance companies." Which is pretty definitely in their power.

Constitutional arguments against the mandate tend to be based on an incomplete understanding of the law. Which, given media coverage, is not surprising.

Doesn't every politician especially from the GOP say that the American Healthcare system and its actual care are the "best" in the world?

By the way, this is despite the fact that various metrics indicate the USA is no where near the top!

There are lots of reasons for Medical Tourism. Canadians come to the US to jump the waiting lists. Americans go to India due to cost reasons. British people go to France due to insufficient capacity. This is to be expected due to the law of comparative advantage. No one locality has an absolute advantage over every other locality, and we would never expect it to.

The US does, due to our sheer size, have a pretty big advantage over many other parts of the world. For instance, my wife is currently suffering from an extremely rare cancer. There are very few hospitals in the world who have any serious expertise in treating it, and most of them are in the US: Chicago, Boston, Chapel Hill, NC, and London. None of those are local to us, so I guess you could say that she is a medical tourist. She is being treated at the hospitals at UNC and Northwestern (Chicago).

People in the comments are saying that Cuba has the best health care system in the world. Maybe in terms of infant mortality, but my kids are plenty alive, while my wife is at serious risk of death, so Cuba doesn't offer us much. A quick search through the literature does not turn up a single instance of the Cubans curing a female patient with her cancer having reached stage IV.

So if we were Cuban, she would likely be quite dead right now. She may yet not celebrate her next birthday, but at least her odds are up to 50/50 now. She arrived at the hospital with about 48 hours to live, so I'd say this is a pretty big improvement. There is no other country in the world that we'd rather have her treated in. If there was, she'd be there right now, believe me.

Here is FDA approved possible death in a bottle.

What do you think, no FDA approved drugs have death as a side effect?

Oh really?

Nonsense, is it?

Nonsense?

Nonsense?

What about clear violation of their very policies on SAFETY? Nonsense?

But if you worked in "health insurance industry", you'd never want FDA to stop doing what they do, after all, any government involvement is beneficial for large corporations, who gain monopoly/oligopoly power by restricting access of small competitors, by forcing any innovator to seek sponsorship of large pharma company, by having government money in insurance, which is the reason that insurance premiums are as high as they are and climbing, having insurance attached to people's jobs, which is the reason there is a problem of "preexisting-conditions" in the first place, because once you change your job and if you have a "condition", it's that much harder to get coverage again.

In a free market an American would have been able to buy health insurance privately from any provider from ANYWHERE in the world.

Why can't an American buy health insurance from Singapore?

Doesn't every politician especially from the GOP say that the American Healthcare system and its actual care are the "best" in the world?

By the way, this is despite the fact that various metrics indicate the USA is no where near the top!

If I remember correctly, Discovery magazine has an article many years ago discussing the fact that scientists had traced human ancestry back umpteen thousands of years to a single female (who's name is withheld to protect her privacy) using mitochondrial DNA, which apparently does not join with the father's, but remains intact from generation to generation.

I'll leave up to someone without a job to look it up.

We all inherit the mitochondria from our mothers' egg as the sperm mitochondria don't get carried inside. Er, scratch that. On reading the wikipedia page, it tells me the male mitochondria are actually targeted for deletion by ubiquitin tagging.

Apparently, there was one recorded incidence of 'Paternal Inheritance of Mitochondrial DNA' (Paper here). Oh, and do have a job, but I'm on holiday...

For a 5 year old story, it is interesting to notice the treatment and at least some of the techniques developed date to 2009. But that requires RTFS which the TFA provided.

The use of the term HIV is more for the mass public than for anything.
I spoke to my step-father about this and even though he is in the field, he did not know of this treatment.
after the news release yesterday, a white paper/research paper was released with more information on it. I can not show it, because of copyright.
http://www.nejm.org/doi/full/10.1056/NEJMoa1103849?query=TOC is another article.
My step-father states that the form of HIV was used because of its RNA, but it was not the vector for the attack on the cancer cells.

From my step-father "the virus that was used was a lentivirus which is a group of viruses that have RNA as their genetic material.".
So the use of HIV is more of a buzz word for standard people.

Actually, if you read the article, it's pretty clear that while this particular experiment was leukemia based the theory should work on nearly any cancer. Basically, they used a modified HIV virus as a carrier to modify the DNA of some of the patients white blood cells (outside of the body). The modified cells are made to specifically target the cancer in question (and replicate, a lot). If trials continue to be successful, there is no reason to think that the "signature" of any cancer couldn't be substituted for the leukemia.

Incorrect. It may work on a significant fraction of some cancers (especially leukemias, cancers of the blood) but it is unlikely to be a generic cure of most or all cancers. (TL;DR of the link which is annoying technical - it's a cool new twist on a general class of cancer fighting strategies that up until now have had limited success. It may well prove to be useful, but it is in the very, very early stages of research and there are some reasons why this general class of treatment would be expected not to work on many different cancers.)

And kudos to MSNBC for actually providing a link to the original literature.

Conspiracy?

The list price for the drug, Makena, turned out to be a stunning $1,500 per dose. Thatâ(TM)s for a drug that must be injected every week for about 20 weeks, meaning it will cost about $30,000 per at-risk pregnancy. If every eligible American woman were to get Makena, the nationâ(TM)s bloated annual health-care tab would swell by more than $4 billion.

What really infuriates patients and doctors is that the same compound has been available for years at a fraction of the cost â" about $10 or $20 a shot.

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Here come the unintended consequences. While the FDA says it hoped there wouldnâ(TM)t be a significant run-up in the price of colchicine â" sold as Colcrys by URL â" the retail cost has soared to more than $5 a bill from the previous pennies a tablet. URL Pharma also sued five makers of manufacturers of colchicine, saying they have been illegally marketing their colchicine products since Colcrysâ(TM)s approval. One of those makers has settled the matter and stopped production. The other four companies are fighting the lawsuit.

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Three years ago, the Food and Drug Administration (FDA) approved the drug Ketek (telithromycin), lauding it as the first of a new class of antimicrobial agents that circumvent antibiotic resistance. Since then, Ketek has been linked to dozens of cases of severe liver injury, been the subject of a series of increasingly urgent safety warnings, and sparked two Congressional investigations of the FDA's acceptance of fraudulent safety data and inappropriate trial methods when it reviewed the drug for approval. ...

Despite these discoveries, FDA managers presented study 3014 to the advisory committee in January 2003 without mentioning the issues of data integrity.1 The managers have stated that they were legally barred from disclosing the problems to the committee because there was an open criminal investigation, but they have not explained why the data were presented at all, in view of the evidence of the study's lack of integrity. Unaware of the integrity problems, the committee voted 11 to 1 to recommend approval of Ketek.

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etc.etc.

You can't dismiss facts, but you sure can call them conspiracies if you wish.