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The Collective Dynamics of Smoking in a Large Social Network http://content.nejm.org/cgi/content/full/358/21/2249

The Spread of Obesity in a Large Social Network over 32 Years http://content.nejm.org/cgi/content/full/357/4/370

However, in these studies, all the subjects had joined the study and given permission in writing for the researchers to use their personal data.

It would clear a lot of things up if we could see the documents that the UMD professor submitted to the university's human subjects review board, and the documents they sent him in reply.

The Collective Dynamics of Smoking in a Large Social Network http://content.nejm.org/cgi/content/full/358/21/2249

The Spread of Obesity in a Large Social Network over 32 Years http://content.nejm.org/cgi/content/full/357/4/370

However, in these studies, all the subjects had joined the study and given permission in writing for the researchers to use their personal data.

It would clear a lot of things up if we could see the documents that the UMD professor submitted to the university's human subjects review board, and the documents they sent him in reply.

Also a good editorial: http://content.nejm.org/cgi/content/full/361/5/522

The big problem is that they finally got a good, cheap, effective, safe drug, artemisin, against the Plasmodium falciparum parasite, but it's becoming resistant.

The reason it's becoming resistant is that people in Pailin, Cambodia were using artemisin alone. If they use it alone, the P. falciparum can develop resistance to it. They're supposed to use it with another drug, like mefloquine, to kill off the parasite with shock and awe, but in some parts of the world they just use artemisin. From Cambodia, it's spreading to the rest of the world. http://content.nejm.org/cgi/content/full/361/5/455 And it's all Pailin's fault.

They can zap mosquitoes with radiation and get parasites that don't reproduce and can be used as vaccines, but you had to get bitten by a lot of them to develop immunity that way.

They also have a subunit vaccine in phase III trials, but it's only 65% effective.

That was a pretty cool study design btw -- using chloroquine to arrest the development of P. falciparum while you develop immunity. (Immunity to to P. falciparum takes a while to develop.)

Interesting thing they pointed out in an article that isn't free is that people in the malaria zone give their children aspirin to reduce the fever (most malaria deaths are children). But aspirin is an anti-platelet agent, and platelets stick to red blood cells to kill off the ones that are infected with the parasite. When the aspirin lowers the platelet activity, the parasite is more likely to survive inside the red blood cell.

Also a good editorial: http://content.nejm.org/cgi/content/full/361/5/522

The big problem is that they finally got a good, cheap, effective, safe drug, artemisin, against the Plasmodium falciparum parasite, but it's becoming resistant.

The reason it's becoming resistant is that people in Pailin, Cambodia were using artemisin alone. If they use it alone, the P. falciparum can develop resistance to it. They're supposed to use it with another drug, like mefloquine, to kill off the parasite with shock and awe, but in some parts of the world they just use artemisin. From Cambodia, it's spreading to the rest of the world. http://content.nejm.org/cgi/content/full/361/5/455 And it's all Pailin's fault.

They can zap mosquitoes with radiation and get parasites that don't reproduce and can be used as vaccines, but you had to get bitten by a lot of them to develop immunity that way.

They also have a subunit vaccine in phase III trials, but it's only 65% effective.

That was a pretty cool study design btw -- using chloroquine to arrest the development of P. falciparum while you develop immunity. (Immunity to to P. falciparum takes a while to develop.)

Interesting thing they pointed out in an article that isn't free is that people in the malaria zone give their children aspirin to reduce the fever (most malaria deaths are children). But aspirin is an anti-platelet agent, and platelets stick to red blood cells to kill off the ones that are infected with the parasite. When the aspirin lowers the platelet activity, the parasite is more likely to survive inside the red blood cell.

Also a good editorial: http://content.nejm.org/cgi/content/full/361/5/522

The big problem is that they finally got a good, cheap, effective, safe drug, artemisin, against the Plasmodium falciparum parasite, but it's becoming resistant.

The reason it's becoming resistant is that people in Pailin, Cambodia were using artemisin alone. If they use it alone, the P. falciparum can develop resistance to it. They're supposed to use it with another drug, like mefloquine, to kill off the parasite with shock and awe, but in some parts of the world they just use artemisin. From Cambodia, it's spreading to the rest of the world. http://content.nejm.org/cgi/content/full/361/5/455 And it's all Pailin's fault.

They can zap mosquitoes with radiation and get parasites that don't reproduce and can be used as vaccines, but you had to get bitten by a lot of them to develop immunity that way.

They also have a subunit vaccine in phase III trials, but it's only 65% effective.

That was a pretty cool study design btw -- using chloroquine to arrest the development of P. falciparum while you develop immunity. (Immunity to to P. falciparum takes a while to develop.)

Interesting thing they pointed out in an article that isn't free is that people in the malaria zone give their children aspirin to reduce the fever (most malaria deaths are children). But aspirin is an anti-platelet agent, and platelets stick to red blood cells to kill off the ones that are infected with the parasite. When the aspirin lowers the platelet activity, the parasite is more likely to survive inside the red blood cell.

The effect was observed 4 weeks after the subjects ceased taking chloroquine.

So good work freaking out about how evil these researchers are. The paper is here:

http://content.nejm.org/cgi/content/full/361/5/468

Linked earlier here:

http://science.slashdot.org/comments.pl?sid=1321071&cid=28890691

There's a reason why we live so much longer now a days compared to middle ages and before and hell, even to beginning of 1900.

Actually, life expectancy for those who make it past childhood hasn't increased much at all. It's a reduction in infant and child mortality that's paid off.

If lifestyle-related obesity, heart disease, and cancers continue to increase, it's quite possible that we will see a decline in life expectancy, even as technology improves.

That is technological improvement, so there's no really any reason why technologically made or improved food would be more riskier.

There's no a priori reason it would be any less riskier.

Technology is not some magical thing that can only do good. "Improvements" in technology often end up doing harm to some people even as they benefit others.

All subjects provided written informed consent. The trial was approved by the institutional review board at the Radboud University Nijmegen Medical Centre. The study sponsor, the Dioraphte Foundation, was not involved in the design of the study, in the gathering or analysis of the data, or in the writing of the manuscript.

Damn. Informed consent to malaria infection.

What exactly is a partial liver transplant? Did you only replace a part of the liver?

http://content.nejm.org/cgi/content/short/356/15/1545

Not quite. In addition to several STDs, neonatal circumcision significantly lowers the (already low) risk of penile cancer and (the somewhat more common) balanitis. Then there are many recent studies indicating that it's protective against HIV, Chancroid and Syphilis, Herpes, and HPV (although I should point out that the previous two studies overlap and arrive at somewhat different conclusions, as the protective effect against Herpes was only borderline significant in the first).

And not only does it protect the male, but it reduces the risk of male-to-female transmission too.

Granted, there are other studies that arrive at opposite conclusions, though I haven't seen any on HIV in particular in quite some time. But it would be grossly inaccurate to claim that this link has been "long since disproven". At best, the jury is still out.

I'm a Canadian, and while our government has loads of problems, they are of the "the free market doesn't always work perfectly" kind, not the "everything the government touches turns to shit" kind.

Is the freemarket the reason Canadians have the come to the US for surgeries? Yea, in the US if you can pay you can have the surgery without waiting a long tyme whereas if you depend on National Health Care in Canada you do wait. A Liberal MP, Belinda Stronach went to California for surgery for her breast cancer, not because of the cost or waiting period but because "the U.S. hospital was the best place to have it done due to the type of surgery required."

And it's not just those who can afford it in the US who get good care, those who can't afford it can get good care too. I am an excellent example. As a college student without health insurance I was riding my bike one day after classes when I was hit by a moving van. At the accident scene I was picked up by a helicopter and flown to the best hospital for my type of injury in the area. I spent about a month in the hospital then lived in a rehabilitation house where I lived another 1 1/2 months. After leaving there I was in therapy about 3 months. My medical bills, which because I did not have insurance I could not afford, came to more than $120,000. I couldn't even afford to pay $1,200 never mind that much but I still got medical treatment.

Falcon

When you adjust for inflation, during Bush's second term the NIH budget shrank. It actually got smaller. You can find the change rates as published in the New England Journal of Medicine http://content.nejm.org/cgi/content/full/354/16/1665/F1 [nejm.org]

The same chart shows that Bush raised the NIH budget by almost 15% for each of his first four years. This is after adjusting for inflation. In fact, we can find some more direct evidence:

The ASM has endorsed a $2.7 billion increase for the NIH in FY 2001, a 15 percent increase in funding which would bring the NIH budget to a level of $20.6 billion.

http://www.sciencemag.org/cgi/content/summary/291/5509/1677b?ck=nck

"President George W. Bush said last week that he will request a record $2.8 billion increase for the National Institutes of Health in his 2002 budget proposal. But some biomedical science groups say that the figure--a 13.8% boost, to $23.1 billion--is only a starting point for their campaign to win a $3.4 billion boost."

And, finally:

http://officeofbudget.od.nih.gov/ui/2008/Summary%20of%20FY%202009%20Budget-Press%20Release.pdf

"The FY 2009 Discretionary Budget Authority request for the NIH is $29,230 million"

So, over the course of his entire term, Bush boosted funding for NIH from 20 billion to 30 billion. The bulk of the increases came during his first term. Note that despite having spent 200 billion dollars over the last 8 years, there have no cures for cancer, the flu, or the cold. So, not only did this olive branch of increased federal spending completely fail the Republicans politically, if we go by the left's yardstick of missile defense, the scientists doing all this research actually accomplished nothing.

It beats bacterium gruel 24/7. Of course, you'd still need to do something about the less than radiation resistant astronauts. I suppose it would be much easier to shield a small habitation pod, than to shield a greenhouse, so that would probably be doable.

It would be interesting, though, to know how difficult it would be to produce human populations with various useful astronaut properties. Unfortunately, most of what you would want to do would involve running right over the medical ethics cliff and into some dubious stuff. You'd pretty much want a bunch of dwarves(transporting mass out of a gravity well is very expensive) with slow metabolisms(ditto) and high radiation tolerance and possibly some sort of Myostatin related mutation that would allow them to preserve muscle mass in low gravity. I can't think of any sort of genetic engineering or selective breeding that would achieve that end, without getting into rather dubious ground.

I'm looking hard for how you can calculate a doubling from any perspective. When you adjust for inflation, during Bush's second term the NIH budget shrank. It actually got smaller. You can find the change rates as published in the New England Journal of Medicine http://content.nejm.org/cgi/content/full/354/16/1665/F1

During Bush's two terms, the funding rates for the NIH went from about 12% to less than 9%. That's a fairly sizable drop in effective funding.

Prolonged exposure (living or going to school) at 200 meters raised the chance of getting leukemia by 70%. 200 meters to 500 meters raised it by 20%. [...] And for those asking for citations, search Google for "power lines leukemia" .

I did. Half of the results I got were of the "study finds no link between power lines, leukemia" type. The rest seemed to be written by internet nuts with no clue what they were talking about. Assuming then you meant to search without the quotes, I repeated the search. This time I found more that substantiate what you said, but realising that half of them didn't know what they were talking about I repeated it on google scholar (as should anyone interested in what actual scientific research on a subject says).

Results: "no relationship was found between leukemia and electric power line configurations", "Residence near high-voltage lines did not increase risk", [test subjects who lived] within 300 metres [of a power line showed a] relative risk [with] 95% confidence interval [of one kind of leukemia of] 0.8-3.5 [, or for another] 0.7-3.8 [, or if exposure was prolonged] 1.0-4.6 [or] 0.9-4.7" (i.e., for those who don't understand how to interpret that last one, no statistically significant effects -- note that this is the study that's usually cited _in favour_ of arguments about power lines causing leukemia). "the risk was not significantly associated with either residential magnetic-field levels ", "The study provides [...] no support for an association between leukemia and [magnetic field exposure]", "the results suggest that typical magnetic fields of high-voltage power lines are not an important cause of leukemia in adults", "These results provide little support for a relation between power-frequency EMF exposure and risk of childhood leukemia", "For residential exposure >= 0.2 uT, the relative risk for leukemia was estimated at .. 95% confidence interval 0.8-2.2" (i.e. not statistically significant). That's the first page of results finished with; I don't see any evidence fdor your assertion of a 70% increase in risk, and I would be cautious at claiming even that there's a link. Google scholar selects widely cited papers first, and papers with the most provocative results are likely to be the most widely cited. Given the number of studies that have been conducted on this subject, we'd expect at least some to come up with postive results based on random variation. That none of the ones I've looked at have even had statistically significant results suggests there's nothing to this, and it really is just random variation we're seeing.

... and here we have just a single anecdote about how the system did not work in one instance. If we are playing the anecdote game, I'm sure I can find a similar example where non-computerized health records lead to bad care. Of course, while the anecdote game is very effective at playing at human emotional response (we tend to assign more weight to a story that we can associate with a single person versus aggregate statistics), it's useless as an actual policy question.

Since every complicated system has failures, even the critical ones like hospitals and air traffic control, the important policy question is not whether it works in all instances, it's whether it produces overall better care than the system it's replacing and whether that improvement is worth the difference in price. If the new system actually reduces costs, then it's a good idea so long as it doesn't degrade care (since, ultimately, reduced cost means either more health care or more dollars to satisfy other wants).

I'm not going to comment on the data myself, since you should read the studies for yourself and draw your own conclusions.

http://journals.cambridge.org/action/displayAbstract;jsessionid=7C274D08947B0625B3B540BEF2E70367.tomcat1?fromPage=online&aid=416400
http://content.nejm.org/cgi/content/abstract/348/22/2218
(PDF)
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1421388

PS. Of course there's no panacea for our medical problem. The question is whether EHR are better than the system we've got, not whether they represent the best possible system. The perfect is not the enemy of the good.

PPS. I have a sneaking suspicion, reading my post (yeah, some /.ers actually read their own posts before hitting submit :-P) that I will be accused of not having the proper sympathy for the guy in TFA. That's not true. I have sympathy for him as an individual, but I'm not going to let that sympathy for him cloud my judgment on the merits of a system.

For example, suppose there was a highway by you that had no center divider, just a grassy median. Suppose also, for the sake of argument, that installing a jersey barrier (http://en.wikipedia.org/wiki/Jersey_barrier will lower the injury/fatality rate in accidents by a statistically significant amount by preventing out-of-control cars from going into oncoming traffic. Now, hypothetically, someone could be in an accident where the jersey barrier caused him serious injury or death (say, by flipping his car even though they are designed to minimize that chance) where the old system would have been just fine (say, because there was no oncoming traffic at the time of the accident). Does someone that still says we have jersey barriers not have sympathy for that guy? No. His death is regrettable but because we can't make a perfect road, we have to settle for the best road we can make.

The problem is that you can point to someone that's injured (and provoke an emotional response related to his regrettable accident) but the only thing the jersey barrier proponent can do is point to the statistics that say there are fewer serious injuries since they've been installed. There's no emotional resonance to the thousands of people that travel without incident each day because they don't make a good story. "Man drives to work safely" isn't news, but because it happens much more often that "Man killed in car wreck", it's actually much more important in the grand scheme of things.

We aren't privy to all the stories where EHR made things smoother, cheaper or helped prevent calamity. Largely, these will be small victories, unsung

And I forgot to mention that on February 9, 2006, the FDA voted to include a Black Box warning on all stimulant drugs used to treat ADHD due to the sometimes significant cardiovascular side-effects. In medical ethics, there is a principle of nonmaleficence, or "do no harm." Prescribing these drugs to otherwise healthy individuals would, in my opinion (and the opinions of some very smart individuals at the FDA, including the author of this New England Journal of Medicine article: http://content.nejm.org/cgi/content/full/354/14/1445), be causing the potential for more harm than good.

Anyway taxing smokers is smart, because smokers have health problems that taxpayers end up subsidizing through medicare/medicaid. Raising taxes on smokers results in fewer smokers, which results in a lower tax burden for nonsmokers. This is one where the "lower my taxes" crowd should be creaming their jeans, and instead they're whining about it.

Actually you're wrong. A non-smoker on average costs more over their life in medical costs than a smoker. Sure smokers get cancer and emphysema, but the treatments are fairly straight forward for these and usually a smoker dies much younger. Non-smokers tend to get more exotic/costly diseases and in the end cost the tax payers more.

This has been known for some time as this was published in 1997: http://content.nejm.org/cgi/content/full/337/15/1052

There have been more recent studies that back this up published out of Holland and at least one other European country in the last year or so.

http://www.msnbc.msn.com/id/22995659/

Is it the same intellectual bankruptcy? The OP might argue that it would be easier to convince an orthopedic surgeon that arthroscopic lavage is no better than placebo surgery by citing an article such as http://content.nejm.org/cgi/content/full/347/2/81 than it would be to convince a homeopath that homeopathy is no better than a placebo.

Do medications count as medical treatments? Such as how statins do not lower your risk of death? Which is not surprising because cholesterol is a symptom not a cause.

I'd be interested why you conclude that. This abastract and this article, and quite a few other sources, offer good evidence that statins lower the risk of death in the general population.

However, Hawkins was a genius even before his ALS got bad, and on average the benefits from avoiding ALS in the first place exceed any theoretical gains. For that matter, it's likely that we'll lose Hawking early, compared to if he was healthy. As for ATP production, does having it be more efficient at the cost of MD make it worth it? Looking at animal life - these are traits that get selected out quickly and efficiently by nature. By nature bad mutations pop up far more frequently than good ones, but the weeding of natural selection promptly removes the bad ones(on average).

I'm not saying that we don't do a thorough workup, it's just that there are any number of hereditary diseases that don't actually have a benefit. Heck - for sickle cell it might be a benefit to simply make sure that no new babies have the double recessive trait. There might be some other recessive diseases that one copy would actually provide some benefits, such as 'Wiedemann-Beckwith syndrome' aka 'double muscle'. A double copy turns average joe into an involuntary Mr. Universe, a single copy makes it possible. Overall the double copy is negative because it produces so much muscle it over strains the body - the heart and other organs remain normal sized. But with today's sedentary society, a mild case might actually help.

Still, on average I'd say that we actually already DO know, at some point we can say 'For disorder X, there are no discernible benefits, even for the latent/recessive gene'. There's a whole host of genetic defects that can be classed this way.

• Nurses were authorised by the hospital administration to correct doctors when they skipped part of a procedure.
• Mundane processes were pushed to a checklist, so recalling them was no longer a human task, letting the doctors focus on the parts that actually require them to think.

In fact, the most important part of the whole article is in these paragraph:

First, they helped with memory recall, especially with mundane matters that are easily overlooked in patients undergoing more drastic events. (When you're worrying about what treatment to give a woman who won't stop seizing, it's hard to remember to make sure that the head of her bed is in the right position.) A second effect was to make explicit the minimum, expected steps in complex processes. Pronovost was surprised to discover how often even experienced personnel failed to grasp the importance of certain precautions. In a survey of I.C.U. staff taken before introducing the ventilator checklists, he found that half hadn't realized that there was evidence strongly supporting giving ventilated patients antacid medication. Checklists established a higher standard of baseline performance.

I think the problem here is that the ones who are saying that MMR causes autism are the exception, not the rule.

While I may have kind of agreed with you that many private practice physicians are behind on their science, I highly disagree that those in academia are. I worked in the Johns Hopkins medical institute and not a single one is devoid of scientific training.

The entire notion that those in academia are practicing substandard science is laughable - the science of medicine is in academia. You are talking about quacks who fear monger and are generally disregarded among the scientific community. They don't get a disproportionately loud voice in the media because they don't understand science - it's because the media loves sensationalist stories and conspiracy theories.

Or releasing countless, unending and contradictory studies about diet.

Ok, I see the problem. First, let me say that dietitians and nutritionists are not physicians - but really that's irrelevant. When you cite diet studies as an example of medicine, you are essentially playing the mainstream media game. You never hear about any of the scientific studies because the public wouldn't understand the science.

Let me give you an example of an actual academic paper. I will not give my father's papers because I do not have his permission, however this is very similar to his area of expertise: http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B8JDD-4RDPT4X-6-6&_cdi=43612&_user=1458830&_coverDate=02%2F29%2F2000&_sk=%23TOC%2343612%232000%23999339997%23677390%23FLA%23display%23Volume_66,_Issue_2,_Pages_i-ii,_347-753_(February_2000)%23tagged%23Volume%23first%3D66%23Issue%23first%3D2%23date%23(February_2000)%23&view=c&_gw=y&wchp=dGLbVzb-zSkzV&md5=acbce1898e1a993e7adeb4badc8ea004&ie=/sdarticle.pdf . I would like you to read this article and tell me where it lacks in science. In fact, here is the link to the New England Journal of Medicine. http://content.nejm.org/current.shtml My parents' house is full of the things. Look at the papers in "Original Articles." These are examples of science and I don't know how you can deny it.

Academia is built on science, much the same way that the academic researchers in computer science are much more closely related with math and science than your average programmer. If someone asked you why computer science is really a "science," you wouldn't point them to the Cathedral and the Bazaar, would you? You would point them to P vs NP or Cellular Automata or any of the other million subsections of computer science theory. In the same way, just because a private practice physician may be behind on his biology, you should never assume the same of an academic researcher, or you will appear quite foolish at any reputable university.

Generally speaking,

consent to treatment isn't predicated on memory per se. Here is the link to a PDF file written by one the noted experts on competence to consent to treatment:

http://content.nejm.org/cgi/reprint/357/18/1834.pdf

The Grisso and Applebaum book "Assessing Competence to Consent for Treatment: A Guide for Physicians and Other Health Care Providers" is the defacto book for health care providers to understand and assess competence as it relates to medical decision making.

hth,
jeff

The work of Arthur Kellermann is probably the most comprehensive. Here's a few of his statistics. Scroll down and click on the tables for a quick overview.

The second statement is a common fact that is tought at the very basic level of (serious) selfe-defense.
The idea of defending yourself against a mugger is rediculous. Crime is the criminal's job. Would you expect to be able to outsmart him, even when he is prepared and has set everything to his advantage? Would you expect the mugger to have a chance if he say, turned up at you office and were to do your job?
The best strategy is de-escelation, so the last thing you want to do is start waving your gun about.
For more on this topic, I would recommend some of the articles at http://www.nononsenseselfdefense.com/robbers.htm
Unfortunately I could only find a study about carrying guns specifically for the workplace: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1449263

The Brian Lehrer show, a popular New York City talk show, had a program on health care in the election, and they invited the listeners to post suggestions to a Wiki.

The Wiki came out pretty good http://issues.wnyc.org/wiki/index.php/Health_Care:_Whose_Plan_Rules%3F (and the subsequent radio program was also pretty good).

The best part is a lot of links to the New England Journal of Medicine http://www.nejm.org/ which has lot of (free-access) articles on health care in the elections in the recent editions.

If you want to read one good article to understand the health care system, I'd recommend http://content.nejm.org/cgi/content/short/358/6/549 7 Feb 2008, 358(6):549, Perspective: Market-based failure -- a second opinion on U.S. health care costs.

A lot of people thought that both Obama and McCain were missing the point -- we need a Canadian-style, single-payer, Medicare for all system, which would cost 1/2 to 2/3 as much as our current insurance-based system (depending on how you calculate it).

One of the people who argues for single-payer is Paul Krugman, the New York Times columnist and Princeton University economics professor who just won the Nobel Prize in economics.

The Brian Lehrer show, a popular New York City talk show, had a program on health care in the election, and they invited the listeners to post suggestions to a Wiki.

The Wiki came out pretty good http://issues.wnyc.org/wiki/index.php/Health_Care:_Whose_Plan_Rules%3F (and the subsequent radio program was also pretty good).

The best part is a lot of links to the New England Journal of Medicine http://www.nejm.org/ which has lot of (free-access) articles on health care in the elections in the recent editions.

If you want to read one good article to understand the health care system, I'd recommend http://content.nejm.org/cgi/content/short/358/6/549 7 Feb 2008, 358(6):549, Perspective: Market-based failure -- a second opinion on U.S. health care costs.

A lot of people thought that both Obama and McCain were missing the point -- we need a Canadian-style, single-payer, Medicare for all system, which would cost 1/2 to 2/3 as much as our current insurance-based system (depending on how you calculate it).

One of the people who argues for single-payer is Paul Krugman, the New York Times columnist and Princeton University economics professor who just won the Nobel Prize in economics.

Your completely unsourced quote was the following: "The Canadian health care system costs every Canadian family an average of C$12,000 per year--that's US$13,000, more or less. That's triple the cost of a deluxe health plan in the US." And the reality, 100% the opposite: "Price of health care Health care is one of the most expensive items of both nationsâ(TM) budgets. The U.S. government spends more per capita on health care than the government does in Canada. In 2004, the government of Canada spent $2,120 (in US dollars) per person on health care, while the United States government spent $2,724.[11] However, U.S. government spending covers less than half of all health care costs. Private spending for health care is also far greater in the U.S. than in Canada. In Canada, an average of $917 was spent annually by individuals or private insurance companies for health care, including dental, eye care, and drugs. In the U.S., this sum is $3,372.[11] In 2006, health care consumed 15.3% of U.S. annual GDP. In Canada, only 10% of GDP was spent on health care.[5] This difference is a relatively recent development. In 1971 the nations were much closer, with Canada spending 7.1% of GDP on health while the U.S. spent 7.6%." http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared#Price_of_health_care See also: "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." http://content.nejm.org/cgi/content/short/349/8/768 You can pull the wool over some peoples eyes but not those will access to a search engine and 30 seconds of time, smirk.

You said, "... you're a drooling ideologue..."

Someone disagrees with you, and you engage in a personal attack? It's a fact, you are justifying a system in which a manufacturer can keep fraud secret.

You said "... hundreds of drugs are approved every year and only a handful turn out to have unknown risks..." [my emphasis]

The February 2008 article in the highly respected journal Nature, 2007 FDA drug approvals: a year of flux says, "The US FDA approved 17 new molecular entities (NMEs) and 2 biologic license applications (BLAs) in 2007, the lowest number recorded since 1983." That article includes a chart showing drug approvals for every year since 1996.

An August 23, 2008 article in the Wall Street Journal, Sick Patients Need Cutting-Edge Drugs says "The FDA approved just 16 new drugs last year, and is on pace to approve only 18 this year. That's down from a high of 53 in 1996 and 39 in 1997." That article says more drugs should be approved. But that is the position of a very ignorant person, who doesn't understand the widespread sloppiness of drug development.

Read the November 23, 2006 article in the New England Journal of Medicine, to which I linked above, Dangerous Deception - Hiding the Evidence of Adverse Drug Effects. That and many, many other articles show that drug fraud is common.

The November 23, 2006 NEJM article, Observational Studies of Drug Safety - Aprotinin and the Absence of Transparency says, "The full safety profile of a new drug is rarely known at the time of approval by the Food and Drug Administration (FDA). Most drug-development programs designed for treatments of symptomatic indications are underpowered to detect any increased risk of rare drug reactions or change in background event rates attributable to the drug. Large, post-marketing, randomized, controlled trials provide robust data on drug safety but may be subject to multiple sources of bias."

Again, "The full safety profile of a new drug is rarely known at the time of approval by the Food and Drug Administration (FDA)", and only 16 drugs were approved in 2007. [my emphasis]

The evidence shows that the FDA is correct when it doesn't approve many drugs. The vast majority of clinical trials, experiments on people, show no benefit whatsoever. That's because new drugs are usually proposed based on wild guessing, not because of truly scientific investigation.

A large percentage of people in the U.S. are drug enthusiasts. They shouldn't be. Drugs, even ones that are considered beneficial by everyone, usually have negative side-effects.

You said, "... you're a drooling ideologue..."

Someone disagrees with you, and you engage in a personal attack? It's a fact, you are justifying a system in which a manufacturer can keep fraud secret.

You said "... hundreds of drugs are approved every year and only a handful turn out to have unknown risks..." [my emphasis]

The February 2008 article in the highly respected journal Nature, 2007 FDA drug approvals: a year of flux says, "The US FDA approved 17 new molecular entities (NMEs) and 2 biologic license applications (BLAs) in 2007, the lowest number recorded since 1983." That article includes a chart showing drug approvals for every year since 1996.

An August 23, 2008 article in the Wall Street Journal, Sick Patients Need Cutting-Edge Drugs says "The FDA approved just 16 new drugs last year, and is on pace to approve only 18 this year. That's down from a high of 53 in 1996 and 39 in 1997." That article says more drugs should be approved. But that is the position of a very ignorant person, who doesn't understand the widespread sloppiness of drug development.

Read the November 23, 2006 article in the New England Journal of Medicine, to which I linked above, Dangerous Deception - Hiding the Evidence of Adverse Drug Effects. That and many, many other articles show that drug fraud is common.

The November 23, 2006 NEJM article, Observational Studies of Drug Safety - Aprotinin and the Absence of Transparency says, "The full safety profile of a new drug is rarely known at the time of approval by the Food and Drug Administration (FDA). Most drug-development programs designed for treatments of symptomatic indications are underpowered to detect any increased risk of rare drug reactions or change in background event rates attributable to the drug. Large, post-marketing, randomized, controlled trials provide robust data on drug safety but may be subject to multiple sources of bias."

Again, "The full safety profile of a new drug is rarely known at the time of approval by the Food and Drug Administration (FDA)", and only 16 drugs were approved in 2007. [my emphasis]

The evidence shows that the FDA is correct when it doesn't approve many drugs. The vast majority of clinical trials, experiments on people, show no benefit whatsoever. That's because new drugs are usually proposed based on wild guessing, not because of truly scientific investigation.

A large percentage of people in the U.S. are drug enthusiasts. They shouldn't be. Drugs, even ones that are considered beneficial by everyone, usually have negative side-effects.

You said, "I'm sure the average research neurobiologist would be far more proficient at eliminating confounding factors, since it is a critical part of the job..."

Actually, I haven't found that to be the case. Only a few of the people doing "science" actually have a careful scientific orientation.

Vioxx is an example. Read Dangerous Deception - Hiding the Evidence of Adverse Drug Effects in the New England Journal of Medicine.

It is my observation that fraud and incompetence is widespread in what is called "science".

http://content.nejm.org/cgi/content/full/NEJMoa0803545

That's the original research. If you read the Yahoo article you'll see the researchers got money from the manufacturer of a computer-aided reading system.

And did you see that list? Nitrous oxide is on there. WTF? Whipped cream causes cancer, then?

The Office of Environmental Health Hazard Assessment (OEHHA) of the California Environmental Protection Agency is adding gallium arsenide to the list of chemicals known to the state to cause cancer and hexafluoroacetone, nitrous oxide and vinyl cyclohexene dioxide to the list of chemicals known to the state to cause reproductive toxicity for the purposes of Proposition 65.

Women who work in dentists' offices have fewer kids.

Everything in your post is informative, up to the statement that "paranoia can and does *frequenttly* cause murders..." I work in mental health, and have had experience with the circumstances you describe. However, there are 1000's of more paranoid folks who don't go on to commit homicide/suicide than those who do. Just a quick google turned up this:

http://bmj.bmjjournals.com/cgi/content/full/318/7193/1225

which estimates roughly 8% of homicide perpetrators having contact with the mental health profession, but that certainly doesn't equate to them all being paranoid, or even having a true psychiatric diagnosis.

http://www.psychlaws.org/BriefingPapers/BP11.htm

And finally here:

http://content.nejm.org/cgi/content/full/355/20/2064

cites a study showing an approximately 5% prevalence rate of schizophrenia amongst persons convicted of homicide. Now I understand this is orders of magnitude higher than the general population, and there is certainly an increased risk of self-inflected injury or homicide as compared to folks who don't have a history of schizophrenia. But the fact still remains that the overwhelming majority of folks with a psychiatric illness, including paranoid schizophrenia are not at risk for perpetrating violence against themselves or others.

Not necessarily disagreeing with your post, per se. Just pointing out the other side of the equation as there is a common misconception that those with mental illness are a risk to themselves and others.

thx,
jeff

>NONE of these 'cures' are actually used on a daily basis.

Gleevec. 89% five-year survival rate: http://content.nejm.org/cgi/content/full/355/23/2408

I just spent 2 days reading a few articles about this general area of research in last week's New England Journal of Medicine, so let me try to explain this to my fellow /.r's who so generously explain to me about warez and the penguin.

Doctors now believe that cancer goes through several stages before it becomes a problem. Cells become cancerous all the time, but usually the immune systen destroys them. To simplify a bit, immune cells such as dendrocytes (which is the hot immune cell these days) recognize cancer proteins. Dendrocytes take a piece of the cancer protein to a T cell, and the T cell kills the cancer cells. There's a great explanation of the immune process on Kimball's Biology Pages http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/A/AntigenPresentation.html, and if you take a few minutes to figure it out you'll understand one of the most amazing discoveries of the last century.

The reason we get cancer is that sometimes that process doesn't work. All it takes is one time during your lifetime when a cancer cell "figures out" a way to evade the immune system, and the cancer takes off.

It obviously occurs to doctors that it would be cool (and probably win a Nobel prize) if they could figure out some way to goose the immune system into fighting cancer, just the way they goose it into fighting viruses with vaccines.

One guy who tried that was Steven Rosenberg http://en.wikipedia.org/wiki/Steven_Rosenberg at the NIH. Rosenberg took melanoma cells from patients, and tried to stimulate the patient's immune system with a molecule called interleukin-2 that cells use to signal immune attacks. I remember reading about that around 1984, I think. The cancer slowed down but it came back. Rosenberg has been working on it ever since.

I remember seeing a cover headline in Fortune magazine back then about Rosenberg, to the effect, "Cure for cancer." (No question mark.) Do you suppose the media hype these things?

In order to understand cancer research, you have to understand that they can kill cancer cells in laboratory bottles, they can cure cancer in mice, but when they try to kill cancer cells in humans, time and again, it doesn't work. When it finally works in humans, that's news. The other thing you have to understand is that there are many treatments that make cancer tumors shrink or disappear for a while, but they usually come back. Cancer patients don't want the cancer to go away for 6 months -- they want it to go away forever. There are a few cancers that can sometimes be cured, like testicular cancer and childhood leukemia, and maybe some prostate cancers, but most of the time, for the big 3 (colon, breast, lung) oncologists are just trying to extend life. Of course, if you're 65 and your doctor can keep you alive for another 20 years with colon cancer or leukemia, that's not so bad. Most of the successful treatments for cancer extend the life of a cancer patient from, say, 20 months to 25 months, or 40 months to 45 months, but sometimes they get a really big jump, and for people with chronic myelogenic leukemia, imatinab (Gleevec) can extend their lives indefinitely.

Anyway, the really big news is that somebody actually managed to get a treatment like Rosenberg's to work on a real human with melanoma, who seems to be cured after 2 years. This was published in the New England Journal of Medicine, Treatment of metastatic melanoma with autologous CD4+ T cells against NY-ESO-1, Naomi Hunder et al., 358:2698 http://content.nejm.org/cgi/content/short/358/25/2698 In the past, they've gotten melanoma (and kidney cancer) to regress for a while, but it came back. This time it seems to be gone for good -- in one patient.

Basically, they had a patient with melanoma that had spread to his lungs. He had T cells that

Enough of this "We found a cure! We're headed to trials!" crap. We've seen this for the past 20 years, yet NONE of these 'cures' are actually used on a daily basis. Either put up, or shut up.

OK, sure. Have a look at the Kaplan-Meier curves for survival for Acute Lymphocytic Leukemia in children. In the 60's your child's chance of long term cancer free survival was less than 10%. Today, your child's chance of long term cancer free survival is in the 90% range. http://scienceblogs.com/pharyngula/2008/06/support_cancer_research_now.php Orignial article: http://content.nejm.org/cgi/content/full/354/2/166

While big leaps and bounds are great. The progress in cancer treatment and research is made through slow and consistent work at the same problem. More power to these people. But each one of these 'we're headed to trials' announcements is one grain of sand - possibly a big one - working toward grinding the machine to a halt.

Be sure to wear your safety goggles. I know!
Although I must say that the eye heals suprisingly well after a minor injury. http://content.nejm.org/cgi/content/full/358/21/2265 (Hyphema is blood in the eye.)

The American Medical Association restricts the supply of MDs, and by law you can't get most medical care from anyone who isn't an MD.

AC is correct: you cannot be a "realtor." You can be a "REALTOR" (Registered trademark) if the National Association of Realtors permits it.

Both restrict capacity of the labor in their industries. This is known to create at best Cournot competition. Meanwhile, a market that is not capacity constrained has Betrand competition - where the mere threat of entry can keep prices near their minimum. Cournot competition reduces economic efficiency (id est, screws you out of money).

I'd estimate the average working American is getting "screwed" (how much he pays less what a competitive market would cost) by about $6,000 per year (of the approximately $16,000/yr of medical expense he and his company pay). Your paycheck is probably light by $500 per month due to the AMA tax.

It is also worth noting that a supply shortage of saved lives is equivalent to preventable deaths. This artificial shortage raises prices of having your life saved while simultaneously reducing your odds of having your life saved.

The AMA and NAR are de facto monopsonists, restricting the ease of health care and real estate purchase respectively, and using your medical bills and need for housing to make their members artificially richer.

Don't believe that doctors are getting paid "too much"? See if you can find the trend in the Forbes best paying jobs in America:
1. Anesthesiologist
2. Surgeon
3. Obstetrician
4. Orthodontist
5. Oral Surgeon
6. Internist
7. Prosthodontist
8. Psychiatrist
9. General Practitioner
10. Chief Executive Officer
11. Physician and Surgeon, Other
12. Pediatrician
13. Dentist
14. Airline Pilot
15. Podiatrist
16. Lawyer

Productivity in the US has been going up steadily over the last decade, but real median income has gone down. Where does all that extra money go that you're not getting paid? Your company spends it on health insurance, most of which ends up in the hands of MDs.

OPEC dominates the trillion dollar global petroleum industry. The AMA dominates the two trillion dollar national medical industry. Politicians blame OPEC for our economy because doctors write big checks.

It's dumb, but during WWII the government started giving companies a tax break for providing health insurance. Meaning the company could write off the expense, but the employee wouldn't be taxed on health insurance. This pushed health insurance to a part of the employement package. Once there, companies bought pooled insurance (meaning every employee is covered you and the insurance company cannot pick employees to cover).

If employees can opt in or out of the insurance, the price rises dramatically. In essense by removing the choice to raise salary by the amount of the premiums or take insurance, the lemon problem is solved. You're half correct that companies won't make you buy insurance with your own money, but few will let you opt out of their insurance either. You can pick your plan/HMO sometimes, but you can't get the premiums as a bonus.

You're correct over a lifetime, but over a working career (18 or 22 to 65, smokers are vastly more expensive. Health care costs are 40% higher for smokers at the same age as non-smokers, non smokers get more expensive in their later years (after the smokers have mostly died). Since employeer paid insurance is provided during your working years, it's much more expensive to insure smokers.

Since the insurance is bought on a pooled basis, changing the nature of the pool (eliminating smokers as an example) dramatically reduces the insurance premiums for the pool. Of course the company could stop offering employeer paid insurance, but the premiums for individual policies would be substantially higher than the previous pooled premiums had been.

No, acupuncture works better than placebo. It's more like, hey, I've just been stuck with something sharp, better give off some endorphins. Similar to how when you have a headache, a kick in the nuts will often cure it.

As for the whole pharmaceutical industry cover up of antidepressants, would you consider the New England Journal of Medicine and the New York Times credible?

Triple my bodymass in grams of protein is 726.75 grams of protein.

Sorry. 2.5x the "high protein" diet.

Back to your enumerated points (I'm focusing on your ridiculously-off-the-charts-high-protein/low carb/low fat diet)

Do you have Inuit genetics? Whoops.
Do you eat large amounts of seal blubber and other fats like the Inuit? Whoops.
Do you eat the mere ~100 grams of protein and ~200 grams of carbohydrate that the Inuit eat per day? Whoops.
Do you have Maasai genetics? Whoops.
Do you eat the very high-fat diet of the Maasai -- so high fat that a common treat for kids is fat boiled in water? Whoops.
Do you have Bantu genetics? Whoops.
"Northern" and "Southern" indians are not technical terms. Whoops. Did you mean to refer to a particular study or were you pulling that out of a hat?
Do you have any native american genetics from any group? Whoops.
Are you of the mistaken notion that people of different genetic makeups process foods the same? Big whoops. (ever heard of "lactose intolerance"? "Lactose tolerance" is an evolutionary adaptation developed in cultures whose diet included dairy. Cultures adapt to their native diets)
Have there been a ridiculously large number of studies on the negative effects of saturated fats? Whoops.

My average training week includes 30mins of weight lifting upon waking, 1hour of training for lunch, and 1 hour of weights/football/throwing everyday for 4 weeks.

That's it? You eat 600 grams of protein per day and that's all you do? For God's sake!

Look, you're free to destroy your body against the recommendations of all major medical organizations who've commented on high protein diets (and by "high protein", they're typically talking about 1g/lb, not 2.5g/lb). But don't try and pretend that it's somehow natural or good for you.

The New England Journal of Medicine actually had an interesting article about direct-to-consumer genetic testing (Jan 10, 2008 -- sorry not a free link (unless you can get it through your institution)). Three main points it makes is that

1. There are questions regarding quality control and transparency. Due to the numbers involved, even small percentage mistakes in sequencing can add up and give wrong information.
2. What is the clinical validity of the sequence such that it can accurately predict the disease? Lack of a sequence may give a false sense of security, and presence of a sequence may cause unnecessary harm.
3. What can you do clinically given the answers? There is little observational or clinical data for how the genetic information can be used effectively, especially for low penetrant conditions.

Clearly, there are disease where knowing ones gene status is very helpful (e.g. BRCA1/2, MEN1/2A/2B, etc...) but many disease we are just in the infancy of determining their genetic basis. The article sums things up like this:

100,000 dead Iraqis, you want, look no further than the New England Journal of Medicine, January 31, 2008 issue, pages 484-493. The article is entitled "Violence-Related Mortality in Iraq from 2002-2006

..and they will take the measured doses, and then go on the street to find more.

You misunderstand. Give them all they want, just make the dosage clear. Overdoses only happen because people don't know how strong their stuff is.

You do realize that we're talking about a drug that will lead people to starve to death if given the choice of one more fix or a meal.

Then don't make them make that choice. Heroin maintenance works. Addicts tend to titrate to a level that they are comfortable with, and lead much better lives than if they had to spend all day drug-seeking.

Not for someone that can't hold a job because they're addicted to heroine.

Merely being addicted to heroin isn't enough to make you unable to hold a job. Hell, one of the founders of John's Hopkin's had an incredible career as a surgeon while being addicted to morphine.

Would the number that don't be 10 times higher if the drug addiction was 10 times as severe.

It's worth pointing out here that by all accounts nicotine is much harder to quit than heroin. Much more physically damaging too. When nicotine is prohibited, you'll see a lot more people having serious problems in their lives because of what they have to do to get their fix. Nicotine and heroin are both incredibly dangerous drugs, prohibition only makes them worse.

New England Journal of Medicine
Volume 358:252-260, Number 3
January 17, 2008
http://content.nejm.org/cgi/content/short/358/3/252

Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy
Erick H. Turner, M.D., Annette M. Matthews, M.D., Eftihia Linardatos, B.S., Robert A. Tell, L.C.S.W., and Robert Rosenthal, Ph.D.

ABSTRACT

Background 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.

Methods We obtained reviews from the Food and Drug Administration (FDA) for studies of 12 antidepressant agents involving 12,564 patients. We conducted a systematic literature search to identify matching publications. For trials that were reported in the literature, we compared the published outcomes with the FDA outcomes. We also compared the effect size derived from the published reports with the effect size derived from the entire FDA data set.

Results Among 74 FDA-registered studies, 31%, accounting for 3449 study participants, were not published. Whether and how the studies were published were associated with the study outcome. A total of 37 studies viewed by the FDA as having positive results were published; 1 study viewed as positive was not published. Studies viewed by the FDA as having negative or questionable results were, with 3 exceptions, either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies). According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive. Separate meta-analyses of the FDA and journal data sets showed that the increase in effect size ranged from 11 to 69% for individual drugs and was 32% overall.

Conclusions We cannot determine whether the bias observed resulted from a failure to submit manuscripts on the part of authors and sponsors, from decisions by journal editors and reviewers not to publish, or both. Selective reporting of clinical trial results may have adverse consequences for researchers, study participants, health care professionals, and patients.

That is the often-repeated mantra. However, it is, at best, simplistic and at worst very misleading. There is a very nice summary of some findings in this week's New England Journal of Medicine, very accessible reading for the non-M.D. too. Take a look if you are interested, it is free access for all:

http://content.nejm.org/cgi/content/full/358/7/661

Before the idiot flamers start -- I am NOT saying that the above poster is absolutely WRONG, just that it is more complex as some of the followup posts suggest (screening ADDS to upfront costs, and the cost of monitoring diseases that have very little outcome change due to treatment, etc.)

Am I saying these things shouldn't be counted? No: certainly not. But it's important for people to be able to discuss with or without related factors, depending on intentional context. Mortality rate is without related factors. Morbidity rate is with external factors. So yes, you're right. Diabetes' mortality rate is much lower than its morbidity rate, due to related considerations such as heart attack, stroke and other descendant complications. It's really just a question of grandparent poster using phrases such as "mortality rate" of whose implications he was unaware.

Wait a second, I didn't realize you actually don't understand the difference between morbidity and mortality. I assumed you did and didn't read your post closely enough. Morbidity is the rate of complications that don't result in death, while mortality is the rate of deaths. And the more I thought about it, I realized that regardless of whether epidemiology textbooks define mortality rates as involving complications or not, the actual medical literature does this all the time. There are clinical trials that calculate the mortality rates for people with a certain blood pressure level, for example, or the mortality rates of people with end stage renal disease on hemodialysis. Neither of those lead directly to death (well, rarely), but both predispose people to vascular disease.

>>Okay, there's one documented case of one person surviving rabies once with lots of medical intervention, but I think we can round up.
It's more like two a week in the United States. You really shouldn't lean on popular myth so hard. Misinformation is pernicious. Try looking it up before you cite it. Being plain, it's just part of being honest, citing only data you've verified. Anything else is lying.

If you really think I'm just making stuff up, fine. The reference is here. To clarify, rabies can be prevented after exposure through the use of vaccine and immunoglobulin, which is what you're referring to, but that's totally different than treating it once it makes it to the CNS. The guidelines say that you're supposed to vaccinate people within 72 hours of an exposure, but the mean time to vaccination in one study I read put it around 5 days, and I don't think there are any documented cases of anyone dying of rabies as long as they were vaccinated in the first week.

The one thing I find appalling in the whole discussion (we are all nerds here after all right?) is the lack of feasibility of the private insurer-based solution.

According to this article in the New England Journal of Medicine, we spend 31% of health care expenditures on administrative costs for the insurance based system whereas Canada spends less than 1/3 of that. There's a huge bureaucracy created to decide who gets which health care treatment, to deny ~10% of said treatments, etc. So from a purely economic standpoint, it would cost us less money money per person to go to a European style system where the super-rich can supplement their care through private insurance.

I don't understand why so-called "fiscal conservatives" can't rally behind a policy that saves money AND gives everyone care.