Obligatory claim of relevance: I am a pediatrician with developmental training. I am also the parent of a teenager with severe autism. It is my informed (but not omniscient) opinion that the odds that this is anything other than a complete red herring are too small to measure accurately.
We will begin with the obvious problem that they are treating autism as a single disorder. We don't know a great deal about the spectrum, but we certainly know that autistic symptoms can be found in a large number of discrete conditions. "Autism" is probably a final common pathway of subtle neurologic failure, and the idea that a single enzyme is associated has been discredited repeatedly. In fact, every time we think we've found "the" cause, more research shows us that we have found, at most, "a" cause, and usually not one that is common. Fragile X syndrome, Rett's syndrome, and others were all previously lumped in as "autism", and I don't think we're done finding things.
The next obvious problem is that if we indeed have a single liposomal storage disease causing most or all autism, you would find it with brain biopsy and/or MRI. We have not found this. You would expect other commonalities as well, since failures of fat metabolism generally have organ impacts outside the brain. We have not found these. I would be unsurprised to discover that there is a rare disorder of this sort with autistic symptoms present, but it means nothing for the vast majority of individuals with autism.
Don't get me wrong - I would give the rest of my life willingly if it would cure my son. I will be grateful beyond words if this works. But it won't, any more than secretin did when it was the last great hope for autism. I have learned much in the fifteen years of my son's life, and the thing I have learned most is that people who claim to have "the cure for autism" are lying. Not always in an evil fashion, and not necessarily knowingly, but they are saying something that is not true.
Thank you, and yes. I have no problem with people trying to eat healthy foods, and my Pop-Tarts comment was irony (which is a dangerous thing on Slashdot), but there is no actual scientific evidence that live culture yogurt does very much for you. It's not harmful, and nobody is foregoing any particular treatment by eating it (unlike the St. John's Wort example, which I've seen). My negativity is the same that I have for any salesman claiming too much for their product.
I have an astonishing fact for people: Activa was created in marketing focus groups, the message was polished to a fine luster with interviews with consumers, and the only reason it is being sold is because its manufacturer wants to make money. This is the way of the world, and I don't even object, but there aren't any altruists here. The product doesn't have to have any value beyond being marketable and, in this case, it really doesn't.
Probiotics in food are part of a larger trend toward 'functional foods,' which stress their ability to deliver benefits that have traditionally been the realm of medicine or dietary supplements.
And so slouches the Baby Boom generation toward their inevitable mortality, scrambling and clutching madly at every huckster's promise to improve "health" and "longevity." This is a minor example of the sort, of course, but it is just as well documented and proven as the others. Which is to say, not.
The primary "benefit" delivered by Activa is indeed that of the dietary supplements (and not a few medicines), which is to separate the victim from their available cash and deliver fuzzy science and placebo effect in return.
There is limited data that active culture supplementation can reduce diarrhea duration in acute gastroenteritis, although the studies are small. The effect in irritable bowel syndrome is contentious, but then virtually everything in irritable bowel syndrome is contentious, including the existence of the syndrome as such. In already-healthy people, Activa has no well-supported benefit of which I am aware.
For myself (and as a practicing physician), I don't have a problem with it - if you like your flavored spoiled milk with extra bacteria, by all means, partake. Nearly all food is nonsterile. Much of it has quite a lot of bacteria, and most of them (Taco Bell notwithstanding) are relatively harmless. Personally, I rather prefer Pop-Tarts.
Standardized human embryonic (or adult) stem cell therapies for Parkinson's disease are a long way away. Not months, or even years, but I'd bet at least a decade and a half. Why? Because of exactly the issues shown in this article.
In order to have a successful therapy you have to have the following:
1. A disorder sufficiently well-understood that you can identify the missing cells. Parkinson's is sort of in this class, although the rat model is a pseudo-Parkinsonian condition caused by chemical poisoning of the cells of the substantia nigra, while "classic" Parkinsonism is the death of these cells by an as-yet undetermined mechanism. The difference will be crucial as we get to further steps.
2. A way to use stem cells to recreate the missing cells. This is the step that these researchers seem to be taking here, although even with their new efforts nearly a third of the cells they've produced do something else. The "something else" appears to involve generation of tumors, although this is speculation.
3. A way to get the stem cells into the right place, and to encourage them to divide. Again, apparently the researchers here have made some progress.
4. A way to stop the proliferation of the cells when they've reached replacement, without unwanted spread or effects. This is the step that stymied the study in question, and they're just guessing about why this may have happened. Just fixing this in this one study will take a year or two.
5. Repetition of the study several dozen times, with concomitant improvements in efficiency and safety of the technique. Only a madman would take a single study, no matter how successful, as proof that the technique is understood.
5. Safe transfer to human beings. This is a HUGE step, because of the ethical and legal implications. This won't begin until the techniques are well studied in animals. It also won't begin in the United States, not because of Republican politics, but because of the plaintiff's bar. Phase 1 studies of a technique like this will start in nations with weaker litigation factories and more authoritarian government. Think large countries in Asia with a strong drive to modernize.
6. Formal studies establishing the efficacy of the treatment. This will take years and billions of dollars, and it won't start until the therapy is shown to be safe. What's worse, this is the step that will run afoul of that little problem that I mentioned in step 1. That is, we don't really understand the disorder as well as we might, and it's not too much of a stretch to believe that whatever was killing neurons before will do it again. In which case, the treatment will have no long-term efficacy, and unless re-implantation of the cells is no more difficult than an outpatient infusion (which is NOT the case with current methods), it will be considered to have been a failure. Return to step 1.
This is not to say that this research is futile, or even that we won't see interim benefits as we understand these systems better. Like most things in science, the point of doing the research is to discover the unknown, not to engineer the perfect treatment for a single disease. This is a fascinating study and an excellent piece of science.
I've peer-reviewed papers. I've written peer-reviewed papers. Does this make me a scientist? Does the fact that I wrote those papers in developmental pediatrics with the assistance of a large number of colleagues make me more or less a scientist?
I agree that you can't take a Slashdot reader's word for anything, but I don't ask you to take my word for it. Or rather, I do, but only after I pointed out the most egregious errors. Inadequate proxying for unmeasurables and failure to consider confounders are fatal flaws in a paper, and it doesn't take an "expert" to point them out. That's the cool thing about science - there's no High Church that determines reality. One really nifty piece of data can put a stake through a hundred years' worth of speculation, and there's no way to salvage it.
In the case of the paper in question, they nicely summarized their points in the header and I based my original comment on a review of that summary. I have now had the time to completely read the paper now, and it didn't get better on my complete read. But I don't expect you to believe that either. I just wanted to point out that I consider myself both a physician and a scientist, and while I agree that the two are not proxies for each other, they're not mutually exclusive either.
As a pediatrician trained in child development (and the parent of an autistic teenager), I've got a strong interest and background in this, and I can tell you quite plainly that the paper is crap.
This is a spectacularly good example of really stupid statistical games. I only skimmed it (Acrobat Reader blew up on me as I tried to save it, and I'll get another copy later), but these people did the following amazing things:
1. Accept as fact that autism itself is increasing (as opposed to the diagnosis of autism). This is possible, but contentious and somewhat controversial. I'll spare you the full story, but the general opinion is that while the disorder is more common than it once was, changes in diagnosis (and benefits for diagnosis) make it hard to do more than guess at the actual rate of increase.
2. Consider de novo a hypothesis "that early childhood television watching is an important trigger for the onset of autism." They do note that nobody else has bothered to consider this, but don't spend much time wondering why. Apparently, they're special. Perhaps because nobody has measured this in a useful manner? They do admit this, but they find a solution!
3. Because there are no good numbers for early television watching, they use precipitation as a proxy for television watching. Apparently, if it rains, you're likely inside with the tube on. They do show a strong positive correlation between rainfall and autism. Yep, that's right - rain causes autism.
4. But wait - it can't be the rain, it has to be the television! That's what we started trying to prove, anyway, so it's important to stay focused. They try it another way: they consider the availability of cable. They show that autism correlates with the availability of cable. No, really, it does. Of course, diagnosis of a LOT of chronic developmental syndromes increases with affluence, because of the increased availability of medical care and the reduction in "grab-bag" diagnoses like "mental retardation". But still, it must be the cable.
5. Having neatly done all the "proof" they require, they then proceed to tear the numbers apart and "prove" that 40% of autism in California is triggered by early television watching, while only 17% is triggered in PA. Why, we don't know, but it appears that rain, or cable, or maybe just TV is more powerful in CA than in PA. Or something like that.
I don't have time for a complete fisking right now, but I may do it later. Aside from the basic methodologic errors (confusing correlation with causation, adopting a highly questionable proxy indicator without validating it, and spending almost no time ruling out confounding factors or tainted data), there remain the dozens of smaller tactical problems that should have sidelined this turkey. I assume the peer reviewers, if there are any, were on drugs.
This paper will be a bombshell, all right. I'll use it over and over again as I explain to medical students and colleagues that you don't have to have much in the way of actual brains to write a scientific paper. Or, as I said about another paper in journal club once, "the font is nice, and I like the layout of the tables. It's a shame the actual science is such garbage."
Fomites (inanimate objects that can spread disease by holding infective organisms between hosts) can spread organisms, but office equipment, including mice and keyboards, has never been shown to contribute to the spread of serious disease. In a hospital environment, especially in something like an ICU where you have multiple providers working with the same computers, this might be an interesting thing to study. In the office, there's no point. You're at far more danger from shaking hands with your co-workers than you are from using their mouse. Tellingly, neither the author of the study nor the manufacturer quote any actual scientific study showing that an antibacterial mouse makes a difference anywhere. This is a talisman, pure and simple.
Which doesn't stop the writer of the article, who breathlessly refers to "the spread of pneumonia, the flu, pink eye and strep throat, among other extremely contagious viruses." As a physician who is continually explaining the difference between viruses and bacteria, and the difference between diseases caused by transmission of specific organisms (like strep) and general conditions that have hundreds of causes (like pink eye or pneumonia), this sentence made me twitch violently. Suffice it to say that with this single phrase, the author ensured that I would ignore the rest of the article as an obvious waste of time.
Fortunately, the manufacturer of the mouse did better. I love the disclaimer:
Disclaimer:
This device cannot be used as antibiotic or anti-viral medication. Do not ingest the surface material of the device under any circumstances. If you have symptoms of bacteria or viral infection please consult with your physician and seek medical attention immediately. This device does not eliminate the entire universe of bacteria or viruses. It is not a replacement for cleanliness and good personal hygiene. Please keep your hands and work area clean for optimal protection.
And there you have it. Remember, don't ingest the damn thing under ANY circumtances.
Speaking as a practicing physician (pediatric hospitalist, to be precise), there are at least three things that are going to keep me from worrying too much about being "rebooted" by a really good CT scanner.
First, there's the unpleasant reality than in medicine the diagnosis is usually not the most important question. I've had about three true diagnostic conundrums in the past two years, and in two of those the question wasn't what was wrong (we were virtually sure it was cancer) but where it was. Yes, in those two cases, a very high-tech scan (a PET/CT) helped make the diagnosis, but for every one of the other hundreds of patients I've seen recently, the key issue was management, where all the 3-d algorithms in the world are brutally inferior to one reasonably well-educated intern.
This is even more important because diagnosis isn't enough, ever. You can't just find the polyps, you have to deal with them. You can't just find the coronary stenosis, you have to repair it. And in both cases, the skill of the physician (and the knowledge to accurately measure benefit and risk) are my real stock in trade. Hand me the diagnosis, and I'm not threatened, I'm thrilled. And since you need a good radiologist to really read the CT well, my radiology colleagues are pretty OK with the new tech as well.
Second, the excerpt is coming from a radiology trade show. I'm glad that the tech is cool, and I love the pictures, but radiology is only a small part of medicine, and most of the non-trauma diagnoses we see aren't really that dependent on a good CT. As other posters have noted, echocardiography and endoscopy do pretty well at all of this, and the CT is at best a screening adjunct that might increase the numbers of people who have the definitive studies. Eventually the imaging will be good enough to really replace colonoscopy (just as it became the standard of care in diagnosis of appendicitis), and I really do hope that it happens before I get to 50. But it's a tiny part of medical care, blown into high relief because it's at a show where nothing else is important. It's like going to an embedded-systems trade show and not noticing that graphics exist, because nobody is embedding 3D in their network storage appliances.
And third, and possibly just because I'm being cynical, I've been replaced by various kinds of high technology since before I even became a doctor. I've been outmoded by fuzzy logic systems, by automated diagnostic software, by genomics, by proteomics, by targeted drug design, and by about fifteen different funding agency mandates. I've been told I'm obsolete so long that the first ones that told me are already dead. Sure, I expect to die myself some day - as far as I know, even in this age of high tech, everybody pretty much does die - but I'm not going to spend much time worrying that technology will make physicians obsolete before then. The game changes, and I practice medicine very differently from the way it was done in my grandfather's day (and thank God that this is so), but as long as I'm willing to employ my intellect and manual skills on behalf of sick kids, there'll be a way to do it.
The only thing that this study "proves" is that the test they used doesn't appear to be a valid measure of accident avoidance.
Over the past fifteen years, cellphone use while driving has increased from nonexistent to ubiquitous. During the same period, the fatality rates and accident rates per passenger mile have fallen to historic lows. Road design, increased use of seat belts, and an apparent reduction in drunk driving have all contributed. (see NHTSA statistics for details)
If cellphone use made any significant difference, you would see the effect in the numbers. There are just too many cellphone users for it to be hidden. If cellphone users really were as bad as drunk drivers, there would be blood in the gutters.
This is not to say that cellphone users are good drivers, or that you're not a better driver if you're not talking on the phone. I'm just pointing out the obvious, which is that driving is a low-risk activity with a large margin for error, and talking on a cellphone, or talking to your passenger, or yelling at your kids, or the million other distractions that drivers endure every day, aren't by themselves enough to use up all that margin.
They probably do statistically increase the chance of an accident, but by the clear and obvious real-world numbers, the degree of increase (or even the fact of increase) is small and quite hard to measure.
I still think that it would be unethical for your employer to request blanket access to your medical data
I agree. Unfortunately, there's no general agreement on this point from HR organizations.
Corporate America foots the bill for health insurance. Insurers will do anything they can to reduce payouts, but I'm not as worried about direct discrimination because it will attract the attention of too many people if it becomes egregious.
I'm far more worried about employer nanny-ism: my health care decisions are, at base, between me and my physicians, and I don't want my employer deciding that I should cut back on coffee or increase my BP medications. Even if both would increase my longevity. If it becomes standard, however, to "encourage" employee participation in online health initiatives (read: if you do exactly as we say, we'll lower the "standard" premium from extortionate to barely affordable), then they can decide all sorts of things that I don't want them touching.
Evil is something I can deal with. Blind good intention directly coupled to my paycheck has me far more concerned.
HIPAA privacy regulations (there's a lot more to HIPAA than just privacy) don't for one second prevent you from consenting to the disclosure of your health care information to anybody you choose. It's not a "need to know" thing, it's a consent thing. Your consent to certain kinds of transfers (billing from your doctor to the insurance company) is obtained in writing, while your consent to others (your doctor talking to another treating physician) is implied. Your employer is completely free to solicit your consent to keep information about you, and if they offer enough compensation (read: reduced medical premiums), a lot of people will consider it.
If you consent to giving your employer all or part of your entire medical record, and if your employer has the means and the desire to obtain it, there's no HIPAA protection at all.
Which doesn't mean that this is what Dell is doing here. In fact, this has nothing to do with what Dell is doing. Dell's press release is just an attempt to dress up a fairly prosaic web service as a "breakthrough" in medical IT, and in so doing inflate the visibility of a fairly minor federal bureaucrat.
Dell has offered limited electronic health records since 2004, but the upgrade coming Apr. 20 adds the ability for the system to automatically capture new information about treatments and test results, rather than waiting for the employee to enter the data manually.
So let me get this straight - this incredible new initiative is actually a lightly-used website, run by WebMD, that Dell employees have had for the past two years. And the newness is that the system can now "electronically" capture results. And Dell trumpets this in a major news release.
We will set aside the interesting question of how (and whether) WebMD has convinced thousands of independent labs, as well as laboratory giants like LabCorp, to send results to WebMD. We will ignore the HIPAA regulations that will require patients to sign releases with anyone sending results to WebMD. We will overlook the balkanized, backward, and poorly-penetrated electronic medical records world in which these patients' doctors work.
Even if all of these things were somehow not an issue, does anybody except Dell and WebMD marketing droids really believe that the only thing that was preventing this dramatic breakthrough from revolutionizing medical care for everybody was the lack of a stupid HL-7 interface?
Oh, wait. Never mind. Check the last part of the article:
The effort meshes with the federal government's plans to build a national health-information network that would keep electronic data on all Americans' care.
Yup. Sure. Got it. Tinfoil hats meet blue-sky dreamers, and the result is ugly.
Possibly true. However, in this case, I base my comment on ideas from Spitzer's The Mind Within The Net. You can read more about this here (it's a pdf): http://www.his.sunderland.ac.uk/ps/farivar.pdf/
Interesting. The PDF, of course, is a review of the work and not the work itself. More suspicious (to me) is that since this is a published book (and a book that is a general work, as opposed to one focused on autism), the age of Spitzer's references is likely to be more than a few years old. This is almost always a problem in the study of autism, because much of the work done prior to the past ten years is heavily confounded.
Autism (and Asperger's for that matter) is a syndrome diagnosis. We don't have an underlying pathology that we can point to, and there are no imaging, genetic, or testing studies that are pathognomonic (that make the diagnosis in and of themselves). We basically say that if you have enough of the behavioral criteria and if there isn't any underlying etiology that better accounts for your symptoms, then you have autism. And with the symptoms not all that specific (as another poster noted, half of Slashdot's regular readers have some of them), it's an easy diagnosis to apply to a child with an unexplained developmental problem.
Prior to the genetic studies for Fragile X, and prior to finding the marker for Rett's syndrome, and prior to the FISH for Prader-Willi, a lot of kids with those diagnoses (in aggregate, more common than severe autism itself) wound up with diagnoses of autism. Biologic research on their brains poisoned much of the research into what we call "autism", because in fact they weren't really autistic and the now-recognized characteristic changes in their biology got mixed in and called part of the findings of autism.
I appreciate the reference, though, and I'll go check it out further. Spitzer might indeed be one of those myriad neuropsychoanatomy books that are more speculative than definitive, but I'm not so arrogant as to dismiss out of hand a book I haven't even skimmed.
I've read that in some parts of the autistic brain, "layers" of neurons are connected directly to each other, such that every neuron in a particular layer is connected to every other neuron in the next layer. However, in normal brains, a third layer exists between pairs of layers.
Link? It's been a few years since I took clinical neuroanatomy, but I don't recall running across this, and it seems quite unlikely. The formation of the neural layers is critical to the basic function of the brain (I mean any normal function) and disruption of this formation is likely to be catastrophic. Lissencephaly, a condition where the cortex forms abnormally (and fails to form normal gross features), is an example of such a condition, and one where the developmental outcome is uniformly horrible.
If you don't believe it, ask any doctor or pharmacist the "incentives" they're given to push brand a over brand b. Drug companies spend 4x the money on marketing than they do on research - and most of that "research" is wasted solving problems that have already been solved (the me-to drugs, or patenting a new use for a drug that the current patent is expiring on, so as to create a monopoly in another area for another 20 years without having to actually "cerate" anything new).
Not to rain too much on this lovely parade, but you're nowhere near as right as you used to be. Things have changed a lot in the past few years.
I'm a doctor. Licensed, boarded, and practicing full-time. I haven't personally seen a drug representative in the past four years. I work at several hospitals; the tertiary-care teaching hospital I'm attending at today no longer permits drug companies to buy lunch for residents. Nobody is going on drug-company sponsored trips. There are still some docs who go to the educational dinners (I don't, mostly, because if I'm going to go out to dinner I prefer to choose better company), but the educational part of the discussion is now done by independent practitioners and they are strictly required to disclose any financial conflicts of interest.
I'm also on the Medication Safety committee (formerly the Pharmacy and Therapeutics committee) at the new hospital in my neighborhood. This committee must approve all medications on formulary at the hospital. Not only are drug representatives not seen at these meetings, but they are banned from the hospital. They are allowed to contact the manager of the pharmacy, but are strictly forbidden to give any gifts of any kind (even promotional freebies). Even the infant formula representatives are banned, and the hospital is not allowed to accept free formula, or free drugs, or other "free" incentives. We do, of course, negotiate the best deals on drugs that we can get, but the actual deal-negotiation occurs separately from the review and approval of these drugs.
I buy my own pens and office stationary at Office Depot. My sticky-notes say "Post-It" on the wrapper like anyone else's.
I'm not saying that all doctors are like me. There are probably a whole bunch of them who do things the old way and who suck up all the free stuff they can get in exchange for listening to the detail rep speak. But I don't actually know any docs like that any more. There's a huge ethical concern about the issue, and it's not going away.
And the drug companies know it. They're changing tactics rapidly.
Notice how many drug ads are on the television these days? Want to know where the money for marketing is being spent? Don't look at me, look at the mirror. These days, the patients themselves are the targets for the drug companies. The days of lavish incentives for physicians and parmacists are passing fast, and good riddance.
"Combination" patents and line extensions are very real, but they don't usually add that much, since you can't patent a new indication, you have to patent a new medication. Meaning you have to test it, in detail, and release it only after the FDA approves it. Generally these line-extension patents add a few years to the patented use of the drug, but only if you and your doctor are too stupid to use the non-combination meds. Claritin-D is patented. Taking a generic loratadine tablet along with a generic pseudoephedrine tablet is not only not patented, it's about a tenth the price.
Not to nit-pick too much, but from that study we now know how to make non-cytotoxic buckyballs, or at least how to control their cytotoxicity. The test was just cell culture driven, and suggested that modifications to the buckyballs reduced their general cytotoxicity in culture. A mechanism (free radical generation by the buckyball) was suggested but has not been proven.
The article stated, and I heartily endorse the statement, that this is not a full toxicologic risk assessment, but simply a first step.
Having said that, however, that first step was a big one and an important one.
I've built medical devices before. This is in essence a medical device. If this were being used in a medical laboratory for medical purposes, source code changes which were not properly recertified would void the FDA approval for the device. There's a reason for that.
It's a truism in software that you can't verify the absence of bugs by black-box testing, no matter how complete the test vectors. This is doubly true when the software is interacting with the real world, in a nontrivial manner.
Consider: The device undoubtedly measures a change in itself that occurs in response to the presence of ethanol. A voltage is produced, a current is seen, or a color change occurs in some sensitized material. Some chemical reaction occurs, and produces a detectable change in the device state. But because chemical reactions are susceptible to variation in temperature, in the age of the reagents, in the particular lot of the reagents, and in subtle machine-to-machine differences between reaction sites, the software for the machine must contain built-in adjustments for all of this. If you have a half-dozen linear adjustments that you have to make (not uncommon, in laboratory equipment), the six-dimensional test vectors that you have to check are massive. If you have a dozen such factors, you literally can't test enough combinations to be sure that every combination works. And even worse, you have to verify that the machine is in a known state at the beginning of such a test, and without access to the source you have no way of knowing.
The question isn't whether the machine can be made to work in a laboratory setting. The question is whether the machine worked this time, in the middle of the night, in an un-airconditioned drunk tank in God-knows-where, as the thirty-fifth breath test that night. If you don't have the source code, you literally can't possibly know what the chances are that it really worked.
As much as I hate drunk drivers, and as much as I think that the machines are probably pretty good, I'm with the defense attorneys here: produce the source, or stop pretending that this machine can produce proof beyond reasonable doubt.
Having built both true high-reliability fault-tolerant devices and clustered systems, I don't see any fundamental theoretical difference. In both cases, you have redundant hardware capacity in place, theoretically to allow you to tolerate the failure of a certain amount of your hardware (and, sometimes, your software) for a certain amount of time. Neither option guards you against failures outside of the cluster or FT system box. Neither one is a panacea. Both are sold as snake-oil insurance against "badness".
In a single fault-tolerant box, you generally have environmental monitoring, careful attention to error detection, and automatic failover. You also have customer-replaceable units for failure-prone components, utiilties for managing all of the redundancy, and a fancy nameplate. In exchange for that, you have more complexity, more cost, serious custom hardware and software modifications, and often (but not always) performance constraints.
In a clustered system, you treat each individual server as a failure unit. Good fault detection is a challenge, especially for damaging but non-catastrophic failure, but it's much easier to configure a given level of redundancy and it's easier to take care of environmental problems like building power (or water in the second floor) -- you just configure part of the cluster a longer distance away.
Where clustering is inadequate is when you have a single mission-critical system where any failure is disaster (like flight-control avionics or nuclear power plant monitoring). There are applications where there's no substitute for redundant design, locked-clock processors and "voting" hardware, and all of the other low-level safeguards you can use.
For Web applications, however, where a certain sloppiness is tolerable, and where the advantages of load balancing, off-the-shelf hardware and software, and system administration that doesn't require an EE with obsessive-compulsive disorder, clusters are the natural solution.
The fact that you get to sell more licenses for the software is just gravy.
It'll come with a dozen flashing GIFs on the page to "enhance my Web experience."
When Google started Google Maps, one of the coolest things was the scrolling technology. The map database was adequate (not spectactular), and now the overlay satellite data is quite decent but again, not world-beating. But the scrolling works well, integration with the Google search engine is a great plus, and the pages plot cleanly.
MSN has had a lousy look-and-feel since the day that Microsoft debuted it, largely because Microsoft debuted it. It's busy, noisy, hard to use for professional purposes, and it screams "cheap." This "feature" is going to be more of the same.
As a CS/Math/Physics BA, with sixteen years of software experience, and then an MD, residency, and now an active practice of medicine, I have got to say that I have found one seriously stupid way to make a living. The pay's not bad (I make about 50% more than I did as an engineer) and I get to stick people with sharp things once in a while, but other than that you'd be smarter to get the MBA. The hours suck, pretty much, and there aren't very many fields where the question is not whether you will be hit with a multimillion-dollar lawsuit, but when.
Hospital IT is particularly entertaining. I do a lot of it, because I'm the only physician in our large organization who's ever written software for a living. But that means that I'm also the only one who knows how to design, document, or test code. It brings life to the old adage, "in the country of the blind, the one-eyed man is the only one who cares about how damn dark it is."
But hey, if you really want to be a doctor, be one. I love the work. My patients like me, mostly. I actually save lives, once in a while. I get to play with cool toys.
And there is that whole sharp-thing gig going. Imagine being able to actually stick long needles into your software clients, and having them thank you, and getting to bill for it!
In principle, I love it. But it's a matter of equipment and staff. "Stabilizing" a patient requires providing appropriate support for their illness, treatment that might involve one of a thousand drugs, a bunch of different devices, and a subset of several dozen different kinds of trained staff. And then you have to give them time to get better.
Which is what a hospital is all about. It's unfortunate that it's a nest for nosocomial disease, inconvenient for everyone involved, and the kind of place that you don't want to be at unless you don't have a choice. Trying to duplicate hospital-level services at every ill person's home in the field would be hideously expensive, stunningly inefficient, and far more likely to kill people.
As soon as we have a pharmacy, imaging suite, operating suite, and ICU (all including staff) that we can send to the patient and afford to leave at the patient's house for the average length-of-stay for their condition, we can talk about eliminating the central hospital.
I agree that telemedicine is on its way for a variety of things. But as a pediatrician (who spends most of my clinical time in a tertiary-care emergency department) I have to wonder how exactly you send a physical examination via telemedicine. I love the idea of sending vitals, except that I really don't look that much at the exact numbers (I'd like them to have a decent blood pressure, a nonzero pulse, and some reasonable respirations; beyond that, everything's negotiable). The first decision in pediatrics is "sick" versus "not sick", and I'd much rather have an experienced medic giving me their gut feeling than a full data stream from a machine.
On the other hand, I love advance warning, and for the occasional long transport it would be great to be able to check periodically on kids as they come in.
As far as protocols and early treatment, we mostly leave that to the adult-type doctors. Other than the "golden hour" and the ABC's, there aren't a lot of well-defined protocols that mean very much to pediatrics.
Don't kid yourself... they don't have vaccines for the super-bugs developed for use as weapons.
Um, this is almost certainly incorrect. While it's possible that a terrorist who seeks martyrdom might develop a biological weapon as lethal to the terrorist as to his enemy, the coldly rational people who did this research had no such desire.
You need to achieve differential lethality, which is why you use agents to which you can immunize your own forces. In the case of biologicals, you also need to immunize your own population, unless you intend your soldiers to become farmers when they get hungry.
Nobody could guarantee that a real use of these weapons wouldn't spread unchecked and wipe out all humanity (and this is one of the reasons that such agents weren't emphasized more), but even the most crafty weapons designers didn't plan to design slate-wiping agents.
In fact, a 20-ounce jumbo cup of house blend at Starbucks or Second Cup contains almost 400 milligrams of caffeine -- the upper limit of what Health Canada says an adult can consume healthily in a day.
...
"There are certain advantages to caffeine but, after 300 milligrams [daily intake], you start getting into health problems," Dr. Marcone said.
...
Problems arise, he said, when people cut back. "You develop headaches, you are irritable, you seek caffeine to relieve those adverse effects," Dr. El Sohemy said.
...
Health Canada recommends that adults limit their consumption of caffeine to 400 mg daily -- the equivalent of about four small cups of coffee.
The health regulator says that because of its diuretic and stimulant properties coffee can cause insomnia, headaches, irritability and nervousness.
Okay, as a physician and a caffeine user I just have to comment. I have no idea where they came up with their 400 mg/day cutoff, but it wasn't from any published data I've seen. Public health nannies have been looking for something bad about caffeine for decades. From "It'll stunt your growth" to "it'll rot your bones" they keep looking for some reason why we shouldn't drink coffee.
The facts, unfortunately, are quite contrary. Caffeine is a drug, albeit a very benign one. Yes, you can overdose on coffee. A truly unpleasant experience, but one that is quite survivable (in large part because coffee doesn't carry very much caffeine compared to the dangerous dosing). You can overdose on No-Doz too, and that actually is more dangerous because you'll get more in before you start feeling it. Neither, however, is seen very often in actual emergency practice (other ingestants, like alcohol or Tylenol, are MUCH more dangerous in moderate overdose).
Caffeine increases alertness and learning. It's been reliably shown to improve test scores (especially for those of us who can't think without it). Interestingly, large public-health studies have correlated a high caffeine intake with decreased gallstones and with a markedly decreased incidence of type II diabetes, although I'm not fool enough to call it causality when I only have correlation.
And that's it. No increased cancer risk (they checked). No increased hypertension (they checked). No increased risk of coronary artery disease (they checked). No increased risk of psychiatric disease (well, okay, I didn't actually read that one, but most of us in THIS forum came by our psychopathology in other ways anyway).
Doctors are not the world's best source of public health information. They live lifestyles that make programmers look positively healthy (I know - I do both professionally). Still, doctors don't smoke any more (seriously - it's down to a few percent) and they don't drink to excess the way they used to. Drug use is relatively uncommon (although not unheard-of, unfortunately) and seriously frowned upon. But caffeine is ubiquitous in the hospitals and clinics, and there's a good reason. Compared to the stress of getting through the day without it, most of my colleagues share my basic view, which is that there are few Good Things in this world, but coffee is definitely one of them.
First of all, it is not Clear Channel but National Association of Broadcasters that filed the complaint (contrary to what the original posting says) which Clear Channel is one of many members (as someone pointed out, they only got about 10% of the radio market).
They may only have about 10% of the market nationally, but they have every large station in the market I'm exposed to (Denver). Radio stinks in Denver, and it's getting worse. I just about gave up on it until I got my Sirius receiver, and now I actually can listen to music again! I'll happily pay $20 per month for me and my wife to never have to listen to those idiots on KOA ever again.
Also, this request isn't that far out there. After all, local radio and TV stations have to pay fees and licenses to transmit locally, so why shouldn't satellite based radios have to-do the same if they want to have local content? DirecTV and Dish both provide local content, but they are very strict on the fact that you can only get your own local channels due to these rules. I don't see why satellite radio should be any different.
And how does it help me, the consumer, to have these licenses and fees? Why on earth should I want to increase my costs (which is all that adding fees to Sirius would do), just to subsidise the very fools who drove me away in the first place?
Now I wouldn't mind if the satellite services were allowed to have local content based on GPS, but I don't think its right to charge money of one group to transmit local content and not the other.
I'm OK with this. Get rid of the fees for local stations. Lower the cost of entry enough and there might be some free competition again. But Clear Channel killed radio in my community, and I won't weep if they find that a dead horse pulls less freight.
Slashdot Mirror
Obligatory claim of relevance: I am a pediatrician with developmental training. I am also the parent of a teenager with severe autism. It is my informed (but not omniscient) opinion that the odds that this is anything other than a complete red herring are too small to measure accurately.
We will begin with the obvious problem that they are treating autism as a single disorder. We don't know a great deal about the spectrum, but we certainly know that autistic symptoms can be found in a large number of discrete conditions. "Autism" is probably a final common pathway of subtle neurologic failure, and the idea that a single enzyme is associated has been discredited repeatedly. In fact, every time we think we've found "the" cause, more research shows us that we have found, at most, "a" cause, and usually not one that is common. Fragile X syndrome, Rett's syndrome, and others were all previously lumped in as "autism", and I don't think we're done finding things.
The next obvious problem is that if we indeed have a single liposomal storage disease causing most or all autism, you would find it with brain biopsy and/or MRI. We have not found this. You would expect other commonalities as well, since failures of fat metabolism generally have organ impacts outside the brain. We have not found these. I would be unsurprised to discover that there is a rare disorder of this sort with autistic symptoms present, but it means nothing for the vast majority of individuals with autism.
Don't get me wrong - I would give the rest of my life willingly if it would cure my son. I will be grateful beyond words if this works. But it won't, any more than secretin did when it was the last great hope for autism. I have learned much in the fifteen years of my son's life, and the thing I have learned most is that people who claim to have "the cure for autism" are lying. Not always in an evil fashion, and not necessarily knowingly, but they are saying something that is not true.
Thank you, and yes. I have no problem with people trying to eat healthy foods, and my Pop-Tarts comment was irony (which is a dangerous thing on Slashdot), but there is no actual scientific evidence that live culture yogurt does very much for you. It's not harmful, and nobody is foregoing any particular treatment by eating it (unlike the St. John's Wort example, which I've seen). My negativity is the same that I have for any salesman claiming too much for their product.
I have an astonishing fact for people: Activa was created in marketing focus groups, the message was polished to a fine luster with interviews with consumers, and the only reason it is being sold is because its manufacturer wants to make money. This is the way of the world, and I don't even object, but there aren't any altruists here. The product doesn't have to have any value beyond being marketable and, in this case, it really doesn't.
The primary "benefit" delivered by Activa is indeed that of the dietary supplements (and not a few medicines), which is to separate the victim from their available cash and deliver fuzzy science and placebo effect in return.
There is limited data that active culture supplementation can reduce diarrhea duration in acute gastroenteritis, although the studies are small. The effect in irritable bowel syndrome is contentious, but then virtually everything in irritable bowel syndrome is contentious, including the existence of the syndrome as such. In already-healthy people, Activa has no well-supported benefit of which I am aware.
For myself (and as a practicing physician), I don't have a problem with it - if you like your flavored spoiled milk with extra bacteria, by all means, partake. Nearly all food is nonsterile. Much of it has quite a lot of bacteria, and most of them (Taco Bell notwithstanding) are relatively harmless. Personally, I rather prefer Pop-Tarts.
Standardized human embryonic (or adult) stem cell therapies for Parkinson's disease are a long way away. Not months, or even years, but I'd bet at least a decade and a half. Why? Because of exactly the issues shown in this article.
In order to have a successful therapy you have to have the following:
1. A disorder sufficiently well-understood that you can identify the missing cells. Parkinson's is sort of in this class, although the rat model is a pseudo-Parkinsonian condition caused by chemical poisoning of the cells of the substantia nigra, while "classic" Parkinsonism is the death of these cells by an as-yet undetermined mechanism. The difference will be crucial as we get to further steps.
2. A way to use stem cells to recreate the missing cells. This is the step that these researchers seem to be taking here, although even with their new efforts nearly a third of the cells they've produced do something else. The "something else" appears to involve generation of tumors, although this is speculation.
3. A way to get the stem cells into the right place, and to encourage them to divide. Again, apparently the researchers here have made some progress.
4. A way to stop the proliferation of the cells when they've reached replacement, without unwanted spread or effects. This is the step that stymied the study in question, and they're just guessing about why this may have happened. Just fixing this in this one study will take a year or two.
5. Repetition of the study several dozen times, with concomitant improvements in efficiency and safety of the technique. Only a madman would take a single study, no matter how successful, as proof that the technique is understood.
5. Safe transfer to human beings. This is a HUGE step, because of the ethical and legal implications. This won't begin until the techniques are well studied in animals. It also won't begin in the United States, not because of Republican politics, but because of the plaintiff's bar. Phase 1 studies of a technique like this will start in nations with weaker litigation factories and more authoritarian government. Think large countries in Asia with a strong drive to modernize.
6. Formal studies establishing the efficacy of the treatment. This will take years and billions of dollars, and it won't start until the therapy is shown to be safe. What's worse, this is the step that will run afoul of that little problem that I mentioned in step 1. That is, we don't really understand the disorder as well as we might, and it's not too much of a stretch to believe that whatever was killing neurons before will do it again. In which case, the treatment will have no long-term efficacy, and unless re-implantation of the cells is no more difficult than an outpatient infusion (which is NOT the case with current methods), it will be considered to have been a failure. Return to step 1.
This is not to say that this research is futile, or even that we won't see interim benefits as we understand these systems better. Like most things in science, the point of doing the research is to discover the unknown, not to engineer the perfect treatment for a single disease. This is a fascinating study and an excellent piece of science.
I've peer-reviewed papers. I've written peer-reviewed papers. Does this make me a scientist? Does the fact that I wrote those papers in developmental pediatrics with the assistance of a large number of colleagues make me more or less a scientist?
I agree that you can't take a Slashdot reader's word for anything, but I don't ask you to take my word for it. Or rather, I do, but only after I pointed out the most egregious errors. Inadequate proxying for unmeasurables and failure to consider confounders are fatal flaws in a paper, and it doesn't take an "expert" to point them out. That's the cool thing about science - there's no High Church that determines reality. One really nifty piece of data can put a stake through a hundred years' worth of speculation, and there's no way to salvage it.
In the case of the paper in question, they nicely summarized their points in the header and I based my original comment on a review of that summary. I have now had the time to completely read the paper now, and it didn't get better on my complete read. But I don't expect you to believe that either. I just wanted to point out that I consider myself both a physician and a scientist, and while I agree that the two are not proxies for each other, they're not mutually exclusive either.
As a pediatrician trained in child development (and the parent of an autistic teenager), I've got a strong interest and background in this, and I can tell you quite plainly that the paper is crap.
This is a spectacularly good example of really stupid statistical games. I only skimmed it (Acrobat Reader blew up on me as I tried to save it, and I'll get another copy later), but these people did the following amazing things:
1. Accept as fact that autism itself is increasing (as opposed to the diagnosis of autism). This is possible, but contentious and somewhat controversial. I'll spare you the full story, but the general opinion is that while the disorder is more common than it once was, changes in diagnosis (and benefits for diagnosis) make it hard to do more than guess at the actual rate of increase.
2. Consider de novo a hypothesis "that early childhood television watching is an important trigger for the onset of autism." They do note that nobody else has bothered to consider this, but don't spend much time wondering why. Apparently, they're special. Perhaps because nobody has measured this in a useful manner? They do admit this, but they find a solution!
3. Because there are no good numbers for early television watching, they use precipitation as a proxy for television watching. Apparently, if it rains, you're likely inside with the tube on. They do show a strong positive correlation between rainfall and autism. Yep, that's right - rain causes autism.
4. But wait - it can't be the rain, it has to be the television! That's what we started trying to prove, anyway, so it's important to stay focused. They try it another way: they consider the availability of cable. They show that autism correlates with the availability of cable. No, really, it does. Of course, diagnosis of a LOT of chronic developmental syndromes increases with affluence, because of the increased availability of medical care and the reduction in "grab-bag" diagnoses like "mental retardation". But still, it must be the cable.
5. Having neatly done all the "proof" they require, they then proceed to tear the numbers apart and "prove" that 40% of autism in California is triggered by early television watching, while only 17% is triggered in PA. Why, we don't know, but it appears that rain, or cable, or maybe just TV is more powerful in CA than in PA. Or something like that.
I don't have time for a complete fisking right now, but I may do it later. Aside from the basic methodologic errors (confusing correlation with causation, adopting a highly questionable proxy indicator without validating it, and spending almost no time ruling out confounding factors or tainted data), there remain the dozens of smaller tactical problems that should have sidelined this turkey. I assume the peer reviewers, if there are any, were on drugs.
This paper will be a bombshell, all right. I'll use it over and over again as I explain to medical students and colleagues that you don't have to have much in the way of actual brains to write a scientific paper. Or, as I said about another paper in journal club once, "the font is nice, and I like the layout of the tables. It's a shame the actual science is such garbage."
Interesting product, illiterate article.
Fomites (inanimate objects that can spread disease by holding infective organisms between hosts) can spread organisms, but office equipment, including mice and keyboards, has never been shown to contribute to the spread of serious disease. In a hospital environment, especially in something like an ICU where you have multiple providers working with the same computers, this might be an interesting thing to study. In the office, there's no point. You're at far more danger from shaking hands with your co-workers than you are from using their mouse. Tellingly, neither the author of the study nor the manufacturer quote any actual scientific study showing that an antibacterial mouse makes a difference anywhere. This is a talisman, pure and simple.
Which doesn't stop the writer of the article, who breathlessly refers to "the spread of pneumonia, the flu, pink eye and strep throat, among other extremely contagious viruses." As a physician who is continually explaining the difference between viruses and bacteria, and the difference between diseases caused by transmission of specific organisms (like strep) and general conditions that have hundreds of causes (like pink eye or pneumonia), this sentence made me twitch violently. Suffice it to say that with this single phrase, the author ensured that I would ignore the rest of the article as an obvious waste of time.
Fortunately, the manufacturer of the mouse did better. I love the disclaimer:
And there you have it. Remember, don't ingest the damn thing under ANY circumtances.
Speaking as a practicing physician (pediatric hospitalist, to be precise), there are at least three things that are going to keep me from worrying too much about being "rebooted" by a really good CT scanner.
First, there's the unpleasant reality than in medicine the diagnosis is usually not the most important question. I've had about three true diagnostic conundrums in the past two years, and in two of those the question wasn't what was wrong (we were virtually sure it was cancer) but where it was. Yes, in those two cases, a very high-tech scan (a PET/CT) helped make the diagnosis, but for every one of the other hundreds of patients I've seen recently, the key issue was management, where all the 3-d algorithms in the world are brutally inferior to one reasonably well-educated intern.
This is even more important because diagnosis isn't enough, ever. You can't just find the polyps, you have to deal with them. You can't just find the coronary stenosis, you have to repair it. And in both cases, the skill of the physician (and the knowledge to accurately measure benefit and risk) are my real stock in trade. Hand me the diagnosis, and I'm not threatened, I'm thrilled. And since you need a good radiologist to really read the CT well, my radiology colleagues are pretty OK with the new tech as well.
Second, the excerpt is coming from a radiology trade show. I'm glad that the tech is cool, and I love the pictures, but radiology is only a small part of medicine, and most of the non-trauma diagnoses we see aren't really that dependent on a good CT. As other posters have noted, echocardiography and endoscopy do pretty well at all of this, and the CT is at best a screening adjunct that might increase the numbers of people who have the definitive studies. Eventually the imaging will be good enough to really replace colonoscopy (just as it became the standard of care in diagnosis of appendicitis), and I really do hope that it happens before I get to 50. But it's a tiny part of medical care, blown into high relief because it's at a show where nothing else is important. It's like going to an embedded-systems trade show and not noticing that graphics exist, because nobody is embedding 3D in their network storage appliances.
And third, and possibly just because I'm being cynical, I've been replaced by various kinds of high technology since before I even became a doctor. I've been outmoded by fuzzy logic systems, by automated diagnostic software, by genomics, by proteomics, by targeted drug design, and by about fifteen different funding agency mandates. I've been told I'm obsolete so long that the first ones that told me are already dead. Sure, I expect to die myself some day - as far as I know, even in this age of high tech, everybody pretty much does die - but I'm not going to spend much time worrying that technology will make physicians obsolete before then. The game changes, and I practice medicine very differently from the way it was done in my grandfather's day (and thank God that this is so), but as long as I'm willing to employ my intellect and manual skills on behalf of sick kids, there'll be a way to do it.
The only thing that this study "proves" is that the test they used doesn't appear to be a valid measure of accident avoidance.
Over the past fifteen years, cellphone use while driving has increased from nonexistent to ubiquitous. During the same period, the fatality rates and accident rates per passenger mile have fallen to historic lows. Road design, increased use of seat belts, and an apparent reduction in drunk driving have all contributed. (see NHTSA statistics for details)
If cellphone use made any significant difference, you would see the effect in the numbers. There are just too many cellphone users for it to be hidden. If cellphone users really were as bad as drunk drivers, there would be blood in the gutters.
This is not to say that cellphone users are good drivers, or that you're not a better driver if you're not talking on the phone. I'm just pointing out the obvious, which is that driving is a low-risk activity with a large margin for error, and talking on a cellphone, or talking to your passenger, or yelling at your kids, or the million other distractions that drivers endure every day, aren't by themselves enough to use up all that margin.
They probably do statistically increase the chance of an accident, but by the clear and obvious real-world numbers, the degree of increase (or even the fact of increase) is small and quite hard to measure.
Corporate America foots the bill for health insurance. Insurers will do anything they can to reduce payouts, but I'm not as worried about direct discrimination because it will attract the attention of too many people if it becomes egregious.
I'm far more worried about employer nanny-ism: my health care decisions are, at base, between me and my physicians, and I don't want my employer deciding that I should cut back on coffee or increase my BP medications. Even if both would increase my longevity. If it becomes standard, however, to "encourage" employee participation in online health initiatives (read: if you do exactly as we say, we'll lower the "standard" premium from extortionate to barely affordable), then they can decide all sorts of things that I don't want them touching.
Evil is something I can deal with. Blind good intention directly coupled to my paycheck has me far more concerned.
HIPAA privacy regulations (there's a lot more to HIPAA than just privacy) don't for one second prevent you from consenting to the disclosure of your health care information to anybody you choose. It's not a "need to know" thing, it's a consent thing. Your consent to certain kinds of transfers (billing from your doctor to the insurance company) is obtained in writing, while your consent to others (your doctor talking to another treating physician) is implied. Your employer is completely free to solicit your consent to keep information about you, and if they offer enough compensation (read: reduced medical premiums), a lot of people will consider it.
If you consent to giving your employer all or part of your entire medical record, and if your employer has the means and the desire to obtain it, there's no HIPAA protection at all.
Which doesn't mean that this is what Dell is doing here. In fact, this has nothing to do with what Dell is doing. Dell's press release is just an attempt to dress up a fairly prosaic web service as a "breakthrough" in medical IT, and in so doing inflate the visibility of a fairly minor federal bureaucrat.
From TFA:
So let me get this straight - this incredible new initiative is actually a lightly-used website, run by WebMD, that Dell employees have had for the past two years. And the newness is that the system can now "electronically" capture results. And Dell trumpets this in a major news release.
We will set aside the interesting question of how (and whether) WebMD has convinced thousands of independent labs, as well as laboratory giants like LabCorp, to send results to WebMD. We will ignore the HIPAA regulations that will require patients to sign releases with anyone sending results to WebMD. We will overlook the balkanized, backward, and poorly-penetrated electronic medical records world in which these patients' doctors work.
Even if all of these things were somehow not an issue, does anybody except Dell and WebMD marketing droids really believe that the only thing that was preventing this dramatic breakthrough from revolutionizing medical care for everybody was the lack of a stupid HL-7 interface?
Oh, wait. Never mind. Check the last part of the article:
Yup. Sure. Got it. Tinfoil hats meet blue-sky dreamers, and the result is ugly.
Interesting. The PDF, of course, is a review of the work and not the work itself. More suspicious (to me) is that since this is a published book (and a book that is a general work, as opposed to one focused on autism), the age of Spitzer's references is likely to be more than a few years old. This is almost always a problem in the study of autism, because much of the work done prior to the past ten years is heavily confounded.
Autism (and Asperger's for that matter) is a syndrome diagnosis. We don't have an underlying pathology that we can point to, and there are no imaging, genetic, or testing studies that are pathognomonic (that make the diagnosis in and of themselves). We basically say that if you have enough of the behavioral criteria and if there isn't any underlying etiology that better accounts for your symptoms, then you have autism. And with the symptoms not all that specific (as another poster noted, half of Slashdot's regular readers have some of them), it's an easy diagnosis to apply to a child with an unexplained developmental problem.
Prior to the genetic studies for Fragile X, and prior to finding the marker for Rett's syndrome, and prior to the FISH for Prader-Willi, a lot of kids with those diagnoses (in aggregate, more common than severe autism itself) wound up with diagnoses of autism. Biologic research on their brains poisoned much of the research into what we call "autism", because in fact they weren't really autistic and the now-recognized characteristic changes in their biology got mixed in and called part of the findings of autism.
I appreciate the reference, though, and I'll go check it out further. Spitzer might indeed be one of those myriad neuropsychoanatomy books that are more speculative than definitive, but I'm not so arrogant as to dismiss out of hand a book I haven't even skimmed.
Not to rain too much on this lovely parade, but you're nowhere near as right as you used to be. Things have changed a lot in the past few years.
I'm a doctor. Licensed, boarded, and practicing full-time. I haven't personally seen a drug representative in the past four years. I work at several hospitals; the tertiary-care teaching hospital I'm attending at today no longer permits drug companies to buy lunch for residents. Nobody is going on drug-company sponsored trips. There are still some docs who go to the educational dinners (I don't, mostly, because if I'm going to go out to dinner I prefer to choose better company), but the educational part of the discussion is now done by independent practitioners and they are strictly required to disclose any financial conflicts of interest.
I'm also on the Medication Safety committee (formerly the Pharmacy and Therapeutics committee) at the new hospital in my neighborhood. This committee must approve all medications on formulary at the hospital. Not only are drug representatives not seen at these meetings, but they are banned from the hospital. They are allowed to contact the manager of the pharmacy, but are strictly forbidden to give any gifts of any kind (even promotional freebies). Even the infant formula representatives are banned, and the hospital is not allowed to accept free formula, or free drugs, or other "free" incentives. We do, of course, negotiate the best deals on drugs that we can get, but the actual deal-negotiation occurs separately from the review and approval of these drugs.
I buy my own pens and office stationary at Office Depot. My sticky-notes say "Post-It" on the wrapper like anyone else's.
I'm not saying that all doctors are like me. There are probably a whole bunch of them who do things the old way and who suck up all the free stuff they can get in exchange for listening to the detail rep speak. But I don't actually know any docs like that any more. There's a huge ethical concern about the issue, and it's not going away.
And the drug companies know it. They're changing tactics rapidly.
Notice how many drug ads are on the television these days? Want to know where the money for marketing is being spent? Don't look at me, look at the mirror. These days, the patients themselves are the targets for the drug companies. The days of lavish incentives for physicians and parmacists are passing fast, and good riddance.
"Combination" patents and line extensions are very real, but they don't usually add that much, since you can't patent a new indication, you have to patent a new medication. Meaning you have to test it, in detail, and release it only after the FDA approves it. Generally these line-extension patents add a few years to the patented use of the drug, but only if you and your doctor are too stupid to use the non-combination meds. Claritin-D is patented. Taking a generic loratadine tablet along with a generic pseudoephedrine tablet is not only not patented, it's about a tenth the price.
Not to nit-pick too much, but from that study we now know how to make non-cytotoxic buckyballs, or at least how to control their cytotoxicity. The test was just cell culture driven, and suggested that modifications to the buckyballs reduced their general cytotoxicity in culture. A mechanism (free radical generation by the buckyball) was suggested but has not been proven.
The article stated, and I heartily endorse the statement, that this is not a full toxicologic risk assessment, but simply a first step.
Having said that, however, that first step was a big one and an important one.
I've built medical devices before. This is in essence a medical device. If this were being used in a medical laboratory for medical purposes, source code changes which were not properly recertified would void the FDA approval for the device. There's a reason for that.
It's a truism in software that you can't verify the absence of bugs by black-box testing, no matter how complete the test vectors. This is doubly true when the software is interacting with the real world, in a nontrivial manner.
Consider: The device undoubtedly measures a change in itself that occurs in response to the presence of ethanol. A voltage is produced, a current is seen, or a color change occurs in some sensitized material. Some chemical reaction occurs, and produces a detectable change in the device state. But because chemical reactions are susceptible to variation in temperature, in the age of the reagents, in the particular lot of the reagents, and in subtle machine-to-machine differences between reaction sites, the software for the machine must contain built-in adjustments for all of this. If you have a half-dozen linear adjustments that you have to make (not uncommon, in laboratory equipment), the six-dimensional test vectors that you have to check are massive. If you have a dozen such factors, you literally can't test enough combinations to be sure that every combination works. And even worse, you have to verify that the machine is in a known state at the beginning of such a test, and without access to the source you have no way of knowing.
The question isn't whether the machine can be made to work in a laboratory setting. The question is whether the machine worked this time, in the middle of the night, in an un-airconditioned drunk tank in God-knows-where, as the thirty-fifth breath test that night. If you don't have the source code, you literally can't possibly know what the chances are that it really worked.
As much as I hate drunk drivers, and as much as I think that the machines are probably pretty good, I'm with the defense attorneys here: produce the source, or stop pretending that this machine can produce proof beyond reasonable doubt.
Having built both true high-reliability fault-tolerant devices and clustered systems, I don't see any fundamental theoretical difference. In both cases, you have redundant hardware capacity in place, theoretically to allow you to tolerate the failure of a certain amount of your hardware (and, sometimes, your software) for a certain amount of time. Neither option guards you against failures outside of the cluster or FT system box. Neither one is a panacea. Both are sold as snake-oil insurance against "badness".
In a single fault-tolerant box, you generally have environmental monitoring, careful attention to error detection, and automatic failover. You also have customer-replaceable units for failure-prone components, utiilties for managing all of the redundancy, and a fancy nameplate. In exchange for that, you have more complexity, more cost, serious custom hardware and software modifications, and often (but not always) performance constraints.
In a clustered system, you treat each individual server as a failure unit. Good fault detection is a challenge, especially for damaging but non-catastrophic failure, but it's much easier to configure a given level of redundancy and it's easier to take care of environmental problems like building power (or water in the second floor) -- you just configure part of the cluster a longer distance away.
Where clustering is inadequate is when you have a single mission-critical system where any failure is disaster (like flight-control avionics or nuclear power plant monitoring). There are applications where there's no substitute for redundant design, locked-clock processors and "voting" hardware, and all of the other low-level safeguards you can use.
For Web applications, however, where a certain sloppiness is tolerable, and where the advantages of load balancing, off-the-shelf hardware and software, and system administration that doesn't require an EE with obsessive-compulsive disorder, clusters are the natural solution.
The fact that you get to sell more licenses for the software is just gravy.
It's MSN.
It'll only run well on IE.
It'll come with a dozen flashing GIFs on the page to "enhance my Web experience."
When Google started Google Maps, one of the coolest things was the scrolling technology. The map database was adequate (not spectactular), and now the overlay satellite data is quite decent but again, not world-beating. But the scrolling works well, integration with the Google search engine is a great plus, and the pages plot cleanly.
MSN has had a lousy look-and-feel since the day that Microsoft debuted it, largely because Microsoft debuted it. It's busy, noisy, hard to use for professional purposes, and it screams "cheap." This "feature" is going to be more of the same.
As a CS/Math/Physics BA, with sixteen years of software experience, and then an MD, residency, and now an active practice of medicine, I have got to say that I have found one seriously stupid way to make a living. The pay's not bad (I make about 50% more than I did as an engineer) and I get to stick people with sharp things once in a while, but other than that you'd be smarter to get the MBA. The hours suck, pretty much, and there aren't very many fields where the question is not whether you will be hit with a multimillion-dollar lawsuit, but when.
Hospital IT is particularly entertaining. I do a lot of it, because I'm the only physician in our large organization who's ever written software for a living. But that means that I'm also the only one who knows how to design, document, or test code. It brings life to the old adage, "in the country of the blind, the one-eyed man is the only one who cares about how damn dark it is."
But hey, if you really want to be a doctor, be one. I love the work. My patients like me, mostly. I actually save lives, once in a while. I get to play with cool toys.
And there is that whole sharp-thing gig going. Imagine being able to actually stick long needles into your software clients, and having them thank you, and getting to bill for it!
In principle, I love it. But it's a matter of equipment and staff. "Stabilizing" a patient requires providing appropriate support for their illness, treatment that might involve one of a thousand drugs, a bunch of different devices, and a subset of several dozen different kinds of trained staff. And then you have to give them time to get better.
Which is what a hospital is all about. It's unfortunate that it's a nest for nosocomial disease, inconvenient for everyone involved, and the kind of place that you don't want to be at unless you don't have a choice. Trying to duplicate hospital-level services at every ill person's home in the field would be hideously expensive, stunningly inefficient, and far more likely to kill people.
As soon as we have a pharmacy, imaging suite, operating suite, and ICU (all including staff) that we can send to the patient and afford to leave at the patient's house for the average length-of-stay for their condition, we can talk about eliminating the central hospital.
I agree that telemedicine is on its way for a variety of things. But as a pediatrician (who spends most of my clinical time in a tertiary-care emergency department) I have to wonder how exactly you send a physical examination via telemedicine. I love the idea of sending vitals, except that I really don't look that much at the exact numbers (I'd like them to have a decent blood pressure, a nonzero pulse, and some reasonable respirations; beyond that, everything's negotiable). The first decision in pediatrics is "sick" versus "not sick", and I'd much rather have an experienced medic giving me their gut feeling than a full data stream from a machine.
On the other hand, I love advance warning, and for the occasional long transport it would be great to be able to check periodically on kids as they come in.
As far as protocols and early treatment, we mostly leave that to the adult-type doctors. Other than the "golden hour" and the ABC's, there aren't a lot of well-defined protocols that mean very much to pediatrics.
Um, this is almost certainly incorrect. While it's possible that a terrorist who seeks martyrdom might develop a biological weapon as lethal to the terrorist as to his enemy, the coldly rational people who did this research had no such desire.
You need to achieve differential lethality, which is why you use agents to which you can immunize your own forces. In the case of biologicals, you also need to immunize your own population, unless you intend your soldiers to become farmers when they get hungry.
Nobody could guarantee that a real use of these weapons wouldn't spread unchecked and wipe out all humanity (and this is one of the reasons that such agents weren't emphasized more), but even the most crafty weapons designers didn't plan to design slate-wiping agents.
...
"There are certain advantages to caffeine but, after 300 milligrams [daily intake], you start getting into health problems," Dr. Marcone said.
...
Problems arise, he said, when people cut back. "You develop headaches, you are irritable, you seek caffeine to relieve those adverse effects," Dr. El Sohemy said.
...
Health Canada recommends that adults limit their consumption of caffeine to 400 mg daily -- the equivalent of about four small cups of coffee. The health regulator says that because of its diuretic and stimulant properties coffee can cause insomnia, headaches, irritability and nervousness.
Okay, as a physician and a caffeine user I just have to comment. I have no idea where they came up with their 400 mg/day cutoff, but it wasn't from any published data I've seen. Public health nannies have been looking for something bad about caffeine for decades. From "It'll stunt your growth" to "it'll rot your bones" they keep looking for some reason why we shouldn't drink coffee.
The facts, unfortunately, are quite contrary. Caffeine is a drug, albeit a very benign one. Yes, you can overdose on coffee. A truly unpleasant experience, but one that is quite survivable (in large part because coffee doesn't carry very much caffeine compared to the dangerous dosing). You can overdose on No-Doz too, and that actually is more dangerous because you'll get more in before you start feeling it. Neither, however, is seen very often in actual emergency practice (other ingestants, like alcohol or Tylenol, are MUCH more dangerous in moderate overdose).
Caffeine increases alertness and learning. It's been reliably shown to improve test scores (especially for those of us who can't think without it). Interestingly, large public-health studies have correlated a high caffeine intake with decreased gallstones and with a markedly decreased incidence of type II diabetes, although I'm not fool enough to call it causality when I only have correlation.
And that's it. No increased cancer risk (they checked). No increased hypertension (they checked). No increased risk of coronary artery disease (they checked). No increased risk of psychiatric disease (well, okay, I didn't actually read that one, but most of us in THIS forum came by our psychopathology in other ways anyway).
Doctors are not the world's best source of public health information. They live lifestyles that make programmers look positively healthy (I know - I do both professionally). Still, doctors don't smoke any more (seriously - it's down to a few percent) and they don't drink to excess the way they used to. Drug use is relatively uncommon (although not unheard-of, unfortunately) and seriously frowned upon. But caffeine is ubiquitous in the hospitals and clinics, and there's a good reason. Compared to the stress of getting through the day without it, most of my colleagues share my basic view, which is that there are few Good Things in this world, but coffee is definitely one of them.
They may only have about 10% of the market nationally, but they have every large station in the market I'm exposed to (Denver). Radio stinks in Denver, and it's getting worse. I just about gave up on it until I got my Sirius receiver, and now I actually can listen to music again! I'll happily pay $20 per month for me and my wife to never have to listen to those idiots on KOA ever again.
Also, this request isn't that far out there. After all, local radio and TV stations have to pay fees and licenses to transmit locally, so why shouldn't satellite based radios have to-do the same if they want to have local content? DirecTV and Dish both provide local content, but they are very strict on the fact that you can only get your own local channels due to these rules. I don't see why satellite radio should be any different.
And how does it help me, the consumer, to have these licenses and fees? Why on earth should I want to increase my costs (which is all that adding fees to Sirius would do), just to subsidise the very fools who drove me away in the first place?
Now I wouldn't mind if the satellite services were allowed to have local content based on GPS, but I don't think its right to charge money of one group to transmit local content and not the other.
I'm OK with this. Get rid of the fees for local stations. Lower the cost of entry enough and there might be some free competition again. But Clear Channel killed radio in my community, and I won't weep if they find that a dead horse pulls less freight.