This. China has very strict ad rules that are subject to change. Some are strict in regards to avoiding false advertising and some are more about censorship.
I know of a group who has created products directed at ad agencies there. The products are used to screen for banned types of wording so the ad agency can more easy create ads that will not violate local law. This is apparently hard to do. Taking all their ideas to a legal team first is expensive and time consuming. They use the tools to filter down to verbiage that is more likely to be acceptable. Something like that.
Physician here. Arguably, no intervention is health care is 100% effective.
It is maddening that anti-vaxxers say vaccines are not 100% effective so they are ineffective. It is flawed logic. Effective means it makes a difference when studied in a large group of people. Not effective means it has no effect on a large study group.
Many interventions in health care have numbers needed to treat (NNT) in the 10 or even 100 range to create one positive outcome. These are effective interventions. Vaccines are highly effective compared to most other interventions done in healthcare. Finding effective interventions in health care is hard.
On the other hand, antivaxxers and the like often push vitamins, herbs, adjustments, accupuncture and all sorts of other interventions that have no proven efficacy or even have been proven to have no efficacy (NNT is infinity!). There logic is literally backwards.
This 'recent' discovery is hardly proven to be true yet. At least two large studies are in progress to confirm, or reject, those early findings.
Sepsis historically has had many preliminary studies suggest a positive intervention only to be shown later it is ineffective or even harmful when studied fully. Further, even if we assume this intervention is effective, its not clear whether all three, two of the three or just one of the ingredients in necessary. We already know in some cases steroids can be helpful.
Inject-able vitamin C has plenty of history of overhyped effects followed by studies that show it has no significant effect. This is especially true as an intervention for cancer.
It should be highly emphasized many of these tests are of questionable utility in the real world. How to interpret the results is often not at all intuitive. Its a wild west type of situation and I generally wouldn't recommend having any of these done without proper guidance.
That sounds about right. There are a lot of problems with health care today. One that is really unappreciated is how bad hospital admins are and enabling their highly trained workers to do their job. Its a joke. The US system has purposefully shifted power to them over the last 15-20 years. Its not surprising now that physician satisfaction is very low and their suicide rate is now among the highest of all professions. That's what happens when lessor trained people tell well-intentioned highly trained people how to do their job.
When I was at the non-profit, I took on a number of admin task related to EMRs. While I did enjoy what improvements I could enable, it was always an uphill battle. They never want to support anything that would require any effort beyond a day or two of developer time. They minimize physician needs based on the grumpy bad players or those that bring in a lot of revenue - not the well intended majority.
I wasn't allowed to perform at a level I was comfortable with. I'm a physician.
Too many people often with training that is not the same as mine (MBA vs MD or nurse admin vs MD) trying to tell me how I should to my job. Being forced to use EHRs that are just good enough for the hospital admins to okay but are nowhere close to what physicians need to perform well. There is only so much time in a day. Not completing all the task you'd like the way you feel they should be after 12-14 hours of work with no lunch or rest is very disheartening on many levels. Experiencing this nearly every day has a way of killing your spirit. After 10+ years I said no more. I had worked at an acedemic cetner and later a community non-profit.
I work in medical informatics now so I am able to solve some of the EMR problems plaguing physicians today. I only practice medicine on weekends - the hospital admins and insurance company representatives are off. Practicing medicine this way is much more enjoyable.
It really depends on what it is your are trying to assess and who you believe. If we are trying to determine the total amount of the expenses that eventually lands in the doctors actual income, 10% seems to be the most widely accepted number. If you go to the CMS website, in their expenditure reports the category "physician and clinical services" is listed as 20% of their expenditures in a given year. Some people quote this value; however, this percentage includes more than just take home income to the provider - it includes equipment and other overhead expenses, I believe. Thus, some chunk of this will never make it to the physician. (this is a little out of my area of expertise but it is something like this). On the other hand, some sources will claim the actual percentage is as low as 5%. Some groups will use this number but my memory is this is a somewhat disingenuously low percentage because it leaves out some less common methods by which a physician can make money from today's system (such as owning their own surgical center). Most experts believe all things considered the true percentage in the US is about 10%. This is actually lower than many other countries when looked at as a percentage of total expenditures.
I know someone who is an expert on these matters and runs a company geared towards helping insurance companies both save money and improve quality. She often says, "Can you really afford to hire the cheapest doctors?" This is because doctors, NPs and PAs generate a huge number of tests, referrals and such whose costs far exceed what that practitioner makes. On the whole, a high quality physician vs a lower quality one will order fewer tests and make fewer referral by sticking with best practices and will overall save resources.
True, Canada does have NPs. I am aware of that - it was a oversight on my part because a lot of the work I do considers Canada domestic, even though they really aren't.
Anyway, most countries do no use NPs or PAs. As you said, there is no evidence they save money.
In the US, about 10% of all expenditures go to physician fees so even if they did save money, its not the kind of money they will be a big difference maker.
"Decades ago it was obvious that many doctors could be replaced, since a nurse using a paper checklist could diagnose with the same accuracy"
I'm not aware of any studies of substance that substantiate such a bold claim. I am aware of some weak studies looking at NPs managing chronic diseases that had already been diagnosed. Perhaps that is what you are referring to?
"This is exactly what was done in many countries, with nurses or PAs handling the routine cases"
Really? Most health care providers in Europe and Australia have never heard of or worked with a PA or NP. Further, I've never heard of their nurses making diagnosis or managing diseases.
I work for an international health care company so I have some idea of the lay of the land here. If you have some sources to back this up, I'm interested. Otherwise, I'm fairly sure this is just BS.
The study is consistent with the possibility that it could improve glycemic control for patients with other types of hyperglycemic disorders (ie. type 2 diabetes mellitus or pre-diabetes) but it certainly hasn't proven this.
To be clear, the intervention is not a cure for type I diabetes mellitus. The authors go out of there way to prove and explain this:
"In this study we observe the long term and stable lowering of blood sugars in humans after BCG vaccinations. In the human, this stable blood sugar control was not driven primarily in these human subjects by pancreas recovery or regeneration. The human pancreas after BCG even at four years after repeat vaccinations did not secrete significant insulin as clinically measured by C-peptide. The mechanism for lowered HbA1c values was not equivalent to the NOD diabetic mouse pancreas regeneration after BCG treatment, despite equally restored and long term improved blood sugar control. The BCG-treated type 1 diabetic subjects at year 4 after glucagon challenge had a negligible to no return of clinically significant C-peptide. The C-peptide values after glucagon were in the range of 2–3 pmol/L of C-peptide (Fig. 1c), but with no known clinical significance. Therefore we concluded that BCG vaccinations did not induce a clinically meaningful return of C-peptide levels in the pancreas by regeneration, as observed in the NOD mouse model of diabetes17,18 Thus pancreas rescue or regeneration could not fully account for the persistent and long term HbA1c lowering in humans receiving BCG."
The study didn't include type 2 so we really can't say how this intervention will work on that group; however, I don't see a reason to think it wouldn't be effective in this group.
This is a really interesting study. I've been heavily involved in the past with diabetes mellitus management. This is a novel approach as far as I know. This may revolutionize the approach to treatment for many with diabetes mellitus.
The reason I said hospital system leadership today has some interest in improving outcomes is only because of standards and policies the government is imposing. It is not because any of them really care in action (most don't). It is because CMS will withhold reimbursements if a system is deemed to have bad care over a limited set of metrics.
They sort of care only because they don't want to lose money. That is all. I have been part of projects to improve the results of these metrics. The only reason the support for the project existed was these policies. Whether or not solving to the metrics really improves meaningful outcomes is a whole other issue.
It is underinvested, poorly organized with focus on maximizing income streams for health care systems rather than improving health care outcome.
I've seen enough at this point in my career in several organizations - some are hospital systems, some a health IT vendors - to be confident about this. Much of the developed systems were overseen by people with little to no real world healthcare experience. They made decisions directed to satisfy hospital system leadership which has had no serious vested interest in improving outcomes until the last few years. Most hospital systems leader have no background taking care of patients or whatever experience they have is seriously limited.
Because I've practiced medicine (and still do) it is been appalling to me to see who is making the decisions and why.
Now that I work for a large healthcare IT vendor and I have quite a bit of autonomy directing our resources to create content and tools that are more useful to the actual health care providers, the problem is we are understaffed to provide these products as thoroughly with as high a quality as they should be. One reason is because we have to undo much of the legacy crap - 20+ years of having non-clinical people doing this has led to frankly incorrect data and logic. If we could start with a fresh plate it would be much easier. Another is, no one wants to pay for clinically experienced people who know how to review scientific data to actually research the problems or the clinical literature to make fully informed decisions.
The chicken pox vaccine is not 'highly likely' to cause a case of Chicken Pox. Does it happen? Absolutely. It doesn't happen often, though. The few case I've seen in my entire career have been one to three lesions. Nothing close to the actual disease.
Is it effective, sure it is. Hardly any vaccinated kids get the disease anymore. When they do, it is also very minimal.
Does it prevent shingles? It might. Japan was the first country to start using the vaccine - a decade or two before the US. The last I checked, and I will grant I haven't looked at there data in about five years, their rate of shingles in adults seems to have gone done quite a bit suggesting that it is indeed effective at preventing shingles.
Agreed. I have two runs of RG-6 to each room in my house plus two runs of Cat6a. Use quad shielded RG-6 coax, btw, its a must for some systems such as satellite. Doing this now will prevent lazy installers from drilling holes all over your house later
Similar story for me. I used a palm pre for about a year. The OS was great. Much more intuitive and easier to use than Android. Its hardware issues and lack of software forced me to change. I use a Samsung Epic now which I like immensely but it has its quirks and took a several days of regular use to become familiar with. On the other hand, the palm pre I had figured out to to a point I was very comfortable with its use in 1-2 hours.
I've invited about 70 people since early this month and as far as I know they all registered without a problem. It did take me 24 hours after my invitation was received to be granted access.
Seriously. If you have an answer then tell me what it is so I can critique it. I'm a physician and part of my job is critiquing articles for a living, so please share.
So far I'm not sure what your point is other than the placebo effect exists which is common knowledge.
Subjectively people will get better from a sugar pill during a cold. Good for them I'm not aware of any objective improvement. Are you? I've read quite of few of the studies and must have missed the objective parts....things readily measured, not just reported by patients, like duration of fever or hospitalization rate.
I'm very well aware of what the placebo effect is.
So docs should prescribe antibiotics to people unnecessarily just so people think they will get better? Is that what you are trying to say? Give the potential side effects and resistance issues (ie MRSA), that doesn't make a damn bit of sense. We don't rx placebos in practice (only in studies) because it is considered unethical.
Slashdot Mirror
This. China has very strict ad rules that are subject to change. Some are strict in regards to avoiding false advertising and some are more about censorship.
I know of a group who has created products directed at ad agencies there. The products are used to screen for banned types of wording so the ad agency can more easy create ads that will not violate local law. This is apparently hard to do. Taking all their ideas to a legal team first is expensive and time consuming. They use the tools to filter down to verbiage that is more likely to be acceptable. Something like that.
A herbicide is by many considered a type of pesticide. This includes the EPA. Calling glyphosate a pesticide isn't wrong; its just less specific.
https://www.beyondpesticides.o....
https://www.epa.gov/minimum-ri...
Otherwise, I wholeheartedly agree.
Physician here. Arguably, no intervention is health care is 100% effective.
It is maddening that anti-vaxxers say vaccines are not 100% effective so they are ineffective. It is flawed logic. Effective means it makes a difference when studied in a large group of people. Not effective means it has no effect on a large study group.
Many interventions in health care have numbers needed to treat (NNT) in the 10 or even 100 range to create one positive outcome. These are effective interventions. Vaccines are highly effective compared to most other interventions done in healthcare. Finding effective interventions in health care is hard.
On the other hand, antivaxxers and the like often push vitamins, herbs, adjustments, accupuncture and all sorts of other interventions that have no proven efficacy or even have been proven to have no efficacy (NNT is infinity!). There logic is literally backwards.
Sorry, I did not realize I was communicating with a wacko. Will avoid wasting my time in the future.
This 'recent' discovery is hardly proven to be true yet. At least two large studies are in progress to confirm, or reject, those early findings.
Sepsis historically has had many preliminary studies suggest a positive intervention only to be shown later it is ineffective or even harmful when studied fully. Further, even if we assume this intervention is effective, its not clear whether all three, two of the three or just one of the ingredients in necessary. We already know in some cases steroids can be helpful.
Inject-able vitamin C has plenty of history of overhyped effects followed by studies that show it has no significant effect. This is especially true as an intervention for cancer.
I wouldn't hold by breath.
Genetic counselors function as analysts.
It should be highly emphasized many of these tests are of questionable utility in the real world. How to interpret the results is often not at all intuitive. Its a wild west type of situation and I generally wouldn't recommend having any of these done without proper guidance.
That sounds about right. There are a lot of problems with health care today. One that is really unappreciated is how bad hospital admins are and enabling their highly trained workers to do their job. Its a joke. The US system has purposefully shifted power to them over the last 15-20 years. Its not surprising now that physician satisfaction is very low and their suicide rate is now among the highest of all professions. That's what happens when lessor trained people tell well-intentioned highly trained people how to do their job.
When I was at the non-profit, I took on a number of admin task related to EMRs. While I did enjoy what improvements I could enable, it was always an uphill battle. They never want to support anything that would require any effort beyond a day or two of developer time. They minimize physician needs based on the grumpy bad players or those that bring in a lot of revenue - not the well intended majority.
I wasn't allowed to perform at a level I was comfortable with. I'm a physician.
Too many people often with training that is not the same as mine (MBA vs MD or nurse admin vs MD) trying to tell me how I should to my job. Being forced to use EHRs that are just good enough for the hospital admins to okay but are nowhere close to what physicians need to perform well. There is only so much time in a day. Not completing all the task you'd like the way you feel they should be after 12-14 hours of work with no lunch or rest is very disheartening on many levels. Experiencing this nearly every day has a way of killing your spirit. After 10+ years I said no more. I had worked at an acedemic cetner and later a community non-profit.
I work in medical informatics now so I am able to solve some of the EMR problems plaguing physicians today. I only practice medicine on weekends - the hospital admins and insurance company representatives are off. Practicing medicine this way is much more enjoyable.
It really depends on what it is your are trying to assess and who you believe. If we are trying to determine the total amount of the expenses that eventually lands in the doctors actual income, 10% seems to be the most widely accepted number. If you go to the CMS website, in their expenditure reports the category "physician and clinical services" is listed as 20% of their expenditures in a given year. Some people quote this value; however, this percentage includes more than just take home income to the provider - it includes equipment and other overhead expenses, I believe. Thus, some chunk of this will never make it to the physician. (this is a little out of my area of expertise but it is something like this). On the other hand, some sources will claim the actual percentage is as low as 5%. Some groups will use this number but my memory is this is a somewhat disingenuously low percentage because it leaves out some less common methods by which a physician can make money from today's system (such as owning their own surgical center). Most experts believe all things considered the true percentage in the US is about 10%. This is actually lower than many other countries when looked at as a percentage of total expenditures.
I know someone who is an expert on these matters and runs a company geared towards helping insurance companies both save money and improve quality. She often says, "Can you really afford to hire the cheapest doctors?" This is because doctors, NPs and PAs generate a huge number of tests, referrals and such whose costs far exceed what that practitioner makes. On the whole, a high quality physician vs a lower quality one will order fewer tests and make fewer referral by sticking with best practices and will overall save resources.
True, Canada does have NPs. I am aware of that - it was a oversight on my part because a lot of the work I do considers Canada domestic, even though they really aren't.
Anyway, most countries do no use NPs or PAs. As you said, there is no evidence they save money.
In the US, about 10% of all expenditures go to physician fees so even if they did save money, its not the kind of money they will be a big difference maker.
"Decades ago it was obvious that many doctors could be replaced, since a nurse using a paper checklist could diagnose with the same accuracy"
I'm not aware of any studies of substance that substantiate such a bold claim. I am aware of some weak studies looking at NPs managing chronic diseases that had already been diagnosed. Perhaps that is what you are referring to?
"This is exactly what was done in many countries, with nurses or PAs handling the routine cases"
Really? Most health care providers in Europe and Australia have never heard of or worked with a PA or NP. Further, I've never heard of their nurses making diagnosis or managing diseases.
I work for an international health care company so I have some idea of the lay of the land here. If you have some sources to back this up, I'm interested. Otherwise, I'm fairly sure this is just BS.
The study is consistent with the possibility that it could improve glycemic control for patients with other types of hyperglycemic disorders (ie. type 2 diabetes mellitus or pre-diabetes) but it certainly hasn't proven this.
To be clear, the intervention is not a cure for type I diabetes mellitus. The authors go out of there way to prove and explain this:
"In this study we observe the long term and stable lowering of blood sugars in humans after BCG vaccinations. In the human, this stable blood sugar control was not driven primarily in these human subjects by pancreas recovery or regeneration. The human pancreas after BCG even at four years after repeat vaccinations did not secrete significant insulin as clinically measured by C-peptide. The mechanism for lowered HbA1c values was not equivalent to the NOD diabetic mouse pancreas regeneration after BCG treatment, despite equally restored and long term improved blood sugar control. The BCG-treated type 1 diabetic subjects at year 4 after glucagon challenge had a negligible to no return of clinically significant C-peptide. The C-peptide values after glucagon were in the range of 2–3 pmol/L of C-peptide (Fig. 1c), but with no known clinical significance. Therefore we concluded that BCG vaccinations did not induce a clinically meaningful return of C-peptide levels in the pancreas by regeneration, as observed in the NOD mouse model of diabetes17,18 Thus pancreas rescue or regeneration could not fully account for the persistent and long term HbA1c lowering in humans receiving BCG."
The study didn't include type 2 so we really can't say how this intervention will work on that group; however, I don't see a reason to think it wouldn't be effective in this group.
This is a really interesting study. I've been heavily involved in the past with diabetes mellitus management. This is a novel approach as far as I know. This may revolutionize the approach to treatment for many with diabetes mellitus.
It is possible and common to both use anonymized patient data and remain HIPAA compliant.
The reason I said hospital system leadership today has some interest in improving outcomes is only because of standards and policies the government is imposing. It is not because any of them really care in action (most don't). It is because CMS will withhold reimbursements if a system is deemed to have bad care over a limited set of metrics.
They sort of care only because they don't want to lose money. That is all. I have been part of projects to improve the results of these metrics. The only reason the support for the project existed was these policies. Whether or not solving to the metrics really improves meaningful outcomes is a whole other issue.
It is underinvested, poorly organized with focus on maximizing income streams for health care systems rather than improving health care outcome.
I've seen enough at this point in my career in several organizations - some are hospital systems, some a health IT vendors - to be confident about this. Much of the developed systems were overseen by people with little to no real world healthcare experience. They made decisions directed to satisfy hospital system leadership which has had no serious vested interest in improving outcomes until the last few years. Most hospital systems leader have no background taking care of patients or whatever experience they have is seriously limited.
Because I've practiced medicine (and still do) it is been appalling to me to see who is making the decisions and why.
Now that I work for a large healthcare IT vendor and I have quite a bit of autonomy directing our resources to create content and tools that are more useful to the actual health care providers, the problem is we are understaffed to provide these products as thoroughly with as high a quality as they should be. One reason is because we have to undo much of the legacy crap - 20+ years of having non-clinical people doing this has led to frankly incorrect data and logic. If we could start with a fresh plate it would be much easier. Another is, no one wants to pay for clinically experienced people who know how to review scientific data to actually research the problems or the clinical literature to make fully informed decisions.
The chicken pox vaccine is not 'highly likely' to cause a case of Chicken Pox. Does it happen? Absolutely. It doesn't happen often, though. The few case I've seen in my entire career have been one to three lesions. Nothing close to the actual disease.
Is it effective, sure it is. Hardly any vaccinated kids get the disease anymore. When they do, it is also very minimal.
Does it prevent shingles? It might. Japan was the first country to start using the vaccine - a decade or two before the US. The last I checked, and I will grant I haven't looked at there data in about five years, their rate of shingles in adults seems to have gone done quite a bit suggesting that it is indeed effective at preventing shingles.
Agreed. I have two runs of RG-6 to each room in my house plus two runs of Cat6a. Use quad shielded RG-6 coax, btw, its a must for some systems such as satellite. Doing this now will prevent lazy installers from drilling holes all over your house later
I'll agree with this. It just works and does so quickly.
Add a good shredder and a secure redundant storage system and you're good to go.
Similar story for me. I used a palm pre for about a year. The OS was great. Much more intuitive and easier to use than Android. Its hardware issues and lack of software forced me to change. I use a Samsung Epic now which I like immensely but it has its quirks and took a several days of regular use to become familiar with. On the other hand, the palm pre I had figured out to to a point I was very comfortable with its use in 1-2 hours.
I've invited about 70 people since early this month and as far as I know they all registered without a problem. It did take me 24 hours after my invitation was received to be granted access.
That's a matter of both taste and opinion. The Itunes software is awful in my opinion.
Seriously. If you have an answer then tell me what it is so I can critique it. I'm a physician and part of my job is critiquing articles for a living, so please share.
So far I'm not sure what your point is other than the placebo effect exists which is common knowledge.
Subjectively people will get better from a sugar pill during a cold. Good for them I'm not aware of any objective improvement. Are you? I've read quite of few of the studies and must have missed the objective parts....things readily measured, not just reported by patients, like duration of fever or hospitalization rate.
I'm very well aware of what the placebo effect is.
So docs should prescribe antibiotics to people unnecessarily just so people think they will get better? Is that what you are trying to say? Give the potential side effects and resistance issues (ie MRSA), that doesn't make a damn bit of sense. We don't rx placebos in practice (only in studies) because it is considered unethical.