>>Its similar to proclaiming that the NHS makes consultant appointments for skin cancer checks free. Well, yes, if you are prepared to wait three months and take whoever's turn it is. You want to see someone next week, pay.
You obviously don't know about the legally mandated maximum 2 week wait for cancer checks on the NHS so I can disregard the rest of your reply as it likely contains the same level of misinformation.
I've never known of drug companies trying to get around that limit, but then again it's relatively new in practice. On your second point - I specifically remember a case when working as a trainee in a urology unit where the reps were pushing really hard on dutasteride as an alternative treatment for benign prostatic hypertrophy versus our standard regimen of using finasteride.
Now, dutasteride costs the NHS about 5-10x what finasteride does (but shows results in half the time and/slightly/ more cases), even though they're both on our formulary. So what did we do in practice? For NHS patients we'd prescribe the dutasteride to patients who were young and wanted to get on with life, or to the old boys who'd already tried finasteride but without any benefit. This meant 90% of our patients still received the old drug, and only 10% the 'newer, sexier' dutasteride alternative - and even those cases were those who we thought would benefit most.
As a doctor in the NHS, costs to the system do feature in many of my decisions when trying to balance what's best for the patient in front of me vs. what's best for the next 100 about to come through my door.
Personally, I'm currently a surgical trainee looking to get out. Long story.
As a doctor myself, I feel I should add my $0.02...
Throughout med school we had the odd scattered lecture on statistics, and later when reading papers I used to skim over most of the maths just to look for the P value at the end (one representation of how statistically significant a result is).
However, I then took a formal stats course and was amazed at how little I understood - Monte Carlo techniques, Markov models, and even something as trivial yet important as the difference between a parametric versus a non-parametric test.
And then it struck me - most of the research I had read had applied parametric statistical tests to their data - that it, the researchers made an assumption that the underlying distribution of results would fall on a normal curve. Yet this simple assumption may be all it takes to skew the data when they should have chosen a non-parametric test instead.
So yes, stats are vitally important, badly taught, and focus too much on the maths rather than the concepts. Remember that we're doctors, not mathematicians - the last set of sums I did were in high school. If I need to analyse data, I'll probably plug it into SPSS - although now with my eyes open.
As a qualified surgeon (albeit junior), I'd like to offer my $0.02 if I may.
To be honest, there aren't many parts of the body that are inaccessible to modern surgery. Closed boxes such as the thorax or skull are a couple, but in these cases the main problem is not physical access but the fact that the cancers themselves are often aggressive and deeply embedded. Brain tumours (particularly GBM) are notorious for sending out stray single-celled metastases before the main tumour even shows itself. Small-cell lung carcinoma is another. Basically, by the time the cancer has revealed itself, it's all but too late to do anything about, and no amount of cutting out the primary will remove distant microscopic spread, even with the best tools for the job.
Fortunately, these 'black book' cancers are the rare ones. Common cancers such as bowel, breast and prostate tend to be slower growing and based in parts of the body that are relatively easy to access.
The main use of robotic surgery is not so much to improve physical access, or to 'remove more', but to reduce surgical trauma, and thereby speed patient recovery and reduce peri-operative complications.
And interestingly, we all know surgery for early or localised tumours is the best chance for 'cure', but did you know that radiotherapy actually cures almost the same proportion of cancers? Together they account for nearly 90% of all cancer cures, but where does all the money go? Chemo - because it's sexy. Well, I guess we're also trying to replicate Erlich's 'magic bullet' theory which applied in the early days of antibiotics but unfortunately it's still a way off.
Not true. Here in the UK, direct inducements for doctors are limited by law to £5 per doctor. I'm a doctor in the NHS myself.
That usually means that they buy us a load of supermarket sandwiches and talk to us for 10 minutes about a drug we already know about and use.
Does that change our prescribing practises? No...because we can only prescribe drugs approved by the hospital trust's drug panel, populated by expert pharmacists.
In the end, it's just a charade - there is effectively no direct marketing of drugs here in the UK, to doctors or otherwise.
My pet gripe with Civs 3 & 4 (never played 2 but LOVED 1) was the time-constrained tech tree.
I used to love dumping all my resources into tech just to get nukes by 1000AD and then quickly ruling the world. Why shouldn't I be allowed to do that in later Civs?
Why can I only get electricity within 100 years of when we discovered it in the real world? Or metallurgy? Or whatever I choose to dump my nation's resources into?
(Oh, and please do an updated version of Alpha Centauri as well...)
I know I'm responding to an AC, so I'll keep it brief.
Your answer is littered with so much misinformation that I wonder whether you keep yourself wilfully misinformed about the realities of the healthcare economy, and in particular that of nations with socialised healthcare services.
Governments pay a large proportions of R&D in terms of university labs and the like. Much of the money spent by big pharma is in marketing.
Insurance is only expensive in countries where healthcare is expensive. No Frenchman or Japanese person goes broke just to pay for healthcare, and their systems are insurance-based.
Careas an afterthough is just plain insulting to the individuals working in the system. In no other developed nation (and I mean literally 'no other') does a doctor turn someone away because of financial considerations.
Your healthcare system is broken, but what's worse is you show no intention of educating yourself as to the alternatives.
To everyone out there who thinks this way...PLEASE do some reading before perpetuating this misinformed nonsense.
Just read it. Very good. Completely applicable and even specifically mentions works on the internet.
Non-story./thread.
Re:apparently in Spain, the accused have privacy
on
Mariposa Botnet Beheaded
·
· Score: 2, Interesting
I always loved the US idea of declaring someone to be a juvenile, yet trying them as an adult in order to get a harsher punishment.
Either someone is a juvenile or they aren't...and if you try a 16 year-old as an adult and they are acquitted, does that mean they can now drink and drive like an adult as well?
Something that hasn't hit the journalistic radar yet:
Jack Straw MP (UK Justice Secretary) announced in the house this Tuesday that he will be undertaking a serious review of Britain's libel laws in light of the fact that Britain is often viewed as a 'libel haven' (paraphrasing) for overseas corporations.
This won't be likely to result in new legislation before the end of this Parliament (likely to be April-May 2010), but at least it will put the issue on the agenda for the next one.
I've been following the upper house debates on the Parliament channel for a couple of weeks now.
The Labour lords are really taking a battering on this bill (The Digital Economy Bill) from all sides - Independent, Lib Dem and Conservative.
There are a couple of points that they (Labour) really can't seem to explain:
- Is the 'subscriber' at fault when infringement occurs, or is it the actual infringer who will be served notice? - How do you correctly identify the guilty party (infringer), when you have only the subscriber's details? - Why is there no provision in the Bill to force those claiming infringement to prove that they hold the copyright in the first place? - Like the point in this article - how does an accused party prove their innocence, and why do they have to?
Two of the other Lords in vocal opposition to this bill include the Earl of Erroll and Lord Whitty (the others I forget).
Watching the Lords is quite slow and painstaking, but they have far more freedom to speak their minds and ignore the party line when it comes to scrutinising legislation.
Which is why the US has the largest prison population in the developed world. Including Russia. And China.
And seriously, 16 years for burglary? What do you think these ultra-long sentences will achieve other than creating adults without the skills or ability to function in normal society.
My solution (to the prison problem) - short but very unpleasant sentences to act as a solid deterrent: Daylight/Nighttime are random and vary on a weekly basis, causing complete disorientation. Cells are unlocked randomly without the prisoner's knowledge so that they don't know when they will socialise or be able to get to chow, and not all cells in a block unlock simultanously so that social circles cannot be solidly maintained.
However, this regime would only go on for a few months at most, until the prisoner is 'softened' and more malleable to an intensive rehabilitation programme also within prison grounds. This would be a pleasant and rewarding place to be, and aim at creating a normal human being at the end of it.
My apologies, I now recognise that your country is actually a shithole, and I will never make claims about it being a nice, clean, efficient, liveable place again.
Although, I do apologise for the speeding ticket thing - it's actually Switzerland that bases fines on income.
Whilst I don't live in Sweden (I'm in the UK), I have to ask quite what your point is?
The Swedes may pay more in taxes, but in return get free healthcare, good roads, low crime, free schooling and university, (i believe) free (or heavily subsidised) childcare, efficient public transport, and much more.
They're also very highly rated in terms of their low wealth disparity (road fines for example are based on a percentage of your annual income so that a rockstar in a ferrari feels the same sting in their speeding ticket as does a poor person in a skoda), and human development index.
I could go on. The key point is that nations all make decisions about their priorities - the US believes in waging war and keeping the poor unhealthy and uneducated, other nations do not.
tl;dr - high taxes are worth paying if you get good services in return. Think of Sweden as the 'Apple' of nations, versus the 'Windows Me' of the USA.
Slashdot Mirror
Parent is about 50% factually incorrect. See the earlier med student's response for the true metabolic process.
Speaking of highways...how you enjoying your federally funded, 'socialised' access to your highway network?
>>Its similar to proclaiming that the NHS makes consultant appointments for skin cancer checks free. Well, yes, if you are prepared to wait three months and take whoever's turn it is. You want to see someone next week, pay.
You obviously don't know about the legally mandated maximum 2 week wait for cancer checks on the NHS so I can disregard the rest of your reply as it likely contains the same level of misinformation.
I've never known of drug companies trying to get around that limit, but then again it's relatively new in practice. On your second point - I specifically remember a case when working as a trainee in a urology unit where the reps were pushing really hard on dutasteride as an alternative treatment for benign prostatic hypertrophy versus our standard regimen of using finasteride.
Now, dutasteride costs the NHS about 5-10x what finasteride does (but shows results in half the time and /slightly/ more cases), even though they're both on our formulary. So what did we do in practice? For NHS patients we'd prescribe the dutasteride to patients who were young and wanted to get on with life, or to the old boys who'd already tried finasteride but without any benefit. This meant 90% of our patients still received the old drug, and only 10% the 'newer, sexier' dutasteride alternative - and even those cases were those who we thought would benefit most.
As a doctor in the NHS, costs to the system do feature in many of my decisions when trying to balance what's best for the patient in front of me vs. what's best for the next 100 about to come through my door.
Personally, I'm currently a surgical trainee looking to get out. Long story.
As a doctor myself, I feel I should add my $0.02...
Throughout med school we had the odd scattered lecture on statistics, and later when reading papers I used to skim over most of the maths just to look for the P value at the end (one representation of how statistically significant a result is).
However, I then took a formal stats course and was amazed at how little I understood - Monte Carlo techniques, Markov models, and even something as trivial yet important as the difference between a parametric versus a non-parametric test.
And then it struck me - most of the research I had read had applied parametric statistical tests to their data - that it, the researchers made an assumption that the underlying distribution of results would fall on a normal curve. Yet this simple assumption may be all it takes to skew the data when they should have chosen a non-parametric test instead.
So yes, stats are vitally important, badly taught, and focus too much on the maths rather than the concepts. Remember that we're doctors, not mathematicians - the last set of sums I did were in high school. If I need to analyse data, I'll probably plug it into SPSS - although now with my eyes open.
-Nano.
As a qualified surgeon (albeit junior), I'd like to offer my $0.02 if I may.
To be honest, there aren't many parts of the body that are inaccessible to modern surgery. Closed boxes such as the thorax or skull are a couple, but in these cases the main problem is not physical access but the fact that the cancers themselves are often aggressive and deeply embedded. Brain tumours (particularly GBM) are notorious for sending out stray single-celled metastases before the main tumour even shows itself. Small-cell lung carcinoma is another. Basically, by the time the cancer has revealed itself, it's all but too late to do anything about, and no amount of cutting out the primary will remove distant microscopic spread, even with the best tools for the job.
Fortunately, these 'black book' cancers are the rare ones. Common cancers such as bowel, breast and prostate tend to be slower growing and based in parts of the body that are relatively easy to access.
The main use of robotic surgery is not so much to improve physical access, or to 'remove more', but to reduce surgical trauma, and thereby speed patient recovery and reduce peri-operative complications.
And interestingly, we all know surgery for early or localised tumours is the best chance for 'cure', but did you know that radiotherapy actually cures almost the same proportion of cancers? Together they account for nearly 90% of all cancer cures, but where does all the money go? Chemo - because it's sexy. Well, I guess we're also trying to replicate Erlich's 'magic bullet' theory which applied in the early days of antibiotics but unfortunately it's still a way off.
-Nano.
Not true. Here in the UK, direct inducements for doctors are limited by law to £5 per doctor. I'm a doctor in the NHS myself.
That usually means that they buy us a load of supermarket sandwiches and talk to us for 10 minutes about a drug we already know about and use.
Does that change our prescribing practises? No...because we can only prescribe drugs approved by the hospital trust's drug panel, populated by expert pharmacists.
In the end, it's just a charade - there is effectively no direct marketing of drugs here in the UK, to doctors or otherwise.
Mod me down or whatever, but the best way to have cheaper hearing aids is to have a cheaper health system overall.
That means....Nationalised...Health...Care...
That's right - the whole nation under one banner, with bulk negotiation rates that bring down drug costs and hardware costs.
Works in the rest of the developed world, so why not try it USA?
anyone care to translate for the rest of us?
are we talking 'cock'?
My pet gripe with Civs 3 & 4 (never played 2 but LOVED 1) was the time-constrained tech tree.
I used to love dumping all my resources into tech just to get nukes by 1000AD and then quickly ruling the world. Why shouldn't I be allowed to do that in later Civs?
Why can I only get electricity within 100 years of when we discovered it in the real world? Or metallurgy? Or whatever I choose to dump my nation's resources into?
(Oh, and please do an updated version of Alpha Centauri as well...)
-Nano.
Does the exhaust also smell like bullshit?
Here in the UK, that's exactly what MRI scans do cost - the NHS 'pays' between £300-£600 per scan. Every scan. Across the whole country.
Private scans work out slightly more, but that's because there is a profit motive involved.
I know I'm responding to an AC, so I'll keep it brief.
Your answer is littered with so much misinformation that I wonder whether you keep yourself wilfully misinformed about the realities of the healthcare economy, and in particular that of nations with socialised healthcare services.
Governments pay a large proportions of R&D in terms of university labs and the like. Much of the money spent by big pharma is in marketing.
Insurance is only expensive in countries where healthcare is expensive. No Frenchman or Japanese person goes broke just to pay for healthcare, and their systems are insurance-based.
Careas an afterthough is just plain insulting to the individuals working in the system. In no other developed nation (and I mean literally 'no other') does a doctor turn someone away because of financial considerations.
Your healthcare system is broken, but what's worse is you show no intention of educating yourself as to the alternatives.
To everyone out there who thinks this way...PLEASE do some reading before perpetuating this misinformed nonsense.
How the hell is this a troll?
I'm AGREEING with the parent post.
The Act specifically mentions works on the internet and says they can be archived.
'Redundant' or 'Overrated' maybe.
'Troll'? WTF?
Just read it. Very good. Completely applicable and even specifically mentions works on the internet.
Non-story. /thread.
I always loved the US idea of declaring someone to be a juvenile, yet trying them as an adult in order to get a harsher punishment.
Either someone is a juvenile or they aren't...and if you try a 16 year-old as an adult and they are acquitted, does that mean they can now drink and drive like an adult as well?
Something that hasn't hit the journalistic radar yet:
Jack Straw MP (UK Justice Secretary) announced in the house this Tuesday that he will be undertaking a serious review of Britain's libel laws in light of the fact that Britain is often viewed as a 'libel haven' (paraphrasing) for overseas corporations.
This won't be likely to result in new legislation before the end of this Parliament (likely to be April-May 2010), but at least it will put the issue on the agenda for the next one.
-Nano.
(Yes, I watch the Parliament channel...)
I've been following the upper house debates on the Parliament channel for a couple of weeks now.
The Labour lords are really taking a battering on this bill (The Digital Economy Bill) from all sides - Independent, Lib Dem and Conservative.
There are a couple of points that they (Labour) really can't seem to explain:
- Is the 'subscriber' at fault when infringement occurs, or is it the actual infringer who will be served notice?
- How do you correctly identify the guilty party (infringer), when you have only the subscriber's details?
- Why is there no provision in the Bill to force those claiming infringement to prove that they hold the copyright in the first place?
- Like the point in this article - how does an accused party prove their innocence, and why do they have to?
Two of the other Lords in vocal opposition to this bill include the Earl of Erroll and Lord Whitty (the others I forget).
Watching the Lords is quite slow and painstaking, but they have far more freedom to speak their minds and ignore the party line when it comes to scrutinising legislation.
If you detect activity, they are neither in a vegetative state nor are they in a coma.
Why is there no '-1 Wrong' mod?
But the atmosphere isn't loose, it's been stripped away.
Oh...you meant lose.
Idiot.
This should be part of the intro - none of these satellites currently exist. They were all blown up during their failed launch.
Which is why the US has the largest prison population in the developed world. Including Russia. And China.
And seriously, 16 years for burglary? What do you think these ultra-long sentences will achieve other than creating adults without the skills or ability to function in normal society.
My solution (to the prison problem) - short but very unpleasant sentences to act as a solid deterrent: Daylight/Nighttime are random and vary on a weekly basis, causing complete disorientation. Cells are unlocked randomly without the prisoner's knowledge so that they don't know when they will socialise or be able to get to chow, and not all cells in a block unlock simultanously so that social circles cannot be solidly maintained.
However, this regime would only go on for a few months at most, until the prisoner is 'softened' and more malleable to an intensive rehabilitation programme also within prison grounds. This would be a pleasant and rewarding place to be, and aim at creating a normal human being at the end of it.
-Nano.
My apologies, I now recognise that your country is actually a shithole, and I will never make claims about it being a nice, clean, efficient, liveable place again.
Although, I do apologise for the speeding ticket thing - it's actually Switzerland that bases fines on income.
-Nano.
Whilst I don't live in Sweden (I'm in the UK), I have to ask quite what your point is?
The Swedes may pay more in taxes, but in return get free healthcare, good roads, low crime, free schooling and university, (i believe) free (or heavily subsidised) childcare, efficient public transport, and much more.
They're also very highly rated in terms of their low wealth disparity (road fines for example are based on a percentage of your annual income so that a rockstar in a ferrari feels the same sting in their speeding ticket as does a poor person in a skoda), and human development index.
I could go on. The key point is that nations all make decisions about their priorities - the US believes in waging war and keeping the poor unhealthy and uneducated, other nations do not.
tl;dr - high taxes are worth paying if you get good services in return. Think of Sweden as the 'Apple' of nations, versus the 'Windows Me' of the USA.
Here in the UK, most people pay tax through the PAYE (Pay-As-You-Earn) scheme. The only people who regularly don't are the self-employed.
This means that the majority of the working population NEVER need to file tax returns.
However, some people do regularly file tax returns -
1. People asked to do so through random audit
2. If you are considered a 'high-rate' taxpayer (meaning you earn more than about £36,000pa).
But, you can elect to file a tax return even if you earn less than the 'high-rate', and you can often get some money back for overpayments.
I still can't believe the amount of hassle you have to go through in the US each year when it comes to tax-time.
-Nano.