1) Let's be clear Hamas has indiscriminantly launched thousands of rockets into Israel. Israel has responded with attacks that they KNOW will result in SOME civilian casualties. The IDF can certainly claim they attempt to minimize civilian harm but by attacking the power plant it is undeniable that they are attempting to end the conflict by making Gaza more unlivable . . . as if that place could get worse. But the price will be paid by the civilian population. It's a fascinating cycle of violence where BOTH sides are responsible for their own behavior yet persist in blaming the other for EVERYTHING.
2) Some people are conflating how Israel treats Gaza/West Bank and how they treat Arabs that live within Israel's borders. Many (if not most) countries lack significant compassion for non-citizens outside their borders but Israeli Arabs are indeed treated as 2nd (or 3rd) class citizens. Could you imagine your parents, grandparents and great grandparents being born somewhere and then a 'country' gets 'created' yet your rights are less due to your religion/ethnicity? It's not apartheid but it's certainly immoral. Israel excuses this behavior by saying allowing full rights to Israeli Arabs would lead to the loss of the 'Jewish nation' within a few generations. Sound familiar? Once you develop the ability to see your neighbor as 'other', almost any behavior becomes excusable in pursuit of what you believe to be the 'greater good' or 'lesser evil'.
Cancer is a disease is SOMETIMES caused (and often exacerbated) by diet but CANNOT be cured by diet.
Type II diabetes, hypertension, heart disease and stroke are diseases dramatically influenced by lifestyle with regards to etiology and treatment.
As physicians we do a HORRIBLE job preventing these illnesses and do a very poor job treating them because we have minimal control over personal behavior. Yet the diseases above account for the majority of morbidity and mortality in this country. They account for the majority of healthcare costs . . . or as we like to put it (revenue/profit).
I'm a physician scientist. I specialize in health behaviors and molecular pharmacology of the brain. There will NEVER be a drug that will get you to NOT eat food that you find appetizing. Why? Because such a drug has to distort the most primal circuits in the brain (reward pathways). So yes such a drug will not only 'end' obesity but it will end drug addiction, curiosity, love, learning and just about everything else that makes the human existence worthwhile.
Several people have posted anecdotes about weight loss on Qsymia and Belviq. But that's like saying "if I videotape myself having unprotected sex and then release in on the Web I'm going to get rich . . . what could possibly go wrong?" You are going to get the typical outcome . . . public shame. In research trials sponsored by drug companies the published results are "efficacy". Efficacy is the ability of a treatment to produce an effect under controlled conditions. Effectiveness is how well it works under typical conditions. Qsymia and Belviq are NOT very effective. A small fraction of people will optimize their diet, increase their physical activity and subsequently realize significant weight loss. But for MOST people they will lose an insignificant amount of weight or lose (then regain the weight). The only thing guaranteed are side effects because there is no such thing as a medicine without side effects. Belviq has a better side effect profile but the combination in Qsymia is probably the more efficacious weight loss approach.
But here's the kicker. This debate is absolutely ridiculous. If we could get the American South (white, black and Hispanic) to live a lifestyle comparable to Colorado or Utah, rates of virtually every major disease would plummet in a matter of years. Healthcare as a percentage of GDP would fall EVERY year. We would be healthier, happier and more productive as individuals and as a nation.
I'm not a fan of big Pharma, but this is horseshit.
Tricyclics are substantially more dangerous than the newer generation of medications, sure you can OD on any of the psych medications, but the newer medications tend to be more narrowly focused than the old ones. Have you ever looked at the listing of things to avoid when it comes to MAO inhibitors?
A lot of the problem with the newer medications is that since they target smaller parts of the brain, it's less likely that any one medication will work properly, but it also means that it's less likely that it will interact with some other medication. For instance you can't take Prozac or Paxil if you're taking stimulant medication for ADHD because they use the same channels in the liver, IIRC.
Ultimately, this is not likely to be a problem in the near future as brain imaging scans to see what exactly is going on in the brain become more prevalent and there's more formal testing of what the medicine is actually doing. At present there's very little attention paid to how much of the medication actually gets to the site where it's needed. Something as simple as an undiagnosed food allergy can result in little or none of the medication making it to the brain. Which also effects how much seratonin, dopamine and the rest are there for the medications to work with.
TCAs are indeed substantially more dangerous in overdose but they are globally more effective as well. More importantly, most people on TCAs won't overdose on them. MAOIs are entering an era where we have both EMSAM (a patch that avoids the tyramine toxicity issue) and more selective, reversible MAOA inhibitors that have comparable efficacy to MAOIs but much better safety and tolerability.
The problem with newer drugs is not a "targeting of smaller parts of the brain". Many newer agents are more selective with regards to receptor and channel targets (pharmacodynamics). It's the primary reason some newer medications have fewer side effects. Unfortunately, many new drugs don't actually have fewer side effects. Instead they have different ones. As for the example you use, there is no blanket contraindication for fluoxetine (Prozac) or paroxetine (Paxil) combined with methylphenidate or amphetamine class stimulants. The primary issue with fluoxetine is it is a potent inhibitor of 2D6 which means other drugs metabolized by that pathway may accumulate to toxic levels when administered with fluoxetine. Paroxetine also has a host of drug-drug interactions but NOT with stimulants. The two antidepressants you cite are selective serotonin reuptake inhibitors they share virtually no pharmacology with stimulants.
As for brain imaging people have been sold a bill of goods with regards to utility in neuropsychopharmacology. fMRI, PET, SPECT, etc with a host of pretty false-color images are nice to look at but have provided minimal advancement in diagnostics or therapeutics. The primary exception is structural/flow imaging that reveals a great big tumor or bleed/clot but a decent neurologist could tell you the same thing for a fraction of the cost. We do have better technology but what we actually KNOW about the brain is not progressing by leaps and bounds. We are taking baby steps at best. We dont' KNOW where medicine should be for most neuropsychiatric conditions and even when we do (Parkinson) we are limited in our ability to target specific areas.
The problem with Big Pharma is their mission has always been to make money. They aren't evil and they aren't incompetent. The old FDA hoop was to prove a drug wasn't lethal . . . and that didn't happen until the 1930s. It's actually a fairly recent rule that companies had to show effectiveness. The conundrum for Big Pharma is that serendipity has driven a lot of advancements (vaccines, antibiotics, antidepressants, antipsychotics) and we just aren't smart enough to solve problems from scratch. And we are too impatient (myopic) to invest the hundreds of billions of dollars and decades of basic research to learn more about human development, physiology and pathophysiology from head to toe.
When your primary motive is profit, many corporations (people) will choose to do whatever will maximize their profits. We are born as egocentric creatures with little regard for others beyond their use as means to our own ends. Appropriate parenting is what 'civilizes' such creatures. Do it properly and you get Mother Teresa. Do it wrong and you get Donald Trump.
Chair, President, CEO - BA, MBA (not a shred of actual engineering experience)
President, CEO - BA, MBA (used to be a 727 mechanic . . . in the 70s)
Senior VP - history major
Senior VP - CIVIL engineering and a master's in engineering management . . . Dilbert says hello)
CTO - BS/MA physics, PhD engineering
I'm not arguing only aeronautical engineers could run an airplane manufacturer. That would be similar to saying only doctors should run hospitals/healthcare companies. BUT . . . if you accumulate too many 'profit' bean counters, an organization can often lose sight of the fact that it's the product that makes money not making money off the product. The only reason we get away with it in healthcare is because society pays us to do stuff . . . regardless of whether we do it well.
"What's the difference between a doctor and a pilot?"
A doctor isn't going to go down with you. -David Healy, MD
Arguably the same could be said for senior management at most US corporations.
There was an interesting story on NPR yesterday about the DPRK. It's a very paternalistic/chauvinistic society much like South Korea used to be. At some point in the past, leadership decided state jobs were too important to be occupied by women. So women were largely moved out of the labor force since there was no private enterprise. Well the collapse of the USSR (and China's reduced interest) decimated the state economy. As rations dwindled, the women had to get rolling for families to survive. Informal (unsanctioned) private markets were initially limited to elderly women but as the economic conditions worsened, the DPRK increasingly looked the other way as women of all ages scrambled to keep the family fed.
In the meantime, the menfolk were busy going to work at jobs that didn't pay much. When I say didn't pay much, we're talking pennies a day. Every male is either in the military (~10 years) or working for the state. But since state jobs pay so little, women have become the dominant family breadwinners. The situation is so dire for men in that arse backwards country that some PAY not to go to their state job. You see you have to go to work at your state job even if there's nothing to do. You have to go to work at your state job even if you don't get paid. If you don't show for work, they coming looking for you. The only 'out' is an informal system where men pay NOT to go to work. Obviously, that money is coming either from remittances or the money the wife makes.
The take home is that the DPRK is running a society-wide, generations-long sociocultural experiment that has far more significance than their rocket launch.
1) Cars have a host of safety features that don't interfere with their intended use. Guns are no different. The features mentioned in the article wouldn't be incorporated if they in any way prevented someone from using the gun for its intended purpose (killing people). The point is making it difficult to use for unintended purposes.
2) Referencing the Army is nonsense. There's no comparison between a trained member of the US military and the typical moron with 1 (or 100) firearms. Truth be told the true gun nut is probably competent to use their weapon. But given the laxity of gun laws in the US, much of the general public is in possession of weapons they cannot competently use. The AR15 was NOT designed for sport. It was designed to spray bullets at the "enemy". Some would argue that not only is there no way to make it safe, it has no business in the hands of civilians at all.
While some people treat the alternative minimum tax (AMT) as if it's evil incarnate, the only reason it exists is that EVERYBODY knows greed compels people to avoid paying taxes. A corporate version of the AMT would mean Apple, Google, Microsoft, et al could do a double Irish with a Bermuda twist as much as they want but they would STILL pay (say some lowball number 10-15%) on profits earned in a given country. And that would be IRS calculated profit! Now the only way it would work is if there were strong disincentives to current practices. The US House is too dysfunctional to revise the tax code in an intelligent manner. So one option would be if the President reallocated some resources (say FBI/CIA) working to create the IRS equivalent of a major crimes division. Not only could they track the profits but even better they could bring criminal charges against lawyers, accountants, bankers, CEO/CFO, corporate boards that get even close to breaking the law. Waterboard a few Kellogg or Wharton boys and I bet patriotic taxpaying will rise dramatically.
Now to entice the raving loons about tax increases, you allow corporations to CHOOSE between the current system (35% + automatic audits yearly) or the new AMT. Choosing the AMT would be a de facto reduction in the corporate tax rate which would benefit EVERY company. In particular, it would be a boon for the hundreds of thousands of small businesses (that don't have an army of lawyers/accountants) that have dutifully paid the corporate rate. A few of the worst corporate citizens might even take the opportunity to repatriate the trillion or so in profits they've parked overseas.
Drinks used to be served in smaller containers, and society survived just fine. Restaurants started using larger containers to exploit flaws in human psychology, allowing them to trick customers into buying more than they want or need. This is done to make more money, and to hell with the health of the general public.
Or public health officials have been tricked into thinking it's more important for people to be healthy than to eat satisfying junk food and are exploiting flaws in human psychology regarding the correlation between physical appearance and mental state (we are biased towards believing that attractive people are happier).
That's the problem with the "people are stupid" line of argumentation that's prevalent in the nanny state -- it doesn't really explain why we should prefer moving decision-making from one group of stupid people to another group of stupid people.
Your comment on the nanny state misses the point. You aren't moving the decision from one group of stupid people to another group of stupid people. Most people are IGNORANT of the negative impact of excess sugar-sweetened beverages. It is a reasonable libertarian argument to say people have a right to make bad decisions. It's another issue altogether to claim people have a right to make bad decisions without knowledge of it being a bad decision. Every obese person on the planet KNOWS they are fat because they consume too many calories. But the vast majority don't know the typical sugar-sweetened beverage contains 10-15kcal per ounce, the average American consumes the equivalent of 700 8oz SSB per year and that merely cutting a portion of their SSB consumption would lead to weight loss without a substantial change in lifestyle.
"A university study asserts that the problems caused by the gas extraction process known as hydraulic fracturing, or 'fracking,' arise because drilling operations aren't doing it right.
----
Same is true about abstinence.
I've never purchased an Apple product for myself. But I bought the wife an ipod, Macbook Pro, Iphone 3, iPad 2 and most recently an iPhone 4S. But I recently told her we are through with retail Apple products. I will use Steve Jobs' argument against him. Apple has made such great products there's no reason to buy any more.
Slashdot Mirror
1) Let's be clear Hamas has indiscriminantly launched thousands of rockets into Israel. Israel has responded with attacks that they KNOW will result in SOME civilian casualties. The IDF can certainly claim they attempt to minimize civilian harm but by attacking the power plant it is undeniable that they are attempting to end the conflict by making Gaza more unlivable . . . as if that place could get worse. But the price will be paid by the civilian population. It's a fascinating cycle of violence where BOTH sides are responsible for their own behavior yet persist in blaming the other for EVERYTHING. 2) Some people are conflating how Israel treats Gaza/West Bank and how they treat Arabs that live within Israel's borders. Many (if not most) countries lack significant compassion for non-citizens outside their borders but Israeli Arabs are indeed treated as 2nd (or 3rd) class citizens. Could you imagine your parents, grandparents and great grandparents being born somewhere and then a 'country' gets 'created' yet your rights are less due to your religion/ethnicity? It's not apartheid but it's certainly immoral. Israel excuses this behavior by saying allowing full rights to Israeli Arabs would lead to the loss of the 'Jewish nation' within a few generations. Sound familiar? Once you develop the ability to see your neighbor as 'other', almost any behavior becomes excusable in pursuit of what you believe to be the 'greater good' or 'lesser evil'.
Cancer is a disease is SOMETIMES caused (and often exacerbated) by diet but CANNOT be cured by diet. Type II diabetes, hypertension, heart disease and stroke are diseases dramatically influenced by lifestyle with regards to etiology and treatment. As physicians we do a HORRIBLE job preventing these illnesses and do a very poor job treating them because we have minimal control over personal behavior. Yet the diseases above account for the majority of morbidity and mortality in this country. They account for the majority of healthcare costs . . . or as we like to put it (revenue/profit). I'm a physician scientist. I specialize in health behaviors and molecular pharmacology of the brain. There will NEVER be a drug that will get you to NOT eat food that you find appetizing. Why? Because such a drug has to distort the most primal circuits in the brain (reward pathways). So yes such a drug will not only 'end' obesity but it will end drug addiction, curiosity, love, learning and just about everything else that makes the human existence worthwhile. Several people have posted anecdotes about weight loss on Qsymia and Belviq. But that's like saying "if I videotape myself having unprotected sex and then release in on the Web I'm going to get rich . . . what could possibly go wrong?" You are going to get the typical outcome . . . public shame. In research trials sponsored by drug companies the published results are "efficacy". Efficacy is the ability of a treatment to produce an effect under controlled conditions. Effectiveness is how well it works under typical conditions. Qsymia and Belviq are NOT very effective. A small fraction of people will optimize their diet, increase their physical activity and subsequently realize significant weight loss. But for MOST people they will lose an insignificant amount of weight or lose (then regain the weight). The only thing guaranteed are side effects because there is no such thing as a medicine without side effects. Belviq has a better side effect profile but the combination in Qsymia is probably the more efficacious weight loss approach. But here's the kicker. This debate is absolutely ridiculous. If we could get the American South (white, black and Hispanic) to live a lifestyle comparable to Colorado or Utah, rates of virtually every major disease would plummet in a matter of years. Healthcare as a percentage of GDP would fall EVERY year. We would be healthier, happier and more productive as individuals and as a nation.
I'm not a fan of big Pharma, but this is horseshit.
Tricyclics are substantially more dangerous than the newer generation of medications, sure you can OD on any of the psych medications, but the newer medications tend to be more narrowly focused than the old ones. Have you ever looked at the listing of things to avoid when it comes to MAO inhibitors?
A lot of the problem with the newer medications is that since they target smaller parts of the brain, it's less likely that any one medication will work properly, but it also means that it's less likely that it will interact with some other medication. For instance you can't take Prozac or Paxil if you're taking stimulant medication for ADHD because they use the same channels in the liver, IIRC.
Ultimately, this is not likely to be a problem in the near future as brain imaging scans to see what exactly is going on in the brain become more prevalent and there's more formal testing of what the medicine is actually doing. At present there's very little attention paid to how much of the medication actually gets to the site where it's needed. Something as simple as an undiagnosed food allergy can result in little or none of the medication making it to the brain. Which also effects how much seratonin, dopamine and the rest are there for the medications to work with.
TCAs are indeed substantially more dangerous in overdose but they are globally more effective as well. More importantly, most people on TCAs won't overdose on them. MAOIs are entering an era where we have both EMSAM (a patch that avoids the tyramine toxicity issue) and more selective, reversible MAOA inhibitors that have comparable efficacy to MAOIs but much better safety and tolerability. The problem with newer drugs is not a "targeting of smaller parts of the brain". Many newer agents are more selective with regards to receptor and channel targets (pharmacodynamics). It's the primary reason some newer medications have fewer side effects. Unfortunately, many new drugs don't actually have fewer side effects. Instead they have different ones. As for the example you use, there is no blanket contraindication for fluoxetine (Prozac) or paroxetine (Paxil) combined with methylphenidate or amphetamine class stimulants. The primary issue with fluoxetine is it is a potent inhibitor of 2D6 which means other drugs metabolized by that pathway may accumulate to toxic levels when administered with fluoxetine. Paroxetine also has a host of drug-drug interactions but NOT with stimulants. The two antidepressants you cite are selective serotonin reuptake inhibitors they share virtually no pharmacology with stimulants. As for brain imaging people have been sold a bill of goods with regards to utility in neuropsychopharmacology. fMRI, PET, SPECT, etc with a host of pretty false-color images are nice to look at but have provided minimal advancement in diagnostics or therapeutics. The primary exception is structural/flow imaging that reveals a great big tumor or bleed/clot but a decent neurologist could tell you the same thing for a fraction of the cost. We do have better technology but what we actually KNOW about the brain is not progressing by leaps and bounds. We are taking baby steps at best. We dont' KNOW where medicine should be for most neuropsychiatric conditions and even when we do (Parkinson) we are limited in our ability to target specific areas. The problem with Big Pharma is their mission has always been to make money. They aren't evil and they aren't incompetent. The old FDA hoop was to prove a drug wasn't lethal . . . and that didn't happen until the 1930s. It's actually a fairly recent rule that companies had to show effectiveness. The conundrum for Big Pharma is that serendipity has driven a lot of advancements (vaccines, antibiotics, antidepressants, antipsychotics) and we just aren't smart enough to solve problems from scratch. And we are too impatient (myopic) to invest the hundreds of billions of dollars and decades of basic research to learn more about human development, physiology and pathophysiology from head to toe.
When your primary motive is profit, many corporations (people) will choose to do whatever will maximize their profits. We are born as egocentric creatures with little regard for others beyond their use as means to our own ends. Appropriate parenting is what 'civilizes' such creatures. Do it properly and you get Mother Teresa. Do it wrong and you get Donald Trump.
Chair, President, CEO - BA, MBA (not a shred of actual engineering experience) President, CEO - BA, MBA (used to be a 727 mechanic . . . in the 70s) Senior VP - history major Senior VP - CIVIL engineering and a master's in engineering management . . . Dilbert says hello) CTO - BS/MA physics, PhD engineering I'm not arguing only aeronautical engineers could run an airplane manufacturer. That would be similar to saying only doctors should run hospitals/healthcare companies. BUT . . . if you accumulate too many 'profit' bean counters, an organization can often lose sight of the fact that it's the product that makes money not making money off the product. The only reason we get away with it in healthcare is because society pays us to do stuff . . . regardless of whether we do it well. "What's the difference between a doctor and a pilot?" A doctor isn't going to go down with you. -David Healy, MD Arguably the same could be said for senior management at most US corporations.
There was an interesting story on NPR yesterday about the DPRK. It's a very paternalistic/chauvinistic society much like South Korea used to be. At some point in the past, leadership decided state jobs were too important to be occupied by women. So women were largely moved out of the labor force since there was no private enterprise. Well the collapse of the USSR (and China's reduced interest) decimated the state economy. As rations dwindled, the women had to get rolling for families to survive. Informal (unsanctioned) private markets were initially limited to elderly women but as the economic conditions worsened, the DPRK increasingly looked the other way as women of all ages scrambled to keep the family fed. In the meantime, the menfolk were busy going to work at jobs that didn't pay much. When I say didn't pay much, we're talking pennies a day. Every male is either in the military (~10 years) or working for the state. But since state jobs pay so little, women have become the dominant family breadwinners. The situation is so dire for men in that arse backwards country that some PAY not to go to their state job. You see you have to go to work at your state job even if there's nothing to do. You have to go to work at your state job even if you don't get paid. If you don't show for work, they coming looking for you. The only 'out' is an informal system where men pay NOT to go to work. Obviously, that money is coming either from remittances or the money the wife makes. The take home is that the DPRK is running a society-wide, generations-long sociocultural experiment that has far more significance than their rocket launch.
1) Cars have a host of safety features that don't interfere with their intended use. Guns are no different. The features mentioned in the article wouldn't be incorporated if they in any way prevented someone from using the gun for its intended purpose (killing people). The point is making it difficult to use for unintended purposes. 2) Referencing the Army is nonsense. There's no comparison between a trained member of the US military and the typical moron with 1 (or 100) firearms. Truth be told the true gun nut is probably competent to use their weapon. But given the laxity of gun laws in the US, much of the general public is in possession of weapons they cannot competently use. The AR15 was NOT designed for sport. It was designed to spray bullets at the "enemy". Some would argue that not only is there no way to make it safe, it has no business in the hands of civilians at all.
While some people treat the alternative minimum tax (AMT) as if it's evil incarnate, the only reason it exists is that EVERYBODY knows greed compels people to avoid paying taxes. A corporate version of the AMT would mean Apple, Google, Microsoft, et al could do a double Irish with a Bermuda twist as much as they want but they would STILL pay (say some lowball number 10-15%) on profits earned in a given country. And that would be IRS calculated profit! Now the only way it would work is if there were strong disincentives to current practices. The US House is too dysfunctional to revise the tax code in an intelligent manner. So one option would be if the President reallocated some resources (say FBI/CIA) working to create the IRS equivalent of a major crimes division. Not only could they track the profits but even better they could bring criminal charges against lawyers, accountants, bankers, CEO/CFO, corporate boards that get even close to breaking the law. Waterboard a few Kellogg or Wharton boys and I bet patriotic taxpaying will rise dramatically. Now to entice the raving loons about tax increases, you allow corporations to CHOOSE between the current system (35% + automatic audits yearly) or the new AMT. Choosing the AMT would be a de facto reduction in the corporate tax rate which would benefit EVERY company. In particular, it would be a boon for the hundreds of thousands of small businesses (that don't have an army of lawyers/accountants) that have dutifully paid the corporate rate. A few of the worst corporate citizens might even take the opportunity to repatriate the trillion or so in profits they've parked overseas.
Drinks used to be served in smaller containers, and society survived just fine. Restaurants started using larger containers to exploit flaws in human psychology, allowing them to trick customers into buying more than they want or need. This is done to make more money, and to hell with the health of the general public.
Or public health officials have been tricked into thinking it's more important for people to be healthy than to eat satisfying junk food and are exploiting flaws in human psychology regarding the correlation between physical appearance and mental state (we are biased towards believing that attractive people are happier).
That's the problem with the "people are stupid" line of argumentation that's prevalent in the nanny state -- it doesn't really explain why we should prefer moving decision-making from one group of stupid people to another group of stupid people.
Your comment on the nanny state misses the point. You aren't moving the decision from one group of stupid people to another group of stupid people. Most people are IGNORANT of the negative impact of excess sugar-sweetened beverages. It is a reasonable libertarian argument to say people have a right to make bad decisions. It's another issue altogether to claim people have a right to make bad decisions without knowledge of it being a bad decision. Every obese person on the planet KNOWS they are fat because they consume too many calories. But the vast majority don't know the typical sugar-sweetened beverage contains 10-15kcal per ounce, the average American consumes the equivalent of 700 8oz SSB per year and that merely cutting a portion of their SSB consumption would lead to weight loss without a substantial change in lifestyle.
"A university study asserts that the problems caused by the gas extraction process known as hydraulic fracturing, or 'fracking,' arise because drilling operations aren't doing it right. ---- Same is true about abstinence.
I've never purchased an Apple product for myself. But I bought the wife an ipod, Macbook Pro, Iphone 3, iPad 2 and most recently an iPhone 4S. But I recently told her we are through with retail Apple products. I will use Steve Jobs' argument against him. Apple has made such great products there's no reason to buy any more.