Turned out that the man hadn't bothered to do much to update his knowledge of his specialty in about 15-20 years.
This is what board certification is for. State licensing boards usually have some requirements for staying up to date, but they really just guarantee that the person went to med school and hasn't had their license revoked. The specialty boards are much more comprehensive. Being board certified is formally optional, imperfect, and hotly debated among doctors - but I would hesitate a lot before going to a doctor who didn't maintain certification. Did they check if the doctor was board certified?
Several surgeries later, the relative ended up going to a major regional university's affiliated hospital.
Always get a second opinion before any surgery. Or any major medical decision. Ideally, get two opinions and then run them by a third party, like a primary care doctor. Always. If you're talking about wanting competition, this is basic stuff. Why did they not go to the regional university up front?
We say "imagine how much harder he'd have worked if he had more competition."... Toughen up the liability laws...
How does making it easier to sue him give him more competition? More importantly, how does making it easier to sue him prevent the harm that was done to your relative? You're arguing for more regulation, not less.
Testosterone supplementation in men with low T levels appears to have the unfortunate side effect of death.
There is a growing literature on the potential dangers of testosterone supplementation. Not enough yet to say it's as clearly a bad idea as female HRT, but for sure it isn't something men should run out and do without a careful and personalized discussion with a knowledgeable (actual) doctor.
In general I think it's safe to say that the "take extra of the hormones that go down with age in some people" theory of fighting aging is pretty thoroughly discredited by now. Thyroid hormone, growth hormone, testosterone, estrogen, etc. - the science is clear this is not how you fight aging. In general, more likely to hasten death than prevent it.
Off topic, but do you have a link to more info about your dynamometer? IAA biologist interested in measuring mouse activity and exercise capacity. Many people still use those treadmills, which seem less than deal to me (for multiple reasons).
The shortage of doctors in the U.S. is due to the AMA cartel's control over university accreditation and corresponding rent-seeking state laws requiring accreditation. The result is speed-exams when you go visit a doctor (or maybe not see the doctor at all, but rather a "nurse practitioner").
The situation of pilots and doctors does seem similar on several levels, but I think you're drawing the wrong conclusions.
The proximate cause of the "speed-exams" is not a doctor shortage, but an artifact of how most doctors are paid - by the visit. You get a tiny bit more money for a long, complicated visit, but not nearly as much as if you see two or three patients in the same time. This is true for almost every payer - private insurance, Medicare, Medicaid, etc. The financial incentives are strongly on the side of the speed-exam.
A more fundamental question is why the financial incentives matter so much, and that's where I think the pilot and doctor stories have some overlap. These are both highly skilled professions with a long, poorly paid training period and a strong incentive on the part of the "payers" to keep downward pressure on wages. Every time an insurance company or Medicare cuts their provider reimbursement rate, the incentive to cram more visits into a day grows that much stronger, because when you start your career at 30 or 35 with hundreds of thousands of dollars in loans, it's hard to take an arbitrary pay cut. (Talking about primary care doctors here, the situation may be different for the "lucrative" specialist du jour.)
Besides, the US actually has plenty of doctors, similar per capita numbers to Canada or the UK. But the financial incentives drive too many of them to lucrative specialties and urban practices, leaving too few doing primary care or working outside the big cities. Attempting to control costs by cutting doctors' fees creates perverse incentives.
The rise of nurse practitioners is more of an alternative attempt at cost control than a response to too few doctors. If you don't need 8 years of school and training to take blood pressure readings or insert an IV, and these things are actually done better by people who do them all the time, maybe some aspects of primary care can be done better by people with shorter but more focused training.
So every loop around the gravity wheel you go through 2A of gravity variance As the +A thrust vector rotates from your feet to head and side to side of you.
Sea-sickness prevails.
At 1G constant acceleration (flipping around mid-way) you'd reach Mars in about 3 days. (Avg Distance 225M km, travel time to half-way point at 10m/s/s = 42 hrs).
Stretching the trip to 90 days works out to 0.0015G acceleration throughout. I'm guessing the crew wouldn't notice that.
[Moral: When talking about acceleration, 1 G is a *lot*. It'll get you to alpha centauri in 4 years!]
Canada has an efficient and effective single-payer system. When you are already spending money well, spending more money might be better.
The US has a fragmented, inefficient, and often ineffective hodgepodge of systems. When you are already spending money poorly, spending more money might be worse.
Or, put another way, Canada is probably somewhere to the right-of-peak on the Laffer curve of health care spending vs outcomes. The US is far, far to the left.
I work for the government and every once in a while my boss says I should try to patent it.
Do you work for the federal government? Work done by an employee of the federal government in the course of his/her duties is public domain. There's not even a question of patent or copyright, it's public domain by law.
If it's work on your own time that's not part of your official duties, however, you can do whatever you like with it.
My apologies, I meant permissive-with-a-small-p only as an antonym for restrictive. I admit I wasn't aware of the technical meaning. Thank you for pointing it out. I think the phrasing still made sense to most readers. Remember that for most of the physicians who read NEJM this was probably the first time they had even heard of copyleft.
The people who devised the test spent time and money to do so. They created the original work. Why shouldn't they be able to license it for fee to others? They've got college loans to pay off. OH so now educators and researchers have to live under the specter of copyright laws! Boo hoo welcome to the real world!
I am one of the authors of the NEJM article.
We did not get into ethical issues in the article. But much of the current value of the MMSE does not lie in its contents but rather in the past 35 of research on it. Hundreds or thousands of studies from researchers around the world have shown doctors in exquisite detail exactly how and when to use the MMSE to best care for patients.
It is this vast accumulation of data on the validity and utility of the MMSE that makes it so valuable - and little of this was done by the MMSE's authors or PAR. In fact, much of this research might never have been done if the MMSE had had its current strict licensing terms 30 years ago. Some people have compared this behavior - waiting until the test is ubiquitous to start enforcing copyright - to patent trolls.
Nevertheless, the MMSE authors and PAR are entirely within their legal rights, and that is why we suggest that policy needs to change to prevent this from happening all over medicine.
Sorry, I didn't see that the summary incorrectly states that the authors of the older test were claiming infringement. AFAIK, they're not.
I guess I failed the comprehension test. Actually, I didn't really read the summary carefully, since I was already familiar with the actual facts.
I am one of the authors of the NEJM op/ed article.
It is all a little confusing. There are three parties here: 1. The original authors of the MMSE, who through PAR are strictly enforcing copyright protections of the MMSE 2. The authors of a new tool, the Sweet 16, which was created as an open-access alternative to the MMSE but was "taken down" by PAR in a copyright dispute 3. Us, the authors of TFA, who have no relationship to #1 or #2 but are very worried about what this all means for the practice and progress of medicine
I'm not saying the MMSE is useless, it's just no big loss if there is copyright being claimed now. We'll move on to something else.
I'm one of the authors of the NEJM article.
People already are moving on. In our practice we mostly use the Montreal Cognitive Assessment (MOCA) for screening, which is much more sensitive and has liberal licensing terms for non-commercial use.
But this is a general issue. The Sweet 16 was an attempt to move on, halted by PAR. I'm surprised that PAR hasn't already sued the MOCA authors given that the MOCA includes recall and orientation, like the Sweet 16. Even if it survives, the MOCA is not perfect- it has laudably generous licensing terms for copying, but no provision for derivative works. In 80 years, the heirs of the MOCA authors might well start suing researchers who use a trails test, clock draw and animal recognition in a new test.
Whether we move on from the MMSE or not, the threat to scientific progress will remain.
We didn't have the space to describe the MMSE and Sweet 16 in detail, but here's a brief description:
The MMSE has 30 items, which include 10 orientation questions (what's today's date, where are we, etc.) and 6 questions for recall (say 3 standard words, repeat them back and remember them for 5 minutes or so).
The Sweet 16 has 16 items which include 8 orientation questions and 6 questions for recall (using different words than the MMSE). The other two questions involve repeating a sequence of numbers backwards.
So there is a lot of overlap between the two tests, and that was presumably the basis for an infringement claim. However, the items that overlap - orientation and recall - are quite generic and were in wide use long before the MMSE was created in 1975. Nevertheless, the authors behind Sweet 16 and their institution could not or chose not to defend the Sweet 16.
It's a little hard to imagine a cognitive assessment tool that doesn't include orientation or short-term memory recall questions, so this will strongly discourage progress in the field. Perhaps one of the Alzheimer's advocacy groups will take notice and defend researchers trying to advance the state of the art.
The developers of the Sweet 16 - the test apparently "taken down" for copyright infringement of the MMSE - were all Harvard faculty, and work for academic centers that are affiliated with Harvard and its hospitals (Hospital Elder Life Program, Institute for Aging Research and Hebrew Senior Life). The senior author of the Sweet 16 is a well-known Harvard professor. One of the things we find concerning about this case is that Harvard Medical School probably has some claim to ownership of the Sweet 16, and was presumably involved in its defense. If Harvard, with its vast resources, could not or chose not to defend the Sweet 16 successfully, what hope do any other researchers have to develop new cognitive testing tools?
The most abundant chemical used in fracing is water. This is the same water that your waiter serves you with your meal. It's not unusual for frac fluid to be 89% water by mass.... If passages are desired, then they are created using hydrochloric acid. This is the same acid that occurs naturally in your stomach.
I triple-dog dare you to drink a glass of 11% (w/w) hydrochloric acid.
It's 89% water and contains only a chemical found in your stomach naturally! That can't possibly hurt you!
These guys aren't fleeing to Seattle because they fear the big-bad regulations of the People's Republic of California. They're fleeing out of fear of Amazon. Amazon's response to the sales tax proposal was to threaten to disown all of its affiliates in California, since the physical presence of affiliates was one of the justifications for asking them to collect sales tax. Amazon would rather stick a knife in the back of all of its partners, putting who knows how many people out of business, than collect a nickel of sales tax from its customers. They can't pull the same thing in Washington because it's hard to deny that giant former hospital on top of a hill with an Amazon logo already constitutes a physical presence.
They left San Francisco because the Bezos bear was gonna swat them out of spite, so they went to cuddle up next to it.
And this "startup" is two guys. Fine, maybe they'll make it big one day, sounds like they got plenty of capital. But it's still two guys. Why does the decision of a two-guy business rate a headline?
We never did pay off WWII debt, and we never will. Modest inflation and a growing economy make perpetual deficits and debt trivial, if they are reasonable. Yet our national economic policy is to minimize inflation at all costs, regardless of unemployment or a flat economy. So we now have near-deflation with near-zero long term nterest rates, yet horrific unemployment and an economy about to enter recession again. What's the problem with our debt again?
We need to return to Clinton administration levels of spending, adjusted for inflation of course. We can't keep the Obushma empire going.
With you 100%, but it should be noted we're not that far off from Clinton levels of spending and will more or less reach it once we wind down our two land wars in Asia. We've cratered revenues, however. If we returned taxes to Clinton levels, we would have a small enough deficit that Republicans would be back to calling for tax cuts to prevent a surplus, instead of tax cuts for whatever reason they give now.
If we had more local control over our lives, your argument would carry much more weight. You could say, "If you hate government so much, move to Mississippi. Seriously." and you would know that the person you are talking to could truly move to Mississippi. Of course, if they are already in MS, you could tell them to keep their noses out of your state's business.
And that works not at all for the three things our federal government spends >75% of its budget on: defense, health care, and social security. Is Mississippi going disown protection from the US Army? Does it make the slightest bit of sense to have a "young whuppersnapper" state with no social security and an "old fart" state that everyone moves to when they're 65? This would make it impossible to have such programs at all (including an Army), or at best would make people a prisoner of whatever state they were lucky enough to be born in. Forget about the problem of Mississippi's toxic waste and air pollution flowing into the next state over.
and only 2GB in the $600 system? and $100.00 more to get 4 GB? better off paying $200 more to get a 4GB ram faster CPU and video card with it's own ram.
$150 to go from 500GB to 750GB? You can get a 3TB HDD for $150.
Ha! And so your innocent slip of the tongue exposes you for what you are, agent of K'breel and the Council of Elders! No human born on Earth could even feign surprise at Apple's exorbitant charges for spec upgrades.
You're here to intercept Curiousity, aren't you? Your mission will now be in vain!
I just switched to Sonic from AT&T DSL when we moved last week. I've fallen in love with Sonic and their Fusion service. This is where they use their own equipment at central offices and offer as much speed as you can get, up to 20Mbps, for a flat $40/mo. Highly recommended.
I didn't particularly have a problem with AT&T before, but when we decided to move less than a mile across the city I was told: 1. I couldn't keep my phone number 2. I had to buy a new DSL modem, even though mine was AT&T recommended and less than 6 months old 3. I had to switch to U-Verse, which meant paying more for less download speed
I understand the technical rationale behind some of this (we'd be served by a different central office that was exclusively U-Verse, which uses a different flavor of DSL, etc.) but it was a lot of shit to swallow in one gulp. And then I heard about the upcoming caps, too. We watch a lot of Netflix and would probably hit it regularly.
Sonic told me: 1. Sure, I can keep my old phone number 2. I can use my current modem 3. I'll get speeds at least as good as before for the same money 4. No speed limits (you get whatever your line can handle), no bandwidth caps 5. Free POTS phone service, just tossed in there
And it's been a pure pleasure to deal with them. Local human beings on tech support, who know what they're talking about, 7 days a week, never more than a minute on hold.
I love it. I wish the local infrastructure were better, so I could get better than 3.5/1 in the middle of San Francisco, but I love everything about Sonic so far. This is what telecom service is supposed to be like.
A lot of doctor's offices are printing out pre-signed perscriptions on 8x11 instead of hand writing/signing on perscription pads whose paper has security features.
But for controlled substances, US pharmacies still require, and all doctors use, secure prescriptions with real signatures and a valid DEA identifier. When filled, the prescription is recorded in a national database referring to the patient, the doctor, and the pharmacy. Those printed 8.5x11 rx's are for stuff like blood pressure meds that no one really cares about, and can't be used for more interesting stuff. If you really want to forge a metoprolol script and sell the extra on a street corner, go ahead.
I am modestly surprised that there isn't a bigger black market for the more expensive (but non-controlled) prescription drugs, but I guess it's easier to get them from Canada than risk a dealer.
Approximately half of the participants were non/low caffeine consumers and the other half were medium/high caffeine consumers. All were asked to rate their personal levels of anxiety, alertness and headache before and after being given either the caffeine or the placebo. They were also asked to carry out a series of computer tasks to test for their levels of memory, attentiveness and vigilance.
They did, but they didn't report it in this paper. Here, they only reported the self-reported scale of alertness, and as the GP poster described it's entirely possible that caffeine drinkers have a higher expected alertness level. We'll have to wait for the sister paper to see what the objective tests show.
Common thing in science, collect all your data at once but report different "stories" in different papers. This story was actually about how certain SNPs in a particular gene might affect how caffeine induced anxiety. Maybe the other paper is going have a story that focuses on how that gene affects the cognitive aspects of caffeine use.
3) We rarely spot fairly large mile-plus asteroids before they actually pass us. What makes you think we could spot even MASSIVE spacecraft with any warning?
If they're planning to stop, instead of just pass through/into us, then they would need to decelerate as much as they accelerated to begin with. The exhaust will be pointed at us, and we should be able to see it either a long way off (if they're going slowly) or a REALLY long way off (if they're going fast). So long as their drives obey the laws of thermodynamics as we understand them, we should be able to see them coming.
What alternate freaking universe are you from? Sounds like a nice place.
The Republican conservatives believe that no taxpayer money should be funding abortions.
Ah, the one thing our universes have in common. Women should be barefoot and pregnant in the kitchen, appropriately inferior and subservient. My head would explode if any universe contained Republicans who felt otherwise.
They also think that the principle reason that healthcare doesn't work in this country is because the cost of health care is too high.
Liberal fascists want to cut Medicare! Death panels! Rationing!
They believe this is due to too many people trying to get a "free pass" by not having insurance.
Liberal fascists want to unconstitutionally force people to pay for insurance! Mandate! Fascism! Or Communism! One or the other. Did any Republican in your universe really demand a mandate?
It's also due, they think, to a serious problem with "impulse" lawsuits which force doctors to buy an incredibly high amount of malpractice insurance.
OK, one more thing in common, Republicans in your universe have a similarly inane and objectively insane view of how much lawsuits add to the cost of health care.
The Republicans also think that there are way too many procedures, both surgical (angioplasty vs. TPA for heart problems) and diagnostic (too often a large, extremely expensive test is conducted for no good reason).
Rationing! Death panels! Liberal fascists want to kill grandma and Sarah Palin's kid! Look at how England kills anyone who's not 6 feet tall and strappingly healthy! Fascist Communists coming between you and your doctor!
Finally, the Republicans think there is no such thing as a single bill that will fix this. What is required is a gradual, step-by-step series of bills, to be written and implemented over a series of years, to ease us into a new era of health care.
Ah, in your universe Republicans will build upon the series of stepwise sensible reform bills they enacted during the years when they had control of all three branches of government. Like when they offered a Medicare prescription drug plan that would lower overall costs by providing national negotiation with drug companies, while reducing the deficit by paying for the program with other spending cuts and new taxes. Sure. Nice place, that universe. Or they offered their series of sensible stepwise reform bills as a proposal during the year-and-a-fucking-half the entire Congress was masturbating over health care reform. Right. Heard a lot about that in this universe.
In our universe the national Republican party is batshit crazy, and has wed itself to the ideal of allowing absolutely nothing to happen, ever, by calling anything that anyone suggests a Fascist Communist plot, even if it was their idea to begin with (as most of the HCR bill was. Romneycare, anyone?). That's gonna work out real well for them, forget about how it works out for the American people. If you seriously think "BOTH sides make VERY good points" you are also batshit insane. Too bad your health insurance company probably doesn't cover Psychiatric care.
The USPS is in debt up to its eyeballs because electronic documents are causing a drop in volume. FedEx and USPS have adjusted their rates , fleets and staffing to accommodate this drop. The USPS is less nimble because it faces restrictions imposed by the government (what kind of business it can do, what rates it can charge, etc.). If we ran healthcare like this, you can bet it would have the exact same problem.
I really like the USPS vs FedEx analogy. It illustrates the fundamental difference between private industry and the government, and applies perfectly to heath care.
The USPS is required by law to provide a service to the people of the US. FedEx is required by its stockholders to make the largest possible profit. USPS has to provide affordable rates for tiny packages picked up at any address anywhere in the US (or overseas for APO addresses) and deliver it to any other address anywhere else in the US. FedEx does no such thing, or at least can charge whatever it actually costs to do so. Try to have FedEx pick up a one-page letter from your house and deliver it somewhere 2000 miles away. How much does that cost? A hell of a lot more than 44 cents. FedEx is better at delivering a package as fast as humanly possible, as certain as humanly possible. But which service to most people need most often?
USPS is single-payer healthcare (imagine affordable primary care instead of letter delivery) while FedEx is a private insurance company (lots of elective cardiac caths and hip replacements). One will provide better services to most people, the other will do certain profitable things well and make a lot of money doing it. Maybe we need both to give everyone the best possible health care. But right now unless you're over 65 or a veteran we live in a country without a postal service, where FedEx charges us $50 to send a birthday card to Grandma, and where they cancel delivery service altogether if you subscribe to too many magazines.
Slashdot Mirror
This is what board certification is for. State licensing boards usually have some requirements for staying up to date, but they really just guarantee that the person went to med school and hasn't had their license revoked. The specialty boards are much more comprehensive. Being board certified is formally optional, imperfect, and hotly debated among doctors - but I would hesitate a lot before going to a doctor who didn't maintain certification. Did they check if the doctor was board certified?
Always get a second opinion before any surgery. Or any major medical decision. Ideally, get two opinions and then run them by a third party, like a primary care doctor. Always. If you're talking about wanting competition, this is basic stuff. Why did they not go to the regional university up front?
How does making it easier to sue him give him more competition? More importantly, how does making it easier to sue him prevent the harm that was done to your relative? You're arguing for more regulation, not less.
Testosterone supplementation in men with low T levels appears to have the unfortunate side effect of death.
There is a growing literature on the potential dangers of testosterone supplementation. Not enough yet to say it's as clearly a bad idea as female HRT, but for sure it isn't something men should run out and do without a careful and personalized discussion with a knowledgeable (actual) doctor.
In general I think it's safe to say that the "take extra of the hormones that go down with age in some people" theory of fighting aging is pretty thoroughly discredited by now. Thyroid hormone, growth hormone, testosterone, estrogen, etc. - the science is clear this is not how you fight aging. In general, more likely to hasten death than prevent it.
Off topic, but do you have a link to more info about your dynamometer? IAA biologist interested in measuring mouse activity and exercise capacity. Many people still use those treadmills, which seem less than deal to me (for multiple reasons).
The situation of pilots and doctors does seem similar on several levels, but I think you're drawing the wrong conclusions.
The proximate cause of the "speed-exams" is not a doctor shortage, but an artifact of how most doctors are paid - by the visit. You get a tiny bit more money for a long, complicated visit, but not nearly as much as if you see two or three patients in the same time. This is true for almost every payer - private insurance, Medicare, Medicaid, etc. The financial incentives are strongly on the side of the speed-exam.
A more fundamental question is why the financial incentives matter so much, and that's where I think the pilot and doctor stories have some overlap. These are both highly skilled professions with a long, poorly paid training period and a strong incentive on the part of the "payers" to keep downward pressure on wages. Every time an insurance company or Medicare cuts their provider reimbursement rate, the incentive to cram more visits into a day grows that much stronger, because when you start your career at 30 or 35 with hundreds of thousands of dollars in loans, it's hard to take an arbitrary pay cut. (Talking about primary care doctors here, the situation may be different for the "lucrative" specialist du jour.)
Besides, the US actually has plenty of doctors, similar per capita numbers to Canada or the UK. But the financial incentives drive too many of them to lucrative specialties and urban practices, leaving too few doing primary care or working outside the big cities. Attempting to control costs by cutting doctors' fees creates perverse incentives.
The rise of nurse practitioners is more of an alternative attempt at cost control than a response to too few doctors. If you don't need 8 years of school and training to take blood pressure readings or insert an IV, and these things are actually done better by people who do them all the time, maybe some aspects of primary care can be done better by people with shorter but more focused training.
At 1G constant acceleration (flipping around mid-way) you'd reach Mars in about 3 days. (Avg Distance 225M km, travel time to half-way point at 10m/s/s = 42 hrs).
Stretching the trip to 90 days works out to 0.0015G acceleration throughout. I'm guessing the crew wouldn't notice that.
[Moral: When talking about acceleration, 1 G is a *lot*. It'll get you to alpha centauri in 4 years!]
h/t Wolfram Alpha
Canada has an efficient and effective single-payer system. When you are already spending money well, spending more money might be better.
The US has a fragmented, inefficient, and often ineffective hodgepodge of systems. When you are already spending money poorly, spending more money might be worse.
Or, put another way, Canada is probably somewhere to the right-of-peak on the Laffer curve of health care spending vs outcomes. The US is far, far to the left.
Do you work for the federal government? Work done by an employee of the federal government in the course of his/her duties is public domain. There's not even a question of patent or copyright, it's public domain by law.
If it's work on your own time that's not part of your official duties, however, you can do whatever you like with it.
My apologies, I meant permissive-with-a-small-p only as an antonym for restrictive. I admit I wasn't aware of the technical meaning. Thank you for pointing it out. I think the phrasing still made sense to most readers. Remember that for most of the physicians who read NEJM this was probably the first time they had even heard of copyleft.
I am one of the authors of the NEJM article.
We did not get into ethical issues in the article. But much of the current value of the MMSE does not lie in its contents but rather in the past 35 of research on it. Hundreds or thousands of studies from researchers around the world have shown doctors in exquisite detail exactly how and when to use the MMSE to best care for patients.
It is this vast accumulation of data on the validity and utility of the MMSE that makes it so valuable - and little of this was done by the MMSE's authors or PAR. In fact, much of this research might never have been done if the MMSE had had its current strict licensing terms 30 years ago. Some people have compared this behavior - waiting until the test is ubiquitous to start enforcing copyright - to patent trolls.
Nevertheless, the MMSE authors and PAR are entirely within their legal rights, and that is why we suggest that policy needs to change to prevent this from happening all over medicine.
I am one of the authors of the NEJM op/ed article.
It is all a little confusing. There are three parties here:
1. The original authors of the MMSE, who through PAR are strictly enforcing copyright protections of the MMSE
2. The authors of a new tool, the Sweet 16, which was created as an open-access alternative to the MMSE but was "taken down" by PAR in a copyright dispute
3. Us, the authors of TFA, who have no relationship to #1 or #2 but are very worried about what this all means for the practice and progress of medicine
I'm one of the authors of the NEJM article.
People already are moving on. In our practice we mostly use the Montreal Cognitive Assessment (MOCA) for screening, which is much more sensitive and has liberal licensing terms for non-commercial use.
But this is a general issue. The Sweet 16 was an attempt to move on, halted by PAR. I'm surprised that PAR hasn't already sued the MOCA authors given that the MOCA includes recall and orientation, like the Sweet 16. Even if it survives, the MOCA is not perfect- it has laudably generous licensing terms for copying, but no provision for derivative works. In 80 years, the heirs of the MOCA authors might well start suing researchers who use a trails test, clock draw and animal recognition in a new test.
Whether we move on from the MMSE or not, the threat to scientific progress will remain.
I'm one of the authors of the NEJM article.
We didn't have the space to describe the MMSE and Sweet 16 in detail, but here's a brief description:
The MMSE has 30 items, which include 10 orientation questions (what's today's date, where are we, etc.) and 6 questions for recall (say 3 standard words, repeat them back and remember them for 5 minutes or so).
The Sweet 16 has 16 items which include 8 orientation questions and 6 questions for recall (using different words than the MMSE). The other two questions involve repeating a sequence of numbers backwards.
So there is a lot of overlap between the two tests, and that was presumably the basis for an infringement claim. However, the items that overlap - orientation and recall - are quite generic and were in wide use long before the MMSE was created in 1975. Nevertheless, the authors behind Sweet 16 and their institution could not or chose not to defend the Sweet 16.
It's a little hard to imagine a cognitive assessment tool that doesn't include orientation or short-term memory recall questions, so this will strongly discourage progress in the field. Perhaps one of the Alzheimer's advocacy groups will take notice and defend researchers trying to advance the state of the art.
I'm one of the authors on the NEJM article.
The developers of the Sweet 16 - the test apparently "taken down" for copyright infringement of the MMSE - were all Harvard faculty, and work for academic centers that are affiliated with Harvard and its hospitals (Hospital Elder Life Program, Institute for Aging Research and Hebrew Senior Life). The senior author of the Sweet 16 is a well-known Harvard professor. One of the things we find concerning about this case is that Harvard Medical School probably has some claim to ownership of the Sweet 16, and was presumably involved in its defense. If Harvard, with its vast resources, could not or chose not to defend the Sweet 16 successfully, what hope do any other researchers have to develop new cognitive testing tools?
I triple-dog dare you to drink a glass of 11% (w/w) hydrochloric acid.
It's 89% water and contains only a chemical found in your stomach naturally! That can't possibly hurt you!
Obfuscated science makes kittens cry.
These guys aren't fleeing to Seattle because they fear the big-bad regulations of the People's Republic of California. They're fleeing out of fear of Amazon. Amazon's response to the sales tax proposal was to threaten to disown all of its affiliates in California, since the physical presence of affiliates was one of the justifications for asking them to collect sales tax. Amazon would rather stick a knife in the back of all of its partners, putting who knows how many people out of business, than collect a nickel of sales tax from its customers. They can't pull the same thing in Washington because it's hard to deny that giant former hospital on top of a hill with an Amazon logo already constitutes a physical presence.
They left San Francisco because the Bezos bear was gonna swat them out of spite, so they went to cuddle up next to it.
And this "startup" is two guys. Fine, maybe they'll make it big one day, sounds like they got plenty of capital. But it's still two guys. Why does the decision of a two-guy business rate a headline?
We never did pay off WWII debt, and we never will. Modest inflation and a growing economy make perpetual deficits and debt trivial, if they are reasonable. Yet our national economic policy is to minimize inflation at all costs, regardless of unemployment or a flat economy. So we now have near-deflation with near-zero long term nterest rates, yet horrific unemployment and an economy about to enter recession again. What's the problem with our debt again?
With you 100%, but it should be noted we're not that far off from Clinton levels of spending and will more or less reach it once we wind down our two land wars in Asia. We've cratered revenues, however. If we returned taxes to Clinton levels, we would have a small enough deficit that Republicans would be back to calling for tax cuts to prevent a surplus, instead of tax cuts for whatever reason they give now.
And that works not at all for the three things our federal government spends >75% of its budget on: defense, health care, and social security. Is Mississippi going disown protection from the US Army? Does it make the slightest bit of sense to have a "young whuppersnapper" state with no social security and an "old fart" state that everyone moves to when they're 65? This would make it impossible to have such programs at all (including an Army), or at best would make people a prisoner of whatever state they were lucky enough to be born in. Forget about the problem of Mississippi's toxic waste and air pollution flowing into the next state over.
Do you guys think these things through at all?
Ha! And so your innocent slip of the tongue exposes you for what you are, agent of K'breel and the Council of Elders! No human born on Earth could even feign surprise at Apple's exorbitant charges for spec upgrades.
You're here to intercept Curiousity, aren't you? Your mission will now be in vain!
I just switched to Sonic from AT&T DSL when we moved last week. I've fallen in love with Sonic and their Fusion service. This is where they use their own equipment at central offices and offer as much speed as you can get, up to 20Mbps, for a flat $40/mo. Highly recommended.
I didn't particularly have a problem with AT&T before, but when we decided to move less than a mile across the city I was told:
1. I couldn't keep my phone number
2. I had to buy a new DSL modem, even though mine was AT&T recommended and less than 6 months old
3. I had to switch to U-Verse, which meant paying more for less download speed
I understand the technical rationale behind some of this (we'd be served by a different central office that was exclusively U-Verse, which uses a different flavor of DSL, etc.) but it was a lot of shit to swallow in one gulp. And then I heard about the upcoming caps, too. We watch a lot of Netflix and would probably hit it regularly.
Sonic told me:
1. Sure, I can keep my old phone number
2. I can use my current modem
3. I'll get speeds at least as good as before for the same money
4. No speed limits (you get whatever your line can handle), no bandwidth caps
5. Free POTS phone service, just tossed in there
And it's been a pure pleasure to deal with them. Local human beings on tech support, who know what they're talking about, 7 days a week, never more than a minute on hold.
I love it. I wish the local infrastructure were better, so I could get better than 3.5/1 in the middle of San Francisco, but I love everything about Sonic so far. This is what telecom service is supposed to be like.
But for controlled substances, US pharmacies still require, and all doctors use, secure prescriptions with real signatures and a valid DEA identifier. When filled, the prescription is recorded in a national database referring to the patient, the doctor, and the pharmacy. Those printed 8.5x11 rx's are for stuff like blood pressure meds that no one really cares about, and can't be used for more interesting stuff. If you really want to forge a metoprolol script and sell the extra on a street corner, go ahead.
I am modestly surprised that there isn't a bigger black market for the more expensive (but non-controlled) prescription drugs, but I guess it's easier to get them from Canada than risk a dealer.
They did, but they didn't report it in this paper. Here, they only reported the self-reported scale of alertness, and as the GP poster described it's entirely possible that caffeine drinkers have a higher expected alertness level. We'll have to wait for the sister paper to see what the objective tests show.
Common thing in science, collect all your data at once but report different "stories" in different papers. This story was actually about how certain SNPs in a particular gene might affect how caffeine induced anxiety. Maybe the other paper is going have a story that focuses on how that gene affects the cognitive aspects of caffeine use.
If they're planning to stop, instead of just pass through/into us, then they would need to decelerate as much as they accelerated to begin with. The exhaust will be pointed at us, and we should be able to see it either a long way off (if they're going slowly) or a REALLY long way off (if they're going fast). So long as their drives obey the laws of thermodynamics as we understand them, we should be able to see them coming.
What alternate freaking universe are you from? Sounds like a nice place.
Ah, the one thing our universes have in common. Women should be barefoot and pregnant in the kitchen, appropriately inferior and subservient. My head would explode if any universe contained Republicans who felt otherwise.
Liberal fascists want to cut Medicare! Death panels! Rationing!
Liberal fascists want to unconstitutionally force people to pay for insurance! Mandate! Fascism! Or Communism! One or the other. Did any Republican in your universe really demand a mandate?
OK, one more thing in common, Republicans in your universe have a similarly inane and objectively insane view of how much lawsuits add to the cost of health care.
Rationing! Death panels! Liberal fascists want to kill grandma and Sarah Palin's kid! Look at how England kills anyone who's not 6 feet tall and strappingly healthy! Fascist Communists coming between you and your doctor!
Ah, in your universe Republicans will build upon the series of stepwise sensible reform bills they enacted during the years when they had control of all three branches of government. Like when they offered a Medicare prescription drug plan that would lower overall costs by providing national negotiation with drug companies, while reducing the deficit by paying for the program with other spending cuts and new taxes. Sure. Nice place, that universe. Or they offered their series of sensible stepwise reform bills as a proposal during the year-and-a-fucking-half the entire Congress was masturbating over health care reform. Right. Heard a lot about that in this universe.
In our universe the national Republican party is batshit crazy, and has wed itself to the ideal of allowing absolutely nothing to happen, ever, by calling anything that anyone suggests a Fascist Communist plot, even if it was their idea to begin with (as most of the HCR bill was. Romneycare, anyone?). That's gonna work out real well for them, forget about how it works out for the American people. If you seriously think "BOTH sides make VERY good points" you are also batshit insane. Too bad your health insurance company probably doesn't cover Psychiatric care.
I really like the USPS vs FedEx analogy. It illustrates the fundamental difference between private industry and the government, and applies perfectly to heath care.
The USPS is required by law to provide a service to the people of the US. FedEx is required by its stockholders to make the largest possible profit. USPS has to provide affordable rates for tiny packages picked up at any address anywhere in the US (or overseas for APO addresses) and deliver it to any other address anywhere else in the US. FedEx does no such thing, or at least can charge whatever it actually costs to do so. Try to have FedEx pick up a one-page letter from your house and deliver it somewhere 2000 miles away. How much does that cost? A hell of a lot more than 44 cents. FedEx is better at delivering a package as fast as humanly possible, as certain as humanly possible. But which service to most people need most often?
USPS is single-payer healthcare (imagine affordable primary care instead of letter delivery) while FedEx is a private insurance company (lots of elective cardiac caths and hip replacements). One will provide better services to most people, the other will do certain profitable things well and make a lot of money doing it. Maybe we need both to give everyone the best possible health care. But right now unless you're over 65 or a veteran we live in a country without a postal service, where FedEx charges us $50 to send a birthday card to Grandma, and where they cancel delivery service altogether if you subscribe to too many magazines.