I think this is a very thoughtful post, and you certainly speak with a good degree of insight into how you got here and why. I would just point a couple things I disagree with:
"Even at high doses, they don't really exhibit any toxic effects on your body. They actually lower your heart-rate and blood pressure"
A hypotensive/hypertensive crisis is most definitely a real medical emergency. Yes your heart rate can go down quite far, depending on what kind of shape your heart is in. But when you start dipping below 60 BPPM and you don't have the heart of a marathon runner, you could be in for some real shit. And in all liklihood, not around anyone who is gonna recognize a slowed heart rate and hypotensive crisis. And actually, the short-term effect is actually an increase in BP and HR, not a decrease. So infarct is a real possibility. It's probably best to characterize heroin use as leading to an irregular heart beat and irregular BP, but neither high or low is particularly good.
"...arguably healthier for you in the physical sense than alcohol, nicotine, and caffeine even."
"Arguably" is the key word here. I think you'd be hard-pressed to say that heroin is healthier than caffeine. I suppose one dose of heroin is healthier than a caffeine addiction. But dose for dose, Heroin is on a whole 'nother level from caffeine in terms of health/health consequences. Same thing with nicotine. Neither A 40 year old, 3 pack a day chain smoker nor a 40 year old regular user of heroin is going to be healthy. Their problems may be different, but neither of them are healthy by any stretch.
"It is unlikely that I will ever die from using heroin"
Well, I suppose that it is true that the direct cause of death won't be heroin, but it will be the secondary medical complications associated with use that will be the final cause of death (i.e. respiratory infection, cardio-vascular problems, vascular disease, infection, etc...).
"... I'm unlikely to suffer any physical consequences from my heroin habit other than perhaps I'll age a little slower than other people (a side effect of chronic heroin use)."
I'm guessing your age to be in your 20's, based on you experience with Counter-Strike. Trust me when I say heroin users do not age "slower" than non-heroin users. Maybe there is some animal model research I'm not aware of on metabollic and/or cellular changes as they relate to aging and heroin use. But i've seen plenty of heroin addicts (in non-mental health settings) who are aged 20+ years beyond their chronological age in terms of mental and physical changes. These people we kindly refer to as, *an old* 40.
Anyway, like i said at the beginning, your post was very thoughtful and I sincerely wish you the best.
"Given that Alzheimers affects everyone in different ways..."
Actually, "Alzheimer's disease" affects people in relatively similar ways, whereas "dementia" affects everyone in different ways. This is because "Alzheimer's disease" is one *very specific* type of "dementia." Simply because one is "demented" does not imply they have "Alzheimer's disease." Other forms of dementia include Vascular Dementia, Parkinson's Dementia, Diffuse Lewy Body Disease, Korsakoff's Dementia, etc... (to name just a few). Knowing what kind of dementia a person has is helpful because treatments, course, and prognosis are different depending on the dementing illness in question.
Better Neuropsychological testing contains a battery of tests designed to disentangle exactly what components of cognitive capacity are impaired. For example, "Memory Deficits" are necessary for a diagnosis of some sort of dementia. However, memory itself requires a number of cognitive processes. Is the person's impaired memory the result of poor attention (person can't concentrate long enough to pay attention to material), poor working memory/slowed mental processing (person can't integrate information into memory stores), poor storage (information can't be stored), or retrieval (information is there, but can't be spontaneously recalled)? Depending on where the deficits lie is often a good indicator of what type of dementing illness the person may have. Of course behavioral observations, presenting personality, medical history, psychiatric history (i.e. substance abuse) and diagnostic imaging (MRIs, CT scans, etc...) go a long way to validating the test data.
Comparing one individual to another using test data is always subject to error, but comparing groups of demented to patients to normal controls, or comparing a group of Alzheimer's patients to Parkinson's patients is pretty safe in terms of overall differences.
jeff
For someone not familiar with DRM downloads
on
Songbird Flies Today
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· Score: 2, Insightful
I'm late to the game of personal MP3 players and what can and can't be played on any given device. The Songbird site is down, but i did read the article. So my main question is:
Can I use this new app to purchase music from any site that supports purchases (i.e. Apple, Napster, Rhapsody, Amazon, etc...), get a plain old MP3 file, which I can then play/burn onto any device I choose?
I had some experience with Rhapsody a few months back, but it seemed to be in some proprietary format, and I could only use their software to play/transfer/burn the file to my media. Will Songbird get around all of that?
"Is there something about being in the presence of giant egos that makes the mundane feel exceptional?"
I don't know about "exceptional," but it does lend some validation. The example I use is, as a pretty serious sim racer myself (N2003), there are several professional nascar drivers that play/use N2003. Scott Pruitt used it after sustaining a head injury before getting back into a real car. Dale Earnhardt Jr. and Kevin Harvick, amongst others, are members of online racing leagues. I've seen documentaries of both showing them playing N2003 online, racing against other, non-professional drivers.
I understand that it's pretty geeky racing online, but the sim racing community takes it real serious and it is the closest most of us will ever come to racing. With that said, explaining it as a hobby elicits the same blank stare from just about everyone , as if the hobby has no merit and a game is a game. They don't appreciate the nature/realism of the simulation, nor do the understand/appreciate the depth. But I can always fall back on the fact that real race car drivers play the sim as well, and somehow that adds some level of legitimacy to the hobby. Do I need that validation? No. But it's nice to have.
I know the example is a little different that the Bono X-Box example, but for me I suspect it's not just about elevating oneself to the level of celebrity because you share the same interests, but recognizing that on many levels, celebrities do the things we like to do and deal with the same headaches we do.
"Wrong. Darwin's theory essentially predicts that the leaves on a given branch of the "tree of life" (your analogy, not mine, but anyway...) will change in response to outside influences such as survival of the fittest, et al..."
Actually,
it's more correct to say that evolution occurs as the result of genetic variation in species. Chromosomes and all genetic material don't "change" to meet the demands of the environment. Chromosomes don't magically combine in new ways because the climate gets colder. They change because biology allows changes in chromosomal mapping when one cell is "fertilized" by another. Those mappings that give an organism a better chance at survival, live to breed another day. Those mappings that don't improve survival simply die off.
This is an arguement that the ID folks use to try and incorporate darwinian evolution into their model. They have a camp that says, sure evolution is happening, but it's god's hand putting the chromosomes together in specific ways to improve survival.
No one, including Darwin suggested that genetics are "guided" or "designed" by the environment. Evolution is simply the product of the reproductive process with more specialized (albeit accidental) adaptations better able to live and survive in one environment vs. another.
"XM/Sirius is complete garbage; a relative has Sirius in his car, and it drops out all the time; tree cover, bridges, tall buildings. The audio quality is atrocious; Plus it doesn't address any issues except the commercials- it's still crap other people want you to listen to, and not crap you want to listen to:-)"
Wow,
that hasn't been my experience at all. I have a Sirius Sportster and it's been great. Granted the quality of the sound for the music channels is "ok", but I'd hardly call it "Atrocious." I'm listening to it in my *car*, not on a $10,000 home audio system where even CD's can sound like crap. I have a plain old VW golf, with a very average sound system and the satellite radio sounds perfectly fine. I will admit that most of the talk stations sound pretty bad, but I only listen to Bears games when i'm on the road, so bad sound is better than no sound and not hearing the game at all.
As far as dropping signals go, I almost never have that problem as well. There are a few underpasses I go through that drop the signal, but an equal number of parking garages where the signal is just fine. Even for a large part of lower Wacker Drive in Chicago, it holds the signal. I drove from Chicago to the north woods of Wisconsin this summer and never once did the signal drop, regardless of the tree cover. I have my antenna mounted to the roof of my car, just behind the factory antenna mast so nothing special there.
About the only real problem I've noticed is that if you try to use the FM Transceiver(?) feature to "broadcast" to the in-car stereo, there is too much intereference from competing stations. There are only a limited number of frequencies available with the Sirius radio itself, and just too many FM stations in the Chicagoland area to get a clean signal. So I went with a cassette adapter and all is well.
I am a psychologist, I chair an ethics committtee, and I also work on an organ transplant team. Ethical issues abound in transplants, even "simple" organ and tissue transplants. Who is allowed to give up an organ? How are organs distributed? How are transplant candidates prioritized, etc...?
This surgery I assume (althought I haven't RTFA) was elective. Elective surgerys also are full of ethical questions? Is the surgery "necessary? Should resources be devoted to elective surgeries and if so, how much? Who should be allowed to get an elective surgery and why/why not?
Take "plain old" cosmetic, plastic surgery. Should a 16 year old woman be allowed to get breast implants, lipo suction, lip enhancements, face lifts etc...? There are plenty of people out there that think these things at least warrant a discussion of bio-ethics.
In these kinds of issues, there is a *long* continuum of procedures, with each point on the continuum having its own orthogonal axis of "ethical loading," from low to high. Where on the continuum a facial transplant falls and what its ethical loading is I'll leave up to the medical ethicists, but to say that there are no ethics here is, quite frankly, naive.
The parent is right. In fact, to describe their tolerance as "narrow" is understating things. A lego piece made 30 years ago fits perfectly with a piece coming off the line today. I've bought 10,000's of legos over the years (basic, old school technic from the 80's, Mindstorm, etc...) and never once have I seen a piece that didn't work. And not only do they fit and work, but they fit tight and stay together despite a fair amount of abuse. Try any of the other block building toys out there and there is no competition. To me, the level of quality control is actually mind boggling. And the more I think about it, I can't think of any product out there that (as far as I'm concerned) is 100% guaranteed to work, the first time out, for the rest of my life or the life of productm whichever comes first.
What PocketPC did you get for $165.00ish? I'm in the market for a similar device. I can't seem to find anything that cheap ($165.00) with these specs. Everything I see seems considerably less capable.
given the topic at hand. Your "opposites" in a person would preclude them from having any sort of success whatsoever, let alone a position of leadership. Their interpersonal sphere of influence would be small to non-existant, except perhaps in their family. And neither would be a person you would want in your family.
A sociopath, on the other hand, has qualities that can allow them to achieve and succeed, meaning that others may be left in their wake.
While i don't know that your comment follows from the parent post or my own, in few cases is it the actual physicians conspiring with insurance carriers. It's the facilities that employ those physicians that set the rates, not the physicians themselves.
Physicians want to and make good money, don't get me wrong. And i'm not exactly sympathetic to their efforts when the believe they are being short changed. But health care provision is big business with substantial profits. While some physicians may be part of management or sit on the board of directors, these are business folks calling the shots, setting the rates, setting reimbursement rates etc... For once, physicians are like the rest of us poor schlubs, working for the man;-). It's new territory for them and they don't like kicking up their earnings to management.
Back in the day when everyone had a private insurer and saw a private physician, then yes the physician had to set a competitive rate for care to be on the insurance panel. But anymore, there are few physicians who practice independently. It's just too damn hard and expensive.
"When it came time to talk billing, the surgeon's office told us up front: the fee is $8k. Unless your insurance will be paying, then the fee is $11k. And oh, by the way, even if he were in network, the "reasonable" fee the insurance would pay was only $2k, tops, and we were responsible for the difference. So basically, by paying ourselves it was $8k, or by claiming insurance we'd have paid $9k!"
I'm sure the issue here is the processing cost and lost future earnings to the hospital for billing an insurance company. It is exceedingly time consuming and labor intensive, even with sophisticated computer record/billing systems, to get a charge out the door to an insurance agency. Clerks pour through and collect all the relevant billing info, then crank it through expensive software that will generate a billing report that may or may not be accepted by the insurer in question. And what is required can vary from insurer to insurer, plan to plan.
Then, there is the delay from the time a patient walks out the door to the time a check arrives in the mail paying for that care. Those care costs are upfront. The reimbursement can easily be months off. So, that is essentially lost revenue on investment income.
And finally, there is the denial of a claim (or part of a claim), which further bogs the process down as well.
It is far from a perfect system with no real answers at this point (baring some radical switch to social medicine), but it's not like the hospital is trying to make more money by having you make a claim. It is by far in the hospital's interest to have more patient's like yourself, who are willing to simply pay out of pocket for their care. It is infinitely easier, far less time consuming and troublesome, and likely more profitable.
As an aside, it's why we're begining to see a cottage industry of "private physicians." Doctors who don't want the hassle of insurance anymore and contract directly with patients to provide care for a set amount each year. It ain't cheap, but there are plenty of wealthy people in this country who are opting for it. And it can be *far* more profitable for the physician, assuming (s)he are established and have the infrastructure in place to provide primary or specialty care.
I'm referring to the GUI front end (CPRS) to the VISTA package. Everything I've stated about the GUI front end is true in VISTA, but some of the nicer windows functions only come from the GUI front end (e.g. you can't view an x-ray from within a VISTA terminal session). But all the progress notes, orders, meds, appointments, reports, etc... can be accessed from a plain old terminal.
I work at a VA, and use the electronic medical record system daily. I have also worked at three of the largest teaching hospitals in my area. I can tell you, hands down, that the system in place at the VA does a horizon shot on anything out there currently in the private sector.
It is an extremely complex piece of software, which is highly modular. With that said...
(1) It is comprehensive in that it includes everything about a patient's medication history, treatment history, all progress notes, labs, images, imaging reports, scanned documents, orders, appointments, etc... dating back to the installation of the system approximately 6-10 years ago (depending on facility). And to a limited degree, I can create custom reports containing information that I need for treatment. Finally, there is a tremendous amount of field data, allowing me to create custom, templated progress notes that will pull relevant information into the electronic note.
(2) I can search almost the entire patient electronic chart by keyword, progress note title, date of entry, author of note etc... making it extremely easy to locate specific information I need.
(3) And of course, there is improved patient care because now everyone has access to everything regarding the patient in question. I can see exactly what other providers are doing, what medication has been ordered, administered and when. I can also access patient education materials, micromedex, the PDR, and a whole host of other material, right from the web while i'm in the chart.
I guess I could go on and on about the quality of the software. I've maybe explained 10-20% of what it does and how it's helpful. The downside is that, because it's modular/extensible, a lot gets added without as much user interface testing as there should be. Also, some parts of the system are cumbersome because they were cleary afterthoughts. But all-in-all, this is an extremely complete electronic medical record system that is hugely beneficial to patient and provider.
And finally, interestingly enough, a cottage industry of consulting firms that can roll out and support this software exists. And of course, this post wouldn't be complete without a typical government story. One of our informatics people (the staff who support the package internally) was recently reassigned to another clinical area. Rather than move to another clinical position, he was hired by the consulting firm we use to support the very software the VA developed, and now he may very well return to our hospital as an external consultant, doing what he did before he left (at a much higher price of course:-) ).
I think the original parent post was referring to the documentary not being released on DVD, not any of the original Dr. Who episodes, which as you point out, are slowly becoming available.
it might be a practice effect your seeing. You should get better over time as you do more of these crossword puzzles (or at least that's what i've heard, i hate the things).
I could describe any number of studies that could get at the result in which you're intersted, but the one you're basing your conclusions on would be the one with the largest confound (e.g. practice).
"Sadly no legislation is ever going to put the horse back in the barn."
True. What could have been more interesting is if the students in the class targetted legislators (state or federal) rather than generic residents of Baltimore.
Regardless of whether one considers this data "private" or not, there is a lot of *personal* information available in the *public* domain. Maybe if lawmakers were themselves targets and it was shown just how much information can be collected, organized and collated they would take these issues of privacy a little more seriously.
Over time, the pendulum swings between patient autonomy and benefiecence/do no harm. Currently, in the US at least, the pendulum is on the side of patient autonomy, and yes a patient can dictate the care that they wish to receive.
With that said, the physician is not obligated to provide that care (in a conscientious objector sort of way) in which case the physician is obligated to find a person who will provide that care.
It happens everyday in every hospital where a patient asks for treatment which may in direct contradiction to that which the treating physician would recommend, and in either direction. That is, (a) patients who want life sustaining treatment despite the fact that it will not improve their current health status (e.g. the Terry Schiavos of the world) and (b) patients who don't want life sustaining treatment despite the clear benefit to their well-being (e.g. high level quadraplegics who ask that their ventilators be turned off so that they can die).
In both cases as stated above, and assuming the patient is competent to make these decisions, then yes the treating physician has to abide by the wishes of the patient or find someone who will. These are *extremely* simplistic examples and the issues are complicated, but the philosophical pendulum is currently on the side of patient autonomy and is the moral compass that physicians should be and need to be held accountable to.
There will come a time when we are back to beneficence > patient autonomy, but we're not their currently.
I don't recall another story involving an Afghan woman, but I could be wrong.
-and-
"she wasn't breaking any afghanni law, and she had NO OTHER RECOURSE for recompse for her labors.. (and good for her)"
Simply because she wasn't breaking a law in her country (which I'm not sure is true anyway) doesn't make it right. So I for one am not saying "good for her."
does allow you to play some of their games online for free. However, unless you buy the game and get an access code included in the game (good for 1 year, then you have to pay a subscription) you can't *create* games, you can only join games already started by members.
For some games, like "Ticket to Ride," this isn't a big deal because it seems there is almost always a game going on you can join. But for games like "Queen's Necklace," there is almost never anyone playing so it's not a game you can expect to play online very often.
maybe I'm being shortsighted, as this is only moderated a +3 at the moment, but that seems like a pretty clever idea. I've had an ATM card eaten by a machine after I punched in the wrong number a few times trying to remember which PIN went with that particular card.
Maybe there's a downside I'm missing, but it seems like a reasonable, short-term, down and dirty solution to a lost ATM card should it fall into the hands of a dishonest person.
jeff
Re:Our Fearless Leaders at Work
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Juiced
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· Score: 1
"What? You're on crack."
Not really, but you can find my recent comments on slashdot about addictive substances elsewhere;-).
"MLB does most certainly NOT control all of baseball."
They certainly control all of Major League Baseball as it exists right now.
"You are more than welcome to start up a competing league and put teams wherever the hell you choose."
True enough, but lets be honest and say that this is not going to happen.
"For more info on this, I strongly encourage you to read up on the history of the MLB itself"
I am a big baseball fan, and was very interested in the hearings that took place yesterday. But you are correct in that i'm not a baseball historian. I did read this however (from a few years back):
http://espn.go.com/mlb/s/2001/1205/1290707.html
and it sure sounds to me like Baseball enjoys certain governmental protections. If they are going to enjoy these added protections, then I think they have to understand that congress can go in and monkey with the works. They (MLB) can't have their cake and eat it to, so to speak.
And this is from MLB.Com
"Kuhn presided over a tumultuous time in baseball. Among the notable events was the Curt Flood reserve case of 1970. Flood was traded by the St. Louis Cardinals to the Phillies, but refused to report to his new team. Instead, the outfielder initiated legal action against baseball, challenging the legality of the reserve clause and the right of clubs to trade players at will. Ultimately, the U.S. Supreme Court upheld the lower courts decisions in favor of baseball, ruling that federal antitrust laws did not apply to the game."
So to say that I'm on crack for suggesting that baseball enjoys governmental protection is a bit extreme;-).
"Your point being? Subsidization to entice business is part of business as usual my friend. Who cares if LA foots half the bill for the Dodgers. Don't like your tax dollars spent that way? Vote differently then or move somewhere where they don't spend tax dollars on this kind of subsidization"
I wasn't complaining at all about the process, and living in Chicago I for one am glad that we have as many major sporting venues as we have. But it doesn't change the fact that, again, certain privileges are afforded to MLB and baseball owners and as such they can be held more accountable than if those privileges had not been granted.
jeff
Re:Our Fearless Leaders at Work
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Juiced
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· Score: 2, Insightful
"Just because your employer (the MLB club owners) benefits from being exempt from some regulation does not make it OK for Congress to start sticking its nose into how you, the employee, do your job."
I'm not sure I understand this. MLB is under scrutiny by congress. Not the players themselves. Congress subpoened players to hear from line level personnel what kind of steroid problems exist in MLB. They weren't after the players. If every player on that panel had admitted to steroid use, the congressional panel would have done nothing to them other than thank them for their honesty. Legally, the players might have been in trouble for using an illicit substance, but that wasn't the focus of the hearings that took place.
"Under such reasoning, it would be OK to subpoena journalist's drug tests because the newspapers that employ them enjoy exemptions from campaign-finance regulations or media-ownership rules."
Now with what I said above, it would be o.k. if the journalists signed a contract with their newspaper publisher that held them to a certain level of accountability.
I work for the federal goverment and we enjoy some serious tax breaks;-). I signed a contract that allows them to test me for illicit substances whenever they see fit, and they can fire me on the spot for a dirty test.
MLB players are contracted employees of team owners and MLB through the collective bargaining agreement. I have no idea what the content of that thing is, but there are certain rules above and beyond the contract a player signs with a team to which they are accountable. The players union negotiated that contract with MLB. If the players signed that agreement and accept accountability for this, then they should be held accountable.
"What is "normal"? Seems today to be "work 9 til 5, eat, watch TV, sleep". Fuck that! Seriously! I'll take the Hunter S Thomson style parties anyday over that depressing life. "Normal"?"
Well, certainly "normal" is subjective. And I never try to move a person to a life that I would consider "normal." Different strokes for different folks.
What I try to do is ensure that the person's life is fulfilled to the degree that they think their life should be fulfilling. When you really sit down with someone who is addicted, and focus on how that addiction has impacted their quality of life, it is almost always the case that the person can identify ways that their life has fallen short of their expectations as a result of their addiction. Not 100% of the time, but very close.
"Are they the ones snapping up all the anti-depressants spat out by the drug industries?"
Not all, but unfortunately you are right in that antidepressant prescriptions are written at a much higher rate than they probably should be. And yes part of it is because of the pharmaceutical companies. They are certainly prescribed at a higher rate than the base rate of mental illness in the population.
"Remember also that you are seeing a biased sample. They people you interact with need your help. Would it be safe to assume that a certain percentage of adicts are below your radar because they are weathy, successful and otherwise healthy?"
Yes and no. There is no question my clinical sample is biased, and you can get very jaded that there are no "normal" people left in the world. And certainly the overwhelming majority of addicts are under my radar since I don't see every addict;-). With that said, I know plenty of people who have substance abuse issues (friends, family, acquaintances) that would be "healthier" in the abscence of that abuse/addiction. I honestly can't think of a situation where a person would be no more healthy in the abscence of an addiction.
"An addition need not be life impacting. Smokers don't seem to have a problem, and the vast majority of them are addicts."
I've yet to meet a smoker who doesn't have some problem, or who won't develop a very serious problem later in life. The cost alone of smoking 1ppd can run well over $1000.00 and it's climbing rapidly. So if nothing else, there is a financial cost that wouldn't otherwise be there. And a cost that a true niccotine addict will find impossible to avoid. Not to mention having to structure their day around opportunites to smoke (going out at lunch, on breaks, etc...). Now of course the impact will be for individuals, but nevertheless the impact is still there.
"If the drug does not affect your ablilty to function, then it's not a problem."
Diagnostically speaking, that is true in that if the use/abuse does not impair a person's day-to-day function, then technically speaking it's not an addiction and the person is not addicted to the substance. And I totally agree that there can be casual users of street drugs (just as there are casual gamblers that make 2 trips to vegas) that get along just fine. There are three points I would make: (1) they are not addicts and so don't necessarily qualify for the discussion, (2) generally speaking, people's lives are better in the absence of addictive substances, and (3) I honestly don't think there is any such thing as a casual, non-addicted heroin user.
"However, if you can function in society, hold down a job, have an active social life (moreso that your average/.'er I might add!), then it's not a problem."
Exactly, and these people aren't addicted. Substance use/abuse exists on a continuum. From abstinence to addiction. Technically / diagnostically speaking, there is no difference from one continuum to the next. In other words, the continuums for alcohol, cocaine, heroin, nicotine etc... are all the same. I tend to operate on the assumption that these continuums are of different lengths, and one can mor
Slashdot Mirror
Overall,
I think this is a very thoughtful post, and you certainly speak with a good degree of insight into how you got here and why. I would just point a couple things I disagree with:
"Even at high doses, they don't really exhibit any toxic effects on your body. They actually lower your heart-rate and blood pressure"
A hypotensive/hypertensive crisis is most definitely a real medical emergency. Yes your heart rate can go down quite far, depending on what kind of shape your heart is in. But when you start dipping below 60 BPPM and you don't have the heart of a marathon runner, you could be in for some real shit. And in all liklihood, not around anyone who is gonna recognize a slowed heart rate and hypotensive crisis. And actually, the short-term effect is actually an increase in BP and HR, not a decrease. So infarct is a real possibility. It's probably best to characterize heroin use as leading to an irregular heart beat and irregular BP, but neither high or low is particularly good.
"...arguably healthier for you in the physical sense than alcohol, nicotine, and caffeine even."
"Arguably" is the key word here. I think you'd be hard-pressed to say that heroin is healthier than caffeine. I suppose one dose of heroin is healthier than a caffeine addiction. But dose for dose, Heroin is on a whole 'nother level from caffeine in terms of health/health consequences. Same thing with nicotine. Neither A 40 year old, 3 pack a day chain smoker nor a 40 year old regular user of heroin is going to be healthy. Their problems may be different, but neither of them are healthy by any stretch.
"It is unlikely that I will ever die from using heroin"
Well, I suppose that it is true that the direct cause of death won't be heroin, but it will be the secondary medical complications associated with use that will be the final cause of death (i.e. respiratory infection, cardio-vascular problems, vascular disease, infection, etc...).
"... I'm unlikely to suffer any physical consequences from my heroin habit other than perhaps I'll age a little slower than other people (a side effect of chronic heroin use)."
I'm guessing your age to be in your 20's, based on you experience with Counter-Strike. Trust me when I say heroin users do not age "slower" than non-heroin users. Maybe there is some animal model research I'm not aware of on metabollic and/or cellular changes as they relate to aging and heroin use. But i've seen plenty of heroin addicts (in non-mental health settings) who are aged 20+ years beyond their chronological age in terms of mental and physical changes. These people we kindly refer to as, *an old* 40.
Anyway, like i said at the beginning, your post was very thoughtful and I sincerely wish you the best.
jeff
"Given that Alzheimers affects everyone in different ways..."
Actually, "Alzheimer's disease" affects people in relatively similar ways, whereas "dementia" affects everyone in different ways. This is because "Alzheimer's disease" is one *very specific* type of "dementia." Simply because one is "demented" does not imply they have "Alzheimer's disease." Other forms of dementia include Vascular Dementia, Parkinson's Dementia, Diffuse Lewy Body Disease, Korsakoff's Dementia, etc... (to name just a few). Knowing what kind of dementia a person has is helpful because treatments, course, and prognosis are different depending on the dementing illness in question.
Better Neuropsychological testing contains a battery of tests designed to disentangle exactly what components of cognitive capacity are impaired. For example, "Memory Deficits" are necessary for a diagnosis of some sort of dementia. However, memory itself requires a number of cognitive processes. Is the person's impaired memory the result of poor attention (person can't concentrate long enough to pay attention to material), poor working memory/slowed mental processing (person can't integrate information into memory stores), poor storage (information can't be stored), or retrieval (information is there, but can't be spontaneously recalled)? Depending on where the deficits lie is often a good indicator of what type of dementing illness the person may have. Of course behavioral observations, presenting personality, medical history, psychiatric history (i.e. substance abuse) and diagnostic imaging (MRIs, CT scans, etc...) go a long way to validating the test data.
Comparing one individual to another using test data is always subject to error, but comparing groups of demented to patients to normal controls, or comparing a group of Alzheimer's patients to Parkinson's patients is pretty safe in terms of overall differences.
jeff
I'm late to the game of personal MP3 players and what can and can't be played on any given device. The Songbird site is down, but i did read the article. So my main question is:
Can I use this new app to purchase music from any site that supports purchases (i.e. Apple, Napster, Rhapsody, Amazon, etc...), get a plain old MP3 file, which I can then play/burn onto any device I choose?
I had some experience with Rhapsody a few months back, but it seemed to be in some proprietary format, and I could only use their software to play/transfer/burn the file to my media. Will Songbird get around all of that?
thx in advance,
jeff
thx,
jeff
"Is there something about being in the presence of giant egos that makes the mundane feel exceptional?"
.02
I don't know about "exceptional," but it does lend some validation. The example I use is, as a pretty serious sim racer myself (N2003), there are several professional nascar drivers that play/use N2003. Scott Pruitt used it after sustaining a head injury before getting back into a real car. Dale Earnhardt Jr. and Kevin Harvick, amongst others, are members of online racing leagues. I've seen documentaries of both showing them playing N2003 online, racing against other, non-professional drivers.
I understand that it's pretty geeky racing online, but the sim racing community takes it real serious and it is the closest most of us will ever come to racing. With that said, explaining it as a hobby elicits the same blank stare from just about everyone , as if the hobby has no merit and a game is a game. They don't appreciate the nature/realism of the simulation, nor do the understand/appreciate the depth. But I can always fall back on the fact that real race car drivers play the sim as well, and somehow that adds some level of legitimacy to the hobby. Do I need that validation? No. But it's nice to have.
I know the example is a little different that the Bono X-Box example, but for me I suspect it's not just about elevating oneself to the level of celebrity because you share the same interests, but recognizing that on many levels, celebrities do the things we like to do and deal with the same headaches we do.
just my
jeff
"Wrong. Darwin's theory essentially predicts that the leaves on a given branch of the "tree of life" (your analogy, not mine, but anyway...) will change in response to outside influences such as survival of the fittest, et al..."
.02
Actually,
it's more correct to say that evolution occurs as the result of genetic variation in species. Chromosomes and all genetic material don't "change" to meet the demands of the environment. Chromosomes don't magically combine in new ways because the climate gets colder. They change because biology allows changes in chromosomal mapping when one cell is "fertilized" by another. Those mappings that give an organism a better chance at survival, live to breed another day. Those mappings that don't improve survival simply die off.
This is an arguement that the ID folks use to try and incorporate darwinian evolution into their model. They have a camp that says, sure evolution is happening, but it's god's hand putting the chromosomes together in specific ways to improve survival.
No one, including Darwin suggested that genetics are "guided" or "designed" by the environment. Evolution is simply the product of the reproductive process with more specialized (albeit accidental) adaptations better able to live and survive in one environment vs. another.
just my
jeff
"XM/Sirius is complete garbage; a relative has Sirius in his car, and it drops out all the time; tree cover, bridges, tall buildings. The audio quality is atrocious; Plus it doesn't address any issues except the commercials- it's still crap other people want you to listen to, and not crap you want to listen to :-)"
.02
Wow,
that hasn't been my experience at all. I have a Sirius Sportster and it's been great. Granted the quality of the sound for the music channels is "ok", but I'd hardly call it "Atrocious." I'm listening to it in my *car*, not on a $10,000 home audio system where even CD's can sound like crap. I have a plain old VW golf, with a very average sound system and the satellite radio sounds perfectly fine. I will admit that most of the talk stations sound pretty bad, but I only listen to Bears games when i'm on the road, so bad sound is better than no sound and not hearing the game at all.
As far as dropping signals go, I almost never have that problem as well. There are a few underpasses I go through that drop the signal, but an equal number of parking garages where the signal is just fine. Even for a large part of lower Wacker Drive in Chicago, it holds the signal. I drove from Chicago to the north woods of Wisconsin this summer and never once did the signal drop, regardless of the tree cover. I have my antenna mounted to the roof of my car, just behind the factory antenna mast so nothing special there.
About the only real problem I've noticed is that if you try to use the FM Transceiver(?) feature to "broadcast" to the in-car stereo, there is too much intereference from competing stations. There are only a limited number of frequencies available with the Sirius radio itself, and just too many FM stations in the Chicagoland area to get a clean signal. So I went with a cassette adapter and all is well.
just my
jeff
Well put.
I am a psychologist, I chair an ethics committtee, and I also work on an organ transplant team. Ethical issues abound in transplants, even "simple" organ and tissue transplants. Who is allowed to give up an organ? How are organs distributed? How are transplant candidates prioritized, etc...?
This surgery I assume (althought I haven't RTFA) was elective. Elective surgerys also are full of ethical questions? Is the surgery "necessary? Should resources be devoted to elective surgeries and if so, how much? Who should be allowed to get an elective surgery and why/why not?
Take "plain old" cosmetic, plastic surgery. Should a 16 year old woman be allowed to get breast implants, lipo suction, lip enhancements, face lifts etc...? There are plenty of people out there that think these things at least warrant a discussion of bio-ethics.
In these kinds of issues, there is a *long* continuum of procedures, with each point on the continuum having its own orthogonal axis of "ethical loading," from low to high. Where on the continuum a facial transplant falls and what its ethical loading is I'll leave up to the medical ethicists, but to say that there are no ethics here is, quite frankly, naive.
jeff
Exactly,
The parent is right. In fact, to describe their tolerance as "narrow" is understating things. A lego piece made 30 years ago fits perfectly with a piece coming off the line today. I've bought 10,000's of legos over the years (basic, old school technic from the 80's, Mindstorm, etc...) and never once have I seen a piece that didn't work. And not only do they fit and work, but they fit tight and stay together despite a fair amount of abuse. Try any of the other block building toys out there and there is no competition. To me, the level of quality control is actually mind boggling. And the more I think about it, I can't think of any product out there that (as far as I'm concerned) is 100% guaranteed to work, the first time out, for the rest of my life or the life of productm whichever comes first.
jeff
Just out of curiosity,
What PocketPC did you get for $165.00ish? I'm in the market for a similar device. I can't seem to find anything that cheap ($165.00) with these specs. Everything I see seems considerably less capable.
thx in advance,
jeff
And I raise your Michael Caine quote with this gem from David Lee Roth:
:-)
"Money can't buy you happiness, but it can buy you a yacht big enough to pull up right alongside it."
jeff
Of course the former is worse,
.02
given the topic at hand. Your "opposites" in a person would preclude them from having any sort of success whatsoever, let alone a position of leadership. Their interpersonal sphere of influence would be small to non-existant, except perhaps in their family. And neither would be a person you would want in your family.
A sociopath, on the other hand, has qualities that can allow them to achieve and succeed, meaning that others may be left in their wake.
just my
jeff
While i don't know that your comment follows from the parent post or my own, in few cases is it the actual physicians conspiring with insurance carriers. It's the facilities that employ those physicians that set the rates, not the physicians themselves.
;-). It's new territory for them and they don't like kicking up their earnings to management.
Physicians want to and make good money, don't get me wrong. And i'm not exactly sympathetic to their efforts when the believe they are being short changed. But health care provision is big business with substantial profits. While some physicians may be part of management or sit on the board of directors, these are business folks calling the shots, setting the rates, setting reimbursement rates etc... For once, physicians are like the rest of us poor schlubs, working for the man
Back in the day when everyone had a private insurer and saw a private physician, then yes the physician had to set a competitive rate for care to be on the insurance panel. But anymore, there are few physicians who practice independently. It's just too damn hard and expensive.
jeff
"When it came time to talk billing, the surgeon's office told us up front: the fee is $8k. Unless your insurance will be paying, then the fee is $11k. And oh, by the way, even if he were in network, the "reasonable" fee the insurance would pay was only $2k, tops, and we were responsible for the difference. So basically, by paying ourselves it was $8k, or by claiming insurance we'd have paid $9k!"
I'm sure the issue here is the processing cost and lost future earnings to the hospital for billing an insurance company. It is exceedingly time consuming and labor intensive, even with sophisticated computer record/billing systems, to get a charge out the door to an insurance agency. Clerks pour through and collect all the relevant billing info, then crank it through expensive software that will generate a billing report that may or may not be accepted by the insurer in question. And what is required can vary from insurer to insurer, plan to plan.
Then, there is the delay from the time a patient walks out the door to the time a check arrives in the mail paying for that care. Those care costs are upfront. The reimbursement can easily be months off. So, that is essentially lost revenue on investment income.
And finally, there is the denial of a claim (or part of a claim), which further bogs the process down as well.
It is far from a perfect system with no real answers at this point (baring some radical switch to social medicine), but it's not like the hospital is trying to make more money by having you make a claim. It is by far in the hospital's interest to have more patient's like yourself, who are willing to simply pay out of pocket for their care. It is infinitely easier, far less time consuming and troublesome, and likely more profitable.
As an aside, it's why we're begining to see a cottage industry of "private physicians." Doctors who don't want the hassle of insurance anymore and contract directly with patients to provide care for a set amount each year. It ain't cheap, but there are plenty of wealthy people in this country who are opting for it. And it can be *far* more profitable for the physician, assuming (s)he are established and have the infrastructure in place to provide primary or specialty care.
jeff
I guess I should clarify one thing,
I'm referring to the GUI front end (CPRS) to the VISTA package. Everything I've stated about the GUI front end is true in VISTA, but some of the nicer windows functions only come from the GUI front end (e.g. you can't view an x-ray from within a VISTA terminal session). But all the progress notes, orders, meds, appointments, reports, etc... can be accessed from a plain old terminal.
jeff
I work at a VA, and use the electronic medical record system daily. I have also worked at three of the largest teaching hospitals in my area. I can tell you, hands down, that the system in place at the VA does a horizon shot on anything out there currently in the private sector.
:-) ).
It is an extremely complex piece of software, which is highly modular. With that said...
(1) It is comprehensive in that it includes everything about a patient's medication history, treatment history, all progress notes, labs, images, imaging reports, scanned documents, orders, appointments, etc... dating back to the installation of the system approximately 6-10 years ago (depending on facility). And to a limited degree, I can create custom reports containing information that I need for treatment. Finally, there is a tremendous amount of field data, allowing me to create custom, templated progress notes that will pull relevant information into the electronic note.
(2) I can search almost the entire patient electronic chart by keyword, progress note title, date of entry, author of note etc... making it extremely easy to locate specific information I need.
(3) And of course, there is improved patient care because now everyone has access to everything regarding the patient in question. I can see exactly what other providers are doing, what medication has been ordered, administered and when. I can also access patient education materials, micromedex, the PDR, and a whole host of other material, right from the web while i'm in the chart.
I guess I could go on and on about the quality of the software. I've maybe explained 10-20% of what it does and how it's helpful. The downside is that, because it's modular/extensible, a lot gets added without as much user interface testing as there should be. Also, some parts of the system are cumbersome because they were cleary afterthoughts. But all-in-all, this is an extremely complete electronic medical record system that is hugely beneficial to patient and provider.
And finally, interestingly enough, a cottage industry of consulting firms that can roll out and support this software exists. And of course, this post wouldn't be complete without a typical government story. One of our informatics people (the staff who support the package internally) was recently reassigned to another clinical area. Rather than move to another clinical position, he was hired by the consulting firm we use to support the very software the VA developed, and now he may very well return to our hospital as an external consultant, doing what he did before he left (at a much higher price of course
hth,
jeff
I think the original parent post was referring to the documentary not being released on DVD, not any of the original Dr. Who episodes, which as you point out, are slowly becoming available.
jeff
ummm,
it might be a practice effect your seeing. You should get better over time as you do more of these crossword puzzles (or at least that's what i've heard, i hate the things).
I could describe any number of studies that could get at the result in which you're intersted, but the one you're basing your conclusions on would be the one with the largest confound (e.g. practice).
later,
jeff
"Sadly no legislation is ever going to put the horse back in the barn."
True. What could have been more interesting is if the students in the class targetted legislators (state or federal) rather than generic residents of Baltimore.
Regardless of whether one considers this data "private" or not, there is a lot of *personal* information available in the *public* domain. Maybe if lawmakers were themselves targets and it was shown just how much information can be collected, organized and collated they would take these issues of privacy a little more seriously.
jeff
Over time, the pendulum swings between patient autonomy and benefiecence/do no harm. Currently, in the US at least, the pendulum is on the side of patient autonomy, and yes a patient can dictate the care that they wish to receive.
With that said, the physician is not obligated to provide that care (in a conscientious objector sort of way) in which case the physician is obligated to find a person who will provide that care.
It happens everyday in every hospital where a patient asks for treatment which may in direct contradiction to that which the treating physician would recommend, and in either direction. That is, (a) patients who want life sustaining treatment despite the fact that it will not improve their current health status (e.g. the Terry Schiavos of the world) and (b) patients who don't want life sustaining treatment despite the clear benefit to their well-being (e.g. high level quadraplegics who ask that their ventilators be turned off so that they can die).
In both cases as stated above, and assuming the patient is competent to make these decisions, then yes the treating physician has to abide by the wishes of the patient or find someone who will. These are *extremely* simplistic examples and the issues are complicated, but the philosophical pendulum is currently on the side of patient autonomy and is the moral compass that physicians should be and need to be held accountable to.
There will come a time when we are back to beneficence > patient autonomy, but we're not their currently.
hth,
jeff
Do you mean this Pakastani woman?
http://archives.mtstars.com/main/7316.html
I don't recall another story involving an Afghan woman, but I could be wrong.
-and-
"she wasn't breaking any afghanni law, and she had NO OTHER RECOURSE for recompse for her labors.. (and good for her)"
Simply because she wasn't breaking a law in her country (which I'm not sure is true anyway) doesn't make it right. So I for one am not saying "good for her."
jeff
Just as a point of clarification,
The Days of Wonder website
http://www.daysofwonder.com/
does allow you to play some of their games online for free. However, unless you buy the game and get an access code included in the game (good for 1 year, then you have to pay a subscription) you can't *create* games, you can only join games already started by members.
For some games, like "Ticket to Ride," this isn't a big deal because it seems there is almost always a game going on you can join. But for games like "Queen's Necklace," there is almost never anyone playing so it's not a game you can expect to play online very often.
jeff
yeah know,
maybe I'm being shortsighted, as this is only moderated a +3 at the moment, but that seems like a pretty clever idea. I've had an ATM card eaten by a machine after I punched in the wrong number a few times trying to remember which PIN went with that particular card.
Maybe there's a downside I'm missing, but it seems like a reasonable, short-term, down and dirty solution to a lost ATM card should it fall into the hands of a dishonest person.
jeff
"What? You're on crack."
;-).
;-).
Not really, but you can find my recent comments on slashdot about addictive substances elsewhere
"MLB does most certainly NOT control all of baseball."
They certainly control all of Major League Baseball as it exists right now.
"You are more than welcome to start up a competing league and put teams wherever the hell you choose."
True enough, but lets be honest and say that this is not going to happen.
"For more info on this, I strongly encourage you to read up on the history of the MLB itself"
I am a big baseball fan, and was very interested in the hearings that took place yesterday. But you are correct in that i'm not a baseball historian. I did read this however (from a few years back):
http://espn.go.com/mlb/s/2001/1205/1290707.html
and it sure sounds to me like Baseball enjoys certain governmental protections. If they are going to enjoy these added protections, then I think they have to understand that congress can go in and monkey with the works. They (MLB) can't have their cake and eat it to, so to speak.
And this is from MLB.Com
"Kuhn presided over a tumultuous time in baseball. Among the notable events was the Curt Flood reserve case of 1970. Flood was traded by the St. Louis Cardinals to the Phillies, but refused to report to his new team. Instead, the outfielder initiated legal action against baseball, challenging the legality of the reserve clause and the right of clubs to trade players at will. Ultimately, the U.S. Supreme Court upheld the lower courts decisions in favor of baseball, ruling that federal antitrust laws did not apply to the game."
So to say that I'm on crack for suggesting that baseball enjoys governmental protection is a bit extreme
"Your point being? Subsidization to entice business is part of business as usual my friend. Who cares if LA foots half the bill for the Dodgers. Don't like your tax dollars spent that way? Vote differently then or move somewhere where they don't spend tax dollars on this kind of subsidization"
I wasn't complaining at all about the process, and living in Chicago I for one am glad that we have as many major sporting venues as we have. But it doesn't change the fact that, again, certain privileges are afforded to MLB and baseball owners and as such they can be held more accountable than if those privileges had not been granted.
jeff
"Just because your employer (the MLB club owners) benefits from being exempt from some regulation does not make it OK for Congress to start sticking its nose into how you, the employee, do your job."
;-). I signed a contract that allows them to test me for illicit substances whenever they see fit, and they can fire me on the spot for a dirty test.
I'm not sure I understand this. MLB is under scrutiny by congress. Not the players themselves. Congress subpoened players to hear from line level personnel what kind of steroid problems exist in MLB. They weren't after the players. If every player on that panel had admitted to steroid use, the congressional panel would have done nothing to them other than thank them for their honesty. Legally, the players might have been in trouble for using an illicit substance, but that wasn't the focus of the hearings that took place.
"Under such reasoning, it would be OK to subpoena journalist's drug tests because the newspapers that employ them enjoy exemptions from campaign-finance regulations or media-ownership rules."
Now with what I said above, it would be o.k. if the journalists signed a contract with their newspaper publisher that held them to a certain level of accountability.
I work for the federal goverment and we enjoy some serious tax breaks
MLB players are contracted employees of team owners and MLB through the collective bargaining agreement. I have no idea what the content of that thing is, but there are certain rules above and beyond the contract a player signs with a team to which they are accountable. The players union negotiated that contract with MLB. If the players signed that agreement and accept accountability for this, then they should be held accountable.
jeff
"What is "normal"? Seems today to be "work 9 til 5, eat, watch TV, sleep". Fuck that! Seriously! I'll take the Hunter S Thomson style parties anyday over that depressing life. "Normal"?"
;-). With that said, I know plenty of people who have substance abuse issues (friends, family, acquaintances) that would be "healthier" in the abscence of that abuse/addiction. I honestly can't think of a situation where a person would be no more healthy in the abscence of an addiction.
/.'er I might add!), then it's not a problem."
Well, certainly "normal" is subjective. And I never try to move a person to a life that I would consider "normal." Different strokes for different folks.
What I try to do is ensure that the person's life is fulfilled to the degree that they think their life should be fulfilling. When you really sit down with someone who is addicted, and focus on how that addiction has impacted their quality of life, it is almost always the case that the person can identify ways that their life has fallen short of their expectations as a result of their addiction. Not 100% of the time, but very close.
"Are they the ones snapping up all the anti-depressants spat out by the drug industries?"
Not all, but unfortunately you are right in that antidepressant prescriptions are written at a much higher rate than they probably should be. And yes part of it is because of the pharmaceutical companies. They are certainly prescribed at a higher rate than the base rate of mental illness in the population.
"Remember also that you are seeing a biased sample. They people you interact with need your help. Would it be safe to assume that a certain percentage of adicts are below your radar because they are weathy, successful and otherwise healthy?"
Yes and no. There is no question my clinical sample is biased, and you can get very jaded that there are no "normal" people left in the world. And certainly the overwhelming majority of addicts are under my radar since I don't see every addict
"An addition need not be life impacting. Smokers don't seem to have a problem, and the vast majority of them are addicts."
I've yet to meet a smoker who doesn't have some problem, or who won't develop a very serious problem later in life. The cost alone of smoking 1ppd can run well over $1000.00 and it's climbing rapidly. So if nothing else, there is a financial cost that wouldn't otherwise be there. And a cost that a true niccotine addict will find impossible to avoid. Not to mention having to structure their day around opportunites to smoke (going out at lunch, on breaks, etc...). Now of course the impact will be for individuals, but nevertheless the impact is still there.
"If the drug does not affect your ablilty to function, then it's not a problem."
Diagnostically speaking, that is true in that if the use/abuse does not impair a person's day-to-day function, then technically speaking it's not an addiction and the person is not addicted to the substance. And I totally agree that there can be casual users of street drugs (just as there are casual gamblers that make 2 trips to vegas) that get along just fine. There are three points I would make: (1) they are not addicts and so don't necessarily qualify for the discussion, (2) generally speaking, people's lives are better in the absence of addictive substances, and (3) I honestly don't think there is any such thing as a casual, non-addicted heroin user.
"However, if you can function in society, hold down a job, have an active social life (moreso that your average
Exactly, and these people aren't addicted. Substance use/abuse exists on a continuum. From abstinence to addiction. Technically / diagnostically speaking, there is no difference from one continuum to the next. In other words, the continuums for alcohol, cocaine, heroin, nicotine etc... are all the same. I tend to operate on the assumption that these continuums are of different lengths, and one can mor