No, he is exactly right. Services WILL need to be cut, while adopting a UK-style national system.
Are you pregnant and want one of the fancy 3D or 4D ultrasounds for a keepsake? Tough, there's no proven medical necessity to get one. Under the UK system, you can't pay cash for services outside of the approved system while receiving government benefits.
Do you have a terminal illness, and want a treatment that will cost $40,000 to extend your life by one year to say your goodbyes? Tough, your life isn't worth that much. Luckily, though, there might be an appeals system that will take about 2 years to work through the red tape in order for you get a humanitarian exemption to get said treatment... oh wait, you're dead.
The UK system is currently finding out exactly what doctors have known for decades - if you want 1960s prices on healthcare, eventually, after picking the low-hanging fruit like too many MRIs and CTs ordered for nonspecific symptoms, you get to the conclusion that you'll have to settle for 1960s care. Witness the latest troubles the UK has had in controlling ballooning medical costs, even with its own system of cost controls that would never fly here in the US.
It seemed after the dullness that was Book 10 (Crossroads of Twilight), Jordan took a machete through the undergrowth of his sub-subplots, and the pacing of the books has improved greatly. Jordan published the deleted scenes, Twittered for the fanbois, director's cut version of Wheel of Time first and then made everyone else slog through it.
The reintegration of Rand al'Thor almost (almost!) makes me forgive Jordan for dragging us through 5 books of Rand's emo. When Min utters something along the lines of, "Yeah, well, we should probably try to stop manipulating Rand, it's just making things worse" it's a real No Shit, Sherlock! moment... especially since Moiraine told them the same thing in... Book 5.
The first meeting of Rand and Tam since Book 1 is a huge emotional payoff. I know a lot of readers, including me, have been waiting for that since Jordan mentioned it during one of his signings.
Gareth Bryne laying the verbal smackdown on Gawyn was a treat.
And Verin... her major contribution to the book was probably the best scene since the cleansing of saidin. Completely unexpected twist on top of an expected twist, at least to me, but also in hindsight 100% true to who Verin is.
Nynaeve was sheer awesomeness, continuing her run since channelling the female Choedan Kal. I only wished she actually did slap Rand when they were discussing Lan.
Min finally realizes how useless she is as a self-appointed knife-wielding bodyguard to the most powerful channeller in the world. Is that character development? It makes her a lot less whiny and clingy and more focused, at any rate.
The Rand/Graendal "fight". The only way that could have been better is if Graendal had used a pet Aes Sedai to lay the Compulsion down and left. Waitaminute...
Major downers:
Egwene is still insufferable. Her saving grace is that 99.9% of the other Aes Sedai she is surrounded by are worse. Egwene and Gawyn: you two were truly made for each other. I can't think of anyone else I would wish either of you upon.
Perrin is still sidelined on his embarrassing plotline. When one of his followers(!) is plucked from him and has a scene of pure greatness right away, you know he is officially drowning in Subplot Hell. (Not that we didn't know that back in Book 8.) At least we potentially have the payoff of Perrin explaining to Rand accidently turning their home into Manetheren (oops!), and then Elayne's reaction to look forward to.
Does the Black Tower exist? I guess we'll RAFO... probably linked with the Demandred foreshadowing, and the prophecies of the Black Tower.
Not enough Mat. By far. Although the "God... I'm married! Me!" was beginning to wear... usually Mat is awesome enough to migrate to another subject, but not this book.
Paging Elayne! Rand could use a decent political advisor, for about the last 2 or 3 books... And maybe some of Nynaeve's awesomeness can rub off on you in the process? The Suck was certainly contagious between the two of you in books 6-8...
Moiraine needs to show up and start kicking some Cadsuane ass. Seriously.
Aviendha is still sidelined, and has yet to regain her Bad MF status. I'm still hoping she and Rand will turn the knob to 11 with Callandor. (With Moiraine? Elayne? Egwene? Who cares?)
What, shooting a credit collector that's trespassing on your property and physically harassing someone in person? If only every sales job was that easy...
First, the *IAA went after the file-sharing services. "Oh no!" The geeks cried. "File-sharing services have their 2-5% legal uses, too. Why can't they go after the illegal usage?"
Next, the *IAA went after the individual copyright violators. "Oh no!" The geeks cried. "You're being mean! And sometimes the computer owner isn't the actual violator."
And now it seems the *IAA wants to increase the noise-to-signal ratio on P2P to raise the difficulty of illegally downloading copyrighted content. "Oh no!" now the geeks are crying (from the comments prior to mine). "It's harder to get my free shit." (literally)
Seriously, out of the three options presented, I would pick #3 any day of the week... I have no need of the latest trash from the next star of American Drooling Idiot, and it's the least punitive measure they've explored.
If you guys really cared about putting the *IAA out of business, you would stop buying AND downloading their products and encourage others to do the same. Their entire business cycle depends on hype and publicity, it doesn't matter HOW they get it.
"But... but... what about [insert favorite author/performer/director here]? I love their stuff!"
Fuck it. Get some priority, and figure out what's more important to you - your self-gratification or putting them out of business. Unfortunately, everyone, including the *IAA, already knows what the large majority of sheeple will pick.
I hate to just jump in, but have you had your thyroid function checked? It takes a lot of effort to make a physiologically normal child at the age of 3 obese. One of my classmates went from skinny to super obese at around 2nd grade; it wasn't until he went to a new doctor in college that he got his thyroid function checked and found out that his wasn't working normally.
>Let me try to calm myself a bit. I can accurately be accused of trolling in a sense, which is to say I'm sensationalistic to get people to at least read something besides the same rhetoric passed to us from major news sites that, in my honest opinion, are completely dishonest.
And yet you, yourself are being intellectually dishonest by trumpeting your opinions as facts and your tinfoil conspiracy theories as truth. And that makes you different from a supermarket tabloid writer because...?
You are trolling. Period. Not in "a sense". So grow up. You started another post about al Qaeda having a grand opportunity with all these "militant Shiites", even though al Qaeda has traditionally terrible relations with Shiites, being a fundamentalist Sunni organization that has killed many innocent Shiites for terror and intimidation purposes. And yet when a poster called you on your ignorance, you immediately retreated to a "I'm really stupid, please enlighten my ignorance on Sunni-Shiite relations" position which you should have taken in the first place, since it was so God-awful clear from your first post.
>Of course I can't read that agreement in the ten minutes I took to respond. Let's say the language was clear and even well intentioned. What happens if Iraq wants to again nationalize their oil fields?
Why the fuck would the Iraqis want to nationalize the oil fields? The Iraqi government is rolling in cash right now due to the petroleum deals(so much so that the US Congress is complaining of how much free money the Iraqis have and how much reconstruction the US is paying for). Contrast this to Venezuela, whose oil rigs are falling into disrepair and whose production will plummet due to the lack of technical expertise available to the Venezuelan government bureaucrats after kicking out the Western energy companies and the reduction of reinvestment in new exploration. Nationalization is sexy and all to the global leftists, but it runs up against the hard reality of actually maintaining resource production (see: Zimbabwe after kicking out all the white farmers). Appointing paper pushers to do the job based on their political loyalty is a great way to send your country on a short road to North Koreaville.
> Do you think the US would just stand by and let them do it?
Yes. Do you know why? Because since oil is Iraq's lifeline, they will still sell it. And it's not control of petroleum that the US is after as a strategic priority, it's the continuing free flow of petroleum to the world market. We don't care who owns the oil. We care that any one person or country isn't threatening to monopolize a large majority of the world's proven reserves, thus allowing them to destabilize the US and world economy, which is highly dependent on energy for transportation.
> We didn't allow it to happen in Iran. We tried to stop it in Venezuela, but the coup failed.
Isn't it ironic? The Iranians have a populist revolution to only set up their own oppressive theocracy. 30 years later, the newest generation wants to have a populist revolution, only to have it squashed under the thumbs of the Ayatollah and the Revolutionary Guard, who at this point are starting to look worse than the Shah in terms of mismanaging their own country and citizens. The CIA had no involvement in the attempted Venezuelan coup, other than to indicate that the US government would rather have a military coup by halfway reasonable generals rather than another crackpot demagogue who is only interested in plundering his country's wealth for his own image and legacy. Which was perfectly fucking reasonable. Unless you happen to l
Re:Not quite what you want...
on
Best eSATA JBOD?
·
· Score: 2, Funny
>And yes, before you say it, that is certainly quite a bit of porn!
I need some quantification here. Put it in layman's terms - how many Libraries of Congress of porn is that, exactly?
>I left comments on various sites, including this one and some of my comments have been disappearing.
Probably because your tinfoil conspiracies have more holes than my 10 year old jeans.
>Isn't it an awfully big coincidence that the destruction of US dollar and these fears of NK nuclear bombs and missiles are happening at exactly the same time? I wouldn't put it past the US government to do with NK what they did with Iraq: create a lie and push it to start a war so that US could have its fleet in Asia. There they could 'protect the world from crazy NK' in return for the largest debt owner of US (Japan) forgiving most of it and creating enough threat for China not to try and call US on its debt (not switching from US dollar to some other currency, say gold.) I absolutely believe that US government, the real government - banks, insurance companies, credit companies, military contractors are totally capable of starting a war even a nuclear war to protect their currency and wealth.
Except that Japan and China have even more to lose from calling in the United States' debts than the United States itself. Did you bother to see what happened to the world economy when the financial crisis hit the United States? China and Japan both have export-driven manufacturing bases, with their biggest and most profitable market being the US. It makes no economic sense for them to turn off the faucet by which the United States buys up their goods (and, employs a large chunk of their citizens). Also, as long as they hold the debt, they maintain leverage over the United States that would disappear if they called their debts in.
>A US destroyer was sent to NK shores, isn't that convenient, a single destroyer. They have cruiser missiles on destroyers now, don't they? The 'news' that NK was going to launch a missile at Hawaii came from Japan, and at about the same time Japanese Finance Minister Kaoru Yosano delivered a speech saying that Japan's confidence in US Treasuries and the US dollar "is absolutely unshakable", he also said "I have faith in the U.S. dollar's status as a reserve currency." So Japan props up the USD and at the same time supplies 'intel' that NK is preparing a strike on US territory? You make me LOL so hard.
Your knowledge of military systems is sadly lacking. There are no missiles mounted on a United States destroyer that has anywhere near the range to reach Hawaii from North Korea. Please check widely available sources on military capability before making retarded statements like that. Also, Russian, European, and probably Chinese intelligence satellites would be able to tell where a missile launch was coming from - a North Korean land-based ballistic missile, or a sea-based missile launch.
The other sites where your comments were disappearing apparently had a lower limit on the intelligence of the posts allowed. Did you make the cut?
>Actually, I believe I remember reading (I forget where, possibly reader's digest) about some compound in dark chocolate that is a highly effective cough suppressant, supposedly better than codeine.
Honey is a damn good cough suppressant, backed up by randomized trials. (IIRC, it's definitely better than dextromethorphan.) I don't recall anything about chocolate.
Wow. This pile of sour grapes gets modded informative?
>>Fact is, there's nothing on the market that can compete with WoW.
>I fairly regularly see trolls making this statement as well, but then never offering anything more specific to back it up.
You mean, other than the tens of millions of World of Warcraft customers. Because it would be a shame if, while proclaiming yet another time that WoW is dying (Netcraft apparently confirms), you would miss the blatantly obvious fact that WoW continues to thrive in terms of both profits and player mindshare.
>a) The levelling game is dead. D-E-A-D. Blizzard reduced the xp requirement between 20-60 by 20%. Then you've got Recruit-A-Friend, and the +10% xp heirloom bonus on top of that. They're killing the ability of new users to really acclimatise, learn the game, or experience what was genuinely good content, all for the sake of letting the established crowd race to the cap.
Wha...? You want the leveling to be slower? What the fuck are you thinking? Do you honestly believe grinding out quests solo as a lowbie in any way relates to becoming a successful PvE raider or PvPer? The storylines are generally good, but staying in lowbie zones for extended periods for the content ought to be a player choice, not a shackle to make new players pay their dues.
>b) Once a person powerlevels their way to the cap in two days, they will very swiftly discover that there is less than no point to being there. Heroics? Boring. Naxx? Boring. Sarth? Boring. Ulduar might be marginally less boring, but I doubt it. WoTLK has the worst instances, as stated previously, that this game has ever seen. They are a total sleepwalk; no strategy required at all. Just get DKs and AoE lol.
Heh. Two days from 1 to 80? Maybe if you give your password^W^W^W buy a Chinese powerleveling service who will grind 5 mans for you nonstop for 48 hours. I'm sorry the PvE content bores you so; the sheer number of random people who are still failing heroics, much less the raid content tells me that it isn't boring for a large number of players. Blizzard has stratified the instances more, not made everything universally easier.
The instances that rate as easy are easier - you can throw a PuG together and faceroll those regardless of who you play with - but that started in BC, too. M-T/SP/Ramps/BF regular or heroic were noob heaven. In other words, Blizzard wanted introductory content that even the least skilled players (read: extreme casuals) can enjoy. The harder instances have actually become harder than in BC. Even in 5-mans, it is extremely difficult to put together a successful PuG for heroic Oculus or HoS without screening extensively for gear/guilds/achievements, and the chances are that without long-term PvE connections or a successful guild to rely on, it won't get done. Factor in hard mode achievements and rewards (starting with Glory of the Hero and going all the way into hard mode Ulduar 25) and the other end of the PvE difficulty spectrum reaches as high as it's ever been in WoW, from AQ40 to Sunwell. The difference is that Blizzard has made all of this optional, instead of a required part of raid progression. And that's got the panties of some elitists in a bind, because it just isn't fair that you no longer have to be an obsessive-compulsive social malcontent working with 39 or 24 others just like you to get to the "end".
Want proof? How many people on your server are walking around with the Twilight Vanquisher title? Or the Immortal title? Probably about the same number of players who were kitted out in Tier 3 or Sunwell gear - hell, they probably are the same hardcore PvE players in many cases.
It's true that DKs have a shallower learning curve than a lot of other classes. But while it's easier to faceroll a DK to a decent level of performance as a DPS or tank, it seems to be just as hard to excel in it as any other class, judging from the low signal:nois
>I know a single mom of 2 who has to raise her kids by herself because her husband was killed in that specific battle. Demonic hordes of hell don't capitalize on the death of her husband or the kids fathers. It would seem that they should be owed a portion of profit made from their own blood (literally).
Perhaps there is a difference?
Should a journalist who writes a best-selling book about the Battle of Fallujah (or any recent military action, for that matter) be required to donate the profits from the up-front fees or sales to the families of the fallen soldiers?
Do the makers of the mind-numbingly large assortment of World War II games owe a large percentage of their profits to families of World War II casualties and organizations like the VFW?
For-profit news organizations are reaping huge advertising windfalls off of human tragedy, calamity and bloodshed.
Shit happens in the world. It's time to end the mindset of being automatically owed money because of it.
>It doesn't matter what conditions you can slip into the warranty under the act, because the act also expressly forbids refusing warranty protection if someone uses a compatible replacement part or consumable (e.g. motor oil.)
Exactly, and the home-brew channel is neither a replacement part or a needed "consumable" like motor oil or gasoline. It modifies the software of the Nintendo in the same way an aftermarket chip modifies an engine computer.
Guess what? In either case, modding your car or modding your Wii, you've just voided your warranty. The M&M Act does NOT cover such aftermarket modifications. It was designed to prevent vertical integration and consumer lock-in, not to protect tinkerers.
Good luck with the lawsuit, I guarantee you're going to lose under the current laws.
>>One president is afforded better treatment and respect because of the color of his skin
>Nope, I shouldn't have to tell you this, but comparing blacks to monkeys is just dripping racism, so you can't use that slur without appearing racist. You can still mock him for being a slimy chicago politico or something - that's OK.
And yet, if someone depicted the ex-President Bush as a giant Saltine in a political cartoon, I doubt there would be one-tenth of the outcry. Certainly not from Al Sharpton.
>If you investigate how, and that how sayas that no who is necessary then what?
Your simplification is useful but I don;t think it is leading where you would have liked it to...
And I think you mistake the two questions again ("who" versus "how"), just like the OP pointed out.
Should I just call you a fundie atheist? Because there seems to be quite a few on Slashdot for this topic. Fundie Christians try to answer the "who", and then use their answers to tie into the "how", even though they are completely unrelated. You and your fellow fundie atheists try to answer the "how" and then answer the "who", even though they are completely unrelated.
"OOOH! Look at me! I just showed that the methods of the universe take no God to work! That must mean I dispr.... um, I mean, reduced to an infinitesmal value the chances of God existing! Check out my aura of smug superiority!"
Repeat after me: showing that God does not need to exist for the universe to work does not relate in any way to the answer to whether or not God exists.
>There's levels of generalization between "treat all men over 75 as an identical class" and "every person must be treated as a unique individual". You could, for example, segregate outcomes by a few major factors, like reported levels of exercise, weight, smoking vs. not, amount of alcohol consumption, etc.
You're absolutely right. And these intermediate levels of generalization is what leads a physician to treat patients as individuals, not as numbers. The governmental guidelines do NOT say, "Don't test men over 75 for prostate cancer, unless they're relatively or absolutely healthy." Nope, they say, "Don't test. Period. There is no evidence of benefit." It doesn't matter if the lack of evidence is because they're right, or because no one has looked into doing the appropriate studies to determine if there are some men over 75 that would substantially benefit from getting checked for prostate cancer.
There is always a grey space between clinical judgement and EBM. (Those intermediate levels of generalization that you talked about, but haven't been studied in appropriate detail.) And I will always err on the side of treating a patient as an INDIVIDUAL, rather than treating a patient as a NUMBER.
>>"Real world patients do not step out of a cookie-cutter, and cookie-cutter medicine (which is what EBM zealots really are promoting) does not always equal best practices."
>This is where you are wrong. Patients are rarely unique in any meaningful way, most get better on their own.
Who the hell are you? I see patients on a daily basis. Most of them have underlying illnesses (or non-illnesses) that are similar to other patients. But most of them also have their own idiosyncrasies that contribute to their direction of care and treatment. They are certainly unique to the point where I have to think about what treatments the patient will derive the most benefit from. And many of the patients I see, rather than "get better on their own", are already far down the path in the other direction, the one that leads to an early exit from this life. It is my job to head them back in the right direction (assuming the patient wants to turn their health around).
>For instance, if you come in with back pain after twisting and lifting an object, the doctor should rule out any obvious problems then send you home (maybe with a scrip for a painkiller). They shouldn't send you for an Xray because there might be something.
I'm confused. You think doctors should rule out "obvious" problems, and yet checking an X-ray or other imaging for "obvious" back problems is out of bounds, even if their story and/or symptoms might suggest a more serious problem than muscle strain? You seem to be under the impression that 100% of patients that come in with acute low back pain "after twisting and lifting an object" have a non-serious complaint. There are plenty of serious problems to consider that could stem from a twisting and lifting injury, starting with serious lumbar disk disease.
>If your pain does not resolve after a period of time, THEN you order an Xray.
Even if your clinical suspicion is high that there is an underlying problem? Even if the physical exam is troubling? You're a genius! If only ERs handled chest pain complaints like you want back pain to be handled. I could certainly prove that most people with chest pain in the ER have a non-serious complaint. We could send them all home with conservative treatment, and THEN admit them if their pain doesn't resolve! Think about the cost savings! Especially from those that die without getting expensive heart caths and bypass surgery!
>If that doesn't show anything, THEN they refer to a specialist.
Fantastic! I would think that if the imaging indicated a diagnosis that could likely benefit from a specialist treating the problem, THEN I would send them to a specialist! But what the hell do I know? Let's send all the people with no evidence of structural back disease to the specialists for... what? Re-imaging?
>And even if it does show a significant finding, it might be irrelevant (most people over 40 have abnormal backs).
What curious thinking. So someone that has an abnormal health state shouldn't receive treatment, if there are sufficiently enough people in their age group that have the same problem? Interesting. By the same token, should we stop treating heart disease in everyone over 60, because older people will invariably have some degree of heart disease? I am certainly glad you won't be directing my medical care as I age.
>I'm sure if you did a study of "average" gastroparetics you could say "due to evidence-based medicine, everyone should take medicine X", and this might be fine for 60% of the patients while forcing 40% into ineffective treatment. Medicine needs to address the individual needs of patients.
Exactly! To bring up a further point about patients as individuals, the Government just announced that testing PSAs for men over 75 is pointless. Which is ridiculous; their entire line of reasoning is based on the odds of the patient dying of something else before they die of prostate cancer. And now let me bring up my father, who had his PSA tested around the age of 75. Unlike most of America, he eats right, exercises nearly every day, has never smoked and has drank alcohol sparingly. He is the perfect candidate to get further PSA testing, because he is less likely than your average American to die of "something else" in the case he has an indolent prostate cancer. Which, in fact, he did - an intermediate-high grade (Gleason 7) prostate cancer that was still local and eminently treatable. But following the Government's advice today for "Best Practices", he would have stopped testing, and this malignancy would have metastasized and in all likelihood killed him.
If practicing medicine consisted of a video game or a board test, then yes, doctors could suspend their own judgement in favor of strict evidence-based medicine. Unfortunately, this is the Real World, and doctors frequently have to approach EBM with a healthy dose of skepticism.
The problem with EBM is threefold: the evidence record is necessarily incomplete; many real-world patients have very little in common to patients that make it through selection criteria into randomized clinical trials (RCTs); it is very easy to skew studies in minute ways through endpoints, study design, and a thousand other ways that are difficult for busy practicing physicians to catch.
Want some examples? A recent multicenter study (in worldwide sites) of blood pressure medications funded by the maker of Lotrel found that their combination ACE inhibitor/calcium channel antagonist (CCA) had slightly better morbidity/mortality outcomes over a given period of time than patients who were placed on a combination of the ACE inhibitor and a thiazide diuretic, with similar reductions in blood pressure. The data is fantastic, and the outcomes are probably real. But when you check closely into the outcomes criteria, one of the "bad" endpoints is "hospitalization for unstable angina" (new or worsening chest pain). One of the indications that CCAs have that diuretics do not is the treatment of angina. CCAs, through the mechanisms of its action, can prevent anginal episodes or make them better. A thiazide diuretic will not treat angina directly. Out of the room of ~20 doctors this study was being presented to, apparently I was the only one who thought of this. And since many of the patients involved in the study had prior cardiac history with ostensible angina, it made perfect sense why CCAs would perform better for these patients. But this study is not being billed as that - the study is being presented as evidence of the possible superiority of using one drug over another in the general population with high blood pressure.
And then there's the Nexium/Prilosec fiasco. Nexium was developed by the makers of Prilosec when patent protection for Prilosec began running out. (You can buy generic Prilosec (omeprazole) over the counter.) Nexium (ESomeprazole [emphasis mine]) is filtered Prilosec - the biologically active enantiomer of Prilosec's racemic mixture. Nexium is on average six times more expensive, mg for mg, than generic omeprazole. The only study I know of (and that is certainly being quoted in wide circulation) comparing the effectiveness of the two was funded by the makers of Prilosec and Nexium, comparing healing rates of acid-reflux esophagitis with "typical" doses of Prilosec and Nexium. Nexium outperformed Prilosec in healing the worst grades of esophagitis - grades C and D. The "typical" doses used were 20 mg of Prilosec and 40 mg of Nexium. As this is the evidence out there, many doctors consider Nexium to be a "stronger" or "better" acid suppressor than Prilosec. I'll let the reader make the logical conclusions.
And let's talk about "typical" patients and the dearth of them in the evidence record. On an inpatient service today, I saw a "typical" patient hospitalized for a hypertensive emergency. He was a type 2 diabetic (DM)(uncontrolled) who came in with a blood pressure of 180s/120s. He has diastolic congestive heart failure (CHF) from his long-term uncontrolled hypertension (HTN). He also has chronic kidney disease probably due to a combination of his smoking, his DM, and his HTN. He also has an exacerbation of his bad chronic obstructive pulmonary disease (COPD) from his smoking. Now the evidence suggests that I place him on a beta-blocker to treat his HTN and his CHF concurrently. But beta-blockers are relatively contraindicated in acute exacerbations of COPD. The evidence suggests that I place him on an ACE inhibitor to treat his DM and HTN, but that would decrease his kidney function, and he's already at the tipping point of needing dialysis so
>There are some choices that are just so simple and basic that the government should be dictating them. Like "hey, the only active ingredient in a drug should not be cocaine."
I beg to differ. When it comes to refractory epistaxis, cocaine is exactly the active ingredient that is needed. =)
>p.s. I meant "The history of Gaza, and indeed all history is *relevant*". All history is RELEVANT. No history is IRRELEVANT. That is what I meant. Your idiocy makes me mad, and being made makes me mis-type. So double-fuck-you for that!
So apparently, by your logic if some Native Americans drive a truck bomb into Washington and blow up the Capitol and all it's Congressmen, staffers, pages, food workers and janitors, it's all justified because all of you white folks (and no, I'm not white) took away all their good land and rounded them up into virtual ghettos 150-200 years ago?
Or, if some Irishmen start lobbing mortar shells into a crowded British subway line, it's OK because the British are oppressing them in Northern Ireland? Or maybe it's OK if they only kill 15 people over a number of years while doing so...
At some point, you have to grow a brain and get on with living if your great-grandparents were oppressed. At some point, history becomes irrelevant, because if all they do (Hamas, Palestinians in general) is live for the insults and mistakes of the past, they just end up repeating the past, mostly to their detriment.
P.S. If Jordan, Egypt, Syria, and Lebanon had made even a token effort to absorb "their brothers" the Palestinian refugees into their own societies over the last 60 years, maybe the rest of the Palestinians would realize there are better things to do with their time than poke the proverbial bear repeatedly with a sharp but inconsequential stick. Hmm... not a single Palestinian fires a Qassam rocket at the Arab states for their massacres of the Palestinian refugees, do they? Maybe the true lesson here is that if Israel were as brutal as say, Jordan was in Black September, maybe the Palestinians would start to figure things out?
You make it pretty clear you hate John McCain and possibly all Republicans in general, but this is borderline obsessive.
"He was, ultimately, in charge... The buck has to stop with the person whose name is on the check."
Really? So if Jiffy Lube or whoever does your oil change on a contractual basis screws up your oil change, it's your fault? You, after all, are in charge of your own car. That's great logic there. If you ever need back surgery, and the surgeon you choose leaves you paralyzed, I suppose your response will be, Well, gee, it's my fault, I should have hired a better surgeon!
I get the whole "captain is responsible for his ship" mentality, but ultimately, you have to stop blaming people for minor details going wrong that aren't remotely in their sphere of responsibility.
The future of Google is more data-mining of your private information. Fantastic. Please, bring on the bread and circus... I wonder when Google will delve into the "free" entertainment for your personal information business? GPorn? GPoker? GQuake? GWarcraft?
Slashdot Mirror
No, he is exactly right. Services WILL need to be cut, while adopting a UK-style national system.
Are you pregnant and want one of the fancy 3D or 4D ultrasounds for a keepsake? Tough, there's no proven medical necessity to get one. Under the UK system, you can't pay cash for services outside of the approved system while receiving government benefits.
Do you have a terminal illness, and want a treatment that will cost $40,000 to extend your life by one year to say your goodbyes? Tough, your life isn't worth that much. Luckily, though, there might be an appeals system that will take about 2 years to work through the red tape in order for you get a humanitarian exemption to get said treatment... oh wait, you're dead.
The UK system is currently finding out exactly what doctors have known for decades - if you want 1960s prices on healthcare, eventually, after picking the low-hanging fruit like too many MRIs and CTs ordered for nonspecific symptoms, you get to the conclusion that you'll have to settle for 1960s care. Witness the latest troubles the UK has had in controlling ballooning medical costs, even with its own system of cost controls that would never fly here in the US.
*WARNING SPOILERS WARNING*
It seemed after the dullness that was Book 10 (Crossroads of Twilight), Jordan took a machete through the undergrowth of his sub-subplots, and the pacing of the books has improved greatly. Jordan published the deleted scenes, Twittered for the fanbois, director's cut version of Wheel of Time first and then made everyone else slog through it.
The reintegration of Rand al'Thor almost (almost!) makes me forgive Jordan for dragging us through 5 books of Rand's emo. When Min utters something along the lines of, "Yeah, well, we should probably try to stop manipulating Rand, it's just making things worse" it's a real No Shit, Sherlock! moment... especially since Moiraine told them the same thing in... Book 5.
The first meeting of Rand and Tam since Book 1 is a huge emotional payoff. I know a lot of readers, including me, have been waiting for that since Jordan mentioned it during one of his signings.
Gareth Bryne laying the verbal smackdown on Gawyn was a treat.
And Verin ... her major contribution to the book was probably the best scene since the cleansing of saidin. Completely unexpected twist on top of an expected twist, at least to me, but also in hindsight 100% true to who Verin is.
Nynaeve was sheer awesomeness, continuing her run since channelling the female Choedan Kal. I only wished she actually did slap Rand when they were discussing Lan.
Min finally realizes how useless she is as a self-appointed knife-wielding bodyguard to the most powerful channeller in the world. Is that character development? It makes her a lot less whiny and clingy and more focused, at any rate.
The Rand/Graendal "fight". The only way that could have been better is if Graendal had used a pet Aes Sedai to lay the Compulsion down and left. Waitaminute...
Major downers:
Egwene is still insufferable. Her saving grace is that 99.9% of the other Aes Sedai she is surrounded by are worse. Egwene and Gawyn: you two were truly made for each other. I can't think of anyone else I would wish either of you upon.
Perrin is still sidelined on his embarrassing plotline. When one of his followers(!) is plucked from him and has a scene of pure greatness right away, you know he is officially drowning in Subplot Hell. (Not that we didn't know that back in Book 8.) At least we potentially have the payoff of Perrin explaining to Rand accidently turning their home into Manetheren (oops!), and then Elayne's reaction to look forward to.
Does the Black Tower exist? I guess we'll RAFO... probably linked with the Demandred foreshadowing, and the prophecies of the Black Tower.
Not enough Mat. By far. Although the "God... I'm married! Me!" was beginning to wear... usually Mat is awesome enough to migrate to another subject, but not this book.
Paging Elayne! Rand could use a decent political advisor, for about the last 2 or 3 books... And maybe some of Nynaeve's awesomeness can rub off on you in the process? The Suck was certainly contagious between the two of you in books 6-8...
Moiraine needs to show up and start kicking some Cadsuane ass. Seriously.
Aviendha is still sidelined, and has yet to regain her Bad MF status. I'm still hoping she and Rand will turn the knob to 11 with Callandor. (With Moiraine? Elayne? Egwene? Who cares?)
Good luck selling that to a jury.
What, shooting a credit collector that's trespassing on your property and physically harassing someone in person? If only every sales job was that easy...
>dude you reek of yourself.
I'm sorry, did I touch a nerve? Or are you one of those who rail against the *IAAs while rushing like a good little sheep to consume their products?*
*buying OR downloading
First, the *IAA went after the file-sharing services. "Oh no!" The geeks cried. "File-sharing services have their 2-5% legal uses, too. Why can't they go after the illegal usage?"
Next, the *IAA went after the individual copyright violators. "Oh no!" The geeks cried. "You're being mean! And sometimes the computer owner isn't the actual violator."
And now it seems the *IAA wants to increase the noise-to-signal ratio on P2P to raise the difficulty of illegally downloading copyrighted content. "Oh no!" now the geeks are crying (from the comments prior to mine). "It's harder to get my free shit." (literally)
Seriously, out of the three options presented, I would pick #3 any day of the week... I have no need of the latest trash from the next star of American Drooling Idiot, and it's the least punitive measure they've explored.
If you guys really cared about putting the *IAA out of business, you would stop buying AND downloading their products and encourage others to do the same. Their entire business cycle depends on hype and publicity, it doesn't matter HOW they get it.
"But... but... what about [insert favorite author/performer/director here]? I love their stuff!"
Fuck it. Get some priority, and figure out what's more important to you - your self-gratification or putting them out of business. Unfortunately, everyone, including the *IAA, already knows what the large majority of sheeple will pick.
>Well I got obese around the age of 3 asshole.
I hate to just jump in, but have you had your thyroid function checked? It takes a lot of effort to make a physiologically normal child at the age of 3 obese. One of my classmates went from skinny to super obese at around 2nd grade; it wasn't until he went to a new doctor in college that he got his thyroid function checked and found out that his wasn't working normally.
>Let me try to calm myself a bit. I can accurately be accused of trolling in a sense, which is to say I'm sensationalistic to get people to at least read something besides the same rhetoric passed to us from major news sites that, in my honest opinion, are completely dishonest.
And yet you, yourself are being intellectually dishonest by trumpeting your opinions as facts and your tinfoil conspiracy theories as truth. And that makes you different from a supermarket tabloid writer because...?
You are trolling. Period. Not in "a sense". So grow up. You started another post about al Qaeda having a grand opportunity with all these "militant Shiites", even though al Qaeda has traditionally terrible relations with Shiites, being a fundamentalist Sunni organization that has killed many innocent Shiites for terror and intimidation purposes. And yet when a poster called you on your ignorance, you immediately retreated to a "I'm really stupid, please enlighten my ignorance on Sunni-Shiite relations" position which you should have taken in the first place, since it was so God-awful clear from your first post.
>Of course I can't read that agreement in the ten minutes I took to respond. Let's say the language was clear and even well intentioned. What happens if Iraq wants to again nationalize their oil fields?
Why the fuck would the Iraqis want to nationalize the oil fields? The Iraqi government is rolling in cash right now due to the petroleum deals(so much so that the US Congress is complaining of how much free money the Iraqis have and how much reconstruction the US is paying for). Contrast this to Venezuela, whose oil rigs are falling into disrepair and whose production will plummet due to the lack of technical expertise available to the Venezuelan government bureaucrats after kicking out the Western energy companies and the reduction of reinvestment in new exploration. Nationalization is sexy and all to the global leftists, but it runs up against the hard reality of actually maintaining resource production (see: Zimbabwe after kicking out all the white farmers). Appointing paper pushers to do the job based on their political loyalty is a great way to send your country on a short road to North Koreaville.
> Do you think the US would just stand by and let them do it?
Yes. Do you know why? Because since oil is Iraq's lifeline, they will still sell it. And it's not control of petroleum that the US is after as a strategic priority, it's the continuing free flow of petroleum to the world market. We don't care who owns the oil. We care that any one person or country isn't threatening to monopolize a large majority of the world's proven reserves, thus allowing them to destabilize the US and world economy, which is highly dependent on energy for transportation.
> We didn't allow it to happen in Iran. We tried to stop it in Venezuela, but the coup failed.
Isn't it ironic? The Iranians have a populist revolution to only set up their own oppressive theocracy. 30 years later, the newest generation wants to have a populist revolution, only to have it squashed under the thumbs of the Ayatollah and the Revolutionary Guard, who at this point are starting to look worse than the Shah in terms of mismanaging their own country and citizens. The CIA had no involvement in the attempted Venezuelan coup, other than to indicate that the US government would rather have a military coup by halfway reasonable generals rather than another crackpot demagogue who is only interested in plundering his country's wealth for his own image and legacy. Which was perfectly fucking reasonable. Unless you happen to l
>And yes, before you say it, that is certainly quite a bit of porn!
I need some quantification here. Put it in layman's terms - how many Libraries of Congress of porn is that, exactly?
>I left comments on various sites, including this one and some of my comments have been disappearing.
Probably because your tinfoil conspiracies have more holes than my 10 year old jeans.
>Isn't it an awfully big coincidence that the destruction of US dollar and these fears of NK nuclear bombs and missiles are happening at exactly the same time? I wouldn't put it past the US government to do with NK what they did with Iraq: create a lie and push it to start a war so that US could have its fleet in Asia. There they could 'protect the world from crazy NK' in return for the largest debt owner of US (Japan) forgiving most of it and creating enough threat for China not to try and call US on its debt (not switching from US dollar to some other currency, say gold.) I absolutely believe that US government, the real government - banks, insurance companies, credit companies, military contractors are totally capable of starting a war even a nuclear war to protect their currency and wealth.
Except that Japan and China have even more to lose from calling in the United States' debts than the United States itself. Did you bother to see what happened to the world economy when the financial crisis hit the United States? China and Japan both have export-driven manufacturing bases, with their biggest and most profitable market being the US. It makes no economic sense for them to turn off the faucet by which the United States buys up their goods (and, employs a large chunk of their citizens). Also, as long as they hold the debt, they maintain leverage over the United States that would disappear if they called their debts in.
>A US destroyer was sent to NK shores, isn't that convenient, a single destroyer. They have cruiser missiles on destroyers now, don't they? The 'news' that NK was going to launch a missile at Hawaii came from Japan, and at about the same time Japanese Finance Minister Kaoru Yosano delivered a speech saying that Japan's confidence in US Treasuries and the US dollar "is absolutely unshakable", he also said "I have faith in the U.S. dollar's status as a reserve currency." So Japan props up the USD and at the same time supplies 'intel' that NK is preparing a strike on US territory? You make me LOL so hard.
Your knowledge of military systems is sadly lacking. There are no missiles mounted on a United States destroyer that has anywhere near the range to reach Hawaii from North Korea. Please check widely available sources on military capability before making retarded statements like that. Also, Russian, European, and probably Chinese intelligence satellites would be able to tell where a missile launch was coming from - a North Korean land-based ballistic missile, or a sea-based missile launch.
The other sites where your comments were disappearing apparently had a lower limit on the intelligence of the posts allowed. Did you make the cut?
>Actually, I believe I remember reading (I forget where, possibly reader's digest) about some compound in dark chocolate that is a highly effective cough suppressant, supposedly better than codeine.
Honey is a damn good cough suppressant, backed up by randomized trials. (IIRC, it's definitely better than dextromethorphan.) I don't recall anything about chocolate.
Wow. This pile of sour grapes gets modded informative?
>>Fact is, there's nothing on the market that can compete with WoW.
>I fairly regularly see trolls making this statement as well, but then never offering anything more specific to back it up.
You mean, other than the tens of millions of World of Warcraft customers. Because it would be a shame if, while proclaiming yet another time that WoW is dying (Netcraft apparently confirms), you would miss the blatantly obvious fact that WoW continues to thrive in terms of both profits and player mindshare.
>a) The levelling game is dead. D-E-A-D. Blizzard reduced the xp requirement between 20-60 by 20%. Then you've got Recruit-A-Friend, and the +10% xp heirloom bonus on top of that. They're killing the ability of new users to really acclimatise, learn the game, or experience what was genuinely good content, all for the sake of letting the established crowd race to the cap.
Wha...? You want the leveling to be slower? What the fuck are you thinking? Do you honestly believe grinding out quests solo as a lowbie in any way relates to becoming a successful PvE raider or PvPer? The storylines are generally good, but staying in lowbie zones for extended periods for the content ought to be a player choice, not a shackle to make new players pay their dues.
>b) Once a person powerlevels their way to the cap in two days, they will very swiftly discover that there is less than no point to being there. Heroics? Boring. Naxx? Boring. Sarth? Boring. Ulduar might be marginally less boring, but I doubt it. WoTLK has the worst instances, as stated previously, that this game has ever seen. They are a total sleepwalk; no strategy required at all. Just get DKs and AoE lol.
Heh. Two days from 1 to 80? Maybe if you give your password^W^W^W buy a Chinese powerleveling service who will grind 5 mans for you nonstop for 48 hours. I'm sorry the PvE content bores you so; the sheer number of random people who are still failing heroics, much less the raid content tells me that it isn't boring for a large number of players. Blizzard has stratified the instances more, not made everything universally easier.
The instances that rate as easy are easier - you can throw a PuG together and faceroll those regardless of who you play with - but that started in BC, too. M-T/SP/Ramps/BF regular or heroic were noob heaven. In other words, Blizzard wanted introductory content that even the least skilled players (read: extreme casuals) can enjoy. The harder instances have actually become harder than in BC. Even in 5-mans, it is extremely difficult to put together a successful PuG for heroic Oculus or HoS without screening extensively for gear/guilds/achievements, and the chances are that without long-term PvE connections or a successful guild to rely on, it won't get done. Factor in hard mode achievements and rewards (starting with Glory of the Hero and going all the way into hard mode Ulduar 25) and the other end of the PvE difficulty spectrum reaches as high as it's ever been in WoW, from AQ40 to Sunwell. The difference is that Blizzard has made all of this optional, instead of a required part of raid progression. And that's got the panties of some elitists in a bind, because it just isn't fair that you no longer have to be an obsessive-compulsive social malcontent working with 39 or 24 others just like you to get to the "end".
Want proof? How many people on your server are walking around with the Twilight Vanquisher title? Or the Immortal title? Probably about the same number of players who were kitted out in Tier 3 or Sunwell gear - hell, they probably are the same hardcore PvE players in many cases.
It's true that DKs have a shallower learning curve than a lot of other classes. But while it's easier to faceroll a DK to a decent level of performance as a DPS or tank, it seems to be just as hard to excel in it as any other class, judging from the low signal:nois
>I know a single mom of 2 who has to raise her kids by herself because her husband was killed in that specific battle. Demonic hordes of hell don't capitalize on the death of her husband or the kids fathers. It would seem that they should be owed a portion of profit made from their own blood (literally).
Perhaps there is a difference?
Should a journalist who writes a best-selling book about the Battle of Fallujah (or any recent military action, for that matter) be required to donate the profits from the up-front fees or sales to the families of the fallen soldiers?
Do the makers of the mind-numbingly large assortment of World War II games owe a large percentage of their profits to families of World War II casualties and organizations like the VFW?
For-profit news organizations are reaping huge advertising windfalls off of human tragedy, calamity and bloodshed.
Shit happens in the world. It's time to end the mindset of being automatically owed money because of it.
>It doesn't matter what conditions you can slip into the warranty under the act, because the act also expressly forbids refusing warranty protection if someone uses a compatible replacement part or consumable (e.g. motor oil.)
Exactly, and the home-brew channel is neither a replacement part or a needed "consumable" like motor oil or gasoline. It modifies the software of the Nintendo in the same way an aftermarket chip modifies an engine computer.
Guess what? In either case, modding your car or modding your Wii, you've just voided your warranty. The M&M Act does NOT cover such aftermarket modifications. It was designed to prevent vertical integration and consumer lock-in, not to protect tinkerers.
Good luck with the lawsuit, I guarantee you're going to lose under the current laws.
>Yet another physical phenomenon fits the theory of everything. How about a prediction from string theory for once?
You'll find that in String Theory 2: The Search For More Grant Money...
>>One president is afforded better treatment and respect because of the color of his skin
>Nope, I shouldn't have to tell you this, but comparing blacks to monkeys is just dripping racism, so you can't use that slur without appearing racist. You can still mock him for being a slimy chicago politico or something - that's OK.
And yet, if someone depicted the ex-President Bush as a giant Saltine in a political cartoon, I doubt there would be one-tenth of the outcry. Certainly not from Al Sharpton.
>If you investigate how, and that how sayas that no who is necessary then what?
Your simplification is useful but I don;t think it is leading where you would have liked it to...
And I think you mistake the two questions again ("who" versus "how"), just like the OP pointed out.
Should I just call you a fundie atheist? Because there seems to be quite a few on Slashdot for this topic. Fundie Christians try to answer the "who", and then use their answers to tie into the "how", even though they are completely unrelated. You and your fellow fundie atheists try to answer the "how" and then answer the "who", even though they are completely unrelated.
"OOOH! Look at me! I just showed that the methods of the universe take no God to work! That must mean I dispr.... um, I mean, reduced to an infinitesmal value the chances of God existing! Check out my aura of smug superiority!"
Repeat after me: showing that God does not need to exist for the universe to work does not relate in any way to the answer to whether or not God exists.
>There's levels of generalization between "treat all men over 75 as an identical class" and "every person must be treated as a unique individual". You could, for example, segregate outcomes by a few major factors, like reported levels of exercise, weight, smoking vs. not, amount of alcohol consumption, etc.
You're absolutely right. And these intermediate levels of generalization is what leads a physician to treat patients as individuals, not as numbers. The governmental guidelines do NOT say, "Don't test men over 75 for prostate cancer, unless they're relatively or absolutely healthy." Nope, they say, "Don't test. Period. There is no evidence of benefit." It doesn't matter if the lack of evidence is because they're right, or because no one has looked into doing the appropriate studies to determine if there are some men over 75 that would substantially benefit from getting checked for prostate cancer.
There is always a grey space between clinical judgement and EBM. (Those intermediate levels of generalization that you talked about, but haven't been studied in appropriate detail.) And I will always err on the side of treating a patient as an INDIVIDUAL, rather than treating a patient as a NUMBER.
>>"Real world patients do not step out of a cookie-cutter, and cookie-cutter medicine (which is what EBM zealots really are promoting) does not always equal best practices."
>This is where you are wrong. Patients are rarely unique in any meaningful way, most get better on their own.
Who the hell are you? I see patients on a daily basis. Most of them have underlying illnesses (or non-illnesses) that are similar to other patients. But most of them also have their own idiosyncrasies that contribute to their direction of care and treatment. They are certainly unique to the point where I have to think about what treatments the patient will derive the most benefit from. And many of the patients I see, rather than "get better on their own", are already far down the path in the other direction, the one that leads to an early exit from this life. It is my job to head them back in the right direction (assuming the patient wants to turn their health around).
>For instance, if you come in with back pain after twisting and lifting an object, the doctor should rule out any obvious problems then send you home (maybe with a scrip for a painkiller). They shouldn't send you for an Xray because there might be something.
I'm confused. You think doctors should rule out "obvious" problems, and yet checking an X-ray or other imaging for "obvious" back problems is out of bounds, even if their story and/or symptoms might suggest a more serious problem than muscle strain? You seem to be under the impression that 100% of patients that come in with acute low back pain "after twisting and lifting an object" have a non-serious complaint. There are plenty of serious problems to consider that could stem from a twisting and lifting injury, starting with serious lumbar disk disease.
>If your pain does not resolve after a period of time, THEN you order an Xray.
Even if your clinical suspicion is high that there is an underlying problem? Even if the physical exam is troubling? You're a genius! If only ERs handled chest pain complaints like you want back pain to be handled. I could certainly prove that most people with chest pain in the ER have a non-serious complaint. We could send them all home with conservative treatment, and THEN admit them if their pain doesn't resolve! Think about the cost savings! Especially from those that die without getting expensive heart caths and bypass surgery!
>If that doesn't show anything, THEN they refer to a specialist.
Fantastic! I would think that if the imaging indicated a diagnosis that could likely benefit from a specialist treating the problem, THEN I would send them to a specialist! But what the hell do I know? Let's send all the people with no evidence of structural back disease to the specialists for... what? Re-imaging?
>And even if it does show a significant finding, it might be irrelevant (most people over 40 have abnormal backs).
What curious thinking. So someone that has an abnormal health state shouldn't receive treatment, if there are sufficiently enough people in their age group that have the same problem? Interesting. By the same token, should we stop treating heart disease in everyone over 60, because older people will invariably have some degree of heart disease? I am certainly glad you won't be directing my medical care as I age.
>I'm sure if you did a study of "average" gastroparetics you could say "due to evidence-based medicine, everyone should take medicine X", and this might be fine for 60% of the patients while forcing 40% into ineffective treatment. Medicine needs to address the individual needs of patients.
Exactly! To bring up a further point about patients as individuals, the Government just announced that testing PSAs for men over 75 is pointless. Which is ridiculous; their entire line of reasoning is based on the odds of the patient dying of something else before they die of prostate cancer. And now let me bring up my father, who had his PSA tested around the age of 75. Unlike most of America, he eats right, exercises nearly every day, has never smoked and has drank alcohol sparingly. He is the perfect candidate to get further PSA testing, because he is less likely than your average American to die of "something else" in the case he has an indolent prostate cancer. Which, in fact, he did - an intermediate-high grade (Gleason 7) prostate cancer that was still local and eminently treatable. But following the Government's advice today for "Best Practices", he would have stopped testing, and this malignancy would have metastasized and in all likelihood killed him.
If practicing medicine consisted of a video game or a board test, then yes, doctors could suspend their own judgement in favor of strict evidence-based medicine. Unfortunately, this is the Real World, and doctors frequently have to approach EBM with a healthy dose of skepticism.
The problem with EBM is threefold: the evidence record is necessarily incomplete; many real-world patients have very little in common to patients that make it through selection criteria into randomized clinical trials (RCTs); it is very easy to skew studies in minute ways through endpoints, study design, and a thousand other ways that are difficult for busy practicing physicians to catch.
Want some examples? A recent multicenter study (in worldwide sites) of blood pressure medications funded by the maker of Lotrel found that their combination ACE inhibitor/calcium channel antagonist (CCA) had slightly better morbidity/mortality outcomes over a given period of time than patients who were placed on a combination of the ACE inhibitor and a thiazide diuretic, with similar reductions in blood pressure. The data is fantastic, and the outcomes are probably real. But when you check closely into the outcomes criteria, one of the "bad" endpoints is "hospitalization for unstable angina" (new or worsening chest pain). One of the indications that CCAs have that diuretics do not is the treatment of angina. CCAs, through the mechanisms of its action, can prevent anginal episodes or make them better. A thiazide diuretic will not treat angina directly. Out of the room of ~20 doctors this study was being presented to, apparently I was the only one who thought of this. And since many of the patients involved in the study had prior cardiac history with ostensible angina, it made perfect sense why CCAs would perform better for these patients. But this study is not being billed as that - the study is being presented as evidence of the possible superiority of using one drug over another in the general population with high blood pressure.
And then there's the Nexium/Prilosec fiasco. Nexium was developed by the makers of Prilosec when patent protection for Prilosec began running out. (You can buy generic Prilosec (omeprazole) over the counter.) Nexium (ESomeprazole [emphasis mine]) is filtered Prilosec - the biologically active enantiomer of Prilosec's racemic mixture. Nexium is on average six times more expensive, mg for mg, than generic omeprazole. The only study I know of (and that is certainly being quoted in wide circulation) comparing the effectiveness of the two was funded by the makers of Prilosec and Nexium, comparing healing rates of acid-reflux esophagitis with "typical" doses of Prilosec and Nexium. Nexium outperformed Prilosec in healing the worst grades of esophagitis - grades C and D. The "typical" doses used were 20 mg of Prilosec and 40 mg of Nexium. As this is the evidence out there, many doctors consider Nexium to be a "stronger" or "better" acid suppressor than Prilosec. I'll let the reader make the logical conclusions.
And let's talk about "typical" patients and the dearth of them in the evidence record. On an inpatient service today, I saw a "typical" patient hospitalized for a hypertensive emergency. He was a type 2 diabetic (DM)(uncontrolled) who came in with a blood pressure of 180s/120s. He has diastolic congestive heart failure (CHF) from his long-term uncontrolled hypertension (HTN). He also has chronic kidney disease probably due to a combination of his smoking, his DM, and his HTN. He also has an exacerbation of his bad chronic obstructive pulmonary disease (COPD) from his smoking. Now the evidence suggests that I place him on a beta-blocker to treat his HTN and his CHF concurrently. But beta-blockers are relatively contraindicated in acute exacerbations of COPD. The evidence suggests that I place him on an ACE inhibitor to treat his DM and HTN, but that would decrease his kidney function, and he's already at the tipping point of needing dialysis so
Congratulations on your 1001001100101100000001011010010 seconds, Unix!
>There are some choices that are just so simple and basic that the government should be dictating them. Like "hey, the only active ingredient in a drug should not be cocaine."
I beg to differ. When it comes to refractory epistaxis, cocaine is exactly the active ingredient that is needed. =)
>p.s. I meant "The history of Gaza, and indeed all history is *relevant*". All history is RELEVANT. No history is IRRELEVANT. That is what I meant. Your idiocy makes me mad, and being made makes me mis-type. So double-fuck-you for that!
So apparently, by your logic if some Native Americans drive a truck bomb into Washington and blow up the Capitol and all it's Congressmen, staffers, pages, food workers and janitors, it's all justified because all of you white folks (and no, I'm not white) took away all their good land and rounded them up into virtual ghettos 150-200 years ago?
Or, if some Irishmen start lobbing mortar shells into a crowded British subway line, it's OK because the British are oppressing them in Northern Ireland? Or maybe it's OK if they only kill 15 people over a number of years while doing so...
At some point, you have to grow a brain and get on with living if your great-grandparents were oppressed. At some point, history becomes irrelevant, because if all they do (Hamas, Palestinians in general) is live for the insults and mistakes of the past, they just end up repeating the past, mostly to their detriment.
P.S. If Jordan, Egypt, Syria, and Lebanon had made even a token effort to absorb "their brothers" the Palestinian refugees into their own societies over the last 60 years, maybe the rest of the Palestinians would realize there are better things to do with their time than poke the proverbial bear repeatedly with a sharp but inconsequential stick. Hmm... not a single Palestinian fires a Qassam rocket at the Arab states for their massacres of the Palestinian refugees, do they? Maybe the true lesson here is that if Israel were as brutal as say, Jordan was in Black September, maybe the Palestinians would start to figure things out?
You make it pretty clear you hate John McCain and possibly all Republicans in general, but this is borderline obsessive.
"He was, ultimately, in charge... The buck has to stop with the person whose name is on the check."
Really? So if Jiffy Lube or whoever does your oil change on a contractual basis screws up your oil change, it's your fault? You, after all, are in charge of your own car. That's great logic there. If you ever need back surgery, and the surgeon you choose leaves you paralyzed, I suppose your response will be, Well, gee, it's my fault, I should have hired a better surgeon!
I get the whole "captain is responsible for his ship" mentality, but ultimately, you have to stop blaming people for minor details going wrong that aren't remotely in their sphere of responsibility.
The future of Google is more data-mining of your private information. Fantastic. Please, bring on the bread and circus... I wonder when Google will delve into the "free" entertainment for your personal information business? GPorn? GPoker? GQuake? GWarcraft?