The current "jackpot jury" system is sot irrevocably broken it's not even remotely funny.
The jury isn't qualified to evaluate the data presented and inevitably comes to ridiculous conclusions. All malpractice/medical injury claims should be decided by a committee of practicing doctors to decide if there was actually malpractice.
But fault and compensation in vaccine cases isn't decided by a jury. It's decided by the Vaccine Injury Compensation Program. It's a no-fault program. http://www.nejm.org/doi/full/10.1056/NEJMp0802904
Taking the decision away from the jury and giving it to an expert panel isn't necessarily going to give better decisions, and it may give worse decisions.
It may be that the Poling case is unusual, and subsequent cases like this will be rejected. The courts threw out the autism cases.
If you want an intelligent assessment from someone who knows the facts, you should go to Brooke Magnanti, PhD (who is smarter than most Slashdot readers).
One correction: The term used in the scientific literature is "commercial sex worker." If she went to work for the companies that made organophosphates, and lobbied to keep them selling dangerous products then she would be a prostitute.
Belle de Jour: On science and prostitution 17:50 20 November 2009 Rowan Hooper
Under the name Belle de Jour, Brooke Magnanti wrote about her experiences as a prostitute for a London escort agency, and her blog became a bestselling book, The Intimate Adventures of a London Call Girl, and a television series.
She has a master's degree in genetic epidemiology and a PhD from the University of Sheffield's department of forensic pathology.
She currently works at the Bristol Initiative for Research of Child Health and told her agent: "if New Scientist asks for an interview, I'll do it". We did ask.
It is true that people like Seldes were a minority, and he printed what he did because the major newspapers didn't print it.
It didn't all start with Amy Goodman.
But if you want to challenge powerful, greedy, unscrupulous interests, you have to expect them to fight back and not let a concern for freedom of ideas get in their way.
You can't depend on the law to protect you. You're better off having anonymous distribution. The American revolution was debated in anonymous pamphlets. A technical means to anonymous distribution might be better than a law.
Are you insinuating that I'm not able to understand it and you somehow are?
Well, now that you put it that way, yeah.
The important thing that you don't understand is the significance of overall survival and progression-free survival.
I don't know why conservatives can't understand a simple news story. Avastin does *not* cure breast cancer, and it does *not* even extend the life of anyone with breast cancer. It extends life in *colorectal* cancer. In breast cancer, all it does is improve the appearance of spots in an x-ray, which is technically called "progression" but in this case is not correlated with survival.
Actually, according to the article, it says the drug slows the spread of breast cancer by about 5 months. Does this look familiar? "The drug was initially approved after a study found that, by preventing blood flow to tumours, it extended the amount of time until the disease worsened by more than five months."?
That statement in the Telegraph is not accurate. The doctors who performed the studies, and their article in the medical journals, say bevacizumab (Avastin) increased "progression-free survival", they don't say that delayed the time until the disease "worsened." Doctors use these particular words for a reason.
Progression-free survival is controversial among oncologists; everybody agrees that what matters is overall survival. Progression-free survival is merely a surrogate or marker that's supposed to predict overall survival. When you finally have a study that gives you the overall survival, you can ignore progression-free survival.
I was at the sessions at the American Society for Clinical Oncology where they first reported on bevacizumab, I've been reading the medical journal articles on bevacizumab for colorectal cancer and breast cancer as they've been reported, and I've gone to lectures and talked to the doctors who were doing the work to make sure I understood them correctly. This is what the doctors told me.
So what if it doesn't extend the life of the patent,
Extending the life of the patient is the whole point. That's what patients want to do.
it slows the spread so other treatments can be more effective which might extend the life of the patient.
No, it doesn't. Avastin (bevacizumab) doesn't slow the spread. It slows the progression, which is different. It doesn't help other treatments become more effective. Even in combination with other treatments, it doesn't extend the life of the patient.
You're misreading the Telegram and WSJ articles (which were intended to be misleading).
I can't explain this to you. You don't understand cancer treatment or research. The Republicans are taking advantage of your ignorance.
Interesting. I once intubated a simulation dummy. You wouldn't want to be that dummy. I didn't know any of this about reversing paralysis.
I can understand why an anesthesiologist would want to add a drug like sugammadex in his armamentum. The problem of weighing costs and benefits when they involve rare, serious risks is damned difficult.
My easy answer is that you create an expert panel, let them review the evidence and hold hearings, and have them decide. If the FDA followed the advice of its expert panels (as I think it should), you should get the same kinds of conclusions with the FDA panels as you would with the professional societies -- or at least the same differences of opinion. (The European regulatory agencies approved sugammadex, didn't they?)
I'm very interested in this question of whether government agencies can make decisions and manage things better than private organizations, professional societies, and businesses.
Most of the time the discussion gets shouted down by people who have a belief based on their political ideology. I'm more interested in seeing the facts. There are social scientists who study this, but I've never systematically looked up their work.
I think a well-managed government regulatory agency could do a good job, if they used a valid process to appoint people to their expert panels, insulated them from politics, and followed their decisions. I used to think that you could quantify all the significant factors and put them into a big decision matrix -- would you have more deaths with or without sugammadex? But sometimes it gets more complicated than that.
I didn't express myself accurately enough. The anesthesiologists successfully used the model of safety engineering from the aircraft industry, which was managed and developed largely by the government (with civilian input).
I think you'll agree with my main point, that "personal responsibility" isn't the solution to hospital safety. Instead, it takes a systems approach. I think you'll also agree that, if you can solve a problem by telling people to follow a rule, or solve it with an engineered solution that makes it impossible for people to do it wrong, the engineered solution is better.
I don't know enough about sugammadex (or anesthesiology) to comment. I'll keep my eye out for it, though.
Yes, this is what I was thinking of. I remember that WSJ story too.
A seminal publication from Harvard in 1978 described the use of the aviation-inspired critical incident analysis technique to understand the causes of anesthesia-related mishaps and injuries. In the early 1980's, national media publicity turned a harsh spotlight on anesthesia accidents that injured patients. Thus stimulated, and avoiding the urge to fixate on tort reform, E. C. Pierce, Jr., MD, the 1984 President of the American Society of Anesthesiologists (ASA) constituted a new ASA standing committee on Safety and Risk Management, emphasizing the need to address the causes of patient injury. That same year, Pierce and Harvard colleagues convened the International Symposium on the Prevention of Anesthesia Mortality and Morbidity, which constituted the first organized examination of what was soon to be known as "anesthesia patient safety." There the idea for the APSF was born....
Overall, the combined impact of all the initiatives has been a 10 to 20-fold reduction in mortality and catastrophic morbidity for healthy patients undergoing routine anesthetics...
I guess when you close your eyes to everything that doesn't fit your own reality, your reality is only what you make it instead of anything real. I'm not going to go through the trouble of actually linking to these articles, but if you are interested in anything more then conformation bias, I suggest you copy and past these links out and read them.
before you start clamoring those are biased sites, I suggest you stop looking only at sites that you agree
Actually, I read the WSJ editorial page every day (a habit from the days when they were rational and got their facts right), so I already read several of those articles. Mostly, I get my information from the New England Journal of Medicine, which is what you have to read if you want to understand these issues. (They print lots of articles by Republican policy-makers.)
The provision for end-of-life counseling was opposed by Republicans and they said it would lead to "death panels" (although it is true that there was more to the "death panels" than that). I agree with the NYT story that they're responsible. You don't have to agree. But you'll be wrong.
I don't know why conservatives can't understand a simple news story. Avastin does *not* cure breast cancer, and it does *not* even extend the life of anyone with breast cancer. It extends life in *colorectal* cancer. In breast cancer, all it does is improve the appearance of spots in an x-ray, which is technically called "progression" but in this case is not correlated with survival. In fact, because of the side effects, breast cancer patients with Avastin do worse than people without it. The Telegraph actually explains most of this if you read it carefully.
David Vitter, the Republican Senator from Louisiana, is lying by saying this demonstrates a death panel. The FDA withdrew its approval from a drug for breast cancer because it didn't work and caused side effects which can require surgery, and frequently kill them, like bowel perforation and kidney failure.
So here's another example of Republicans shouting "death panels" for political advantage where it's clearly not true, and where they're causing people actual harm as a result.
I agree with you that one should read publications they disagree with and I recommend that you follow your own advice. I recommend Paul Krugman's column in the New York Times.
I've worked in ISO-9000 certified shops where actual compliance was shitty. If you want to get ISO-9000 certified, you just need to demonstrate that you have processes, and that you have processes for monitoring and evaluating compliance with processes. You don't actually NEED to comply.
That's interesting. I just saw an article about process standards in hospitals. One of the requirements is for telling heart attack patients to take aspirin. Another requirement is to "counsel" them on smoking cessation. The electronic medical record has a check box to confirm that you recommended aspirin and counseled smoking cessation. All they have to do is check the box. There's no way to tell whether they actually gave the advice, or whether the patient understood it. The article recommended against unverifiable process standards.
You're so wrong it's a good educational lesson to show why you're wrong.
Any nurse who does something like this is purely incompetent. I know several RNs and talk to a few on a daily basis. It is a somewhat stressful and fast-paced job, but you cannot ethically exceed your working pace. Every nurse should physically trace each tube to its receptacle. If there are two tubes in the vicinity but not even in proximity, extra care should be taken to trace the tube tactilely.
I deal with nurses too, particularly on safety issues. I also deal with government and civilian safety experts, and you're being unfair to them.
You display a fundamental misunderstanding of safety engineering.
You raise some important issues, but you've come to the completely wrong conclusion. Your political bias leads you to depend on "personal responsibility." Engineers have found that depending on "personal responsibility" is exactly what leads to disaster.
In the history of American engineering and industrial development, government "bureaucrats" have done a good job, often better than the industry they're regulating. If you want to see an unregulated pharmaceutical industry, go to China, where the free-market suppliers made drugs like heparin, cough syrup and infant formula that killed people. U.S. government regulators are responsible for dramatically improving the safety of the medical, airline, auto and electrical products industry, to name 4 that I'm familiar with. Even people in the regulated industries know this.
Think of these tubes. Engineers talk about an accident chain -- this includes mechanical factors and human factors. Every step of the chain has to fail for an accident to occur. If you interrupt one step, you stop an accident. You can tell nurses to trace tubes and lecture them about personal responsibility. But according to Murphy's law (the real Murphy's law, not the joke), if there is more than one way to do a job, and one way will end in disaster, then eventually somebody will do it the wrong way. The point is that if you depend on human action -- personal responsibility -- you'll have an accident. If you instead design mechanical fail-safe features, you won't have an accident. My question for you is: Do you want accidents or not?
As the TFA said:
“Nurses should not have to work in an environment where it is even possible to make that kind of mistake,” said Nancy Pratt, a senior vice president at Sharp HealthCare in San Diego who is a vocal advocate for changing the system. “The nuclear power and airline industries would never tolerate a situation where a simple misconnection could lead to a death.”
One nurse told me, "Have you ever been in an operating room?" There are thousands of devices, all of them with safety labeling, most of them with something that can go wrong. It's not humanly possible to check a thousand devices before each operation. You're asking people to do the impossible. If you demand "personal responsibility," you will have accidents. Do you want accidents or not?
What you can do is standard, textbook safety management. Anesthesiologists were having a lot of problems, patients dying, malpractice suits, etc. They adopted accident-prevention methods used by the airline industry. Government studies identified certain design features of aircraft cockpits as responsible for crashes -- for example, cockpit instruments and controls weren't standardized, so pilots would pull the wrong lever. The government ordered them to be standardized. Those crashes stopped.
Anesthesiologists had the same problem. They worked at different hospitals, with different equipment, and that caused mistakes. They standardized equipment, mistakes went down, fatalities went down, insurance premiums went down.
This shows that government can work. At the end of World War II, flying was an adventurous activity limited to people who were willing to risk their lives. T
The NYT is correct. I read the conservative attacks on Obama's health care plan in the WSJ, including Betsy McCaughey. I also read about the health plan in the New England Journal of Medicine.
For McCaughey, or anyone else, to claim that these were or would be anything like "death panels" to decide when to let someone die for cost-control purpose, is a lie. The conservatives lied. You can go to places like Factcheck.org to confirm that.
You don't think Al Franken's libel lawyers would have let him print a book like "Lies: and the Lying Liars who Tell them" if he couldn't actually prove that Republicans lied, do you? Actually, all Franken did was assign a bunch of summer interns to fact-check statements by right-wing crackpots like Limbaugh.
McNeil reports, based on a study in the NEJM which I also read, that having an end of life discussion with your doctor actually extends life by several months, and improves quality of life at the end.
He also reports, as everybody who reads the Wall Street Journal editorial page knows, that there was funding for end-of-life counseling in the health care bill, but that Rush Limbaugh, Glenn Beck, Sarah Palin and Betsy McCaugh campaigned against it as "death panels," and that provision was defeated.
So at the end of your life, because of these Republicans, you're more likely to wind up demented, in a hospital bed, warehoused in a poorly-staffed nursing home, crippled by a stroke, cognitive abilities gone, kidney dialysis, breathing tube, suffering pain and indignity because you never had an end-of-life discussion with your doctor.
The custom of making things up, like "death panels," to scare people, is more common among those Republicans I cited.
i would WELCOME an intellectually honest conversation with an honest open minded intelligent conservative, FOR ONCE
but they seem to all be dead. they seemed to have been taken over by the bleacher creatures, cretins like yourself who OPENLY and WITHOUT SHAME, as a mark of PRIDE (amazing!), trumpet the fact that they PREFER rumor, innuendo, and outright deceit... over neutral news sources
That's true -- William Buckley, Irving Kristol, all gone.
The new round of "conservatives" -- Rush Limbaugh, Sarah Palin, Glen Beck -- just make things up. They got end-of-life counseling taken out of the health care bill by calling it "death panels," for example. Really shameless.
The Pentagon repeatedly denied allegations that the provincial reconstruction teams endangered aid workers, but the U.S. government continued to refer to NGOs as partners in the war effort. Secretary of State Colin Powell referred to them as “force multipliers” and members of the “combat team” in a speech delivered before NGO community leaders.1 In May 2004, one month before the murders, coalition forces distributed leaflets in southern Afghanistan showing a man carrying provisions with this message: “In order to continue the humanitarian aid, pass over any information related to Taliban or Al-Qaida to the coalition forces.”
I'll bet you'll shut up the next time something bad happens to your country and the U.S. parks a giant hospital ship off your shores and starts dispensing free medical care.
I can tell you don't know anything about hospital ships or the U.S. delivery of health care to the third world. Here's an article by somebody who does, Paul Farmer, who has been helping the Hatians develop their own health care system (not "dispensing free medical care," but giving them the developmental assistance the Haitian doctors told him they need).
... There is no denying that Haiti's 33rd coup d'etat brings an end to constitutional rule. As physicians and health workers, we must note that Haiti's only large public teaching hospital has been paralyzed by violence and dissent. For years, economic pressure resulting largely, though not wholly, from an international embargo on loans and aid has left almost nothing to invest in the care of the destitute sick.
To make that clear, the U.S. government had an embargo on Haiti, preventing them from getting basic economic necessities, including medical supplies and medical services. The Clinton Administration imposed a neoliberal program on Haiti that also helped to destroy the economy:
http://en.wikipedia.org/wiki/Aristide Noam Chomsky is highly critical of what he calls hidden American imperialist actions in Haiti; "When Clinton restored Aristide--Clinton of course supported the military junta, another little hidden story...he strongly supported it in fact. He even allowed the Texaco Oil Company to send oil to the junta in violation of presidential directives; Bush Sr. did so as well-well, he finally allowed the president to return, but on condition that he accept the programs of Marc Bazin, the US candidate that he had defeated in the 1990 election. And that meant a harsh neoliberal program, no import barriers. That means that Haiti has to import rice and other agricultural commodities from the US from US agribusiness, which is getting a huge part of its profits from state subsidies. So you get highly subsidized US agribusiness pouring commodities into Haiti; I mean, Haitian rice farmers are efficient but nobody can compete with that, so that accelerated the flight into the cities."
As Paul Farmer explained, there is a health care myth that developed nations can "deliver" health care to third-world nations. This provides propaganda pictures of doctors in helicopters and hospital ships, but doesn't help the real problems. What third world countries need is doctors (like Farmer) who will help them develop their own health care system, and make a commitment to stay as long as it takes. Patients in Haiti will have needs for their entire lifetimes. U.S. hospital ships will only be around for a month and then will go home. A country like Haiti needs a coordinated health care system. The U.S. was disrupting the Haitian doctors' attempts to coordinate care by setting up alternative health care providers to compete with the Aristide government. The U.S. was politicizing health care, at the expense of the patients and the Haitian health care system.
According to first-hand accounts that I heard on the radio (but can't find the links to), when the U.S. moved into Haiti during the recent flood, the first thing they did was set up a military beachhead of marines to provide unnecessary "security," not send medical workers out where they were needed.
The Cuban government also sent doctors to Haiti, and they're still there. Since they're familiar with third world conditions (Cuba
Interestingly, that Wikipedia article says that the Soviet occupation resulted in the killings of between 600,000 and two million Afghans, but those numbers are not supported by the cited source. I could believe that it's true if I had a reliable source.
I would also want to know whether this large number of deaths was the result of the Soviet-supported regime, or the result of the U.S. involvement.
If you're discussing the morality or acceptability of political actions, I don't think it's acceptable to kill 600,000-2 million people to impose your political or economic philosophy on them, whether you're the Soviet Union or the U.S.
Yes, I have a bias in favor of the scientific method and scientific evidence. I admit it.
Carl Sagan said that we live in a society in which it's vital for our survival to understand science and engineering, yet we have a population that doesn't understand science and technology.
Since Sagan died, it's gotten even worse. The Republicans are displaying open contempt for science and scientists.
So for example Bush took us to war in Iraq on the basis of claims about weapons of mass destruction that scientists like Hans Blik said were not supported by the evidence. Result: 4,000 American soldiers died so far.
Slashdot Mirror
The current "jackpot jury" system is sot irrevocably broken it's not even remotely funny.
The jury isn't qualified to evaluate the data presented and inevitably comes to ridiculous conclusions. All malpractice/medical injury claims should be decided by a committee of practicing doctors to decide if there was actually malpractice.
But fault and compensation in vaccine cases isn't decided by a jury. It's decided by the Vaccine Injury Compensation Program. It's a no-fault program.
http://www.nejm.org/doi/full/10.1056/NEJMp0802904
Taking the decision away from the jury and giving it to an expert panel isn't necessarily going to give better decisions, and it may give worse decisions.
It may be that the Poling case is unusual, and subsequent cases like this will be rejected. The courts threw out the autism cases.
I realize that people are using humor to deal with their fears and discomfort over death, but there's no way to make this funny:
December 17, 2009, 12:29 pm
Announcing a Child’s Death on Twitter
By LISA BELKIN
http://parenting.blogs.nytimes.com/2009/12/17/tweeting-about-a-childs-death/
Here's a few more details in the German story, thanks to Google translate. (Contains amusing malapropisms.)
Apparently German workers have legal rights.
If they get fired arbitrarily, they can sue and get their job back.
http://www.bild.de/BILD/politik/wirtschaft/2010/09/02/stromklau-gericht-urteilt/mann-behaelt-seinen-job-es-ging-um-1-komma-8-cent.html
If you want an intelligent assessment from someone who knows the facts, you should go to Brooke Magnanti, PhD (who is smarter than most Slashdot readers).
One correction: The term used in the scientific literature is "commercial sex worker." If she went to work for the companies that made organophosphates, and lobbied to keep them selling dangerous products then she would be a prostitute.
(Although you might argue that charging $31.50 to read your paper is prostitution http://dx.doi.org/10.1016/j.toxlet.2009.06.835)
Belle de Jour: On science and prostitution
17:50 20 November 2009
Rowan Hooper
Under the name Belle de Jour, Brooke Magnanti wrote about her experiences as a prostitute for a London escort agency, and her blog became a bestselling book, The Intimate Adventures of a London Call Girl, and a television series.
She has a master's degree in genetic epidemiology and a PhD from the University of Sheffield's department of forensic pathology.
She currently works at the Bristol Initiative for Research of Child Health and told her agent: "if New Scientist asks for an interview, I'll do it". We did ask.
http://www.newscientist.com/blogs/culturelab/2009/11/belle-de-jour-on-science-and-prostitution.html
The entire professional news industry & every US reporter, investigator & journalist is a gutless fucking coward for supporting this.
That's 99% of the professional news industry.
On what planet?
I am glad to see you approach journalism with skepticism, but the truth is somewhere in between (I hate that phrase).
There always have been journalists who were willing to take risks to bring important information to the public. http://en.wikipedia.org/wiki/George_Seldes http://en.wikipedia.org/wiki/I.F._Stone During the McCarthy days, there really were risks -- many people were blacklisted and unable to work, and quite a few were sent to jail for publishing unpopular ideas. http://en.wikipedia.org/wiki/Dennis_v._United_States
It is true that people like Seldes were a minority, and he printed what he did because the major newspapers didn't print it.
It didn't all start with Amy Goodman.
But if you want to challenge powerful, greedy, unscrupulous interests, you have to expect them to fight back and not let a concern for freedom of ideas get in their way.
You can't depend on the law to protect you. You're better off having anonymous distribution. The American revolution was debated in anonymous pamphlets. A technical means to anonymous distribution might be better than a law.
This is a better way to phrase it: “There’s a distinction (between) how WikiLeaks works and how news media organizations work,”
http://en.wikipedia.org/wiki/Judith_Miller_(journalist)
You: Gorgeous redhead, red dress, big brown eyes, smile like an angel.
Me: Nerdy-looking guy in torn dungarees and blue T-shirt
You came up to me in Starbucks at 47th St. and Eighth Ave. and said in a golden voice, "Excuse me, but haven't we met in California last year?"
I said, "Uh, yeah. maybe."
You turned around and disappeared on Eighth Ave.
Please, please call me on UVB-76.
Are you insinuating that I'm not able to understand it and you somehow are?
Well, now that you put it that way, yeah.
The important thing that you don't understand is the significance of overall survival and progression-free survival.
Actually, according to the article, it says the drug slows the spread of breast cancer by about 5 months. Does this look familiar? "The drug was initially approved after a study found that, by preventing blood flow to tumours, it extended the amount of time until the disease worsened by more than five months."?
That statement in the Telegraph is not accurate. The doctors who performed the studies, and their article in the medical journals, say bevacizumab (Avastin) increased "progression-free survival", they don't say that delayed the time until the disease "worsened." Doctors use these particular words for a reason.
Progression-free survival is controversial among oncologists; everybody agrees that what matters is overall survival. Progression-free survival is merely a surrogate or marker that's supposed to predict overall survival. When you finally have a study that gives you the overall survival, you can ignore progression-free survival.
I was at the sessions at the American Society for Clinical Oncology where they first reported on bevacizumab, I've been reading the medical journal articles on bevacizumab for colorectal cancer and breast cancer as they've been reported, and I've gone to lectures and talked to the doctors who were doing the work to make sure I understood them correctly. This is what the doctors told me.
Extending the life of the patient is the whole point. That's what patients want to do.
No, it doesn't. Avastin (bevacizumab) doesn't slow the spread. It slows the progression, which is different. It doesn't help other treatments become more effective. Even in combination with other treatments, it doesn't extend the life of the patient.
You're misreading the Telegram and WSJ articles (which were intended to be misleading).
I can't explain this to you. You don't understand cancer treatment or research. The Republicans are taking advantage of your ignorance.
Interesting. I once intubated a simulation dummy. You wouldn't want to be that dummy. I didn't know any of this about reversing paralysis.
I can understand why an anesthesiologist would want to add a drug like sugammadex in his armamentum. The problem of weighing costs and benefits when they involve rare, serious risks is damned difficult.
My easy answer is that you create an expert panel, let them review the evidence and hold hearings, and have them decide. If the FDA followed the advice of its expert panels (as I think it should), you should get the same kinds of conclusions with the FDA panels as you would with the professional societies -- or at least the same differences of opinion. (The European regulatory agencies approved sugammadex, didn't they?)
I'm very interested in this question of whether government agencies can make decisions and manage things better than private organizations, professional societies, and businesses.
Most of the time the discussion gets shouted down by people who have a belief based on their political ideology. I'm more interested in seeing the facts. There are social scientists who study this, but I've never systematically looked up their work.
I think a well-managed government regulatory agency could do a good job, if they used a valid process to appoint people to their expert panels, insulated them from politics, and followed their decisions. I used to think that you could quantify all the significant factors and put them into a big decision matrix -- would you have more deaths with or without sugammadex? But sometimes it gets more complicated than that.
Anesthesiologists had the same problem...
This shows that government can work.
The Anesthesia Patient Safety Foundation has nothing whatsoever to do with government. Never did.
I didn't express myself accurately enough. The anesthesiologists successfully used the model of safety engineering from the aircraft industry, which was managed and developed largely by the government (with civilian input).
I think you'll agree with my main point, that "personal responsibility" isn't the solution to hospital safety. Instead, it takes a systems approach. I think you'll also agree that, if you can solve a problem by telling people to follow a rule, or solve it with an engineered solution that makes it impossible for people to do it wrong, the engineered solution is better.
I don't know enough about sugammadex (or anesthesiology) to comment. I'll keep my eye out for it, though.
Yes, this is what I was thinking of. I remember that WSJ story too.
http://www.apsf.org/about_history.php
A seminal publication from Harvard in 1978 described the use of the aviation-inspired critical incident analysis technique to understand the causes of anesthesia-related mishaps and injuries. In the early 1980's, national media publicity turned a harsh spotlight on anesthesia accidents that injured patients. Thus stimulated, and avoiding the urge to fixate on tort reform, E. C. Pierce, Jr., MD, the 1984 President of the American Society of Anesthesiologists (ASA) constituted a new ASA standing committee on Safety and Risk Management, emphasizing the need to address the causes of patient injury. That same year, Pierce and Harvard colleagues convened the International Symposium on the Prevention of Anesthesia Mortality and Morbidity, which constituted the first organized examination of what was soon to be known as "anesthesia patient safety." There the idea for the APSF was born....
Overall, the combined impact of all the initiatives has been a 10 to 20-fold reduction in mortality and catastrophic morbidity for healthy patients undergoing routine anesthetics...
I guess when you close your eyes to everything that doesn't fit your own reality, your reality is only what you make it instead of anything real. I'm not going to go through the trouble of actually linking to these articles, but if you are interested in anything more then conformation bias, I suggest you copy and past these links out and read them.
before you start clamoring those are biased sites, I suggest you stop looking only at sites that you agree
Actually, I read the WSJ editorial page every day (a habit from the days when they were rational and got their facts right), so I already read several of those articles. Mostly, I get my information from the New England Journal of Medicine, which is what you have to read if you want to understand these issues. (They print lots of articles by Republican policy-makers.)
The provision for end-of-life counseling was opposed by Republicans and they said it would lead to "death panels" (although it is true that there was more to the "death panels" than that). I agree with the NYT story that they're responsible. You don't have to agree. But you'll be wrong.
I understand that Telegraph article, http://www.telegraph.co.uk/health/healthnews/7948878/US-breast-cancer-drug-decision-marks-start-of-death-panels.html which is about Avastin (bevacizumab). The WSJ editorial page just published a deceptive editorial about Avastin again, so I checked the facts again to make sure I remembered it right.
I don't know why conservatives can't understand a simple news story. Avastin does *not* cure breast cancer, and it does *not* even extend the life of anyone with breast cancer. It extends life in *colorectal* cancer. In breast cancer, all it does is improve the appearance of spots in an x-ray, which is technically called "progression" but in this case is not correlated with survival. In fact, because of the side effects, breast cancer patients with Avastin do worse than people without it. The Telegraph actually explains most of this if you read it carefully.
David Vitter, the Republican Senator from Louisiana, is lying by saying this demonstrates a death panel. The FDA withdrew its approval from a drug for breast cancer because it didn't work and caused side effects which can require surgery, and frequently kill them, like bowel perforation and kidney failure.
So here's another example of Republicans shouting "death panels" for political advantage where it's clearly not true, and where they're causing people actual harm as a result.
I agree with you that one should read publications they disagree with and I recommend that you follow your own advice. I recommend Paul Krugman's column in the New York Times.
I've worked in ISO-9000 certified shops where actual compliance was shitty. If you want to get ISO-9000 certified, you just need to demonstrate that you have processes, and that you have processes for monitoring and evaluating compliance with processes. You don't actually NEED to comply.
That's interesting. I just saw an article about process standards in hospitals. One of the requirements is for telling heart attack patients to take aspirin. Another requirement is to "counsel" them on smoking cessation. The electronic medical record has a check box to confirm that you recommended aspirin and counseled smoking cessation. All they have to do is check the box. There's no way to tell whether they actually gave the advice, or whether the patient understood it. The article recommended against unverifiable process standards.
You're so wrong it's a good educational lesson to show why you're wrong.
Any nurse who does something like this is purely incompetent. I know several RNs and talk to a few on a daily basis. It is a somewhat stressful and fast-paced job, but you cannot ethically exceed your working pace. Every nurse should physically trace each tube to its receptacle. If there are two tubes in the vicinity but not even in proximity, extra care should be taken to trace the tube tactilely.
I deal with nurses too, particularly on safety issues. I also deal with government and civilian safety experts, and you're being unfair to them.
You display a fundamental misunderstanding of safety engineering.
You raise some important issues, but you've come to the completely wrong conclusion. Your political bias leads you to depend on "personal responsibility." Engineers have found that depending on "personal responsibility" is exactly what leads to disaster.
In the history of American engineering and industrial development, government "bureaucrats" have done a good job, often better than the industry they're regulating. If you want to see an unregulated pharmaceutical industry, go to China, where the free-market suppliers made drugs like heparin, cough syrup and infant formula that killed people. U.S. government regulators are responsible for dramatically improving the safety of the medical, airline, auto and electrical products industry, to name 4 that I'm familiar with. Even people in the regulated industries know this.
Think of these tubes. Engineers talk about an accident chain -- this includes mechanical factors and human factors. Every step of the chain has to fail for an accident to occur. If you interrupt one step, you stop an accident. You can tell nurses to trace tubes and lecture them about personal responsibility. But according to Murphy's law (the real Murphy's law, not the joke), if there is more than one way to do a job, and one way will end in disaster, then eventually somebody will do it the wrong way. The point is that if you depend on human action -- personal responsibility -- you'll have an accident. If you instead design mechanical fail-safe features, you won't have an accident. My question for you is: Do you want accidents or not?
As the TFA said:
“Nurses should not have to work in an environment where it is even possible to make that kind of mistake,” said Nancy Pratt, a senior vice president at Sharp HealthCare in San Diego who is a vocal advocate for changing the system. “The nuclear power and airline industries would never tolerate a situation where a simple misconnection could lead to a death.”
One nurse told me, "Have you ever been in an operating room?" There are thousands of devices, all of them with safety labeling, most of them with something that can go wrong. It's not humanly possible to check a thousand devices before each operation. You're asking people to do the impossible. If you demand "personal responsibility," you will have accidents. Do you want accidents or not?
What you can do is standard, textbook safety management. Anesthesiologists were having a lot of problems, patients dying, malpractice suits, etc. They adopted accident-prevention methods used by the airline industry. Government studies identified certain design features of aircraft cockpits as responsible for crashes -- for example, cockpit instruments and controls weren't standardized, so pilots would pull the wrong lever. The government ordered them to be standardized. Those crashes stopped.
Anesthesiologists had the same problem. They worked at different hospitals, with different equipment, and that caused mistakes. They standardized equipment, mistakes went down, fatalities went down, insurance premiums went down.
This shows that government can work. At the end of World War II, flying was an adventurous activity limited to people who were willing to risk their lives. T
/end FreeMarketIdealogueIdiot
How did I do? Does that just about sum up the FMII position on regulation?
Pretty good. You had me going there for a while.
The NYT is correct. I read the conservative attacks on Obama's health care plan in the WSJ, including Betsy McCaughey. I also read about the health plan in the New England Journal of Medicine.
For McCaughey, or anyone else, to claim that these were or would be anything like "death panels" to decide when to let someone die for cost-control purpose, is a lie. The conservatives lied. You can go to places like Factcheck.org to confirm that.
You don't think Al Franken's libel lawyers would have let him print a book like "Lies: and the Lying Liars who Tell them" if he couldn't actually prove that Republicans lied, do you? Actually, all Franken did was assign a bunch of summer interns to fact-check statements by right-wing crackpots like Limbaugh.
Do you have actual PROOF Glenn Beck is making ANYTHING up, or are you just shaking your head in a "me too" fashion here.
Actually when I wrote it I was thinking of this article http://www.nytimes.com/2010/08/19/health/19care.html Palliative Care Extends Life, Study Finds By DONALD G. McNEIL Jr. August 18, 2010
McNeil reports, based on a study in the NEJM which I also read, that having an end of life discussion with your doctor actually extends life by several months, and improves quality of life at the end.
He also reports, as everybody who reads the Wall Street Journal editorial page knows, that there was funding for end-of-life counseling in the health care bill, but that Rush Limbaugh, Glenn Beck, Sarah Palin and Betsy McCaugh campaigned against it as "death panels," and that provision was defeated.
So at the end of your life, because of these Republicans, you're more likely to wind up demented, in a hospital bed, warehoused in a poorly-staffed nursing home, crippled by a stroke, cognitive abilities gone, kidney dialysis, breathing tube, suffering pain and indignity because you never had an end-of-life discussion with your doctor.
The custom of making things up, like "death panels," to scare people, is more common among those Republicans I cited.
i would WELCOME an intellectually honest conversation with an honest open minded intelligent conservative, FOR ONCE
but they seem to all be dead. they seemed to have been taken over by the bleacher creatures, cretins like yourself who OPENLY and WITHOUT SHAME, as a mark of PRIDE (amazing!), trumpet the fact that they PREFER rumor, innuendo, and outright deceit... over neutral news sources
That's true -- William Buckley, Irving Kristol, all gone.
The new round of "conservatives" -- Rush Limbaugh, Sarah Palin, Glen Beck -- just make things up. They got end-of-life counseling taken out of the health care bill by calling it "death panels," for example. Really shameless.
Thank you. That's Slashdot. Sometimes you get modded up, sometimes you just reach an appreciative audience, which is also nice.
It just goes to show how much you can learn from the New England Journal of Medicine.
Here's another one that you might be interested in:
Perspective
International Medical Aid
Collateral Damage — Médecins sans Frontières Leaves Afghanistan and Iraq
Ingrid T. Katz, M.D., M.H.S. and Alexi A. Wright, M.D.
http://www.nejm.org/doi/full/10.1056/NEJMp048296
The Pentagon repeatedly denied allegations that the provincial reconstruction teams endangered aid workers, but the U.S. government continued to refer to NGOs as partners in the war effort. Secretary of State Colin Powell referred to them as “force multipliers” and members of the “combat team” in a speech delivered before NGO community leaders.1 In May 2004, one month before the murders, coalition forces distributed leaflets in southern Afghanistan showing a man carrying provisions with this message: “In order to continue the humanitarian aid, pass over any information related to Taliban or Al-Qaida to the coalition forces.”
I also posted this on Slashdot, although the ensuing discussion was not always worthwhile.
http://slashdot.org/comments.pl?sid=1740870&cid=33118542
Any enemy of the US is our friend.
I'll bet you'll shut up the next time something bad happens to your country and the U.S. parks a giant hospital ship off your shores and starts dispensing free medical care.
I can tell you don't know anything about hospital ships or the U.S. delivery of health care to the third world. Here's an article by somebody who does, Paul Farmer, who has been helping the Hatians develop their own health care system (not "dispensing free medical care," but giving them the developmental assistance the Haitian doctors told him they need).
http://www.nejm.org/doi/full/10.1056/NEJMp048081
Perspective: Political Violence and Public Health in Haiti
Paul Farmer, M.D., Ph.D.
N Engl J Med 2004; 350:1483-1486 April 8, 2004
To make that clear, the U.S. government had an embargo on Haiti, preventing them from getting basic economic necessities, including medical supplies and medical services. The Clinton Administration imposed a neoliberal program on Haiti that also helped to destroy the economy:
http://en.wikipedia.org/wiki/Aristide
Noam Chomsky is highly critical of what he calls hidden American imperialist actions in Haiti; "When Clinton restored Aristide--Clinton of course supported the military junta, another little hidden story...he strongly supported it in fact. He even allowed the Texaco Oil Company to send oil to the junta in violation of presidential directives; Bush Sr. did so as well-well, he finally allowed the president to return, but on condition that he accept the programs of Marc Bazin, the US candidate that he had defeated in the 1990 election. And that meant a harsh neoliberal program, no import barriers. That means that Haiti has to import rice and other agricultural commodities from the US from US agribusiness, which is getting a huge part of its profits from state subsidies. So you get highly subsidized US agribusiness pouring commodities into Haiti; I mean, Haitian rice farmers are efficient but nobody can compete with that, so that accelerated the flight into the cities."
As Paul Farmer explained, there is a health care myth that developed nations can "deliver" health care to third-world nations. This provides propaganda pictures of doctors in helicopters and hospital ships, but doesn't help the real problems. What third world countries need is doctors (like Farmer) who will help them develop their own health care system, and make a commitment to stay as long as it takes. Patients in Haiti will have needs for their entire lifetimes. U.S. hospital ships will only be around for a month and then will go home. A country like Haiti needs a coordinated health care system. The U.S. was disrupting the Haitian doctors' attempts to coordinate care by setting up alternative health care providers to compete with the Aristide government. The U.S. was politicizing health care, at the expense of the patients and the Haitian health care system.
According to first-hand accounts that I heard on the radio (but can't find the links to), when the U.S. moved into Haiti during the recent flood, the first thing they did was set up a military beachhead of marines to provide unnecessary "security," not send medical workers out where they were needed.
The Cuban government also sent doctors to Haiti, and they're still there. Since they're familiar with third world conditions (Cuba
in 5 years, 1 unspayed mouse will have 60,466,176 offspring.
Gustav Eiffel already gave his tower an anthropomorphic makeover.
http://www.uh.edu/engines/statlibskel.jpg
Interestingly, that Wikipedia article says that the Soviet occupation resulted in the killings of between 600,000 and two million Afghans, but those numbers are not supported by the cited source. I could believe that it's true if I had a reliable source.
I would also want to know whether this large number of deaths was the result of the Soviet-supported regime, or the result of the U.S. involvement.
If you're discussing the morality or acceptability of political actions, I don't think it's acceptable to kill 600,000-2 million people to impose your political or economic philosophy on them, whether you're the Soviet Union or the U.S.
Medicare is not only a major problem all on its own but is actually a major reason for the increased health care costs born by all.
An excellent example of the subject under discussion: "I'm continually surprised by what passes for argumentation among conservatives."
You just make things up, without regard to facts or logic.
If I asked you to support that claim with evidence, you wouldn't know what to do.
Yes, I have a bias in favor of the scientific method and scientific evidence. I admit it.
Carl Sagan said that we live in a society in which it's vital for our survival to understand science and engineering, yet we have a population that doesn't understand science and technology.
Since Sagan died, it's gotten even worse. The Republicans are displaying open contempt for science and scientists.
So for example Bush took us to war in Iraq on the basis of claims about weapons of mass destruction that scientists like Hans Blik said were not supported by the evidence. Result: 4,000 American soldiers died so far.