" If changing to a single-payer national system is, for political reasons, out of the question, then, at the very least, the Affordable Care Act must be fully implemented in all states. "
"Single-payer." Like the VA. Because unaccountable, lying government officials and patients dying while on fake waiting lists are exactly what we need during an ebola epidemic.
I have read studies published by the VA on the outcomes of people treated at different VA hospitals for conditions like prostate cancer colorectal cancer, and I've talked to VA doctors. The VA has some of the best outcomes in the world. They did some of the major studies in cardiology to find out what works and what doesn't work, and every cardiologist in the world follows the recommendations of the VA studies. If I had cancer or a heart attack, I would be confident in any major VA hospital. (Although like all health care providers, they do have problems in rural areas.)
The reason they had that problem with waiting list fraud (which is unexcusable) is that their managers gave them politically-mandated targets for appointments, without giving them the money that they needed to hire more doctors to meet those targets. (Would you have predicted any problems with that?) That's what corporate-style management by financial incentives gets you. Now they're giving them more money to hire doctors.
But it doesn't affect their main purpose, which is to save the lives and health of veterans, many of whom have service-related injuries. In rehabilitation medicine, they've been doing a great job since at least WWII. I know a lot of veterans in their 70s and 80s who go to the VA and are very happy with it. You're seeing a doctor who is on salary and trying to treat you with the best possible medicine, not a doctor who gets 10 minutes to see you and gets paid for the procedures he does on you, even if they do more harm than good.
And Obamacare. Because of Obamacare I can not afford medical care. My premiums are about 3x before Obamacare. My deductible is $5,000.00. I am taxed $300.00/month on my health insurance because I am employed at a small company which can not purchase the plan directly from an insurer. (Obamacare revokes the tax exemption for employer-subsidized health insurance.) I am buying the least-expensive plan mandated by Obamacare to avoid the penalty and paying about $1,300.00 per month in insurance and taxes. I had a shoulder injury, went to an in-network doctor and had to pay for the entire visit, treatment and the physical therapy myself.
To summarize, now, because of Obamacare, I am required by law to pay $1,300.00 per month for health insurance and taxes at a minimum and on top of that I have to pay for my own medical expenses. Because of Obamacare, unless I am absolutely certain that I am dying I will not be going anywhere near a health care provider. By both making the patients poorer with higher insurance premiums and by raising the cost of treatment with higher deductibles Obamacare has created a massive financial disincentive to seeing medical care during an epidemic. And then also there is the decreased access to health care because of shrinking provide networks.
In addition to advocating for evidently broken and corrupt systems, the author wants to re-write the Constitution. You know, that document which guarantees citizens rights. What could possibly go wrong?
I am no fan of Obama or Obamacare, which was designed on a Republican model (Romneycare) and on a proposal put out by the Heritage Foundation, which now denies it.
And how do you like those free-market insurance company bureaucracies? Good thing you don't have to deal with government bureaucracies like Medicare.
The big problem with Obamacare is that, instead of expanding Medicare, as the progressives wanted, it gives the insurance companies about 30% of your health care premium, and that's the main reason why i
then you have a problem and you need to go through and re-think your entire worldview, starting from base principles. Either that, or We The People need to introduce you dictatorial fuckheads to hemp rope and cottonwood trees.
You never recited the Pledge of Allegiance, did you?
Without a top-down bureaucracy calling the shops, states can try 50 different methods to control the pandemic, and compare results to see who has the best one. They're not stuck mindlessly doing what Washington has dictated, even if it's wrong.
The CDC is swearing up and down Ebola can be transmitted by airborne infection, but what if they're wrong about this strain?
The federal government is much more likely than the states to continue a wrong course of action long after it's been proven a bad idea than the states. See also: Welfare, agribusiness subsidies, the food pyramid...
People who do these things for a living in real life would disagree with you.
By the time you try 50 different methods and compare the results, the epidemic will be all over (or out of control, depending on your luck). Why don't we disband Homeland Security and let 50 states deal with the terrorists in their own way?
If you have a mysterious disease spreading across the country, such as the spinal infections caused by the contaminated injections distributed by the New England Compounding Center last year, it's a lot harder for a state agency to figure out what's going on from 2 or 3 cases than it is for the CDC to figure out what's going on from 2-300 cases. And it turned out that the NECC was regulated by the states, not the federal government. After the disaster, everybody involved decided that maybe the federal government should have a little more oversight in this matter.
But even if you were right, unfortunately the (Republican, tax-cutting) states have been disbanding the very state health agencies that did such good reporting work on the New England Compounding Center disaster. I remember years ago California had a great occupational safety and health department, which was identifying how workers were dying and figuring out ways to stop it. They found that the major cause of electrocutions were (1) boom trucks hitting overhead wires, which could be prevented by just warning drivers about the hazard, and (2) short circuits in power tools, which could be prevented with a 25-cent ground fault interrupter. CAL OSHA was disbanded by Ronald Reagan.
And then there was the NIH grant to study why gay men are often thin and lesbians are often obese.
Why is this a problem? Research should always be done, however ridiculous your hypothesis may be. The freedom to do such insane research is what has made USA the leader of all sciences.
You mean "insane-appearing research." Some of the most important medical research looked insane, especially to the uninformed. Medical insurance is like going to the racetrack, with very good odds.
For example, a marine scientist studying sea sponges discovered Adriamycin, which was one of the first drugs that cured cancer, and formed the basis of all of our cancer drugs.
Of course these right-wing Congressmen would have a field day with that. Our government money going to study Spongebob.
It's not a local responsibility any more. According to the New England Journal of Medicine, the states are cutting back. Those state health departments that tracked the contaminated steroid injections from the New England Compounding Center, which killed about 100 people, were in the process of being disbanded. So if it happened again, we'd have people dying of a mysteriously transmitted disease and we wouldn't be able to figure it out.
Realize that when people start getting sick, you don't necessarily know whether an infectious disease is causing it, or whether it's an environmental factor like arsenic in the drinking water.
We don't need to change the Constitution, just the spending and research priorities of a bunch of bureaucracies.
Who says? Some right-winger who doesn't know anything about public health and has never been responsible for saving the life of a dying child, in an editorial that only gets one side of the story?
The CDC is setting its priorities according to the morbidity and mortality of the causes of illness, which is a rational way to do it.
Since there are about 4-5,000 workplace fatalities a year, virtually all of them preventable, that's a good return for the money.
There are about 30,000 firearms deaths a year, and when Congress, after NRA lobbying, cancelled the CDC's firearms research 15 years ago, nobody else did scientific research.
So if CDC doesn't do this stuff, nobody will. Particularly not the states, which are cutting back their local health departments.
I'm speaking as someone who has talked with CDC scientists, and read their MMWR regularly, so I know what they do.
What do you know about the CDC, besides what you get from anti-government opinion pieces?
And hospitals are already on the hook for uninsured patients due to the EMTALA laws.
No, the article said:
The Emergency Medical Treatment and Labor Act (EMTALA) of 1986 was enacted to prevent hospitals from refusing care to anyone needing urgent care and presenting at a hospital’s emergency room, regardless of insurance status. Unfortunately, EMTALA has sometimes been viewed as a mandate not funded by the federal government, and violations occur without reprisals or corrective actions.
It's even worse in Texas. They refused to implement Obamacare, fought it, and kicked people out of Medicaid. I think MedPage Today's KevinMD had a blog entry by a doctor at one of the charity clinics who said that the hospitals were referring uninsured people to them (after the hospitals kicked them out) even though the clinic didn't even have an x-ray machine.
Texas is a good example of the Republican health care plan -- you get sick, you die. http://online.wsj.com/articles... Legal Loophole Ensnares Breast-Cancer Patients; Shirley Loewe Chooses The Wrong Clinic And Starts Long Ordeal
Texas didn't enact the Affordable Care Act, and they have (I think) the lowest rate of people with health insurance in the country. Adam Smith, in Wealth of Nations, said that it was a government responsibility to provide for health care. Wealth of Nations was published in 1776, so those ideas were around when the Constitution was written. You don't need the germ theory of disease to see that diseases spread. I don't know where free market types get the idea that people who can't pay for health insurance should be left to suffer; maybe from Milton Friedman or Ayn Rand. Or Thomas Malthus.
If the first question asked in most American emergency rooms concerns insurance status, the uninsured and illegal aliens will likely continue to delay seeking treatment....
Policy makers should understand that having a large fraction of the US population uninsured poses a national security threat during deadly epidemics such as Ebola. If changing to a single-payer national system is, for political reasons, out of the question, then, at the very least, the Affordable Care Act must be fully implemented in all states. In addition, as it now stands, the CDC must wait until a state invites it to conduct epidemiologic investigations, and national disease surveillance depends on states voluntarily submitting data. This is a ridiculous and dangerous state of medical affairs.
My advice: Don't use Solr. Don't use PCRd PDFs. Don't support full-text searching, because no one fucking uses it. We get thousands of searches against title, keywords, dates, and other meta shit every day in our internal application. The only full-text searches performed are by me when I'm testing shit.
Lawyers use it. Magazines use it. Lots of people use it.
Lawyers use it because they have to - there is no alternative to search shit short of hiring monkeys to manually type up mountains of old documents. Often, those monkeys would have to be legally privileged to look at the documents, so it's not something you can shunt off to cheap labor / Mechanical Turk. OCR sucks. Solr sucks. Mixing the two is a big ol' suck fest.
Magazines use it because... they're stupid? There's no need to OCR a massive backlog of shit. For old shit that may not be digital, you can go ahead and hire a monkey to type it in. You're still left with Solr sucking, but on top of that much of a magazine's content is so heavily formatted/styled/image-based that a Solr index would not suit it well.
If you NEED a fulltext index. there are plenty of alternatives, some mentioned by others in the comments on this article. I can only speak to OCR sucking, Solr's indexer sucking, and Solr's search giving me way too many things for it to be useful.
What are some fulltext indexed open-source alternatives to Solr?
The best search engine I've ever seen is PubMed http://www.ncbi.nlm.nih.gov/pu... They structure information better than anybody else. But it requires a librarian to look at every document and code it according to a fairly elaborate coding scheme, the MESH headings, which basically requires a degree in library science and a good medical education to do well.
My advice: Don't use Solr. Don't use PCRd PDFs. Don't support full-text searching, because no one fucking uses it. We get thousands of searches against title, keywords, dates, and other meta shit every day in our internal application. The only full-text searches performed are by me when I'm testing shit.
Lawyers use it. Magazines use it. Lots of people use it.
I just read this in Science, with regard to using animal studies as the basis of human treatment:
The littlest patient; cutting-edge mouse models fuel hope for understanding and treating cancer By Jenniver Couzin-Frankel Science 3 October 2014
"About 90% of cancer drugs that enter clinical trials based on upbeat mouse data fail."
"Dozens if not hundreds of drugs have subdued cancer in these mice. A handful have done the same for people."
(The article describes how a drug company had been running a clinical trial in 122 people with advanced pancreatic cancer, who were getting a drug that was successful in mice. The human patients were dying more quickly on the new drug.)
You sound like somebody who knows statistics, but doesn't have much practical experience in applying statistics to real-world medical studies, as opposed to the examples they use in statistics textbooks.
Real-world medical statistics is fairly complicated. A recent article in JAMA explained how the same investigators can analyze the same data twice in 2 different papers and get the opposite conclusion, using different reasonable, appropriate methods. They know this. They have methods for dealing with it.
It also is not cool the way the government went after him. I mean he recently outted himself as a racist asshole, but we do need to remember the big picture here which IMO is more important than the fact that he is an asshole. Check out this article from wired I found today - http://www.wired.com/2014/10/u...
Miranda, the guy who gave us the Supreme Court decision that you have the right to an employer when the cops interrogate you, was a confessed rapist. A lot of cases that establish our rights were defending not-very-nice guys.
Pakistan and India have been hostile since they first were separated from each other, but they're not so different!! Surely this gesture will make them realize this and they'll have no choice but to bury the hatchet, that's just how human psychology works.
Actually there is good scientific evidence for that.
http://www.sciencemag.org/site... Human Conflict Why We Fight—In this special issue we consider the deep evolutionary roots of violent confrontation. We trace the trajectory of violence and war throughout history, exploring racism, ethnic conflicts, the rise of terrorism, and the possible future of armed conflicts.
tldr; Human conflict and mass exterminations are constants that have been going on for as long as we have historical or anthropological records. Reconciliation is just as much of a constant. Human populations fight and make peace.
To illustrate, let's assume that Africans are terrible at running medical facilities and experience a 75% transmission rate per week: 3/4 of their healthcare providers in Ebola treatment facilities contract ebola EVERY WEEK. European facilities with similar load experience a 1% transmission rate. If your drug is 50% effective, you should immediately see a 37.5% drop in Ebola transmission in African facilities; in European facilities, you'll see a 0.5% drop.
Your assumptions are all wrong.
First, there is no ethics committee in the world that would allow western scientists to go to African clinics to perform such an experiment and not give them help in cutting their Ebola transmission. You're describing the Tuskegee syphilis study. Gowns, gloves and standard procedures would reduce transmission more than a vaccine.
Second, people used to do studies like you describe and they didn't produce reliable results. Drug companies used to do studies like that and still do. By chance, sometimes they give correct results, but sometimes they don't. When doctors do randomized, controlled trials they get different results. You can read that just about every week in NEJM or Lancet. This happens regularly with cancer drugs. Usually, a drug company is trying to (illegally) promote a drug for off-label use, as Genentech did with Avastin for metastatic breast cancer. When they finally had to do a RCT it didn't work.
I don't care how smart you are. Science is based on empirical results. People tried it your way and it didn't work. They got the wrong results. If you want to insist you're right in the face of a documented history of failure, I can't help you. Find somebody who does clinical trials and ask him to explain it.
Yeah, I knew that. I heard Lester Grinspoon give a lecture in which he talked about Carl Sagan smoking pot. It might have been in 1996. http://motherboard.vice.com/bl...
Funny thing is, I went to Colorado this March for a medical conference which actually had a panel on marijuana. Denver is a great place, finally pot is legal, people were offering me grass, and I couldn't smoke any because I had to work.
Useful tip: Leela's European Cafe is a great bar.
Another useful tip: The Colorado newspapers checked and no one has ever been arrested in Denver airport for trying to bring pot home, airport screening notwithstanding.
Yeah, I knew that. I heard Lester Grinspoon give a lecture in which he talked about Carl Sagan smoking pot. It might have been in 1996. http://motherboard.vice.com/bl...
Funny thing is, I went to Colorado this March for a medical conference which actually had a panel on marijuana. Denver is a great place, finally pot is legal, people were offering me grass, and I couldn't smoke any because I had to work.
Useful tip: Leela's European Cafe is a great bar.
Another useful tip: The Colorado newspapers checked and no one has ever been arrested in Denver airport for trying to bring pot home, airport screening notwithstanding.
Not true. First off, we DO NOT KNOW if these treatments will work.
We have reason to believe the treatment will work. We also have reason to believe they're safer than death (we have reason to believe they're reasonably harmless in their own right, but that's extreme compared to the benchmark of preventing death). Thus your statement is both misleading (not entirely inaccurate) and irrelevant.
Personally, I could accept giving drugs from Phase II trials to informed patients if the only costs were the financial costs, and the risks of adverse effects. But the real danger is that the medical community goes off in all different directions, without a strategy, and winds up with data that doesn't give them the information they need.
It's moot, because the costs to a drug company of giving individualized premarket drugs to patients is enormous, and they don't usually have drugs available for compassionate use anyway. They need their drugs for clinical trials.
Not true. That's the point -- more statistical data is useless if you're not collecting it in a way that will give you an answer. The only way to get an answer is with a randomized, controlled trial. Animals aren't humans.
I see you've done no real statistics or explored any real science.
Well, gee, I read half a dozen clinical studies in the major medical journals every week and write reports on them. My boss seems to think I understand them OK. And I go to conferences where I meet the investigators and talk to them, to make sure I got it right.
If, like them, you have a PhD or MD and work in drug development, I'll give your opinions appropriate weight. Although I think it's commendable when a layman tries to learn more about medicine and science.
Many mechanisms of actions for many modern drugs are explained by animal models. For example: anything that affects brain chemistry is explained by experimentation on rats. We know exercise and noopept (nootropic drug) both improve learning dramatically by increasing BNF and BDNF levels in the brain--because we tried this with rats (run on a wheel, then run a maze; compare to a lazy rat, and the exercised ones learn twice as fast, consistently) and then cut their heads open to see what was going on in their brains (this is fatal). Anti-depressants, SSRIs, NDRIs, and other drugs that modify your brain chemistry directly are known to work in those specific ways by animal model--nobody actually checked an actual human, ever.
The people who do actual drug development tell me it doesn't work that way.
http://www.sciencemag.org/cont... Science 18 July 2014: Vol. 345 no. 6194 pp. 252-257 DOI: 10.1126/science.345.6194.252 The elusive heart fix Jennifer Couzin-Frankel “In mouse studies there's always dramatic improvement,” says Joseph Wu, a cardiologist studying stem cells at Stanford University in Palo Alto, California. “Once you go to a large animal study, it's moderate improvement, once you go to a phase I trial, it's decent improvement, and once you go to phase II, phase III, there's no improvement. This happens again and again and again. It's the entire field of biological research.”
And just in case you say, "Well, it works half the time" -- the database studies they do are much more thorough than anything they could do in west Africa, where they don't even have medical records or death certificates. They do these studies in places like Sweden, where they have detailed medical databases of every citizen from birth to death. We don't have data like this for west Africa.
And this is where you show you don't understand what you're talking about.
"It works half the time" is roughly chance. "It's wrong 99% of the time" is proced
Not true. First off, we DO NOT KNOW if these treatments will work.
Statistics works better if you gather lots of data. For HIV, cancer, and ebola, you can gather more statistical data over time even without doing direct controlled studies. You can also compare those to animal models. You can keep cracking on the problem of why and to what degree. In other words: you can better control the experiment in a future setting, and possibly reduce risk to humans.
Not true. That's the point -- more statistical data is useless if you're not collecting it in a way that will give you an answer. The only way to get an answer is with a randomized, controlled trial. Animals aren't humans.
I read the New England Journal of Medicine every week. Every week they have a randomized, controlled trial. Before they did the RCT, they did everything you describe and more to try to see if the treatment would work. They did big data studies. They did database studies. They did historical studies. Then they came up with an answer. Sometimes they came up with contradictory answers. The reason they did the RCT was to confirm the earlier studies, or to see which one of the contradictory studies works.
About half the time, the RCT confirms the previous studies. About half the time it proves the previous studies were wrong. There's no way to tell whether a treatment works without RCTs.
And just in case you say, "Well, it works half the time" -- the database studies they do are much more thorough than anything they could do in west Africa, where they don't even have medical records or death certificates. They do these studies in places like Sweden, where they have detailed medical databases of every citizen from birth to death. We don't have data like this for west Africa.
We've been through this many times over the last 90 years. (This was the plot of Sinclair Lewis' novel Arrowsmith.) Skipping the phase III RCT has failed and caused great damage repeatedly.
The last time, when we should have known better, was using hormone replacement therapy in postmenopausal women to prevent heart attacks, on the basis of the Nurses' Health Study. The nurses who took hormone replacement therapy had fewer heart attacks than the women who didn't, so the drug companies marketed them to women around the country.
When they finally did a RCT, they found out that the women who took hormone replacement therapy had more heart attacks, and more breast cancer. In fact, hormone replacement therapy caused an epidemic of breast cancer in the U.S.
It turned out that the nurses who took hormone replacement therapy were different from the nurses who didn't -- they were more concerned about their health, so they exercised more, controlled their weight more -- and took hormone replacement therapy, because they thought it might be healthy.
The only objective is to keep them from dying, and we already know the death rate of ebola through empirical observation, so we don't need a control group.
What's the death rate through empirical observation?
According to John Dean, Nixon's former White House counsel, the purpose of the Republican "Southern strategy" was for the Republicans to replace the Democrats by appealing to racism, among other things. They seem to have succeeded. A lot of the old racist southern Democratic politicians became Republicans.
I too would like to see firearms laws based on evidence. However, the NRA killed the government funding for science-based research, and there wasn't much private research to fill in the gap. A whole generation of scientists and criminologists didn't make a career out of firearms research, because there was no funding for it. I'm not sure it makes any difference, because the decisions will probably made on the basis of politics, not science, in any case.
http://www.nytimes.com/2011/01... N.R.A. Stymies Firearms Research, Scientists Say By MICHAEL LUO Published: January 25, 2011 The dearth of money can be traced in large measure to a clash between public health scientists and the N.R.A. in the mid-1990s. At the time, Dr. Rosenberg and others at the C.D.C. were becoming increasingly assertive about the importance of studying gun-related injuries and deaths as a public health phenomenon, financing studies that found, for example, having a gun in the house, rather than conferring protection, significantly increased the risk of homicide by a family member or intimate acquaintance. Alarmed, the N.R.A. and its allies on Capitol Hill fought back. The injury center was guilty of “putting out papers that were really political opinion masquerading as medical science,” said Mr. Cox, who also worked on this issue for the N.R.A. more than a decade ago. Initially, pro-gun lawmakers sought to eliminate the injury center completely, arguing that its work was “redundant” and reflected a political agenda. When that failed, they turned to the appropriations process. In 1996, Representative Jay Dickey, Republican of Arkansas, succeeded in pushing through an amendment that stripped $2.6 million from the
The point of the New Yorker article is that, contrary to Antique Geekmeister, there were many laws in the U.S. during the 19th century regulating the possession of handguns, up to and including allowing towns to ban their possession entirely within their borders.
And even the NRA supported the regulation of firearms, at least up to and beyond 1957.
The earliest "gun control laws" were applied by Imperial governments to colonists, to control a growing civilian population with a remotely managed and badly outnumbered Imperial military in _every_ nation's colonies. Then there was a long gap, due to the War for Independence and the 2nd Amendment, then it started up as a US federal policy in the 1930's applied to machine guns and sawed off shotguns. It grew in the 1960's _due to the assassination of John F. Kennedy and Martin Luther King_, which illustrated the growing risk of assassination for respected leaders.
As Adam Winkler, a constitutional-law scholar at U.C.L.A., demonstrates in a remarkably nuanced new book, “Gunfight: The Battle Over the Right to Bear Arms in America,” firearms have been regulated in the United States from the start. Laws banning the carrying of concealed weapons were passed in Kentucky and Louisiana in 1813, and other states soon followed: Indiana (1820), Tennessee and Virginia (1838), Alabama (1839), and Ohio (1859). Similar laws were passed in Texas, Florida, and Oklahoma. As the governor of Texas explained in 1893, the “mission of the concealed deadly weapon is murder. To check it is the duty of every self-respecting, law-abiding man.”
Although these laws were occasionally challenged, they were rarely struck down in state courts; the state’s interest in regulating the manufacture, ownership, and storage of firearms was plain enough. Even the West was hardly wild. “Frontier towns handled guns the way a Boston restaurant today handles overcoats in winter,” Winkler writes. “New arrivals were required to turn in their guns to authorities in exchange for something like a metal token.” In Wichita, Kansas, in 1873, a sign read, “Leave Your Revolvers at Police Headquarters, and Get a Check.” The first thing the government of Dodge did when founding the city, in 1873, was pass a resolution that “any person or persons found carrying concealed weapons in the city of Dodge or violating the laws of the State shall be dealt with according to law.” On the road through town, a wooden billboard read, “The Carrying of Firearms Strictly Prohibited.” The shoot-out at the O.K. Corral, in Tombstone, Arizona, Winkler explains, had to do with a gun-control law. In 1880, Tombstone’s city council passed an ordinance “to Provide against the Carrying of Deadly Weapons.” When Wyatt Earp confronted Tom McLaury on the streets of Tombstone, it was because McLaury had violated that ordinance by failing to leave his gun at the sheriff’s office.
The National Rifle Association was founded in 1871 by two men, a lawyer and a former reporter from the New York Times. For most of its history, the N.R.A. was chiefly a sporting and hunting association. To the extent that the N.R.A. had a political arm, it opposed some gun-control measures and supported many others, lobbying for new state laws in the nineteen-twenties and thirties, which introduced waiting periods for handgun buyers and required permits for anyone wishing to carry a concealed weapon. It also supported the 1934 National Firearms Act—the first major federal gun-control legislation—and the 1938 Federal Firearms Act, which together created a licensing system for dealers and prohibitively taxed the private ownership of automatic weapons (“machine guns”). The constitutionality of the 1934 act was upheld by the U.S. Supreme Court in 1939, in U.S. v. Miller, in which Franklin Delano Roosevelt’s solicitor general, Robert H. Jackson, argued that the Second Amendment is “restricted to the keeping and bearing of arms by the people collectively for their common defense and security.” Furthermore, Ja
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from the commentary linked in the summary:
"Single-payer." Like the VA. Because unaccountable, lying government officials and patients dying while on fake waiting lists are exactly what we need during an ebola epidemic.
I have read studies published by the VA on the outcomes of people treated at different VA hospitals for conditions like prostate cancer colorectal cancer, and I've talked to VA doctors. The VA has some of the best outcomes in the world. They did some of the major studies in cardiology to find out what works and what doesn't work, and every cardiologist in the world follows the recommendations of the VA studies. If I had cancer or a heart attack, I would be confident in any major VA hospital. (Although like all health care providers, they do have problems in rural areas.)
The reason they had that problem with waiting list fraud (which is unexcusable) is that their managers gave them politically-mandated targets for appointments, without giving them the money that they needed to hire more doctors to meet those targets. (Would you have predicted any problems with that?) That's what corporate-style management by financial incentives gets you. Now they're giving them more money to hire doctors.
But it doesn't affect their main purpose, which is to save the lives and health of veterans, many of whom have service-related injuries. In rehabilitation medicine, they've been doing a great job since at least WWII. I know a lot of veterans in their 70s and 80s who go to the VA and are very happy with it. You're seeing a doctor who is on salary and trying to treat you with the best possible medicine, not a doctor who gets 10 minutes to see you and gets paid for the procedures he does on you, even if they do more harm than good.
And Obamacare. Because of Obamacare I can not afford medical care. My premiums are about 3x before Obamacare. My deductible is $5,000.00. I am taxed $300.00/month on my health insurance because I am employed at a small company which can not purchase the plan directly from an insurer. (Obamacare revokes the tax exemption for employer-subsidized health insurance.) I am buying the least-expensive plan mandated by Obamacare to avoid the penalty and paying about $1,300.00 per month in insurance and taxes. I had a shoulder injury, went to an in-network doctor and had to pay for the entire visit, treatment and the physical therapy myself.
To summarize, now, because of Obamacare, I am required by law to pay $1,300.00 per month for health insurance and taxes at a minimum and on top of that I have to pay for my own medical expenses. Because of Obamacare, unless I am absolutely certain that I am dying I will not be going anywhere near a health care provider. By both making the patients poorer with higher insurance premiums and by raising the cost of treatment with higher deductibles Obamacare has created a massive financial disincentive to seeing medical care during an epidemic. And then also there is the decreased access to health care because of shrinking provide networks.
In addition to advocating for evidently broken and corrupt systems, the author wants to re-write the Constitution. You know, that document which guarantees citizens rights. What could possibly go wrong?
I am no fan of Obama or Obamacare, which was designed on a Republican model (Romneycare) and on a proposal put out by the Heritage Foundation, which now denies it.
And how do you like those free-market insurance company bureaucracies? Good thing you don't have to deal with government bureaucracies like Medicare.
The big problem with Obamacare is that, instead of expanding Medicare, as the progressives wanted, it gives the insurance companies about 30% of your health care premium, and that's the main reason why i
then you have a problem and you need to go through and re-think your entire worldview, starting from base principles. Either that, or We The People need to introduce you dictatorial fuckheads to hemp rope and cottonwood trees.
You never recited the Pledge of Allegiance, did you?
Without a top-down bureaucracy calling the shops, states can try 50 different methods to control the pandemic, and compare results to see who has the best one. They're not stuck mindlessly doing what Washington has dictated, even if it's wrong.
The CDC is swearing up and down Ebola can be transmitted by airborne infection, but what if they're wrong about this strain?
The federal government is much more likely than the states to continue a wrong course of action long after it's been proven a bad idea than the states. See also: Welfare, agribusiness subsidies, the food pyramid...
People who do these things for a living in real life would disagree with you.
By the time you try 50 different methods and compare the results, the epidemic will be all over (or out of control, depending on your luck). Why don't we disband Homeland Security and let 50 states deal with the terrorists in their own way?
If you have a mysterious disease spreading across the country, such as the spinal infections caused by the contaminated injections distributed by the New England Compounding Center last year, it's a lot harder for a state agency to figure out what's going on from 2 or 3 cases than it is for the CDC to figure out what's going on from 2-300 cases. And it turned out that the NECC was regulated by the states, not the federal government. After the disaster, everybody involved decided that maybe the federal government should have a little more oversight in this matter.
But even if you were right, unfortunately the (Republican, tax-cutting) states have been disbanding the very state health agencies that did such good reporting work on the New England Compounding Center disaster. I remember years ago California had a great occupational safety and health department, which was identifying how workers were dying and figuring out ways to stop it. They found that the major cause of electrocutions were (1) boom trucks hitting overhead wires, which could be prevented by just warning drivers about the hazard, and (2) short circuits in power tools, which could be prevented with a 25-cent ground fault interrupter. CAL OSHA was disbanded by Ronald Reagan.
And then there was the NIH grant to study why gay men are often thin and lesbians are often obese.
Why is this a problem? Research should always be done, however ridiculous your hypothesis may be. The freedom to do such insane research is what has made USA the leader of all sciences.
You mean "insane-appearing research." Some of the most important medical research looked insane, especially to the uninformed. Medical insurance is like going to the racetrack, with very good odds.
For example, a marine scientist studying sea sponges discovered Adriamycin, which was one of the first drugs that cured cancer, and formed the basis of all of our cancer drugs.
Of course these right-wing Congressmen would have a field day with that. Our government money going to study Spongebob.
It's not a local responsibility any more. According to the New England Journal of Medicine, the states are cutting back. Those state health departments that tracked the contaminated steroid injections from the New England Compounding Center, which killed about 100 people, were in the process of being disbanded. So if it happened again, we'd have people dying of a mysteriously transmitted disease and we wouldn't be able to figure it out.
Realize that when people start getting sick, you don't necessarily know whether an infectious disease is causing it, or whether it's an environmental factor like arsenic in the drinking water.
One of the core problems today is that the CDC has lost focus [usatoday.com] , and instead of controlling infectious disease, they spend money things like playground safety, workplace accidents, guns, and birth defects. And then there was the NIH grant to study why gay men are often thin and lesbians are often obese. [newsmax.com]
We don't need to change the Constitution, just the spending and research priorities of a bunch of bureaucracies.
Who says? Some right-winger who doesn't know anything about public health and has never been responsible for saving the life of a dying child, in an editorial that only gets one side of the story?
The CDC is setting its priorities according to the morbidity and mortality of the causes of illness, which is a rational way to do it.
Since there are about 4-5,000 workplace fatalities a year, virtually all of them preventable, that's a good return for the money.
There are about 30,000 firearms deaths a year, and when Congress, after NRA lobbying, cancelled the CDC's firearms research 15 years ago, nobody else did scientific research.
So if CDC doesn't do this stuff, nobody will. Particularly not the states, which are cutting back their local health departments.
I'm speaking as someone who has talked with CDC scientists, and read their MMWR regularly, so I know what they do.
What do you know about the CDC, besides what you get from anti-government opinion pieces?
And hospitals are already on the hook for uninsured patients due to the EMTALA laws.
No, the article said:
The Emergency Medical Treatment and Labor Act (EMTALA) of 1986 was enacted to prevent hospitals from refusing care to anyone needing urgent care and presenting at a hospital’s emergency room, regardless of insurance status. Unfortunately, EMTALA has sometimes been viewed as a mandate not funded by the federal government, and violations occur without reprisals or corrective actions.
It's even worse in Texas. They refused to implement Obamacare, fought it, and kicked people out of Medicaid. I think MedPage Today's KevinMD had a blog entry by a doctor at one of the charity clinics who said that the hospitals were referring uninsured people to them (after the hospitals kicked them out) even though the clinic didn't even have an x-ray machine.
Texas is a good example of the Republican health care plan -- you get sick, you die. http://online.wsj.com/articles... Legal Loophole Ensnares Breast-Cancer Patients; Shirley Loewe Chooses The Wrong Clinic And Starts Long Ordeal
Texas didn't enact the Affordable Care Act, and they have (I think) the lowest rate of people with health insurance in the country. Adam Smith, in Wealth of Nations, said that it was a government responsibility to provide for health care. Wealth of Nations was published in 1776, so those ideas were around when the Constitution was written. You don't need the germ theory of disease to see that diseases spread. I don't know where free market types get the idea that people who can't pay for health insurance should be left to suffer; maybe from Milton Friedman or Ayn Rand. Or Thomas Malthus.
The article http://thebulletin.org/who%E2%... said
If the first question asked in most American emergency rooms concerns insurance status, the uninsured and illegal aliens will likely continue to delay seeking treatment....
Policy makers should understand that having a large fraction of the US population uninsured poses a national security threat during deadly epidemics such as Ebola. If changing to a single-payer national system is, for political reasons, out of the question, then, at the very least, the Affordable Care Act must be fully implemented in all states. In addition, as it now stands, the CDC must wait until a state invites it to conduct epidemiologic investigations, and national disease surveillance depends on states voluntarily submitting data. This is a ridiculous and dangerous state of medical affairs.
My advice: Don't use Solr. Don't use PCRd PDFs. Don't support full-text searching, because no one fucking uses it. We get thousands of searches against title, keywords, dates, and other meta shit every day in our internal application. The only full-text searches performed are by me when I'm testing shit.
Lawyers use it. Magazines use it. Lots of people use it.
Lawyers use it because they have to - there is no alternative to search shit short of hiring monkeys to manually type up mountains of old documents. Often, those monkeys would have to be legally privileged to look at the documents, so it's not something you can shunt off to cheap labor / Mechanical Turk. OCR sucks. Solr sucks. Mixing the two is a big ol' suck fest.
Magazines use it because... they're stupid? There's no need to OCR a massive backlog of shit. For old shit that may not be digital, you can go ahead and hire a monkey to type it in. You're still left with Solr sucking, but on top of that much of a magazine's content is so heavily formatted/styled/image-based that a Solr index would not suit it well.
If you NEED a fulltext index. there are plenty of alternatives, some mentioned by others in the comments on this article. I can only speak to OCR sucking, Solr's indexer sucking, and Solr's search giving me way too many things for it to be useful.
What are some fulltext indexed open-source alternatives to Solr?
I wrote a few stories about this. http://www.nasw.org/users/nbau...
The best search engine I've ever seen is PubMed http://www.ncbi.nlm.nih.gov/pu... They structure information better than anybody else. But it requires a librarian to look at every document and code it according to a fairly elaborate coding scheme, the MESH headings, which basically requires a degree in library science and a good medical education to do well.
My advice: Don't use Solr. Don't use PCRd PDFs. Don't support full-text searching, because no one fucking uses it. We get thousands of searches against title, keywords, dates, and other meta shit every day in our internal application. The only full-text searches performed are by me when I'm testing shit.
Lawyers use it. Magazines use it. Lots of people use it.
I just read this in Science, with regard to using animal studies as the basis of human treatment:
The littlest patient; cutting-edge mouse models fuel hope for understanding and treating cancer
By Jenniver Couzin-Frankel
Science
3 October 2014
"About 90% of cancer drugs that enter clinical trials based on upbeat mouse data fail."
"Dozens if not hundreds of drugs have subdued cancer in these mice. A handful have done the same for people."
(The article describes how a drug company had been running a clinical trial in 122 people with advanced pancreatic cancer, who were getting a drug that was successful in mice. The human patients were dying more quickly on the new drug.)
You sound like somebody who knows statistics, but doesn't have much practical experience in applying statistics to real-world medical studies, as opposed to the examples they use in statistics textbooks.
Real-world medical statistics is fairly complicated. A recent article in JAMA explained how the same investigators can analyze the same data twice in 2 different papers and get the opposite conclusion, using different reasonable, appropriate methods. They know this. They have methods for dealing with it.
And yes, I know about Simpson's paradox.
It also is not cool the way the government went after him. I mean he recently outted himself as a racist asshole, but we do need to remember the big picture here which IMO is more important than the fact that he is an asshole. Check out this article from wired I found today - http://www.wired.com/2014/10/u...
Miranda, the guy who gave us the Supreme Court decision that you have the right to an employer when the cops interrogate you, was a confessed rapist. A lot of cases that establish our rights were defending not-very-nice guys.
Pakistan and India have been hostile since they first were separated from each other, but they're not so different!! Surely this gesture will make them realize this and they'll have no choice but to bury the hatchet, that's just how human psychology works.
Actually there is good scientific evidence for that.
http://www.sciencemag.org/site...
Human Conflict
Why We Fight—In this special issue we consider the deep evolutionary roots of violent confrontation. We trace the trajectory of violence and war throughout history, exploring racism, ethnic conflicts, the rise of terrorism, and the possible future of armed conflicts.
tldr; Human conflict and mass exterminations are constants that have been going on for as long as we have historical or anthropological records. Reconciliation is just as much of a constant. Human populations fight and make peace.
To illustrate, let's assume that Africans are terrible at running medical facilities and experience a 75% transmission rate per week: 3/4 of their healthcare providers in Ebola treatment facilities contract ebola EVERY WEEK. European facilities with similar load experience a 1% transmission rate. If your drug is 50% effective, you should immediately see a 37.5% drop in Ebola transmission in African facilities; in European facilities, you'll see a 0.5% drop.
Your assumptions are all wrong.
First, there is no ethics committee in the world that would allow western scientists to go to African clinics to perform such an experiment and not give them help in cutting their Ebola transmission. You're describing the Tuskegee syphilis study. Gowns, gloves and standard procedures would reduce transmission more than a vaccine.
Second, people used to do studies like you describe and they didn't produce reliable results. Drug companies used to do studies like that and still do. By chance, sometimes they give correct results, but sometimes they don't. When doctors do randomized, controlled trials they get different results. You can read that just about every week in NEJM or Lancet. This happens regularly with cancer drugs. Usually, a drug company is trying to (illegally) promote a drug for off-label use, as Genentech did with Avastin for metastatic breast cancer. When they finally had to do a RCT it didn't work.
I don't care how smart you are. Science is based on empirical results. People tried it your way and it didn't work. They got the wrong results. If you want to insist you're right in the face of a documented history of failure, I can't help you. Find somebody who does clinical trials and ask him to explain it.
I dunno. Lots of association-or-causation questions there.
I read Nora Volkow's review article in NEJM. Here's a good article in MedPage Today commenting on it. http://www.medpagetoday.com/Ps...
Yeah, I knew that. I heard Lester Grinspoon give a lecture in which he talked about Carl Sagan smoking pot. It might have been in 1996.
http://motherboard.vice.com/bl...
Funny thing is, I went to Colorado this March for a medical conference which actually had a panel on marijuana. Denver is a great place, finally pot is legal, people were offering me grass, and I couldn't smoke any because I had to work.
Useful tip: Leela's European Cafe is a great bar.
Another useful tip: The Colorado newspapers checked and no one has ever been arrested in Denver airport for trying to bring pot home, airport screening notwithstanding.
Yeah, I knew that. I heard Lester Grinspoon give a lecture in which he talked about Carl Sagan smoking pot. It might have been in 1996.
http://motherboard.vice.com/bl...
Funny thing is, I went to Colorado this March for a medical conference which actually had a panel on marijuana. Denver is a great place, finally pot is legal, people were offering me grass, and I couldn't smoke any because I had to work.
Useful tip: Leela's European Cafe is a great bar.
Another useful tip: The Colorado newspapers checked and no one has ever been arrested in Denver airport for trying to bring pot home, airport screening notwithstanding.
Not true. First off, we DO NOT KNOW if these treatments will work.
We have reason to believe the treatment will work. We also have reason to believe they're safer than death (we have reason to believe they're reasonably harmless in their own right, but that's extreme compared to the benchmark of preventing death). Thus your statement is both misleading (not entirely inaccurate) and irrelevant.
Personally, I could accept giving drugs from Phase II trials to informed patients if the only costs were the financial costs, and the risks of adverse effects. But the real danger is that the medical community goes off in all different directions, without a strategy, and winds up with data that doesn't give them the information they need.
It's moot, because the costs to a drug company of giving individualized premarket drugs to patients is enormous, and they don't usually have drugs available for compassionate use anyway. They need their drugs for clinical trials.
Not true. That's the point -- more statistical data is useless if you're not collecting it in a way that will give you an answer. The only way to get an answer is with a randomized, controlled trial. Animals aren't humans.
I see you've done no real statistics or explored any real science.
Well, gee, I read half a dozen clinical studies in the major medical journals every week and write reports on them. My boss seems to think I understand them OK. And I go to conferences where I meet the investigators and talk to them, to make sure I got it right.
If, like them, you have a PhD or MD and work in drug development, I'll give your opinions appropriate weight. Although I think it's commendable when a layman tries to learn more about medicine and science.
Many mechanisms of actions for many modern drugs are explained by animal models. For example: anything that affects brain chemistry is explained by experimentation on rats. We know exercise and noopept (nootropic drug) both improve learning dramatically by increasing BNF and BDNF levels in the brain--because we tried this with rats (run on a wheel, then run a maze; compare to a lazy rat, and the exercised ones learn twice as fast, consistently) and then cut their heads open to see what was going on in their brains (this is fatal). Anti-depressants, SSRIs, NDRIs, and other drugs that modify your brain chemistry directly are known to work in those specific ways by animal model--nobody actually checked an actual human, ever.
The people who do actual drug development tell me it doesn't work that way.
http://www.sciencemag.org/cont...
Science 18 July 2014:
Vol. 345 no. 6194 pp. 252-257
DOI: 10.1126/science.345.6194.252
The elusive heart fix
Jennifer Couzin-Frankel
“In mouse studies there's always dramatic improvement,” says Joseph Wu, a cardiologist studying stem cells at Stanford University in Palo Alto, California. “Once you go to a large animal study, it's moderate improvement, once you go to a phase I trial, it's decent improvement, and once you go to phase II, phase III, there's no improvement. This happens again and again and again. It's the entire field of biological research.”
And just in case you say, "Well, it works half the time" -- the database studies they do are much more thorough than anything they could do in west Africa, where they don't even have medical records or death certificates. They do these studies in places like Sweden, where they have detailed medical databases of every citizen from birth to death. We don't have data like this for west Africa.
And this is where you show you don't understand what you're talking about.
"It works half the time" is roughly chance. "It's wrong 99% of the time" is proced
Not true. First off, we DO NOT KNOW if these treatments will work.
Statistics works better if you gather lots of data. For HIV, cancer, and ebola, you can gather more statistical data over time even without doing direct controlled studies. You can also compare those to animal models. You can keep cracking on the problem of why and to what degree. In other words: you can better control the experiment in a future setting, and possibly reduce risk to humans.
Not true. That's the point -- more statistical data is useless if you're not collecting it in a way that will give you an answer. The only way to get an answer is with a randomized, controlled trial. Animals aren't humans.
I read the New England Journal of Medicine every week. Every week they have a randomized, controlled trial. Before they did the RCT, they did everything you describe and more to try to see if the treatment would work. They did big data studies. They did database studies. They did historical studies. Then they came up with an answer. Sometimes they came up with contradictory answers. The reason they did the RCT was to confirm the earlier studies, or to see which one of the contradictory studies works.
About half the time, the RCT confirms the previous studies. About half the time it proves the previous studies were wrong. There's no way to tell whether a treatment works without RCTs.
And just in case you say, "Well, it works half the time" -- the database studies they do are much more thorough than anything they could do in west Africa, where they don't even have medical records or death certificates. They do these studies in places like Sweden, where they have detailed medical databases of every citizen from birth to death. We don't have data like this for west Africa.
We've been through this many times over the last 90 years. (This was the plot of Sinclair Lewis' novel Arrowsmith.) Skipping the phase III RCT has failed and caused great damage repeatedly.
The last time, when we should have known better, was using hormone replacement therapy in postmenopausal women to prevent heart attacks, on the basis of the Nurses' Health Study. The nurses who took hormone replacement therapy had fewer heart attacks than the women who didn't, so the drug companies marketed them to women around the country.
When they finally did a RCT, they found out that the women who took hormone replacement therapy had more heart attacks, and more breast cancer. In fact, hormone replacement therapy caused an epidemic of breast cancer in the U.S.
It turned out that the nurses who took hormone replacement therapy were different from the nurses who didn't -- they were more concerned about their health, so they exercised more, controlled their weight more -- and took hormone replacement therapy, because they thought it might be healthy.
The only objective is to keep them from dying, and we already know the death rate of ebola through empirical observation, so we don't need a control group.
What's the death rate through empirical observation?
According to John Dean, Nixon's former White House counsel, the purpose of the Republican "Southern strategy" was for the Republicans to replace the Democrats by appealing to racism, among other things. They seem to have succeeded. A lot of the old racist southern Democratic politicians became Republicans.
I too would like to see firearms laws based on evidence. However, the NRA killed the government funding for science-based research, and there wasn't much private research to fill in the gap. A whole generation of scientists and criminologists didn't make a career out of firearms research, because there was no funding for it. I'm not sure it makes any difference, because the decisions will probably made on the basis of politics, not science, in any case.
http://www.nytimes.com/2011/01...
N.R.A. Stymies Firearms Research, Scientists Say
By MICHAEL LUO
Published: January 25, 2011
The dearth of money can be traced in large measure to a clash between public health scientists and the N.R.A. in the mid-1990s. At the time, Dr. Rosenberg and others at the C.D.C. were becoming increasingly assertive about the importance of studying gun-related injuries and deaths as a public health phenomenon, financing studies that found, for example, having a gun in the house, rather than conferring protection, significantly increased the risk of homicide by a family member or intimate acquaintance.
Alarmed, the N.R.A. and its allies on Capitol Hill fought back. The injury center was guilty of “putting out papers that were really political opinion masquerading as medical science,” said Mr. Cox, who also worked on this issue for the N.R.A. more than a decade ago.
Initially, pro-gun lawmakers sought to eliminate the injury center completely, arguing that its work was “redundant” and reflected a political agenda. When that failed, they turned to the appropriations process. In 1996, Representative Jay Dickey, Republican of Arkansas, succeeded in pushing through an amendment that stripped $2.6 million from the
I don't know about U.S. v. Miller.
The point of the New Yorker article is that, contrary to Antique Geekmeister, there were many laws in the U.S. during the 19th century regulating the possession of handguns, up to and including allowing towns to ban their possession entirely within their borders.
And even the NRA supported the regulation of firearms, at least up to and beyond 1957.
The earliest "gun control laws" were applied by Imperial governments to colonists, to control a growing civilian population with a remotely managed and badly outnumbered Imperial military in _every_ nation's colonies. Then there was a long gap, due to the War for Independence and the 2nd Amendment, then it started up as a US federal policy in the 1930's applied to machine guns and sawed off shotguns. It grew in the 1960's _due to the assassination of John F. Kennedy and Martin Luther King_, which illustrated the growing risk of assassination for respected leaders.
Not quite.
http://www.newyorker.com/magaz...
April 23, 2012 Issue
Battleground America
One nation, under the gun.
By Jill Lepore
As Adam Winkler, a constitutional-law scholar at U.C.L.A., demonstrates in a remarkably nuanced new book, “Gunfight: The Battle Over the Right to Bear Arms in America,” firearms have been regulated in the United States from the start. Laws banning the carrying of concealed weapons were passed in Kentucky and Louisiana in 1813, and other states soon followed: Indiana (1820), Tennessee and Virginia (1838), Alabama (1839), and Ohio (1859). Similar laws were passed in Texas, Florida, and Oklahoma. As the governor of Texas explained in 1893, the “mission of the concealed deadly weapon is murder. To check it is the duty of every self-respecting, law-abiding man.”
Although these laws were occasionally challenged, they were rarely struck down in state courts; the state’s interest in regulating the manufacture, ownership, and storage of firearms was plain enough. Even the West was hardly wild. “Frontier towns handled guns the way a Boston restaurant today handles overcoats in winter,” Winkler writes. “New arrivals were required to turn in their guns to authorities in exchange for something like a metal token.” In Wichita, Kansas, in 1873, a sign read, “Leave Your Revolvers at Police Headquarters, and Get a Check.” The first thing the government of Dodge did when founding the city, in 1873, was pass a resolution that “any person or persons found carrying concealed weapons in the city of Dodge or violating the laws of the State shall be dealt with according to law.” On the road through town, a wooden billboard read, “The Carrying of Firearms Strictly Prohibited.” The shoot-out at the O.K. Corral, in Tombstone, Arizona, Winkler explains, had to do with a gun-control law. In 1880, Tombstone’s city council passed an ordinance “to Provide against the Carrying of Deadly Weapons.” When Wyatt Earp confronted Tom McLaury on the streets of Tombstone, it was because McLaury had violated that ordinance by failing to leave his gun at the sheriff’s office.
The National Rifle Association was founded in 1871 by two men, a lawyer and a former reporter from the New York Times. For most of its history, the N.R.A. was chiefly a sporting and hunting association. To the extent that the N.R.A. had a political arm, it opposed some gun-control measures and supported many others, lobbying for new state laws in the nineteen-twenties and thirties, which introduced waiting periods for handgun buyers and required permits for anyone wishing to carry a concealed weapon. It also supported the 1934 National Firearms Act—the first major federal gun-control legislation—and the 1938 Federal Firearms Act, which together created a licensing system for dealers and prohibitively taxed the private ownership of automatic weapons (“machine guns”). The constitutionality of the 1934 act was upheld by the U.S. Supreme Court in 1939, in U.S. v. Miller, in which Franklin Delano Roosevelt’s solicitor general, Robert H. Jackson, argued that the Second Amendment is “restricted to the keeping and bearing of arms by the people collectively for their common defense and security.” Furthermore, Ja