The problem with retroviruses is that while they are capable of inserting genes into DNA, they do so at random. If the insertion occurs in the vicinity of an oncogene, the retroviral treatment can actually result in a malignancy.
Phase III trials in this situation would assess the efficacy of this treatment relative to the current standard of care. The whole point of phase III is to figure out whether the drug is at least as effective as the current standard and, as you correctly state, it would be medically unethical to administer a placebo treatment to a cancer patient.
The fact is, and that I keep on bringing up in these discussions, is that most education is quite useless and a waste of time for most people. For example, most medical doctors are required to take "science" courses like biochemistry even though they don't plan on becoming biochemists. It's quite useless, but to those people who have passed the course they often rationalize its importance (sometimes with lame reasons like it helps push their competition outside of the bell curve).
FWIW, as someone in the middle of a medical education, I can tell you that while the vast majority of the stuff in basic science courses isn't particularly applicable, some of the basics are indeed very important. My chemistry and biology courses (to include biochem) allow me to understand why medications that are quaternary amines such as Pyridostigmine don't usually cross the blood-brain barrier, why certain medications exhibit different efficacy in various parts of the body due to pH differences, and why G protein-coupled receptors are both slower and diverse in their actions than ionotropic receptors. Our curriculum is based on the assumption that we already have a fundamental understanding of physics, biology, and chemistry, and thus can understand the principles underlying physiological and pharmacological actions. To put it another way, undergrad put a lot of stuff in my mental toolbox that I'll likely never need, but thus far I've always had the tool for the job given to me in my training.
cheers.
I've been saying for years that if they offered a sort of Science/Technology/Learning bundle (i.e. Discovery channels, Learning channels, History, Military), I'd sign up in a heartbeat. What I don't want to do is pay for MTV, ESPN, and a couple of hundred other channels in which I have no interest. Perhaps the cable industry will have to change a lifelong habit and start giving a damn about what their customers want?
More like med student prank. Holy crap. Wire up a set of bellows to inflate and deflate the lungs, and you've got a guaranteed lifetime of therapy for the victim.
All true. However the antibiotic usage in humans is vastly outweighed by the antibiotic usage in livestock. One of my med-school courses cited an instance in...Denmark, I believe it was. The annual human consumption of an antibiotic came to something like 25kg that year. Consumption of an analogous antibiotic in livestock for that same year was something on the order of 25,000kg.
Over-prescription of antibiotics for CYA or, more commonly, to patients who aren't satisfied until they've receive an antibiotic for their viral (sigh) infection is certainly a problem. Before we get too worked up over that, however, let's stop feeding the drugs to the damned cows, pigs, and chickens!
That is because if these vitamins are produced in a test tube, rather than by nature, they are NOT much good and indeed may be harmful.
See, this is the sort of post that irritates me. It's complete pseudoscience, with a large helping of truthiness. The idea that "natural" vitamins would be superior to artificially-made vitamins *feels* right to most people, so they accept this sort of drivel.
See, here's the scoop: form defines function at the molecular level. All that hand-waving about vitamins produced by nature being better is total crap, because a molecule is either vitamin C, or it isn't. Sure, you could conceivably create an analogue that mimics the form of vitamin C, but that would be a spectacularly difficult and expensive task.
People, vitamin C created artificially is *precisely* the same molecule as is found in, say, an Orange. Now, if you want to argue that an orange is a superior source because there's some fibre there too, I won't argue that. But these vague assertions about "natural" vitamins smacks of an agenda that fails the critical thinking test.
what effects are the ones you're not deficient in having on the way your body functions?
Likely none, as the body simply excretes the excess. The mega-doses of vitamin C are amusing, as the body doesn't actually retain any of it beyond its immediate needs. Fat-soluble vitamins are more problematic, however, and shouldn't be taken to excess.
If they are going to have breaks anyway, I wish they were a bit longer. It would give me time to get a snack.
Yes, if only they could develop a technology for Hulu that would allow people enough time to get snacks...to pause the action if you will. A button, perhaps.;)
This is a completely legitimate practice. After all, if we don't catch people holding up cans of beer at a party before they are admitted, why, they'll be doing it at colleges around the country next before you know it!
How much is PA/nursing school? - always heard that another reason for docs having a large salary is the med school bills
Well, PA school is a 2-year grad program, with each year running in the region of $55,000, so I imagine the average PA exits school with a little over $110,000 in graduate education debt. Med school, being a four-year program, tends to set students back about $250,000 or more, depending on the program.
The problem is that during residency (2-5 years post-med school for most specialties), physicians are earning $35,000 to $45,000 a year depending on the program (last I checked). New legislation is apparently removing the ability of residents to defer education loan payments, so you've got people who have been living on Ramen noodles for the last 10-12 years while in school having to listen to how horribly overpaid they are.
I seem to remember someone doing a breakdown of wages vs. hours worked for doctors in residency. It evidently came out to something rather less than minimum wage. I've got to tell you, after putting up with that for years, I won't be apologising for a six-figure income in my forties.
The problem with PAs and NPS (at least, from what I see as an outsider) is that the barriers to entry are still quite high, but not with a correspondingly high "payoff."
Doctors make obscene amounts of money, while those working below them seem to have a hard time just scraping by...
A popular perception, but let's see what the Bureau of Labor Statistics says.
Mean Annual earnings:
Family Physician: $137,119
Physician Assistant: $74,980
Registered Nurse: $57,280
Sure, the doctor makes more than the PA or RN, but not "obscene amounts" more, and arguably well within a range corresponding to a higher level of responsibility. I'll also argue that even the lowest wage on that list is hardly "scraping by".
To head off a possible counter-point, a surgeon makes significantly more on average ($282,504 with >1 yr experience) but also has a massively higher level of responsibility and liability. When PA's and nurses have similar responsibility and especially similar liability to physicians, then they should get similar pay. Until then, it's an apples-to-oranges comparison.
If we're going to cram you with a lot of facts, why not make it clinically relevant ones you actually have some hope of using to help someone?
Because then it wouldn't be undergrad, it'd be medical school? Joking aside, I'd agree that second-semester O-Chem might be better replaced with Biochemistry or Molecular Genetics. My understanding on O-Chem though is that it's a lot of science very quickly, hence its perceived value as a signifier in the black art of medical school candidate evaluation.
As someone who taught chemistry to nursing students for years an "army of trained nurses" is the scariest thing to me ever. Those dumb bunnies can not calculate percentage to save their lives, much less their patient's...
Personally, I believe that nurses and PAs should be in a role to support patients. Doctors should be there for their patients and not in a management capacity.
That would be ideal, but the logistics simply can't work. With the Boomers starting to stress the medical system, exacerbating the nightmarish problems caused by "managed" healthcare and a legal system that does as much harm as it does good, physicians are increasingly moving away from primary care. I absolutely agree with you that the problem stems from overwork, in addition to the other things. Even with medical schools increasing enrollment, there simply aren't enough doctors to serve the population. Unfortunately the same is true for nurses, the last I checked.
For what it's worth, I certainly decided on medicine because it's an intellectually demanding career with a very real impact on the lives of others. But I also realise that my particular value lies in the application of my intellect and/or skill in the service of relieving the suffering of others.
I will best achieve this, I believe, by allowing nurses and PA's to give shots, perform basic procedures, and so on. While this is perhaps an "overseer" position in a sense, it's an efficient use of my time that will allow me to create the greatest good for the most people. The downside is that it sabotages the intimacy that used to lie at the heart of the doctor-patient relationship. I don't have a good answer for that, unfortunately, except that perhaps all physicians must find their own balance of quantity vs. quality in the medical care of their patients.
Actually, what you need are more mid-level providers. Physician Assistants, Nurse Practitioners, and the like are probably the future of front-line medical care, while doctors will provide an increasingly overseer role. Hell, as a future doc, I'm not particularly happy about that, but it's the reality. I'd rather see fewer but better doctors surrounded by an army of trained nurses and PAs, than the converse.
Speaking as a current medical student, I absolutely think that Organic Chemistry is an appropriate pre-med subject. While the material covered isn't particularly useful beyond establishing a solid basis for understanding the chemistry of biochemical pathways, the value of O-Chem is that it's usually the first time an undergrad student is hit by a tidal-wave of information. O-Chem, just like a lot of the stuff in med school, isn't necessarily difficult stuff; the challenge lies in assimilating information and understanding relationships at a high rate.
O-Chem was an excellent primer for the drinking-from-a-firehose atmosphere of medicals school, as well as a good tool to test scientific critical thinking on the MCAT.
Well, I guess even if I could see it in something like the Tesla...but, I could never seen an electric motorcycle replacing the real thing....I mean, half the fun of the bike IS the sound, the rumbling...and even the smell of oil and gas, etc...
Clearly you ride a Harley.;)
As a sport-biker, if my bike is rumbling, or I smell oil/gas, I'm taking the damned thing to the shop! For me, the fun of a bike is the maneuverability, visceral sense of speed, and 0-60 takeoffs that leave everyone in my rearviews. If I can get that sort of performance from an electric sportbike, I'd switch in a heartbeat.
Bought a Buffalo router and flashed it with DD-WRT. The only time the thing reset was when the power went out. If you're restarting your router every few days, I'd suggest looking into your config for the problem.
Ridiculous standard of perfection? I agree. But does that mean there are no consequences for mistakes? Not at all! It's interesting that there are many people (not implying that you are one of them) who seem hold a false dichotomy in their head of no responsibility vs. full-on litigation. In the tragic instance you describe, that was a screw-up bordering on malpractice (IMO), with my definition of malpractice being that the "reasonable person" doctrine would have said that the doctor/nurse failed to check the chemical appropriately. In this instance, clear harm occurred and I certainly believe that it should be made right as far as possible. Whether "making it right" would involve a monetary payout, cosmetic surgery to remove the scarring, or some combination thereof is beyond the scope of our discussion. However, the bottom line here is that clear harm was done and should be made right.
My problem is with people who aren't satisfied with making it right, preferring instead to use litigation as a sort of medical lottery number, hoping for the big payout. Expecting to be dealt with honourably after a mistake is absolutely right, but I suspect a number of folks suddenly see dollar signs when a doctor tells them that a mistake has been made. Still, I think we're actually in quite close agreement here.
Fair enough. But what I'm arguing is that we hold doctors to an inhuman level of perfection. To demand of doctors their very best and most conscientious efforts when we entrust ourselves to them is entirely reasonable. It is not reasonable, however, to expect them to perform flawlessly. Personally, I'd much prefer that my doctor be upfront about making a mistake, what it meant, and how they were going to try to fix it, than to beat around the bush in an effort to avoid giving me fodder for litigation.
It also occurs to me that likely more than one life has been screwed up as a result of being on the wrong end of a bungled court proceeding. While lawyers certainly don't operate (ha!) at the same level as surgeons, they can certainly have a deleterious effect on the life of their client!
One of the interesting points of the book was that there is very little scientific study on medical errors and how to best avoid them. Of course there isn't a lot of study, because the ever-more litigious state of modern medicine has created an atmosphere in which a physician/surgeon cannot say "I screwed up, let's learn from this" for fear of being sued into oblivion. While I certainly acknowledge that doctors should be accountable for true malpractice, we hold them to a standard of perfection that would be considered absolutely ridiculous in any other field. Here's a thought: how about no lawyer is allowed to file suit against a physician (on behalf of a patient) unless that lawyer has never screwed up a piece of paperwork. Alternatively, we could create a climate in which lawyers can be sued by their clients for the "pain and suffering" of losing a court case if the lawyer didn't pursue absolutely every available avenue, even the ones with a very poor likelihood of success.
See how completely unreasonable that would be? I should be clear that I'm not bagging on lawyers here, but using them as an example of how another profession might be held to ridiculous standards of perfection. M&M conferences would be a far more effective learning tool if there was no sense of blame, and doctors could freely help their colleagues learn from prior mistakes.
It just makes me angry that some doctors spout that they are people of science when they are never really trained in the scientific method or really understand what that means. Interesting. You're postulating that the General and Organic Chemistry, Biology, and Physics (not to mention some schools requiring Biochemistry, Genetics, and Microbiology) requirements for medical school admissions don't cover the Scientific Method? That the majority of medical school applicants have hard-science degrees but don't understand what the Scientific Method means? That the MCAT isn't a rigorous test of scientific (and other) reasoning? That the MD/PhD researchers don't understand science?
Here's a thought: maybe the human body is fantastically fucking complicated and the intersection of science and humanity is the spot at which a lot of science falls flat on its face. Perhaps many doctors would love to have scientifically "proven" explanations for crap that happens in the human body, but the reality is that medical science is still very much in its infancy and we just don't know how a lot of stuff works yet. There are a hell of a lot of doctors who wade through shamans, faith healers, spiritualists, and other CAM crap in order to fly the flag for evidence-based medicine and yes, these doctors are indeed "people of science".
Slashdot Mirror
The problem with retroviruses is that while they are capable of inserting genes into DNA, they do so at random. If the insertion occurs in the vicinity of an oncogene, the retroviral treatment can actually result in a malignancy.
Phase III trials in this situation would assess the efficacy of this treatment relative to the current standard of care. The whole point of phase III is to figure out whether the drug is at least as effective as the current standard and, as you correctly state, it would be medically unethical to administer a placebo treatment to a cancer patient.
The fact is, and that I keep on bringing up in these discussions, is that most education is quite useless and a waste of time for most people. For example, most medical doctors are required to take "science" courses like biochemistry even though they don't plan on becoming biochemists. It's quite useless, but to those people who have passed the course they often rationalize its importance (sometimes with lame reasons like it helps push their competition outside of the bell curve).
FWIW, as someone in the middle of a medical education, I can tell you that while the vast majority of the stuff in basic science courses isn't particularly applicable, some of the basics are indeed very important. My chemistry and biology courses (to include biochem) allow me to understand why medications that are quaternary amines such as Pyridostigmine don't usually cross the blood-brain barrier, why certain medications exhibit different efficacy in various parts of the body due to pH differences, and why G protein-coupled receptors are both slower and diverse in their actions than ionotropic receptors. Our curriculum is based on the assumption that we already have a fundamental understanding of physics, biology, and chemistry, and thus can understand the principles underlying physiological and pharmacological actions. To put it another way, undergrad put a lot of stuff in my mental toolbox that I'll likely never need, but thus far I've always had the tool for the job given to me in my training. cheers.
I've been saying for years that if they offered a sort of Science/Technology/Learning bundle (i.e. Discovery channels, Learning channels, History, Military), I'd sign up in a heartbeat. What I don't want to do is pay for MTV, ESPN, and a couple of hundred other channels in which I have no interest. Perhaps the cable industry will have to change a lifelong habit and start giving a damn about what their customers want?
More like med student prank. Holy crap. Wire up a set of bellows to inflate and deflate the lungs, and you've got a guaranteed lifetime of therapy for the victim.
All true. However the antibiotic usage in humans is vastly outweighed by the antibiotic usage in livestock. One of my med-school courses cited an instance in...Denmark, I believe it was. The annual human consumption of an antibiotic came to something like 25kg that year. Consumption of an analogous antibiotic in livestock for that same year was something on the order of 25,000kg. Over-prescription of antibiotics for CYA or, more commonly, to patients who aren't satisfied until they've receive an antibiotic for their viral (sigh) infection is certainly a problem. Before we get too worked up over that, however, let's stop feeding the drugs to the damned cows, pigs, and chickens!
That is because if these vitamins are produced in a test tube, rather than by nature, they are NOT much good and indeed may be harmful.
See, this is the sort of post that irritates me. It's complete pseudoscience, with a large helping of truthiness. The idea that "natural" vitamins would be superior to artificially-made vitamins *feels* right to most people, so they accept this sort of drivel. See, here's the scoop: form defines function at the molecular level. All that hand-waving about vitamins produced by nature being better is total crap, because a molecule is either vitamin C, or it isn't. Sure, you could conceivably create an analogue that mimics the form of vitamin C, but that would be a spectacularly difficult and expensive task. People, vitamin C created artificially is *precisely* the same molecule as is found in, say, an Orange. Now, if you want to argue that an orange is a superior source because there's some fibre there too, I won't argue that. But these vague assertions about "natural" vitamins smacks of an agenda that fails the critical thinking test.
what effects are the ones you're not deficient in having on the way your body functions?
Likely none, as the body simply excretes the excess. The mega-doses of vitamin C are amusing, as the body doesn't actually retain any of it beyond its immediate needs. Fat-soluble vitamins are more problematic, however, and shouldn't be taken to excess.
If they are going to have breaks anyway, I wish they were a bit longer. It would give me time to get a snack.
Yes, if only they could develop a technology for Hulu that would allow people enough time to get snacks...to pause the action if you will. A button, perhaps. ;)
This is a completely legitimate practice. After all, if we don't catch people holding up cans of beer at a party before they are admitted, why, they'll be doing it at colleges around the country next before you know it!
How much is PA/nursing school? - always heard that another reason for docs having a large salary is the med school bills
Well, PA school is a 2-year grad program, with each year running in the region of $55,000, so I imagine the average PA exits school with a little over $110,000 in graduate education debt. Med school, being a four-year program, tends to set students back about $250,000 or more, depending on the program.
The problem is that during residency (2-5 years post-med school for most specialties), physicians are earning $35,000 to $45,000 a year depending on the program (last I checked). New legislation is apparently removing the ability of residents to defer education loan payments, so you've got people who have been living on Ramen noodles for the last 10-12 years while in school having to listen to how horribly overpaid they are.
I seem to remember someone doing a breakdown of wages vs. hours worked for doctors in residency. It evidently came out to something rather less than minimum wage. I've got to tell you, after putting up with that for years, I won't be apologising for a six-figure income in my forties.
The problem with PAs and NPS (at least, from what I see as an outsider) is that the barriers to entry are still quite high, but not with a correspondingly high "payoff."
Doctors make obscene amounts of money, while those working below them seem to have a hard time just scraping by...
A popular perception, but let's see what the Bureau of Labor Statistics says. Mean Annual earnings:
Family Physician: $137,119
Physician Assistant: $74,980
Registered Nurse: $57,280
Sure, the doctor makes more than the PA or RN, but not "obscene amounts" more, and arguably well within a range corresponding to a higher level of responsibility. I'll also argue that even the lowest wage on that list is hardly "scraping by".
To head off a possible counter-point, a surgeon makes significantly more on average ($282,504 with >1 yr experience) but also has a massively higher level of responsibility and liability. When PA's and nurses have similar responsibility and especially similar liability to physicians, then they should get similar pay. Until then, it's an apples-to-oranges comparison.
If we're going to cram you with a lot of facts, why not make it clinically relevant ones you actually have some hope of using to help someone?
Because then it wouldn't be undergrad, it'd be medical school? Joking aside, I'd agree that second-semester O-Chem might be better replaced with Biochemistry or Molecular Genetics. My understanding on O-Chem though is that it's a lot of science very quickly, hence its perceived value as a signifier in the black art of medical school candidate evaluation.
As someone who taught chemistry to nursing students for years an "army of trained nurses" is the scariest thing to me ever. Those dumb bunnies can not calculate percentage to save their lives, much less their patient's...
You stop talking about my dates that way!
Personally, I believe that nurses and PAs should be in a role to support patients. Doctors should be there for their patients and not in a management capacity.
That would be ideal, but the logistics simply can't work. With the Boomers starting to stress the medical system, exacerbating the nightmarish problems caused by "managed" healthcare and a legal system that does as much harm as it does good, physicians are increasingly moving away from primary care. I absolutely agree with you that the problem stems from overwork, in addition to the other things. Even with medical schools increasing enrollment, there simply aren't enough doctors to serve the population. Unfortunately the same is true for nurses, the last I checked.
For what it's worth, I certainly decided on medicine because it's an intellectually demanding career with a very real impact on the lives of others. But I also realise that my particular value lies in the application of my intellect and/or skill in the service of relieving the suffering of others.
I will best achieve this, I believe, by allowing nurses and PA's to give shots, perform basic procedures, and so on. While this is perhaps an "overseer" position in a sense, it's an efficient use of my time that will allow me to create the greatest good for the most people. The downside is that it sabotages the intimacy that used to lie at the heart of the doctor-patient relationship. I don't have a good answer for that, unfortunately, except that perhaps all physicians must find their own balance of quantity vs. quality in the medical care of their patients.
Actually, what you need are more mid-level providers. Physician Assistants, Nurse Practitioners, and the like are probably the future of front-line medical care, while doctors will provide an increasingly overseer role. Hell, as a future doc, I'm not particularly happy about that, but it's the reality. I'd rather see fewer but better doctors surrounded by an army of trained nurses and PAs, than the converse.
Speaking as a current medical student, I absolutely think that Organic Chemistry is an appropriate pre-med subject. While the material covered isn't particularly useful beyond establishing a solid basis for understanding the chemistry of biochemical pathways, the value of O-Chem is that it's usually the first time an undergrad student is hit by a tidal-wave of information. O-Chem, just like a lot of the stuff in med school, isn't necessarily difficult stuff; the challenge lies in assimilating information and understanding relationships at a high rate. O-Chem was an excellent primer for the drinking-from-a-firehose atmosphere of medicals school, as well as a good tool to test scientific critical thinking on the MCAT.
Well, I guess even if I could see it in something like the Tesla...but, I could never seen an electric motorcycle replacing the real thing....I mean, half the fun of the bike IS the sound, the rumbling...and even the smell of oil and gas, etc...
Clearly you ride a Harley. ;)
As a sport-biker, if my bike is rumbling, or I smell oil/gas, I'm taking the damned thing to the shop! For me, the fun of a bike is the maneuverability, visceral sense of speed, and 0-60 takeoffs that leave everyone in my rearviews. If I can get that sort of performance from an electric sportbike, I'd switch in a heartbeat.
Bought a Buffalo router and flashed it with DD-WRT. The only time the thing reset was when the power went out. If you're restarting your router every few days, I'd suggest looking into your config for the problem.
Fixed that for you.
Oh come on, mods. Parent was hardly a troll!My problem is with people who aren't satisfied with making it right, preferring instead to use litigation as a sort of medical lottery number, hoping for the big payout. Expecting to be dealt with honourably after a mistake is absolutely right, but I suspect a number of folks suddenly see dollar signs when a doctor tells them that a mistake has been made. Still, I think we're actually in quite close agreement here.
Fair enough. But what I'm arguing is that we hold doctors to an inhuman level of perfection. To demand of doctors their very best and most conscientious efforts when we entrust ourselves to them is entirely reasonable. It is not reasonable, however, to expect them to perform flawlessly. Personally, I'd much prefer that my doctor be upfront about making a mistake, what it meant, and how they were going to try to fix it, than to beat around the bush in an effort to avoid giving me fodder for litigation.
It also occurs to me that likely more than one life has been screwed up as a result of being on the wrong end of a bungled court proceeding. While lawyers certainly don't operate (ha!) at the same level as surgeons, they can certainly have a deleterious effect on the life of their client!
See how completely unreasonable that would be? I should be clear that I'm not bagging on lawyers here, but using them as an example of how another profession might be held to ridiculous standards of perfection. M&M conferences would be a far more effective learning tool if there was no sense of blame, and doctors could freely help their colleagues learn from prior mistakes.
Here's a thought: maybe the human body is fantastically fucking complicated and the intersection of science and humanity is the spot at which a lot of science falls flat on its face. Perhaps many doctors would love to have scientifically "proven" explanations for crap that happens in the human body, but the reality is that medical science is still very much in its infancy and we just don't know how a lot of stuff works yet. There are a hell of a lot of doctors who wade through shamans, faith healers, spiritualists, and other CAM crap in order to fly the flag for evidence-based medicine and yes, these doctors are indeed "people of science".