She's obviously smarter than I, since I can't figure out what it is she does, other than "biology research". Um, if you RTFA, you would see the following at the top of the page: "I'm a graduate student studying the molecular and biochemical evolution of HIV within patients and within populations. I also study epigenetic control of ERVs." So gee, someone studying molecular evolution who has strong opinions about evolution. Shock! Horror!
And were it not for the fact that creationist whack-jobs spend so much time trying to corrupt the teaching of science, then biological science researchers would spend absolutely zero time defending our science classrooms from that corruption.
Nick
PS: ERV = Endogenous RetroViruses - ancient retroviruses that have been passed down into our DNA as the result of an infection of germ cells some time in our evolutionary past.
and ask yourself: "Which part of that original narration supports Darwinian evolution?" The entire thing supports evolutionary theory. This is because biology - in all its manifestations - cannot be understood without an understanding of evolutionary theory. It would be like trying to discuss or explain organic chemistry while denying the existence of the atom.
"food, medicine, condoms, and many other things." Are you old enough to have lived back when your average high school student had minimal to none information about condoms? My thirteen year old niece can give me pointers about it that she learned on teh internets. Do you think that its obvious that with the write knowledge food and medicine will be more abundant and effective. Its more than just throwing seeds in the ground.
And one great way to learn to do better agriculture science is to have access to the www. The biggest and best thing that internet access brings to the developing world is the knowledge of how to develop themselves.
First off, the scientific method does not offer proof. It offers varying degrees of certainty that the conclusion you make accurately reflects the truth in the universe.
Secondly, perhaps you might want to experience medical school before you make that sort of broad judgment. The med student's comments were quite accurate with regards to medical school. Although there is another issue that he brings up that needs emphasized: when people finish their training there is a temptation to neglect the science part of the equation, especially if you are a throat swabbing, boil lancing, pill pushing primary care doctor. However, from Family Practice as a specialty you get some of the best Evidence Based Medicine focused practice. The whole idea of EBM has been embraced by FP in recent years and the focus is on emphasizing on translating scientific rigor into clinical practice.
So it was there all along, but its becoming even more the case today in day to day practice.
gift that your nephew or nerdy niece OK, so boys who like cool science or tech toys = boys. Girls who like cool tech or science toys = nerds.
As the uncle of multiple nieces, none of whom are nerdy (though two are definitely budding geeks) I find that a little annoyingly sexist. And as the gay-platonic-male-friend of several adult female geeks (who gets the unfiltered opinions,) I can assure you they pick up on that shit in a heartbeat.
That's why I married a guy. No matter how big the fight is, you won't ever get kicked in the nuts. Admittedly, there is less to fight about: "Hey, you wanna order a pizza, play video games, then have sex?" "Schweet, me too!"
Actually salt (or rather salt water - in particular 0.9% saline) is slightly preferable to plain water when cleansing wounds. Water is hypotonic, so causes a shift of water into the exposed cells causing them to swell and rupture. Dead cells are a breeding ground for bacteria, so 0.9% saline (which is isotonic to the exposed cells) is preferable.
That said, the most preferable cleansing is quickly and copiously right after the injury. So immediately running your cut under the tap for several minutes or rinsing it with your bottle of evian is preferable to waiting till you get your hands on a liter of saline. The biggest axiom in wound care is: the solution to pollution is dilution.
P.S. If you have a chance to vacation in Mexico, take a trip to a pharmacy and you can not only get hella cheap QVAR (and other inhaled steroids) but you can also get the old albuterol MDIs: Mmmmmmm chlorofluorocarbons.
Well 2 seconds checking on google and you can get it for $36's at Canada Drug Superstore. That gets you 200 inhalations, which for most asthmatics is over three months worth - so $12/month. You can get albuterol even here for slightly more than the cost of spit. 40 unit doses of albuterol neb solution at WalMart is $8.
Of course that price for QVAR is in a health care system that is not as terminally fucked as the US system where we pay a lot more and get a lot less. But at least you can still order it on line from a normal country.
Because more important than my personal experience with a given drug is the actual research results. Just because I haven't had a patient on Zyprexa develop diabetes, that doesn't mean its a safe drug. In addition, if albuterol plus QVAR costs $20 a month and Advair costs $200 a month, both are equally effective at controlling asthma, then just being more convenient is not a good argument to use the latter from the perspective of the whole health care system. And sometimes its not even that there is better convenience or effectiveness or safety... the only difference may be that drug A is newer and better marketed than drug B.
Um... fuck research. They wouldn't spend it if it didn't work. So I refuse entirely to take any swag except for samples. I feel like the samples is a deal with the devil, but if I can circumvent the intent of the drug rep some, its not so bad(E.G. give all the advair diskus inhalers to supply my single patient without insurance and with severe asthma rather than the 'free starter' for multiple people that leads to further rxs for the drug companies.)
Its still a big risk... now I know how much easier it is to get an asthmatic to take advair than cheaper albuterol plus QVAR. So I am probably more likely to rx in the future because of that knowledge. But that is a moral choice I pay for my patient.
Other than that, I don't eat a cookie, take a plastic pancreas, or write with a Viagra pen. I don't even like to look at the time on a Tequin clock.
Nick
What is to keep me from putting something nasty about how overweight and foul smelling you are, that will prejudice any future docs against you...if fat and stinky aren't enough think HepC and HIV+
Largely the fact that you could sue the snot off me if I said "this douchebag is a fat smelly POS" or if I said you had HIV or HCV when you did not have that diagnosis.
Of course generally its things which are factual that piss people off the most. If your BMI is 35, you are obese. If you have an abscess from skin popping drugs of abuse and are urine tox positive for heroin and meth, you have taken drugs of abuse. If your alcohol is 256mg/dL after you kill three kids with your SUV, you are a drunk driver. Of course anyone who reads your chart will know that. But the solution to those problems is not in suppressing your medical record, its in changing your behaviors so that is not in your medical record.
No one is forcing you to divulge your personal medical information. Unless you are suicidal, homicidal, or gravely disabled so that you are placed on an involuntary psychiatric hold, you have every right to ask for my assistance or go elsewhere.
However if you wish me to provide you with medical care, you will need to provide that information. The biggest part of this is to provide you with good medical care... for example things you might not think are important might be important. However this is also to protect providers and to prevent drug diversion.
For example a female physician should be allowed to decline an unchaperoned exam with a serial rapist. I have a right to know whether you have TB before I spend time in a small room with you without an N-95 mask. If while I am suturing you move unexpectedly and I get stuck with a dirty needle, I and my partner deserve to know whether I might get infected with HIV or Hepatitis. Now if you have hepatitis, HIV, TB, or are a serial rapist, you do still have the right to decent quality health care. But you have to realize that in the doctor-patient relationship there are TWO people. Becoming a physician does mean that you agree to accept some risks... I have sutured more people with HIV and hepatitis than I can count and treat people with other communicable diseases or who are violent every day I work (I'm an ER physician). However that doesn't mean that I should have to endure risks to my life and health that can otherwise be minimized by information.
If I know you have EDR-TB, I will be wearing an N-95 mask to decrease my risk. It is unreasonable that you having an ultimate right to privacy should place me at such significant risk because you don't wish to reveal you have Extremely Drug Resistant TB. It's reasonable that you expect you will get care regardless of the disease you have... but it is unreasonable to expect that you can get this care at the cost of the lives of myself and my family.
The one concern that I would have about this in the hands of the consumer is data suppression. For 97% of people that is of no importance, but in a small percentage its pertinent. (I am an ER doctor, so necessarily I am a bit jaded.)
For example, I've been lied to many times by patients regarding narcotic pain medicine prescriptions. For example, I treated someone this year to whom I gave an rx for 30 vicodins. I get a letter a month later from the State Controlled Substance guys (because one physician who rx'd to this patient requested a print out of the patient's controlled substance prescription records - which triggers a letter sent to everyone who rx'd him controlled medicines in the past.) So this guy had gotten the equivalent of 30 vicodins daily over a period of a few months (from many doctors, using different pharmacies, often getting two or three rxs in one day.) This means either he is in fulminant liver failure from all the tylenol or he's selling it for fun'n'profit.
So now, if he returns to my hospital (or any of the physicians or hospitals he shopped at) any provider who has not seen him before can pull his record their and see his real history. That's the benefit of a record that is out of the hands of the patient. Now that is meaningless for the 97% of people who are above-board. However the fact that the 3% exist do mean that any patient maintained record that providers can't add to independent of the patient's wishes will be taken with at least a bit of a grain of salt in some circumstances. Your old EKG or Chest Xray is not going to be suspect, but the report that you have only filled one rx for vicodin in the past 6 years and your 'documented allergy' to every pain medicine except for vicodin might be a bit suspect.
Well I was talking about the idea of scanning films that AC spoke of - which is a moot point about now (unless you are talking archives.)
A single view chest is about 5-7 Mb.... though of course CT scans will multiply that by many slices. However, I think google might have the advantage that the ability to store data cheaply will in all likelihood increase at a rate higher than the rate at which the resolution of radiographs increases. So the problem would still seem to be a self-solver. Its pricier now, but eventually I think it will be less expensive.
Lastly, I think google will probably take advantage of the fact that most people have relatively short and limited medical histories. Its only the unhealthy or neurotic who will have 100 gig of data to store.
Excellent idea. Though if I were you, I would also consider emailing the pertinent stuff to yourself lest your drive be lost in the car wreck when you get to the ER. I have had patients in the past who said "If you can get me online I can get you my old EKG, medications list, etc" and that has been quite useful.
I would also like to fire them (and their ability to have access to my records) at whim.
For future records, yes. If I treat you and subsequently you fire me, you have every right that I not be able to see records of your future medical care. However, any records of your care (or records you previously have had sent to me from other providers) not only should, but must (by law) be maintained by me and thus available to me.
Of course I might be willing to agree to remove your records from my office or record storage facility if: 1) it were no longer against the law, 2) there was no issue with FDA regulated drug abuse or diversion, and 3) by doing so you relinquish all rights in the future to sue me since your medical record is my entire documentation of my version of events should we have a disagreement in the future.
That won't be too hard, since more and more radiographs are digital now. In 10 years you will be hard pressed to find someone who does things the old fashioned way. So Google can offer that now, knowing that ultimately, you will just upload them the digital file.
"I don't disagree with you about the concept of screening healthy people, in most cases, it's a bad idea."
Its not that screening is a bad idea. Its that BAD screening is a bad idea. Medical screening (like for hypertension, diabetes, obesity, depression, alcoholism, certain types of cancer like cervical, breast, colon, domestic violence, etc) is a GREAT idea and has saved the lives of millions. However, for a test to be a valid and good screening test, it much meet some very specific criteria. The ultimate question is: does it save more active, quality years of life than it costs for a decent price?
"But don't tell me somebody have been using CT for screening - was that in the US ?"
Yep, though not exclusively. Fortunately it has fallen out of favor in the US, but is used in other countries - often for medical tourists. http://www.fda.gov/cdrh/ct/
"I live in Denmark where there was a minor debate a couple of years ago regarding screening mid-aged women for brest cancer. Your exact argument was the primary reason a lot of doctors opposed the idea. But even if they use X-ray for screening it's nowhere near as risky as doing full body CT. And the primary proponent of the screening was suggesting Ultrasound as the screening technique - which makes sense since modern ultrasound is almost as accurate , and in some cases more accurate, than X-ray mammography."
That debate was probably around screening for women aged 40-50. There is solid evidence that the benefits of mammography outweigh the risks in women over age 50, while the evidence for women 40-50 is less certain. The big issue is whether the (small but real) net benefit is worth the financial cost. For example, in women of average risk if you did mammography only every 2-3 years over 50 rather than yearly and put the money saved into prevention and treatment of alcohol, drug, and tobacco abuse, you would save far more lives with the same amount of money.
However, often it is the case that money is allocated based on who has better lobbying power and who is seen as 'more deserving.' For example, worldwide research money favors type 1 diabetes (about 5-10% of diabetics) rather than type 2. This is because the parents of kids with Type 1 are hella better at lobbying for funds, and overall people feel more sympathy for a kid who got type 1 diabetes at six than a morbidly obese type 2 diabetic who people perceive as having caused his own disease by gluttony. So in the case of mammography vs drug treatment funding - women who had/have breast cancer are better at lobbying and garner more sympathy than people with drug, alcohol or tobacco addiction who are (again) seen as having caused their own problems. So guess where the money gets spent?
And this is not simply a US phenomenon - for a good example of how these politics get played out, look at the coverage for Herceptin in the UK's NHS: http://www.bmj.com/cgi/content/full/333/7578/1118 For every one woman with early stage breast cancer saved it will cost over a million US dollars (which might save dozens of people if spent on other less expensive cancer therapies.)
With regard to ultrasound's performance, its not a good screen. It is a good diagnostic test in women who have clinically apparent lumps (especially those who are younger.) But as a screen it is neither as effective nor as consistent (its effectiveness varies considerably between different US techs.) A better (and minimally safer) method is MRI - but again it would cost a gazillion dollars, so its crappy as a screen.
It is not CT scans that I am saying are the problem. It is indiscriminate use of diagnostic tests as screening tests. The risk of doing the wrong test is far greater than people think. And the functional characteristics of tests (the positive and negative predictive values) change with use in different populations.
Take for example an HIV test that is 99.9% specific and 100% sensitive. That is, of 1000 positives, 999 are true positives. Sounds like a good test, right?
Well it depends....
Use the test in an urban population of men who have sex with men and IV drug users (with a high prevalence of HIV) and its a great test. Use it in a nursing home population in Kansas, and it sucks ass. (And please before you label me homophobic... I'm a gay physician that practices in northern California. Lets not go there, kay? And no the numbers below are not accurate... but they are round and therefore will be used because as you figured out, I suck ass with numbers. I have to wear a calculator watch to work.)
So, we test 1000 inner city MSMs and IVDAs, of whom 5% have the disease. We get 50 true positives, and in a population of 1000, we get 1 false positive (since its 99.9% specific.) Not bad, one guy has to sweat it out till the confirmatory test, but that's a pretty good test (better than most tests we have, BTW.) So then we go to Kansas and test 1000 nursing home patients who have a prevalence of 0.1%. So we get one true positive, and out of 1000 one false positive. Pretty crappy predictive value since half the positive test results you get are false positives.
If you get a positive in the first population, there is a 98% chance its a true positive. If you get a positive in the second population with a lower prevalence of the disease, then the chance you actually have the disease is much lower (50:50.)
It works the same with all tests... if you have a low prevalence of disease, you will get more false positives. If you have a population of young 'worried well' folks (i.e. many of the people who opted for full body CTs) the test has worse performance because more of the positive results will be false positives.
And yes, radiation is bad too. But I would rather have several CTs than take the risk of getting an invasive work-up like an open lung or liver or kidney biopsy. However, when necessary, radiography is important. If you have a 10% chance of having appendicitis - getting a CT may be better bet than either sitting on it (and risking perforation) or going to the OR for the stomach flu. If your odds of appendicitis are greater... say 90%, I would opt with the operative exploration. If you odds are 1%, go home and come back if you get worse. It all depends on the clinical scenario - which is why tests like the full body CT (or other diagnostic tests used for inappropriate screening) are a menace.
I'm not an expert in medical imaging, but a 50-fold selectivity and nano-molar detection limit seem medical usable. No doubt other techniques for detecting inflammation already exist, but this technique may be a useful addition to the diagnostic toolbox.
You are talking about something entirely different. When you talk about the sensitivity and specificity of a medical test that refers only to ratios of true/false positives/negatives. The sensitivity is 'of people who have the disease, how many will have a positive test?' The specificity is 'of positive tests, how many people have the disease.'
This would be (like many tests for general things like a WBC scan) would likely have a very low specificity (too many false positives). That in and of itself is not necessarily a deadly failure in a screening test. Pap smears are a good example of a test that is not very specific, but is a good screening test because it is quite sensitive. So if you have positives on the pap, you go for a test with better specificity like colposcopy.
A good screening test has a high sensitivity for a specific disease that is amenable to treatment (like pre-cervical cancer, or hypertension, or diabetes), and that is cheap enough to do in a society-wide level (like checking a BP or a blood sugar or pap - all of which are dirt cheap). I am guessing this will be slightly less than a gazillion dollars, so it sounds like it would be a quite craptastic screening tool from TFA's description.
Um, we can already detect inflammation. Try a technetium-111 or indium-99 labeled WBC scan.
I doubt that this would be specific enough (and of uncertain sensitivity) to be useful. How many false positives and false negatives would you get? It might end up being helpful in situations where you are looking to diagnose a suspected disease, but something this non-specific does not seem like it would be a good screening tool.
A few years back they were hawking full body (or if you were cheap partial body) CT scans as a screen. The brochures would show you the 38 year old mother of two whose renal cell carcinoma was detected and removed when it was 1cm in size, thus saving her life. They did not show you the guy who had a nodule detected on CT that looked suspicious, required a biopsy that caused a pneumothorax requiring a chest tube, that caused him to have a pneumonia with empyema, which caused respiratory failure, which caused him to be intubated for two weeks, needing a tracheostomy, etc.... to diagnose the totally benign lesion he had since he was born.
I wouldn't bet on this as the medical tricorder they are making it out to be.
Slashdot Mirror
And were it not for the fact that creationist whack-jobs spend so much time trying to corrupt the teaching of science, then biological science researchers would spend absolutely zero time defending our science classrooms from that corruption.
Nick
PS: ERV = Endogenous RetroViruses - ancient retroviruses that have been passed down into our DNA as the result of an infection of germ cells some time in our evolutionary past.
"food, medicine, condoms, and many other things." Are you old enough to have lived back when your average high school student had minimal to none information about condoms? My thirteen year old niece can give me pointers about it that she learned on teh internets. Do you think that its obvious that with the write knowledge food and medicine will be more abundant and effective. Its more than just throwing seeds in the ground.
And one great way to learn to do better agriculture science is to have access to the www. The biggest and best thing that internet access brings to the developing world is the knowledge of how to develop themselves.
First off, the scientific method does not offer proof. It offers varying degrees of certainty that the conclusion you make accurately reflects the truth in the universe.
Secondly, perhaps you might want to experience medical school before you make that sort of broad judgment. The med student's comments were quite accurate with regards to medical school. Although there is another issue that he brings up that needs emphasized: when people finish their training there is a temptation to neglect the science part of the equation, especially if you are a throat swabbing, boil lancing, pill pushing primary care doctor. However, from Family Practice as a specialty you get some of the best Evidence Based Medicine focused practice. The whole idea of EBM has been embraced by FP in recent years and the focus is on emphasizing on translating scientific rigor into clinical practice.
So it was there all along, but its becoming even more the case today in day to day practice.
As the uncle of multiple nieces, none of whom are nerdy (though two are definitely budding geeks) I find that a little annoyingly sexist. And as the gay-platonic-male-friend of several adult female geeks (who gets the unfiltered opinions,) I can assure you they pick up on that shit in a heartbeat.
If its "Terabit-Per-Second Class Connection" I wonder what a first class connection gets you.
Damien Rice has that... what do you call it.... oh yeah, talent.
That's why I married a guy. No matter how big the fight is, you won't ever get kicked in the nuts. Admittedly, there is less to fight about: "Hey, you wanna order a pizza, play video games, then have sex?" "Schweet, me too!"
Nick
Actually salt (or rather salt water - in particular 0.9% saline) is slightly preferable to plain water when cleansing wounds. Water is hypotonic, so causes a shift of water into the exposed cells causing them to swell and rupture. Dead cells are a breeding ground for bacteria, so 0.9% saline (which is isotonic to the exposed cells) is preferable.
That said, the most preferable cleansing is quickly and copiously right after the injury. So immediately running your cut under the tap for several minutes or rinsing it with your bottle of evian is preferable to waiting till you get your hands on a liter of saline. The biggest axiom in wound care is: the solution to pollution is dilution.
As is my age, however I celebrate birthdays once annually. Have a look at the date the thing was detonated.
/. might actually have repeat articles in another year.
Happy birthday to you. Happy birthday to you. Happy birthday dear big-effing-stupid-violent-explody-thingy. Happy birthday to you!
And I suspect Digg and
P.S. If you have a chance to vacation in Mexico, take a trip to a pharmacy and you can not only get hella cheap QVAR (and other inhaled steroids) but you can also get the old albuterol MDIs: Mmmmmmm chlorofluorocarbons.
Well 2 seconds checking on google and you can get it for $36's at Canada Drug Superstore. That gets you 200 inhalations, which for most asthmatics is over three months worth - so $12/month. You can get albuterol even here for slightly more than the cost of spit. 40 unit doses of albuterol neb solution at WalMart is $8.
Of course that price for QVAR is in a health care system that is not as terminally fucked as the US system where we pay a lot more and get a lot less. But at least you can still order it on line from a normal country.
Nick
Because more important than my personal experience with a given drug is the actual research results. Just because I haven't had a patient on Zyprexa develop diabetes, that doesn't mean its a safe drug. In addition, if albuterol plus QVAR costs $20 a month and Advair costs $200 a month, both are equally effective at controlling asthma, then just being more convenient is not a good argument to use the latter from the perspective of the whole health care system. And sometimes its not even that there is better convenience or effectiveness or safety... the only difference may be that drug A is newer and better marketed than drug B.
Nick
Um... fuck research. They wouldn't spend it if it didn't work. So I refuse entirely to take any swag except for samples. I feel like the samples is a deal with the devil, but if I can circumvent the intent of the drug rep some, its not so bad(E.G. give all the advair diskus inhalers to supply my single patient without insurance and with severe asthma rather than the 'free starter' for multiple people that leads to further rxs for the drug companies.)
Its still a big risk... now I know how much easier it is to get an asthmatic to take advair than cheaper albuterol plus QVAR. So I am probably more likely to rx in the future because of that knowledge. But that is a moral choice I pay for my patient.
Other than that, I don't eat a cookie, take a plastic pancreas, or write with a Viagra pen. I don't even like to look at the time on a Tequin clock.
Nick
Of course generally its things which are factual that piss people off the most. If your BMI is 35, you are obese. If you have an abscess from skin popping drugs of abuse and are urine tox positive for heroin and meth, you have taken drugs of abuse. If your alcohol is 256mg/dL after you kill three kids with your SUV, you are a drunk driver. Of course anyone who reads your chart will know that. But the solution to those problems is not in suppressing your medical record, its in changing your behaviors so that is not in your medical record.
No one is forcing you to divulge your personal medical information. Unless you are suicidal, homicidal, or gravely disabled so that you are placed on an involuntary psychiatric hold, you have every right to ask for my assistance or go elsewhere.
However if you wish me to provide you with medical care, you will need to provide that information. The biggest part of this is to provide you with good medical care... for example things you might not think are important might be important. However this is also to protect providers and to prevent drug diversion.
For example a female physician should be allowed to decline an unchaperoned exam with a serial rapist. I have a right to know whether you have TB before I spend time in a small room with you without an N-95 mask. If while I am suturing you move unexpectedly and I get stuck with a dirty needle, I and my partner deserve to know whether I might get infected with HIV or Hepatitis. Now if you have hepatitis, HIV, TB, or are a serial rapist, you do still have the right to decent quality health care. But you have to realize that in the doctor-patient relationship there are TWO people. Becoming a physician does mean that you agree to accept some risks... I have sutured more people with HIV and hepatitis than I can count and treat people with other communicable diseases or who are violent every day I work (I'm an ER physician). However that doesn't mean that I should have to endure risks to my life and health that can otherwise be minimized by information.
If I know you have EDR-TB, I will be wearing an N-95 mask to decrease my risk. It is unreasonable that you having an ultimate right to privacy should place me at such significant risk because you don't wish to reveal you have Extremely Drug Resistant TB. It's reasonable that you expect you will get care regardless of the disease you have... but it is unreasonable to expect that you can get this care at the cost of the lives of myself and my family.
The one concern that I would have about this in the hands of the consumer is data suppression. For 97% of people that is of no importance, but in a small percentage its pertinent. (I am an ER doctor, so necessarily I am a bit jaded.)
For example, I've been lied to many times by patients regarding narcotic pain medicine prescriptions. For example, I treated someone this year to whom I gave an rx for 30 vicodins. I get a letter a month later from the State Controlled Substance guys (because one physician who rx'd to this patient requested a print out of the patient's controlled substance prescription records - which triggers a letter sent to everyone who rx'd him controlled medicines in the past.) So this guy had gotten the equivalent of 30 vicodins daily over a period of a few months (from many doctors, using different pharmacies, often getting two or three rxs in one day.) This means either he is in fulminant liver failure from all the tylenol or he's selling it for fun'n'profit.
So now, if he returns to my hospital (or any of the physicians or hospitals he shopped at) any provider who has not seen him before can pull his record their and see his real history. That's the benefit of a record that is out of the hands of the patient. Now that is meaningless for the 97% of people who are above-board. However the fact that the 3% exist do mean that any patient maintained record that providers can't add to independent of the patient's wishes will be taken with at least a bit of a grain of salt in some circumstances. Your old EKG or Chest Xray is not going to be suspect, but the report that you have only filled one rx for vicodin in the past 6 years and your 'documented allergy' to every pain medicine except for vicodin might be a bit suspect.
Well I was talking about the idea of scanning films that AC spoke of - which is a moot point about now (unless you are talking archives.)
A single view chest is about 5-7 Mb.... though of course CT scans will multiply that by many slices. However, I think google might have the advantage that the ability to store data cheaply will in all likelihood increase at a rate higher than the rate at which the resolution of radiographs increases. So the problem would still seem to be a self-solver. Its pricier now, but eventually I think it will be less expensive.
Lastly, I think google will probably take advantage of the fact that most people have relatively short and limited medical histories. Its only the unhealthy or neurotic who will have 100 gig of data to store.
For future records, yes. If I treat you and subsequently you fire me, you have every right that I not be able to see records of your future medical care. However, any records of your care (or records you previously have had sent to me from other providers) not only should, but must (by law) be maintained by me and thus available to me.
Of course I might be willing to agree to remove your records from my office or record storage facility if: 1) it were no longer against the law, 2) there was no issue with FDA regulated drug abuse or diversion, and 3) by doing so you relinquish all rights in the future to sue me since your medical record is my entire documentation of my version of events should we have a disagreement in the future.
That won't be too hard, since more and more radiographs are digital now. In 10 years you will be hard pressed to find someone who does things the old fashioned way. So Google can offer that now, knowing that ultimately, you will just upload them the digital file.
Yep, though not exclusively. Fortunately it has fallen out of favor in the US, but is used in other countries - often for medical tourists. http://www.fda.gov/cdrh/ct/
That debate was probably around screening for women aged 40-50. There is solid evidence that the benefits of mammography outweigh the risks in women over age 50, while the evidence for women 40-50 is less certain. The big issue is whether the (small but real) net benefit is worth the financial cost. For example, in women of average risk if you did mammography only every 2-3 years over 50 rather than yearly and put the money saved into prevention and treatment of alcohol, drug, and tobacco abuse, you would save far more lives with the same amount of money.
However, often it is the case that money is allocated based on who has better lobbying power and who is seen as 'more deserving.' For example, worldwide research money favors type 1 diabetes (about 5-10% of diabetics) rather than type 2. This is because the parents of kids with Type 1 are hella better at lobbying for funds, and overall people feel more sympathy for a kid who got type 1 diabetes at six than a morbidly obese type 2 diabetic who people perceive as having caused his own disease by gluttony. So in the case of mammography vs drug treatment funding - women who had/have breast cancer are better at lobbying and garner more sympathy than people with drug, alcohol or tobacco addiction who are (again) seen as having caused their own problems. So guess where the money gets spent?
And this is not simply a US phenomenon - for a good example of how these politics get played out, look at the coverage for Herceptin in the UK's NHS: http://www.bmj.com/cgi/content/full/333/7578/1118 For every one woman with early stage breast cancer saved it will cost over a million US dollars (which might save dozens of people if spent on other less expensive cancer therapies.)
With regard to ultrasound's performance, its not a good screen. It is a good diagnostic test in women who have clinically apparent lumps (especially those who are younger.) But as a screen it is neither as effective nor as consistent (its effectiveness varies considerably between different US techs.) A better (and minimally safer) method is MRI - but again it would cost a gazillion dollars, so its crappy as a screen.
It is not CT scans that I am saying are the problem. It is indiscriminate use of diagnostic tests as screening tests. The risk of doing the wrong test is far greater than people think. And the functional characteristics of tests (the positive and negative predictive values) change with use in different populations.
Take for example an HIV test that is 99.9% specific and 100% sensitive. That is, of 1000 positives, 999 are true positives. Sounds like a good test, right?
Well it depends....
Use the test in an urban population of men who have sex with men and IV drug users (with a high prevalence of HIV) and its a great test. Use it in a nursing home population in Kansas, and it sucks ass. (And please before you label me homophobic... I'm a gay physician that practices in northern California. Lets not go there, kay? And no the numbers below are not accurate... but they are round and therefore will be used because as you figured out, I suck ass with numbers. I have to wear a calculator watch to work.)
So, we test 1000 inner city MSMs and IVDAs, of whom 5% have the disease. We get 50 true positives, and in a population of 1000, we get 1 false positive (since its 99.9% specific.) Not bad, one guy has to sweat it out till the confirmatory test, but that's a pretty good test (better than most tests we have, BTW.) So then we go to Kansas and test 1000 nursing home patients who have a prevalence of 0.1%. So we get one true positive, and out of 1000 one false positive. Pretty crappy predictive value since half the positive test results you get are false positives.
If you get a positive in the first population, there is a 98% chance its a true positive. If you get a positive in the second population with a lower prevalence of the disease, then the chance you actually have the disease is much lower (50:50.)
It works the same with all tests... if you have a low prevalence of disease, you will get more false positives. If you have a population of young 'worried well' folks (i.e. many of the people who opted for full body CTs) the test has worse performance because more of the positive results will be false positives.
And yes, radiation is bad too. But I would rather have several CTs than take the risk of getting an invasive work-up like an open lung or liver or kidney biopsy. However, when necessary, radiography is important. If you have a 10% chance of having appendicitis - getting a CT may be better bet than either sitting on it (and risking perforation) or going to the OR for the stomach flu. If your odds of appendicitis are greater... say 90%, I would opt with the operative exploration. If you odds are 1%, go home and come back if you get worse. It all depends on the clinical scenario - which is why tests like the full body CT (or other diagnostic tests used for inappropriate screening) are a menace.
This would be (like many tests for general things like a WBC scan) would likely have a very low specificity (too many false positives). That in and of itself is not necessarily a deadly failure in a screening test. Pap smears are a good example of a test that is not very specific, but is a good screening test because it is quite sensitive. So if you have positives on the pap, you go for a test with better specificity like colposcopy.
A good screening test has a high sensitivity for a specific disease that is amenable to treatment (like pre-cervical cancer, or hypertension, or diabetes), and that is cheap enough to do in a society-wide level (like checking a BP or a blood sugar or pap - all of which are dirt cheap). I am guessing this will be slightly less than a gazillion dollars, so it sounds like it would be a quite craptastic screening tool from TFA's description.
Um, we can already detect inflammation. Try a technetium-111 or indium-99 labeled WBC scan.
I doubt that this would be specific enough (and of uncertain sensitivity) to be useful. How many false positives and false negatives would you get? It might end up being helpful in situations where you are looking to diagnose a suspected disease, but something this non-specific does not seem like it would be a good screening tool.
A few years back they were hawking full body (or if you were cheap partial body) CT scans as a screen. The brochures would show you the 38 year old mother of two whose renal cell carcinoma was detected and removed when it was 1cm in size, thus saving her life. They did not show you the guy who had a nodule detected on CT that looked suspicious, required a biopsy that caused a pneumothorax requiring a chest tube, that caused him to have a pneumonia with empyema, which caused respiratory failure, which caused him to be intubated for two weeks, needing a tracheostomy, etc.... to diagnose the totally benign lesion he had since he was born.
I wouldn't bet on this as the medical tricorder they are making it out to be.