Great idea! So since the majority of drugs brought to market by Pharma are discovered in research that is primarily funded by public funds, the public should own the patent. And as a member of the public, I vote that Brazil can make Elfavirenz on the house. All in favor?
The first effective HIV drug, AZT is a great example. 90% of the money that went into discovery and bringing AZT to market was NIH and other federal grant money and then Glaxo-Wellcome (I believe Burroughs-Wellcome at the time) stepped in, frosted the cake, and walked away with a blockbuster drug courtesy of you and me.
Not that Pharma doesn't spend a lot of money: most of it is drug detailing and direct to consumer marketing (which makes up a larger proportion of every large pharmaceutical corporation's budget than research.) You should see some of the shit I get offered... plastic pancreas laser pointers don't grow on trees you know!
Re:Makes a little bit of sense. . .
on
Treating the Dead
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· Score: 4, Insightful
Actually the primary reasoning for the change was largely to keep it simple. This means there is ONE ratio to remember for all lay-rescuer (single person) CPR for anyone that is not an infant.
There is not a single 'ideal' compression to ventilation ratio. We know that for garden variety cardiac arrest due to V-Fib, ventilation in the first minute or so is probably almost meaningless. We also know that for hypoxic arrests (like a drowning) that ventilation is far more important. We also know that VFib makes up a greater percent of adult arrests and hypoxic arrests are more common in kids (all of whom get the same ratio.) Moreover the AHA made this decision knowing that they didn't even know the ideal ratio for the single most common type of arrest in the community (from VFib.) The 30:2 ratio was a way of keeping it simple that is not perfect for every kind of arrest, but is a reasonable compromise to try to deliver at least a reasonably acceptable type of CPR to all victims of arrest.
That is a good thing for lay-rescuers, but the AHA understands that people who are more highly trained and knowledgeable will guide their actions based on that knowledge. For example, if my partner grabbed his chest and collapsed, I would run to the phone, call 911. Return to him, check for a pulse, and if he had none, start wailing on his chest like a crazed weasel on crack. I would not even consider breaking compressions to give a breath till at least minutes had passed - or more trained people arrived and ACLS could be initiated. If however, I pulled him out of a pool, I would check for breathing and if none, give two full rescue breaths. Then check for a pulse, if none, start CPR with probably about a 15-20:2 ratio. I would stop for a moment at 1 minute. If he had a pulse, I would continue breathing for him a full minute or two before I ran to the phone. If he had no pulse, I would give two last breaths and run for the phone.
Those are drastically different methods that I chose knowing that they would give him the best chance in either situation. But if you try to teach lay-rescuers that, you will get blank stares and some shitty-assed CPR. So it is better to make things as simple as possible and make them so at least everyone gets 'reasonable' CPR.
For the same reason that if a river runs through my property onto yours, I can't damn up the river on my property. Actions I take on my land may directly affect yours and so we have a vested interest in negotiation use of that river so I don't starve you and you don't come to my home and shoot me.
I read other (obviously inferior) news sites, and when some idiot like the poster to which you replied mentions Herbal Medicines people lose their shit with how safe, natural, and effective the carbonated weasel urine the witchdoctor down the street uses. (Medicines not drugs... So the FDA can't regulate it since it is only a medicine and not a drug. Duh!)
On a bad day, I engage. On a good day I mutter to myself and go kick a dog or something.
So I clicked this link and... Ooooohhh.... yeeeessssss.... WONDERFUL! All the smart people were modded up, and the idiots modded down. AND you threw in a Scientology dig to start it off too. You have made my week.
Nah, don't need to mod you down, honey. You did that yourself.
Though I will admit I was in special classes in school. The NC School of Science and Math, then NCSU, then UNC School of Medicine, then residency and chief residency in Emergency Medicine at SUNY-Brooklyn.
Actually I suspected you were a troll from your 2nd post about Cayce and because you are modding your own posts up with your other account (which must currently have mod points). However I also suspect with someone who has such a weak ego and so much time on his hands (like searching to find the single document that included all of my references about Cayce's head being up his ass) you might have an axe to grind the size of Wisconsin. Of course after having your ass handed to you, a coping mechanism might be claiming your posts were trolling.
Whatever slays your dragon, honey.
Incidentally, I saw WTC7 fall with my own eyes. I was chief resident in Emergency Medicine at Brooklyn's largest trauma center and NYPD was driving me and 6 other physicians and nurses to south of Canal to help. After we crossed the Brooklyn bridge I looked to my left and saw the top of WTC7 quiver then the whole thing collapsed.
I've met Randi too (once after a lecture) and I thought he was quite intelligent and funny. Sort of Jon Stewart of science rather than politics.
And I was the gunman on the grassy knoll too. (OK that last one was a lie.)
I've read about Cayce before. I actually remembered the Atlantis comment and certainly remembered that he'd come up with some total whackjob treatments. Though the remainder of the specifics was from:
And I'm sooooooo truly disappointed that you aren't impressed. However, when deciding who is trusting secondary sources you might want to consider: I don't have to ask my doctor since I am one and can read the research and judge for myself as well as using my own clinical experience. Now, I do ask my doctor because I value her judgment too and it nice to have that second opinion. What I don't do however, is listen to every half-baked conspiracy theorist and whack-job like yourself that thinks that putting eye-of-newt and a pinch of the hair of a newborn baby in a poultice made during the full moon is going to do jack shit.
But please feel free to further embarrass yourself: Cayce, Area 51, can I get a 'Gunman on the grassy knoll'?
Oh my goodness, aren't we pure. Never have a wicked thought, eh? I suspect you can't see race either, do you? Or perhaps its that you don't have to see the lives destroyed by discrimination and prejudice like this? Live in a nice secluded upper-middle-class neighborhood and the only people of color you see are ones who are essentially from the same SES as you, do we?
Nope. I don't buy the PollyAnna crap dude. And having been a victim of such violence... though largely now as a witness to other's suffering, I can tell you it royally torques my nads.
Maybe on TV.... but from my experience as an ER physician, I can tell you bullets may not mean certain death, but they are a damn sight more effective than blunt trauma or low velocity penetrating trauma.
But then death is only one of the horrible things that guns can do. Personally I think being a C3 quad would be worse than death. And I've seen many spinal cord injuries from guns but few from knives or fists. Go figure.
Though one thing that the gun nuts do say is absolutely correct: Guns don't kill people. Its the gaping holes in vital organs, exsanguinating hemorrhage, and ultimately cardiac arrest in the face of overwhelming shock produced by the bullets propelled by the guns that actually kills people. So we should address this problem at the real source: Physics!
Absolutely correct and shown by numerous real world (Abu Ghraib) and even a couple of experimental situations like the Stanford Prison Experiment. Some of the 'animals' who perpetrated crimes against the other prisoners in the SPE were exactly the same kind of college kids who died today.
It is precisely what was described by Hannah Arendt in Eichmann in Jerusalem: A Report on the Banality of Evil
Its people who think they could never ever do that who are the most dangerous.
Um... are we talking about the same Cayce who predicted (while channeling in trance) that in 1958 the US would discover the Death Ray that was used in Atlantis? The same one who said that China would be converted to Christianity by 1968? The same one who prescribed "bedbug juice" for heart failure, "fumes of apple brandy from a charred keg" for tuberculosis, and "the raw side of a freshly skinned rabbit, still warm with blood, fur side out, placed on the breast" for breast cancer.
Thanks, but I'll take a PPI for my ulcer and if I ever got breast cancer, I gotta say I'd go with Paclitaxel over bleeding bunny fur any day. The brandy thing... well maybe if I could drink it and not just inhale.
I was waiting to listen to Jon Stewart or perhaps Keith Olbermann to find out which fucknut had said the most offensive thing about this in the first 24 hours. But I find it within hours on slashdot.
If you were not posting as an anonymous coward I would suggest that for every single minority student was killed in that shooting, I should be able to fill a 2 liter bottle with piss and make you drink it.
If there was a single Asian student among the dead, I should be able to shit on a plate and force you to eat it.
He was just bullshitting you. The brain controls a lot of stuff in the body, and it certainly modulates blood pressure significantly. However, there isn't a single part of the brain that controls BP to that extent that you can damage with a concussion. However, what is more likely (and common) is that despite starting with a low BP, your mom aged and developed age related hypertension which was first discovered when she had a visit due to the injury.
Death from bleeding gastric ulcers was quite common historically. Ulcers were so life-threatening that surgery to remove them was fairly common as the benefit of removing the ulcer outweighed the risk of major abdominal surgery. There was a decrease in incidence when we got better sanitation, but there was also a significant drop in the 80's when we got the H2RAs, learned to eradicate H. Pylori, and eventually got the PPIs.
I'm a GP and an ER physician and went to school in the 90s (after the era of modern ulcer treatment.) I have seen a LOT of bleeding ulcers. I can't remember a death from an ulcer causing a GI bleed in any of my patients. Period. I also don't remember having seen ulcer surgery on anyone who is my age or younger. You just never see it anymore because its so rarely needed.
I also had a gastric ulcer from H. Pylori. I took triple therapy, missed exactly zero doses of medicine, and had a full cure. The biggest issue with eradication therapy in my experience is getting people to be compliant with the whole treatment. (Its not easy... especially shitting those special bismuth turds.) And what happens when you don't take the antibiotic correctly? Resistance.
I volunteer at a hippy clinic in San Francisco 2 days a week where I treat a disproportionately hippy population. And among this hippy population I have a number of thin, vegan, yoga-types who have: hypertension, hypercholesterolemia, etc. Making good choices is part of the battle, but unfortunately you can't choose your parents.
The one thing I will say is that hippies with hypertension are much less likely to have well controlled hypertension. They are much more likely to insist that if they do X more yoga or eat Y more fiber they can get their BP under control. Unfortunately thats usually not possible. So they refuse to take old, safe, cheap medicines like atenolol because they see their hypertension as a personal failure.
Take medicines when they are necessary and helpful, but not when they aren't either. My best rule of thumb is that you are allowed one chronic medicine for every decade you are old - if you are taking more than that without good reason (like having HIV, heart failure, etc), you probably need to prune the medicines bush a bit.
Well if you had a single meningococcus adhere to that blood vessel and try to squeeze its way through the blood brain barrier (that would result in fatal meningitis,) you'd want to be able to have a way to call WBCs to the area to kill it before it decides to start reproducing.
We are not disbarring the firm, only the supervising attorney. Your work (especially as a corp) was spread out among all the associates of the firm. Maybe you don't go out to lunch with Jack (Now Jill manages your account) but the firm still represents you.
As a doctor you have a 1-to-1 relationship with the patient.
Maybe if you watch "Marcus Welby, MD" reruns. But that is not the norm for many people in the US. If you see a solo practitioner, you see your doctor in her office. However, typically today you see a physician in a multi-provider practice. You may have a primary assigned doc, but are very likely to be seen by other providers in the group.
This is just like with legal practice, with most people are in larger multi-provider practices, while some are in solo practice. Either way its the same if you remove a doctor or a lawyer from their practice. Those for whom Joe was the lawyer or doctor will feel a loss if he's gone because he was the most familiar with their case. If Joe is in a large group, his partners will take over the case, but that is not preferable if Joe is the lawyer who was working on your custody case or the doctor who was treating your asthma. If Joe was a solo practitioner though, you are totally fucked, since you now have to start from scratch with a new provider.
Also, how is making a mistake when advising someone whether their kid needs a CT for a bump on the head different from making a mistake when advising someone to sue? You admit that the reason these suits may be undertaken are because an attorney did not know (whether through not getting all the facts, not digesting them, not drawing the right conclusions from that data, not knowing enough about the law itself, etc.) that the case was frivolous. So how is that different from me not getting all the facts about a kid's head injury, not taking time to digest what I've heard, not putting the data together correctly, or just not knowing the evidence that tells us when we need to do a CT?
The basic argument is that if you levy draconian punishments against professionals for making errors we can force them to not make them. That is as doomed to fail with attorneys as it is with physicians or any other professional. It will change behavior, just not in the way you think.
The big issue is a slippery slope of indications. Its not totally unneeded surgery that is the issue, but 'not quite so needed' surgery. And that's something you can't really regulate (or even detect) easily. The decision to get a procedure is a risk/benefit calculation and its dependent on where the balance of the scale is. Some guy who is really doing flat out non-indicated procedures is an easy mark, but those are pretty rare compared with the ones who shift the balance just slightly.
But then part of that very problem is the malpractice system in the first place. Why do you think so many women get C-sections? Because no one ever sues you for the C-section you do. But if you are more conservative, the one time the baby does badly and you don't do a section, you are fucked. Same thing with a cardiologist: say you have a patient with chest pain that has really weak indications for doing an angiogram. If you do one and its clean that's great. The patient incurs a slight risk from the cath, and it costs several thousand dollars, but you wont be faulted for being 'careful'. However if you don't do one, eventually you are going to send someone away and they will have a heart attack the next week, at which point you are again, fucked. The system is set up for people to me more aggressive, send too many tests, do too many procedures, and prescribe too many antibiotics. In the US we are set up to not reward the avoidance of false positives but we severely punish getting a single false negative. So its no wonder cardiologists are loose with the caths and gynecologists with the sections.
You want an easier target that is both readily regulated and will seriously decrease unnecessary treatments? Outlaw physician drug detailing and advertisement for drugs in the popular media. More people are harmed with unnecessary drugs than with unnecessary surgery. Yet we allow some of the most dangerous drugs (those most recently approved) to be advertised like they are Taco Bell or an iPod.
Then use a "three strikes" law. If it's good enough for punishing criminals, it's good enough for punishing lawyers.
Who said three strikes laws are good? Um, putting people in jail for the rest of their lives for passing a bad check is idiotic (not to mention a wast of tax-dollars). Just because we have one fucked up law, that doesn't mean that we should make all of our laws equally fucked up.
And if you used a three strikes law for malpractice claims you can just add the words 'practicing for 10 years' to my previous statement about physicians. The average OB/Gyn has over a dozen suits in their practice lifetime (which starts at age 30 if you go straight through hs to college to med school to residency. Which means that is a suit every few years.) So if you actually want a doctor to deliver your baby, you might want to reconsider that statement.
Except we're talking about the specific act of initiating a frivolous lawsuit. If the cost of initiating lawsuits goes up as a result of the lawyer being forced to be extremely careful, then good! It'll mean that the lawsuits that do get initiated will have much more solid footing. Just like they should.
No, it means that we will have less lawsuits period. If the cost of entering the game is higher then fewer people will play. However, who plays is largely determined by who has enough money to enter rather than who has s legitimate claim.
While I have a natural aversion to lawyers as a physician... this kind of suggestion is about as useful as the idea of revoking the license of physicians who lose a malpractice lawsuit. It might seem like a way to prevent errors, but its not going to work out the way you think.
Doing so in either case will have a lot of consequences that we would all not like:
1) Other clients/patients of the guy who loses his licensure will suffer the loss of the relationship and professional services they get. You might think that no one would want to see a lawyer or doctor who had lost a malpractice case, but if that was the case the majority of physicians in the US would not be practicing today.
2) Every professional by virtue of being a human being will make honest mistakes. Punishing single mistakes by completely destroying that professional's ability to practice will lead to a shortage of people willing to enter that field as well as a shortage of people willing to take the difficult cases in that field. (I can tell you I would never have entered Emergency Medicine where I cannot choose who I will and won't see had this been the case.)
3) If you are defending your own ability to practice (and perhaps your children's livelihood) you are going to go to extremes in order to protect it. If I was under this kind of pressure the amount of defensive medicine I (and every other physician) practice would go through the roof meaning increased costs, unnecessary tests, unnecessary antibiotics, etc. I suspect the same would be the case for lawyers if you pressed them to that extreme.
So while it may seem like it would help to levy draconian punishments for medical or legal malpractice, if you have that sort of system, you won't be happy with the results.
That doesn't mean that you should not use those kind of extreme punishments against professionals who are habitual douchebags. It also doesn't mean you should not levy punishments for errors. But it does mean that you shouldn't punish people innocent of any wrongdoing (the lawyer's other clients) and you should not extract unreasonable punishments for common mistakes.
It makes perfect sense if you realize that identical in the colloquial sense means something different from the scientific sense.
Its like the word normal with regards to statistics or common usage: Being a lefty, red-headed, or type AB- blood may be on the tail end of the bell curve, but they are not 'abnormal' in the colloquial sense.
Intersex is not the same thing as a hermaphrodite. All hermaphrodites are intersex, but the vast majority of intersex people are not hermaphrodites. To be a human hermaphrodite, you have to have ovarian and testicular tissue in the same person. Most people who are intersex have only ovarian OR testicular tissue. Instead of having both types of gonads there is some problem with sexual development in the womb that results in a person with physical characteristics somewhere on the spectrum between the poles of male and female bodies. (Hence the newer term for intersex conditions: DSD or disorder of sex development.)
More importantly, if you call a person who is intersex a hermaphrodite many will likely be quite unhappy with you. Its akin to calling a Native American an 'Indian' - not only generally disliked by the people you are labeling but also factually incorrect because of a misunderstanding of what the term means (or on what continent you are located.)
OK, and I object to your use of my tax-payer funded roads for doing things like driving to the beach or bar. So we'll be placing a GPS unit in your car and for all travel that is not necessary for work/school/church, you'll be surcharged $0.10 per mile.
And while we are at it, why don't we address the issues of this 'fun' occurring in public schools that my niece has be telling me about. Something about development of social whatever... sorry, if its not reading, writing, math, or a marketable skill, I don't want my tax dollars paying for that. Valentine's Day party my ass!
Not only will scientists have produced a more robust mosquito that multiplies faster, but we'll also find new strains of malaria living in them and passing on. This isn't a maybe, it's going to happen.
That's absurd. All of this is a maybe. Evolution occurs through natural selection of random mutations. Nature isn't intelligently designing things that work best in an evolutionary arms race, but when beneficial mutations randomly occur, the certainly stay around longer. Moreover, not every trait that helps an organism necessarily confers a complete survival advantage. Having one copy of the sickle cell mutation of the beta hemoglobin gene confers a survival benefit in malaria endemic areas. But it also means that your kids may die from SSA, so its not entirely beneficial.
For example, penicillin resistance occurred in Staph aureus, and is now very common. However group A Strep is still exquisitely sensitive to penicillin after decades of use. If evolution of bacteria to be penicillin resistant was inevitable, you wouldn't still get penicillin for Strep throat after over 6 decades of use.
Slashdot Mirror
Great idea! So since the majority of drugs brought to market by Pharma are discovered in research that is primarily funded by public funds, the public should own the patent. And as a member of the public, I vote that Brazil can make Elfavirenz on the house. All in favor?
The first effective HIV drug, AZT is a great example. 90% of the money that went into discovery and bringing AZT to market was NIH and other federal grant money and then Glaxo-Wellcome (I believe Burroughs-Wellcome at the time) stepped in, frosted the cake, and walked away with a blockbuster drug courtesy of you and me.
Not that Pharma doesn't spend a lot of money: most of it is drug detailing and direct to consumer marketing (which makes up a larger proportion of every large pharmaceutical corporation's budget than research.) You should see some of the shit I get offered... plastic pancreas laser pointers don't grow on trees you know!
Actually the primary reasoning for the change was largely to keep it simple. This means there is ONE ratio to remember for all lay-rescuer (single person) CPR for anyone that is not an infant.
There is not a single 'ideal' compression to ventilation ratio. We know that for garden variety cardiac arrest due to V-Fib, ventilation in the first minute or so is probably almost meaningless. We also know that for hypoxic arrests (like a drowning) that ventilation is far more important. We also know that VFib makes up a greater percent of adult arrests and hypoxic arrests are more common in kids (all of whom get the same ratio.) Moreover the AHA made this decision knowing that they didn't even know the ideal ratio for the single most common type of arrest in the community (from VFib.) The 30:2 ratio was a way of keeping it simple that is not perfect for every kind of arrest, but is a reasonable compromise to try to deliver at least a reasonably acceptable type of CPR to all victims of arrest.
That is a good thing for lay-rescuers, but the AHA understands that people who are more highly trained and knowledgeable will guide their actions based on that knowledge. For example, if my partner grabbed his chest and collapsed, I would run to the phone, call 911. Return to him, check for a pulse, and if he had none, start wailing on his chest like a crazed weasel on crack. I would not even consider breaking compressions to give a breath till at least minutes had passed - or more trained people arrived and ACLS could be initiated. If however, I pulled him out of a pool, I would check for breathing and if none, give two full rescue breaths. Then check for a pulse, if none, start CPR with probably about a 15-20:2 ratio. I would stop for a moment at 1 minute. If he had a pulse, I would continue breathing for him a full minute or two before I ran to the phone. If he had no pulse, I would give two last breaths and run for the phone.
Those are drastically different methods that I chose knowing that they would give him the best chance in either situation. But if you try to teach lay-rescuers that, you will get blank stares and some shitty-assed CPR. So it is better to make things as simple as possible and make them so at least everyone gets 'reasonable' CPR.
Nick
For the same reason that if a river runs through my property onto yours, I can't damn up the river on my property. Actions I take on my land may directly affect yours and so we have a vested interest in negotiation use of that river so I don't starve you and you don't come to my home and shoot me.
I read other (obviously inferior) news sites, and when some idiot like the poster to which you replied mentions Herbal Medicines people lose their shit with how safe, natural, and effective the carbonated weasel urine the witchdoctor down the street uses. (Medicines not drugs... So the FDA can't regulate it since it is only a medicine and not a drug. Duh!)
On a bad day, I engage. On a good day I mutter to myself and go kick a dog or something.
So I clicked this link and... Ooooohhh.... yeeeessssss.... WONDERFUL! All the smart people were modded up, and the idiots modded down. AND you threw in a Scientology dig to start it off too. You have made my week.
Nah, don't need to mod you down, honey. You did that yourself.
Though I will admit I was in special classes in school. The NC School of Science and Math, then NCSU, then UNC School of Medicine, then residency and chief residency in Emergency Medicine at SUNY-Brooklyn.
So that's Doctor Faggot to you, asshole.
Actually I suspected you were a troll from your 2nd post about Cayce and because you are modding your own posts up with your other account (which must currently have mod points). However I also suspect with someone who has such a weak ego and so much time on his hands (like searching to find the single document that included all of my references about Cayce's head being up his ass) you might have an axe to grind the size of Wisconsin. Of course after having your ass handed to you, a coping mechanism might be claiming your posts were trolling.
Whatever slays your dragon, honey.
Incidentally, I saw WTC7 fall with my own eyes. I was chief resident in Emergency Medicine at Brooklyn's largest trauma center and NYPD was driving me and 6 other physicians and nurses to south of Canal to help. After we crossed the Brooklyn bridge I looked to my left and saw the top of WTC7 quiver then the whole thing collapsed.
I've met Randi too (once after a lecture) and I thought he was quite intelligent and funny. Sort of Jon Stewart of science rather than politics.
And I was the gunman on the grassy knoll too. (OK that last one was a lie.)
Um, no.
I've read about Cayce before. I actually remembered the Atlantis comment and certainly remembered that he'd come up with some total whackjob treatments. Though the remainder of the specifics was from:
http://skepdic.com/cayce.html http://www.straightdope.com/mailbag/mcayce.html http://psychicinvestigator.com/demo/ReinSkp4.htm (James Randi) http://en.wikipedia.org/wiki/Edgar_Cayce (mostly the links)
And I'm sooooooo truly disappointed that you aren't impressed. However, when deciding who is trusting secondary sources you might want to consider: I don't have to ask my doctor since I am one and can read the research and judge for myself as well as using my own clinical experience. Now, I do ask my doctor because I value her judgment too and it nice to have that second opinion. What I don't do however, is listen to every half-baked conspiracy theorist and whack-job like yourself that thinks that putting eye-of-newt and a pinch of the hair of a newborn baby in a poultice made during the full moon is going to do jack shit.
But please feel free to further embarrass yourself: Cayce, Area 51, can I get a 'Gunman on the grassy knoll'?
Oh my goodness, aren't we pure. Never have a wicked thought, eh? I suspect you can't see race either, do you? Or perhaps its that you don't have to see the lives destroyed by discrimination and prejudice like this? Live in a nice secluded upper-middle-class neighborhood and the only people of color you see are ones who are essentially from the same SES as you, do we?
Nope. I don't buy the PollyAnna crap dude. And having been a victim of such violence... though largely now as a witness to other's suffering, I can tell you it royally torques my nads.
Fuck him.
Maybe on TV.... but from my experience as an ER physician, I can tell you bullets may not mean certain death, but they are a damn sight more effective than blunt trauma or low velocity penetrating trauma.
But then death is only one of the horrible things that guns can do. Personally I think being a C3 quad would be worse than death. And I've seen many spinal cord injuries from guns but few from knives or fists. Go figure.
Though one thing that the gun nuts do say is absolutely correct: Guns don't kill people. Its the gaping holes in vital organs, exsanguinating hemorrhage, and ultimately cardiac arrest in the face of overwhelming shock produced by the bullets propelled by the guns that actually kills people. So we should address this problem at the real source: Physics!
Absolutely correct and shown by numerous real world (Abu Ghraib) and even a couple of experimental situations like the Stanford Prison Experiment. Some of the 'animals' who perpetrated crimes against the other prisoners in the SPE were exactly the same kind of college kids who died today.
It is precisely what was described by Hannah Arendt in Eichmann in Jerusalem: A Report on the Banality of Evil
Its people who think they could never ever do that who are the most dangerous.
Yes, Jay. We exist. We stand up to bigots who refer to people as 'gooks', 'niggers', 'faggots', 'spics' etc.
In fact, we aren't always nice about it either. Some of us call ignorant racist fuckwits (like the aforementioned one) exactly as we see them.
Um... are we talking about the same Cayce who predicted (while channeling in trance) that in 1958 the US would discover the Death Ray that was used in Atlantis? The same one who said that China would be converted to Christianity by 1968? The same one who prescribed "bedbug juice" for heart failure, "fumes of apple brandy from a charred keg" for tuberculosis, and "the raw side of a freshly skinned rabbit, still warm with blood, fur side out, placed on the breast" for breast cancer.
Thanks, but I'll take a PPI for my ulcer and if I ever got breast cancer, I gotta say I'd go with Paclitaxel over bleeding bunny fur any day. The brandy thing... well maybe if I could drink it and not just inhale.
This is news for nerds, dude. Not for nuts.
I was waiting to listen to Jon Stewart or perhaps Keith Olbermann to find out which fucknut had said the most offensive thing about this in the first 24 hours. But I find it within hours on slashdot.
If you were not posting as an anonymous coward I would suggest that for every single minority student was killed in that shooting, I should be able to fill a 2 liter bottle with piss and make you drink it.
If there was a single Asian student among the dead, I should be able to shit on a plate and force you to eat it.
He was just bullshitting you. The brain controls a lot of stuff in the body, and it certainly modulates blood pressure significantly. However, there isn't a single part of the brain that controls BP to that extent that you can damage with a concussion. However, what is more likely (and common) is that despite starting with a low BP, your mom aged and developed age related hypertension which was first discovered when she had a visit due to the injury.
Death from bleeding gastric ulcers was quite common historically. Ulcers were so life-threatening that surgery to remove them was fairly common as the benefit of removing the ulcer outweighed the risk of major abdominal surgery. There was a decrease in incidence when we got better sanitation, but there was also a significant drop in the 80's when we got the H2RAs, learned to eradicate H. Pylori, and eventually got the PPIs.
I'm a GP and an ER physician and went to school in the 90s (after the era of modern ulcer treatment.) I have seen a LOT of bleeding ulcers. I can't remember a death from an ulcer causing a GI bleed in any of my patients. Period. I also don't remember having seen ulcer surgery on anyone who is my age or younger. You just never see it anymore because its so rarely needed.
I also had a gastric ulcer from H. Pylori. I took triple therapy, missed exactly zero doses of medicine, and had a full cure. The biggest issue with eradication therapy in my experience is getting people to be compliant with the whole treatment. (Its not easy... especially shitting those special bismuth turds.) And what happens when you don't take the antibiotic correctly? Resistance.
I volunteer at a hippy clinic in San Francisco 2 days a week where I treat a disproportionately hippy population. And among this hippy population I have a number of thin, vegan, yoga-types who have: hypertension, hypercholesterolemia, etc. Making good choices is part of the battle, but unfortunately you can't choose your parents.
The one thing I will say is that hippies with hypertension are much less likely to have well controlled hypertension. They are much more likely to insist that if they do X more yoga or eat Y more fiber they can get their BP under control. Unfortunately thats usually not possible. So they refuse to take old, safe, cheap medicines like atenolol because they see their hypertension as a personal failure.
Take medicines when they are necessary and helpful, but not when they aren't either. My best rule of thumb is that you are allowed one chronic medicine for every decade you are old - if you are taking more than that without good reason (like having HIV, heart failure, etc), you probably need to prune the medicines bush a bit.
Well if you had a single meningococcus adhere to that blood vessel and try to squeeze its way through the blood brain barrier (that would result in fatal meningitis,) you'd want to be able to have a way to call WBCs to the area to kill it before it decides to start reproducing.
This is just like with legal practice, with most people are in larger multi-provider practices, while some are in solo practice. Either way its the same if you remove a doctor or a lawyer from their practice. Those for whom Joe was the lawyer or doctor will feel a loss if he's gone because he was the most familiar with their case. If Joe is in a large group, his partners will take over the case, but that is not preferable if Joe is the lawyer who was working on your custody case or the doctor who was treating your asthma. If Joe was a solo practitioner though, you are totally fucked, since you now have to start from scratch with a new provider.
Also, how is making a mistake when advising someone whether their kid needs a CT for a bump on the head different from making a mistake when advising someone to sue? You admit that the reason these suits may be undertaken are because an attorney did not know (whether through not getting all the facts, not digesting them, not drawing the right conclusions from that data, not knowing enough about the law itself, etc.) that the case was frivolous. So how is that different from me not getting all the facts about a kid's head injury, not taking time to digest what I've heard, not putting the data together correctly, or just not knowing the evidence that tells us when we need to do a CT?
The basic argument is that if you levy draconian punishments against professionals for making errors we can force them to not make them. That is as doomed to fail with attorneys as it is with physicians or any other professional. It will change behavior, just not in the way you think.
Nick
The big issue is a slippery slope of indications. Its not totally unneeded surgery that is the issue, but 'not quite so needed' surgery. And that's something you can't really regulate (or even detect) easily. The decision to get a procedure is a risk/benefit calculation and its dependent on where the balance of the scale is. Some guy who is really doing flat out non-indicated procedures is an easy mark, but those are pretty rare compared with the ones who shift the balance just slightly.
But then part of that very problem is the malpractice system in the first place. Why do you think so many women get C-sections? Because no one ever sues you for the C-section you do. But if you are more conservative, the one time the baby does badly and you don't do a section, you are fucked. Same thing with a cardiologist: say you have a patient with chest pain that has really weak indications for doing an angiogram. If you do one and its clean that's great. The patient incurs a slight risk from the cath, and it costs several thousand dollars, but you wont be faulted for being 'careful'. However if you don't do one, eventually you are going to send someone away and they will have a heart attack the next week, at which point you are again, fucked. The system is set up for people to me more aggressive, send too many tests, do too many procedures, and prescribe too many antibiotics. In the US we are set up to not reward the avoidance of false positives but we severely punish getting a single false negative. So its no wonder cardiologists are loose with the caths and gynecologists with the sections.
You want an easier target that is both readily regulated and will seriously decrease unnecessary treatments? Outlaw physician drug detailing and advertisement for drugs in the popular media. More people are harmed with unnecessary drugs than with unnecessary surgery. Yet we allow some of the most dangerous drugs (those most recently approved) to be advertised like they are Taco Bell or an iPod.
Nick
And if you used a three strikes law for malpractice claims you can just add the words 'practicing for 10 years' to my previous statement about physicians. The average OB/Gyn has over a dozen suits in their practice lifetime (which starts at age 30 if you go straight through hs to college to med school to residency. Which means that is a suit every few years.) So if you actually want a doctor to deliver your baby, you might want to reconsider that statement.
No, it means that we will have less lawsuits period. If the cost of entering the game is higher then fewer people will play. However, who plays is largely determined by who has enough money to enter rather than who has s legitimate claim.
Nick
While I have a natural aversion to lawyers as a physician... this kind of suggestion is about as useful as the idea of revoking the license of physicians who lose a malpractice lawsuit. It might seem like a way to prevent errors, but its not going to work out the way you think.
Doing so in either case will have a lot of consequences that we would all not like:
1) Other clients/patients of the guy who loses his licensure will suffer the loss of the relationship and professional services they get. You might think that no one would want to see a lawyer or doctor who had lost a malpractice case, but if that was the case the majority of physicians in the US would not be practicing today.
2) Every professional by virtue of being a human being will make honest mistakes. Punishing single mistakes by completely destroying that professional's ability to practice will lead to a shortage of people willing to enter that field as well as a shortage of people willing to take the difficult cases in that field. (I can tell you I would never have entered Emergency Medicine where I cannot choose who I will and won't see had this been the case.)
3) If you are defending your own ability to practice (and perhaps your children's livelihood) you are going to go to extremes in order to protect it. If I was under this kind of pressure the amount of defensive medicine I (and every other physician) practice would go through the roof meaning increased costs, unnecessary tests, unnecessary antibiotics, etc. I suspect the same would be the case for lawyers if you pressed them to that extreme.
So while it may seem like it would help to levy draconian punishments for medical or legal malpractice, if you have that sort of system, you won't be happy with the results.
That doesn't mean that you should not use those kind of extreme punishments against professionals who are habitual douchebags. It also doesn't mean you should not levy punishments for errors. But it does mean that you shouldn't punish people innocent of any wrongdoing (the lawyer's other clients) and you should not extract unreasonable punishments for common mistakes.
Nick
It makes perfect sense if you realize that identical in the colloquial sense means something different from the scientific sense.
Its like the word normal with regards to statistics or common usage: Being a lefty, red-headed, or type AB- blood may be on the tail end of the bell curve, but they are not 'abnormal' in the colloquial sense.
Nick
Intersex is not the same thing as a hermaphrodite. All hermaphrodites are intersex, but the vast majority of intersex people are not hermaphrodites. To be a human hermaphrodite, you have to have ovarian and testicular tissue in the same person. Most people who are intersex have only ovarian OR testicular tissue. Instead of having both types of gonads there is some problem with sexual development in the womb that results in a person with physical characteristics somewhere on the spectrum between the poles of male and female bodies. (Hence the newer term for intersex conditions: DSD or disorder of sex development.)
More importantly, if you call a person who is intersex a hermaphrodite many will likely be quite unhappy with you. Its akin to calling a Native American an 'Indian' - not only generally disliked by the people you are labeling but also factually incorrect because of a misunderstanding of what the term means (or on what continent you are located.)
Nick
OK, and I object to your use of my tax-payer funded roads for doing things like driving to the beach or bar. So we'll be placing a GPS unit in your car and for all travel that is not necessary for work/school/church, you'll be surcharged $0.10 per mile.
And while we are at it, why don't we address the issues of this 'fun' occurring in public schools that my niece has be telling me about. Something about development of social whatever... sorry, if its not reading, writing, math, or a marketable skill, I don't want my tax dollars paying for that. Valentine's Day party my ass!
Nick
For example, penicillin resistance occurred in Staph aureus, and is now very common. However group A Strep is still exquisitely sensitive to penicillin after decades of use. If evolution of bacteria to be penicillin resistant was inevitable, you wouldn't still get penicillin for Strep throat after over 6 decades of use.
Nick