There are two reasons why ER care is financially backed by the government. The first is a moral, no one should be allowed to die just because they are down on their luck. In that sense, your distinction is valid. Um, emergency care (in the US) is not financially backed by the government. It is mandated but paying for it isn't. The EMTALA law says if you come to the ER and have an emergency medical condition, I have to provide you with a medical screening exam and any emergent and necessary care. However if you don't have money, are uninsured, and you can't get retroactive Medicaid, I don't get paid.
EMTALA is an unfunded mandate that says that the nurses who work in an ER, the hospital who runs the ER, and ER physicians like me have to pay for uninsured emergency care. It takes a segment of the US economy and says we have to take responsibility for and subsidize what everyone else doesn't. That cheap McDonalds hamburger you ate today that is less expensive because McDonalds doesn't offer health insurance? I paid for a part of that.
Of course I am thankful for EMTALA every time that I use it to force a surgeon to take the appendix out of an uninsured teenager. I also feel that I am paid quite well enough even though about 30% of the ER care and 50% of the overall care I provide is uncompensated (I volunteer two days a week at a low income clinic that sees a lot of uninsured patients so that bumps the % up.) However overall I hate EMTALA precisely because its used as a crutch: I'm sure Bush slept very well at night after vetoing SCHIP because he thinks that every American gets health care since even if we are uninsured we can go to the ER (where most of the care people need - like prevention and treatment of chronic disease can't be done).
If you don't want to pay the cost associated with my behavior, then don't pay it. If I overdose on drugs, let me lay there and die if I don't have insurance or can't pay the bill myself if you so choose. But your actions in assuming responsibility for my debts don't give you any legitimate authority over my behavior. I am always amused by these sorts of comments... and its not just yours, but the whole lot of the comments about letting people suffer and die if they are uninsured and in some way bear responsibility for their injuries.
That sentiment and $4 will get you a cup of Starbucks coffee. I defy any of you who talk so tough to spend a Saturday night in the ER with me and then tell me not to aid someone dying of an overdose or because they didn't wear a bike helmet, or because they have a spare tire and are having a heart attack. Or better yet, we'll do that with one of the local college kids whose health insurance doesn't pay for any of their alcohol related ER visits. When a 19 year old girl who is someone's daughter is choking on her own vomit because she doesn't have the experience to drink responsibly and got shit faced... you tell me to let her turn blue, stop breathing, and go into cardiac arrest. And after, I will let you have the pleasure of telling her weeping parents that we just let that happen because its her own fault.
You are all so full of shit and bluster you make Ann Coulter seem reasonable. Not a single one of you would have the balls to do that, and would likely be cowering in the corner screaming at me to do something! while you wet your pants.
That said, I do think that we as a society have a right to make non-punitive behavior modification strategies to improve the overall function of society. That means we should decriminalize drug use. However then spend the same money on drug treatments, prevention, and mandating treatment for dangerous behaviors (if you end up in the ER overdosed, drive stoned, etc. we should be able to force you to seek some sort of drug treatment.) Like everything else, black and white don't cut it. Locking up people for 20 years for smoking a doobie is as retarded as making heroin available to anyone at the 7-11.
And I thought I was just a hypertensive who takes atenolol (a beta blocker like inderal.) What makes it even better is that I usually write my own rx for atenolol (largely since its easier than getting one from my doctor and its perfectly legal for non-scheduled drugs.)
Ooooh! I am a druggie. A rebel. D-d-d-dangerous and hip! This is so SCHWEET!
And if atenolol is drug abuse, I am sure its just a gateway drug for me... next thing you know I will be freebasing lipitor!
Probably because everything that exists today was influenced by everything that took place in the past. Some traits are probably just random mutations that neither increased nor decreased the chances for survival - human handedness, hair/eye color, ear shape... these have few impacts on survival save some extreme conditions. Until science can come up with a good reason why most of us are right handed, I doubt one could really call it evolution, rather random mutation. No, its still evolution. Even if we don't know the utility of something, that is no reason to believe that its not the product of evolution. For example, quite recently we discovered the reason why we have an appendix (other than to make my life as an ER doctor a living hell.) However 5 years ago, if you asked any evolutionary biologist they would have still said that the appendix is a product of evolution. It would be like suggesting that gravity wasn't really there until Newton described it.
Of course that just made my tee shirt with the picture of a colon with an appendix saying: "Intelligent design? OK, show me the elegant design of my appendix" just that much more cool.
Or conversely, alligators as a species have always had these antibiotics. Why is it that every interesting or perplexing feature about a species must be somehow attributed to, or be a product of, evolution? Um, because every perplexing feature of a species is a product of evolution. Unless you feel that "alligators as a species [sic]" somehow were magically created with the wave of some supernatural creator's wand, then there is no way that they can have 'always been there' except as a product of the evolution of the genus.
I'm as much a believer in evolution as the next, but I've grown a bit tired of every amazing discovery being associated with evolution. No you aren't. You are a creationist theo-tard who is trying to utilize feigned credibility as a real scientists to make his ignorant claims have some reasonableness.
Thanks for playing. And by the way, alligators are a genus, not a species.
On the other hand, especially in the US we do have a severe prevalence of toxic chemicals floating around. Like oxygen and water - both of which can kill you in sufficient quantities. Of course pretty much everything is toxic in too high concentration, so your statement is nonsensical.
But you claim that they cannot tell the difference between a puff of air and a puff of the compound, which they necessary must be able to smell. Either you are not explaining yourself very well, the study you cite is flawed beyond belief, or you are full of shit. Perhaps you are leaving something critical out; perhaps the study does not operate from the realization that larger quantities of a compound sometimes need to be ingested per unit of time to cause a reaction; perhaps you are just making things up. I doubt the last one. I wonder which of the first two is the case. I will give you that I probably should have explained in further detail. So the basic point is that people who feel they are chemically sensitive do not have the reaction unless they can smell or see the offending agent (i.e. they know its there.) If you take someone with MCS and put their hand in a box they cannot see. Then you spray it ten times at ten minute intervals - 9 with a puff of CO2 and once with a puff of something they have listed they are sensitive to, they are unable to determine which was the puff of sensitive compound unless they can smell it or see it. The exposure alone to the compound doesn't elicit the response. Worse, if you 'weight the deck' that is, if you do say 4 puffs in succession, then the operator looks like he is doing something (that the subject perceives may be loading the 'toxic compound' into the machine) they quite reliably indicate that the next puff is the toxin despite the fact that the toxin was done as puff 1 or puff 10.
I regularly go out and end up being straight up choked by some chick's toxic, artificial perfume. It's gotten to be where I almost won't go out to eat any more because I can't finish a meal without some bitch stinking me out of my seat. And you have personified the issue with MCS: confusion of don't like with allergic to.
But lets say that its only a sensitivity when your nose is exposed to the toxin. Then wear a pair of swimming nose clips so you don't get exposed in your sensitive area, rather than expecting everyone else in society to cater to your dislikes... er I mean chemical sensitivity. I have a severe allergy to a certain medication, such that I've had anaphlaxis to just the dust from the pill. I don't make the rule that people in my clinic can't have that medicine, but I do carry an Epi-Pen (also because I have anapylaxis to hymenoptera.) I accept the inconvenience of lugging the pen with me because it is unreasonable for me to expect otherwise (and bees seem to love me) - just as you should not unreasonably expect the 'bitch' whose perfume you dislike to go without it because it smells bad and you work yourself into a snit complete with coughing since you feel it ruins your dinner. And perhaps if you stopped referring to women as 'bitches' and 'chicks' you might get a better response if you ask them to refrain from using scents you dislike?
People who complain of RF sensitivity are in the same category as people who complain of Multiple Chemical Sensitivity. They really do suffer from a disease that causes real symptoms. However the disease they have is a form of panic attack - which can in the case of MCS especially progress to something akin to agoraphobia. When you test people who are labeled as having MCS in a blinded fashion to things they are sensitive to, they don't get triggered any more often than placebo. (Expose them to placebo puffs of air and expose them to the chemical they are sensitive to but don't tell them which is which, and they can label them correctly no more better than would be expected from chance.)
However, the problem is that people with these really are tortured - they are truly convinced of this sensitivity and sometimes end up housebound and with ruined lives because of profound avoidance of perceived triggers.
The question is though, how do you address this in a patient and from a societal perspective. Say I have a person with RFS or MCS as a patient. If you say: 'Look, hon. You are a total whackadoodle. You need to just get over it and stop having panic attacks, K?' that may fix the problem in that they will not haunt your practice, but they will go to another provider who will further validate their phobias and be worse off. If however, you can engage the person in care, even perhaps give them medicines in what may be a placebo effect (and maybe in a manner that helps the basic panic attack), and help them gradually get over the symptoms and regain their life, you are doing a better thing. But that requires controlled validation of their experience, and it ain't something you are doing in a few months. This is a long haul thing... and its a lot of energy. I limit myself to only a few people who require this at any given time in my practice.
From a societal perspective, its the same issue: if a person with RFS or MCS says 'I can't access X public venue without Y accommodation' what do you do? Even knowing that its a form of panic disorder, that doesn't obviate the need for accommodations. We let people with mental health problems have a lot of accommodations not aimed at 'toughening them up' but aimed at making them able to fully participate in society. And like all accommodations, we have to balance the reasonableness of the request against the rest of societies needs. Expecting a wheelchair ramp on public buildings is very reasonable. Expecting that all buildings have lights turned off at 6pm is not. If a person with MCS needs a 'scent free space' in order to be able to go to college, that's reasonable... until a person with psoriasis is told she can't use her medications that control her disease. They can reasonably expect me to limit cologne use, but not things that are required to treat a serious health problem.
In this case, I actually think the reasonableness of the request doesn't balance out. Though there are other ways that it could be addressed. Talk to local businesses who already offer wifi, request that they take down their wifi if the city guarantees free and consistent access for their customers.
Why in the world would you want to control a robot with your eyes? You can't even tell it how hard or deep to cut. Because most surgeons only have two hands. This represents a new means of input and control. Think of it as using both your hands and feet for driving. You can certainly drive with only your hands and a setup with the brake and gas on the steering wheel. However, having the break and gas operated by the feet gives the driver greater ability to use his hands for steering or drinking his coffee while shaving and eating a muffin.
You would like a good margin around the entire tumor. If you were able to precisely get 1cm margins all around that would be far preferable to getting 1.7 cm margins in one place and 0.1 cm margins in another. As it stands even if the ideal is 1cm, you often shoot for more on average because you would rather have one place that is 3cm than one place that is 0.1 cm.
So precision would definitely give you less tissue loss, if nothing else than by allowing a smaller target for margins.
On a more ethical standpoint, being interested in Medicine and Machines myself, I feel this is going in the opposite direction of what I hope for medicine. Distancing doctors from patients, and life from reality may prove a nasty combo. First, you need some distance. If you are in respiratory failure, I have precious little time to get you intubated and ventilated. That is not the time you want active listening and human touch. You want technical skill and someone who does not dick around. You may even want someone who has toys like this hella sexy video laryngoscope: http://medgadget.com/archives/2006/10/mcgrath_series.html
Want.
Of course with that I am less in touch with you physically and less likely to end up spattered in the half digested pasta, beans, or nachos that everyone who needs emergency intubation invariably eats right before they crap out. Honestly though I think we are both happier that way.
Secondly though, the motivation for me that makes me want to save your life is the same one that makes me select the best tool for doing so. If that is a McGrath video laryngoscope (mmmmmmmmm....) or a good old fashioned Mac 4 blade then that's what I use. It would be malfeasance from my perspective if I chose the least effective means because I was a dilettante about technology.
You might be able to get some decent advice if you would listen to what people are saying rather than what you would like them to say. There are a lot of people here who are quite successful who started with far less opportunities than you have and if you would quit whining that your SAT scores are too high to justify you attending a plebeian state school, you might find out how they got what you want to have on less money than you think.
I went to school with zero parental support and graduated undergrad and medical school with a total of $70,000 in student loans. I did this by 1) actually doing the research and finding scholarships instead of asking others to do it for me, 2) working while in school, 3) going to a (hold your nose now, honey) state school where I got a world class education (which also shockingly involved work) and 4) selling my plasma.
I also managed to get one of the most competitive residency spots in the US because while I did not graduate from Yale or Harvard, I did actually know my shit. This knowing of one's shit will not come to you because you have a sooper-smart study group who hands it to you on a silver platter, but because you spend the time teaching yourself.
Quit whining that the kids at your school are so beneath you and you're so special that you'll be wasted on a state school, and realize that you're lucky you get to go to college. There are kids far more talented than you who are forced by circumstances to stop their formal education before college. Your continued whining shows you to be a malignantly entitled and arrogant little shit who needs to grow up considerably before you start wasting the time of college professors.
put a donut magnet over it and it can be stopped And to clarify, I mean stop many potential hacks. The magnet doesn't turn a pacer off, just flips a reed switch and renders it dumb so that it just paces at a set background rate. And I suspect that if it were hacked and the person arrived to the ER still alive (or at least freshly dead) you could solve a lot of that with a magnet.
Actually what the magnet does is turn off the sensing function (by flipping a reed switch in the pacer), and demotes a highly functional piece of electronics into something much dumber. (It just paces at a set rate without having any look at what the heart is doing.)
This can be used to stop a lot of 'runaway pacer' issues (which almost never happen with modern devices), and I suspect a lot of potential hacks. However it doesn't precisely shut it off. But it does solve a lot of problems.
I'm not so sure about that (speaking as an ER physician who would generally be the one saying WTF is the password???)
In the worst case scenarios, either 1) put a donut magnet over it and it can be stopped or 2) give me a scalpel and 30 seconds and I can cut the leads, and then we can externally pace and/or defibrillate the person.
So I am not sure that the risk of being password protected would outweigh the risk of not being password protected. I'd want mine password protected, then put the password on a medic-alert bracelet that I wear.
From TFA:
a team of computer security researchers plans to report Wednesday that it had been able to gain wireless access to a combination heart defibrillator and pacemaker. They were able to reprogram it to shut down and to deliver jolts of electricity that would potentially be fatal
hundreds of thousands of people in this country with implanted defibrillators or pacemakers to regulate their damaged hearts -- they include Vice President Dick Cheney -- have no need yet to fear hackers No need to fear they tell us because:
One:
The experiment required more than $30,000 worth of lab equipment and a sustained effort by a team of specialists from the University of Washington and the University of Massachusetts to interpret the data gathered from the implant's signals. And two:
"To our knowledge there has not been a single reported incident of such an event in more than 30 years of device telemetry use, which includes millions of implants worldwide," Um, that was until a NYTimes article described that it could be done and (more importantly) a/. article linked to that NYTimes article so tons of geeks worldwide see the information. While security through obscurity doesn't really work, there is something to be said for people just not noticing that a thing is hackable.
Similarly the argument that it took $30,000 worth of equipment and a 'team of experts' is retarded because the same might probably have been said about DVD encryption till an adolescent did it in his bedroom with his home computer and enough caffeine.
If I had an AICD, I sure as hell wouldn't want to be around Cheney, lest the signal from mine be confused with his. Of course maybe that is why he has a man sized safe in his office is a Faraday cage.
Well then no soymilk for your vegan toddler, and no apples. Or oats. Or barley. Or carrots. Or many kinds of berries. Because all of those contain phytoestrogens at doses higher than the parts per gazillion that TFA was describing. We've always lived with environmental hormone modulators. Its not making kids gay. Or making them have menses earlier. Or be fatter.
However hysteria over environmental exposures to hormones, vaccinations, fluoridation, staph in the playground, and anything else that people will get nuts over is having an adverse effect on kids. Largely because their nutty parents will refuse to use safe public health prevention techniques and by trying to avoid perceived risks place their kids at greater risk.
Though what always amazes me is that the same nutter parents who feed their kids a vegan diet at two, refuse to vaccinate, and go nuts over stories like this are the first to bring their runny-nosed kid to the ER and demand the biggest gorillacillin in the formulary for what is an obvious viral syndrome.
Further research would be required to determine if we are exactly in line with the axis of the system - but even if we are, we probably still have hundreds of thousands of years to come up with a solution, said Tuthill. Thanks for putting that at the end of TFA. Now I need to go change my shorts.
So because you were part of a failed economic model (totalitarian communism), you feel that its near opposite (capitalist plutocracy) is better. Well that and you make more money here and can buy more cool junk. Wow. How painfully short sighted and somewhat ignorant. This is why people with expertise in one area should not be expected to render cogent opinions in another area.
Though you would hope that most people would see as a civic duty a certain minimal level of competence in civics, the natural sciences, the humanities, logic and math. Sigh.
And that's what really torqued my nads about this: not that Leonidovich embraces that idea that the only real way to motivate people is to progressively increase their wealth past all reasonable needs and wants for yourself and extended family, but that he's so goddamn stupid. If FOSS is a doomed business model and bad for markets, why is it still here? I mean c'mon. If the market is the only thing that is either sustainable or creates progress, why even be worried about this? Its just a bunch of hippy dork college students and a few old guys with personal hygiene problems and poor social skills that make software that no one can use and no one would want to because its crap, right? Just give it some time and it will go away just like other unsustainable fads. Go back to writing video games and put up a link to the don't copy that floppy video on your website, K?
You forgot Adam Savage and Jamie Hyneman. They are not quite so rigorous as Shermer and Randi, but only Penn and Teller come even close to their audience share.
Stephen Jay Gould wrote an exceptional (and entertaining - bonus) piece in 1994 about selling Evolution to the lay public - combating the Creationist spin that evolution is 'only a theory' by calling it a 'scientific fact'. He justified this with... well crap, I should let the good Professor say it much better than I could:
http://www.stephenjaygould.org/library/gould_fact-and-theory.html
I understand supporting free speech, but let's face facts here: drawing a picture of Mohammad wearing a bomb for a turban is pretty much exactly the definition of "provocation".
Its not the right to be provocative or to express solidarity with others in your field that we are talking about. Its the right to free expression.
However, provocation is often used as an excuse to censor. As someone who is used to that excuse, perhaps its more apparent to me.
I'm gay. I am married to another man. We live together and love each other in our nice little house in suburban California. The computer on which I am typing this response, and my partner's XO across the table from me in the coffee shop where I am getting caffeinated both have small rainbow flags on them. When he took off while I was writing this, he leaned over the table and gave me a peck on the cheek.
There are places in the US where what I just typed would make us vulnerable to getting the shit kicked out of us. Having been in places like that, I can tell you the risk is serious. And that risk is used to intimidate people back into the closet. The 14 year old Jr High Student who was murdered this month in Oxnard California is dead undoubtedly because of violent reactions to his behavior, that many people to this day would label 'provocative': He was out as gay, wore effeminate clothing, jewelry and make-up to school. In fact, that is such a common justification for homophobic violence that we even have to have laws that prevent people from using the 'gay panic' defense (that is, a queer person because his behavior was so provocative, incited the defendant to violence.)
The problem is that any behavior viewed from another standpoint can be provocative. Just as the cartoons of Mohammad are provocative to many Muslims, I find these images from Iran to be provocative (especially given the position of militant extremists within Islam who would like to impose Sharia on the entire world): http://www.youtube.com/watch?v=2dgsZYA1mPY
I defy you to watch that in its entirety and then tell me how its reasonable that people who torture and then put children to death for consensual gay sex shouldn't have to have their delicate sensibilities shattered by such provocation as having their religion (the same one that justifies those murders) be mocked? (Because its the same militant fundamentalist factions that are offended by the cartoons - not all of Islam. In fact many Muslims are far more shocked at the death threats than the existence of the cartoons.)
If you want to defend the right to be provocative, more power to you. But don't try to piss in my face and tell me it's raining: provocation was EXACTLY the goal of the cartoonist and the publishers in this case.
No the goal is to speak truth to violence and hatred. Its hard not to give in and meet that violence and hatred with its reflection. Its hard for me to see that video (and I think hard for most human beings not in that culture of violence) and not want to hate Islam. But I don't. I have worked really hard at not hating Islam. I was the chief resident on call in the ER in Brooklyn's largest trauma center that day, had family in Manhattan on 9/11/01, and had close friends who lost family that day. I can still remember the smell afterwards - and knowing that the noxious air that set my asthmatic lungs into spasm was infused with the bodies of three thousand people. It would have been so easy.... painfully easy to demonize and hate an entire religion and culture. To see them as nothing more than animals who should be locked away safely so they cannot harm human beings.
So I read the Qur'an. Its a beautiful book; simple and very powerful - especially if read from the perspective of someone who is not a believer (and perhaps who is suffering a little PTSD due to the violence of true believers.) I also talked a lot with my co-chief at th
The cartoons were published by many Danish papers after the police foiled a plot to murder the cartoonist. By publishing these cartoons, the papers were stating something important: we stand in solidarity, we don't give in to bullies, and the sword will never be mightier than the pen.
Let's go over the alternative in a country which has your blessed "universal healthcare":
You suffer kidney failure. You can't afford private treatment. You're put on a wait-list because dialysis is expensive and in short supply. You're over 55. You don't make the cut off. Your socialist system has decided that a 55+ year old person is not worth the expenditure. Since you depended on the state to support you, you have no private recourse. You die. Great. Show me that hypothetical western country that has 55 as a cut off for hemodialysis and you will have a point. I believe in the UK the cutoff is 80 now. Not sure what Canada's is, but I met a patient who was traveling recently and had arranged HD locally who was from Canada and was in his 70s, so I am assuming its at least 80.
Though funny you should use that as an example, because all HD patients in the US are covered if they have no other insurance by Medicare-Renal. So we already in the US pay on public insurance for HD to age 116 if needed.
Of course the best way to save money and provide the most useful life to everyone is to prevent people from getting renal failure in the first place. In the UK, if you have diabetes and hypertension (the number 1 and 2 causes of end stage renal disease) you get care for those ailments, so fewer patients get to the point of needing HD. In the US however, if you are poor and have diabetes and hypertension, you are shit outta luck. We wont pay $2000 per year to treat those conditions, but when your kidneys fail we will swoop in and pay $40,000 a year to give you HD three days a week (not to mention the costs of line infections, shunt surgeries, etc.)
Its like buying a car and just putting gas in it till the engine falls out and then buying a new engine. Its stupid, wasteful, and will cost you a lot more money in the long run. And unfortunately its not engines that we are talking about, its people's lives.
Actually you are right. Thanks for catching that. EMTALA, COBRA, HIPPA, JCAHO, LOLINAD, etc. I just worked a long night in the ER... acronyms begin merging after an all nighter.
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EMTALA is an unfunded mandate that says that the nurses who work in an ER, the hospital who runs the ER, and ER physicians like me have to pay for uninsured emergency care. It takes a segment of the US economy and says we have to take responsibility for and subsidize what everyone else doesn't. That cheap McDonalds hamburger you ate today that is less expensive because McDonalds doesn't offer health insurance? I paid for a part of that.
Of course I am thankful for EMTALA every time that I use it to force a surgeon to take the appendix out of an uninsured teenager. I also feel that I am paid quite well enough even though about 30% of the ER care and 50% of the overall care I provide is uncompensated (I volunteer two days a week at a low income clinic that sees a lot of uninsured patients so that bumps the % up.) However overall I hate EMTALA precisely because its used as a crutch: I'm sure Bush slept very well at night after vetoing SCHIP because he thinks that every American gets health care since even if we are uninsured we can go to the ER (where most of the care people need - like prevention and treatment of chronic disease can't be done).
That sentiment and $4 will get you a cup of Starbucks coffee. I defy any of you who talk so tough to spend a Saturday night in the ER with me and then tell me not to aid someone dying of an overdose or because they didn't wear a bike helmet, or because they have a spare tire and are having a heart attack. Or better yet, we'll do that with one of the local college kids whose health insurance doesn't pay for any of their alcohol related ER visits. When a 19 year old girl who is someone's daughter is choking on her own vomit because she doesn't have the experience to drink responsibly and got shit faced... you tell me to let her turn blue, stop breathing, and go into cardiac arrest. And after, I will let you have the pleasure of telling her weeping parents that we just let that happen because its her own fault.
You are all so full of shit and bluster you make Ann Coulter seem reasonable. Not a single one of you would have the balls to do that, and would likely be cowering in the corner screaming at me to do something! while you wet your pants.
That said, I do think that we as a society have a right to make non-punitive behavior modification strategies to improve the overall function of society. That means we should decriminalize drug use. However then spend the same money on drug treatments, prevention, and mandating treatment for dangerous behaviors (if you end up in the ER overdosed, drive stoned, etc. we should be able to force you to seek some sort of drug treatment.) Like everything else, black and white don't cut it. Locking up people for 20 years for smoking a doobie is as retarded as making heroin available to anyone at the 7-11.
And I thought I was just a hypertensive who takes atenolol (a beta blocker like inderal.) What makes it even better is that I usually write my own rx for atenolol (largely since its easier than getting one from my doctor and its perfectly legal for non-scheduled drugs.)
Ooooh! I am a druggie. A rebel. D-d-d-dangerous and hip! This is so SCHWEET!
And if atenolol is drug abuse, I am sure its just a gateway drug for me... next thing you know I will be freebasing lipitor!
Of course that just made my tee shirt with the picture of a colon with an appendix saying: "Intelligent design? OK, show me the elegant design of my appendix" just that much more cool.
Thanks for playing. And by the way, alligators are a genus, not a species.
But lets say that its only a sensitivity when your nose is exposed to the toxin. Then wear a pair of swimming nose clips so you don't get exposed in your sensitive area, rather than expecting everyone else in society to cater to your dislikes... er I mean chemical sensitivity. I have a severe allergy to a certain medication, such that I've had anaphlaxis to just the dust from the pill. I don't make the rule that people in my clinic can't have that medicine, but I do carry an Epi-Pen (also because I have anapylaxis to hymenoptera.) I accept the inconvenience of lugging the pen with me because it is unreasonable for me to expect otherwise (and bees seem to love me) - just as you should not unreasonably expect the 'bitch' whose perfume you dislike to go without it because it smells bad and you work yourself into a snit complete with coughing since you feel it ruins your dinner. And perhaps if you stopped referring to women as 'bitches' and 'chicks' you might get a better response if you ask them to refrain from using scents you dislike?
People who complain of RF sensitivity are in the same category as people who complain of Multiple Chemical Sensitivity. They really do suffer from a disease that causes real symptoms. However the disease they have is a form of panic attack - which can in the case of MCS especially progress to something akin to agoraphobia. When you test people who are labeled as having MCS in a blinded fashion to things they are sensitive to, they don't get triggered any more often than placebo. (Expose them to placebo puffs of air and expose them to the chemical they are sensitive to but don't tell them which is which, and they can label them correctly no more better than would be expected from chance.)
However, the problem is that people with these really are tortured - they are truly convinced of this sensitivity and sometimes end up housebound and with ruined lives because of profound avoidance of perceived triggers.
The question is though, how do you address this in a patient and from a societal perspective. Say I have a person with RFS or MCS as a patient. If you say: 'Look, hon. You are a total whackadoodle. You need to just get over it and stop having panic attacks, K?' that may fix the problem in that they will not haunt your practice, but they will go to another provider who will further validate their phobias and be worse off. If however, you can engage the person in care, even perhaps give them medicines in what may be a placebo effect (and maybe in a manner that helps the basic panic attack), and help them gradually get over the symptoms and regain their life, you are doing a better thing. But that requires controlled validation of their experience, and it ain't something you are doing in a few months. This is a long haul thing... and its a lot of energy. I limit myself to only a few people who require this at any given time in my practice.
From a societal perspective, its the same issue: if a person with RFS or MCS says 'I can't access X public venue without Y accommodation' what do you do? Even knowing that its a form of panic disorder, that doesn't obviate the need for accommodations. We let people with mental health problems have a lot of accommodations not aimed at 'toughening them up' but aimed at making them able to fully participate in society. And like all accommodations, we have to balance the reasonableness of the request against the rest of societies needs. Expecting a wheelchair ramp on public buildings is very reasonable. Expecting that all buildings have lights turned off at 6pm is not. If a person with MCS needs a 'scent free space' in order to be able to go to college, that's reasonable... until a person with psoriasis is told she can't use her medications that control her disease. They can reasonably expect me to limit cologne use, but not things that are required to treat a serious health problem.
In this case, I actually think the reasonableness of the request doesn't balance out. Though there are other ways that it could be addressed. Talk to local businesses who already offer wifi, request that they take down their wifi if the city guarantees free and consistent access for their customers.
You would like a good margin around the entire tumor. If you were able to precisely get 1cm margins all around that would be far preferable to getting 1.7 cm margins in one place and 0.1 cm margins in another. As it stands even if the ideal is 1cm, you often shoot for more on average because you would rather have one place that is 3cm than one place that is 0.1 cm.
So precision would definitely give you less tissue loss, if nothing else than by allowing a smaller target for margins.
Want.
Of course with that I am less in touch with you physically and less likely to end up spattered in the half digested pasta, beans, or nachos that everyone who needs emergency intubation invariably eats right before they crap out. Honestly though I think we are both happier that way.
Secondly though, the motivation for me that makes me want to save your life is the same one that makes me select the best tool for doing so. If that is a McGrath video laryngoscope (mmmmmmmmm....) or a good old fashioned Mac 4 blade then that's what I use. It would be malfeasance from my perspective if I chose the least effective means because I was a dilettante about technology.
You might be able to get some decent advice if you would listen to what people are saying rather than what you would like them to say. There are a lot of people here who are quite successful who started with far less opportunities than you have and if you would quit whining that your SAT scores are too high to justify you attending a plebeian state school, you might find out how they got what you want to have on less money than you think.
I went to school with zero parental support and graduated undergrad and medical school with a total of $70,000 in student loans. I did this by 1) actually doing the research and finding scholarships instead of asking others to do it for me, 2) working while in school, 3) going to a (hold your nose now, honey) state school where I got a world class education (which also shockingly involved work) and 4) selling my plasma.
I also managed to get one of the most competitive residency spots in the US because while I did not graduate from Yale or Harvard, I did actually know my shit. This knowing of one's shit will not come to you because you have a sooper-smart study group who hands it to you on a silver platter, but because you spend the time teaching yourself.
Quit whining that the kids at your school are so beneath you and you're so special that you'll be wasted on a state school, and realize that you're lucky you get to go to college. There are kids far more talented than you who are forced by circumstances to stop their formal education before college. Your continued whining shows you to be a malignantly entitled and arrogant little shit who needs to grow up considerably before you start wasting the time of college professors.
Actually what the magnet does is turn off the sensing function (by flipping a reed switch in the pacer), and demotes a highly functional piece of electronics into something much dumber. (It just paces at a set rate without having any look at what the heart is doing.)
This can be used to stop a lot of 'runaway pacer' issues (which almost never happen with modern devices), and I suspect a lot of potential hacks. However it doesn't precisely shut it off. But it does solve a lot of problems.
I'm not so sure about that (speaking as an ER physician who would generally be the one saying WTF is the password???)
In the worst case scenarios, either 1) put a donut magnet over it and it can be stopped or 2) give me a scalpel and 30 seconds and I can cut the leads, and then we can externally pace and/or defibrillate the person.
So I am not sure that the risk of being password protected would outweigh the risk of not being password protected. I'd want mine password protected, then put the password on a medic-alert bracelet that I wear.
One: The experiment required more than $30,000 worth of lab equipment and a sustained effort by a team of specialists from the University of Washington and the University of Massachusetts to interpret the data gathered from the implant's signals. And two: "To our knowledge there has not been a single reported incident of such an event in more than 30 years of device telemetry use, which includes millions of implants worldwide," Um, that was until a NYTimes article described that it could be done and (more importantly) a
Similarly the argument that it took $30,000 worth of equipment and a 'team of experts' is retarded because the same might probably have been said about DVD encryption till an adolescent did it in his bedroom with his home computer and enough caffeine.
If I had an AICD, I sure as hell wouldn't want to be around Cheney, lest the signal from mine be confused with his. Of course maybe that is why he has a man sized safe in his office is a Faraday cage.
Well then no soymilk for your vegan toddler, and no apples. Or oats. Or barley. Or carrots. Or many kinds of berries. Because all of those contain phytoestrogens at doses higher than the parts per gazillion that TFA was describing. We've always lived with environmental hormone modulators. Its not making kids gay. Or making them have menses earlier. Or be fatter.
However hysteria over environmental exposures to hormones, vaccinations, fluoridation, staph in the playground, and anything else that people will get nuts over is having an adverse effect on kids. Largely because their nutty parents will refuse to use safe public health prevention techniques and by trying to avoid perceived risks place their kids at greater risk.
Though what always amazes me is that the same nutter parents who feed their kids a vegan diet at two, refuse to vaccinate, and go nuts over stories like this are the first to bring their runny-nosed kid to the ER and demand the biggest gorillacillin in the formulary for what is an obvious viral syndrome.
So because you were part of a failed economic model (totalitarian communism), you feel that its near opposite (capitalist plutocracy) is better. Well that and you make more money here and can buy more cool junk. Wow. How painfully short sighted and somewhat ignorant. This is why people with expertise in one area should not be expected to render cogent opinions in another area.
Though you would hope that most people would see as a civic duty a certain minimal level of competence in civics, the natural sciences, the humanities, logic and math. Sigh.
And that's what really torqued my nads about this: not that Leonidovich embraces that idea that the only real way to motivate people is to progressively increase their wealth past all reasonable needs and wants for yourself and extended family, but that he's so goddamn stupid. If FOSS is a doomed business model and bad for markets, why is it still here? I mean c'mon. If the market is the only thing that is either sustainable or creates progress, why even be worried about this? Its just a bunch of hippy dork college students and a few old guys with personal hygiene problems and poor social skills that make software that no one can use and no one would want to because its crap, right? Just give it some time and it will go away just like other unsustainable fads. Go back to writing video games and put up a link to the don't copy that floppy video on your website, K?
You forgot Adam Savage and Jamie Hyneman. They are not quite so rigorous as Shermer and Randi, but only Penn and Teller come even close to their audience share.
Stephen Jay Gould wrote an exceptional (and entertaining - bonus) piece in 1994 about selling Evolution to the lay public - combating the Creationist spin that evolution is 'only a theory' by calling it a 'scientific fact'. He justified this with... well crap, I should let the good Professor say it much better than I could: http://www.stephenjaygould.org/library/gould_fact-and-theory.html
I understand supporting free speech, but let's face facts here: drawing a picture of Mohammad wearing a bomb for a turban is pretty much exactly the definition of "provocation".
Its not the right to be provocative or to express solidarity with others in your field that we are talking about. Its the right to free expression.
However, provocation is often used as an excuse to censor. As someone who is used to that excuse, perhaps its more apparent to me.
I'm gay. I am married to another man. We live together and love each other in our nice little house in suburban California. The computer on which I am typing this response, and my partner's XO across the table from me in the coffee shop where I am getting caffeinated both have small rainbow flags on them. When he took off while I was writing this, he leaned over the table and gave me a peck on the cheek.
There are places in the US where what I just typed would make us vulnerable to getting the shit kicked out of us. Having been in places like that, I can tell you the risk is serious. And that risk is used to intimidate people back into the closet. The 14 year old Jr High Student who was murdered this month in Oxnard California is dead undoubtedly because of violent reactions to his behavior, that many people to this day would label 'provocative': He was out as gay, wore effeminate clothing, jewelry and make-up to school. In fact, that is such a common justification for homophobic violence that we even have to have laws that prevent people from using the 'gay panic' defense (that is, a queer person because his behavior was so provocative, incited the defendant to violence.)
The problem is that any behavior viewed from another standpoint can be provocative. Just as the cartoons of Mohammad are provocative to many Muslims, I find these images from Iran to be provocative (especially given the position of militant extremists within Islam who would like to impose Sharia on the entire world): http://www.youtube.com/watch?v=2dgsZYA1mPY
I defy you to watch that in its entirety and then tell me how its reasonable that people who torture and then put children to death for consensual gay sex shouldn't have to have their delicate sensibilities shattered by such provocation as having their religion (the same one that justifies those murders) be mocked? (Because its the same militant fundamentalist factions that are offended by the cartoons - not all of Islam. In fact many Muslims are far more shocked at the death threats than the existence of the cartoons.)
If you want to defend the right to be provocative, more power to you. But don't try to piss in my face and tell me it's raining: provocation was EXACTLY the goal of the cartoonist and the publishers in this case.
No the goal is to speak truth to violence and hatred. Its hard not to give in and meet that violence and hatred with its reflection. Its hard for me to see that video (and I think hard for most human beings not in that culture of violence) and not want to hate Islam. But I don't. I have worked really hard at not hating Islam. I was the chief resident on call in the ER in Brooklyn's largest trauma center that day, had family in Manhattan on 9/11/01, and had close friends who lost family that day. I can still remember the smell afterwards - and knowing that the noxious air that set my asthmatic lungs into spasm was infused with the bodies of three thousand people. It would have been so easy.... painfully easy to demonize and hate an entire religion and culture. To see them as nothing more than animals who should be locked away safely so they cannot harm human beings.
So I read the Qur'an. Its a beautiful book; simple and very powerful - especially if read from the perspective of someone who is not a believer (and perhaps who is suffering a little PTSD due to the violence of true believers.) I also talked a lot with my co-chief at th
The cartoons were published by many Danish papers after the police foiled a plot to murder the cartoonist. By publishing these cartoons, the papers were stating something important: we stand in solidarity, we don't give in to bullies, and the sword will never be mightier than the pen.
Though funny you should use that as an example, because all HD patients in the US are covered if they have no other insurance by Medicare-Renal. So we already in the US pay on public insurance for HD to age 116 if needed.
Of course the best way to save money and provide the most useful life to everyone is to prevent people from getting renal failure in the first place. In the UK, if you have diabetes and hypertension (the number 1 and 2 causes of end stage renal disease) you get care for those ailments, so fewer patients get to the point of needing HD. In the US however, if you are poor and have diabetes and hypertension, you are shit outta luck. We wont pay $2000 per year to treat those conditions, but when your kidneys fail we will swoop in and pay $40,000 a year to give you HD three days a week (not to mention the costs of line infections, shunt surgeries, etc.)
Its like buying a car and just putting gas in it till the engine falls out and then buying a new engine. Its stupid, wasteful, and will cost you a lot more money in the long run. And unfortunately its not engines that we are talking about, its people's lives.
Actually you are right. Thanks for catching that. EMTALA, COBRA, HIPPA, JCAHO, LOLINAD, etc. I just worked a long night in the ER... acronyms begin merging after an all nighter.