|there have been two cases of a weird new respiratory disease in the Middle east and Wired has an article about the New England journal of Medicine article |
Supposedly this is a coronavirus, but unlike SARS is not spreading to medical personnel.there is a real danger here, because the Haj, the yearly pilgrimage to Mecca, is coming up, and that is a major worry as a way to spread any infectious disease.
The editorial puts those findings into context. It recounts four recent viral public health emergencies — Nipah virus in 1998, West Nile virus in 1999, SARS in 2003 and the pandemic H1N1 flu in 2009 — to demonstrate that the time from identification, to analysis with increasingly sophisticated tools, and then to public health response, is shortening....This is somewhat reassuring — but it also raises so many questions. What happens, on the one hand, if recognition doesn’t take place, or communication is not swift? (Recall that, though the Saudi hospital contacted the Erasmus lab quickly, most of public health did not learn of the case until 3 months had gone by.) And what happens if, on the other hand, all those communications work well enough to raise public alarm — and then nothing further happens? (Recall that, in 2009, public reaction to the generally mild presentation of pandemic H1N1 was generally that authorities were crying wolf.)
Of course, with today's air travel, you can spread a disease quickly: About the time the US was just starting to report Swine Flu that originated in a couple of Mexican cases, we had an outbreak here because folks had flew home for the holidays. Luckily in that case, the flu was mild.
But with SARS, they had no treatment, but they contained the disease by old fashioned methods of quarantine....all the airports were scanning you for fever....
|This AAFP article is behind a firewall, but it discusses the problems with "scientific guidelines". An excerpt.|
Let's talk about “evidence,” a term that is thrown around far too loosely. The USPSTF's technique of question development followed by a detailed, standardized analysis of the literature to answer a specific question is “best in class.” Far too often, recommendations that are purported as evidence-based are nothing more than a consensus recommendation from a group of experts without any well-defined data to support it. Case in point: A 2009 review of 14 American Heart Association/American College of Cardiology (AHA/ACC) guidelines revealed that only 11 percent were based on multiple randomized trials or meta-analyses (AHA/ACC level A evidence), whereas nearly one-half were based on consensus (AHA/ACC level C evidence).4 Simply put, a group of experts expressing their views is not evidence.
Andrea: And just who are these experts involved with guideline development? The USPSTF dismisses experts with conflicts of interest, and so does the United Kingdom's National Institute for Health and Clinical Excellence. This is a no-brainer in my book. However, a review of 17 ACC/AHA guidelines involving 498 contributors revealed that 56 percent of the guidelines had an author with a conflict of interest.5 And this ethical dilemma is not limited to ACC/AHA guidelines. A 2011 review of 14 U.S. and Canadian clinical practice guidelines on diabetes mellitus and hyperlipidemia revealed that there was no conflict-of-interest documentation in five of the guidelines (this does not mean there were no conflicts of interest), and of the nine with documentation, 48 percent had authors who disclosed conflicts of interest.6 Digging deeper, specialty society guidelines in particular seem to have strong ties to pharmaceutical manufacturers. A 2002 survey of 100 specialty society guidelines revealed that 87 percent had ties to the pharmaceutical industry.7
Bob: One has to wonder why an organization that is creating a guideline does not seek conflict-of-interest disclosure or recuse authors that have a conflict of interest. Perhaps the truth is that specialty society organizations themselves may sometimes have a conflict of interest (e.g., receiving income from pharmaceutical companies). This can lead to the organization consciously or unconsciously predetermining the outcome of a guideline. Don't believe this can happen? A British Medical Journal report revealed that a prominent “nonprofit” organization that received a total of $11 million from a pharmaceutical company subsequently placed six members with ties to this company on a nine-person committee that was to determine the role of the company's drug in a guideline.8
Many have called for transparency in the clinical practice guideline development process. Currently, final recommendations often appear as if there was unanimity among the contributors' recommendations. This is not always the case. It would be more appropriate to disclose how the committee members voted on the final recommendation, similar to Supreme Court rulings. Wouldn't a five-to-four decision reflect a level of concern (or conflict) that clinicians should be aware of?
There are no controlled trials demonstrating that lipid screening in children improves long-term health outcomes.
Many guidelines are dominated by recommendations from experts and are not based on sound clinical studies. The development of clinical practice guidelines needs to be transparent and devoid of commercial, financial, and political influences.
Be wary of outdated guidelines.
Primary care guidelines tend to be more methodologically sound than specialty society guidelines.
The level of evidence of clinical practice guidelines should be reviewed before widespread implementation.
so the next time your doctor seems to be ignoring guidelines, it's just something to remember...
|From the NYTimes. Translated:|
The American medical system squanders 30 cents of every dollar spent on health care,
squanders implies deliberate wasting. So you see the spin already.
The Institute of Medicine report — its research led by 18 best-of-class clinicians, policy experts and business leaders —unelected experts who appointed themselves to tell the rest of us how to live
the American medical system wastes an estimated $750 billion a year while failing to deliver reliable, top-notch care.again, a value judgement. What do they mean by "reliable"? or "top notch"?
So maybe we find it easier to do a test than the experts. Sometimes it is lazyness (easier to check than assume it is okay) Sometimes it is driven by fear of a malpractice suit. And sometimes it is because we know the patient and figure he might not be taking the medicines, so we do the test to check.
The institute’s analysis of 2009 data shows $210 billion spent on unnecessary services, like repeated tests,
Yes, again they assume that the tests are equal, and that both places are equal in the eyes of a patient. i.e. parking, convenience, niceness of staff (I once used to send all of my Barium enemas to a hospital 30 miles away because the local radiologist was an SOB)...
$130 billion spent on inefficiently delivered services, like a scan performed in a hospital rather than an outpatient center.
And they are also talking about outpatient surgery. Never mind you are half dead, and have no one at home to care for you: it will be done outpatient.
Only 75 billion? heh...American docs are more honest than I expected...and of course some of the "fraud" is overbilling so you get paid, (it costs you 40 dollars for a visit, but Medicare/medicaid pays 60 percent of the visit, so you up your price to get a fair reimbursement) and of course some of the billing is "fraud" because the doc didn't fill all the boxes right, either not documenting why he took 40 minutes to see a cold (included 30 minute discussion on personal matters you didn't put into the record because her sister in law works in medical records).
It also shows the health care system wasting $75 billion a year on fraud,
This means you didn't fill out all the blanks that the person has all their shots, etc. Of course, if you did all the "prevention" stuff that the "experts" want you to do at every visit, and then did the paper work to document this, you would not have time to see the patient. Every expert has something else you are supposed to ask, from gun ownership to smoking to abuse to sexual practices to foreign travel to diet to exercize.
$55 billion on missed prevention opportunities
Our nurses would screen the chart about shots, and if the yearly blood sugar was tested for, and if you were on the pill etc. but a lot of the time we didn't document these routine things, and I personally didn't spend time checking it on every patient every time.
a whopping $190 billion on paperwork and unnecessary administrative costs.and if you think that is high, just wait for electronic medical records and Obamacare's numerous regulations kick in....
|checking my RSS feed and find most of the headlines are ominous.|
they are using transgenetic mice to research a human disease.
ScienceDaily (Sep. 10, 2012) — A novel human liver-chimeric mouse model developed at Oregon Health & Science University and Yecuris Corporation has made possible a research breakthrough at Seattle Biomedical Research Institute that will greatly accelerate studies of the most lethal forms of human malaria.,,,Catholic ethics sees using a single or limited human gene into an animal as ethically okay if it is needed for research or other benefits to humans (e.g. transplanting organs). But they are cautious because if a large amount of human genes are in an animal, it is potentially human.
The liver-to-blood stage of P. falciparum is the focus of this research because the parasite is virtually harmless, causing no disease symptoms, prior to its transition to the blood stage.
In this study, researchers at Seattle Biomedical Research Institute, Yecuris Corporation, Oregon Health & Science University and The Rockefeller University have demonstrated that a complete liver-to-blood stage infection of P. falciparum is possible using a unique immunocompromised mouse model engrafted with human liver-chimeric cells.
And the chance that a bacteria could mutate in the transgenetic animal is the real worry.
Are Blood pressure medicines safe in pregnancy?
Some probably are (especially ACE and other angiotensin inhibitors; the "pril" and "artan" families), and a few are known to cause problems. But most are taken in the last trimester, where high blood pressure contributes to aging of the placenta/small for dates babies/stillborn children.
I love this headline: Wine For Swine.
wine is better to protect the heart than Vodka: if you are a pig, that is.
The Placebo effect is probably subconscious.well, duh.
As PiPS Director and study coauthor Ted Kaptchuk notes, "It's not what patients think will happen [that influences outcomes] it's what the nonconscious mind anticipates despite any conscious thoughts. This mechanism is automatic, fast and powerful, and does not depend on deliberation and judgment. These findings open an entirely new door towards understanding placebos and the ritual of medicine."
what I took a course in hypnosis, it linked creativity/suggestibility/hypnosis/meditation/deep prayer/faith healing/acupuncture etc. according to the "eye roll" ability and personality (how much of the white of the eye shows when you look up and close your eyes at the same time).
All of these things were neurological, and people varied in their ability to enter into them. So if you can do one, you can do them all...and the scale of how easily you can be hypnotized/persuaded/respond to placebo varies from person to person.
Until they start doing studies that differentiate the groups according to this ability, ,I would take all such studies (which includes a lot of studies on "alternative medicine) with a grain of salt. Lots of magical thinking out there.
I suspect a similar effect (depending on one's ability) can be found in Music.
So a NYTimes article says early music training will make your brain work better, but of course the study was done on college students who either did or did not have music training.
. The group of students who reported musical training in childhood had more robust responses — their brains were better able to pick out essential elements, like pitch, in the complex sounds when they were tested. And this was true even if the lessons had ended years ago.But, of course, a lot of kids don't like music or are tone deaf, so was the ability to like music due to training or due to the fact that they already had an innate ability to hear things?
I suspect, however, that like hypnosis ability, (which also is present in 90 percent of the population to one degree or another, and also gets better with training) that this might indeed be true for many, but not all, people since many, but not all, people have some ability in music.
another scare story on flame resistant couches.
Yes, but when you see people who die because of a cigarette fell on a couch, maybe you might want to risk the tiny theoretical chance of cancer.
The "logic" is A that X is present in the articles,
B that children have X in their bloodstream (no data on how much or how tiny)
and C that X causes health problems. But again no data on how much or how tiny an amount can do that.
So let's not ask for scientific experiments, let's just go overboard and ban chemicals!
I remember the "good old days": One of my gradeschool classmates was playing with matches and his non flame retardent clothing caught fire...and then there was a neighbor's son who lost five kids because the couch caught fire from a dropped cigarette and the smoke from the conflagration killed his kids asleep upstairs.And the alcoholic up the street died when he passed out on his couch and again died of burns...all these stories are from my neighborhood (not the even more numerous stories of those we saw in training). Then the "fire resistant" stuff began to be mandated, and although we still see tragedies, they are much less common.
Why is it that "chemicals" are always assumed by nature lovers to be evil, yet the very real "natural" dangers of life are shrugged off?
a caption of the "crusader" says the "mother" behind the crusade sees nothing wrong with risking her kids lives hiking up and down mountains, so why believe her here?
I should add that I do suspect a subgroup of people are sensitive to chemicals, including medicines and vaccines, but having worked in "natural" areas, I am loath to worry about a minor problem in a few people versus the very real dangers of what we saw before the chemical or vaccine was available.
So Rachel Carson's scare killed a million African kids from Malaria, but hey, she saved the birds didn't she?
|The new finding that taking a daily anti viral drug lowers your chance of getting HiV is controversial because in developed countries like the US, it will just lead to an increase of not using condoms with promiscuous sex (and therefore increase the risk of other diseases such as Hepatitis B or syphillis).|
But treating the HIV positive patient (leading to a lower viral load) and making the daily prophylaxis medicine available to the spouse or mistress might be lifesaving in Africa where only 10 percent of people are willing to use a condom.
The "Condom wars" usually bash Catholics for the non use of condoms in Africa, overlooking that condoms are against the culture; one result of the condom loving crowd's wrath was to remove the gay head of the program for his admitting that Condoms don't work in Africa.
But now there is a new option.
Notice I put the part about "mistresses" there? Because in some areas, rich men will often limit their sex to one partner (a mistress who might only have a few clients) to cut the risk.