A guy with a PCR machine could make a few billion copies in a few hours....RIAA would have a fit.

But on the other hand....

Just hope a retrovirus doesn't get into your library....

Hmmmm....Actually went to medical school > 8 years ago....let me detail somethings that most may not know about it....

1st year for a "traditional" medical school, fall semester is usually biochem and anatomy....both usually involve a lot of diagrams and less note taking. Your prof may or may not have handouts....ours used slides and were just transitioning to powerpoint....no joke...but think about it...not much of that information has changed over the years....esp for anatomy. Biochem, they add on for a (very) few new disease processed, and recently added the HMGCoA pathway.

Spring is usually histology and physiology....again histo is a lot of drawing of cells. Physio is less so, but more flow chart like diagrams. Micro...some note taking some diagrams....Neuro science...._lots_ of diagrams....

2nd year....hardly anyone goes to class....our second year class room was ~1/3 the size of the first year....so small that the entire 2nd year class could not fit into the lecture hall at the same time. I am neither joking nor exaggerating. Fall is pharm...good for notetaking...as is path....spring is a continuation of path and intro clinical medicine....again both are ok for note-taking.

The problem here is also that most schools still have a note-service....this is where someone is responsible for taping the lectures and distributing them out for people to review and type out the notes....the original crowd-sourcing. This is usually why most realize that going to class is rarely helpful.

3rd year....clinicals...ha - forget about note taking....you're on the move constantly, and scribbling furiously on a scrap of paper, and mostly reading out of a pocket sized book when you have those rare moments of down time....that or you're sleeping. The few lectures you have, you'll be too busy eating, or catching up on sleep. No...not kidding here either.

4th year....you pick easy electives, finish your core classes.....the fall you're off interviewing for residency, you hardly ever take notes..."'cause you know it all" already. You're just killing time til you match and then killing more time til you graduate.

Intern year.....you realize you know squat -- just like 3rd year of med school, but now you actually have responsibility! You never get a chance to sit through a lecture cause you're damn pager is going off...during rounds the orders are barked out so quickly, you'll only be able to jot 1/2 of it down on any available scrap of paper....you'll devise your own system of how to handle this....and I assure you....it will not be electronically.

2nd year....you actually find that you did learn something the previous year (must have been via diffusion)....but now you're the one barking orders, or you have a much better idea of what's coming so you rarely have to write much down.

Just my $0.02....YMMV

Source: Spent the last 9 years as a resident/fellow and the 4 years prior to that as a med student....and saw everyone else doing the _same_exact_thing_.

What you cite is "anecdotal evidence" and what works for you, may not work for anyone else...and in fact, you probably ended up removing a number of food sources that contribute to heartburn such as caffeine.

The reason your physicians don't see to care is that they can't generalize the information....so they would be remiss to pass this information on.

Someone could set up a project to research this... but that takes time and money...so who would pay for the study? The corn growers? The makers of proton-pump inhibitors? Neither one cares, and would actually discourage such a study as it would hurt their bottom-line...so the federal government might fund it...but then there are those lovely folk known as lobbyists...I'm sure they would love to push for funding for said research....

Guess I'd have to say, it's just not a hot-button issue.

And for the record, I'm a physician. (But certainly not a primary care physician).

--- From WebMD: (http://www.webmd.com/heartburn-gerd/guide/understanding-heartburn-basics)

What Causes It?

The basic cause of heartburn is an underactive lower esophageal sphincter, or LES, that doesn't tighten as it should. Two excesses often contribute to this problem: too much food in the stomach (overeating) or too much pressure on the stomach (frequently from obesity or pregnancy). Certain foods commonly relax the LES, including tomatoes, citrus fruits, garlic, onions, chocolate, coffee, alcohol, caffeinated products, and peppermint. Dishes high in fats and oils (animal or vegetable) often lead to heartburn, as do certain medications. Stress increases acid production and can cause heartburn. And smoking, which relaxes the LES and stimulates stomach acid, is a major contributor.

LOL...if it is a _lethal_ dose, why treat the patient?

They are going to get a _theraputic_ dose of directed radiation to target a specific tumor bed. The reduction in the imaging scan portion will lower _total_body_ dosing.

Not all body tissues deal with radiation the same way. Thyroid and small bowel mucosa are the most radio-sensitive tissues, while areas like bone and muscle are much more tolerant...If you can avoid thyroid cancer or radiation enteritis, you'll have or be a much happier patient.

Certainly not from the perspective of a physician. I continually bear in mind the cancer risk for CT scans that I order....the problem is that what I'm scanning for is an immediate threat to life, so I have to take a long term potential risk to offset a more immediate, more probable, and higher risk.

As for saving time...it is negligible...most new scanner (64 slice and up) process the images as quickly as the machine can scan. And even if there is a delay (e.g. 16 slice machines) most scans are put into a queue while the machine continues to process the signals and are read after the 3-5 scans done earlier are read. The exception is when I show up, the radiologists are required to prioritize my scans...(I'm a trauma surgeon)...but I usually don't have to wait very long even with the older scanners (most are done within 15 min)...if my patient is too unstable to wait 15-20 min for a scan, I take them directly to the OR.

As for saving electricity, there are several factors...1) the machines are always kept "on", 2)there is the power consumed to generate the x-rays and 3) there is a mechanical gantry (that I estimate weighs 0.5 to 1 ton) that spins around the pt when the scan is being performed that probable outweighs the power used by the other two put together.

Eventually it might. The exact technique they are using is for planning a radiation _treatment_ (cone beam CT), not a _diagnostic_ (helical scan) CT. They are quoted at the bottom that it _might_ be applicable. There are probably 100 to 1000 diagnostic scans for every treatment protocol.

There currently protocols that are used to lower the radiation dose for pediatric patients...the problem is that not all hospital use them. Except in a life threatening emergency, the parents should ask before a routine/elective scan is performed on their children.

Source: someone who has ordered enough scans to have statistically killed someone.

Mr I. M. Atwit, lead council for Dewy, Suck'em, and Dry Corp headquartered in Topeka KS, was quoted as saying "Nature has finally overstepped her bounds by infringing on our copyright! We intend to prosecute this to the fullest extent of the law [of man]."

Nature, unfortunately, could not be reached for comment.

In unrelated news, NASA and several prominent astronomers today warned of an impending meteorite strike that was predicted to hit somewhere in the Mid-West of the US. The most like impact site was around Topeka, KS.

Well...no. First the robot costs more to use...the instruments are of limited use - they only function X times before the lock out - that way the company can keep making money after the robot is sold. Those intruments also cost a lot more than standard lap instruments (and don;t last as long).

Second, as was noted in another post, this isn't really an automaton. It is still _very dependent_ upon the skill and judgement of a trained, experienced surgeon. A teenager may be able to operate it, but won't have a clue what to do. Surgery residency is at least 5 years of 80 hrs/week (used to be 100-120+ hrs/wk) (fellowship adds 1-3 years of additional training). So from that alone, I have well over to 30,000 hrs of expereince and training in the OR and managing my patients pre- and post-operatively and I'm still a young surgeon.

In addition, as I noted, the robot adds a layer of complexity (requiring more training to master) than a normal laparoscopic surgery, even though the procedures are often very similar, the un-natural-ness of controlling the robot and the slim margin of error (you can't swing an instrument wildly while it is inside a body) have all consipred to limit the use of the "robots".

Third, a lot of the cost of surgery is in the pre and post operative period. The OR itself in often just a portion of the total bill. I've had cases where a weeks worth of antibiotics cost 2-3 times the reimburstment of the surgery itself....

To conclude, let me take your anaolgy one step further...the first time the database blows up.: someone dies. How would that look on the bottom line? Surgery (and medical care in general) is not somewhere you want to find the lowest bidder. -- QG

To set the record staight, the robot is a tool looking for a problem. The robot is no better than a skilled laparoscopic surgeon, and in fact suffers from a "fatal flaw". I'll explain: the most common procedure for the robot is for prostatectomy which involved going deep into the pelvis to remove a walnut sized gland at the base of the penis and below the bladder. To do this using standard laparoscopic instruments is hard beause you would have to stand where the pt's head is to have the proper angle. The robot can operate "upside down" and removes this restriction.

The draw back to the robot is that it does not provide "haptic feedback" or force-feedback....a skilled surgeon relies on his sense of touch as much as his sense of sight. I've removed a pt's colon doing 80% of the surgery not needing to see what I was doing and just going by touch which was more revealing than my sight for those parts of the procedure(hand assisted laparoscopic colectomy). If I can't feel the tumor in the bowel because the robot doesn't provide a sense of touch, guess what - the robot will not provide any advantage.

The true falacy is that the human surgeon is a butcher and that the precision of the robot will be superior. In truth, the surgeon relies on the body's ability to heal to accomplish the miracle of the cure. I cut, but I rely on the body's ability to mend. There are precious few procedures out there that requrie such precise touch...and trust me I've sewn a 1mm vein to a 2mm artery during a bypass operation using my own hand, and with a suture that would break if you sneezed on it (another reason to use a surgical mask!). This case would not be possible with the current generation of robots.

Now, don't get me wrong, there may be some advances in the furture where the robot-assisted surgeon can out perform me, but for at least the next 5-10 years, the robot will be relegate the corner of one of our ORs and used 2-3 times a week for the RALP (robot assisted lapr prostatectomies).

As an aside, the tele-surgery concept may be a valid use in the future, but A) you need 100% up-time on your link B) you still need a semi-qualified individual at the pt's beside to 1) set up the robot, 2) put the ports in so the robot can slip the intruments in to the pt. And in reality, you need someone on stand-by to take over if the case can not be completed and you are stuck at a critical juncition.

[hemo] dialysis is using a counter current "dialysate" to effect a net removal of solvent and solute from the blood...aka accomplishing a filtration the way a kidney works by using a semi-permeable membrane. Can also be done via a process of peritoneal dialysis using a catheter inserted into the abdominal cavity.

plasmaphoresis is the process of removing the plasma from the body and replacing it with albumin or other colloid solution (fresh frozen plasma). This is used to reduce the immune components of the blood e.g. antibodies. Most commonly used for auto-immune disorders.

lukopheresis is selectively removing the white cells from blood. This is mostly commonly used in packed red cells used in transfusions.

The latter two procedures would be contraindicated in the face of a bacterial infection as they would severely inhibit the immune function of the body.

While the idea sounds like a good idea on paper, I have to tell you, as a practicing surgeon, it really sucks.

First let me clear up, the antibiotics themselves are either directly nephrotoxic (damage the kidneys) or their breakdown products are. Its not a matter of taking the kidneys “off-line”. And in addition not all drugs are removed with dialysis.

To access both renal arteries and veins (assuming normal anatomy many people have duplicated renal vascular systems) is not an benign undertaking. The vessels are in the retroperitoneum (behind all the structures in the "classic" abdominal cavity. So it is not a "trivial" procedure. Next to totally bypass the kidneys is not a great idea...extended bypass systems tend to cause a lot of damage to the blood, they can speed up the drestructiong of red cells (oxygen carrying) and platelets (clotting cells). The circuit also tends to active the clotting system and you get a paradoxical, hyper/hypo-coagulable state. This is similar to DIC (Disseminated intravascular coagulation) [http://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation]

Also the bypass circuit itself is made of synthetic material with acts to harbor bacteria. Given large scale infections, we as surgeon, routinely remove all sorts of prosthetics (AV graft material used for dialysis, artificially heart valves, pacemakers, rods and screws from orthopedic procedures)

The information in the article itself is not new. When I did a rotation in a burn unit in 2004, we had a standing problem with the unit harboring several species of Acinetobacter, and these organisms were resistant to all the antibiotics that the lab routinely tested. We routinely had to use Imipenem(tm) [http://en.wikipedia.org/wiki/Imipenem]. And it was not unusual to have bugs start to build resistance to that drug. We usually had to resort to poly-pharmacy as opposed to mono-therapy as we usually prefer.

Again as I posted a few weeks ago: As physicians we need to be vigilant in our use of antibiotics, but patients need to be respectful of them as well and to stop asking for an antibiotic (that is useless for viral infections) for every little sniffle when you have the common cold or flu (both caused by viruses).

Forgive me for quoting wikipedia, but I felt some footnotes were warrented. I usually yell at my students and residents when they quote it to me, but for the level of discussion here, it is adequate.

Quite a while. Part of the success they had with lungs is that they don't require blood...or more precisely hemoglobin which carries oxygen...so they can get away with just "feeding" the lung nutrients as they oxygenate themselves.

There are currently systems used that keep solutions circulating through transplant kidneys, that help keep them viable longer.

Brains pose unique problems. We don't have the technology to reconnect them so they function properly...and no prospect of fixing this anytime soon.

Not really. An iron lung works by negative pressure outside the body causing a negative intrathoracic pressure which draws a breath into the lungs. This is mimicking the physiologic function of the chest wall where the intercostal muscles contract causing the ribs to rise (bucket handle) and the diaphram to contract and drop. This increases intrathoracic volume and decreases the pressure.

Looking at the video, they are using a positive pressure system, where much like the modern ventilators, forces air into the lung. This is less physiologic, but more efficient and provides more precise control.