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Comment Re:And every one of them... (Score 0, Troll) 61

Learn a little history. They'll target conservative extremists, but they create files on liberals just for being liberal.

IRS affair has nothing to do with the FBI. (Also, there is some indication that it's more Bengazi-style spin from the right than actual substance.)

Obama has nothing to do with it.

Comment Re:Too Many Women Die from "All in your head." (Score 1) 47

Too many women die by the "all in your head" diagnosis.

My friend's ex-girlfriend went to the hospital for chest pain, was diagnosed with anxiety. She died less than a week later.

There's too many generalities and not enough specifics for this to be useful, in any way. To preface what I'm about to say: yes, medicine, like most professions, historically has had sexism problems. Although with the older generation of doctors retiring and/or dying, and more women studying medicine than men at many schools, that is changing.

For every woman that dies by the "all in your head" diagnosis, there's a substantial number of women that are harmed through expensive and unnecessary testing and even surgery or procedures because everyone involved is sure there's an actual physical problem related to a symptom that isn't going away and everyone involved is willing to dive down the rabbit hole to figure out what it is. Case in point: one of my hospital's most frequent patients is a nice woman who came in originally due to unexplained long standing abdominal pain and nausea and vomiting. Even though all the relevant testing was coming back negative, eventually after enough visits, a consulting surgeon felt her symptoms resembled dysfunctional gallbladder pain enough for her to have it surgically removed. Fast forward, the patient is still coming in for the same symptoms, but develops a small bowel obstruction from scar tissue from her previous surgery. Fast forward again after multiple bowel resections for multiple obstructions, and she has developed short gut syndrome on top of her previous symptoms with chronic diarrhea and malabsorption of basic nutrients. She's doing better now on daily IV nutrition. I'll let you imagine what her quality of life is with a permanent IV that has to be changed every so often for serious line infections, and being tethered every day to a bag of nutrients to drip in. And she is by no means a unicorn in the medical world.

And now, back to your friend's ex-girlfriend. What tests were run? What were the results? What description of pain was she having? What did she die of? Have you contemplated the possibility that the hospital ran appropriate tests for a chest pain evaluation, everything came back negative, your friend's ex-girlfriend was dealing with concurrent anxiety disorder, and died with something unrelated a week later?

Comment Re:Something wrong with this story (Score 1) 47

Since you're asking a similar question to someone else I replied to, I'll cut and paste my answer from below.

The doctor didn't think her story, as it was told to them at the time, was a TIA. What happened to cause the misdiagnosis? Most likely, a "failure of doctor-patient communication. With a completely normal physical/neurological exam, all it takes is for a slightly confusing or badly told patient story (which NEVER happens, of course, with a patient freaked out about a possible medical problem) or a doctor that's not hearing or associating the right phrases to lead them down the TIA/stroke diagnosis pathway to be sent home." Sometimes it's a fine balance to walk between putting words in a patient's mouth that they can enthusiastically nod their heads to versus listening to them stumble around trying to find a way to describe what happened.

"Why didn't the doctor ask for an MRI the first time around? Well, she went to the ER. Now, admittedly, I haven't worked in the Canadian system or outside of 2 confluent states here in the US, but standard of practice where I have worked is that ER doctors do not have access to MRI scans. They take way too long for the fast turnaround of ER care. MRIs can take 30 minutes to multiples of hours. CT scans take a few minutes. MRIs are either handled by outpatient scheduling or by admitting the patient for an inpatient stay in the hospital. On top of that, any stroke suspicion automatically gets a CT of the head without contrast to rule out intracranial bleeding, which is by far the most serious and emergent diagnosis from that class of symptoms. Tangentially, a CT of the head likely would not have picked up a small ischemic stroke like her later MRI."

Comment Re:Why no MRI the first time? (Score 4, Insightful) 47

I'd like to know why the doctors didn't ask for an MRI the first time around. Why did the patient need to wait and get "proof" there was a real problem? Intact why don't we get an full body MRI and maybe even a CT scan maybe every 20 years to find possible problems before they happen?

Well, IAAD. I don't have access to the notes/file, but I can give a pretty reasonable guess to your answers.

Why didn't the doctor ask for an MRI the first time around? Well, she went to the ER. Now, admittedly, I haven't worked in the Canadian system or outside of 2 confluent states here in the US, but standard of practice where I have worked is that ER doctors do not have access to MRI scans. They take way too long for the fast turnaround of ER care. MRIs can take 30 minutes to multiples of hours. CT scans take a few minutes. MRIs are either handled by outpatient scheduling or by admitting the patient for an inpatient stay in the hospital. On top of that, any stroke suspicion automatically gets a CT of the head without contrast to rule out intracranial bleeding, which is by far the most serious and emergent diagnosis from that class of symptoms. Tangentially, a CT of the head likely would not have picked up a small ischemic stroke like her later MRI.

Why did the patient need to wait and get proof? Well, with the story written down and no workplace rush, hindsight says she probably deserved an inpatient workup for a TIA the first time around. The #1 cause of misdiagnosis is failure of doctor-patient communication. With a completely normal physical/neurological exam, all it takes is for a slightly confusing or badly told patient story (which NEVER happens, of course, with a patient freaked out about a possible medical problem) or a doctor that's not hearing or associating the right phrases to lead them down the TIA/stroke diagnosis pathway to be sent home.

Now let's turn this around, based on her initial episode on presentation to the ER. You're the patient that just had a five minute spell of weirdness that includes, "had trouble speaking words". In a few minutes, those symptoms were gone like it never happened. A CT scan will likely be negative for anything (but it will dose you with about 20 chest X-rays' worth of radiation to your brain). By definition, a TIA won't show anything on MRI (a small-scale infarct on MRI is a stroke, period). There is no medical "fix", as TIAs are self-limiting and resolve themselves - there is only secondary prevention. If this is a TIA, your best treatment includes going on aspirin daily (ulcer risk), antiplatelet medication like Plavix daily (bleeding risk), and a statin daily (multiple adverse effects well-documented. You can avoid taking if LDL is already low). On the basis of five minutes of symptoms that haven't returned, would you feel like taking this medication for the rest of your life? Does dosing every single person that comes in with a similar story with a combination of multiple medications sound like a good outcome?

Third, why doesn't everyone get a full body MRI and maybe even a CT scan every 20 years? Well, you can. You'll need a credit/debit card or an appropriately-sized stack of cash, but radiology suites will be glad to scan you. I'd hate to put words in their mouths, but I would venture to say that would be their preferred business model. Especially if they could get away with not having to deal with third-party payers.

Oh! You want someone else to pay for your scan. First, you need a good reason to order the scan to get someone else to pay for it. So let's think about it. Multiply thousands of dollars of unnecessary scans times 300 million people+ here in the US, rotating every 20 years. Then factor in all the incidental findings which will be inconclusive and need either further scans or maybe invasive surgical procedures to investigate. Factor in complications and harms from procedures and radiation dosing (a single CT of the chest is equivalent to about 70 chest X-rays, which is not insignificant in terms of lifetime cancer risk), and the fact there will be a lot of false positives, especially when you're screening 300 million people. Then, after all that, you've caught a very small percentage of actual problems by doing mass screenings. A significant fraction of those you will have no better outcomes than if you waited for symptoms to develop (see: prostate cancer). So now you get to weigh spending billions of dollars every year to get the benefit described

Comment Re:Qualifications: thinker and visionary (Score 1) 107

Authors, including authors of cartoons, tend to spend most of their time thinking, so they're a fairly good profession for spawning visionaries quite regularly.

IMO he should have spent more time thinking about his cartoon strip, which (back in the day) had one that was funny, interesting, or insightful out of every few hundred.

Comment Re:Disappointingly Linux-centric (Score 3, Funny) 611

Disappointingly computer-centric too. My favorite desktop environment consists of a pencil, a paperweight, and a stapler.

And I can put my head on it for a nap whenever I think that will increase productivity.

(As for the survey, I voted, but I'm not sure it's correct to identify one as my favorite when I haven't actually tried all of them.)

Comment Re:salty seawater vs melt ? (Score 2, Interesting) 298

It's seasonal, and one of the reasons for the increase is increased precipitation (caused by, you guessed it, global warming).
The sea there is actually warmer, and the land ice is shrinking.
In short, this is only interesting if you need facts with superficial interpretations that can "refute" global warming to the uninformed masses.

http://www.skepticalscience.co...

p.s. - I notice in another skepticalscience link that gw deniers have joined evolution deniers in invoking the second law of thermodynamics as "proof that it couldn't happen". As if scientists are ignorant of the 2LoT.

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