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Comment: Re:No, they don't work (Score 3, Interesting) 670

by Custard (#45628219) Attached to: Diet Drugs Work: Why Won't Doctors Prescribe Them?

I wish /. had a like button.

I remember when I realized that not only had a chosen to take the stairs because the elevator was taking too long, but I had run up the last flight.

I disagree about only allowing special people to get treatment, but I can totally validate the intangible of losing a bunch of weight after having been stuck for a couple years.

It is all very subtle and nuanced. Slashdot, alas, is not a good forum for intelligent discussion.

The problem, as I see it, is that we are all speaking from our experience. As an obese person, who has struggled with the disease all my life, it is easy for me to understand that it is a disease. I also have the benefit of having seen the research and spoken with the researchers. I have the experience and the knowledge, so the truth is obvious to me.

But I confess I have little sympathy for people with chronic pain. If I take the time to think about it, I can imagine what it must be like to be in agony all the time, but in the moment I just think "suck it up, we all have crosses to bear."

Seeing the uninformed here is a good reminder for me.

Comment: Re:mechanisms that are not yet fully understood (Score 5, Informative) 670

by Custard (#45628153) Attached to: Diet Drugs Work: Why Won't Doctors Prescribe Them?

You might want to review the full research before posting.

> - they don't work very well in the short term and not at all in the long term

Qsymia gives about 10% weight loss beyond "placebo" (which was a diet and exercise program that all treatment arms got.) Weight loss was maintained out to two years, which was the end of the study. Qsymia is a combination of two medications that have been on the market for a long time. Weight loss docs have been prescribing them together for quite a while and I haven't heard any talk about them not working after a certain point. Qsymia just takes two existing meds and makes one pill out of small amounts (if you want to match the Qsymia doses with generics you have to chop tablets as small as an eighth) and uses a time release formula so the side effects (carbonated drinks taste funny and tingling in the fingers are common. I have the change in taste) aren't as bad. There is no research on Qsymia past two years, but there is experience with the components. Belviq is a 5-HT2C receptor agonist, and I'm on a SSRI. I haven't paid much attention to it, but I assume it has data out two years also.

> - they are expensive

True dat. And not covered by a lot of insurance. I buy mine out of pocket. About $170 per month. It's worth it to me.

> - they have lots of bad side effects:

Other people have pointed out that is not the case, but I thought I would address the pregnancy thing.

First, if I, as a 45 year old man, get pregnant on Qsymia it will be news. Much bigger news than a birth defect.

Second, obesity also increases in risk of birth defects.

Third, this is why they have a program to tell people that if you take Qsymia in the first few months of pregnancy there is an increased risk of cleft lip/palate. This is because Qsymia contains topiramate, a medication prescribed about 10,000,000 times a year. Interestingly you can take 400mg a day of topiramate for neurological conditions without a warning, but if you take 23mg a day for weight loss you have to be warned of the risk. Not that there is a bias against obesity or anything...

I think I have posted more in this one topic than in all the rest of the time I have been on slashdot, but this drug has made such a difference in my life.

Comment: Re:Obesity is not a disease (Score 1) 670

by Custard (#45628015) Attached to: Diet Drugs Work: Why Won't Doctors Prescribe Them?

The "is it a disease or a symptom" argument is a fascinating one for me, as a somewhat outside observer.

There are *many* studies showing that weight loss around 5% will have a huge impact on blood pressure; total, LDL and HDL cholesterol; and T2DM. RYGB pretty much cures T2DM. I know that losing body fat dropped my A1c more than metformin. The DPP studies show that is expected.

If losing weight curesT2DM, does that make a symptom? Do you refuse to treat diabetes because you want to treat obesity instead? But you can't treat obesity because that is a symptom of something else, an endocrine imbalance perhaps. Of course the endocrine imbalance is the result of a primary endocrine problem, so we can't treat it. and the primary endocrine is because of a pituitary issue. So unless we can treat the pituitary problem, the patient dies?

Of course nobody would do that, but I hear people say obesity is a symptom all the time without thinking about all the other diseases that are also symptoms.

I'm not meaning to criticize here. I really do think it is a fascinating discussion. I have never been able to get anyone to tell me the difference between a disease and a symptom other than "we have treatments for diseases." Now that we have good treatments for obesity, it is time we face up to the fact that it is a disease.

BTW, there was a great NEJM article a while back on "the myths of obesity" or something similar. You should check it out. You might also want to look at the AACE guidelines on treating T2DM*. The doctors who are going ofter obesity are seeing great results. If you drop body weight by 5% you can get A1c drop similar to a second line treatment, BP drop similar to an ACE/ARB, and nice improvements in lipids. Your patients won't be happy, 5% is barely visible, but there are some really nice health benefits.

* Or try to. I find the algorithm a confusing mass of randomly colored boxes.

Comment: Actually they do work. (I'm on one of them.) (Score 3, Interesting) 670

by Custard (#45627737) Attached to: Diet Drugs Work: Why Won't Doctors Prescribe Them?

(tl:dr The drugs work. People think about obesity wrong.)

To those that say they don't work, I would suggest you look at the trials. One of the differences between these regulated prescription drugs and supplements or (most) diets is that there are actual double-blind placebo controlled studies behind them. They do work. There is very good research to show that they do.

Qsymia, which I am on, gives an average of ten percent body weight loss beyond placebo, and the weight stayed off out to two years, which was the end of the study. I went from 269 to 253 in my first six weeks (13 pounds or 4.8%.) I feel much better now, and I have taken up weight lifting again. My weight isn't dropping, but I am clearly losing fat and gaining muscle. My weight is pretty stable, but I can feel ribs that I haven't felt since the nineties. None of my leather belts fit anymore. I'm wearing a belt with a friction buckle until I stop shrinking.

I also just got my quarterly labs back and my A1c is down 1.2% and my lipids are great. I'm getting lightheaded when I stand up too fast (orthostatic hypertension;) I have an appointment next week to talk to my doctor about reducing my blood pressure medication. You don't just lose weight, but the comorbidities go away with about 5% weight loss.

The main problem with obesity drugs can be seen in the comments here. People for whom obesity is not a disease don't understand what it is like to fight the disease. I'm old enough to remember when depression was treated the same way as obesity is treated now. Polite people said "try to think happy thoughts." "Just snap out of it" was a more common response. Today most people understand that some people have broken brain chemistry, and telling a depressed person to work harder at being happy isn't going to work. The researchers understand that obesity is a disease, and telling people to work harder at being healthy isn't going to work either. But most people don't understand that yet.

To the person who said diet pills are short term only, you are right and wrong. When a person who is on medication for a chronic condition stops taking their medication, the condition returns. That is how you know the medication is working. Obesity is a chronic condition. Because obesity was once thought of as something that could be cured, like an infection, pills used to be given for a short period. People would lose weight on the meds, the doctor would pronounce them cured, they would stop the meds, and they would regain the weight (and the high blood pressure, and the diabetes, and the dislypidemia, and all the other fun stuff that goes along with central body fat.) The researchers and educated doctors now understand that obesity is a chronic condition that responds well to medications. (It also responds very well to *intensive* lifestyle modification and surgery. Most doctors miss the word "intensive" in that sentence, which is the subject of another rant.) The current expectation is that you stay on the drug the rest of your life, possibly with drug holidays.

For me, Qsymia has been life changing. I had lost about 100 pounds of fat over about six years, but I was stuck and I still had type 2 diabetes, high blood pressure, and horrible lipid numbers. I was working out, hard, at least eight and a half hours a week plus two 50 minute weight lifting sessions with a private trainer. I watched what I ate, but I was still obese and I still had the health problems. Eventually I got discouraged and stopped working out hard. I still did 300 minutes a week on a treadmill, but I wasn't killing myself in the gym or lifting. Interestingly, I lost muscle and gained a little fat, but it made very little difference to my overall health. With Qsymia my eating changed dramatically, I lost a bunch of fat, and my lab numbers got better.

Whether you prefer anecdote or data, the result is the same. Qsymia is a game changer.

(Some disclosure. I'm a computer guy with no medical training. My girlfriend is an MD who is, at this very minute, sitting for her board certification in obesity. She is probably the world expert on Qsymia, and one of the top doctors in the world on obesity in general. Because of her, and my own condition, I go to conferences and have had at least 50 hours of continuing medical education in obesity and the related comorbidities. I read a lot of journal articles and I am personal friends with a lot of the leaders in the field, including Dr. Kaplan, who is mentioned in TFA. I AM NOT A DOCTOR AND I DO NOT GIVE MEDICAL ADVICE, but I am a pretty well informed patient.)

+ - What Can Lord of the Rings Teach Us About Surveillance?->

Submitted by Jeremiah Cornelius
Jeremiah Cornelius (137) writes "Slate has an article: The Eye of Sauron Is the Modern Surveillance State . Although the insights provided are not necessarily unique, and echo the observations of some like Bruce Schneier, Glenn Greenwald and Chris Hedges, they do illustrate them nicely, through an unexpected allegorical reading of Tolkien's familiar epic. The gist is that unlike most dystopian fantasy — especially the explicitly political variety — Tolkien understood that the minions of absolute power were untrusted by that power, itself. It's also worth reading for the defense of the fantasy-epic genre, which offered Tolkien the opportunity to explore themes like the "distinction between omnipotence and omniscience," that were under-examined in modern idioms, but relevant to Tolkien from a theological interest and connected to the experience under tyranny."
Link to Original Source

Comment: That depends on what you do in and with your room (Score 1) 416

by Custard (#42134843) Attached to: Ask Slashdot: Server Room Toolbox?

It is interesting to read people's responses. A lot of people don't seem to get that we don't all do their job. I would never buy a soldering iron. I suck at soldering and, at my hourly rate, it would be criminal to bill a client for having me try to fix something.

A few things that I have found.

A headlamp is generally better than a flashlight. You can take a headlamp off and use it as a flashlight, but it is a lot harder to mount a flashlight on your head. I have a great big thing that is designed for construction workers. I look like a fool when I wear it, but it works great.

The "network testers" that are really continuity testers annoy me. They cost a lot for not much information. I use a Byte Brothers Real World Certifier. http://www.bytebros.com/bb_pdf/RWC1000K_Real_World_Certifier_RS.pdf It gives you a lot of information for not a lot of money. Their LowVoltage Pro looks even better, but I haven't ever used one. I don't know what they mean by "pass/fail" on the cable test.

ifixit's 54-bit driver kit is nice to have around. http://www.ifixit.com/Tools/54-Bit-Driver-Kit/IF145-022 It doesn't replace real screwdrivers, but it is always there when I need it. I'm embarrassed by the number of times I have used the #2 Phillips out of their kit because I can't find a real screwdriver.

I believe in PC attached label makers. I am much more likely to label things when I don't have to find the labelmaker and type on a chiclet keyboard. I still have a Brother 1500pc, but there are current models. Get one that does 1" labels. You don't use them often, but when you do you are happy to have them.

But it all depends on what you do. For me, a USB to PATA/SATA adapter and an external power supply that will spin a HD is invaluable. Maybe not so much for you.

Comment: Re:Buy crap tools! (Score 1) 416

by Custard (#42134463) Attached to: Ask Slashdot: Server Room Toolbox?

This is marked funny, but it really works. I was constantly having my 6-n-1 screwdriver disappear until I bought a yellow one with pink flowers. I've had it for years.

I worked with a shop foreman who got tired of losing tools and bought a complete set of things people would want to borrow and painted them all hot pink. Everyone knew that they were welcome to borrow anything pink. If you saw a pink tool left somewhere you knew to return it. It worked great.

Comment: Re:Did the signal degrade, or the noise increase? (Score 1) 615

by Custard (#41730999) Attached to: Ask Slashdot: Why Does Wireless Gear Degrade Over Time?

MAYBE.

On channel two you are competing with the side lobes of two channels, but your peak has little competition.

If 1 and 6 are heavily congested you might be better on three. You can get an idea using a spectrum analyzer, but do real world tests. I often go off the "big three" in a downtown office.

Most people I know use MetaGeek tools, but I also like to drop an Aerohive AP in an office for a while as part of my network assessment. It can gather a lot of useful information and is completely managed from the web.

Comment: Re:Signal isn't chaning, the noise floor is (Score 1) 615

by Custard (#41730827) Attached to: Ask Slashdot: Why Does Wireless Gear Degrade Over Time?

It isn't just a hardware problem. You can increase *transmit* power on the AP but not receive sensitivity on the AP or transmit power on the client. (Unless you can increase it on the client; I run networks for other people, I don't get to tweak their equipment. I don't think you can tweak iOS devices at all.)

So, best case, you end up with in a situation where the client hears the AP fine but the AP might, sometimes, barely, hear the client. In a single AP network you are dramatically increasing retransmits. In a multiple AP environment you might be preventing the client from roaming to an AP that can hear it fine. Again, best case scenario, your throughput probably goes down. Don't believe me? Fire up a sniffer and check for yourself. You can use Wireshark under BackTrack really easily. You need linux (or expensive hardware) if you want to capture the management frames.) Or FreeBSD? ;-)

The reality is worse than that. As you increase transmit power your signal distorts. Just like a stereo; it gets fuzzy when you crank it. Just like a stereo, better equipment can go higher without sounding like crap, but I bet the people who don't already know this aren't running high end hardware.

You are much better off getting a good antenna. Antennas help both transmit and receive power.

But there is nothing to stop you from doing a little experimenting. Wi-Fi is funny. You might do better running hot and replacing your AP every year. I generally have happier users when I *decrease* power. YMMV. HTH. HAND.

Comment: Ah, history (Score 2) 101

by Custard (#41707847) Attached to: Making a Slashdot Omelet

JonKatz was the reason I got a /. login. I had stopped reading because his blatherings annoyed me too much. Someone let me know that if you had a login you could filter out his crap.

It is fitting that his reminiscence is a grammatical and logical train wreck. "If convention media had followed the idealism and values of Rob and Jeff, they might not now be such a shambles."

If he had started writing sooner I could have gotten a four digit ID

Comment: Trays? (Score 1) 422

by Custard (#41517133) Attached to: Ask Slashdot: What Would You Include In a New Building?

Thanks for the added info. I think most of the people talking about dedicated HVAC are used to bigger installations, from challenging climates, or both. I occasionally have cold air run into a server closet, but ambient works for a few switches and a couple servers.

Dedicated power is easy and you should always have it. Just get as many 15 or 20 amp circuits as you need. I don't know the AC side of the business, but I have never had a problem getting an electrician to rearrange circuits. You just don't want your gear on a breaker that can be tripped by someones personal heater.

I haven't seen anyone else mention wiring trays. I've used them a few times and like them a lot. It makes it easy to add and subtract and, depending on your decor, can be a fashion statement. But i have never worked in a high noise environment.

Do install lots of conduit that is bigger than you want. Consider having your electrician drop conduit to your network locations and then stub it out over the ceiling. That can make MACs a lot easier.

You know your building better than we do. I think you have this covered.

Comment: Talk to an expert (Score 1) 227

by Custard (#40740131) Attached to: Ask Slashdot: Stepping Down From an Office Server To NAS-Only?

> full time lawyer and part time nerd doing most of the IT support

I am clearly biased since I am one of the horde of consultants to small business, but I suggest talking to someone who has done this at least a dozen times before.

How would you respond to someone who posted "I'm a full time sysadmin and part time (self-taught) lawyer who handles the contract work..."

Plus your billing rate is probably higher than an IT guys.

"Help Mr. Wizard!" -- Tennessee Tuxedo

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