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Comment: Re:Not just microbiome studies (Score 2) 53

by nbauman (#47714047) Attached to: How To Read a Microbiome Study Like a Scientist

Those 5 questions should be asked of pretty much every scientific study done, no matter what the field

That's the way to write a good science story. Whatever the story is about, you explain the basic questions that the reader should ask.

I despair about ever having people know the difference between association and causation. Nevertheless, it's worth repeating.

Gary Schwitzer's web site http://www.healthnewsreview.or... has more detail http://www.healthnewsreview.or...

Comment: Home fecal transplant went wrong (Score 5, Informative) 53

by nbauman (#47713895) Attached to: How To Read a Microbiome Study Like a Scientist

There was an article this week in the New England Journal of Medicine about a guy who tried a home fecal transplant, and wound up in the hospital. He gave himself cytomegalovirus, with very bad gastrointestinal symptoms.

He had a 7-year history of ulcerative colitis. The doctors made recommendations but he declined many of them. Instead, he gave himself a "home brew" fecal microbiota transplant. He used stool from his wife and 10-month-old child. Some people think that stool from children is more "pristine" than stool from adults, and doesn't need testing for infectious disease. Actually, children are a bad source of stool, because they get frequent viral infections, especially if they attend day care.

He finally started following doctors' recommendations and the ulcerative colitis and cytomegalovirus cleared up after a couple of weeks.

Fecal microbiota transplant actually works well for Clostridium difficile, with more than 90% effectiveness, which is great since C. difficile can be fatal and is often antibiotic-resistant. However, in the few studies with ulcerative colitis it didn't work too well and sometimes made it worse.

The article found two other cases of people who got infections from fecal transplant.

http://www.nejm.org/doi/full/1...

case records of the massachusetts general hospital
Case 25-2014 — A 37-Year-Old Man with Ulcerative Colitis and Bloody Diarrhea
Elizabeth L. Hohmann, M.D., Ashwin N. Ananthakrishnan, M.D., M.P.H., and Vikram Deshpande, M.D.
N Engl J Med 2014; 371:668-675
August 14, 2014DOI: 10.1056/NEJMcpc1400842

A 37-year-old man with ulcerative colitis was admitted to the hospital because of abdominal cramping, diarrhea, hematochezia, fever to a peak temperature of 38.8C, and drenching night sweats. Several weeks earlier, he had performed home fecal transplantation.

Comment: Re:I definitely share password with family (Score 2) 115

by nbauman (#47713597) Attached to: 51% of Computer Users Share Passwords

Ideally, the repository should then be placed in a safety deposit box that can't be accessed outside of the hit-by-a-bus scenario, but that would admittedly be an extra expense and arguably overkill.

The problem with a safe deposit box is:

(1) The survivor needs to be authorized to access the safe deposit box after death, and then needs a death certificate. http://www.ehow.com/how_579095... You're letting the bank decide who gets access to your passwords.

(2) Anybody with a judge's order can also access the safe deposit box, even if the owner isn't dead. So a safe deposit box isn't a good place to keep your Swiss bank account passbook, or anything else you don't want the government or the adverse party in a lawsuit to get.

Comment: Re:uh-huh (Score 1) 170

by nbauman (#47708457) Attached to: Why Chinese Hackers Would Want US Hospital Patient Data

The idea that somebody would get a million-dollar heart transplant with a stolen SSN number and DOB seems especially preposterous. The surgeons would have to go over the previous medical history and records in great detail.

The guy they quoted was CIO of Beth Israel Deaconess hospital. Either I'm awfully stupid, or he got it wrong.

Comment: Re:Time for medicare for all in the usa (Score 1) 170

by nbauman (#47708359) Attached to: Why Chinese Hackers Would Want US Hospital Patient Data

I never said it was free,

Liar. Well, unless you really don't pay taxes (which may well be true, dunno):

He never said "free." He said it won't cost him anything when he needs it. He paid for it in advance with his taxes.

Why is it that when somebody disagrees with you, you wingnuts call him a "liar"? Look up "liar" in the dictionary. A paper dictionary.

Comment: Re:Time for medicare for all in the usa (Score 1) 170

by nbauman (#47708265) Attached to: Why Chinese Hackers Would Want US Hospital Patient Data

Not necessarily. Administration is a very nebulous term, and your data is incomplete. Is this 31% of expenditures covered by medicare? Medicaid? Private insurance? A combination of two or more?

Paul Krugman (who has a fucking Nobel prize in economics) has explained all that in his New York Times column.

One of Krugman's examples is to compare regular Medicare with Medicare Advantage. The insurance industry and their Republican and "moderate" Democratic supporters said that they could do it more efficiently in the free market. They had their chance. The government paid the insurance companies 15% more for Medicare Advantage to "help them get started," and it finally went down to 5% more. They were never able to do it more cheaply than government. Krugman keeps asking, if they can do it so much more efficiently, why can't we cut their payments below Medicare? That's a rhetorical question.

I like to explain it with one area I've researched. Private insurance companies charge at least 15% of your premium dollar for administration and profits. It's in their annual report, under "Loss ratio." Look it up. That means that your doctor gets 85 cents of your premium dollar. He has to pay another 15 cents to administer his private insurance payments, according to medical office managers and doctors that I've talked to. That leaves 70 cents to pay for actual medical treatment -- staff, equipment, rent, etc. That's why a lot of doctors take Medicare and Medicaid even though it costs less. The government bureaucracy is easier to deal with than the private insurance bureaucracy.

The US government is also far more wasteful when it comes to "administration" than Canada. What makes you think those numbers wouldn't be similar under single payer? Who's to say that it won't even balloon, given that we need a larger bureaucracy to cope with more citizens.

I know health care. When the government runs health care directly, in regular Medicare, the Veterans Affairs system, or the military system, they do it as well as they do it in Canada, and much more efficiently than the private insurance industry.

There are exceptions. If every private insurance company worked as well as Kaiser-Permanente, it might work. But they're not.

Comment: Re:Time for medicare for all in the usa (Score 1) 170

by nbauman (#47708119) Attached to: Why Chinese Hackers Would Want US Hospital Patient Data

Yes, because the single payer systems in Europe of trouble free right?

Ever hear, "Price, quality and service. Pick any 2." The Europeans, and Canadians, have decided that they would let their waiting times increase to what they feel is a tolerable amount. In exchange, they have quality about equal to ours and it costs around half of what we pay.

I've compared the outcomes of surgery, cancer, heart disease, and other treatments in the US/Canada/Europe/Australia, and they're all about the same in developed countries. Some of the best outcomes are in the Veterans Affairs system -- our own socialized medicine.

You might have a six-month wait for a knee transplant, but you should wait six months before a knee transplant to get informed about the risks and benefits and try the less-aggressive methods like physical rehabilitation and weight loss before major surgery that has a death rate of 1-2%.

But if you get a heart attack or stroke, there are many places in Europe and Canada where you'll get to the hospital faster than you would here.

And in those mostly socialized systems, you can see any doctor you want -- unlike the US, where you can only see a doctor in your insurance company's ever-narrowing panel. Want to get your cancer treated at Memorial Sloan-Kettering or M.D. Anderson? Tough luck.

Yes, we have more CAT scans and MRIs. But we use them when there's no rational medical justification, and they are significantly increasing the leukemia rate.

I'm not saying we don't have an issue, but your 1 step solution is a joke. The same corruption, greed and poor administration that afflicts us now would continue in the new system.

Sometimes people say, "Canadian-style health care sounds very nice, but what do you do if somebody like George W. Bush is running the government?"

Well, you've got me there. If the Republicans are running things, nothing will work. We're doomed.

Comment: Re:Time for medicare for all in the usa (Score 1) 170

by nbauman (#47707939) Attached to: Why Chinese Hackers Would Want US Hospital Patient Data

Time for medicare for all in the usa also the million-dollar heart transplant is loaded with markup where you can likely go out side of the usa and pay way less for it.

also due to court rulings in favor of inmate care you can just go to prison / jail to get one as well.

http://www.cbsnews.com/news/pr...

Boy, is that ever the exception that proves the rule. In order to get a heart transplant somebody had to sue the California prison system for him.

If they didn't want to pay for it, they could have released him on parole. He was sentenced for burglary and robbery. A patient with heart failure isn't going to be able to commit any more burglaries and robberies. He'll be lucky if he can walk around the block.

Despite this unusual example, prisoners have some of the worst health care in the country.

I read a series of articles on prison health care by Andrew Skolnick in the Journal of the American Medical Association in 1998 http://www.aaskolnick.com/new/... and I've seen dozens of articles since then to show that it hasn't gotten any better (it couldn't get worse).

They were leaving diabetic patients to die in their cells without insulin. Dozens of patients died because doctors and nurses simply ignored them and didn't give them their regular medication.

Sue, you say? It's almost impossible for a prisoner or his estate to sue the prison or the private contractor in most prisons, Correctional Medical Services.

There was a provision in a lot of states by which a doctor who was convicted of sexually abusing patients or dealing drugs would get his license reinstated but limited only to treating prisoners, so many of the prison doctors had worse convictions than their patients.

Don't forget, a lot of these prisoners were in because of the war on drugs.

Journalists know that if you want to do a sensational investigative story, write about prison health care. The New York Times did a series a while back:

https://www.google.com/webhp?r...

http://www.nytimes.com/2005/02...

HARSH MEDICINE
As Health Care in Jails Goes Private, 10 Days Can Be a Death Sentence
By PAUL von ZIELBAUER
Published: February 27, 2005

Brian Tetrault was 44 when he was led into a dim county jail cell in upstate New York in 2001, charged with taking some skis and other items from his ex-wife's home. A former nuclear scientist who had struggled with Parkinson's disease, he began to die almost immediately, and state investigators would later discover why: The jail's medical director had cut off all but a few of the 32 pills he needed each day to quell his tremors.

Candy Brown died in September 2000, investigators say, when her withdrawal from heroin went untreated in this Rochester jail cell, shown in a recent photo.

Aja Venny with a photo of her son, Scott Mayo Jr., and the urn holding his ashes. She lives in a Bronx apartment with her husband, Scott Mayo, and their daughter, Skye, who is at her mother's knee.

HARSH MEDICINE
The New York Times's yearlong examination of Prison Health Services, the biggest commercial provider of medical care to inmates, found instances of disturbing deaths and other troubling treatment.

DAY 1: Dying Behind Bars

DAY 2: Lost Files, Lost Lives

DAY 3: Mistreating Tiffany

Comment: Re:Biometric security (Score 1) 170

by nbauman (#47707457) Attached to: Why Chinese Hackers Would Want US Hospital Patient Data

All they need to do is ask for a government issued photo ID card, and make sure the name on the card matches the name on the insurance form. My experience is that about 100% of doctors and hospitals already do that. TFA claims that just knowing an SSN and DOB is enough, and that is not true.

All they need to do is look up the patient's electronic medical record (if they ever get that working), and see that the height, weight, blood pressure, and contact information are all different.

I don't know how somebody could get my SSN and DOB, and figure out where I get my health insurance. If they did, I'd get their bills, and I'd know that something was wrong.

Hospitals do get patients coming into the ER with fake names, and they have systems in place for dealing with it. There were a couple of articles about that in the medical journals recently. Some guy said he thought he had leukemia, and had been treated in another hospital under another name. They called the other hospital and that story seemed to check out, although they had to make sure he really had leukemia.

If you really wanted to go to an ER with a fake name, you could get away with it, but all they'll do is stabilize you. If you need expensive ongoing treatment, you'd have to come back regularly.

It doesn't make sense. I can't imagine how somebody could use just your name, DOB and SS to get health care that they couldn't get in simpler ways.

Comment: Re:Uninsured? (Score 1) 170

by nbauman (#47707293) Attached to: Why Chinese Hackers Would Want US Hospital Patient Data

Obamacare is hardly a socialist program.

Given that Obamacare follows the essential features (mandates and private insurance) of a Heritage Foundation idea. http://krugman.blogs.nytimes.c...

In fact, calling Obama socialist or liberal is a stretch.
Obama, one of the better republican presidents we have had.
Hopefully we get a real liberal next time instead of a poser.

I wanted an FDR and all I got was this lousy Obama.

Comment: Re:Uninsured? (Score 1) 170

by nbauman (#47707191) Attached to: Why Chinese Hackers Would Want US Hospital Patient Data

More than 7 million people now have insurance paid for by taxpayers and rising insurance costs to all because of Socialism.

There. I fixed that for you.

You ought to fix your high school education, too, since you don't know what socialism is.

I mean, really, totally clueless. You think that "socialism" is just some word to call people that you don't like, like "retarded."

Just for fun, define socialism, and explain how Obamacare is socialist, in two sentences.

Comment: Re:Actually... (Score 1) 120

by nbauman (#47705941) Attached to: No, a Huge Asteroid Is Not "Set To Wipe Out Life On Earth In 2880"

Last time I had somebody run a catheter (or whatever) into my heart, I was having a heart attack. Having the clot simply removed is worth a bit of risk. I wouldn't do it for fun (particularly since lying still while the groin incision healed enough for me to move was agonizing).

It sounds like you either got a thrombolytic like TPA, or you got a stent placed.

In principle, the doctor should be able to say, "In randomized controlled trials, when people in your situation are treated with this procedure, their survival rate is X, and when people are untreated, their survival rate is Y."

I haven't been following the literature carefully lately, but in my understanding there's a small but significant advantage to using a thrombolytic or a stent.

Cardiology has a lot of treatments with small but significant advantages. They add up to a large advantage. People with heart disease live a lot longer today than they did 50 years ago. The NEJM had a 200-year historical review, A Tale of Coronary Artery Disease and Myocardial Infarction, http://www.nejm.org/doi/full/1... [FREE] which had a nice table showing deaths from cardiovascular disease declining from 4/1,000 in 1950 to 1/1,000 in 2010.

I would estimate that it represents an increase in life expectancy of about 10-15 years. That's about equal to the life expectancy that cigarette smoking takes away.

So you had your heart attack at a good time. It's a good thing you waited.

Comment: Re:How many years could he be charged with? (Score 1) 297

by nbauman (#47705617) Attached to: WikiLeaks' Assange Hopes To Exit London Embassy "Soon"

I realized that at one time rape victims were stigmatized merely for having sex outside of marriage, and for that reason their names were not published in newspapers.

However, today, that stigma applies just as much to the men who are accused of rape. I don't think there's any justification for keeping their names secret in a public case like this. They're in Sweden, not Afghanistan.

I can't figure out an account that refers to to the accusers as "AA" and "SW". I can't tell who is accusing Assange of what. I can't easily look them up on the Internet to check their credibility. The Wikipedia article refers to them as "a 26-year-old in Enköping and a 31-year-old in Stockholm." Which one is AA and which one is SW?

You have not given any sources for your claims. If you know of any sources that I can access on the Internet I'd be happy to read them. I give credibility to stories that give both sides, as in traditional journalism, rather than trying to make a case for one side.

One picture is worth 128K words.

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