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Comment: Science needs funding (Score 1) 281

by rickyb (#45020271) Attached to: Do Comments On Web Pages Ruin Science?
This has been alluded to, but the real issue here isn't whether scientists are going to be persuaded to alter their pursuits. Rather, it's how non-scientists perceive the value of scientists. And, when most scientists are funded by non-scientists (i.e. all of us, through our taxes), this can have a profound effect on whether scientists can continue their work.

+ - New Open Development Platform on World's Largest EHR 1

Submitted by rickyb
rickyb (898092) writes "Epic, the largest electronic health record used by 51% of the US and 2.4% of the world, has just announced a new, open platform for mobile development at their annual User Group Meeting in Verona, WI. It's available at http://open.epic.com./ Right now it's geared towards mobile apps and the medical devices that connect to them, but it appears that additional APIs will shortly be made available. As a physician and developer, this is exciting in the sense that we now have a way to connect these innovations to over half the US population. However, being tied to one vendor, this is still not the truly open platform desired by physicians across the country. What apps will you create?"

Comment: There's a problem on both ends (Score 5, Insightful) 294

by rickyb (#41423063) Attached to: Medicare Bills Rise As Records Turn Electronic
Yes, some physicians will abuse the system. Some will do so willingly, while others will do so out of ignorance. However, many physicians at large academic medical centers (also known as "residents"), are not taught how to code and bill at all until they reach independent practice. This leads to very bad habits and often to underbilling quite significantly for their services. They all do the work, but don't appreciate the importance of recording and documenting the work for billing purposes, leaving money on the table. This impacts primary care most of all, where margins are very slim, and many physicians are struggling to remain solvent. EMRs actually take care of the coding and billing far more efficiently and accurately than the physicians themselves. But as the saying goes, "garbage-in, garbage-out." The coding is only as accurate as the physician documentation. The vast majority of physicians do not intentionally document erroneously to inflate billing - once the error is pointed out to them, they are more than willing to fix it. And for those physicians who are maliciously abusing the system, there's no better solution than EMRs to record and track this behavior.

Comment: Re:100% Accurate, Nearly All of the Time! (Score 1) 138

by rickyb (#33198364) Attached to: Spinal-Fluid Test Confirmed To Predict Alzheimer's
Exactly. Especially in medicine, no diagnostic test can ever be considered 100% accurate unless it could be tested on every single person who ever had the disease in question and who ever will have the disease. Try getting funding for that! Any article (or summary of an article) discussing the statistics of a diagnostic test should also include mention of the specificity and sensitivity of the test. Biostats 101, guys (and gals).

Comment: Re:1password (Score 1) 1007

by rickyb (#30054572) Attached to: Best Tool For Remembering Passwords?
I second this. I've been using 1Password since it was 1Passwd (remember that?!) and it's saved tons of time and kept me secure. 1Password 3 is now in beta. It's a great program - unparalleled on the Mac or PC (passwords saved on Mac can be accessed on the PC through a secure html file - it's made to work well with Dropbox in particular).

Comment: Re:What about the legality? (Score 2, Insightful) 369

by rickyb (#27728383) Attached to: Cosmetic Neurology
This is simply not known. The safety of drugs cannot be known until a huge number of people have used the drug for a long time. Caffeine has been in use for hundreds (if not thousands) of years by literally billions of people. We know that it is pretty safe.

Modafinil (Provigil), on the other hand, has only been around for about a decade and has had limited use. We already know about some serious side-effects of Provigil that aren't associated with caffeine (see the Wikipedia article here: http://en.wikipedia.org/wiki/Modafinil#Severe_adverse_reactions). In addition, many drugs are often found to have more serious and deadly side-effects in small numbers that are only discovered after the drug has been in use for a long time (e.g. Vioxx). In addition, Modafinil is a Schedule IV drug, but caffeine is not a controlled substance at all. There is absolutely no data of which I know that indicates Modafinil is safer than caffeine. Please share if you have such data.

Comment: Re:I call BS (Score 1) 369

by rickyb (#27724619) Attached to: Cosmetic Neurology

But who are you to tell other people which drugs they should have a legitimate right to contain in their bodies?

The words "legitimate" and "legal" share the same root. That's the point. Someone without an FDA-approved use for these medications does NOT have a legitimate right to take them. Just because we want to doesn't mean we have the right to (although on a case-by-case basis this can be debated, and rights often change. This is what our legislative system is for.)

Let me guess: you're in favor of legalizing marijuana?

Comment: Re:What about the legality? (Score 3, Informative) 369

by rickyb (#27724379) Attached to: Cosmetic Neurology
And I forgot to mention that on February 9, 2006, the FDA voted to include a Black Box warning on all stimulant drugs used to treat ADHD due to the sometimes significant cardiovascular side-effects. In medical ethics, there is a principle of nonmaleficence, or "do no harm." Prescribing these drugs to otherwise healthy individuals would, in my opinion (and the opinions of some very smart individuals at the FDA, including the author of this New England Journal of Medicine article: http://content.nejm.org/cgi/content/full/354/14/1445), be causing the potential for more harm than good.

Comment: What about the legality? (Score 2, Insightful) 369

by rickyb (#27724297) Attached to: Cosmetic Neurology
What hasn't yet been brought up in this discussion is the fact that these are all controlled substances, meaning that they are not just prescription drugs, but that their use and prescription by a physician is closely monitored to ensure they they are only given for FDA-approved uses. In fact, Adderall is a Schedule II controlled substance, which puts in in the same category as Opium, Morphine, Percocet, Hydrocodone, etc. Whatever your position on using these substances is, all of the above uses are not FDA approved and if a physician is caught prescribing these medications for these uses, he/she would have his/her medical license revoked.

The above summary makes it sound as if anyone can go to their physician and ask for Adderall or Provigil to enhance their study routine. As a physician myself, this is simply not the case.

"You stay here, Audrey -- this is between me and the vegetable!" -- Seymour, from _Little Shop Of Horrors_

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