A lot of doctor's offices are printing out pre-signed perscriptions on 8x11 instead of hand writing/signing on perscription pads whose paper has security features.

But for controlled substances, US pharmacies still require, and all doctors use, secure prescriptions with real signatures and a valid DEA identifier. When filled, the prescription is recorded in a national database referring to the patient, the doctor, and the pharmacy. Those printed 8.5x11 rx's are for stuff like blood pressure meds that no one really cares about, and can't be used for more interesting stuff. If you really want to forge a metoprolol script and sell the extra on a street corner, go ahead.

I am modestly surprised that there isn't a bigger black market for the more expensive (but non-controlled) prescription drugs, but I guess it's easier to get them from Canada than risk a dealer.

They did that. From the press release:

Approximately half of the participants were non/low caffeine consumers and the other half were medium/high caffeine consumers. All were asked to rate their personal levels of anxiety, alertness and headache before and after being given either the caffeine or the placebo. They were also asked to carry out a series of computer tasks to test for their levels of memory, attentiveness and vigilance.

They did, but they didn't report it in this paper. Here, they only reported the self-reported scale of alertness, and as the GP poster described it's entirely possible that caffeine drinkers have a higher expected alertness level. We'll have to wait for the sister paper to see what the objective tests show.

Common thing in science, collect all your data at once but report different "stories" in different papers. This story was actually about how certain SNPs in a particular gene might affect how caffeine induced anxiety. Maybe the other paper is going have a story that focuses on how that gene affects the cognitive aspects of caffeine use.

3) We rarely spot fairly large mile-plus asteroids before they actually pass us. What makes you think we could spot even MASSIVE spacecraft with any warning?

If they're planning to stop, instead of just pass through/into us, then they would need to decelerate as much as they accelerated to begin with. The exhaust will be pointed at us, and we should be able to see it either a long way off (if they're going slowly) or a REALLY long way off (if they're going fast). So long as their drives obey the laws of thermodynamics as we understand them, we should be able to see them coming.

What alternate freaking universe are you from? Sounds like a nice place.

The Republican conservatives believe that no taxpayer money should be funding abortions.

Ah, the one thing our universes have in common. Women should be barefoot and pregnant in the kitchen, appropriately inferior and subservient. My head would explode if any universe contained Republicans who felt otherwise.

They also think that the principle reason that healthcare doesn't work in this country is because the cost of health care is too high.

Liberal fascists want to cut Medicare! Death panels! Rationing!

They believe this is due to too many people trying to get a "free pass" by not having insurance.

Liberal fascists want to unconstitutionally force people to pay for insurance! Mandate! Fascism! Or Communism! One or the other. Did any Republican in your universe really demand a mandate?

It's also due, they think, to a serious problem with "impulse" lawsuits which force doctors to buy an incredibly high amount of malpractice insurance.

OK, one more thing in common, Republicans in your universe have a similarly inane and objectively insane view of how much lawsuits add to the cost of health care.

The Republicans also think that there are way too many procedures, both surgical (angioplasty vs. TPA for heart problems) and diagnostic (too often a large, extremely expensive test is conducted for no good reason).

Rationing! Death panels! Liberal fascists want to kill grandma and Sarah Palin's kid! Look at how England kills anyone who's not 6 feet tall and strappingly healthy! Fascist Communists coming between you and your doctor!

Finally, the Republicans think there is no such thing as a single bill that will fix this. What is required is a gradual, step-by-step series of bills, to be written and implemented over a series of years, to ease us into a new era of health care.

Ah, in your universe Republicans will build upon the series of stepwise sensible reform bills they enacted during the years when they had control of all three branches of government. Like when they offered a Medicare prescription drug plan that would lower overall costs by providing national negotiation with drug companies, while reducing the deficit by paying for the program with other spending cuts and new taxes. Sure. Nice place, that universe. Or they offered their series of sensible stepwise reform bills as a proposal during the year-and-a-fucking-half the entire Congress was masturbating over health care reform. Right. Heard a lot about that in this universe.

In our universe the national Republican party is batshit crazy, and has wed itself to the ideal of allowing absolutely nothing to happen, ever, by calling anything that anyone suggests a Fascist Communist plot, even if it was their idea to begin with (as most of the HCR bill was. Romneycare, anyone?). That's gonna work out real well for them, forget about how it works out for the American people. If you seriously think "BOTH sides make VERY good points" you are also batshit insane. Too bad your health insurance company probably doesn't cover Psychiatric care.

The USPS is in debt up to its eyeballs because electronic documents are causing a drop in volume. FedEx and USPS have adjusted their rates , fleets and staffing to accommodate this drop. The USPS is less nimble because it faces restrictions imposed by the government (what kind of business it can do, what rates it can charge, etc.). If we ran healthcare like this, you can bet it would have the exact same problem.

I really like the USPS vs FedEx analogy. It illustrates the fundamental difference between private industry and the government, and applies perfectly to heath care.

The USPS is required by law to provide a service to the people of the US. FedEx is required by its stockholders to make the largest possible profit. USPS has to provide affordable rates for tiny packages picked up at any address anywhere in the US (or overseas for APO addresses) and deliver it to any other address anywhere else in the US. FedEx does no such thing, or at least can charge whatever it actually costs to do so. Try to have FedEx pick up a one-page letter from your house and deliver it somewhere 2000 miles away. How much does that cost? A hell of a lot more than 44 cents. FedEx is better at delivering a package as fast as humanly possible, as certain as humanly possible. But which service to most people need most often?

USPS is single-payer healthcare (imagine affordable primary care instead of letter delivery) while FedEx is a private insurance company (lots of elective cardiac caths and hip replacements). One will provide better services to most people, the other will do certain profitable things well and make a lot of money doing it. Maybe we need both to give everyone the best possible health care. But right now unless you're over 65 or a veteran we live in a country without a postal service, where FedEx charges us $50 to send a birthday card to Grandma, and where they cancel delivery service altogether if you subscribe to too many magazines.

To my surprise, one of the most important functions I wanted in a book reader was not there -- I could not import my own documents.

There are a few apps for that. I like MobileStudio. It lets you upload arbitrary files to the iPhone/Pod via FTP, and can view PDFs, Word and iWork docs (among others). I use it for viewing PDFs of scientific papers on the go, works awesome.

You cannot tax a corporation. Increased tax burdens just trickle down to reduced wages for low level employees and increased prices. I'm not sure why that is so hard for people to get.

You cannot tax me. Increased tax burdens just trickle down to less disposable income to spend on cars and cable tv and smaller tips for low level employees like delivery boys and waitstaff. I'm not sure why that is so hard for corporations to get.

That's a pack a day for 47 years, which is admittedly within the bounds of possibility, but still an awful lot of smoking.

Never worked in a VA hospital, eh? :) You measure smoking history in "pack-years" (actually packs/day * years). 47 is pretty unremarkable. It's not until you hit triple digits that it seems extraordinary.

Most reports are that swine flu has been mild compared to the typical in most individuals. This includes reports that some exposed have never developed any symptom. The reported numbers for swine flu rely on the presumption of swine flu rather than the regular seasonal flu, not actual tests. That is, died so must have been swine flu.

What evidence there is suggests that children and the elderly should have priority for vaccination (greater potential benefit for the same risk). Healthy adults should be at the end of the list.

Fucking shit, could you cram any more potently concentrated misinformation into a single post?

The swine flu is *usually* a mild flu, just like the regular seasonal flu. But it *is* killing healthy young people, which the regular flu does not. It's landing them in the hospital, and then killing them after prolonged ICU courses. The mortality rate for pregnant women hospitalized with novel H1N1 infections is about 50% based on case series from several hospitals, including my own.

There is no "presumption" here. Novel H1N1 is tested via PCR of nasal swabs or sputum samples, and/or at autopsy on lung tissue. Every suspicious hospitalized case in California (at least) is tested like this. For certain, every death in the hospital is definitively tested. There is no "presumption". Novel H1N1, followed by bacterial superinfection, is what is killing these healthy young people. Just like in 1918.

The formal CDC recommendations are that *young* people be first in line for the vaccine. OK, pregnant women, infants and the immunocompromised are first, but of the general public, young people are next. For once, the elderly can safely wait, since most have partial immunity from the 1957 pandemic H1N1, and the most severe cases of novel H1N1 are in young people, not old (where it's acting much like the seasonal flu).

Seriously, read the CDC recommendations on who should get the vaccine. In fact, the CDC has an unbelievable website on novel H1N1 with the best real data available on rates, outcomes, and recommendations.

Read a few of the emerging case reports, like the these 68 young people in Oceania who were in the ICU on heart-lung machines, of whom 1/3 died. Or the 10 young ICU cases from Michigan back in the spring.

This is serious stuff, and healthy young people (especially pregnant) are at risk. If you want relative risk, then know that the swine flu has already, beyond any doubt, killed more young healthy Americans than the number who got Guillain-Barre from the 1976 vaccine, and the flu season hasn't even started yet. Get the vaccine.

How about vein or arteries stiffening? I can imagine that having a pulse might help these vessels keep certain elasticity and fight stiffening.

Sure, but being too stiff only matters in that it's harder for the vessel to accommodate the pressure increase of systole. The result then is that the peak BP is transmitted directly to the organs, instead of being dampened by the elastic vessels. If there is no systole, I'm not sure it would matter if your vessels became as stiff as lead pipes.

I wonder if the lack of elasticity would make them more likely or less likely to form atherosclerotic plaques - the "narrowing" of the arteries that goes with the "hardening" part and causes pain and damage to the organs those narrowed vessels feed. On the other hand it's probably academic to wonder what the effects would be 20 years down the line. Bridge to heart transplant is still the goal. I don't think we even did artificial hearts anymore (until this new one) because the benefit was so minimal. LVADs more or less replaced them, but are explicitly a bridge to transplant only.

non-stealthy F-35s

Is that the variant where you take a stealthy F-35 and strap it to a barn door?

The DNA in question must be "isolated". The DNA is not "isolated" when it is naturally occurring. Nobody is claiming your DNA that you were born with. Only an isolated DNA product.

Ah, thank you for clarifying that. Then I would be in the clear, of course, to isolate and clone BRCA1 from my own germline DNA and then develop a diagnostic test of my own. Because, by your interpretation, Myraid could only own the rights to their specific isolate of BRCA1. The current law, however, appears to extend that right to *any* isolate of BRCA1, even one created by completely independent technique from my very own DNA, as well as any application of any isolate of BRCA1 for genetic testing. How this is functionally different from owning the rights to the gene itself escapes me.

What complicates this specific case, as I'm sure you know, is that Myraid did not discover the identity nor the importance of the BRCA1 gene, nor did they develop any unique techniques for isolating it. Nor was it their idea to develop a diagnostic test for the gene (seriously? How could anyone think this wasn't a goal of the scientific community from the beginning?). They were the first to create an isolate, likely by a matter of days, by completely obvious and open techniques, and they were the first to file a patent.

it's just that without Myriad, *no one* would know that having the BRCA1 gene was a precursor to breast cancer.

Are you ^!&%! kidding? Are people so bamboozled by the FUD of pharmaceutical companies that anyone who doesn't know the truth assumes that the big, nice company must have sunk a ton of time and money into finding this gene from scratch, and without them the gene would never have been found? The truth is very, very different, and this is why Myriad is so hated in the scientific community.

BRCA1 was discovered by Mary-Claire King, now a geneticist at the University of Washington, following over a decade of government-funded basic science work that started when she was a graduate student and then junior faculty at UC Berkeley. Back then genetics was hard work - not hard like today, *really* hard. When she started no one really believed that one could even find a gene for a trait that wasn't expressed 100%, it just seemed too complicated to pick one mutation out of a huge haystack when you had to allow for some people having the bad mutation yet having a normal phenotype. Remember this is before the human genome project, before automated sequencing; she even started before PCR. Just pinning the candidate gene down to one small region of one chromosome took over a decade of work by dozens of people.

As the process came towards fruition, they first narrowed the field to a small part of chromosome 17 (paper), then made a laborious map of the region of interest (paper), and then together with a group at the NIH, they identified the actual single gene we now know as BRCA1, sequenced it, and spelled out the mutations in it that caused breast cancer in the affected families (paper1, paper2). Notice that all of this was done completely in the public eye, with all of her lab's results published immediately so as to help other researchers advance the field with her. It was good science.

But wait, where's Myriad genetics so far? What's left to do? Didn't we already "discover" BRCA1? How could anyone patent it now? All good questions. The next thing to do was to make a copy of this gene, by itself, in a test tube. This would be preliminary work for all sorts of biochemical analysis. The act of copying a gene off of a chromosome onto a separate loop of DNA in a test tube is called "cloning". Cloning is still pretty hard even today, especially for long genes like BRCA1. It can take months, especially since you usually need to copy it in bits and then glue those bits together.

What Myriad understood, and perhaps Dr. King did not, is that a cloned gene (that loop in a test tube) is patentable because it's considered "artificial", even if it's a perfect copy of a natural sequence of DNA. Myriad jumped in at this point, threw their whole company into cloning the gene and then patenting it, and did it before Dr. King or anyone else realized they were in a race. Ironically, Dr. King's lab had probably already cloned it in pieces (usually a prerequisite to sequencing) but hadn't made a complete intact copy yet, and certainly hadn't filed any patents. Myriad did none of the prior work on BRCA1. They did not come up with the idea of hereditary breast cancer. They did not do the laborious work of mapping where BRCA1 might be. They did not pinpoint the gene that was BRCA1. They did not sequence it. They did not find the mutations in that gene that cause breast cancer. They just copied it into a test tube first, and filed a patent. They did not even publish their result, nor make it available to the scientific community. Given the publicly available knowledge, *anyone* in the genetics community could have done this, and a number did. It was pure grunt work. There was no insight, no great advancement involved. Many genes had been cloned before, the techniques were widely published. Once you knew the location and the sequence, cloning just took time. Myriad's only insight was appreciating that a patent lay at the end of that grunt work.

So that's the real story of BRCA1. Finding it was a triumph of government-funded university science, open and collaborative to a fault. Then Myriad swooped in with patent lawyers at the opportune moment to lock things up, close them off, and proceed to make money off the public's huge investment. It was a brilliant business move. But the result has only been to disrupt and delay the science and medicine and breast cancer.

What you link to is the real "Journal of Bone and Joint Surgery", which *is* a very reputable, genuinely peer-reviewed, and very old journal for actual orthopedists. Definitely not to be confused with the Merck fake.