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Comment Re:My family learned the hard way about licenses (Score 1) 193

Turned out that the man hadn't bothered to do much to update his knowledge of his specialty in about 15-20 years.

This is what board certification is for. State licensing boards usually have some requirements for staying up to date, but they really just guarantee that the person went to med school and hasn't had their license revoked. The specialty boards are much more comprehensive. Being board certified is formally optional, imperfect, and hotly debated among doctors - but I would hesitate a lot before going to a doctor who didn't maintain certification. Did they check if the doctor was board certified?

Several surgeries later, the relative ended up going to a major regional university's affiliated hospital.

Always get a second opinion before any surgery. Or any major medical decision. Ideally, get two opinions and then run them by a third party, like a primary care doctor. Always. If you're talking about wanting competition, this is basic stuff. Why did they not go to the regional university up front?

We say "imagine how much harder he'd have worked if he had more competition." ... Toughen up the liability laws...

How does making it easier to sue him give him more competition? More importantly, how does making it easier to sue him prevent the harm that was done to your relative? You're arguing for more regulation, not less.

Comment Side effects may include death (Score 3, Interesting) 201

Testosterone supplementation in men with low T levels appears to have the unfortunate side effect of death.

There is a growing literature on the potential dangers of testosterone supplementation. Not enough yet to say it's as clearly a bad idea as female HRT, but for sure it isn't something men should run out and do without a careful and personalized discussion with a knowledgeable (actual) doctor.

In general I think it's safe to say that the "take extra of the hormones that go down with age in some people" theory of fighting aging is pretty thoroughly discredited by now. Thyroid hormone, growth hormone, testosterone, estrogen, etc. - the science is clear this is not how you fight aging. In general, more likely to hasten death than prevent it.

Comment Re:Overregulation = poor customer experience (Score 1) 421

The shortage of doctors in the U.S. is due to the AMA cartel's control over university accreditation and corresponding rent-seeking state laws requiring accreditation. The result is speed-exams when you go visit a doctor (or maybe not see the doctor at all, but rather a "nurse practitioner").

The situation of pilots and doctors does seem similar on several levels, but I think you're drawing the wrong conclusions.

The proximate cause of the "speed-exams" is not a doctor shortage, but an artifact of how most doctors are paid - by the visit. You get a tiny bit more money for a long, complicated visit, but not nearly as much as if you see two or three patients in the same time. This is true for almost every payer - private insurance, Medicare, Medicaid, etc. The financial incentives are strongly on the side of the speed-exam.

A more fundamental question is why the financial incentives matter so much, and that's where I think the pilot and doctor stories have some overlap. These are both highly skilled professions with a long, poorly paid training period and a strong incentive on the part of the "payers" to keep downward pressure on wages. Every time an insurance company or Medicare cuts their provider reimbursement rate, the incentive to cram more visits into a day grows that much stronger, because when you start your career at 30 or 35 with hundreds of thousands of dollars in loans, it's hard to take an arbitrary pay cut. (Talking about primary care doctors here, the situation may be different for the "lucrative" specialist du jour.)

Besides, the US actually has plenty of doctors, similar per capita numbers to Canada or the UK. But the financial incentives drive too many of them to lucrative specialties and urban practices, leaving too few doing primary care or working outside the big cities. Attempting to control costs by cutting doctors' fees creates perverse incentives.

The rise of nurse practitioners is more of an alternative attempt at cost control than a response to too few doctors. If you don't need 8 years of school and training to take blood pressure readings or insert an IV, and these things are actually done better by people who do them all the time, maybe some aspects of primary care can be done better by people with shorter but more focused training.

Comment Re:gravity wheel has weird orientation wrt thrust (Score 1) 589

So every loop around the gravity wheel you go through 2A of gravity variance As the +A thrust vector rotates from your feet to head and side to side of you.

Sea-sickness prevails.

At 1G constant acceleration (flipping around mid-way) you'd reach Mars in about 3 days. (Avg Distance 225M km, travel time to half-way point at 10m/s/s = 42 hrs).

Stretching the trip to 90 days works out to 0.0015G acceleration throughout. I'm guessing the crew wouldn't notice that.

[Moral: When talking about acceleration, 1 G is a *lot*. It'll get you to alpha centauri in 4 years!]

h/t Wolfram Alpha

Comment Is this a trick question? (Score 1) 504

Canada has an efficient and effective single-payer system. When you are already spending money well, spending more money might be better.

The US has a fragmented, inefficient, and often ineffective hodgepodge of systems. When you are already spending money poorly, spending more money might be worse.

Or, put another way, Canada is probably somewhere to the right-of-peak on the Laffer curve of health care spending vs outcomes. The US is far, far to the left.

Comment Re:Shouldn't all work by public employees be open? (Score 1) 237

I work for the government and every once in a while my boss says I should try to patent it.

Do you work for the federal government? Work done by an employee of the federal government in the course of his/her duties is public domain. There's not even a question of patent or copyright, it's public domain by law.

If it's work on your own time that's not part of your official duties, however, you can do whatever you like with it.

Comment Re:Apologies (Score 2) 116

My apologies, I meant permissive-with-a-small-p only as an antonym for restrictive. I admit I wasn't aware of the technical meaning. Thank you for pointing it out. I think the phrasing still made sense to most readers. Remember that for most of the physicians who read NEJM this was probably the first time they had even heard of copyleft.

Comment Re:And ? (Score 1) 116

The people who devised the test spent time and money to do so. They created the original work. Why shouldn't they be able to license it for fee to others? They've got college loans to pay off. OH so now educators and researchers have to live under the specter of copyright laws! Boo hoo welcome to the real world!

I am one of the authors of the NEJM article.

We did not get into ethical issues in the article. But much of the current value of the MMSE does not lie in its contents but rather in the past 35 of research on it. Hundreds or thousands of studies from researchers around the world have shown doctors in exquisite detail exactly how and when to use the MMSE to best care for patients.

It is this vast accumulation of data on the validity and utility of the MMSE that makes it so valuable - and little of this was done by the MMSE's authors or PAR. In fact, much of this research might never have been done if the MMSE had had its current strict licensing terms 30 years ago. Some people have compared this behavior - waiting until the test is ubiquitous to start enforcing copyright - to patent trolls.

Nevertheless, the MMSE authors and PAR are entirely within their legal rights, and that is why we suggest that policy needs to change to prevent this from happening all over medicine.

Comment Re:Apologies (Score 5, Informative) 116

Sorry, I didn't see that the summary incorrectly states that the authors of the older test were claiming infringement. AFAIK, they're not.

I guess I failed the comprehension test. Actually, I didn't really read the summary carefully, since I was already familiar with the actual facts.

I am one of the authors of the NEJM op/ed article.

It is all a little confusing. There are three parties here:
1. The original authors of the MMSE, who through PAR are strictly enforcing copyright protections of the MMSE
2. The authors of a new tool, the Sweet 16, which was created as an open-access alternative to the MMSE but was "taken down" by PAR in a copyright dispute
3. Us, the authors of TFA, who have no relationship to #1 or #2 but are very worried about what this all means for the practice and progress of medicine

Comment Re:Not a big loss (Score 2) 116

I'm not saying the MMSE is useless, it's just no big loss if there is copyright being claimed now. We'll move on to something else.

I'm one of the authors of the NEJM article.

People already are moving on. In our practice we mostly use the Montreal Cognitive Assessment (MOCA) for screening, which is much more sensitive and has liberal licensing terms for non-commercial use.

But this is a general issue. The Sweet 16 was an attempt to move on, halted by PAR. I'm surprised that PAR hasn't already sued the MOCA authors given that the MOCA includes recall and orientation, like the Sweet 16. Even if it survives, the MOCA is not perfect- it has laudably generous licensing terms for copying, but no provision for derivative works. In 80 years, the heirs of the MOCA authors might well start suing researchers who use a trails test, clock draw and animal recognition in a new test.

Whether we move on from the MMSE or not, the threat to scientific progress will remain.

Comment Re:Sweet 16 vs MMSE (Score 4, Informative) 116

I'm one of the authors of the NEJM article.

We didn't have the space to describe the MMSE and Sweet 16 in detail, but here's a brief description:

The MMSE has 30 items, which include 10 orientation questions (what's today's date, where are we, etc.) and 6 questions for recall (say 3 standard words, repeat them back and remember them for 5 minutes or so).

The Sweet 16 has 16 items which include 8 orientation questions and 6 questions for recall (using different words than the MMSE). The other two questions involve repeating a sequence of numbers backwards.

So there is a lot of overlap between the two tests, and that was presumably the basis for an infringement claim. However, the items that overlap - orientation and recall - are quite generic and were in wide use long before the MMSE was created in 1975. Nevertheless, the authors behind Sweet 16 and their institution could not or chose not to defend the Sweet 16.

It's a little hard to imagine a cognitive assessment tool that doesn't include orientation or short-term memory recall questions, so this will strongly discourage progress in the field. Perhaps one of the Alzheimer's advocacy groups will take notice and defend researchers trying to advance the state of the art.

Comment Re:They did. Didn't help. (Score 4, Informative) 116

I'm one of the authors on the NEJM article.

The developers of the Sweet 16 - the test apparently "taken down" for copyright infringement of the MMSE - were all Harvard faculty, and work for academic centers that are affiliated with Harvard and its hospitals (Hospital Elder Life Program, Institute for Aging Research and Hebrew Senior Life). The senior author of the Sweet 16 is a well-known Harvard professor. One of the things we find concerning about this case is that Harvard Medical School probably has some claim to ownership of the Sweet 16, and was presumably involved in its defense. If Harvard, with its vast resources, could not or chose not to defend the Sweet 16 successfully, what hope do any other researchers have to develop new cognitive testing tools?

Comment Re:What Chemicals?? (Score 2) 288

The most abundant chemical used in fracing is water. This is the same water that your waiter serves you with your meal. It's not unusual for frac fluid to be 89% water by mass. ...
If passages are desired, then they are created using hydrochloric acid. This is the same acid that occurs naturally in your stomach.

I triple-dog dare you to drink a glass of 11% (w/w) hydrochloric acid.

It's 89% water and contains only a chemical found in your stomach naturally! That can't possibly hurt you!

Obfuscated science makes kittens cry.

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