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Comment Re:There is no vaccine for the worst diseases (Score 2) 1051

The chicken pox vaccine is not 'highly likely' to cause a case of Chicken Pox. Does it happen? Absolutely. It doesn't happen often, though. The few case I've seen in my entire career have been one to three lesions. Nothing close to the actual disease.

Is it effective, sure it is. Hardly any vaccinated kids get the disease anymore. When they do, it is also very minimal.

Does it prevent shingles? It might. Japan was the first country to start using the vaccine - a decade or two before the US. The last I checked, and I will grant I haven't looked at there data in about five years, their rate of shingles in adults seems to have gone done quite a bit suggesting that it is indeed effective at preventing shingles.

Comment Re:I just switched last week (Score 1) 137

Similar story for me. I used a palm pre for about a year. The OS was great. Much more intuitive and easier to use than Android. Its hardware issues and lack of software forced me to change. I use a Samsung Epic now which I like immensely but it has its quirks and took a several days of regular use to become familiar with. On the other hand, the palm pre I had figured out to to a point I was very comfortable with its use in 1-2 hours.

Comment Re:This article is so RIGHT (Score 1) 595

Subjectively people will get better from a sugar pill during a cold. Good for them I'm not aware of any objective improvement. Are you? I've read quite of few of the studies and must have missed the objective parts....things readily measured, not just reported by patients, like duration of fever or hospitalization rate.

I'm very well aware of what the placebo effect is.

Comment Re:This article is so RIGHT (Score 1) 595

So docs should prescribe antibiotics to people unnecessarily just so people think they will get better? Is that what you are trying to say? Give the potential side effects and resistance issues (ie MRSA), that doesn't make a damn bit of sense. We don't rx placebos in practice (only in studies) because it is considered unethical.

Comment Re:This article is so RIGHT (Score 1) 595

Using an antibiotic to prevent a secondary infection does not work. It just kills the normal bacteria and allows bacterial that are resistant to the antibiotic to colonize you. Those more resistant bacteria can cause secondary infections just as well as the original.

Multiple studies have shown over and over again, that the course of a cold, sinus infection, bronchitis are in no way altered by treating with antibiotics. Yes, we have given people placebos to people and compared the results to those given antibiotics. Guess what? no difference. So your theory about preventing ER visits and such is just wrong.

Comment Re:This article is so RIGHT (Score 1) 595

I'd like to know where these financial incentives are for prescribing antibiotics because I've never received one. The drug reps do push there meds, but I don't know anyone that takes them seriously. They're usually just eye candy or a person to be made fun of after they leave.

I'll give you the heckling thing tho. Occasionally after 5 cold visits in a row and multiple demands for antibiotics, some mothers literally screaming at you for not giving their kids antibiotics, one can become weak and may give into a demanding patient later. We are only human after all. I actually very rarely cave like that, but it happens.

Comment Re:The People Problem (Score 1) 595

Agreed. Patient education would go a long way. Too many parents and adult patients believe they need an antibiotic for every sinus infection, cold, ear infection or episode of 'bronchitis' they have when in most of these cases an antibiotic is actually not needed. Unfortunately, many docs also have been led to believe some of these problems need an antibiotic, too

I'm not sure what financial incentives physicians have to prescribe abx. God knows I have have never been given any of these financial 'incentives'. The only incentive I have is to prescribe it when I feel it is warranted or because the patient is being a such a pain in my ass and I just need them to leave. The latter rarely happens.

Comment Re:Screenings do more harm than good? (Score 1) 365

It depends on the screening test. Some are very good - like colonoscopy. Others can cause more harm than good on average - PSA is a great example.

Early detection is absolutely the way to go, how to do it for any given condition is the hard part. Many cancers have no screening tests because it is a hard to develop good, quality tests (good sensitivity and specificity). Just testing because it can be done is usually a very bad idea.

Comment screening tests in medicine (Score 2, Insightful) 365

"The problem is important in any area where a less-than-perfect screen is used to detect a rare event in a population"

Unfortunately, there is no such thing as a perfect screening test for anything in medicine. Some are better than others, but none are perfect. This is a very difficult concept for most people, unfortunately, and for many insurance companies.

It is not such an issue for the better screening tests such as colonoscopy but it is very difficult for things like PSA where there is a large body of evidence it can do more harm than good on average if used routinely even within the recommended ages. For a patient, you're lucky if you can have a meaningful discussion in 5-10 minutes which is an awful large chunk of an office visit that usually has >4 talking points.

It is a problem for doctors and insurance companies because some well intended person with the insurance company will decide to measure the quality of its doctors (which I support in theory) by measuring, for instance, the percentage of age and gender appropriate patients under the care of a given physician that have their PSA checked annually. The problem is, there is absolutely no concensus in medicine that it should be checked regularly as a screening test. I'm not sure I want mine tested when the time comes around unless my family history changes between now and then. So to measure a physician by this marker or other screening tests is fraught with problems, since many patients might opt out for very good reasons. Also, I'm not going to recommend any test because an insurance company wants me to, only if it is right for any given patient.

Bottom line is there are no perfect tests and testing is not always the right thing to do. Most people do not understand that because it is a hard concept to grasp.

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