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Comment Re:methadone is very useful in managing chronic pa (Score 1) 385

Not only do the kinetics exhibit a long half-life, the actual half life has been shown to be poorly characterized in clinical trials and even seems to vary over the course of treatment. There are also issues with drug-drug interactions with hepatic and intestinal CPY450 isoenzymes. Methadone is a drug that really needs to have regular clinician follow-up and extensive patient education about the nature of the drug and which drugs to avoid using concomitantly. It's a good (and cheap) drug, but it needs to be use intelligently or it loses that cheap characteristic -- death is not cheap as an outcome measure.

How Much Math Do We Really Need? 1153

Pickens writes "G.V. Ramanathan, a professor emeritus of mathematics, statistics and computer science at the University of Illinois at Chicago, writes in the Washington Post that although a lot of effort and money has been spent to make mathematics seem essential, unlike literature, history, politics and music, math has little relevance to everybody's daily life. 'All the mathematics one needs in real life can be learned in early years without much fuss,' writes Ramanathan. 'Most adults have no contact with math at work, nor do they curl up with an algebra book for relaxation.' Ramanathan says that the marketing of math has become similar to the marketing of creams to whiten teeth, gels to grow hair and regimens to build a beautiful body, but even with generous government grants over the past 25 years, countless courses, conferences, and books written on how to teach teachers to teach, where is the evidence that these efforts have helped students? A 2008 review by the Education Department found that the nation is at 'greater risk now' than it was in 1983, and the National Assessment of Educational Progress math scores for 17-year-olds have remained stagnant since the 1980s (PDF). Meanwhile those who do love math and science have been doing very well and our graduate schools are the best in the world. 'As for the rest, there is no obligation to love math any more than grammar, composition, curfew or washing up after dinner. Why create a need to make it palatable to all and spend taxpayers' money on pointless endeavors without demonstrable results or accountability?'"

Comment Re:Thinking out of the box (Score 1) 520

I don't know if this nurse was fired or not. I hope so, too. Criminal liability in healthcare is kind of tricky and really needs to be looked at on a case-by-case basis. Generally there are four levels of liability -- at the employer/employee level (fired, reprimanded, re-trained, suspended), at the regulatory body level (lose license, require re-education), criminal level (prosecution in a criminal court), and civil liability (getting sued by an individual).
For employers, the current trend within institutions is to consider all errors to be system errors and not individual errors (my observation, I don't have any data to support this). If someone made a mistake, you perform a root-cause analysis. Even if that comes down to the actions of one person, there can be reasons to push it back as a system error. Was the employee improperly trained? Was the environment too distracting? Was their workload to high? Can you reasonably expect a human to perform hundreds of actions a day without error? If you're coding all day and you make an error, there are layers of QA (hopefully!) to go through before it gets to market. And even after that, you can fix it in a bug report. You don't get all of those things when you're working a double shift in an understaffed nursing unit. That's why we try to make it as hard as possible to mess up.
I don't know that I agree with criminal liability in any but the most egregious cases. And I mean that there is criminal intent. An expectation of perfection is unreasonable. An expectation of perfection with the consequence of criminal prosecution isn't helping anybody at all. Sending a nurse to jail because she was distracted and grabbed the wrong drug doesn't seem just to me.
Nobody in healthcare likes making mistakes. I can honestly say I've made mistakes and luckily none of them have caused harm. It's changed the way I practice for sure, but I know that I am flawed and will make errors again. I work with other flawed people and I learn from them. Whenever I hear of a medical error harming a patient (and I think this can be generalized to all but the most sociopathic of healtcare workers), I get the sickest feeling in my stomach. In the same environment, with the same mindset, could I have done the same thing? Taping two tubes together because they don't fit? Probably not.

Comment Re:Thinking out of the box (Score 5, Informative) 520

This does happen, and unfortunately the journalist either somehow did not discover this or failed to report it.
I work in a hospital -- in the pharmacy, not nursing. I can't be sure that this is generalizable to other hospital systems, but we already do have incompatible connections for almost every route. You can't connect an IV line to an oral syringe. You can't connect a gastric feeding tube to an IV line. They just don't fit.
In cases where injectable drugs have potentially dangerous routes, we have other safeguards -- if a drug is to be injected intrathecally (into the spinal fluid), there is a giant, black sticker on it that essentially says "Hold on. Take a second and review everything. This is serious business." If it is commonly given with another drug that is given intrathecally, it comes double-bagged with a giant label that says "DON'T GIVE THIS INTRATHECALLY OR SOMEBODY WILL DIE".
I don't know that these practices occur across the US, but I'm pretty sure that there are at least products on the market that do all of these things. Without the FDA making new laws.
In many cases it comes down to the resourcefulness of the nurse. I have heard of at least one case of a nurse who gave an enteral feeding intravenously. The connections were incompatible. Her solution was to attach the two ends together and keep them in place with surgical tape.
One exception that I know is a problem is in the neonatal arena. It is a specialized area without a whole lot of specialized equipment in some cases. For instance, the enteral feeding is sometimes so small and required to go so slowly that the only alternative may be to put it into an IV syringe and run it through a syringe pump. This is (and has been) a recipe for disasterous outcomes.

Comment Re:Biochemist Zheng Cui’s funding was cut (Score 5, Informative) 363

The stem cell transplants currently used for leukemias and lymphomas involves completely eradicating the host immune system through chemotherapy and/or radiation therapy. Then a donor stem cell is implanted and is used to replace the host immune system (which will hopefully be completely eradicated and not pumping out cancer cells). Dr Cui's research is a little different. He is keeping the host immune system intact, but is taking sample immune cells from donors with cancer resistance and injecting them into the host. The goal is that the donor cells will kill the cancer but not the rest of the host's cells which leads to GVHD. This seems to work for solid tumours in rats. A good summary of is research is here.
In the US, the usual FDA process for drug approval is to go through 3 phases of human trials (then a mandatory phase 4 during which adverse event data from the wild is gathered and analyzed). There is a Fast Track program at the FDA for serious diseases where there is a need for treatment options. This allows drugs to get approved faster by skipping steps and using surrogate end points instead of proving complete efficacy and safety.
I'd be interested to hear the reasons that grants were not given to continue this research. It might have something to do with there not being a specific mechanism of action identifiable in his experiments. In his interview he admits that he has no idea why it works, but it seems to work. Sciency people don't like things like that. They probably have a better reason than "it seems a little hokey", though.

Comment It's not that bad (Score 1) 141

When I was a child we lived in Trinidad for a few years. The Pitch Lake isn't really as bad as the article makes it sound. It doesn't smell. You won't die from noxious fumes by going near it. You can even take tours and walk out into the lake if you want. There are some areas that are solid pitch and other areas that you will sink into and die if you try to walk on them. There are guides who know (hopefully!) where it is safe to walk. It's a pretty cool place to visit if you get the chance.

Comment Why not release the information earlier? (Score 1) 133

I honestly don't understand this. Can someone explain this to me: If the analysts are concerned that their information is being disseminated before they can get it to their clients, why don't they just give the information their clients earlier? If someone else can aggregate all of their data and get it out at 0700, why is it so hard for the people who -made the data- get it out at 0630?
If someone is paying me big bucks to determine the probability that it's going to rain today I'm going to make sure they know what I know ASAP. I'm not going to figure it out then go grab a latte and do a few Sudoko puzzles first while someone else sells my leaked meteorological research to somebody else.

Comment Re:Zero Incentive for Success Equals Certain Failu (Score 2, Interesting) 116

I also work for an IT contractor, although fairly small so I can go smack the sales guys on the head a few doors over as needed. I go for option B/E all the time. In my view, IT is kind of like a a bottomless pit you throw money into. You can throw more and more, but there is ALWAYS something else you can do. There's always an extra backup system you can add, an extra redundancy, an user experience you can improve, etc. But businesses have finite IT budgets, and all the slick sales guys in the world won't change that. So seeing as how there's a practically infinite opportunities to spend IT money in an organization that will have tangible benefits, I don't see the point in letting the sales guys get away with wasting their money. If I feel its a waste, I tell them that, and point out 2 or 3 things to them and the sales guys that should be higher priority. In my experience, the sales guys in IT are some of the most easily influenced by other salesmen I've ever met. A vendor comes through, gives a demonstration of their network appliance or software package of the week, tells them how all their customers will be knocking down the door to give them their money to buy it, and uses every tired old pitch technique in the book. The same techniques the sales guys use on their customers every day. And they buy it hook, line, and sinker. They go out and tell all their customers they have to have X, even when they themselves don't really understand what it does, but the vendors salesman told them so. Someone needs to inject some reality into the situation, or you wind up with a customer that has spent their entire budget on the latest buzzwords and their basic IT infrastructure is a disaster. Whether we spent their IT money on buzzwords, or we spent their IT money on things they needed, we still got their money. But one way leads to the customer saying at the end of the year "We spent $x on IT with you guys, and we still have tons of problems! Our PC's crash, our network is slow, our backups don't work, wtf?" and the other way leads to building a long term relationship with the customer that will keep them as our customer.

    Uncontrolled greed is the enemy of IT contracting in my mind. We are all in business to make money, but wanting to make money and being blinded by greed are very different. If every time you went to the doctor, he tried to sell you some new wonder drug you can only get from him, the first you might be inclined to believe him, after all he is the doctor, he knows more about medicine then you do. So you would buy it, and the doctor would make extra money. But when the medicine didn't make you feel better, and everytime you went back he wanted to sell you a new, different wonder drug, that THIS time would solve all your problems, pretty quickly you would find a new doctor. Next thing you know, the practice that doctor has built up over a decade is gone. The same thing for IT. Most of our customers don't know what they have, they don't understand it, they don't know what they need. They rely on us to tell them. But if we tell them lies, we will make a lot of money in the short term, but eventually they will get tired of shoveling money at us and seeing no results.

Besides, is helping some sleazebag salesman make an extra $1000 in commission (that he would not share with you even if he saw you laying half dead in the gutter) worth your professional ethics?

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