Archive for the ‘Medicine’ Category

“Not Our Job”

Friday, June 29th, 2012

Clayton Cramer, among others, points out this passage in the NFIB v. Sebelius decision:

Members of this Court are vested with the authority to interpret the law; we possess neither the expertise nor the prerogative to make policy judgments. Those decisions are entrusted to our Nation’s elected leaders, who can be thrown out of office if the people disagree with them. It is not our job to protect the people from the consequences of their political choices.

I disagree with what I understand of the Court’s logic, but this really is the key point in the entire business.

“We, the People,” it says here; and if we don’t do our job, we deserve what ever we get.


Randy Barnett explains the point about as clearly as can be done.

“Chief Justice Roberts rewrote the (health care) statute to change this from a requirement, or mandate, to an option to buy insurance or pay a penalty,” Barnett explained. “This is far less dangerous than had the mandate been upheld under the commerce power. Because a Commerce Clause regulation could be upheld up to and including imprisonment as drug laws are, but this power is limited to paying a tax (for those who pay taxes) and can be as politically toxic as taxes are.”

I asked him whether a future Congress could just repeat what we saw in this instance – call a mandate a penalty for the purposes of passing the bill, then switch around and call it a tax in court.

“That is never going to happen again,” he insisted. “No one is ever going to fall for that again…The findings in the (health care) bill were Commerce Clause. The findings in the next bill will have to be taxing power.”

Warning: See comments there. The situation is still dangerous.

Sayeth the Sages:

Between honorable men, no contract is necessary. Between dishonorable men, no contract will suffice.

Slings And Arrows of Science

Monday, December 20th, 2010

Oh, this is going up on blogs, bulletin boards, office doors, and hospital bed stands all over the world, damn betcha. This is one of the great classics.

At least, with p < 0.05 confidence

Transcript, because this is important:

Hat Guy: So, has this sickness opened you up to looking for answers beyond science?

Other Guy: …No, not really.

We’ve groped for comfort before the slings and arrows of fortune for millenia, and I begrudge nobody their sources of solace.

But science provides tools.

$100 Billion a year in scientific studies and medical R&D has bought us some pretty damn powerful slings and arrows of our own.

This world is amazing, and I’m going to live to experience more of it thanks to people who refused to gracefully accept the ineffability of reality.

I find my courage where I can, but I take my weapons from science.

Because they work, bitches.

May the Powers bless and keep you, Randall Munroe. That is something that desperately needs to be said and remembered.

Do You Trust The Post Office To Manage This?

Wednesday, July 28th, 2010

Via National Review Online:

PDF here.

As NRO notes:

Texas Republican Rep. Kevin Brady says in a release that committee analysts actually couldn’t fit everything in: “This portrays only about one-third of the complexity of the final bill. It’s actually worse than this.”

I have some quibbles about the graphic itself — primarily, I wish it were interactive, so you could choose which aspects of the tangle to concentrate on — but the reality they represent is horrific.

Things to looks at:

Red circles with dark orange interiors are “Rationing Potentials”.

Orange circles with light blue interiors are “Involvements with the health insurance market”.

Note that the Patient, lower right hand corner, is not directly connected to the Physician, lower left hand corner. I suspect, I hope, I pray, that this is a fault in the chart, not a true representation. If it is true, this means that I, cash in hand, cannot go to my doctor, pay him, and be examined and treated without getting some kind of government approval. [update]OK, close examination of the chart shows that the lines are actually labeled with the section number of the Obamacare act establishing that connection. Unless Obamacare breaks the existing patient-doctor connection, no wonder it does not appear on the chart.

One more charting quibble: I’d like to be able to click on one entity and see all the other entities it connects to, and how.

My title asks if you trust the Post Office. This chart shows that you have to trust several non-health-care related agencies, including the IRS, which has a history of being openly hostile to citizens. Other agencies include Justice, Homeland Security, Labor, and Treasury.

Cold Water and Drowning

Friday, July 9th, 2010

Two life-saving articles. I’m very tempted to just reprint both in their entirety, but no. Just, as you love life and your children, read both of these:
Drowning Doesn’t Look Like Drowning

  1. Except in rare circumstances, drowning people are physiologically unable to call out for help. Th e respiratory system was designed for breathing. Speech is the secondary or overlaid function. Breathing must be fulfilled, before speech occurs.
  2. Drowning people’s mouths alternately sink below and reappear above the surface of the water. The mouths of drowning people are not above the surface of the water long enough for them to exhale, inhale, and call out for help. When the drowning people’s mouths are above the surface, they exhale and inhale quickly as their mouths start to sink below the surface of the water.
  3. Drowning people cannot wave for help. Nature instinctively forces them to extend their arms laterally and press down on the water’s surface. Pressing down on the surface of the water, permits drowning people to leverage their bodies so they can lift their mouths out of the water to breathe.
  4. Throughout the Instinctive Drowning Response, drowning people cannot voluntarily control their arm movements. Physiologically, drowning people who are struggling on the surface of the water cannot stop drowning and perform voluntary movements such as waving for help, moving toward a rescuer, or reaching out for a piece of rescue equipment.
  5. From beginning to end of the Instinctive Drowning Response people’s bodies remain upright in the water, with no evidence of a supporting kick. Unless rescued by a trained lifeguard, these drowning people can only struggle on the surface of the water from 20 to 60 seconds before submersion occurs.

Look for these other signs of drowning when persons are n the water:
* Head low in the water, mouth at water level
* Head tilted back with mouth open
* Eyes glassy and empty, unable to focus
* Eyes closed
* Hair over forehead or eyes
* Not using legs – Vertical
* Hyperventilating or gasping
* Trying to swim in a particular direction but not making headway
* Trying to roll over on the back
* Ladder climb, rarely out of the water.

The Truth About Cold Water

  • It is impossible to die from hypothermia in cold water unless you are wearing flotation, because without flotation – you won’t live long enough to become hypothermic.
  • You Can’t Breath
  • You Can’t Swim
  • You Last Longer than You Think
  • Rescue Professionals Think You Live Longer
  • Out of the Water is Not Out of Trouble
    I lost count of the number of survivors I annoyed in the back of the helicopter because I wouldn’t let them move. I had a rule – if they came from a cold water environment – they laid down and stayed down until the doctors in the E.R. said they could stand. It didn’t matter to me how good they felt or how warm they thought they were. Because the final killer of cold water immersion is post-rescue collapse.

I excerpted more from that last not only because it’s the thing that surprised me the most, but because it contains a general survival rule:

Do What The Rescue People Tell You To Do

The drowning article also contains a story about a very annoyed couple trying to wave off a rescuer who refused to understand that they were fine and didn’t need any help — except he was coming for their daughter whom they didn’t realize was drowning.

Andrew Wakefield, Vaccination Autism Panic Starter, No Longer a Doctor

Monday, May 24th, 2010

Andrew Wakefield, who pushed the idea that childhood vaccinations cause autism, resulting in many children being crippled or killed, has lost his British medical license. (He was never licensed to practice in the U.S.)

Rogue Medic is blunt, as is appropriate:

…[Anti-vaccinationists] claim that this is some sort of global conspiracy, the reality is much more simple. Andrew Wakefield was caught taking hundreds of thousands of pounds from lawyers to create evidence that would help the lawyers to sue vaccine companies for billions of pounds.

Andrew Wakefield’s defense?

He claims that his research – research that nobody else has been able to reproduce – is legitimate. When research cannot be reproduced there are two possibilities. Researcher error and researcher fraud.

The interpretation that is favorable to Andrew Wakefield is that he is just incompetent, since he is not able to recognize where he screwed up. The interpretation that is unfavorable is that he intentionally lied.

Andrew Wakefield lied.

Andrew Wakefield was paid a lot of money to lie.

Andrew Wakefield mistreated the children he used as research subjects.

Andrew Wakefield was trying to sell a vaccine to compete with the vaccine he was telling lies about.

Real doctors have recognized this fraud and had Andrew Wakefield’s fraudulent research retracted.

Real doctors have recognized this fraud and had Andrew Wakefield’s medical license revoked.

[bold in original]

The autism from vaccinations myth is life and death for your children, people. Read Grunt Doc’s take-down as if your children’s lives depended on it.

“His Pants Are Falling Down”

Tuesday, May 4th, 2010

Go. Read.

Too short to excerpt, but you need to read it.

“Trepanazine” Needs a PDR Writeup, Stat

Tuesday, March 9th, 2010

So, your friendly neighborhood Ambulance Driver describes a malady for which “220 grains of Trepanazine” is the recommended treatment regimen.

You arrive on the scene for the unconscious male lying in the roadway, cruise slowly past the police cars blocking traffic, and without even getting out of your ambulance, you roll down the window and bark, “Leon! Get your ignorant ass outta the road! Someone runs over you, you might damage a perfectly good car!”

And not only does Leon obediently cease being an impediment to traffic flow, he also hobbles meekly to your ambulance and climbs aboard. You should have seen the face of the cops who called us.

Which is indeed educational, but WTF is “Trepanazine”? A Google search turns up no dosing info, no link to the manufacturer, no….Oh, wait.

“Trepanazine” as in “trepanning“, right? Drilling a hole in the skull to let out the evil spirits, or “remove the stone of madness”?
trepanning-Hieronymus_Bosch_053-w

Slight risk of lead poisoning with the dosage I believe AD refers to.

And I note that the 230 grain dose for close-range injection is far more common than 220 grains.
bullet45acp-w

“Never Bring A Knife to a What Kind of Fight?”

Thursday, February 4th, 2010

Fifteen year old girl gets pregnant despite lacking a cooter — her former boyfriend caught her performing oral sex on her new lover, and stabbed her in the stomach….

Mammograms

Sunday, December 27th, 2009

Dr. P has the go-to post on the new mammography guidlines. Detailed and accessible, this is what you need to know in the wake of the US Preventive Services Task Force’s recent ill-worded guidlines.

Unless you’ve been living on another planet, you know that in mid-November, the US Preventive Services Task Force released new recommendations on screening mammography, in which they recommended against routine mammogram screening in women under age 50, and recommended that mammograms now be every two years in women ages 50-74.

What you may not have heard is that the Task Force has acknowledged that the mammogram guidelines were poorly worded, and have revised their original statement to clarify their intentions, mostly by removing those two little words “recommends against”.

Here’s how the guidelines now read (changes in red)

  • The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
  • The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.
  • The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.
  • The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.

Cuts through the politics and puts everything in perspective. The whole thing, which you should read, is an excellent exercise in risk assessment; even if you or someone you know is not in the risk group, you should read the whole thing just to see how it’s done.

“You Are Not Qualified”

Sunday, November 22nd, 2009

Chris Muir explains just exactly what the Senate is getting ready to debate:
daybyday-112209
[Click to embiggen.]

I’m not the only one blogging this strip today.

I wish this were funny. It’s not; it cuts way too close to the bone.