Good Entropy

Science-Based Medicine » Why haven’t we cured cancer yet?

Cancer is not a single disease, and cancers are different

Alternative medicine quacks deny efficacy of conventional medicine : denialism blog

“There cannot be two kinds of medicine – conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works, and medicine that may or may not work.”

quote in New England Journal of Medicine (NEJM Sept. 17, 1998 pg 839-841), by then
current editor in chief Marcia Angell and former editor in chief Jerome
P. Kassirer.

The Covert Rationing Blog – Sage

From the ominously-titled book, “New Rules,” by Donald Berwick MD and Troyen Brennan MD:

“Today, this isolated relationship [between doctor and patient] is no longer tenable or possible. . . Traditional medical ethics, based on the doctor-patient dyad, must be reformulated to fit the new mold of the delivery of health care. . . The primary function of regulation in health care…is to constrain decentralized individualized decision making.”

A Photon In The Darkness » Blog Archive » Three Popular Anti-vaccine Myths Deconstructed

The key to this myth is the use of mortality data rather than incidence data. Although the myth is that the incidence of the disease was waning prior to the vaccine, the data show something very different: that the number of deaths attributed to the disease were declining.

The Political Economy of Health Care | The Unbroken Window

If people truly cared about the poor and the permanently infirm being taken care of, I would not be as ascerbic as I am. I don’t believe for a second that the majority of people who argue for health reform really give a damn about the poor or infirm – it just makes them feel good to say it, or be more acceptable in the company of others. Why do I say this so strongly? Because providing even a very generous level of support to the poor and the infirm is so easily within our reach that it is laughable to suggest otherwise. Instead, “we” use the poor and infirm as pawns in a corporatist game, in a middle-class entitlement game, special-interest game, political-nanny-statism game, and no one is willing to admit it.

Patrick’s Price Controls – WSJ.com

On Thursday, Democratic Governor Deval Patrick’s insurance regulators announced that they had rejected 235 of 274 insurer requests for premium increases for individuals and small businesses over the coming year. This power has been on the books since 1977 but never used, and Mr. Patrick announced in February that he was dusting it off as an opening bid for rate-setting for hospitals, doctors and all other providers as well. The state’s health costs have risen to the nation’s highest since Beacon Hill passed the ObamaCare prototype that was supposed to reduce health costs.

The premium increases were “excessive and unreasonable,” Mr. Patrick said in a statement, though his insurance division issued no actuarial analysis to justify its decision. “Now, the big insurance companies will criticize this action,” he said. “But the fact is that for three years now, both they and health-care providers have sat around the table talking the issue of excessive cost to death and coming up with no solutions.” In other words, price controls are supposedly the only option.

Yet campaigns against the insurance industry are always the first political resort, as Mr. Obama’s assault on Anthem Blue Cross of California showed. In Massachusetts, however, the major insurers—Blue Cross Blue Shield, Harvard Pilgrim, Tufts Health Plan—are all nonprofits. The state itself calculates that they spend at least 88 cents of every premium dollar on the underlying costs of medical care, often more.

Just-as-good Medicine » American Scientist

That decrementally cost-effective innovations are so rarely described in the health-care literature suggests that medicine is distinct from most other markets, in which cost-decreasing, quality-reducing products are continuously being introduced—think IKEA, Walmart and the Tata car. Several reasons may explain this “medical exceptionalism.” First, there is fundamentally a lack of incentives both for physicians to control costs, especially under a fee-for-service regime, and for patients to demand less expensive treatment when insurance shields them from the direct costs of care. Second, medical “bargains” frequently come with health risks, and trading health for money strikes some as vulgar, regardless of ratio. The inherent ethical unease that decrementally cost-effective innovations can elicit poses a serious public relations and marketing challenge.

From Mounting evidence links language pathway to autism

FOXP2 codes for a protein that regulates the expression of other genes. Last year, an international group of scientists identified one of its targets, contactin-associated protein-like 2 (CNTNAP2). They also found that certain common variants of CNTNAP2 tend to crop up in people with specific language impairment, a developmental disorder.

CNTNAP2 was an exciting find because three independent teams had recently published that common variants of the gene up the risk of developing autism.

“I think the evidence now that CNTNAP2 is involved [in autism] is quite good,” says leader of one of the teams, Aravinda Chakravarti, professor at the McKusick Nathans Institute of Genetic Medicine at Johns Hopkins University. “We’re now interested in finding the molecular basis of this.”

In unpublished data, Chakravarti says he’s found that CNTNAP2 is over-expressed in a small number of postmortem autistic brains.

Geneticists have discovered many different autism-related variants of CNTNAP2, a massive gene spanning 2.3 million base pairs. “Disruptions in the front end of the gene [usually] mean you’ll get a more severe disorder, like full-blown autism or severe expressive language delay,” notes Martin Poot, research associate professor of medical genetics at the University Medical Center Utrecht, in the Netherlands.

Great site:
http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/

In the comments to
The Data Model That Nearly Killed Me

Alexander Scarlat MD
April 18, 2009

“Data modeling is not optional” (Data Modeling Essentials by Simsion & Witt)

Great article and a correct diagnosis of one of the main problems of the Healthcare Informatics industry.
I am a physician with a degree in computer sciences currently employed as Chief Medical Informatics Officer with a medium sized hospital in the USA. We are now in the process of setting up a clinical data repository to store and present the users with laboratory results, imaging links and pharmacy orders on top of the diagnosis and procedures. I found out repeatedly that vendors are not willing to share the database schema of their products with the excuse it is a proprietary document. Unfortunately, many times this is just an excuse for a complete lack of such a schema. Even worse -the conceptual diagram, logical and physical data model is either non existent, poorly defined or kept in someone’s vault. The analogy that comes to mind is trying to build a house without a blueprint or with one that is kept in the builder’s vault.
I strongly recommend anyone in the HIT industry to read the book I have quoted above. I have no doubt it will save millions of $, mountains of users ‘ frustrations and most probably a couple of lives.