#WhoIsJohnGalt

The Last of the Ayn Rand Acolytes

This year's Objectivist Conference revealed that her cult of hyper-capitalism has a major recruiting problem: All the young people want to be socialists!

"This was the grim setting for a nearly week-long celebration of Rand’s genius that coincided with the fiftieth anniversary of her clarion call for a capitalist-aligned cultural and aesthetic movement, The Romantic Manifesto. Thrumming in the background was a related, similarly unnerving trend for Objectivists: The romance of the movement has lost a good deal of its cachet in an unequal, austerity-battered America—particularly when it comes to pulling in the young recruits who were once the backbone of the Rand insurgency. All the kids these days are becoming socialists and communists. Only 45 percent of young Americans view capitalism positively, compared with 51 percent who profess a fondness for socialism. They want higher taxes, regulations, a Green New Deal. Their thousand-page tome of choice isn’t Atlas Shrugged; it’s Marx’s Capital (or perhaps Thomas Piketty’s Capital in the Twenty-First Century)."

From Tim Mackey and colleagues: Surgical Data Recording Technology: A Solution to Address Medical Errors?

Ann Surg. 2019 Jul 25. doi: 10.1097/SLA.0000000000003510. [Epub ahead of print]

Surgical Data Recording Technology: A Solution to Address Medical Errors?

Shah NA1, Jue J2, Mackey TK1,3.

Author information

1

Global Health Policy Institute, San Diego, CA.

2

Joint Masters Program in Health Policy and Law, University of California, San Diego School of Medicine, San Diego, CA.

3

Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, University of California, San Diego School of Medicine, San Diego, CA.

Abstract

: Reducing preventable medical errors remains a universal goal, yet implementing effective solutions remains a challenge. The development of surgical data recording technology shows promise to generate robust qualitative and quantitative data in the surgical theater. These data can allow physicians and their teams to capture specific sources of error and implement corrective interventions. Surgical data recording technology encompasses rudimentary data tabulation on notecards, to integrated audio-video systems containing cameras, microphones, and sensors, capturing and synthesizing intraoperative, environmental, and instrumentation information, along with devices tailored to robotic surgical systems. There is growing interest in the implementation of such technology in medical centers, particularly in the United States, Canada, and Europe, but existing medicolegal and regulatory challenges necessitate further research and clinical assessment in order for this technology to facilitate improved surgical patient safety.

The False Promise of Fish Oil Supplements

After decades of promises that they “may work” to reduce cardiovascular the lack of demonstrated benefit leads me to conclude that consumers are wasting their money

"Because the US Food and Drug Administration (FDA) classification for dietary supplements such as fish oil is different from that of prescription drugs, these supplements are not manufactured or reviewed by the FDA in as stringent a manner. Most found on the market—unlike prescription medications and certain over-the-counter (OTC) drugs—have not demonstrated effectiveness and safety in placebo-controlled clinical trials. This can be confusing: fish oil supplements, for example, are readily available to patients and often have labels that imply a benefit to cardiovascular health, yet they are not intended to treat any medical condition."

"The existing medical malpractice system increases medical spending mainly because it has evolved in tandem with other inflationary features of the health care system and may make those features even more difficult to change."

Forum Health Econ Policy. 2012 Sep 10;15(3):83-106. doi: 10.1515/fhep-2012-0010.

Both Symptom and Disease: Relating Medical Malpractice to Health-Care Costs.

Sage WM1.

Author information

1

Vice Provost for Health Affairs, James R. Dougherty Chair for Faculty Excellence, The University of Texas, 727 E. Dean Keeton Street, Austin, TX 78705.

Abstract

Tort reformers blame the high cost of American health care on defensive responses to rampant medical malpractice litigation. Defenders of the tort system counter that holding health care providers liable for negligence improves safety and ensures compensation for injury. The relationship between medical malpractice and health care expenditures is more complex than either of these positions reflects. The existing medical malpractice system increases medical spending mainly because it has evolved in tandem with other inflationary features of the health care system and may make those features even more difficult to change. In other words, medical malpractice is both a symptom of a costly health care system and a costly disease in its own right.

"...until courts provide clinicians with clear guidelines and protections, violations of patients' advance directives are likely to continue."

J Healthc Risk Manag. 2019 Aug 21. doi: 10.1002/jhrm.21388. [Epub ahead of print]

Overriding advance directives: A 20-year legal and ethical overview.

Banja J, Sumler M.

Abstract

Health professionals have been known to override patients' advance directives. The most ethically problematic instances involve a directive's explicitly forbidding the administration of some life-prolonging treatment like resuscitation or intubation with artificial ventilation. Sometimes the code team is unaware of the directive, but in other instances, the override is done knowingly and intentionally with clinicians later pleading that it was done "in the patient's best interests." This article surveys a twenty-year period extending back to 1997 when ethicists began to question the legitimacy of overriding advance directives despite clinicians believing they had compelling reasons to do so. A legal and ethicalanalysis of advance directive overrides is provided as no court to date has awarded damages to plaintiffs who alleged their loved one suffered "wrongful life" following a successful life-prolonging intervention. A hypothetical scenario is especially discussed wherein a patient's DNR status is overridden because her cardiac arrest was caused by error whose effects might be reversible. The authors conclude with a strategy for mitigating certain vagaries associated with overriding advance directives, but suggest that until courts provide clinicians with clear guidelines and protections, violations of patients' advance directives are likely to continue.

‘Sport has changed my life’: Serena Williams on how it can benefit girls and boys

"Serena also emphasised that more girls should be encouraged to participate in sports. 'I think sport, especially in young ladies’ lives, is incredibly important at whatever level you choose to play at,' she added."

Regulating Artificial Intelligence for a Successful Pathology Future.

Allen TC

From the Department of Pathology, University of Mississippi Medical Center, Jackson.

"Physicians, including pathologists, must now rethink what it means to be caring, and how to preserve and foster social interaction with patients while using AI efficiently. It will be especially important that physicians use AI in a manner that respects physician and patient heterogeneity and supports equity. It is physicians, with pathologists at the head of the table, who must lead and forever maintain this conversation with policymakers, providing regulatory guidance that ensures empathy is always considered and respected throughout the complicated discussion around AI regulation and governance."

Men often don't get medical help because of self-image issues

"Some may be surprised by this result, but according to the report, weight stigma is pervasive in men with obesity and as many as four out of 10 say that this stigma stops them from reaching out the physicians to get help for other medical issues." 

OBESITY CANCER RISK 

Being fat is almost as likely as smoking to cause cancer, experts warn

Referring to the study, he said: “Many people don’t yet realise that obesity causes cancer and now there is evidence that it’s a graver danger than first thought.

“If we continue to pile on the pounds we’re heading for thousands more avoidable cancer deaths every year.”

Curr Oncol Rep. 2019 Jul 29;21(9):80. doi: 10.1007/s11912-019-0829-8.

Malnutrition in Older Adults with Cancer.

Zhang X1,2, Edwards BJ3.

Author information

1

Department of Medicine, Epidemiology & Population Sciences, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, One Baylor Plaza, MS: BCM307, Room 613D, Houston, TX, 77030, USA.

2

Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

3

Geriatric Medicine, Supportive Care, Central Texas Veterans Healthcare System, Temple, TX, 76504, USA. bjedwards2400@gmail.com.

Abstract

PURPOSE OF REVIEW:

Malnutrition is a common and under-recognized geriatric condition in older adults with cancer. This review describes the public health burden, malnutrition prevention, and the relationship among cancer cachexia, malnutrition, and sarcopenia. Finally, clinical practice recommendations on malnutrition and prevention are presented.

RECENT FINDINGS:

Advanced age and cancer stage, frailty, dementia, major depression, functional impairment, and physical performance are important risk factors for malnutrition in older adults with cancer. The Mini Nutrition Assessment (MNA), Malnutrition Universal Screening Tool (MUST), and Patient Generated Subjective Global Assessment (PG-SGA) are the most commonly used assessment tools in older adults with cancer. In addition, malnutrition is independently associated with poor overall survival and quality of life, longer hospital stays, greater hospital cost, and hospital readmission. Comprehensive malnutrition prevention is required for improving the nutrition status among older adults with cancer.

Arch Pathol Lab Med. 2019 Aug 7. doi: 10.5858/arpa.2019-0191-RA. [Epub ahead of print]

Chondroblastoma-like Osteosarcoma.

Hmada YA1, Bernieh A1, Morris RW1, Lewin J1, Allen T1.

Author information

1

From the Departments of Pathology (Drs Al Hmada, Bernieh, Lewin, and Allen), and Radiology (Dr Morris), University of Mississippi Medical Center, Jackson.

Abstract

CONTEXT.—:

Chondroblastoma-like osteosarcoma is an exceedingly rare variant of osteosarcoma, with 22 cases reported in the English-language literature. The tumor is slightly more common in males, with a broad age range (from childhood to elderly). The most commonly involved bones are the metatarsus and tibia, followed by the femur. Most tumors have malignant or worrisome radiographic findings. Prognosis is variable, depending on the presence or absence of lung metastases, local recurrence, and probably tumor location. Histologically, chondroblastoma-like osteosarcoma is characterized by monotonous, minimally to moderately atypical rounded cells with ovoid nuclei resembling chondroblastoma, and abnormal osteoid deposition with destruction of the bone.

OBJECTIVE.—:

To review the clinical, radiographic, and histopathologic features of chondroblastoma-like osteosarcoma.

DATA SOURCES.—:

PubMed-published chondroblastoma-like osteosarcoma cases in the English-language literature.

CONCLUSIONS.—:

Although exceedingly rare, chondroblastoma-like osteosarcoma should be considered in the differential diagnosis of chondroblastoma, especially in the presence of radiologic findings suggestive of an aggressive lesion.

Asleep At The Wheel - "The House Of Blue Lights" [Live from Austin, TX]

Mona Charin: So, You Want Canadian Health Care? "Advocates respond that Canadians are happy with their system, and that’s fine. It’s their choice. But Americans tend not to be so docile about delays."

So, You Want Canadian Health Care?

"Advocates respond that Canadians are happy with their system, and that’s fine. It’s their choice. But Americans tend not to be so docile about delays."

A Better Way to End Surprise Medical Bills

Happily, there is a better way, an alternative approach that can end surprise bills without harming patients’ access to care. It consists of two elements: 

1. A market-based default payment. Instead of the median rate, the benchmark would be set at the current average rate paid to all similar providers in the area, or alternatively at the individual provider’s most recent contracted rate, if a contract has ever existed. Insurers would have to pay this default rate to out-of-network providers, up front.

2. Baseball arbitration. If either party were dissatisfied with the default payment, they could take their dispute to so-called baseball arbitration, in which both parties would present a first-and-final offer and then a neutral arbitrator would choose one of the two offers without change.

"Back in the 1960s, China suffered a devastating famine that killed nearly 20 million people. But now, the country faces a new scourge: Obesity."

Obesity: China's Big Problem

After famine comes obesity. 101 East explores China's unconventional methods for getting its citizens fit and healthy.

"Back in the 1960s, China suffered a devastating famine that killed nearly 20 million people. But now, the country faces a new scourge: Obesity.

One in five children - and tens of millions of adults - are now overweight or obese."

@UNTsocial One O'Clock Lab Band: Harlem Nocturne (1939)

UNT One O'Clock Lab Band: Harlem Nocturne (1939)

What You Won't Do For Love. Bobby Caldwell vs. Go West

What You Won't Do For Love

Bobby Caldwell vs. Go West

"We tend to fixate on the measure of lifespan, but overlook morbidity." #PumpIron

Raising the American Weakling

There are two very different interpretations of our dwindling grip strength.

We tend to fixate on the measure of lifespan, but overlook morbidity. Here, Lieberman says, the data are unequivocal. “As we are living longer,” he says, people “are also suffering from much longer periods of chronical illness as they age.” People may be living longer, due to advances in pharmaceuticals or medical care, but as he asks, “is she/he healthy?” Health, he says, “is not just life expectancy.”

Our weakening grips are, if nothing else, a corollary of an increasingly sick population. So, by all means, go to the gym, not to turn back the evolutionary tide, but for your own well-being. Evolution, as Lieberman reminds us in The Story of the Human Body, is just about passing your genes, not ensuring a long and healthy life.  “From an evolutionary perspective, there is no such thing as optimal health.”  Creating that definition is up to you.

Washington State Supreme Court Rules That Obesity Is A Disability

Whether obesity should be considered a disability still remains an unanswered question in many legal systems but the recent Washington ruling is a step in the right direction. If a potential employee can perform job requirements, with or without reasonable accommodations, then the employer must not disqualify the candidate based merely on their physical appearances. It is inherently wrong to “fat shame” someone out of a job or promotion.

"...although AI’s use will fundamentally alter pathology practice, it is perhaps pathologists’ greatest opportunity to invest themselves more fully in their patients’ care."

Arch Pathol Lab Med. 2019 Jul 3. doi: 10.5858/arpa.2019-0229-ED. [Epub ahead of print]

Regulating Artificial Intelligence for a Successful Pathology Future.

Allen TC1.

Author information

1

From the Department of Pathology, University of Mississippi Medical Center, Jackson.

"Artificial intelligence (AI), a set of techniques aimed at approximating some aspect of human cognition using machines,1 promises to provide pathologists a tool to improve inefficiencies and inaccuracies in diagnosis and laboratory testing, and to facilitate an anticipated smaller number of pathologists’ ability to serve an increasing number of patients with timely diagnoses, even as those diagnoses exhibit an increasingly complicated molecular complexity.2–4 Pathology has long examined the use of AI in

pathologic diagnosis5 and is already using AI. Papanicolaou test imaging, approved by the US Food and Drug Administration (FDA) for screening purposes, is now fully, if not widely, used.6,7 Other areas of cytopathology are investigating the use of AI for diagnosis,8 and AI will undoubtedly play a strong and central role in its continuing progress toward becoming fully automated.9–11 Artificial intelligence in pathology promises to outperform human beings in their assessment of the specific characteristics

necessary for pathologic and radiologic diagnosis.9,12 Despite the initial hysteria,13–16 it is now clear that AI will be, at least for the foreseeable future, a tool for pathologists, not a replacement for  pathologists, and it is evident that although AI’s use will fundamentally alter pathology practice, it is

perhaps pathologists’ greatest opportunity to invest themselves more fully in their patients’ care.3,7 Pathologists’ success with AI, however, will depend to a large degree on the successful implementation of efficient AI governance and regulation."

"Classifying obesity as a disease is neither essential nor beneficial. It’s much more complicated than that."

Should obesity be recognised as a disease?

"Classifying obesity as a disease is neither essential nor beneficial. It’s much more complicated than that."

US blood donation crisis: Millennials not keen on 'anonymous' act, 'want to know the impact they have on others', say experts

The fundamental reason for the crisis is not just a decline in the frequency of donors. There has been a decline in the number of donors too. What started off as a civic duty-driven phenomenon, she says, has changed into more of an "individual transformational impact". 

HT:DA

Doctors Are Turning to Artificial Intelligence to Diagnose Cancer Patients

"Now we can look at the individual genetic pathways of a patient's tumor, and in the lab we can measure the different unique features of a cancer, so that we can often specify drugs that target that cancer's individual mechanisms. Twenty-five years from now we'll be at a whole new, deeper level of diagnostics that goes beyond genetics with new pathology tests that point to new types of drugs we can't imagine yet."

HT:MM

Obesity linked more to diet than genes: Study #EatRighWorkOut

Obesity linked more to diet than genes: Study

"A study suggests that obesity is more linked to lack of exercise and considerable shift in diet to unhealthy pattern and not just genes.

The study says genes do play a role but the excess kilos don’t just depend on them. Food habits and exercise also do play a part in getting obese."

Expert Opin Investig Drugs. 2019 Jul 1:1-14. doi: 10.1080/13543784.2019.1638363. [Epub ahead of print]

What can independent research for mesothelioma achieve to treat this orphan disease?

Guazzelli A1, Meysami P1, Bakker E2, Bonanni E3, Demonacos C4, Krstic-Demonacos M1, Mutti L5.

Author information

1

a School of Environment and Life Sciences , University of Salford , Salford , UK.

2

b School of Medicine , University of Central Lancashire , Preston , UK.

3

c National Asbestos Observatory , Rome , Italy.

4

d Faculty of Biology, Medicine and Health, School of Health Sciences , University of Manchester , Manchester , UK.

5

e Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology , Temple University , Philadelphia , PA , USA.

Abstract

Introduction: Malignant pleural mesothelioma (MPM) is a rare neoplasm with a poor prognosis, as current therapies are ineffective. Despite the increased understanding of the molecular biology of mesothelioma, there is still a lack of drugs that dramatically enhance patient survival. 

Area Covered: This review discusses recent and complete clinical trials supported by the NIH, other U.S. Federal agencies, universities and organizations found on clinicaltrials.gov. Firstly, chemotherapy-based trials are described, followed by immunotherapy and multitargeted therapy. Then we introduce drug repositioning and the use of drug docking as tools to find new interesting molecules. Finally, we highlight potential molecular pathways that may play a role in mesothelioma biology and therapy. 

Expert Opinion: Numerous biases are present in the clinical trials due to a restricted number of cases, inappropriate endpoints and inaccurate stratification of patients which delay the finding of a treatment for MPM. The most crucial issue of independent research for MPM is the lack of more substantive funding to translate these findings to the clinical setting. However, this approach is not necessarily scientific given the low mutational load of mesothelioma relative to other cancers, and therefore patients need a more solid rationale to have a good chance of successful treatment.

ELO - Telephone Line (Live) #BeforeCellPhones

ELO - Telephone Line (Live)

I am a Candidate for College of American Pathologists' President-Elect, 2019-2021 term. My vision is here.

I am a Candidate for College of American Pathologists' President-Elect, 2019-2021 term.  My vision is here.

Membership Growth. Pathologist Payment.

"...obese and inactive people prefer empowering campaigns, find them more motivating and less stigmatising."

Obesity has become the new normal but it’s still a health risk

"There has, to my knowledge, been no high-quality research comparing the actual effectiveness of shaming versus empowering anti-obesity, or pro-physical activity, campaigns.

However a number of studies show, unsurprisingly, that obese and inactive people prefer empowering campaigns, find them more motivating and less stigmatising."

"Those born after 1970 were far more likely to have a substantially higher BMI as young adults than earlier generations."

Genes, yes, but obesity pandemic mostly down to diet: study

Those born after 1970 were far more likely to have a substantially higher BMI as young adults than earlier generations.

Vehicle - The Ides Of March

"To grasp the affinities between administrative governance and algorithmic governance, one must first get over that intellectually debilitating article of libertarian faith, namely that 'the government' poses the only real threat to liberty."

Algorithmic Governance and Political Legitimacy

by Matthew B. Crawford

To grasp the affinities between administrative governance and algorithmic governance, one must first get over that intellectually debilitating article of libertarian faith, namely that “the government” poses the only real threat to liberty. For what does Silicon Valley represent, if not a locus of quasi-governmental power untouched by either the democratic process or by those hard-won procedural liberties that are meant to secure us against abuses by the (actual, elected) government? If the governmental quality of rule by algo­rithms remains obscure to us, that is because we actively welcome it into our own lives under the rubric of convenience, the myth of free services, and ersatz forms of human connection—the new opiates of the masses.

To characterize this as the operation of “the free market” (as its spokespersons do) requires a display of intellectual agility that might be admirable if otherwise employed. The reality is that what has emerged is a new form of monopoly power made possible by the “network effect” of those platforms through which everyone must pass to conduct the business of life. These firms sit at informational bottlenecks, collecting data and then renting it out, whether for the purpose of targeted ads or for modeling the electoral success of a political platform. Mark Zuckerberg has said frankly that “In a lot of ways Facebook is more like a government than a traditional company. . . . We have this large community of people, and more than other technology companies we’re really setting policies.”

"...the term 'health care provider' is a generic term that does not communicate the emphasis on education and concern for patients embodied by the traditional term 'physician' or 'doctor.'"

245.002 Health Care Provider

245.002

Health Care Provider: The Texas Medical Association recognizes that the term "health care provider" is a generic term that does not communicate the emphasis on education and concern for patients embodied by the traditional term "physician" or "doctor." Similarly, the term "covered lives" is a dehumanizing phrase that often is used instead of "patients." Therefore, TMA should refrain whenever possible from the use of such terms as "provider," "covered lives," and similar terms in all communications with members, the public, and the media, and "patient" and "physician" should be used in place of these terms (Council on Communication, p 49, I-91; amended CC Rep. 5-A-02; reaffirmed BOT Rep. 12-A-12; reaffirmed BOT Rep. 12-A-12).

Red Skelton - Explains "The Pledge of Allegiance"

Obesity overtakes smoking as the leading cause of cancer

Now, latest figures from a charity showed that excess body weight has overtaken smoking as the main cause of four different types of cancer - bowel, kidney, ovarian and liver cancer. The charity warned that millions of people are at risk of cancer because of their excess weight, adding that obese people now outnumber smokers by two to one in the UK.

Our obsession with paternalism has turned obesity into a disease from which there can be no escape

Where is the personal responsibility, where are the attempts to empower people?

Boris Johnson’s pledge to review the “sin taxes” that have spread across the statute book with the inevitability of holiday weight gain has certainly divided opinion. Some have branded the move irresponsible and even dangerous, highlighting new Cancer Research UK findingslinking obesity to more cases of common cancers in the UK than smoking. Steve Brine, the minister responsible for implementing the tax on sugary drinks, described the move as “transparent dog whistle politics” (whistling to whom? People who enjoy a full-fat Coke?)

Timothy Craig Allen (2019) Regulating Artificial Intelligence for a Successful Pathology Future. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Regulating Artificial Intelligence for a Successful Pathology Future

Timothy Craig Allen, MD, JD
"Physicians, including pathologists, must now rethink what it means to be caring, and how to preserve and foster social interaction with patients while using AI efficiently. It will be especially important that physicians use AI in a manner that respects physician and patient heterogeneity and supports equity. It is physicians, with pathologists at the head of the table, who must lead and forever maintain this conversation with policymakers, providing regulatory guidance that ensures empathy is always considered and respected throughout the complicated discussion around AI regulation and governance."