http://www.cnn.com/2010/TECH/innovation/06/09/technology.prize.window/index.html?hpt=Sbin
A professor who invented low-cost solar cells that may be incorporated into energy-producing windows has been awarded the Millennium Technology Prize.
Friday, June 11, 2010
Monday, June 7, 2010
Overtreatment in the news
http://news.yahoo.com/s/ap/20100607/ap_on_bi_ge/us_med_overtreated
Overtreatment means someone could have fared as well or better with a lesser test or therapy, or maybe even none at all. Avoiding it is less about knowing when to say no, than knowing when to say, "Wait, doc, I need more information!"
It's great this is in the news but again the way overtreatment is framed leaves people without a clear picture of the harms. They do mention a risk of cancer with excessive CT scans but they refer only to the "limitations" of PSA screening. They don't mention the harms of screening mammograms at all. They don't mention the blockbuster (expensive) vaccines gardasil and prevnar which have more evidence of harm than benefit.
They mention a couple medications which are overprescribed such as Nexium and antibiotics but they again leave the magnitude of harm vague.
It's interesting to watch the system attempt to retreat slightly and reduce the overtreatment burden slightly with guidelines and payment incentives for physicians to counsel more and test/over treat less.
Amend and reform, amend and reform.
But what if the core of the system is rotten?
What if the fundamentals of health care incentivize overtreatment? How are some guidelines going to counteract the massive marketing power of pharmaceutical companies?
See it's times like these that "lip stick on a pig" would be appropriate but our friend Sarah P ruined that gem for us all.
Oh well.
But this article does sample a pretty large chunk of the super-sized american health care experience. It's a superficial view of the harms from all this over testing, over treating. It doesn't make the connection between overtreatment and marketing. It doesn't make the connection between over everything and lack of coverage via high costs.
It doesn't talk about how overtreatment and over testing are the same things as economic growth in the so called health care industry.
IF
IF we somehow reverse this trend toward more and more unnecessary/harmful health care, then what will it do to the economy? I mean other than the military and other government spending, health care has been one of the few consistent sources of economic growth. Do we really have a system that punishes society with yet another bursting bubble (dot com followed by housing followed now by health care) because society finally figures out that more is less?
Because as we break this mindless cycle of excessive treatment and testing and reduce the harms that go with it all, some mighty powerful industries will be forced to shrink and good, hardworking people will be out of a job.
The stuff about low back pain in the article reminds me of a local phenomenon. Here in Yakima one of the few highly lucrative health care institutions is the pain clinic. The pain clinic functions as a kind of deep injection factory. Nerve blocks, epidurals, spinals. These deep injections often under xray guidance pay very well. The benefits are almost always short-lived and the potential harms remain vague in most minds but the financial incentives to do more tests and more procedures are painfully evident at the pain clinic.
And now that the ER has a fancy new MRI scanner, there's even more opportunity to find common disc abnormalities that can be harvested at the pain clinic.
But almost all of their business at the pain clinic is discretionary spending. Most of the patients walking in their doors will either get better on their own and/or not benefit from the procedures preformed.
It's not that we don't need specialists who can do nerve blocks well. It's just that the incentive to do more procedures, advertise and repeat runs counter to the best interests of the average patient in pain.
Put another way: If most people with low back pain will get better just as rapidly with certain treatments as without, then most people are harmed in some fashion by said treatments.
It's pretty grotesque but almost every popular AKA lucrative treatment and test in medicine is over applied. It just makes sense, if you limit interventions to just the people who need them, you are missing out on a larger market. The goal, financially, of any medical intervention is to apply something studied in a limited population of patients to the general population.
Like with acid blockers like Nexium. If it works well in people with ulcers then focus on the symptoms that are most common in the general population and get people used to treating the symptoms. There are thousands of times more potential customers who have occasional heartburn versus the rare individual with stomach ulcers.
Interesting times
Overtreatment means someone could have fared as well or better with a lesser test or therapy, or maybe even none at all. Avoiding it is less about knowing when to say no, than knowing when to say, "Wait, doc, I need more information!"
It's great this is in the news but again the way overtreatment is framed leaves people without a clear picture of the harms. They do mention a risk of cancer with excessive CT scans but they refer only to the "limitations" of PSA screening. They don't mention the harms of screening mammograms at all. They don't mention the blockbuster (expensive) vaccines gardasil and prevnar which have more evidence of harm than benefit.
They mention a couple medications which are overprescribed such as Nexium and antibiotics but they again leave the magnitude of harm vague.
It's interesting to watch the system attempt to retreat slightly and reduce the overtreatment burden slightly with guidelines and payment incentives for physicians to counsel more and test/over treat less.
Amend and reform, amend and reform.
But what if the core of the system is rotten?
What if the fundamentals of health care incentivize overtreatment? How are some guidelines going to counteract the massive marketing power of pharmaceutical companies?
See it's times like these that "lip stick on a pig" would be appropriate but our friend Sarah P ruined that gem for us all.
Oh well.
But this article does sample a pretty large chunk of the super-sized american health care experience. It's a superficial view of the harms from all this over testing, over treating. It doesn't make the connection between overtreatment and marketing. It doesn't make the connection between over everything and lack of coverage via high costs.
It doesn't talk about how overtreatment and over testing are the same things as economic growth in the so called health care industry.
IF
IF we somehow reverse this trend toward more and more unnecessary/harmful health care, then what will it do to the economy? I mean other than the military and other government spending, health care has been one of the few consistent sources of economic growth. Do we really have a system that punishes society with yet another bursting bubble (dot com followed by housing followed now by health care) because society finally figures out that more is less?
Because as we break this mindless cycle of excessive treatment and testing and reduce the harms that go with it all, some mighty powerful industries will be forced to shrink and good, hardworking people will be out of a job.
The stuff about low back pain in the article reminds me of a local phenomenon. Here in Yakima one of the few highly lucrative health care institutions is the pain clinic. The pain clinic functions as a kind of deep injection factory. Nerve blocks, epidurals, spinals. These deep injections often under xray guidance pay very well. The benefits are almost always short-lived and the potential harms remain vague in most minds but the financial incentives to do more tests and more procedures are painfully evident at the pain clinic.
And now that the ER has a fancy new MRI scanner, there's even more opportunity to find common disc abnormalities that can be harvested at the pain clinic.
But almost all of their business at the pain clinic is discretionary spending. Most of the patients walking in their doors will either get better on their own and/or not benefit from the procedures preformed.
It's not that we don't need specialists who can do nerve blocks well. It's just that the incentive to do more procedures, advertise and repeat runs counter to the best interests of the average patient in pain.
Put another way: If most people with low back pain will get better just as rapidly with certain treatments as without, then most people are harmed in some fashion by said treatments.
It's pretty grotesque but almost every popular AKA lucrative treatment and test in medicine is over applied. It just makes sense, if you limit interventions to just the people who need them, you are missing out on a larger market. The goal, financially, of any medical intervention is to apply something studied in a limited population of patients to the general population.
Like with acid blockers like Nexium. If it works well in people with ulcers then focus on the symptoms that are most common in the general population and get people used to treating the symptoms. There are thousands of times more potential customers who have occasional heartburn versus the rare individual with stomach ulcers.
Interesting times
Saturday, June 5, 2010
Stress
http://www.yesmagazine.org/happiness/want-the-good-life-your-neighbors-need-it-too
....It's not the inferior housing that gives you heart disease, it's the stress, the hopelessness, the anxiety, the depression you feel around that. The psychosocial effects of inequality affect the quality of human relationships. Because we are social beings, it's the social environment and social relationships that are the most important stressors. For individuals, of course, if you're going to lose your home, or if you're terribly in debt, those can be more powerful stressors. But amongst the population as a whole, it looks as if these social factors are the biggest stressors because so many people are exposed to them.
...
If you grow up in an unequal society, your actual experience of human relationships is different. Your idea of human nature changes. If you grow up in a consumerist society, you think of human beings as self-interested. In fact, consumerism is so powerful because we're so highly social. It's not that we actually have an overwhelming desire to accumulate property, it's that we're concerned with how we're seen all the time. So actually, we're misunderstanding consumerism. It's not material self-interest, it's that we're so sensitive. We experience ourselves through each other's eyes—and that's the reason for the labels and the clothes and the cars.
.....
....It's not the inferior housing that gives you heart disease, it's the stress, the hopelessness, the anxiety, the depression you feel around that. The psychosocial effects of inequality affect the quality of human relationships. Because we are social beings, it's the social environment and social relationships that are the most important stressors. For individuals, of course, if you're going to lose your home, or if you're terribly in debt, those can be more powerful stressors. But amongst the population as a whole, it looks as if these social factors are the biggest stressors because so many people are exposed to them.
...
If you grow up in an unequal society, your actual experience of human relationships is different. Your idea of human nature changes. If you grow up in a consumerist society, you think of human beings as self-interested. In fact, consumerism is so powerful because we're so highly social. It's not that we actually have an overwhelming desire to accumulate property, it's that we're concerned with how we're seen all the time. So actually, we're misunderstanding consumerism. It's not material self-interest, it's that we're so sensitive. We experience ourselves through each other's eyes—and that's the reason for the labels and the clothes and the cars.
.....
The gift in a sense is a symbol that you and I don't compete for the necessities of life. We don't need to fight each other for them. You feel a sense of indebtedness and you reciprocate the gift, which anthropologists have suggested is a sort of basic social contract. That symbolism is still really important: You invite your friends over, sit around the same table, and share food, the basic necessity of life. The symbolism is also there in religious services and communion—these things are very fundamental, very deep.
Inequality is a reflection of how strong hierarchies are, how much we share or how much we don't. It shows us which part of our potential we're developing. What game do I play? Have I got to fend for myself? Or have I got to get people to trust me and cooperate with me? Is my survival dependent on good relationships? Are you my rival? Are you going to steal from me? Have I got to keep what I've got, defend it? Or can we share? Human beings can do both. We've lived in the most egalitarian and the most awful, hierarchical, tyrannical societies. It's very interesting that we can measure how unequal societies are and how that can elicit more of certain kinds of behavior.
Friday, June 4, 2010
Blow Back
http://www.yesmagazine.org/issues/water-solutions/real-people-v.-corporate-people-the-fight-is-on
Real People v. Corporate “People”: The Fight Is On
The Supreme Court says corporations can spend as much money as they want on political advertising. Millions of Americans say they've had it.
Hard to add anything to that so I won't.
Saturday, May 29, 2010
Jama Article about shenanigans and a loose tangent on a new vaccine
http://jama.ama-assn.org/cgi/content/short/303/20/2058
So of the articles reporting on clinical trials that didn't reach statistical significance 40% contained some "spin". Spin being a fancy way to say lie. Distract, trick, deceive .... Whatever
They say in the comment section of the article (which isn't free online):
Our results are consistent with those of other related studies showing a positive relation between financial ties and favorable conclusions stated in trial reports. Other studies assessed discrepancies between results and their interpretations in the Conclusions sections.....
The publication process in biomedical research tends to favor statistically significant results and to be responsible for "optimism bias" (ie, unwarranted belief in the efficacy of a new therapy). Reports of RTCs with statistically significant results for outcomes are published more often and more rapidly than are those of trials with statistically nonsignificant results. Good evidence exists of selective reporting of statistically significant results for outcomes in published articles.
So, not only are clinical trials showing a positive effect from a new med or treatment more likely to be published and published faster than those showing negative effects or lack of benefit but also trials get published spinning a lack of effect into benefit?
It's not really a surprise then when medications proven to increase suicidal thinking in teens and children get marketed as safe and effective depression treatments.
Of course the same JAMA has an entire section called "from the centers for disease control and prevention". This issue has basically an Ad for Prevnar 13. The CDC editorial note points out that "Overall, rates of IPD have remained stable at 22-25 cases per 100,000 since 2002."
IPD is invasive pneumococcal disease. It means the bacteria pneumococcus got in the ear fluid, blood, lungs, spinal fluid. Prevnar came out in 2000 and wasn't widely available because of production problems for at least 2 years. If Prevnar made a big impact, then why didn't the rates drop more?
Oh but the CDC looks at a subgroup for us, children less than 5 years old, it shows that in 2007 black children had a rate of 35.8 per 100,000 while other races was 30.7 and white children 18.4
Prevnar was famous for how it was going to eliminate the racial disparity of the infectious diseases caused by pneumococcus.
This new vaccine, Prevnar 13, covers approximately 64% of the serotypes that cause IPD in 2007. The previous prevnar covered about 80%. There's no worry about testing the effectiveness of the new vaccine. They just did some antibody studies and then backpedaled on how they measured success of that when 3 serotype-specific antibodies didn't reach target levels after 3 shots. After 4 shots one serotype (6) still wasn't reaching the target antibody levels.
Who knows how this will translate to clinical cases of IPD. MAYBE we will get lucky and drive the rate down further from 22-25 per 100,000. And maybe we'll get lucky and not cause another serotype like 19A which currently tends to be multidrug resistant and difficult to cure. And maybe the MRSA spike in children wasn't related to the effects the 1st Prevnar had on the normal nasal flora of children.
I guess we're going to find out as the experiment rolls on.
Unless the 24% uptake of the swine flu shot is any indication of the state of trust in organizations like the CDC.
So of the articles reporting on clinical trials that didn't reach statistical significance 40% contained some "spin". Spin being a fancy way to say lie. Distract, trick, deceive .... Whatever
They say in the comment section of the article (which isn't free online):
Our results are consistent with those of other related studies showing a positive relation between financial ties and favorable conclusions stated in trial reports. Other studies assessed discrepancies between results and their interpretations in the Conclusions sections.....
The publication process in biomedical research tends to favor statistically significant results and to be responsible for "optimism bias" (ie, unwarranted belief in the efficacy of a new therapy). Reports of RTCs with statistically significant results for outcomes are published more often and more rapidly than are those of trials with statistically nonsignificant results. Good evidence exists of selective reporting of statistically significant results for outcomes in published articles.
So, not only are clinical trials showing a positive effect from a new med or treatment more likely to be published and published faster than those showing negative effects or lack of benefit but also trials get published spinning a lack of effect into benefit?
It's not really a surprise then when medications proven to increase suicidal thinking in teens and children get marketed as safe and effective depression treatments.
Of course the same JAMA has an entire section called "from the centers for disease control and prevention". This issue has basically an Ad for Prevnar 13. The CDC editorial note points out that "Overall, rates of IPD have remained stable at 22-25 cases per 100,000 since 2002."
IPD is invasive pneumococcal disease. It means the bacteria pneumococcus got in the ear fluid, blood, lungs, spinal fluid. Prevnar came out in 2000 and wasn't widely available because of production problems for at least 2 years. If Prevnar made a big impact, then why didn't the rates drop more?
Oh but the CDC looks at a subgroup for us, children less than 5 years old, it shows that in 2007 black children had a rate of 35.8 per 100,000 while other races was 30.7 and white children 18.4
Prevnar was famous for how it was going to eliminate the racial disparity of the infectious diseases caused by pneumococcus.
This new vaccine, Prevnar 13, covers approximately 64% of the serotypes that cause IPD in 2007. The previous prevnar covered about 80%. There's no worry about testing the effectiveness of the new vaccine. They just did some antibody studies and then backpedaled on how they measured success of that when 3 serotype-specific antibodies didn't reach target levels after 3 shots. After 4 shots one serotype (6) still wasn't reaching the target antibody levels.
Who knows how this will translate to clinical cases of IPD. MAYBE we will get lucky and drive the rate down further from 22-25 per 100,000. And maybe we'll get lucky and not cause another serotype like 19A which currently tends to be multidrug resistant and difficult to cure. And maybe the MRSA spike in children wasn't related to the effects the 1st Prevnar had on the normal nasal flora of children.
I guess we're going to find out as the experiment rolls on.
Unless the 24% uptake of the swine flu shot is any indication of the state of trust in organizations like the CDC.
Friday, May 28, 2010
Now THIS is punishment
http://money.cnn.com/2010/05/26/news/companies/boycott_BP/index.htm
The truth is it's not as easy to boycott BP as activists might think because BP is one of the biggest companies on the planet with many different businesses. So, even if you're not buying BP gas you're likely a consumer. Your mechanic may be putting Castrol motor oil into your car, the soda you're drinking today may be in a can produced from Arco Aluminum and the next aircraft you board may using BP fuel and BP hydraulic fluid.
Oh really? Well a .2 second google search alerted me to the group of 118,000 declaring their intention to boycott BP.
http://www.facebook.com/pages/Boycott-BP/119101198107726
And right there on the front page it says
Boycott BP stations. BP brands to boycott include Castrol, Arco, Aral, am/pm, Amoco, and Wild Bean Cafe, Safeway gas. laissez le bon temps rouler pas chez Bp.http://twitter.com/bayoule
It's not that hard to find out which products BP profits from and punish them at a time when they are the most vulnerable.
It's a shame that good people who work for BP and are insured by BP are going to be harmed by the fall out. But just like with pharmaceuticals that do us more harm than good and/or are overhyped/marketed, we have to be selfish with our health.
Powering civilization with ancient carbon is poisoning our air and water. Even without this spill we have to change our power source to survive.
"There's not enough money"
Absurd. Money isn't real. It's just one old concept in a medieval method of organizing society. We wave a congressional magic wand and make 2 trillion appear to bail out financial institutions who somehow managed to lose at a rigged game.
I'm all for punishing BP just to remind everyone how powerful a weapon the masses hold. Especially in a consumer driven economy, our mundane choices prop up the wealthy. But I wish the boycott were more of an ultimatum....
Something like "we will boycott BP until they begin applying their drilling expertise to geothermal heat mining"
Google that and look at the estimates from the US government about the potential zetajules of energy waiting to be mined in the US alone.
NEW YORK (CNN) -- An online movement to boycott BP for its role in the Gulf of Mexico oil spill is growing at a rate of better than 25,000 names a day.
"I won't buy their gas any more. I won't patronize a company that's destroying our planet," New Jersey resident Patricia Jarozynski told CNN, one of 118,000 fans of the "Boycott BP" Facebook page as of this writing.
The truth is it's not as easy to boycott BP as activists might think because BP is one of the biggest companies on the planet with many different businesses. So, even if you're not buying BP gas you're likely a consumer. Your mechanic may be putting Castrol motor oil into your car, the soda you're drinking today may be in a can produced from Arco Aluminum and the next aircraft you board may using BP fuel and BP hydraulic fluid.
Oh really? Well a .2 second google search alerted me to the group of 118,000 declaring their intention to boycott BP.
http://www.facebook.com/pages/Boycott-BP/119101198107726
And right there on the front page it says
Boycott BP stations. BP brands to boycott include Castrol, Arco, Aral, am/pm, Amoco, and Wild Bean Cafe, Safeway gas. laissez le bon temps rouler pas chez Bp.http://twitter.com/bayoule
It's not that hard to find out which products BP profits from and punish them at a time when they are the most vulnerable.
It's a shame that good people who work for BP and are insured by BP are going to be harmed by the fall out. But just like with pharmaceuticals that do us more harm than good and/or are overhyped/marketed, we have to be selfish with our health.
Powering civilization with ancient carbon is poisoning our air and water. Even without this spill we have to change our power source to survive.
"There's not enough money"
Absurd. Money isn't real. It's just one old concept in a medieval method of organizing society. We wave a congressional magic wand and make 2 trillion appear to bail out financial institutions who somehow managed to lose at a rigged game.
I'm all for punishing BP just to remind everyone how powerful a weapon the masses hold. Especially in a consumer driven economy, our mundane choices prop up the wealthy. But I wish the boycott were more of an ultimatum....
Something like "we will boycott BP until they begin applying their drilling expertise to geothermal heat mining"
Google that and look at the estimates from the US government about the potential zetajules of energy waiting to be mined in the US alone.
In the words of Bill Murray, "which is nice"
http://www.nytimes.com/2010/05/25/opinion/25gyatso.html
WHEN I was a boy in Tibet, I felt that my own Buddhist religion must be the best — and that other faiths were somehow inferior. Now I see how naïve I was, and how dangerous the extremes of religious intolerance can be today.
Such tensions are likely to increase as the world becomes more interconnected and cultures, peoples and religions become ever more entwined. The pressure this creates tests more than our tolerance — it demands that we promote peaceful coexistence and understanding across boundaries.
Granted, every religion has a sense of exclusivity as part of its core identity. Even so, I believe there is genuine potential for mutual understanding. While preserving faith toward one’s own tradition, one can respect, admire and appreciate other traditions.
An early eye-opener for me was my meeting with the Trappist monk Thomas Merton in India shortly before his untimely death in 1968. Merton told me he could be perfectly faithful to Christianity, yet learn in depth from other religions like Buddhism. The same is true for me as an ardent Buddhist learning from the world’s other great religions.
A main point in my discussion with Merton was how central compassion was to the message of both Christianity and Buddhism. In my readings of the New Testament, I find myself inspired by Jesus’ acts of compassion. His miracle of the loaves and fishes, his healing and his teaching are all motivated by the desire to relieve suffering.
I’m a firm believer in the power of personal contact to bridge differences, so I’ve long been drawn to dialogues with people of other religious outlooks. The focus on compassion that Merton and I observed in our two religions strikes me as a strong unifying thread among all the major faiths. And these days we need to highlight what unifies us.
Take Judaism, for instance. I first visited a synagogue in Cochin, India, in 1965, and have met with many rabbis over the years. I remember vividly the rabbi in the Netherlands who told me about the Holocaust with such intensity that we were both in tears. And I’ve learned how the Talmud and the Bible repeat the theme of compassion, as in the passage in Leviticus that admonishes, “Love your neighbor as yourself.”
In my many encounters with Hindu scholars in India, I’ve come to see the centrality of selfless compassion in Hinduism too — as expressed, for instance, in the Bhagavad Gita, which praises those who “delight in the welfare of all beings.” I’m moved by the ways this value has been expressed in the life of great beings like Mahatma Gandhi, or the lesser-known Baba Amte, who founded a leper colony not far from a Tibetan settlement in Maharashtra State in India. There he fed and sheltered lepers who were otherwise shunned. When I received my Nobel Peace Prize, I made a donation to his colony.
Compassion is equally important in Islam — and recognizing that has become crucial in the years since Sept. 11, especially in answering those who paint Islam as a militant faith. On the first anniversary of 9/11, I spoke at the National Cathedral in Washington, pleading that we not blindly follow the lead of some in the news media and let the violent acts of a few individuals define an entire religion.
Let me tell you about the Islam I know. Tibet has had an Islamic community for around 400 years, although my richest contacts with Islam have been in India, which has the world’s second-largest Muslim population. An imam in Ladakh once told me that a true Muslim should love and respect all of Allah’s creatures. And in my understanding, Islam enshrines compassion as a core spiritual principle, reflected in the very name of God, the “Compassionate and Merciful,” that appears at the beginning of virtually each chapter of the Koran.
Finding common ground among faiths can help us bridge needless divides at a time when unified action is more crucial than ever. As a species, we must embrace the oneness of humanity as we face global issues like pandemics, economic crises and ecological disaster. At that scale, our response must be as one.
Harmony among the major faiths has become an essential ingredient of peaceful coexistence in our world. From this perspective, mutual understanding among these traditions is not merely the business of religious believers — it matters for the welfare of humanity as a whole.
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