alphaoverlord

This blog post seems like a jumble of ideas that are neither consistent or connected.

It starts with colleges should be more than job training centers, then ends with trying to create an accreditation process to prove value to external entities (of which I assume employers are a big part?).

It mentions the high cost of education, then describes how his current options are lacking because the number of classes in each major is limited.

He talks about how administrators are unnecessary, then suggests a similarly labor intensive accreditation system that requires experts, committees and other logistics that requires significant manpower and time/energy.

There are many flaws with the educational system, of which convenience, rigor, equality, and cost are a few the OP mentions, however his solution doesn't seem to solve many of the challenges he mentions. I doubt that accreditation is a major cost to running a university - there are simply many other market forces (wanting facilities, a good football team, strong researchers that might not put teaching first) that causes the cost/benefit relationship to be the status quo. He finds it unconscionable that adjunct faculty don't make enough money, then hopes to solve it with a free market - where honestly the things he values might not be the things many others value. He wants rigor - then critiques current accreditation processes that largely does what he suggests.

Each of the major MOOCs already are trying to accredite/build reputation/be rigorous. What OP is essentially doing is describing the idea of Udacity, Coursera, etc without the technical backend, the users to attract such a marketplace, connections, support, or actually being able to do a MOOC.

Thats actually not true. The readmission penalties make it so hospitals are not paid at all for the readmission.

Really? That article has no data. It only says: “When you look at senior management, you tend to see men disproportionately represented. So while there may be less than 5% of all nurses who are male, you see a much larger percentage than 5% in senior-level positions like hospital administrators.”

Which is understandable because administrator != higher level nurse. Most hospital administrators are MBAs, occasional MDs and RNs.

I am a current UCSF medical student and I majored in statistics in undergrad. I program in R and python. In undergrad, did consider doing an internship at a tech company as a data scientist, so I feel like I understand the perspective from both sides.

That said, I feel this is entirely a false dichotomy - there are actually very few people choosing between nursing and computer science, and it is not "diverting some of these students to computer science rather than remaining in health care". They are simply very different students and workforces with different motivations, strengths, and weaknesses.

I am sure we can agree that there are many fields that are worse off than computer science. Retail, administration, and many disciplines don't have the flexibility or financial compensation. To me, in some ways, it does sound like sour grapes when one says "well, look women have nursing. They make good money." Regardless whether healthcare is a good field, that creates a false dichotomy when there are many people (both male and female) who aren't in these fields.

Even digging into this false dichotomy, it is another discussion whether healthcare is actually more flexible, has fewer hours, and is a better career choice than software development. The grass is always greener on the other side, but I would say that only in healthcare does a significant proportion of the workforce have to work overnight shifts, 30 hour workdays, and have to deal with relatively hazardous or infectious materials.

I love medicine, it's a great field, and I really enjoy having an impact on people's lives. But similarly, there are intangibles in software development like the satisfaction of creating something and doing things that can touch people far away. I think that to split these professions into "male" and "female" is a huge disservice and it brings nothing to the discussion to say some female predominant fields have good earning potential.

PS. UCSF medicine is typically between 47 - 54% female each year. Not sure where you got the 58% statistic. There are a lot of applicants, so the administrators probably have a lot of flexibility on how they want to shape the class demographics.

Contrast this with stack ranking and other metrics for developers and PMs. Can you now see the OPs reservations about such a system? Particularly as the article critiques the system as flawed.

The article does mention and debuffs it. Its the difference between 32 and 40% Its based off one study of small sample size and is not biologically plausible.

>The incidence of what are known as serious adverse events — a catchall category that includes hospitalizations for any reason — was slightly higher in the Avastin group: 40 percent vs. 32 percent. The adverse events included broken bones and urinary tract infections.

“The majority of the adverse events would be difficult to imagine being caused by the drug,” Martin said. Martin noted that while small, probably random effects favored Lucentis in some cases and in others they favored Avastin. Neither should be viewed as conclusively related to the drug, he said. >

And finally there is Dr. Oz, who talked well, was attractive, knew Oprah and was interested in talking about all sorts of diseases and conditions outside his training. He has a TV show, multiple book deals, is a millionaire, and doesn't have to see a patient.

That's really cool. Where did you get your ECG machine? I'd be interested in getting one if its that cheap.

I got one for free for a demo and while it was interesting, I can't think of a good use case. A single lead ECG is not useful for much more than heart rate, and there are already many interesting ways to get that ( light sensor on phone ) that i dont know if it has much more utility from extra hardware. Perhaps if you have lqts, it can flag it but otherwise very very few usecases.

I think the parent comment's argument is that improvement on specific items isn't well correlated with "better health". Even interventions aimed at specific metrics have shown to have no or negative consequences. For example, niacin in the AIM-HIGH trial.

haha, good catch! thanks.

> People often forget that the medical profession's highest priority isn't the health of you, the patient. If you were to grab a medical ethics book you will first be told that the well being of the population as a whole surpasses any individuals rights.

That is just not true. Completely, 100%, entirely false. In medical decision making, the principles of beneficence, malfeasance, and autonomy far outweigh the concept of social justice. As someone who works in the medical setting, hearing something like this stuns me.

It's never just about the product. There's also the market, the logistics, and the peripherals. Even if it is the same product and "before its time", it's still before its time.

Other than for research, surgeries are not routinely recorded.

Because that's not how diabetes works

Again, my first paragraph is: > I'm all for people having the freedom to eat whatever they want and I really like the quantified self aspect of seeing how diet affects how they feel and metrics of health, but I have to say the author grossly does not understand the medical tests he had done and misinterprets the data. I'm not going to comment on the drink, but rather on his misunderstanding of medicine.

I'm not trying to refute what he says about how he feels, whether that saves him money, or his mental ability - those aren't my areas of expertise. I do know a little about medical tests, and I think it's valid to point out that he clearly does not and how the results he reports are either incorrect or irrelevant. I'm just suggesting you shouldn't consider his medical tests in deciding how good this product is.

I have no horse in this race, but I'll tell you if this racetrack is not standard regulation. Self experimentation might be useful, but only if you understand the metrics you measure and whether it's stochastic noise or meaningful results.

I'm all for people having the freedom to eat whatever they want and I really like the quantified self aspect of seeing how diet affects how they feel and metrics of health, but I have to say the author grossly does not understand the medical tests he had done and misinterprets the data. I'm not going to comment on the drink, but rather on his misunderstanding of medicine.

First, EGFR is not "Epidermal Growth Factor Receptor", rather is it estimated glomerular filtration rate, which is a metric of kidney function and is derived entirely from age, sex, and Cr.

Second, all his labs are normal, well within the range of normal and stay normal after two weeks. There is normal daily fluctuation (for example, my Cr will probably go from 1 to 1.2 just by not drinking water for a day) which the labs show. All the changes he mention in his metabolic panel does not even register to me as changes and most likely would happen had he ate a regular diet.

Third, the body is a powerfully homeostatic system, even had he not ate for two weeks, most of the labs he got would stay the same. Recently, on HN there was the article of the guy who didn't eat for a year - his BMP would have been similar. The only potentially reasonable medical test to get would have been the lipid panel, which stayed grossly the same.

Finally, a DEXA scan is really silly in this scenario. It's for old ladies and others at risk for osteoporosis. Your bones are a large of reservoir that it wouldn't put a dent on your Ca levels even if you had no Ca for two weeks, and even if it did, it would not show up as a meaningful change on a DEXA scan.

Why would this not just cause inflation to a point most people need to work again?

There are significant risks to such an experiment, and it's a shame that there isn't any record of what happened to him after the fact or his long term health.

There is a significant body of literature suggests that in addition to risks during starvation, there is significant harm and danger in trying to eat again [1]. The GI tract atrophies (much like when we don't use a muscle or a limb for a long time with a neurological disorder), and there are many metabolic complications in restarting to eat.

http://en.wikipedia.org/wiki/Refeeding_syndrome

Actually unlike antibiotics, there is limited evidence of rrsidtence to antifungals. Amphotericin and fluconazole have been around forever and still useful.

Perhaps the game is less deterministic if you can choose any board as soon as the board is won - not when it is filled. Then, you can only force 3 moves before you have to give up control. Then approaches like the Orwin gambit would not work (it is too costly to lose a board if it only lets you choose three spots.)

Perhaps the game makes more sense if you can choose any board as soon as the board is won - not when it is filled. Then, you can only force 3 moves before you have to give up control.

Why is it reasonable to assume that? Its fiat on both examples and both examples currently are impossible.

> It seems a little premature to jump to that conclusion. The US and Great Britain are entirely different countries with different geography, climate, history, culture, laws, economies, etc.

I would say that there is also significant intra-country variation. I have a hard time imagining that there isn't some part of the US where conditions are not similar to the UK. At the point that these regulations work for these locales, I don't see compelling evidence that it wouldn't work elsewhere.

My argument isn't that there isn't culture, climate, or a variety of other factors that influence how things are done - rather, at the point that there is variation, but they all generally work, I have a hard time imagining each of them are important.

> What I found interesting about the article was that while each system was different, each was internally cohesive.

Hence the idea that these narratives are contrived. If we look at any system (that works/is real), there is internal consistency. It is very easy to point to any particular aspect of the system, and say that it is crucial/unique/signifantly valid and valuable.

I would say that this argument is very similar to creationism arguments that the universe's constants/parameters are uniquely functional because we are here. I'm not saying it can't be true, but it seems like a logical fallacy to presume that a particular aspect causes the system in place.

I feel like this story is a great example of how its easy to come up with ad hoc justifications. After you decide to do something, it's quite easy to find evidence for your perpsective and justify standard practice.

At the point that there is such a huge variation in practice, for most of these steps, I can't imagine that they are very significant/important. The two systems are made to sound like there is significant justification for each step, which protects one from the shortfalls of other steps, but I can imagine that a combinatorial approach for each of the requirements would work just as well.

Then again, I don't know anything about hens. Just my thoughts.

There are a variety of technical online references. One example would be uptodate.com. they are generally behind pay walls though, so hard to access as a patient.

It is frequently referenced.

Looks like protovis, unless they are using different tools for each graphic. http://mbostock.github.com/protovis/ex/pack.html

so what's the plan doc? EHR in the style of practicefusion, drchrono, Epic, GE Healthcare?

Generally Enron is described as an example of deregulation gone wrong as Enron was able to control supply. That has nothing to do with passing off costs to ratepayers.

Even if that's not a perfect example, do we really disagree that a pure free market doesn't always lead to the optimum outcome?

Also, I don't think its civil to downvote simply b/c you disagree.

Necessity vs. non-essential is quite a slippery slope as there is a gradient of need. How would one draw the line?

As Enron and countless other examples show, a purely free market does not always result in an optimum outcome, even for something as perfectly fungible.