davak

Doc here. Not negative on this story, but it is completely false to say 0/18 would have improvement with standard care. Patients frequently improve from strokes; some quite rapidly. Maybe you had a typo?

The next step is intervention versus placebo. Strokes are very common. It should be easy to find patients to enroll.

Hopefully this will turn out to work and be worth the cost.

Typically those are different types of steroids though. Anti allergy steroids are called the "body's universal solvent" because of all the side effects including muscle weakness and fat gain. Anabolic steroids work on a different pathway.

Of note some of modern human allergies come from infant avoidance. Kids who eat peanuts younger are less likely to get peanut allergies for example. If you want to decrease allergies, let your infants get dirty, play with dogs, and liberalize their diet.

In general, of course.

But if you had a database of 1000s of people with STDs, how many lives might get destroyed if that got hacked?

As a physician and code slinger, I will say that I often worry about my patients, my servers, my partners, my code, my projects...

Part of doing tough complex things is worrying if you are making the right decisions. If a patient dies inappropriately, that can be career ending. If my server crumbles or leaks private information, that too can be career ending.

Nerdness is kinda cool now, right?

Anyway, friends made fun of all the stereotypical characters... I'm nerd plus plus but I remember Ross being a dick.

Complete garbage.

Source -- My personal everyday experience.

Imagine you are in a small hospital room and unable to get out. A 300 pound 6'2 dude is yelling that he's going to kill you. His brain is so scrambled that the tazor did nothing. You are backed into a corner and he's walking toward you.

Working in hospitals over the last ten years, I have noticed an increase in how violent patients are. I believe the increasing use of synthetic rec drugs and the failing mental health system is to blame.

Previously many of these dangerous cases would be locked up until they were safe. Now, everybody just tries to treat them as an outpatient. That with the easy access to guns makes hospitals very dangerous places these days.

MD here. I agree with this completely. I will also add that Chronic Fatigue Syndrome is unlikely one disease although we are not smart enough yet to know to divide them more specifically.

I've "fixed" cases like this by diagnosing and treating rare rheumatological and sleep disorders. However, most patients clearly have psych or personality disorders. Is the mental illness a cause or effect?

It's my job not to give up and blow off patients. Just realize that there is a ton about medicine that is unknown still--we are scientists searching for answers too.

See how much money your physician takes from drug companies.

https://www.cms.gov/openpayments/

As a physician I can tell you that this type of public reporting has radically decreased the amount of stuff that doctors take from drug companies.

Removing advertising from the TV will do the same. It is much easier for a physician to give a patient the most correct medication without these biases. Remember that in the US, we spend about 2-3X as much as anybody else for less length and quality of life.

http://qz.com/553181/americans-spend-nearly-three-times-as-m...

* Source needed.

As an ICU physician, I hate the NOAKs. The data may say that they bleed less. However, when they do bleed, I've got nothing that really reverses the bleeding.

Of course, novel reversal agents are coming and each one will likely only reverse one drug... and each one will cost an arm and a leg.

I understand why patients do it. I just don't like bleeding that I often can't directly control.

I assuming hsv-1 was approved and successful because it's a pcr test requiring very little blood already. Most of the other tests require much more volume. It sounds like these tests were the ones that were supposed to be revolutionary but were not successful.

Then you are lucky. You could have been told you have brca, huntingtons, or several other horrible genetic disease. A negative test is often the best result!

Arq is the tool you need.

Yes. Yes you should be tested.

"Normal" lab values are typically the 95% range of normal people tested. This is why over-testing is dangerous; about one out of twenty tests will be abnormal in normal folks.

He spends a lot of time trashing the physicians because they won't do additional workup and chase MRI abnormalities. When he finally gets somebody to do something, he just put his brother in some temporary pain without any long lasting improvement.

Yes, the doctors debated on if he has this or that specific condition, because ultimately it didn't matter because he has a condition that isn't fixable. Doctors are best trained to identify what is fixable.

Disease states are fuzzy. Many times if somebody has a disease is not boolean in nature. However, all the doctors correctly predicted that current medical knowledge had nothing that would be helpful.

If they would have just believed the physicians, they would have saved some money and the patient some pain. Autism is an awful collection of diseases, but slamming the medical system in this case is not justified.

MD here. Something is odd. If it's big enough to be tumor-like it's big enough to be biopsied.

If it's small, they can just watch it on serial CT scans. If it's growing, they can put her on bypass and replace that section of her aorta. Not as easy as it sounds, but still usually possible.

Repair with stem cells is very different than curing a tumor.

In complex, atypical cases the answer is always to go to a large teaching institution.

This is typically because of sleep apnea or snoring. I had a whole family of thin folks with sleep apnea that this was their initial complaints.

I loved it. To me medical school was the entire reason that I had worked so hard in high school and college. I finally could quit worrying about grades and just focus on learning.

Every waking moment was studying. I knew if I slipped that I would fail. Overall, though, it was great because I was really interested.

The people who didn't like it were those that either focused on grades and couldn't keep up or those people who realized that medicine was not their passions.

I would type more but I'm on mobile.

Non-anesthesiologist ICU physician here so slight bias should be noted.

I'm a huge fan of this. Machine will be much more anal about minor issues that some anesthesiologists / CRNAs may ignore. Additionally, this will greatly bring down costs for healthy routine procedures that need sedation. Machines don't "get bored" and if things fall out of parameters they happily yell to get attention. Properly coded they should also not make medication errors. Additionally, they should be able to record data and find patterns in patients that unexpectedly don't do well.

Michael Jackson would probably still be alive if a machine had been used to help monitor his propofol!

Dialysis, for example, used to be a much more manual process. Now, it is mostly driven by nurses and machines. Heck, people even do self-directed dialysis at home.

This isn't the end of anesthesiology by any means. The more difficult patients such as those who are obese or have a bunch of health problems will still need more aggressive observations. However, I suspect these machines will move into bigger and bigger surgeries to help assist the gas-passers provide safer analgesia and sedation.

Just like robotic assisted surgery became too popular too fast and outcomes suffered, I suspect these type of machines will not be trouble-free. How long before the HN articles about one of these being hacked start appearing? Nevertheless, medical machines like this with tight feedback loops are essential for improving the safety and efficiency in the future practice of medicine.

MD but not an oncologist.

Some of these cases of breast "cancer" would likely resolve on their own if the screening hadn't detected them. We all have "cancer" cells that our body does a pretty good job handling on a routine basis.

Many people would die of something else other than their prostate cancer if we didn't screen for it.

By no means am I saying that screening isn't valuable, it truly is wonderful. However, at some point screening tests get to the point of being too sensitive and causing more harm than good.

"Overdiagnosed" is an interesting read about this topic.

See a doctor certified in sleep medicine. Sleep is a delicate habit that can be tough to fix. The consequences of poor sleep are huge. Frequently broken sleep is a warning sign of other health problems.

As a physician I think the diversity hypothesis should really be challenged. Our guts, microbes, and even genes take a while to change. Is diversity really helpful or harmful?

When you study people that live to be very old, many of them eat the same simple things on a daily basis for decades.

Anyway, just a personal hypothesis...

I would love to buy you a beer sometime and discuss that with you. If you have any sources for that epiphany... please let me know.

Ohhh. I want this for my area. Great idea.

MD here. Just remember that women live longer than men. Although it'll never be proven that hormones are part of that provess, I think it's a good assumption.

Many males as they get older become more lovable and more pleasent to be around because of natural hormone declines.

There are a ton of health issues such as balding, coronary artery disease, prostate cancer, obstructive sleep apnea that are related to testosterone. Whether these clinics can find the correct cocktail to find a healthy balance isn't clear.

I'm neither pro nor con. I've seen people who have been positively and negatively impacted by steroid supplementation.

For normal people monthly lab testing would be overkill at best and dangerous at worse.

The thing to remember about lab tests is that the "normals" are based on bell curves so approximately 1 out of 20 labs will be abnormal from this phenomena alone. The more labs you get, the more false abnormals you get. If each false abnormal gets worked up, you are talking a lot of additional testing and worry.

Typical recommendations to test hypercholesterolemia is every 90 days at most if actively treating and then yearly once stable.

To your aside, I think annual physicals are probably overkill, but primary care doctors are now expertly trained in screening for multiple issues that could affect young healthy folks. Seeing your PCP for a "well-person" visit every few years is a good idea. Most of the time the doctor isn't going to order labs and will just chat a bit, do a physical exam, and get you on your way. A good doctor will have informed opinions about your exercise and diet regimen, for example.

MD here.

Hyperbole much? Only gram negative rods have cell walls. Many resistant organisms are gram positive species which do not have cell walls at all.

The one truism of microbiology is that the germs will win. Germs will find resistance to this process and pass it around to their buddies eventually. Evolution is just too efficient of a process.

Obviously I'm happy for new weapons against gram negatives... especially in this era when companies have largely stopped researching antibiotics.