tellak

> The American medical system acts like the smallest bit of discomfort warrants being knocked out.

There is a tremendous variation in both pain tolerance and anxiety. You sound like you’re in the minority.

The anesthetist still gets paid. His concern is if you freak out (this happens more often then you may think), he may at minimum have paperwork to do and worse you may sue him for malpractice (“well he didn’t clearly explain it would be that bad during the consent process).. again this problem happens more than you may think. Ie the negative ev for them if you do not do the typical protocol is considerable.

I tried to keep my statements factual and my own opinion out of it.

While “shit” was a bit tongue in cheeky the term “dirty” is used among practitioners because of the wide range of metabolic side effects that the atypical psychotics have. Seroquel is a metabolically “dirty” drug. Taken in therapeutic doses long term a high percentage of people will end up with metabolic syndrome derangements.

Likewise, in the US and Canada, is not indicated for sleep disorder/insomnia use either. In Lexicomp it’s not even listed for off-label use. That’s just a fact, I don’t know what you’re trying to convince me of. In the US there is also a storied history with Astra-Zeneca and a lawsuit due to their practices of pushing off-label use resulting in a $.5 billion settlement.

Another fact is that Seroquel was one of the most heavily marketed drugs ever to primary care providers. As my 100s of dollars of Seroquel branded swag my office accumulated 15 or so years ago will attest to (I am not a psychiatrist).

My own personal experience has been that most psychiatrists I’ve spoken to at a large academic center, are appalled at the idea of using seroquel for insomnia long term due to serious side effects and the consensus is that it’s MOA is mostly due to its antihistamine property. That’s really all I was saying.

Also most atypicals are not highly sedating, lurasidone especially so. I have not heard of it seriously being mentioned likely for primary insomnia.

The original commenter mentioned a “knee operation”

Propofol is an anesthetic, seroquel is not... it’s an antipsychotic. The thing with antipsychotics is they’re shit or “dirty” drugs... seroquel is not even indicated for insomnia (and depending on who you ask is a terrible choice.. a lot of family med/internists use it, psychiatrists often cringe). It works because it has a strong antihistamine side effect, so it’s basically a very potent Benadryl.

The point being, you’re still arousable. A vigorous rub of the sternum will likely wake you up. Not so much on propofol.

Early in residency, had a guy once that seemed “out” as normal during an operation. No abnormalities. In the recovery room claims he heard everything we were saying in the OR. We of course initially thought he was full of shit, but he quoted verbatim much of the chit chat the team was having (not that any of it was bad thankfully). This is very much not typical.

Were you under with propofol the whole time though? Usually the propofol is just to put you down (it is very short acting) you’re intubated, and then anesthesia is maintained with a volatile fluorane such as sevo.

50% is “super conservative”?? By what reasoning? How is that more appropriate than 5% or .5% or .05%? Either you have a justification for that estimate or you’re just making something up, which doesn’t mean squat.

You’re so confused.

> FLAC has no benefit over traditional 16/24 encoded content

Yes it does. It’s anywhere from 70-30% the size depending on genre. That’s a benefit.

> you might think that FLAC/lossless is audibly better.

No I think and expect it to sound audibly identical. That’s the whole point.

> why the C programming language is the way it is.

I’m curious specifically why you think this is. The 6502 with its poor register set and special purpose addressing mode seems to make it a relatively terrible/challenging C target.

It’s not a big deal. I only mentioned as a response because the op started off saying they were from a family of MDs.

Also the vast majority of practicing physicians are expected to have detailed expertise to understand the indications, application, and interpretation of imaging within their speciality. Most imaging orders are issued by medical or surgical staff, not radiologists.

> That’s asinine, obviously he doesn’t mean more data is always better even if the test is invasive or dangerous.

With him classifying all MDs as idiots, no it is not asinine.

I’ve known few academic physicians that would turn down data if it can be ethically obtained.

The difference between the medical profession and, say Google, is that we as a general rule do not consider the populace one big lab to experiment on as we please. The consequences are more than a little different.

It’s not like things were always this way in medicine either.

I am actually an MD.

> Had we enforced a full-body MRI for every patient, we would quickly amass enough imaging data to know which anomalies are malignant and which are not to a very high degree

How, pray tell, are we actually determining which are malignant and which are not?? I’ll give you a hint: the charitable explanation is you are completely ignorant, the less charitable one is that you consider Mengele and Ishii modern medicine heroes. And that is even if the determination by imaging alone is even possible.

Once again I have to point out on HN... not everyone in the medical world is an idiot incapable of analytical thinking, it is just that a lot of us care about ethics. Our patients, even in research, are more than just numbers.

There new guidelines in the US that still recommend aspirin based on cardiovascular risk. That aspirin increases the risk of bleeding is old news. The difficulty has been in quantifying the risk/benefit. You should consult with your doctor about your specific circumstance.

If that’s what he’s saying, he’s wrong. Python threads are based on native threads. They are parallel executed, they just don’t do so very well because of the GIL.

Your example is the epitome of bullshit.

There is a tremendous amount of tech in medicine and considerable investment at larger healthcare systems. If medical coding were such a simple automateable problem it would have been done (I mean it’s freaking billing... absolutely the strongest and direct financial incentives to solve).

The first mistake/flaw you’re making is that the healthcare provider uses codes. That is most often not the case. Even if they do, it gets more complicated with submitting claims.

There are plenty of LUTs in healthcare that are managed by the EMR, billing ain’t one.

Absolute bullshit. To say there are no studies demonstrating better effectiveness than placebo is a tired old meme. It is true that SSRIs don’t have a profound effectiveness over placebo like some drugs.. but that does not make them useless. Current understanding is that they are effective, just not very much.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

This meta analysis has John Ionaddis as one of the coauthors (if you don’t know why this is interesting look it up).

Also nothing is easily “disproved” in medicine (or most science) so even if “neurotransmitter imbalance” is false, you’re still wrong nothing is on the way to being disproved. Furthermore, current understanding of SSRI effectiveness is not based on “correcting neurotransmitter imbalance”.

From a healthcare background I find your points to be incredibly rare in practice, and the articles more on point.. which makes sense given the context of the article.

For the most part patients trust their healthcare providers in privacy concerns, even in relatively speaking formerly strained contexts (predominant black patients with white providers).

I ask patients everyday about illegal or embarrassing or “wrong” activities with little resistance to candor.

Tech and social media has engendered a much more toxic attitude that the healthcare industry as a whole has avoided.

It’s supposedly “news”, not editorializing. It’s their responsibility to get the facts right.

Acids aren’t inherently dangerous. And I know plenty of “average” people that know that vinegar is an acid and swear by it as a household cure-all to a fault. Same goes for carbolic acid.

This is all stupid when we have perfectly correct adjectives in the English language to use like caustic, toxic, noxious, incendiary, poisonous etc.

I read the article and it seems like a fair summary. I mean they even added the onus to bring more games to Linux first and then we will get moving on our part. I’m a Linux user, really a small private company making a business decision doesn’t bother me and people getting pissy about the first message was silly imho. But the only thing that changed here was the pr.

So tempting to put a link to jwz.org here.

But seriously, this sounds more like the responsibility of the link submitter and/or this website then every person on the internet that wants to write a blog post for a limited audience.

Note that you don’t have to use the connection credentials to make use of row level security in pg. the security policy can be based on session variables (or anything really) which can be changed during the connection.

Edit: it’s not the same thing but fwiw pg row level security is completely decoupled from the dbms access control.

No not misreading. Ruby mongrel was the antithesis of a bulky server environment, it was a single threaded worker host generally spawned behind something like Apache or nginx or lighttpd. The need to keep mongrel workers around was more a function of the slow startup of rails then ruby or mongrel itself.

Like I said the Java (and .NET) were the exception. As far as trends... java and .net dominate enterprise and they still do. The trend is very slow in the grand scheme.

Frankly your comment seems to be conflating language issues with framework issues with “serverless” and even scripting. I don’t think there is a cogent argument to be had about overall trends with all that. Yes lambda and serverless are a thing but half the whole world still runs on JavaEE or ASP behemoths

The terms are in common use since the 80s at least (no, Microsoft did not invent these terms with D3D). You can prove this in google scholar.

In fact for 3D rendering, retained mode was touted as a the new way forward, there was even a standard predating OpenGL called PHIGS, a retained mode system.. OpenGL was the worse is better (also PHIGS had many limitations basically limiting its use to CAD) backlash promoting its immediate mode in the early 90s.

Don’t really agree with the history.

MRI ruby had always had a fast startup time and was not originally created for the web... it’s more like a “better” Perl cum toolkit for C/unixy stuff- ironically what python became more popular for despite python not originally being written for that purpose.

Also in the old days of the web.. CGI was literally spawning a process per request.

Regardless it’s bizarre to think nodejs pioneered startup time... Ruby, lua, python, and good lord Perl would really like to have a word with you for starters.

Java was really more the exception.

And I’m not sure it’s true that these serverless platforms are spawning a new process per request ... but wow what is old is new again. Sounds like you’re describing inetd (look it up). Nothing of what you’re talking about is 5 years. Try 30-40.

You’re oversimplifying.. selling while everyone else is often due to irrationality, but quite often it is the best move. In the case of a crashing asset that is determined to be unlikely to recover, selling with “everyone” else is the rational action. cf cutting your losses. In fact I’ve feel like more experienced investors are prone to the opposite problem... irrationally holding on to a hopeless asset when they could have cut it.

I switched to taxact a number of years back because of this shit. They aren’t perfect in the upselling either but at least you can start as many new returns on an account as you want.

I couldn’t import shit from many things anyway so last couple of years I’ve just used excel and the fillable PDFs.

> Doctors noticing that Watson is wrong is expected.

Well as a doctor if I’m still ultimately responsible then nothing has fundamentally changed, this is just another tool, possibly one I’ll be forced to use by someone with not one day of medical training.

And medicine in the US is in a precarious position. Software engineers are generally not licensed, and they’re not sued (it’s virtually unheard of). It’s different for doctors. There’s a complex dynamic of removing autonomy from providers to ostensibly improve outcomes (and revenue cycle) while also still holding those same personally liable.

So much of what I do is indirectly dictated by wonks in IT and billing, but they have virtually no liability. And one wonders why burnout in medicine continues climbing with no end.

I don’t understand this argument (which comes up often). Isn’t the answer an unqualified yes? It’s obvious the current system has fuck ups. Are we supposed to be happy if a new system has double or triple the fuckups because “technology”? Like where are you going with this? These clinical decision systems have not proven they improve outcomes and we have no reason to believe they won’t make things worse.

Winchester became widely used as an industry term outside of IBM for HDDs.

https://www.nytimes.com/1982/01/10/business/new-from-silicon...

I personally think the gp is full of crap. I’m trained as an engineer and worked in industry a few years. There is no issue of smartness or skill, and of course computers are necessary, but its ridiculous to think they are some magic box... In the US, engineering has become a relatively shit profession. Poor pay, poor work environment (congruent with the op), poor status. You can make tons more (not just a little more) working for a decent software tech company, finance, medicine. You have to really love what you’re doing to stay in engineering.