vendredi 13 mai 2016

Big pharma is purchasing a clean conscience cheaply

Struggle between minimum wage and robots: how regulations accelerates the decline of low skilled workers...

BTW one can why immigration is NOT the solution anyway.

Cipro is not the first choice...

Healthcare systems cannot share data: we need translators!

This issue recalls an old story. Babel tower. The same malediction plagues healthcare systems. This is not a problem only in US. That saying I confess that it should not diminish the frustration of patients from the country which spends the highest amount of its GDP on healthcare. 
First, health data (which can be life saving) are not sharable.
How can it be possible that a country with trillions of spending in healthcare gave birth to uncommunicable data systems between states and even between physicians or hospitals of the same state? If it is impossible to share data about care this is not because of the lack of "regulations" ( It is perhaps because there is no incentive to do it and also because an old habit of information retention.
Can we reverse this situation? 
Obviously yes. 
One very simple way is to follow the bacteria and human cells. They can communicate, exchange data and even modify their DNA... It is also interesting to look after the way imaging companies unified their data production with DICOM.
Second, you cannot understand your bill after a hospital stay.
Precise and understandable billing is another issue which is linked to the fact that third payers can increase the insurance premium even if they don't understand why bills are increasing. This cannot occur with restaurant or car repair bills... However I don't think that flat-rate systems of hospital compensation are better. The reason is that flat-rate payments are inflationary and more opaque. One question: why a new company cannot or has no incentive to bill patients and third payers in a manner that is understood by all?
 I found very interesting this challenge (only 10K$ of tax payer money):

mercredi 11 mai 2016

From savannah, lakes and seas to mega cities

Les Panamas papers

The myth of Facebook neutrality

A propos du tabac...

Progress in Autism?

CRISPR from science to patents and politics and Nobel prize

Epigenetics: it is trendy but what does it mean?

Usually people who are opposed to genetic determinism tend to overvalue environmental concepts and to believe in every fuzzy logic which annihilates the role of genes.

Fasting and pills for brain clarity

Is it worth the price

mardi 10 mai 2016

Asymptomatic carotid stenosis (ACS) : medical treatment is the rule, surgery or CAS only in RCT

These patients need Best Medical Treatment and often they don't get it.
Statin: atorvastatin
For diabetics
"In conclusion, ACE inhibitors should be given to all type 1 diabetic patients with microalbuminuria or nephropathy, and to type 2 patients with hypertension, microalbuminuria, or existing cardiovascular disease. All diabetic patients with hypertension and left ventricular hypertrophy should have an ARB such as losartan as first-line therapy."

Instead of operating on patients without symptoms verify that the BMT is prescribed and is working:
Non HDL cholesterol
LDL cholesterol
Ambulatory measure of Arterial Pressure
No arrhythmia
Efficient antiplatelet treatment.

More don't be fooled by the medical illusion:
Look at your complications first.

Then don't be fooled by mathematics used in statistics

Are there evidence based indications of revascularization in ACS above 80% with special features?
All those indications are a matter of personalised medicine and very few scientific evidence back such indications. No RCT, only case reports and small series could be taken in account in these cases:
1/ Contralateral thrombosis
2/ Documented non focal symptoms like hemodynamic symptoms correlated with Willis anomalies and brain flow imaging
3/ Progressing stenosis despite BMT above 80% in verified NASCET measurement (angio or angioCT)
4/ Silent emboli without any other cause (heart, aorta, blood)
5/ Focal symptoms of more than 6 months

Keep in mind that those patients are not many perhaps 5%.

To bring a benefit to those patients the vascular team should keep the peri-operative mortality to 0%, the perioperative morbidity inferior to 3% and the perioperative permeability above 98%.

In conclusion ACS patients should be randomized in RCT instead of being operated on without clear benefit.

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Ejaculation healthy for the prostate gland?

And those news about less invasive and more predictive screening methods for prostate cancer:

Do you have PAD? News on best treatments