• comment on a post The Best Days Of My Life over 6 years ago

    I think we may be due for one more Poetry Friday.

  • on a comment on Ron Paul Insurgency over 6 years ago

    What exactly is a 1970's online activist?

  • on a comment on Open Thread over 6 years ago

    I think the only action the "war czar" can take to improve the situation in Iraq is to replace the commander-in-chief.  

  • Use it in a sentence: Regularize your use of English words please.

  • comment on a post Republican Presidential Debate Open Thread over 6 years ago

    How come no serious presidential candidates wear glasses?  Or have facial hair?  Is running for president like entering the Air Force Academy?

    I'll say it again.. Gravel for President in '08.

  • on a comment on Our MySpace Experiment over 6 years ago

    Agree.  If the site was called, "Fans of Barack Obama" or whatever, then the site founder should do be able to do whatever he wants.  

    But the MySpace page was called "Barack Obama." (www.myspace.com/barackobama) and as far as I am concerned, Barack Obama has every right to take over THAT MySpace page whenever he wants, and for whatever reason.  

  • comment on a post Not the Headline We Want on Iraq over 6 years ago

    The Democratic congress is haunted by the ghosts of 1995.  After the GOP swept congress in the '94 election, they shut down the government, and were seen as obstructionist crybabies.  

    I even remember that Gingrich went to Rabin's funeral aboard Airforce One, and as Speaker, expected to sit up front with the president, but was instead put at the back of the plane.  This was cited on cable news as one reason why the GOP was unwilling to work with Clinton.  

    The GOP congress became so unpopular that they guaranteed Clinton's re-election.  It appears that this congress does not want to repeat this act.

    For the Democrats to make this analogy is a huge mistake.  First, Clinton in '95 was a reasonable president.  He was more than willing to turn right to capitulate to the GOP.  He abandoned universal health care, and took up issues like welfare reform.  He was the antithesis of the current president, who is reckless, and adamantly refuses any compromise.  

    Also, why did the Republicans shut down the government?  They wanted lower taxes or some shit?  They were just self-righteous egomanics.  There was not one massive issue that overwhelmed national attention, like the war in Iraq.  The Democrats have the overwhelming support of the people, and to back down on this issue to a president with Nixonian approval ratings would be a massive political and moral failure.  

  • on a comment on Not the Headline We Want on Iraq over 6 years ago

    Actually, according to the US Constitution, it is the congress that is endowed with the ability to  "To declare war, grant letters of marque and reprisal, and make rules concerning captures on land and water;"

    The President is the commander-in-chief of US armed forces, but in his military capacity, by law, is subordinate to the congress.  The president can tell the army what to do and where to go, but should act within overarching policies set by congress.  

    If congress deauthorized the war by a majority vote, in order to reign in this president, could the president simply veto the deauthorization?  Wouldnt this be an usurpation of power by the executive, not intended by constitution?

  • And to speak to the potential toxic effects of EPO, the AP article cites "stroke and heart attacks."  This is incorrect.  One might say that profound anemia can protect against stroke and heart attacks, and that normal hgb levels can therefore increase the risk.

    I dont believe that though.  EPO increases delivery of oxygen to the heart and brain.  Anemia itself is a far great risk for heart attack than increased plt function that can result from EPO administration.  And EPO is being investigated as a therapy for stroke victims because it increases cerebral perfusion.  

    All drugs list pages of potential toxic effects.  They have to be read in context to understand their significance, something not done by the author of the AP article.  

    For instance, this is the short list of adverse reactions to over-the-counter Aspirin.  (The full list is much to long to cut and paste.)

    ADVERSE REACTIONS SIGNIFICANT -- As with all drugs which may affect hemostasis, bleeding is associated with aspirin. Hemorrhage may occur at virtually any site. Risk is dependent on multiple variables including dosage, concurrent use of multiple agents which alter hemostasis, and patient susceptibility. Many adverse effects of aspirin are dose related, and are extremely rare at low dosages. Other serious reactions are idiosyncratic, related to allergy or individual sensitivity. Accurate estimation of frequencies is not possible.

    Cardiovascular: Hypotension, tachycardia, dysrhythmias, edema

    Central nervous system: Fatigue, insomnia, nervousness, agitation, confusion, dizziness, headache, lethargy, cerebral edema, hyperthermia, coma

    Dermatologic: Rash, angioedema, urticaria

    Endocrine & metabolic: Acidosis, hyperkalemia, dehydration, hypoglycemia (children), hyperglycemia, hypernatremia (buffered forms)

    Gastrointestinal: Nausea, vomiting, dyspepsia, epigastric discomfort, heartburn, stomach pain, gastrointestinal ulceration (6% to 31%), gastric erosions, gastric erythema, duodenal ulcers

    Hematologic: Anemia, disseminated intravascular coagulation (DIC), prothrombin times prolonged, coagulopathy, thrombocytopenia, hemolytic anemia, bleeding, iron-deficiency anemia

    Hepatic: Hepatotoxicity, transaminases increased, hepatitis (reversible)

    Neuromuscular & skeletal: Rhabdomyolysis, weakness, acetabular bone destruction (OA)

    Otic: Hearing loss, tinnitus

    Renal: Interstitial nephritis, papillary necrosis, proteinuria, renal failure (including cases caused by rhabdomyolysis), BUN increased, serum creatinine increased

    Respiratory: Asthma, bronchospasm, dyspnea, laryngeal edema, hyperpnea, tachypnea, respiratory alkalosis, noncardiogenic pulmonary edema

    Miscellaneous: Anaphylaxis, prolonged pregnancy and labor, stillbirths, low birth weight, peripartum bleeding, Reye's syndrome

    Postmarketing and/or case reports: Colonic ulceration, esophageal stricture, esophagitis with esophageal ulcer, esophageal hematoma, oral mucosal ulcers (aspirin-containing chewing gum), coronary artery spasm, conduction defect and atrial fibrillation (toxicity), delirium, ischemic brain infarction, colitis, rectal stenosis (suppository), cholestatic jaundice, periorbital edema, rhinosinusitis

  • comment on a post Killing Patients and Bilking Taxpayers over 6 years ago

    First, Bill Peckham is right that most dialysis patients qualify for social security and disability benefits, covering their medical costs.  I often see new kidney failure patients in the ER before those benefits kick in, which led me to believe that dialysis patients had less benefits than actually exist.  

    As for the JAMA article, I trust their data.  I think Matt's response is an over-reaction.  EPO is not some strange toxic drug, it is a hormone produced naturally by the kidneys.  When kidneys fail, it needs to be replaced, or patients will suffer profound anemia, worsened by the process of hemodialysis, which tends to chew up red blood cells.  

    The JAMA article concluded that patients at for-profit centers receive more EPO than patients in non-profit centers.  I cant speak to the EPO algorithms they use, but the differences between the two groups are quite minimal.  Normal hemoglobin (test for anemia) is roughly 13- 15.  Standard of care for dialysis patients is keep hgb 11-13.  Patients in for-profit centers, according to JAMA, will stay on EPO doses higher than necessary for standard of care, and will have their hgb levels corrected to the normal range.  

    To interpret the data, it is important to recognize that patients are not given EPO doses that are high enough to push patients above normal ranges or even to the high normal range, and there is no evidence that the doses of EPO given these patients are toxic, and that bad outcomes result.  

    Its also important to remember that this not a question of continuing EPO treatment.  Nearly all dialysis patients will stay on EPO.  The question is whether the EPO can be titrated down, and lower doses used.  Certainly data does not indicate a significant benefit to patients corrected higher than the 11-13 hgb range, and considering the cost of the drug, it seems reasonable to change the algorithms used by the for-profit centers to address this.  

    It's also important to keep in mind that it is much harder to maintain steady-state drug concentrations in hemodialysis patients because the process of dialysis, usually done at least 3 times a week, will strip drugs from circulation.  I can't shed too  much light on the pharmakinetics, though, and will defer to the nephrologists.  

    I'll repeat my mantra on this thread.  If EPO was fairly priced, this would not be an issue.  Insulin, another synthetic hormone produced exactly like EPO,  is often administered according to algorithms.  Insulin is potentially far more toxic than EPO.  Many deaths occur from insulin overdoses.  There are different algorithms, and some use more insulin than others.  All the protocols used are designed with patient safety the primary concern.  The difference between EPO and insulin, is that generic insulin costs $30 a vial, and EPO, protected by patent, is sold at prices that are incomprehensible, $18,000 for an eight week supply.  

    Perhaps Amgen has gotten away with this pricing scheme because patients who use EPO, cancer patients or dialysis patients, are covered by medicare, and dont actually see the drug bills.  

    But strategically, the goal should be to lower drug prices, not accuse doctors of "Killing Patients" for drug company profits.   Not only are patented medications sold at prices that far exceed legitimate profit margins, but drug companies use a system of loopholes to extend patents beyond the time period for which they were designed.  

    EPO is not the only example of course.  In South America, I used ceftriaxone, an antibiotic, and was shocked to learn that it costs less than 50 cents a dose.  These prices are not subsidized, its just the cost of a generically produced drug.  In the US, the drug is under patent, and sold at about $200 a dose.  

    We are not talking about a little graft here, but pricing practices that are so abusive, that big pharma literally holds people hostage.  "You wanna live, you pay our price."  

    This is not a bigger issue because the targeted population is small, and more vulnerable.  To address this, the pharmacuetical industry has established charity programs, and paid for the big scam, medicare part D.  These programs are designed to keep prices high.  

    I would suggest that we impose some price controls, limit the number of years drug patents are allowed, eliminate all loopholes to extend patents, and allow importation of foreign drugs.  

  • on a comment on The Outreach over 6 years ago

    I was wondering if you'd notice that comment.  I remember it well, and to explain why, I'll tell a story, if you'll indulge me.  (I think the thread is mostly dead anyway)

    Maybe put this in the "Some Cliches Are True" file, I think there is a "gay," sort of exaggeratedly feminine, persona that is universal in human society.  I dont mean to imply that I think all gays act in a stereotypical way, but some gay men do, and I have seen it all over the world.  

    It first occurred to me that it was a constant thing in human culture in college.  My roommate was really flaming, and when we were college roommates, I was had to translate Lysistrata, an ancient Greek play written like 430BC.  One of the characters was an effeminate man, (mocked in staunchly bisexual ancient Athens, not for having sex with men, but for "acting gay.")  It was hard to translate his lines, until I realized that he was written with an ancient Greek lisp, just like the lisp my roommate had, and Dana Carvey had in that SNL skit, the Effeminate Heterosexual.  

    I just assumed it was mostly a western culture thing, but it definately transcends that.  And it seems to be unrelated to the actual behavior of women in society.  I mean, I have seen it in the middle east, where I never saw a woman act that "gay."  I also saw it in asia and polynesia.  I remember a Samoan boy living on a small island who constantly played with a bright silk scarf, and was totally "gay."

    So in the Amazon jungle, I work with a group that develops public health infrastructure, and one time I was in an indian village way up some little tributary, to identify vaccination needs.  One boy, maybe 15 stood out, because he had the identical persona.  This was a kid who never went shopping, saw TV, or ever used an electric light bulb, and man, he was just flaming gay.  I noticed that none of the women in the village acted like he did.  

    Well, being an indigenos teenager, he didn't have a lot of opportunity to show off his gayness, but as Nathan Lane said in the 'BirdCage' : "One does want a hint of color."  So he had caught and hand-reared a parrot chick, and wore it like an accessory.  It was a memorable image, a village of Amazonian indians, with very subdued and quiet men and women, totally upstaged by a "gay" teenage boy, wearing a vivid emerald green and peach parrot.  

    I did actually see a "tree full of parrots," but to be honest, it didnt strike me as particularly gay.  But that kid, with a literal limp wrist, lisp, and drama queen stance in the middle of jungle, was about the gayest thing I ever saw.  

    Again, I dont mean to come off sounding dismissive or to stereotype people, but when you said that you were "gay as a tree full of parrots," I could not get that image out of my mind.

  • How do I explain why for-profit companies use more EPO than non-profits?  Why, its obvious: "the incentives in Medicare are apparently designed around killing patients."  Any other conclusion would be ridiculous.

    Seriously, the link was just another summary of the JAMA article, and I want to read the article before I attempt a lucid response.  There are several issues, in fact, that I want to address, including Peckham's summary, so I think I will wait til tomorrow to write them up.  

  • comment on a post Al Gore: Strongest Democrat in Swing States over 6 years ago

    Recommended because I like the Draft Gore sentiment.  I disagree with the premise that the blogosphere should endorse one candidate.  I think the way they play it, being able to support in good faith any potential candidate who wins the primary is probably not a bad idea.  I doubt I would have the self-discipline, especially considering that Gore is such a better candidate than everyone else.  

    Also, if MyDD and DK had to choose a candidate to endorse now, I suspect it would be Edwards.  

    About the names, I think Markos is very receptive to Gore.  He was quoted in the Gore endorsement in Rolling Stone linked to from DraftGore.com.  Jerome seems very friendly to Gore.  I think Chris is open to Gore as a candidate, but hates him as an obstruction to current primary opinion polling.  

  • on a comment on The Outreach over 6 years ago

    I was in Peru just after their elections.  The turn-out rate is near 100%.  I asked some friends if they voted in the election and they looked shocked.  Apparently, its a crime not to vote in Peru.

    By the way, last time I was in the Peruvian Amazon, I saw an actual tree full of parrots.  Man, was that GAY!

  • The AP article was just silly, clearly written by someone who knows nothing about medicine and likes to sensationalize things.  Like you.  

    I am reviewing my hard copies of JAMA now, and I dont find the article referred to.  It is not in the 4/25 issue.  Do you have a specific reference for that?

    The other link you provide is not working for me.  

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