HN user
U.S. Physician trained in Radiology, INTJ
As a neuroradiologist, I see these cases occasionally. People presenting with TGA sometimes have small infarcts in their hippocampus.
An example paper you can read if you are curious:
Convicted in the US of something that is not in crime in much of the world. You are conflating US law with ethics/morals.
You are also appealing to emotion by using 'children' and 'pedophile' in inaccurate ways. If you are going to strictly interpret 'statutory rape' as being morally reprehensible regardless of the circumstances, then I would ask that you stop using peodphile unless you can show me one of his victims that was pre-pubescent. I didn't define that word, it has a dictionary and wikipedia entry that you are welcome to read.
And regarding your claim about emotional and mental development, I would agree that it IS true what you say. However, there are plenty of people who've made it to older age who lack the maturity of their juniors (Stallman apparently being an example!). Age should NEVER be a surrogate marker of capacity... we define ages of legal consent arbitrarily, agreed? There are plenty of 22 year olds making bad decisions...
And the self-righteous political agenda was referring to this legislation:
https://en.wikipedia.org/wiki/Stop_Enabling_Sex_Traffickers_...
Plenty of groups including the EFF think this went too far and the way that people throw around 'sex trafficking' and 'raping children' and 'pedophile' are emotional appeals that do a disservice to the actual victims of these crimes.
Of course all of these things are bad, but was Hugh Hefner a sex trafficker because he kept a well-paid harem of women at his mansion? If age is the only discriminator, then why is the US your moral compass when clearly age of consent differs throughout the world? What about Romeo and Juliet laws? States like Hawaii where age of consent is lower?.
Unless of course it had happened in about half of Europe or many other places in the world where he wouldn't have even been charged with a crime...
https://en.wikipedia.org/wiki/Ages_of_consent_in_Europe
We are conflating 'law' and 'morals/ethics' in these arguments. If you act with strict adherence to the law, I'm assuming you've never jaywalked, committed piracy, ran a red light, etc.
Oh, these are 'victimless crimes?' What about sex after having a couple drinks? Technically neither of you can consent under the law... a person has probably committed rape if their consensual partner had a 0.08 BAC.
I think that our lack of a legal word other than 'rape' to describe 'statutory rape' does a disservice to those women are victims of forcible, violent sex acts.
Although technically correct in many US jurisdictions, I think you would have a VERY hard time arguing that an 'adult' having consensual sex with a 17 year old being described as 'raping minors' is morally equivalent to the things that 'rape' is typically used to describe.
I'm going to argue in good faith to try and derail this hate train. First, I'm a physician and I consider myself about a borderline expert in medical billing/insurance.
Let's disrupt some stuff here:
First, it is EXTREMELY rare for a physician to be paid a million dollars. You can easily look at most state's open records (California, Texas, Florida) and search the online databases and see that it's usually only several in an entire state and these are people of extreme qualification or unique talent. The Dean of a large/famous medical school (a CEO essentially), a very famous chair of a department (they helped invent some special technology or are well-known leaders in their field), or are simply prestigious to the institution because of notoriety (imagine an Atul Gawande or an Oliver Sacks).
Second, the costs of healthcare have been sliced and diced by countless experts and the numbers tell a different story than your theory--most analyses place physician payments at 10-20% of the total cost of healthcare depending on who is doing the study.
Third, there's no way you received ONE bill that wasn't itemized. Typically you receive two bills--one for the 'facility' and one for the 'professional.' It's usually obvious which is which because an ER might charge $1000 or more for that quick visit, while the physician probably would've charged in the $100-200 range. When you hear about those scary $50,000 bills for a night in the hospital and a $30 box of tissues... that's the hospital bill. It's extremely high because of many complicated reasons... most of which have to do with the fact that it NEEDS to be that high or insurance companies won't pay the negotiated rate of about 40% or less of that--it's an arms race that needs to stop.
I'll give you that there are complicated price gouging issues that come up on the physician side (out-of-network billing, surprise bills, etc) that may be unethical and some states are dealing with this... but it's usually a tenth or less of the total of what is coming from the facility in the same scenario.
So anyway, you could literally pay doctors nothing and you would save maybe 10-20% on all those bills. Does that sound like a viable setup?
You can Google some articles and read studies, but I'll save you the time and give you something to think about that should convince you that the physicians can't possibly be the primary problem:
Many (most?) physicians are now wage earners. They increasingly own less and less of the infrastructure (capital) of healthcare and are less independent than ever (consolidated, hospital owned groups, VC and publicly owned groups like Envision and MEDNAX).
In this kind of capitalist setting, where would your profits go? To your doctor workforce? No! It goes into C-level administration, shareholders/investors AND reinvestment/M&A.
Hospitals and Insurance companies, Drug companies, Device companies.... these are the real power players and their influence in seen all the time as they negotiate sweetheart deals (Medicare Part D for example), continue to consolidate ownership, and literally price gouge from consumers (EpiPen, insulin, etc, where a cheap drug is inflated in price for no reason).
I'm truly sorry for the state of the system in the US, but the fix has to come from Congress. If tomorrow every doctor was perfectly ethicall and paid 50% of what they earn today, all that savings would just end up as dividends for the capital owners and NOT as lower hospital bills.
Great! I'd love to talk more. I don't see your email posted in your profile though.
Email me: ivandequesada@gmail.com
"It boggles the mind how anyone in their right mind can believe that a cyber-squatter shoud somehow have the right to hold the domain name of a sovereign nation for ransom."
I... just don't know how to respond to this. Do you have any proof that it was 'being held for ransom'? It sounds like it wasn't for sale at any price... it was hosting the man's business.
And I definitely don't agree with cyber-squatting... in fact I personally think that 'parked' domains should be returned to the public domain after some X years. I hate that there are people holding vast numbers of potentially useful domain names and not using them for anything.
I just don't understand how you drew that conclusion in this particular case... it sounds like the opposite actually.
I edited my post. I meant to say that governments have assigned/protected names like .fr, .de, etc.
I edited my post. I meant to say that governments have assigned/protected names like .fr, .de, etc.
I'm pretty disappointed by all the armchair lawyering in this thread that isn't defending the individual/citizen in this case.
.gov, .fr, etc were created for a reason. Trademark law is intended to protect people from intentionally misleading branding.
These two items taken together should make it obvious that France.gov is the only name the government of France 'should' be entitled to. If you are willing to say that France.com should be available to the French government... then it's a slippery slope. Are you going to give them to right to take down critical websites with titles like Francesucks.com or Francegenocide.com.
These lawsuits have played out before between private individuals like Madonna et al.
https://en.wikipedia.org/wiki/Cybersquatting
Why should a government be privileged to seize any .com that they deem to be in their interest? There is no evidence that France.com was not being used in a nefarious or misleading way.... in fact it sounds like the government had at least unofficially endorsed the site's usage and contributed. It was being used for a bonafide business.
I really think anyone defending a government's 'right' to seize this domain name is forgetting the underlying liberal democratic principles of the internet. Rights are for people, not governments. I don't see how France acting in this way serves its people constructively.
EDIT: It seems like all people care to comment on is the fact that they (and I) already know that .gov is for the US government, while other countries have their own TLDs.
Let me play Devil's Advocate for a moment to hopefully make you think more critically about this decision.
What if you owned a famous China (dishware, cups, etc) company and registered China.com back in 1994. Do you think China should be allowed to take that domain?
Or another, what if a new country were formed that were suddenly the same name as a pre-existing multinational corporation.... Government wins? Always?
Really? The negative is that they didn't act in the best interests of humanity--the very people that make up their shareholders, employees, customers, etc.
For example, it's well documented that DuPont fought to continue using CFCs until they had secured patents on replacement products and suffered public humiliation by our government.
Companies will not generally act in the best interests of the citizens, which is why we have a government which should be independent of influence by leaders of companies.
This is a great comment and I have to add a shady tactic that I have noticed hosts doing in competitive cities during peak times... I travel to a particular city yearly for a large conference and every time I've tried to use AirBnB for a stay, it always ends with me sticking to a hotel.
The host posts a bunch of very desirable locations and then when you try to book it, they message you with 'this one is unavailable, but how about these other entirely different units I have?' which is clearly a 'bait and switch' tactic.
I even booked one successfully and I know they had accidentally underpriced that week--similar to their other week costs, not raised for this conference like a lot of other hosts--and instead of just honoring my reservation, they cancelled it saying, 'oh, it turns out the prior guest will be leaving late on your first day.' Of course, this was a total lie because I offered to come even later, give up the first day, etc to no further response. Well, guess what... they re-posted the same dates at a much higher rate.
I honestly think a host should not be able to turn down a verified guest reservation under any circumstance or perhaps be unable to relist for those dates if they deny a person's request.
I emailed their customer service about these clear 'scams' and heard no significant reply.... they offered me a coupon.
Wow. I'm really trying to understand this house price. I just can't imagine who would think 1.3 million is a reasonable price for this house? I mean that's like a $10,000 mortgage. That's the same amount of money as a $333/night hotel room. A quick search of the area reveals $100/night hotels--typical across the country. So... how is this market priced housing? I mean I could have housekeeping and free breakfast every morning plus two or three 'bedrooms and bathrooms' in a secure, maintained property for the same price as this house. Sure, I am not building home equity... but I'm assuming a house rented in this area would not be a lot cheaper than that.
So your choices are rent or live in a hotel if you don't want to buy a home this expensive?
I would be making some tough choices if I had to move out there.
Not surprised. I'm also saddened that the whistle blower died under suspicious circumstances.
This is one area where you might admire Chinese government then:
https://en.wikipedia.org/wiki/2008_Chinese_milk_scandal#Cont...
If you read the part that talks about criminal prosecutions, many top executives were put to death or received life imprisonment.
It's up for debate whether this is 'good' or 'justice' because the economic causes that led to the problem are complex, but babies were literally being killed because of this.
I appreciate the sarcastic comment, but I don't think you understand the implication of a system like that. Even if you have more data, it doesn't better inform a patient's decision process.
For example, let's say you could--you can't--but let's say you could without a shadow of a doubt predict that the pulmonary nodule in your lung is not a cancer with 98% certainty. Well if you are 40, that's not that good actually.... that means 2 out of 100 people in a very productive time of their lives may have a cancer go completely ignored! So should I tell every patient in my report, "There is a 2% chance that this is malignant, but I won't recommend biopsy because there are chances of complications from that and we can save a lot of money by letting a few slip through the cracks--it will cost the healthcare system too much. Thanks for your understanding."
Remember, statistics predict population outcomes... not individual outcomes. I can tell someone that something very rare might happen.. but guess what, when it happens... the idea that it was a rare possibility doesn't assuage any negative feelings about it.
There is no right answer. Some people are illiterate! Even educated people don't understand statistics... how am I going to quantify that kind of risk/benefit analysis in a way that ensures a patient truly understands the implications. What if that risk were 1%, or what if the patient was 70 years old? Should either of those affect my recommendation? Who am I to decide who should be recommended one thing vs another... it's a value judgement! But if I leave it solely to the patient, a lot of times they will ask me, "What would you do?" Probably the most common thing asked after a long discussion like that. The answer is, "I don't know."
Bottom line: We can do 'strong' recommendations for things that are well studied like breast cancer and pulmonary nodules, but we don't have data to support recommendations in many other areas of everyday practice. A machine learning system would need data that just isn't available yet to make recommendations.
Really happy you wrote this anecdote because it illustrates a point that physicians are arguing about a lot right now--how to measure quality care. Is it readmission rates, is it 30-day mortality, is it getting all the required screening exams for each patient... we don't know. In the US, the CMS is trying to mandate many of these and it's really hard to measure quality of care.
For example, I am a radiologist. Probably 90% of my cases are mundane and are either normal or have 'easy' pathology that I can readily detect and quickly report. Another 9% is a mixed bag of things that take a lot more time--something I need to reference or think a bit more about or possibly show a colleague. And then there's the 1% that is truly a 'make' or 'break' case. My sub-specialty training and experience can really shine in these situations and I can easily dispense a diagnosis or make a 'tough call' where another might equivocate or defer to more imaging or a follow-up. I like to think I'm not being paid for that 90%... I'm being paid for the other 9+1% That's where I truly add value in the system. But how would I measure my 'success' rate when even the best eventually make mistakes given a long enough time and there is often not a gold standard for diagnosis or even long term follow-up/resolution to many of the tough cases I've seen.
Studies have been done where experts review a sampling of cases and that's essentially what we do now for quality control--we randomly review a few prior exams for a case we are reading and then submit feedback based on our opinion on the same case. In these studies, trained radiologists do very well and make clinically significant mistakes only rarely.
But here's the problem. Let's say we use machine learning to interpret a scan, something like a CT of the chest to look for a pulmonary embolus. On that scan, the machine may see an incidental pulmonary nodule. Well that's fine, we have good data on how to follow-up on those and what to recommend. Well, what about an anterior mediastinal lesion? Now it's not as clear. The differential is wide and dependent on age, sex, symptoms, history, etc. Let's say we build that logic tree, let the machine learn from 1000 anterior mediastinal mass cases with tissue diagnosis. Well guess what, we do those studies all the time and it turns out that NOTHING is 100% sensitive AND 100% specific. You have to sacrifice one for the other... it's a balance. So, you would need to build ROC curves for every possible finding on every scan and decide that 1% of the time you will miss a cancer to save having to biopsy an extra 20 people... or maybe you want to miss cancer only 0.1% of the time, but that means you'll have to biopsy an extra 200 people and one will have to be hospitalized from complications. You think they will be happy knowing you made that decision? Guess what, we are already doing that with Mammography. The screening guidelines that the different societies and agencies argue about are this very rationale... how many women should be allowed to die to prevent those extra biopsies, false positive workups and all the things that come with that. I welcome machine learning into medicine. Guess what, it's destined to be mired in the same ethical dilemmas we face everyday.
I have a feeling I'll make it to retirement.
In the long view of history, all societies will fail. Is three generations of success enough to qualify it as a success? I don't know. But it's subjective to say it failed.
Ah, I think I misunderstood your situation. Yes, your specific case I think warrants that kind of specific, careful monitoring.
I was speaking more generally about people who don't have significant past medical history who arrive with superfluous data.
Well, I'm sorry you aren't coming back to this post because I think you should read the reply.
The healthcare system has problems, but NOT because of most doctors. Yes, just like in every field, there are unscrupulous individuals... but most of the people I have known and worked with are not sociopaths in white coats. Just follow the money... Medicare Part D was the single biggest travesty visited on the American people in recent memory. It was literally a theft of our tax money and a gift to the drug companies. While Insurance companies, hospitals, drug companies, devices companies, etc. continue to increase gains and conspire to steal from the healthcare system (inversions, mergers, price-fixing, the list goes on...) physician pay actually represents a small percentage of healthcare costs. (Depending on who you get the numbers from, it is about 10% of the total). Believe me, when I have to get healthcare, I see the same problems you do. I've waited on hold, been over-billed, late appointments, all of it... even medical complications. The fact is, the bureaucracy is strangling any attempts at improvement.
I'll give you an example, I work in a bunch of different healthcare systems and each one of them is required to independently verify my credentials. Everything from my medical school diploma to my training and license. It requires primary source too! So every hospital--even different hospitals owned by the same system--has to do this incredibly redundant and wasteful process. Not to mention that it does nothing to ensure quality. So here's a whole army of people doing something that should be a simple database query that takes 1 minute. That's increased cost. There are these companies now that an insurer can hire to field imaging orders and determine which are appropriate and which are not. If they save the insurer even $1 over what they are being paid... then they win. Meanwhile, that's maybe $1-2 million that could've just been used to pay for care... instead it's going to a middleman simply to DENY care!
Believe me. Your frustrations are justified... but don't hang the physicians out to dry. My generation was not the architects of this disaster and we are suffering from it too. We are still individuals, wage-earners. We are not the corporations that would happily merge and invert our way off-shore. They are the real conspirators in this.
Because--for better or worse--this raises red flags I think. I could see a lot of people getting defensive.
It looks great! I will read it over the next few days.
Wow. I am a physician and this is perfect.
1. You just need to read about the Dunning-Kruger effect. Enough said. https://en.wikipedia.org/wiki/Dunning%E2%80%93Kruger_effect
2. Each physician has their own motivations for this one... some liability, some internal moral code, but some just understand that science is about being objective. That being said, prevailing wisdom is that medicine is as much an art as it is a science.
3. Yes, but be careful. Try to establish a relationship with your provider before pulling out the graphs and spreadsheets.
Fair enough. I agree on both points.
But my point was not that one system is 'better' or 'worse' but that religious head-wear should not be seen as some inalienable right that we have to accommodate to remain a free society. Even if many young Iranian women may feel 'naked' without it, it only took the religious dictators there one generation to make them forget how it used to be.
Culture can be affected by draconian laws also. I believe religious clothing designed to oppress women is regressive and detrimental to Democracy. Please read this:
https://www.theguardian.com/artanddesign/2015/sep/03/hengame...
I wish I could share the stuff behind the paywall, but memory is a very interesting question in Neuroscience. I am a neuroradiologist and I still learn about truly incredible phenomena that challenge my preconceived notions about how the brain functions. For example, we had a case recently of "transient global amnesia" and although initially we thought the MRI was normal... more careful review showed a tiny infarct in the hippocampus, a structure critical in memory. Here's a paper behind the paywall discussing a similar case report:
http://www.ncbi.nlm.nih.gov/pubmed/15746236
Or consider the fact that the cerebellum is a lot more crucial in global brain function than was previously taught. It's really exciting, cutting-edge work:
https://en.wikipedia.org/wiki/Cerebellar_cognitive_affective...
Yes! It's not that somebody said, "hey, we can pay this person less simply because they are a woman." It's that the employee themselves may have negotiated for more.
Correlation is NOT causation.
Trump? I'd love to see the odds on that bet. Mere name recognition alone does not a successful candidate make. In fact, he's already proven his loose lips will sink his primary ship long before it sailed. He successfully angered Latinos and veterans--two groups that any Republican candidate will need to win at the polls.
For example?
I agree with the dissonance between physical and psychological self you mentioned and it's great that you have achieved that insight. Unfortunately, it seems like most people do not understand this dichotomy and there are also many (maybe the majority?) who do not understand how commonly images are photoshopped to be almost unrecognizable from their original.