shanacarp

Actually, this isn't true in the slightest. The VAST majority of management consulting firms, law firms, and yes, even investment firms like hedge funds are very small and closely held. Most do not get to global size with hundreds of employees ala Renassaisance or BCG or MoFo.

They are maybe 6 people, 10 people and as a result, most people in them do find that they can, in fact, structure their own hours to be family friendly.

This does not mean they are not competitive in their niche. It just means they are small and prefer to be that way, in part because the people in them prefer to have time for their lifestyles.

For this very reason, it bothers me that there is no adult equivalent to Apgar scores

It isn't low volume per say: lots of women get (medically unnecessary) 3d ultrasounds when pregnant to get "a nicer picture" at independent clinics.

A lot of is regulatory, but not completely. - other issues include 1) expensive software integrations for EMR and billing reasons 2) that most machines have multiple wands to attach 3) That billing codes tend to support the use of expensive machines rather than cheap ones if a doctor wants to make money is probably related to billing codes/other non-embedded software

Actually, she's got a point.

The stuff you don't read don't become part of a knowledge base. Figuring out how to circumvent that in order to learn and think is a huge issue, especially if you want common culture and/or more knowledge growth.

EG: You could read about the nuance of every computer language by every author out there - how does this help you become a better programmer? Alternatively, how do you know when you should read something, especially if it isn't about your language/issues you are dealing with right now, because it could be insightful to problems you will be about to have in general. Multiply by lots of people facing the same choices, and then what?

Follow-up question based on your question:

Medical Devices ALSO need approval from the FDA.

Why is the Epi-Pen body not approved separately from the Drug, allowing the body to be sold without epinephrine and to be filled with whatever, including generic epinephrine from a vial?

Why does workalike matter?

Very true, and radically underdiscussed as an issue.

Part of me really wants to know if it is Actually Cheaper for BigPharmaCo to offset research costs to university/government/startups and then do a Merger/Acquisition to get the promising drug past a certain phase (what have you) vs costs to do research in house.

Is lawyering and banking the process to get a drug to market BEFORE final approval really that much cheaper, or is this an accounting slight of hand issue? What is the actual cost minus marketing to develop a drug and bring it to market that created this situation.

Furthermore, what is the cost of marketing on the books for drug companies that also would drive R&D into third parties. Marketing costs are really not cheap - and they have been rising, especially as more prescription drugs are advertised to consumers. How much of this cost is also driving cost cutting/offset of risk?

(especially wondering since these issues appear appears the recall + no more manufacturing of Avui-Q. The auto-injector issues that caused the recall were untraceable/not replicatable at the Sanofi factory - and seem to be based on descriptions user error driven - and lower than the user error/failure rate of EpiPen. Meanwhile, Sanofi isn't the inventor - Kaléo/pair of brother founders is/are, and they brought nearly the exact same injector technology to market by themselves for heroin overdose. Sanofi just licensed the technology - and in the wake of the recall, decided to forfeit the license. I'm wondering how much of that deal's provisions killed the Auvi-Q, since it appears the issues behind the injector are long term fixable and profitable)

you're lucky. My year didn't have nearly as entertaining a speech.

I still think his points hold (as do many of the speeches points, most of which in some ways are similar).

However, attaching liberal education to everything may or may not be a good idea - and with the trade-ism of college, liberal education is sort of conceptually odd

I'm reminded of the U of C's Aims of Education Address when this discussion comes up.

EG: https://aims.uchicago.edu/node/83

I tend to think that many things that are now in college degree programs are actually things that should be in trade programs - we've turned everything into a degree, and in the process, stopped realizing what the value of a degree is and/or what the purpose of a theory driven/liberal arts education is.

(TL:DR if you don't end up reading the link - to think, to create the ability to teach yourself, to encounter new ideas and figure out which ones are hot air and which ones are not. To learn how to create good new ideas for yourself! To become a better human being and citizen in order to better participate in this world)

If we separated out the trade school aspect, well, it becomes very hard to value an education in the traditional degree/liberal arts sense - and it becomes easier to tell what's the value of that immediate trade school diploma by market forces. In that, then the government could apply a limit on loans to what is very knowable (market forces) and apply some other metric because of the public good gained by aiming towards education in general

I don't think you understand genetics.

There technically is no such thing as a "good" or "bad" gene, only an advantageous, disadvantageous, and neutral variant of a gene. Given that some genes can be read forwards and backwards, and that simple environmental causes, aka just changing an environment, can turn a disadvantageous gene expression into neutral or positive, it's hard to say something is eugenically good in a population unless it is a 1 gene mutation with 99% penetration that always causes death. (Huntingtons would be in this group)

Genomics says what you are saying is frankly impossible. If it weren't A) there would be no such thing as incomplete penetrance B) or traits linked to multiple genes C) or ways to manipulate social science statistics with simple experiments, like subsidizing iuds for high school students and seeing what happens. That's a purely environmental factors, and yet your supposed "bottom 20" stops acting like it as thier environment changes in one subtle way

Where did you get the Idea that any of what you are saying is scientifically sound?

That doesn't sound like it was properly put in. Why not cut the strings shorter (minimum issue of what you felt!

Why no copper iud?

No hormones

Can you measure linguistic shifts with your model?

No, mostly timing ones. Php was the cutting edge yet fully developed technology when they launched at Harvard. Developing CakePHP was in part a technical decision driven by the reality that a full rewrite in a new language is a form of technical debt in and of itself because of the time involved.

Or so I've heard

what happens if someone goes into anaphylaxis?

so why aren't there more case manufactures

Semi-yes, semi-no. The epi-pen case is specially made to try and get people to shoot it into themselves/other people correctly. They are super color coded and once triggered can't be untriggered

Other than that, they could be 3-d printed or whatever is cheapest by many providers

This is one of those devices that also should be low cost because businesses, locations, ect should have them as well as individuals (many people can have first time deadly allergic reactions, including as adults)

That the price for the case is expensive just rose as random is serious business. There really is no need for it to be so expensive

Are the derivatives in pill form legal? Are there any provisions to allow the dying in belgium (would your doctor or someone here on HackerNews know?)

You deserve to enjoy the time you have

And the summer months appear to be dead throughout the west. eh. It seems to be a thing

Pathways genomics is actually in clinical trials for blood tests to detect very very early masses that won't show up on scans.

One of the vps from Google's moonshot division,Jeff Huber, just left to head up a company that is a spinout of illumina, called Grail

No affiliation, but they have a bunch of interesting software jobs open after looking at thier site

http://newton.newtonsoftware.com/career/CareerHome.action?cl...

I think it is super important to answer yes to that question as a patient.

At the end of the day, it it your body. You are responsible for it. You may not be an expert in what all of it does in its majestic form and function, but that is why doctors, nurses, and researchers exist.

You live in it. When you are explaining stuff, be it pain or pleasure, to a doctor, that experience is mediated by the sheer fact that your doctor is not you and does not live in your body, does not receive sensory input from your body. Your doctor receives sensory input from his/her body.

Even if your doctor has extremely similar experiences, there is no guarantee that they will fully understand you and your predicaments. Most doctors in the US know what a severe sunburn looks like, and many will have had them growing up. Most also have not seen Phytophotodermatitis (aka lime disease http://www.theatlantic.com/science/archive/2016/07/burned-by... ), nor will have had them growing up. With the growth of artsinal cocktails and people realizing fresh citrus juice tastes better, it's occurring more frequently. Now there is an educational push,but that doesn't equal expedient treatment and lots of doctors recognizing on sight yet before it gets bad.

While Phytophotodermatitis is a trivial example, for patients with serious diseases (and not serious but not common ones too) the example holds and can be expanded. Patients banding together to change this is generally what causes major changes in healthcare policy in the US president,as well as direction in research. (The most famous example is in the late 90s/early 00 with aids via act up nyc. The documentary "how to survive a plague" covers this extremely well")

So yes, you totally should question. You totally have more power than you think. Act on it.

We have a huge environment we live in, plus we shape are environment to an extraordinary high degree. Furthermore, we're actually quite sensitive as organisms to those changes, including in ways where it's only now coming out in some cases because our previous equipment wasn't sensitive enough to register what was happening. We also actually know very little about genetics, genomics, and epigenetic despite posturing that we do. That's why the error bars are big

Fundamentally, actually shrinking that error bar for many diseases is one of the biggest hard science and math problems of the future.

It's going to be so exciting!

First, for the general Reader: Outside of really breast/ovarian cancer, getting most common cancers at a young age is fairly within your control. http://www.nytimes.com/2016/07/06/upshot/helpless-to-prevent...

Pieter doesn't have a common cancer and he's way beyond that stage within stage IV cancer. In general it's really rude to say "fight more" because he's right, what do you think these patients are doing instead, joining the circus? Fighting isn't a great metaphor. The reason it got introduced was so that Reagan would create the National Cancer Institute, a Division of the NIH. A full page ad was taken out by Mary Lasker and the American Cancer Society to convince him that researching the causes and cures for cancer was a US healthcare priority (and to be frank, at the time, it essentially was) asking him to declare war on cancer in the NY times because the US was in the middle of the cold war. The other thing that the add did (along with the creation of the Jimmy Fund) was it normalized discussions of cancer in the US at that time. To explain how much of a big deal that ad was, my maternal grandmother died around 1973-1974 of cancer. The ad came out in 1969. My maternal grandfather is only now settling the argument if it was metastasis of her internal breast cancer from when she was younger, new breast cancer that spread to the bones, or a totally new bone cancer, because now we talk about cancer, whereas in 1969 -73 talking about cancer was difficult if not possible.

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Aa a personal note to Pieter, if he sees this: 1) I'm extraordinarily happy you are doing as well as you are in your end of days and I hope you are enjoying them to your fullest. i hope, for whatever it's worth, you are still experiencing moments of joy too. 2)im slightly concerned as an American about your distrust of marijuna at this stage, especially since it seems like low pain and enjoying food is a high priority for you. In the US, marijuna is partially approved (don't ask) for cancer patients as an appetite stimulant and pain suppressor, and many of the chemicals in it are made synthetically and prescribed to cancer patients for the same purpose. Meanwhile, many opiates are appetite suppressants (that's the other reason behind the Medrol). Since you deserve to enjoy your time and have as many thalis as you want, just think about it. (Again, I'll totally admit that this is a bias of seeing Americans treated) 3)do you need help getting the paperwork done. On a percentage scale, how much is left? How much can be done by volunteers/family/friends? (And I hate asking this, how much is in English, because I'm happy to volunteer, but I'm an English speaker...) 4)thalis. Mmmm. Thalis.

What is he like in person

I know a few real people like this. It's hard for them

I actually watch this.

I'm in a private group for what is collequally called previvors (specifically Young previvors - though some people have had/current do have breast/ovarian cancer, including a few who are dying of it). I need specialized DNA testing for complicated reasons in my family history for risk assessment. It isn't covered. We have UK and European Members. I see who their doctors ares, what research they publish. I know what they pay. ($0) I know that for patients like me, European doctors are way more proactive, even for joining studies, because they can afford to be.

I know factually that if I were in europe that test would have been done LAST YEAR. Instead I'm still looking around for one doctor outside of my regular provider to do this one DNA test under research protocols.

Doing this one test could potentially save the medical system thousands of dollars. That's what baffles me the most: The insurance companies wants me to use a certain amont of services, but only so much, in the US

It is like they actually don't want me to be healthy - and I am not sure why.

So I have read through the US Preventative Service Task Force Recommendation about 10 times in conjunction with Obamacare and preventative services, as well as been involved in some of the politics behind the data sets.

The US government actually tracks mammograms in the US through the Breast Cancer Surveillance Consortium. http://www.bcsc-research.org/

Their research basically has it come down to a massive case of Simpson's Paradox among many important subgroups needing early screening (black women, ashkenazi women, previous radiation to the chest) that suddenly disappears when they are added together en masses.

The US Preventative Service Task Force, however, is not in the business of explaining stats: it is basically a guidebook of what insurance will or will not cover, and they went with the rating they did as a compromise over the simpson paradox over the fear that these subgroups would lose coverage in high deductable plans

In exchange, they actually did cause problems by not doing comprehensive DNA testing and ONLY covering BRCA testing - which is bad science.

Immediate necessary. Once you are out of the emergency room they no longer have to provide care

I'm starting to become a little shocked at the lack of black box warnings involved with Acetaminophen given how easy it is to poison yourself with it, and what appears to be a growing list of long-term side effects

First thought Finally! Jobs are worth what the market bears right then, not what they were previously worth, so why do employers want to ask such demeaning questions Second thought Boy, all of those recruiting/hr programs are going to need to be re-written to comply. A lot require you to say what you've been paid at every previous job. Since they are sold nationally, all of those HR departments will need that one field stripped out to now comply to MA law.