From: firstname.lastname@example.org(Steven B. Harris)
Subject: Re: Greedy GP's vaccine ploy
Date: 5 Feb 2000 07:45:36 GMT
In <389BA1AA.AF2CB28B@lumbercartel.com> "D. C. & M. V. Sessions"
>> OK folks!
>> Let's hear it like it is:
>> "Politics of Health; Evaluating Modern Medicine: How Scientific is
>> "Only about 15% of all contemporary clinical interventions are
>> supported by objective scientific evidence that they do more good than
>He's right, you know. We checked into that when DCS had a
>broken hand, and there have been no double-blind placebo-controlled
>studies of fracture reduction. Shocked by this, we looked into
>it more and found that there are also no DBPC studies of cleaning
>and suturing open wounds! THAT got us really angry, and we found
>out that almost all of the office interventions that our FP did
>had no scientific basis, either.
Add to that the idea of direct pressure to stop flow of blood. The
Let em Bleed strategy has yet to be scientifically tested on arterial
We can laugh about all this, but we must keep in the back of our
minds that sometimes obvious things turn out not so obvious, and human
epidemiology and controlled animal studies must ever be our guide to
controlled experiments with people. For example, it used to be obvious
that one gave plasma expanders to bleeding people in the field, when
you could. Animal studies show, however, that in some cases it only
increases the loss of hemoglobin and clotting elements, and you'd be
better off in the short term, during transport, letting the
uncontrolled bleeding taper off under the stress of shock and sludging.
Epidemiology suggests that plasma expanders in the field don't always
do good. Hmmm.
And what do you do with abdominal bleeding and penetrating traumas,
anyway? Is scoop-and-run the best strategy, or stay-and-play? And what
are the circumstances which dictate one or the other? Or both? In the
end, you simple have to do the studies. First the animal studies and
epidemiology, and then (for important questions that remain) the
The reason such trials are not done as often in the US as in some
other countries (India comes to mind) is basically a failure of
imagination. Plus a third party payer system which sucks money for
improvement right out of private medical research. Plus a government
regulatory system which hobbles it further, and is in partial thrall to
patent protected treatments and the profits only they can generate in
our present US system.
From: email@example.com(Steven B. Harris)
Subject: Re: Greedy GP's vaccine ploy
Date: 6 Feb 2000 11:47:34 GMT
firstname.lastname@example.org (Kurt Ullman) writes:
>In article <email@example.com>,
>firstname.lastname@example.org(Steven B. Harris) wrote:
>> The reason such trials are not done as often in the US as in some
>>other countries (India comes to mind) is basically a failure of
>>imagination. Plus a third party payer system which sucks money for
>>improvement right out of private medical research. Plus a government
>>regulatory system which hobbles it further, and is in partial thrall to
>>patent protected treatments and the profits only they can generate in
>>our present US system.
> I would suggest you were doing okay to the last. To that I
>would also add the political impact of the victim's political play. Just
>like a lot of other things in the US, the cult of celebrity works in
>medical research, too.
> There are studies that show no relationship between the amount
>of money we spend on research and number of people actually with the
>disease, the amount of money we spend treating it, person years lost,
>etc. So whatever is sexy gets the money.
> Unless you think people Micheal J. Fox and Christopher Reeves
>are really pawns of the drug companies.
But you missed the point. The reason research dollars go to
whatever's politically sexy, is that the diseases that really cause
more grief in more people, simply have a hard time making a profit. 80
year old women with fractured hips don't hold up the Golden Gate bridge
in San Francisco and demand that congress fund basic research on the
effect of vitamin K on osteoporosis (or whatever). That's because
these days the government pays Medicare for that hip surgery, and
everybody's pretty happy about that, including the surgeons. The only
people really feeling the bite are the folks who fund Medicare, and
they don't exactly have the gumption to find anti-aging research. Most
of them are half afraid that if we prevent the diseases of old age,
people will just get even older, and the cost will go up further.
In a market-driven system without a heavy regulatory burden, people
would have the incentive to spend money in whatever hospital offered
them what they wanted. And the option to decide when the benefits
outweigh the costs. That's how it works in middle class medicine in
Bombay, and their ICUs by most measures are better than ours. You can
get a bypass for $5,000 in Bombay, and that's the works: ICU, surgeon,
everything. Mortality rate is less than 1% --as good as any place in
the this country. Part of that is one-to-one ICU nursing, a nosocomial
infection rate a fraction of ours, and overhead which is practically
non-existant by comparison with ours. Of course, it's paid out of
pocket, by the people who can afford it. But the middle class in India
is larger than in the US, straight numbers-wise, and plenty of people
An associate of mine just got back from looking at the medical
systems in a number of countries: India was one of them. In a number
of areas, particularly in computer integration of ICU care, the private
pay middle class hospitals are ahead of us (that's the software thing).
And due to the quality of the research and the kind of commitment the
people have, the gap is going to widen. My coworker was full of
stories about medical devices being tried which wouldn't have a prayer
of making it though the FDA here, and no Medicare market if they did.
He said he'd forgotten what sheer joy medical progress could be. I
understand completely. Doing medical research in India is like doing
medical research in the US in the 1950's and 60's-- the golden era.
You deal with the patient, the family, the doctor, and the hospital
ethics committee. That's it. None of them are fools, and all of them
have a direct stake in outcomes.
It extends down to every level, BTW-- not just complicated surgery.
They have a $5 sterilizable electronic device which can be attached to
any needle, and which signals by sound (transduction of a pressure
wave) whether the tip is in a vessel. You won't see it here. And the
Indians learned by basic epidemiology the same thing the US has found:
that a major source of transmission of nosocomial infections is the
attending doctor's stethoscope. The difference is that they didn't
just make a bow to having doctors wipe their chestpieces with alcohol:
they banned personal stethoscopes from ICUs entirely. It was offending
their orderly minds, and it was hurting their profits.
From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Subject: Re: medical research is tainted
Date: Thu, 31 Oct 2002 18:33:00 GMT
amp_spamfree wrote in message
>Do you or have you ever done contract research at a university? In
>the years I did, my dean never gave me credit for money I brought in
>that didn't have a publication associated with it. Have things
More than likely, they have. These days, unless you're working for an Ivy
League place with a huge endowment, or for a rich state which puts BIG bucks
into higher education (eg California), your dean is going to be horribly
short of money. In a place like Utah*, he'll be running a spreadsheet
looking at every buck which comes in from grants, restricted and not. That's
somewhere around 50% to the university (with kickback to departments) for
government grants. For private directed grants, generally none of the money
goes to department overhead, but some of it does go for investigator
salaries, which means the dean doesn't have to pay it. If he's a pauperish
dean, he cares about that a LOT. If your directed private grant also buys
lab equipment that everybody can use (as some of it usually does), so much
the better. If you have a lot of grant money, you can generally parlay that
into academic position (if that's what you're into), whether you publish a
lot or a little.
Let me commend to all here Uncle Al Schwartz' Rule, which applies to
academics, medicine, industry, and generally most enterprises: A) the hand
that runs the spreadsheet ultimately runs the organization. B) the only
entry in a spreadsheet is money.
*Utah: Western desert state without gambling, oil, shipping, or really much
of anything to generate state revenues except taxation. But lots and lots
and lots of small children to eat what revenues there are. Contains two
major universities, of which the secular unsupported one ( The University
of Utah) is left to do nearly all the medical research on private donations
(the state picks up 10%), while the other religious university (BYU)
collects most of the private religious donations from the Mormons and spends
them on other things than biomed research (they have a law school, but no
medical school). Of course, the Mormons are having the kids. Medical
research connected with kids (the big problem with the above system) is
funneled through Primary Children's Hospital, through a complicated
mechanism which extracts a different stream of tax and private money from
the Utahns without passing most of it through the secular U of U, or the
University of Utah hospital and school of medicine, which are starving next
I welcome email from any being clever enough to fix my address. It's open
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