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I got pushback on a post I put up yesterday critical of the health care reform bill from readers who pointed to the fact that folks like Paul Krugman and Al Franken were supporting it meant it must be at least OK.
Well, it isn't, and don't delude yourself into thinking that. Why did health insurance stocks rise to all time highs when the bill was passed?
This tidbit comes from reader Chuck S, and refers to the Senate version (the House version is pretty much certain to be made to conform to the Senate bill).
Top 10 Reasons to Kill Senate Health Care Bill
1. Forces you to pay up to 8% of your income to private insurance corporations - whether you want to or not. [So what -- 8% is not much -- NNB]
2. If you refuse to buy the insurance, you'll have to pay penalties of up to 2% of your annual income to the IRS.
3. Many will be forced to buy poor-quality insurance they can't afford to use, with $11,900 in annual out-of-pocket expenses over and above their annual premiums. [As if the current situation is different -- NNB]
4. Massive restriction on a woman's right to choose, designed to trigger a challenge to Roe v. Wade in the Supreme Court.
5. Paid for by taxes on the middle class insurance plan you have right now through your employer, causing them to cut back benefits and increase co-pays.
6. Many of the taxes to pay for the bill start now, but most Americans won't see any benefits - like an end to discrimination against those with preexisting conditions - until 2014 when the program begins.
7. Allows insurance companies to charge people who are older 300% more than others.
8. Grants monopolies to drug companies that will keep generic versions of expensive biotech drugs from ever coming to market.
9. No re-importation of prescription drugs, which would save consumers $100 billion over 10 years.
10. The cost of medical care will continue to rise, and insurance premiums for a family of four will rise an average of $1,000 a year - meaning in 10 years, your family's insurance premium will be $10,000 more annually than it is right now.
Background information on each point:
1. Hardship Waiver And Restrictions On Immigrants Buying Insurance Undercut Arguments For An Individual Mandate, by Jon Walker
2. What's in the Manager's Amendment by David Dayen
3. MyBarackObama Tax by Marcy Wheeler
4. Emperor Ben Nelson: All Your Uteruses Are Belong To Me by Scarecrow
5. The Senate Bill is Designed to Make Your Health Insurance Worse by Jon Walker
6. Best way to "Fix It Later" Is With No Individual Mandate Now by Jon Walker
7. The Senate Health Care Bill is Built on a Mountain of Sand by Jon Walker
8. The Devil in Anna Eshoo's Details by Jane Hamsher
9. Liveblog of the Dorgan Reimportation Amendment by David Dayen
10. Answering Nate Silver's 20 Questions on the Health Care Bill by Jon Walker
The Senate bill isn't a "starter home," it's a sink hole. It needs to die so something else can take its place. It doesn't matter whether people are on the right or the left - once they understand the con job that's about to be foisted on them, they agree. That's why Harry Reid and President Obama are trying to jam it through as fast as they can, before people get wise. So email the list to your friends and family, tweet it and spread the word.
Yves here. This list still misses a few very bad features. For instance, most have fallen for the "preexisting conditions" bit, that the new plan is better because it forces insurers to cover those with preexisting conditinos. Well first, if you recall, insurers have used the failure to report ANY preexisting condition, no matter how trivial, as a reason to deny coverage when someone gets a costly illness. So health insurers will be permitted to charge those with "preexisting conditions," again even if trivial, a 50% premium to the rest of the population. This not only defeats the idea of enlarging the pool, but also continues the abusive use of the notion of "preexsiting condition". And before you argue that including all those people is costly and needs to be recouped somehow, every other advanced economy has a form of government-supported medicine that covers all citizens, is cheaper than ours, and delivers no worse, and in many cases, better health outcomes. Covering these people is not the problem; the problem is the system we now have.
Second, insurers that cross state lines get to be regulated by the state with the least regulations. Just as we saw with financial services, this will lead to a race to the bottom. For instance, I have a plan regulated by New York State, and New York State allows me to appeal to the state if I think I have been denied coverage incorrectly. Every time I have used this option, I have prevailed (and once, the NYS response was quite a smackdown to my insurer, Cigna). I'd lose this very valuable right under a new plan.
Third, Obama has engaged in a massive bait and switch. As Marshall Auerback pointed out,
From a Washington Post interview:
Obama said the public option "has become a source of ideological contention between the left and right." But, he added, "I didn't campaign on the public option."
Lots of links below the fold that appear to create a contradiction between the statement above and the actual facts.
- In the 2008 Obama-Biden health care plan on the campaign's website, candidate Obama promised that "any American will have the opportunity to enroll in [a] new public plan." 
– During a speech at the American Medical Association, President Obama told thousands of doctors that one of the plans included in the new health insurance exchanges "needs to be a public option that will give people a broader range of choices and inject competition into the health care market." [6/15/09]
– While speaking to the nation during his weekly address, the President said that "any plan" he signs "must include…a public option." [7/17/09]
– During a conference call with progressive bloggers, the President said he continues "to believe that a robust public option would be the best way to go." [7/20/09]
– Obama told NBC's David Gregory that a public option "should be a part of this [health care bill]," while rebuking claims that the plan was "dead." [9/20/09]
Obama sees Reagan as one of his role models, but as my politically-minded buddies like to point out, Reagan sought to get and succeeded in winning 75-80% of what he wanted. Obama starts out with a much less ambitious ask and settles for at most 60%.
steve from virginia :
The overarching reason for rejection is that is too expensive as drafted. No attempts have been made to constrain the ever-expanding medical care bubble.
The medical business is at the same place the real estate business was in 2005. Deflation – not Congress – is calling the shots.
Deflation and Ali al- Naimi, Saudi Arabia's oil minister. What the current nonsense represents is a bailout of the medical insurance business. Too bad for them, the valve on the dollar pump is in the hands of the Saudis who have decided the dollar is now worth something. A oil- supported dollar opens a fierce competition for them, with finance possessing all advantages with insurance companies far downstream.
At bottom, reality rules; the gods destroy both the mad and the sane if they are all standing on the wrong street corner. I almost cannot blame Congress because they don't understand the new, deflationary ground rules. Most people in the developed West don't understand, even economists.
The mandate is un-Constitutional and will fail in court. At that point the plan will be pointless. What a waste of time …
Those are valid reasons to dislike the bill or to wish the bill was better in those 10 areas….but it doesnt make a good argument to kill the bill.
If you had any chance of passing a bill that improved all of those 10 areas you could make a good argument. Since that wont happen, the kill the bill argument is poorly thought out.
If an employer offered you a job at $20/hour, 3 vacation days, bad benefits, required long hours, required odd hours and required you to be on call sometimes….you could probably come up with a long, long list of why that job is not the best job ever. But it is better than being unemployed.
It is an error to compare the bill to the best possible scenario. Make a comparison to current conditions. This list has valid issues, but was put together by someone who cant see the big picture.
Getting a staple punched through your toe is bad, but it looks awful good if you have 10 staples in your toe right now.
How odd, liberals complaining about restrictions on health insurance. Liberal are living in some fantasyland that Obama is writing this legislation himself. His administration has to create something that will be acceptable to the insiders of a Political system split 50-50 between socialists and fascists; while the normal "citizens" look on (maybe, if there's nothing on TV).
And, in typical big-government manner, the liberals can't project themselves ahead 20 years and image what the resulting government subsidized health-care scam will look like after the "conservatives" have had their shot at ruining the country for a few political rounds (which, unbelievably to a liberal, WILL actually happen again).
Think there are limits on fornicating harlots and rules about proper male 5th appendage placement now, wait `till then.
Wrong, wrong, wrong. This bill isn't perfect but it's an historic advance and improvement on what we have now. I'm not prepared for a political discussion on this - and others, such as Krugman and Nate Silver, et. al. have done it far better than I could - but to to compare Obama's achievements with Reagan's (such as they were) neglects the traditional bias of the MSM toward Republicans (yes, you read that right), not to mention that Reagan had carte blanche after he was shot by a deranged would-be assassin. Reagan's bravery ('Honey, I forgot to duck") boosted his popularity enormously and helped ensure passage of legislation he backed.
I was thinking of attempting to play peace maker above, but based on my own history of rabble-rousing over at "baselinescenario" I'm not going down that road. I would argue though that if the person isn't using vulgarity, or using racist or sexist comments, it does NOT behoove blog hosts to deny guests ability to post. In the end almost all info presented on these blogs comes from places like New York Times, Bloomberg, WSJ, LA Times, Reuters, etc. The only special function blogs provide is a different lens to view already available data and an outlet for people's steam. A safety valve if you will.
That being said, I am right on the borderline myself. I probably support the health care reform bill as it stands, but I find myself wavering quite a bit. I think Yves Smith's arguments and point by point blows (with maybe the exception of abortion) are quite persuasive. And her post above gives me reason for pause to chew on this issue some more.
I rank Yves' post up there with one of the better posts I've seen on the issue, from Paul Krugman http://krugman.blogs.nytimes.com/2009/09/08/why-the-public-option-matters/ He seems to be arguing in the post that without a public option there is ZERO leverage to get private insurers to lower costs. I think it's the most important point in this big mess. Also if you are looking for facts or substantive arguments on the health care issue, there is none better than Uwe Reinhardt. You can find his posts over at New York Times. http://economix.blogs.nytimes.com/author/uwe-e-reinhardt/
Number 1 reason for passing the current health care bill: This is not the end, it is just the beginning. Modifying an existing program is much, much easier than trying to pass a new program. Every session, every budget bill will be an opportunity to change, modify, extend the existing program.
Bill Clinton told the Obama's that his biggest mistake on health care was that he made it an all or nothing deal. And we got nothing for 15 years. Clinton believes that if he had compromised on his original bill and allowed a flawed bill to pass that we would today have a better system today than his original bill tried to put into place and a MUCH better system than we actually have today.
Piss this one away and you will be waiting another 15 years for another chance. I am tired of waiting.
With all due respect, I believe you have been conned.
This bill bears absolutely no resemblance to a proper health care system, nor is it a credible bridge to one. A government requirement that citizens by health insurance or face fines bears no resemblance to government funded health care.
Given its fundamentally flawed design, that it further entrenches a health insurance industry that simply increases the cost of delivery (US administrative costs are in the double digit %, while in every other advanced economy, they are in the single digit %), this is in no way, shape or form a transition to a better plan. And as other readers have pointed out, more conservative Administration are certain to make it even more corporate, less citizen favorable.
Any plan to contain the cost of health care, at a minimum, has to be willing to put the health insurers out of business (save for oddball stuff like travel insurance) and arm wrestle with Big Pharma over prices. This plan not only takes no steps in that direction, it actually cedes ground.
I honestly do not believe that. I do not believe that this plan is worse than doing nothing. And that is your choice. This or nothing for the next 15 or 20 years. This is as liberal a plan as you can get at this time.
I know with 99% certainty that I will be buying insurance in the open market in the next 10 years. 60% chance of it happening in the next 5 years. I have done it before, several times and each time gets harder and more expensive. The next time me and my wife will be in our 50's.
My personal finances are good, house paid off, SEP IRA fully funded even after the market declines. I have worked my whole life to get to this point. One major illness without insurance and it is all gone. This matters to me. It is not some philosophical discussion. I dont really care about most of what you are talking about. What matters is if I will be able to purchase insurance at a reasonable rate. Without I face financial ruin. With it, I have a chance.
And I think I will be able to do that with this plan. Maybe you are right and I am wrong but I think if this does not work that it will be easier to fix this than to start over. And I absolutely know I will be better off with this plan than with nothing. And that is what we will get if this fails, nothing.
Yves, I'm a big fan of your writing on financial issues, but as someone who studies public health policy, I think you're dead wrong on this one.
Many of the things you cite are false. For example, the bills do NOT allow insurers to sell insurance from a low-regulation state to another state – the bill does allow the selling of insurance across state lines, but any policy that does so must meet the regulations in EACH STATE it sells in. Also, the point on taxes is false – the taxes kick in later, such as the excise tax kicking in 2013.
The mandate is more controversial, but the reason every health economist and health policy analyst endorses it is because without it there is no way to protect against adverse selection issues which would send the cost of insurance far higher for each individual. In MA, for example, though overall premiums have climbed since the reform (due, I might add, to the high cost of health CARE, not so much the insurance itself), in the individual and small group markets, premiums have DROPPED 40% since the mandate was imposed. Jonathon Gruber at MIT has calculated that without a mandate, insurance premiums per person would average $4400, versus $2700 with a mandate.
You complain that the bill allows insurers to charge older people 3x what they do younger people – yes, but compared to what? The current reality is that in some states, insurers charge up to 25 times what they charge younger people.
The >$11,000 claim you cite is a maximum – most people's out-of-pocket expenses wouldn't climb anywhere near that. And that again compares to today, where there is NO cap and someone would wind up in medical bankruptcy.
No insurers cannot drop you for not reporting a pre-existing condition because they are not permitted to ask about any pre-existing conditions due to guaranteed issue.
I know you've had issues with Nate Silver, but the graph he posts here is absolutely correct – yes, the system will still be overly expensive, but compared to today, costs will be FAR cheaper.
I agree fully on the abortion issue and the pharmaceutical deal. In regards to the former, keep in mind this is the price of Ben Nelson's vote. Reconciliation, as has been pointed out multiple times, even by progressive senators like Feingold and Harkin, will not work for this, although you could conceivably use it for adding a public option or Medicare buy-in later. And so long as you need 60 votes to overcome a filibuster, you need Nelson's vote unless Olympia Snowe or Susan Collins are willing to vote for it, which they aren't. It's best to deal with this through the courts.
The Pharma Deal is bad, but not worth sinking the whole bill over when, again, that is something that can be taken up again later.
You argue that only a bill that puts the insurance companies out of business is worth doing, but I have to ask where you are going to get the support in Congress to do that. I know you have issues with Obama, but I doubt any president could get a single-payer bill through Congress when even Bernie Sanders has said there are no more than 10 votes for single-payer in the Senate. Nor did either the House or Senate have anywhere near the votes for a strong, Medicare-rates public option. All that could have passed would have been a weak public option, which most estimates had putting almost no downward pressure on premiums due to its limited scale and need to self-support itself via premiums.
Moreover, the bill allows states to opt out and craft single-payer systems (if you're looking at single-payer, that's the most promising field, since CA, WA, and PA all have viable efforts). It vastly expands federally-funded community health centers for 25 million people (eventually up to 45 million), while allowing them to use Veterans Admin. prices for drugs.
The biggest failings are the slow implementation, the low actuarial value of "bronze" plans, the Senate bill's multiple, state-based exchanges instead of a single national exchange, and the low subsidies. The subsidies and low actuarial value of the bronze plan are things that can be very easily fixed and expanded through simple appropriations.
Always enjoy your commentary. However, I do want a public health care option and it is not going to happen in one step. So it may take a few reveisions, but we will get there over time. THere are too many special interests to get it done any other way unfortunately. It's sickening, but the system is so corrupt we will not get there any other way.
Some random points for discussion:
- The decision who should live and who should not are implicit in any old age treatment. Keeping cost of insurance for older people high is one way to resolve this problem. There might be others but one need to demonstrate that they are better...
- I agree with Yves as for "Massive restriction on a woman's right to choose, designed to trigger a challenge to Roe v. Wade in the Supreme Court." That's a real shame and paint the country in very unfavorable light (blend of neo-theocracy with neo-plutocracy ;-)
- The current situation in medical insurance in the USA is not that horrific. Basic insurance (hospital coverage only ) is reasonably cheap. I think in most states it is around $200 a month. When you pay $40 for internet access per month and $100 for cable TV this in not that much. If you accept restriction on choice of doctors (in-network option) you payments are also not that high even in present system (say $500 a month per family).
- Good corporate plan provides for very high level of care at a reasonable cost. Especially dental care. I think that is competitive with any country on the globe including Germany.
- No matter what is the origin (public or private) the existence of insurance inflates the costs of treatment in the current system. Doctors milk insurance and that's a know fact. Similar situation exists in body shops for cars when the price paid by insurance companies inflates the cost of repairs quite dramatically (often 100%).
- I agree with Yves that public option is strategically important. But for a different reason. First of all not all waist in private insurance can be recovered in government option. We need to understand that government is wasteful in its own right: If in private insurance companies a lot of money are paid to top brass, in government they partially will be wasted in red tape. In my view the main value of public option is not what it provides but that it exists is a competitor and creates that possibility of arbitrage and rotation. I think the role that it plays should be similar to USPS vs FedEx and UPS. Moreover it is inevitable that without public option private insurers will milk the system much harder in ways similar to investment banks. I think there should be even some rotation of legislation (pro-anti government) over the time. May be 10 year is a period after which some private insurance companies which provide less efficient care by some metrics need to be nationalized for 10 year and so on. That will an effective put a ceiling of executive pay which is out of control. May be such periodic rotation can help to eliminate the excessive milking of population by private insurance providers.
- Absence of public option makes government jobs somewhat more attractive.
Andrew Pekosz, an associate professor of molecular microbiology and immunology at Johns Hopkins University's Bloomberg School of Public Health in Baltimore, answers questions about H1N1 swine flu.
How can I tell if I have swine flu? And does it matter if it's that flu or the seasonal one?
Virtually all the cases of influenza occurring at this time are caused by 2009 H1N1. While individuals with severe flu-like illness are being tested to determine for certain which virus is causing the disease, there is no need for most people to get tested.
How do I know if I or someone in my family should go to the hospital?
Some key symptoms to watch for include rapid but shallow breathing, difficulty in breathing and lethargy or extreme weakness. A complete list of symptoms can be found at http:/
/. www.cdc.gov/ h1n1flu/ sick.htm#3
What is the best source of information about the H1N1 virus?
There are couple of Web sites that provide good general information on the H1N1 virus; the one I like for information to the general public is http:/
/, but be sure to check with your state or county public health department. www.flu.gov
Who should get vaccinated? What are the priority groups?
There are several priority groups being targeted for vaccination while the vaccine is in short supply. The complete list is at http:/
/but includes pregnant women, health-care and emergency medical personnel, household contacts or caregivers of children under the age of 6 months, anyone between the ages of 6 months and 24 years of age, and people age 25 to 64 who have underlying medical conditions. www.flu.gov/ individualfamily/ vaccination/ vprioritygroups.html
What's the difference between nasal spray and injection? Who should get what kind?
The nasal-spray vaccine is a weakened form of the virus that does not cause influenza but does generate a good immune response. The injectable vaccine is an inactivated or "killed" form of the virus which is injected into the muscle of your arm. The nasal spray is only available to healthy individuals age 2 to 49, while the injectable vaccine is available to a wider range of the population. More information is available at http:/
/. Yes. . . . We are not certain how long the flu season will last, or if we will have several flu seasons or "waves" this year, so when vaccine becomes available, everyone should take advantage of it. www.cdc.gov/ h1n1flu/ vaccination/ general.htm
How quickly does the vaccination take effect? Is it possible to come down with the flu soon after getting vaccinated?
After three weeks, most people have an immune response that will protect them from infection with 2009 H1N1. The immune response begins to be detected seven to seven to 10 days after vaccination. The vaccines cannot cause the flu, but you certainly could catch influenza during the time after vaccination when your body hasn't developed a strong anti-influenza immune response.
Should everyone who comes down with the flu take Tamiflu or Relenza?
No. The CDC guidelines recommend that only individuals who are in high-risk groups should receive Tamiflu or Relenza at the first sign of symptoms. If you develop symptoms of severe influenza, then you should seek out medical treatment and begin to take Tamiflu and Relenza. For most people who will come down with the mild form of the disease, the use of Tamiflu or Relenza is not recommended in order to ensure enough of the drugs are available.
President Barack Obama has declared the swine flu outbreak a national emergency, allowing hospitals and local governments to speedily set up alternate sites for treatment and triage of any surge of patients, the White House said.
The declaration Saturday did not signify any unanticipated worsening in the United States of the H1N1 outbreak, officials said. It seemed likely, however, to increase concerns, disruptions and at times, panicky reactions, to a disease now affecting most parts of the world.
At some vaccination sites people have stood in line through the night; hundreds have been turned away. On Chicago's North Side, Mary Kate Merna, 28, a teacher, arrived too late. "I thought I'd be a priority, being nine months pregnant," she said. "You hear it's a national emergency and it scares you."
Snack WiselyI've found that when I'm concentrating I like to be eating or drinking something at the same time. When I started programming from home, I used to make a 12-cup pot of coffee from espresso beans, and then follow it up over the rest of the day with Coca Cola, supplemented with Doritos. When I was feeling virtuous, I would switch to Smartfood Popcorn.
I'm really glad that I never took up smoking, because I know that I would have a terrible two-pack-a-day habit.
A few years ago, I discovered a key thing: it doesn't actually matter what I'm snacking on. My brain just needs some idle fidgeting and consumption to work more smoothly, but it doesn't have to be junk food.
So, now I always have a pint glass of water (just tap water) on my desk, with some lemon concentrate for flavour. I still have coffee in the morning, but I use a French press, which not only makes tastier coffee, but less of it. For snacks, I've switched to carrot sticks - I'll eat a small bag of them every day.
This doesn't mean that I've cut the tasty things out of my life - I still eat cheeseburgers and drink beer and wine and all of that - but I don't eat unhealthy snacks, especially when I'm not paying attention anyhow.
Use Your PausesAs computer users, we often have little bits of downtime in our work - waiting for uploads or downloads, compiling, running large database processes, or whatever. I used to just switch to Reddit or Slashdot or whatever in those pauses - and then get lost down a rat-hole of distraction. I've recently found a new thing for those distractions: push-ups. It takes less than a minute to do a few pushups - not enough time to be a big distraction in your day, and it's not like you're doing something else while you're downloading.
The trick is to bypass your motivation. Getting up in the morning and saying "today I'm going to do 50 push-ups" is a setup for failure. I need my coffee first, and then usually there's a phone call with some kind of emergency, and then there's a lunch meeting, and I get caught up in programming - and then when I do have time, I'm too mentally exhausted to commit to that extra exertion. But there are always brief pauses in the middle of the day - and they're enough of a lull for me to do a few push-ups. Try to do an extra push-up each time. I started with 10 just a few weeks ago, and now I can do 50 without too much trouble.
Your mileage may vary if you work in an office with other people, but it's great if you have some privacy.
WalkIf you can, walk as much as possible. I know people who have lost an astounding amount of weight simply by walking to work in the morning. This won't work so well if you live way out in the suburbs and work downtown (or vice-versa, like I used to do), but seriously consider walking if you have a short trip to make. Also, with traffic the way that it is in many cities, walking may not be much slower than driving. Simply getting out of the house/office and walking around the block or the office complex can clear your head and help your programming. Longer walks can be a great way to tune back into the real world - something I often need to do if I've been working too hard. If you'd rather avoid reality, an iPod full of Audiobooks and podcasts can turn long walks into learning and enrichment opportunities.
Feb 18, 2007 | The Joel on Software Discussion Group
I had sore back neck problems after some 10 hours days. Until I learned that the top of the monitor should level with my eyes.
My keyboards are in the "okay" position but there is no "mouse tray" on my desk. So I just put the mouse on the desktop (no, I mean the physical one :) ). After a few years, plus the lack of exercises, I have mild thumb arthritis with my "mouse hand".
I remember in the university, some Unix guys were proud of programming almost without the use of a mouse. Perhaps I should remember all those Visual Studio short-cuts or use vi.
Do you have any tips or experiences to share?
I started getting aches and pains after years of computing, and the following helped me:
- Switched from a mouse to a trackball. Logitech Marble Mouse in my case. Love it, and I won't go back to a mouse.
- Lowered my desk. Didn't have a keyboard tray, so I just cut off several inches off my desk to bring the height down.
- I no longer rest my arms or wrists on the desk or keyboard. My hands now float above the keyboard while I'm typing. After years of resting my arms/wrists on the desk I had to see a doctor for ulnar nerve inflammation, which I'm still recovering from a year later.
- Stretching. I googled for various stretches, and found a combination that did wonders for me.
- Exercise. Strengthening my upper body muscles has made a HUGE difference. sloop
This is what I would suggest, having recovered from what could've been very bad RSI:
1) Get an ergonomic chair and sit up straight. Most software engineers have terrible posture.
2) Get an ergonomic keyboard, whatever works for you. I've used the Goldtouch but the newer versions are terrible compared to the old one that I currently use. Some people have worked well with the Microsoft keyboard.
3) Make sure that you take some time out during the day to take breaks, roughly 10-15 minutes or so at a time. This means getting up off your rear end and go outside for a walk, stretch your hands, arms and legs.
4) Make use of the tools like Intellisense, auto-complete, etc. that will make yo do much less typing over the course of a day. Same goes for using any macro-like software to help automate manually typed items.
5) Set a good mouse as well - as with keyboards, this is a personal taste. Also, make sure that you put it at the correct height. Your upper back, wrists and arms will thank you. QADude
Sunday, February 18, 2007 Deleting … Approving …
Tai Chi: I've learned to regulate my posture (the curvatures of my back), and relax my shoulders.
I also have one of http://www.humanscale.com/products/keyboard_systems.cfm at home for my keyboard. Christopher Wells
Swap your mouse hand now and then. One shock that occurred to me was that my thought-processes actually change when using my nooby-esque left hand.
I find on Windows I have to use the mouse much more than I do on Linux. Windows is much more complex for requiring plenty of mouse activity all the time. On the plus side, maybe you get some productivity improvement due to that? :-) At least the sensation of increase of productivity must be there...
Seriously, if I could I would have as many different setups of posture as possible, just to avoid the stressing of trying to work from the same one all the time.
And that brings to mind: why do we have the same limitations of the physical world in the virtual world? For example, why do we have to use VS.NET with all the options enabled, instead of keeping things as straightforward as possible for our use of it? These big IDEs still haven't made the simple editors irrelevant, maybe because they are to stringent in the way they work. NetBeans, Eclipse, VS.NET, SharpDevelop, etc...
Haven't we learned to adapt things to our needs? Isn't the virtual world supposed to be more flexible? Why can't we script, adapt, etc, all the softwares we developers rely on? It should be simple, need only a scripting language, etc... If XML is all the rage for configuration files, it probably could handle versioning, plenty of options changes, from time to time, huh? :-)
I digress... Lostacular
Had severe headacahes and its defiantely posture related. So find the sweat spot in your monitor and chair height. Thats huge in fixing that.
The top two disks in your vertibrae in your neck under your skull are wired into controlling nerves that travel throughout and around your head. As your posture degrades over long programming cycles, you pinch these disks and that turns into a huge migraine headache.
For me removing this was simply to remove the risers I had used fro my monitors and now look down more on them than up. joe
Sunday, February 18, 2007 Deleting … Approving …
Beware: A bad diet and a sedentary lifestyle, two things programmers are notorious for, lead to an increased risk of Type II Diabetes.
Rotate some fruits and vegetables into your diet and get some exercise. Avoid foods and drinks with a lot of simple carbohydrates, i.e., avoid the vending machines at work. At the minimum, go for a good walk at least four times per week.
Some very bad advice here for not resting your arms on the desk or the arm supports of the chair. It may help for some, but do not do this without consulting a specialist.
I have arthritus naturally, and found that the TENS machine ( http://en.wikipedia.org/wiki/TENS ) that I use for the pains in other joints works wonders for the strain of typing and mousing all day. Bit expensive though.
"Some very bad advice here for not resting your arms on the desk or the arm supports of the chair."
Pretty much every article I've read on ergonomics says that you're not supposed to rest your arms while typing. Microsoft's keyboards even come with warnings saying you're not supposed to do that. I didn't say anything about resting them when you're not typing. sloop
my whole body "hurt" after 8 hrs and sometime 8+ hrs of work. i recently join 24hrs fitness and hit the gym after work and workout for an hour. i don't know if the pain from workout beat out the pain from work but i feel better on the inside. i still feel the physical pain tho.
also try to use as much keyboard as you can. there are many short cut key in Windows. goolge it. notSure
Do not put the keyboard feet down. The back-end of keyboard should not be higher than the front. The legs up on the keyboard make you bend your wrists into an unnatural position. Your wrists should be as straight as possible.
An additional vote for both a bit of strength training and tai chi; my own arm and wrist pain have lessened considerably since I did both. Granted, I make no claims that one caused the other, but it is another datapoint.
In fact, when I started tai chi, there was a lot of pain in my arms after a class. 6 months or so after starting, my elbows and wrists were much more flexible, and that pinching agonizing wrist pain is extremely rare, going on 4 years now.
Taking a weapons form (sword, spear, sabre) helps a lot with flexibility in the wrist, provided you start with lighter weapons and move up to heavier ones only as you become comfortable. Fencing might accomplish much the same. Dan Fleet
Are you of average height? If not, you'll need to be especially careful in setting your environment up correctly. I've taken a lot of trouble in that regard, and it has helped a lot.
In my case (I'm tall) I now work with a raised desk, and an extra pad to raise the mouse even further, and some really tall monitor stands.
I also use a Kinesis sculpted keyboard.
You can probably get a professional, who specialised in assessing ergonomics, to come and give you some advice. John Rusk
We're programmers, not professional atheletes. Get off your ass and get an exercise program that includes both strength training and cardio. Stop drinking Mountain Dew and eating Hot Pockets. Jeremy Read
Shovelglove does wonders for the back/arms. Google for it.
And yes, go out for some walks, eat properly, etc.
Common sense, really. Jimmy Jones
I consulted with an specialist recently, she came to my office and checked everything: monitor position, desk, chair, etc. Her advice was:
1) To get a monitor support to make the monitor stand a little bit higher so I don't need to look down
2) To rest my arms completely on the table. I used to touch the table with the middle of my forearm, but she said it's not the correct position and that I should lay my forearms completely on the table. To do so I had to place my keyboard past the middle of the table.
3) To get a new chair that provides better support for my back.
4) To get a headset
5) To work less and to take vacations (It's been 7 years since the last one) Anon Anon
Monday, February 19, 2007 Deleting … Approving …
"... Perhaps I should remember all those Visual Studio short-cuts or use vi. "
Why not both at the same time?
Highly recommended. JAG
Monday, February 19, 2007 Deleting … Approving …
Once upon a time when I was working at home, I changed to a captain's chair with arms higher than the arms on a true office chair. After a while, my left elbow started hurting. I decided it was due to having to hold it in close to my body. It tooks some months after changing back to my original chair for the pain to subside. Peter Vanderwaart
> Shovelglove does wonders for the back/arms.
I tried shovelglove and it was terror on my joints. I still work out with a sledge hammer, but treat it more like a regular free weight doing curls stuff with it. ~~~x
What helped you with recovery from that ulnar nerve inflamation?
I used to rest a lot on my left elbow while sitting at my desk and now I'm having one helluva time w/ the ulnar nerve inflamation. I'm just glad that it was not my mouse arm. Daemon
Trackball - get the big ones you maneuver with your hand, not the little ones that you wiggle with your thumb. You can get an RSI from those.
Keyboard shortcuts are good.
One thing I try to do is to not use same hand for multi-key combos. Like Ctrl-C, use the Control key on the right side, and hold down C with the left instead of the stretches to use one hand. frustrated
David H. Newman, M.D. has an interesting article in the NY Times where he discusses common medical treatments that aren't supported by the best available evidence. For example, doctors have administered 'beta-blockers' for decades to heart attack victims, although studies show that the early administration of beta-blockers does not save lives; patients with ear infections are more likely to be harmed by antibiotics than helped - the infections typically recede within days regardless of treatment and the same is true for bronchitis, sinusitis, and sore throats; no cough remedies have ever been proven better than a placebo. Back surgeries to relieve pain are, in the majority of cases, no better than nonsurgical treatment, and knee surgery is no better than sham knee surgery where surgeons 'pretend' to do surgery while the patient is under light anesthesia. Newman says that treatment based on ideology is alluring, 'but the uncomfortable truth is that many expensive, invasive interventions are of little or no benefit and cause potentially uncomfortable, costly, and dangerous side effects and complications.' The Obama administration's plan for reform includes identifying health care measures that work and those that don't, and there are signs of hope for evidence-based medicine: earlier this year hospital administrators were informed by the Centers for Medicare and Medicaid Services that beta-blocker treatment will be retired as a government indicator of quality care, beginning April 1, 2009. 'After years of advocacy that cemented immediate beta-blockers in the treatment protocols of virtually every hospital in the country,' writes Newman, 'the agency has demonstrated that minds can be changed.'"
Posted by samzenpus on Friday December 19, @12:33PM
from the read-all-about-it dept.
brothke writes "The recent collapse of financial companies occurred in part because their operations were run like a black box. For many years, alternative medicine has similarly operated in the shadows with its own set of black boxes. In Trick or Treatment: The Undeniable Facts about Alternative Medicine, Simon Singh and Edzard Ernst, MD, break open that box, and show with devastating clarity and accuracy, that the box is for the most part empty." Keep reading for the rest of Ben's review.
Trick or Treatment: The Undeniable Facts about Alternative Medicine author Simon Singh and Edzard Ernst pages 352 publisher W. W. Norton rating 9 reviewer Ben Rothke ISBN 978-0393066616 summary Peels away the fallacies of acupuncture, homeopathy, chiropractic and herbal medicine>[Nov 27, 2008] http://www.sciencedaily.com/releases/2008/11/081126122203.htm
Nov 27, 2008 | ScienceDaily
Researchers have uncovered what may be a universal cause of aging, one that applies to both single cell organisms such as yeast and multicellular organisms, including mammals. This is the first time that such an evolutionarily conserved aging mechanism has been identified between such diverse organisms.
The mechanism probably dates back more than one billion years. The study shows how DNA damage eventually leads to a breakdown in the cell's ability to properly regulate which genes are switched on and off in particular settings.
Like our current financial crisis, the aging process might also be a product excessive deregulation.
Researchers have discovered that DNA damage decreases a cell's ability to regulate which genes are turned on and off in particular settings. This mechanism, which applies both to fungus and to us, might represent a universal culprit for aging.
"This is the first potentially fundamental, root cause of aging that we've found," says Harvard Medical School professor of pathology David Sinclair. "There may very well be others, but our finding that aging in a simple yeast cell is directly relevant to aging in mammals comes as a surprise."
These findings appear in the November 28 issue of the journal Cell.
For some time, scientists have know that a group of genes called sirtuins are involved in the aging process. These genes, when stimulated by either the red-wine chemical resveratrol or caloric restriction, appear to have a positive effect on both aging and health.
Nearly a decade ago, Sinclair and colleagues in the Massachusetts Institute of Technology lab of Leonard Guarente found that a particular sirtuin in yeast affected the aging process in two specific ways-it helped regulate gene activity in cells and repair breaks in DNA. As DNA damage accumulated over time, however, the sirtuin became too distracted to properly regulate gene activity, and as a result, characteristics of aging set in.
"For ten years, this entire phenomenon in yeast was considered to be relevant only to yeast," says Sinclair. "But we decided to test of this same process occurs in mammals."
Philipp Oberdoerffer, a postdoctoral scientist in Sinclair's Harvard Medical School lab, used a sophisticated microarray platform to probe the mammalian version of the yeast sirtuin gene in mouse cells. The results in mice corroborated what Sinclair, Guarente, and colleagues had found in yeast ten years earlier.
Oberdoerffer found that a primary function of sirtuin in the mammalian system was to oversee patterns of gene expression (which genes are switch on and which are switch off). While all genes are present in all cells, only a select few need to be active at any given time. If the wrong genes are switched on, this can harm the cell. (In a kidney cell, for example, all liver genes are present, but switched off. If these genes were to become active, that could damage the kidney.) As a protective measure, sirtuins guard genes that should be off and ensure that they remain silent. To do this, they help preserve the molecular packaging-called chromatin-that shrink-wraps these genes tight and keeps them idle.
The problem for the cell, however, is that the sirtuin has another important job. When DNA is damaged by UV light or free radicals, sirtuins act as volunteer emergency responders. They leave their genomic guardian posts and aid the DNA repair mechanism at the site of damage.
During this unguarded interval, the chromatin wrapping may start to unravel, and the genes that are meant to stay silent may in fact come to life.
For the most part, sirtuins are able to return to their post and wrap the genes back in their packaging, before they cause permanent damage. As mice age, however, rates of DNA damage (typically caused by degrading mitochondria) increase. The authors found that this damage pulls sirtuins away from their posts more frequently. As a result, deregulation of gene expression becomes chronic. Chromatin unwraps in places where it shouldn't, as sirtuin guardians work overtime putting out fires around the genome, and the unwrapped genes never return to their silent state.
In fact, many of these haplessly activated genes are directly linked with aging phenotypes. The researchers found that a number of such unregulated mouse genes were persistently active in older mice.
"We then began wondering what would happen if we put more of the sirtuin back into the mice," says Oberdoerffer. "Our hypothesis was that with more sirtuins, DNA repair would be more efficient, and the mouse would maintain a youthful pattern gene expression into old age."
That's precisely what happened. Using a mouse genetically altered to model lymphoma, Oberdoerffer administered extra copies of the sirtuin gene, or fed them the sirtuin activator resveratrol, which in turn extended their mean lifespan by 24 to 46 percent.
"It is remarkable that an aging mechanism found in yeast a decade ago, in which sirtuins redistribute with damage or aging, is also applicable to mammals," says Leonard Guarente, Novartis Professor of Biology at MIT, who is not an author on the paper. "This should lead to new approaches to protect cells against the ravages of aging by finding drugs that can stabilize this redistribution of sirtuins over time."
Both Sinclair and Oberdoerffer agree with Guarente's sentiment that these findings may have therapeutic relevance.
"According to this specific mechanism, while DNA damage exacerbates aging, the actual cause is not the DNA damage itself but the lack of gene regulation that results," says Oberdoerffer. "Lots of research has shown that this particular process of regulating gene activity, otherwise known as epigenetics, can be reversed-unlike actual mutations in DNA. We see here, through a proof-of-principal demonstration, that elements of aging can be reversed."
Recent findings by Chu-Xia Deng of the National Institute of Diabetes, Digestive and Kidney Diseases, has also found that mice that lack sirtuin are susceptible to DNA damage and cancer, reinforcing Sinclair's and Oberdoerffer's data.
This research was funded by the National Institutes of Health, and the Glenn Foundation for Medical Research. David Sinclair is a consultant to Genocea, Shaklee and Sirtris, a GSK company developing sirtuin based drugs.
To visual or auditory learners, Spencer's study habits may only make sense in context: He was a competing member of the United States Olympic cycling team in the 1972 Games in Munich. He later turned pro. Recently, he published a book, Turn it Up! How to Perform at Your Highest Level for a Lifetime, which he wrote while riding a stationary bike.
Even to people who learn or reason best by reading or listening, Spencer's basic premise is absolutely correct: People do perform better when fit, and some even think better when their bodies are in motion.
"Being out of shape means that you cannot respond at your best when an opportunity or challenge comes your way," he says.
Unfortunately for many of us, this physiological fact bumps straight up against the reality of days spent largely at a desk.
However, all is not lost. It may not be possible to exercise for a full hour, as many doctors recommend, during a typical workday -- but it is possible to squeeze in some beneficial activity.
Get up and move every 30 to 45 minutes or so, advises Debbie Mandel, a stress management expert and author of Addicted to Stress.
... ... ...
"Bring exercise bands to work -- these are easy to use and require no extra space," she recommends.
Another option is an exercise ball; even just sitting on it works core muscles. Small hand weights can be hidden under the desk, notes Jampolis, and used to work one body part -- say, biceps, triceps or shoulders -- for five minutes a day.
"If you have a private office, take off your shoes and skip rope for five minutes to torch calories," she advises, "or take the jump rope to the stairway landing if your office is too small."
Freeman likes the FLOW system, for example, which offers a video of five-minute chair exercises that work all of the muscle groups.
For people serious about both work and fitness, an investment in the latest exercise equipment for the office may be in order. The Treadmill Desk combines a conventional treadmill with a work station.
People can trod along at one mile per hour and still lose weight if they do it consistently throughout the day, according to James Levine of the Mayo Clinic, who came up with the idea.
"The Geek-a-Cycle is a bit more manageable than the treadmill workstation," says Lowe.
Red wine appears to protect the heart and prolong life. Now a new study suggests it may also be a weapon against obesity.
Resveratrol, a compound present in grapes and red wine, appears to inhibit the development of fat cells and have other anti-obesity properties, according to a report from researchers at the University of Ulm in Germany. The findings, to be presented this week at The Endocrine Society's annual meeting in San Francisco, show that in laboratory experiments with so-called "pre-fat cells,'' resveratrol prevented them from converting into mature fat cells. Resveratrol also hindered fat storage in the cells.
The compound also reduced production of certain cytokines, substances that may be linked to the development of obesity-related disorders like diabetes and clogged coronary arteries. Resveratrol also stimulated the formation of a protein called adiponectin. The substance, known to decrease risk of heart attack, is diminished by obesity.
"Resveratrol has anti-obesity properties by exerting its effects directly on the fat cells," said the study's lead author, Pamela Fischer-Posovszky, a pediatric endocrinology research fellow in the university's diabetes and obesity unit. "Thus, resveratrol might help to prevent development of obesity or might be suited to treating obesity."
Whether to add red wine to your daily diet must be balanced against other health risks. For people with alcohol dependency problems, the health benefits of red wine are far offset by the risks of drinking to excess. Excessive use of alcohol can lead to addiction, traffic accidents and potentially fatal medical problems.
Increasingly, studies support the idea that drinking a small amount of alcohol each day - no more than one to two servings - is better for you than not drinking, but the findings don't apply to everyone. Even small amounts can increase risk for certain health worries, like breast and colon cancer. Although those risks are generally offset by the extra heart benefits, some people may decide it is not worth it.
For more on how red wine appears to slow aging, click here.
[Jun 17, 2008] An Opera Singers Fat Relocation Project - Well - Tara Parker-Pope - Health - New York Times BlogI first met Austin opera singer Cindy Sadler through her blog, "The Next Hundred Pounds." After a lifetime of being overweight, Ms. Sadler last September set out on a journey to gain control of her health. Nine months later, on June 12, she reached an important milestone, losing 100 pounds.
"Diets do fail,'' Ms. Sadler wrote me recently. "I have never liked the term diet, and I don't consider myself to be on a diet. (I have many alternate names for it … "fat relocation project" is one of my faves.) I consider myself to be in the process of making a lifestyle change, and to a large degree I have made that change, though there is a lot of work still to be done and there will never be a time when I don't have to work at it. Some days I simply have to work harder than others.''
To stay motivated, Ms. Sadler regularly refers to a book she has filled with reminders and sayings that keep her on track.
"I have a lot of tools to help me keep motivated, but the main thing is to get what my friend Karen calls the mental game in place,'' she said. "The mental game has to be tight. That is what I have been able to do this time that I never was able to do before…. I've been able to counter every roadblock (eventually - some are harder than others!) and learn to demand honesty from myself. The main motivation, though, is probably that I like how I look and feel now, and I like eating and exercising the way I do now, better than I liked the way I looked, felt and ate before."
To learn more about Ms. Sadler's weight loss journey, watch the video below.
I'm not a fan of the term diet either. It ought simply to mean "what I eat," but has picked up the meaning of "what I restrict myself to eating during my weight-loss period." I'm not restricting myself as much as sampling a range of better choices for health and fitness. Ms. Sadler makes a good point in that there will never be a time when I don't strive to eat more cleanly and healthfully. Can I call the new scope of food selections a menu instead? At least it implies I'm sitting down somewhere nicer than my kitchen table.
- I came to know of Cindy Sadler via her articles in Classical Singer Magazine and in turn, her "Business of Singing" Website. How pleasantly surprised I was after finally reading her blog on losing the weight (including the note of the unidentified guest media person) JUST YESTERDAY, to see this article in the NY Times! Although I have never met her, Cindy is inspiring not only because she is a singer who is successfully juggling a career and family (a major pressure point particularly for young women who are pursuing careers in opera), but tackling her weight challenges with equally as much tenacity as the stage demands. I am amazed by her courage and generosity to invite the rest of us along to witness her journey. Brava Cindy and in boca al lupo in all of your endeavors!
- Posted by Hope is Springing Up Everywhere!
By DAN HURLEY
Published: June 3, 2008
There was nothing very interesting in Katherine P. Rankin's study of sarcasm - at least, nothing worth your important time. All she did was use an M.R.I. to find the place in the brain where the ability to detect sarcasm resides. But then, you probably already knew it was in the right parahippocampal gyrus.
What you may not have realized is that perceiving sarcasm, the smirking put-down that buries its barb by stating the opposite, requires a nifty mental trick that lies at the heart of social relations: figuring out what others are thinking. Those who lose the ability, whether through a head injury or the frontotemporal dementias afflicting the patients in Dr. Rankin's study, just do not get it when someone says during a hurricane, "Nice weather we're having."
"A lot of the social cognition we take for granted and learn through childhood, the ability to appreciate that someone else is being ironic or sarcastic or angry - the so-called theory of mind that allows us to get inside someone else's head - is characteristically lost very early in the course of frontotemporal dementia," said Dr. Bradley F. Boeve, a behavioral neurologist at the Mayo Clinic in Rochester, Minn.
"It's very disturbing for family members, but neurologists haven't had good tools for measuring it," he went on. "That's why I found this study by Kate Rankin and her group so fascinating."
Dr. Rankin, a neuropsychologist and assistant professor in the Memory and Aging Center at the University of California, San Francisco, used an innovative test developed in 2002, the Awareness of Social Inference Test, or Tasit. It incorporates videotaped examples of exchanges in which a person's words seem straightforward enough on paper, but are delivered in a sarcastic style so ridiculously obvious to the able-brained that they seem lifted from a sitcom.
"I was testing people's ability to detect sarcasm based entirely on paralinguistic cues, the manner of expression," Dr. Rankin said.
In one videotaped exchange, a man walks into the room of a colleague named Ruth to tell her that he cannot take a class of hers that he had previously promised to take. "Don't be silly, you shouldn't feel bad about it," she replies, hitting the kind of high and low registers of a voice usually reserved for talking to toddlers. "I know you're busy - it probably wasn't fair to expect you to squeeze it in," she says, her lips curled in derision.
Although people with mild Alzheimer's disease perceived the sarcasm as well as anyone, it went over the heads of many of those with semantic dementia, a progressive brain disease in which people forget words and their meanings.
"You would think that because they lose language, they would pay close attention to the paralinguistic elements of the communication," Dr. Rankin said.
To her surprise, though, the magnetic resonance scans revealed that the part of the brain lost among those who failed to perceive sarcasm was not in the left hemisphere of the brain, which specializes in language and social interactions, but in a part of the right hemisphere previously identified as important only to detecting contextual background changes in visual tests.
"The right parahippocampal gyrus must be involved in detecting more than just visual context - it perceives social context as well," Dr. Rankin said.
The discovery fits with an increasingly nuanced view of the right hemisphere's role, said Dr. Anjan Chatterjee, an associate professor in the Center for Cognitive Neuroscience at the University of Pennsylvania.
"The left hemisphere does language in the narrow sense, understanding of individual words and sentences," Dr. Chatterjee said. "But it's now thought that the appreciation of humor and language that is not literal, puns and jokes, requires the right hemisphere."
Dr. Boeve, at the Mayo Clinic, said that beyond the curiosity factor of mapping the cognitive tasks of the brain's ridges and furrows, the study offered hope that a test like Tasit could help in the diagnosis of frontotemporal dementia.
"These people normally do perfectly well on traditional neuropsychological tests early in the course of their disease," he said. "The family will say the person has changed dramatically, but even neurologists will often just shrug them off as having a midlife crisis."
Short of giving such a test, he said, the best way to diagnose such problems is by talking with family members about how the person has changed over time.
After a presentation of her findings at the American Academy of Neurology's annual meeting in April, Dr. Rankin was asked whether even those with intact brains might have differences in brain areas that explain how well they pick up on sarcasm.
"We all have strengths and weaknesses in our cognitive abilities, including our ability to detect social cues," she said. "There may be volume-based differences in certain regions that explain variations in all sorts of cognitive abilities."
So is it possible that Jon Stewart, who wields sarcasm like a machete on "The Daily Show," has an unusually large right parahippocampal gyrus?
"His is probably just normal," Dr. Rankin said. "The right parahippocampal gyrus is involved in detecting sarcasm, not being sarcastic."
But, she quickly added, "I bet Jon Stewart has a huge right frontal lobe; that's where the sense of humor is detected on M.R.I."
A spokesman for Mr. Stewart said he would have no comment - not that a big-shot television star like Jon Stewart would care about the size of his neuroanatomy.
MD Report – Check for disciplinary action, certifications, background.
People who consider this dangerous procedure should first read: LASIKComplications.com - LASIK complications and risks
1. LASIK causes dry eye
Dry eye is the most common complication of LASIK. Corneal nerves that are responsible for tear production are severed when the flap is cut. Medical studies have shown that these severed nerves never return to normal densities. Symptoms of dry eye include pain, burning, foreign body sensation, and eyelid sticking to the eyeball. The FDA website warns that LASIK-induced dry eye may be permanent.
2. LASIK results in loss of visual quality
LASIK patients have more difficulty seeing detail in dim light (known as loss of contrast sensitivity), and also experience an increase in visual distortion at night (multiple images, halos, and starbursts). A review of the clinical trials for FDA approved lasers reveals a significant proportion of patients experience night vision impairment.1 The FDA website warns that patients with large pupils may suffer from debilitating visual symptoms at night.
3. The cornea is incapable of complete wound healing after LASIK
Researchers found that the flap heals to only 2.4% of normal tensile strength. LASIK flaps can be surgically lifted or accidentally dislodged for the remainder of a patient's life. For these reasons, the FDA website warns that patients who participate in contact sports are not good candidates for LASIK.
Collagen bands of the cornea provide its form and strength. LASIK severs these collagen bands and thins the cornea, resulting in permanent weakening. The thinner, weaker post-LASIK cornea is more susceptible to forward bulging due to normal intraocular pressure, which may progress to a condition known as keratectasia and corneal failure, requiring corneal transplant.
4. The true rate of LASIK complications is unknown
There is no clearinghouse for reporting of LASIK complications. Side effects occur frequently but are downplayed by LASIK surgeons. Moreover, there is no consensus among LASIK surgeons on the definition of a complication.
5. LASIK results in loss of near vision
Nearsighted patients who do not have LASIK retain the ability to see up close naturally after the age of 40 simply by removing their glasses. LASIK patients over the age of 40 may discover they have traded one pair of glasses for another.
6. There are long-term negative consequences of LASIK
LASIK affects the accuracy of intraocular pressure measurements, exposing patients to risk of vision loss from undiagnosed glaucoma. Like the general population, LASIK patients will develop cataracts. Calculation of intraocular lens power for cataract surgery is inaccurate after LASIK. This may result in poor vision following cataract surgery and exposes patients to increased risk of repeat surgeries. Ironically, steroid drops routinely prescribed after LASIK increase IOP and hasten the onset of cataracts.
Research demonstrates persistent decrease in corneal keratocyte density after LASIK. These cells are vital to the functionality of the cornea. Ophthalmologists have speculated that this loss might lead to delayed post-LASIK ectasia.
7. Bilateral simultaneous LASIK is not in patients' best interest
In a 2003 survey of American Society of Cataract and Refractive Surgery (ASCRS) members, 91% of surgeons who responded did not offer patients the choice of having one eye done at a time. Performing LASIK on both eyes in the same day places patients at risk of vision loss in both eyes, and denies patients informed consent for the second eye.
8. Serious complications may emerge later
The medical literature is filled with reports of late onset LASIK complications such as loss of the cornea due to biomechanical instability, vision-threatening infection, inflammation resulting in corneal haze, flap dislocation, and retinal detachment. Complications may emerge weeks, months, or years after "successful" LASIK.
9. Rehabilitation options after LASIK are limited
LASIK is irreversible, and treatment options for complications are extremely limited. Hard contact lenses may provide visual improvement if the patient can obtain a good fit and tolerate lenses. The post-LASIK contact lens fitting process can be time consuming, costly and ultimately unsuccessful. Many patients eventually give up on hard contacts and struggle to function with impaired vision. In extreme cases, a corneal transplant is the last resort and does not always result in improved vision.
10. Safer alternatives to LASIK exist
Some leading surgeons have already abandoned LASIK for surface treatments, such as PRK, which do not involve cutting a corneal flap. It is important to remember that LASIK is elective surgery. There is no sound medical reason to risk vision loss from unnecessary surgery. Glasses and contact lenses are the safest alternatives.
1. Bailey MD, Zadnik K.
Outcomes of LASIK for myopia with FDA-approved lasers.
Cornea. 2007 Apr;26(3):246-54.
Lasik Study Is Priority in U.S., Will Start by 2009 (Update1)
This is a dangerous procedure that can ruin you programming career. People who say they've had unsuccessful surgery air their complaints on Web sites such as lasikcomplications.com, which lists the ``Top 10 Reasons Not to Have Lasik surgery.''
By Catherine Larkin
April 24 (Bloomberg) -- Complaints about Lasik eye surgery using lasers made by companies including Advanced Medical Optics Inc. and Alcon Inc. are a priority for U.S. regulators, a government official said today.
The Food and Drug Administration, working with doctors' groups and the National Eye Institute, plans to study how Lasik affects patients' quality of life no later than next year, Daniel Schultz, head of the agency's medical devices center, said today. Identifying why complications occur will help those considering Lasik make more educated choices, he said.
More than 12 million people in the U.S. have had Lasik to improve their vision since the procedure was approved in 1995, and 5 percent say they aren't satisfied with the results, according to the American Society of Cataract and Refractive Surgery. Complications after surgery can include dry eye, blurriness and even loss of vision. The FDA got 140 reports of side effects with Lasik from 1998 to 2006.
``Clearly there is a group that aren't satisfied and don't get the results that they expect,'' Schultz told reporters on a conference call. Studying these patients ``is very, very high on the agency's priority list.''
Advanced Medical, of Santa Ana, California, fell 11 cents to $20.05 in New York Stock Exchange composite trading at 4:15 p.m. Alcon, the Hunenberg, Switzerland-based company selling a majority stake to Novartis AG, gained $1.62, or 1.1 percent, to $154.99.
Lasik surgeons slice a paper-thin hinged flap from the top of the cornea covering the front of the eye and then reshape it, taking about 10 to 15 minutes per eye. Flattening the cornea fixes nearsightedness, making it steeper corrects farsightedness and smoothing out irregularities repairs astigmatism, or blurry vision. Lasik stands for laser-assisted in situ keratomileusis.
Permanent vision correction has become increasingly popular as new technologies eliminate the need for glasses and contact lenses. Some unhappy patients have urged the FDA in citizen petitions to rescind approval of lasers linked to side effects and phase out older devices as new technology is introduced.
People who say they've had unsuccessful surgery air their complaints on Web sites such as lasikcomplications.com, which lists the ``Top 10 Reasons Not to Have Lasik surgery.''
A Wax Paper View
Barbara Berney, 54, of Rockford, Illinois said she often feels as if she is viewing the world through wax paper since undergoing Lasik surgery in 2001. She had the surgery because she was no longer able to read and her doctor said Lasik would solve that, she said.
Instead, her vision constantly changes, she can't see in some lighting conditions and can no longer drive at night and her eyes are dry, said Berney, a graphic designer who composes digital art on a computer.
``You only get one pair of eyes,'' she said in a telephone interview. ``And once they're gone, you're done. There is no getting them back. You can't undo this.''
Berney is the president of the Vision Surgery Rehab Network, a non-profit dedicated to patient advocacy and rehabilitation of vision surgery complications.
The FDA asked the American Academy of Ophthalmology, the government-funded Eye Institute and the cataract surgery society in July to review published data on Lasik surgery and make a recommendation as to whether additional research was needed to examine patients' quality of life.
A joint task force, formed of representatives from the four groups, reported in March that its analysis of 19 studies in the past 10 years found a 95 percent satisfaction rate among 2,199 patients worldwide.
TLC Vision, LCA-Vision
An FDA advisory panel will discuss the planned study at a public hearing tomorrow in Gaithersburg, Maryland.
``There is no surgical procedure or contact lens that you can wear or aspirin tablet that you can take that doesn't entail some risk,'' said Roy Rubinfeld, an ophthalmologist in Chevy Chase, Maryland, who has performed more than 20,000 Lasik surgeries, in a phone interview. ``I hope that this hearing will validate what has been my personal experience, that Lasik is perhaps one of the greatest surgical procedures.''
'Tis the season of indulgence, a time when many of us get little more exercise than lifting a glass of eggnog.
But unless you want to start looking like that jolly old elf with the jelly belly, it's a good idea to try to get some physical activity and to exercise restraint at the buffet table.
Here are 6 simple steps to limit the damage during the holidays:
*Work out in the morning.
Get moving before all the hustle and bustle starts. Bear in mind that most gyms have limited hours on holidays, so check with your club. If the gym is closed, consider a brisk walk or some calisthenics at home. You could also do a DVD workout or follow a fitness program on TV.
*Eat before the party.
Don't skip meals earlier in the day to save your appetite for the holiday party. You will be ravenous and end up eating everything in sight -- and then storing it exactly where you've been working so hard all year long to get rid of it!
*Play in the snow.
Gather up a group and get outdoors for a day of fitness fun -- skiing, snowboarding, snowshoeing or good old-fashioned sled riding.
*Schedule extra time with your trainer.
It can be particularly hard to stay motivated to exercise during the holidays. Hire your trainer to crack the whip.
*Go easy on the holiday cheer.
Have one drink and then move on to a sparkling water or diet soda.
*Find a calorie-free zone.
Sit, stand and socialize as far from the food table as possible. Enjoy good conversation without the temptations of desserts and other decadent dishes.
By making smart choices about diet and exercise now, you'll kick off the New Year right!
To Protect Yourself You Must Read This Book!, September 20, 2007
DJE (Williamstown, MA USA) - See all my reviewsShannon Brownlee's manifesto, Overtreated, is a an extraordinarily important volume for those of us who question the mercantile thrust of health care in these United States. The sad reality is that to many physicians, hospitals, insurance carriers, and, of course, most pharmaceutical companies the American patient is a valuable cash cow. This impeccably researched book will allow the reader to make informed health care decisions. It is lucidly written and difficult to put down. It should be required reading for all who find themselves on the consumer end or "health care."
As a physician, I will keep copies in my office for patients to peruse and borrow. Thank you, Ms. Brownlee for shedding light on a dimly lit landscape.
Queen_Anne_Drizzle (Seattle, WA) - See all my reviewsLoyd E. Eskildson "Pragmatist" (Phoenix, AZ.)
Don't just do something - stand there!,This is an extremely important book to read for anyone who has or will come into contact with the healthcare industry - that is pretty much every single person alive in the USA.
December 4, 2007
The current health care system is broken very badly. The media and politicians talk about it but not enough. The problem is far more serious than any national issue.
The US spends over 15% of its GDP per capita on health care which is by far the greatest amount compared to other nations. What do we get for it? According to WHO the our outcomes are roughly comparable to Chile (worse than Greece).
For outcomes, I am using "Life expectancy at birth", "Healthy life expectancy at birth", and "Probability of dying between 15 and 60 years". (See http://www.who.int/countries/usa/en/).
Chile spends only about 6% of their GDP on healthcare. There are lots of reasons for this poor performance but Brownlee discusses one that is rarely talked about which happens to be the most important reason. That reason is overtreating.
Brownlee has done her research very well and presents a well balanced (until the last chapter but more on that later) account of why our current system leads to overtreating. She discusses the three main reasons as being
- fear of malpractice law suits by physicians (ie: doctor orders head CT scan for a patient with a headache even though chances of brain tumor is very small).
- The second reason is consumer demand (ie: patients demanding unnecessary tests)
- and finally financial incentives and culture in medicine (From early on medical students are taught to gain as much information as possible hence leading to unnecessary tests and procedures).
All 3 reasons are valid. Perhaps Brownlee underestimates the importance of the first two reasons.
The reason I gave this book 4 stars instead of 5 was because of my disappointment at the final chapter. In the final chapter she proposes some solutions. Throughout the book I was excited to hear her solutions. Given her insights and brilliant research, I expected well thought of solutions with solid backing.
She basically proposes copying the VHA (Veterans Health Administration) or HMO's like Group Health. She also touts electronic record keeping. She ignores the problems that will undoubtedly arise from the proliferation of these systems. For example, she states that under the current system physicians have perverse financial incentives to perform procedures since they get paid for each procedure. Under a system, where physicians are salaried like Group Health or VHA, physicians would have perverse incentives NOT to do appropriate procedures.
Why would that system not lead to undertreating? Furthermore she begrudges drug companies like Pfizer for having gross margins of 27%, considerably higher than GE and Walmart. One cannot compare a drug company's single financial stats with another company in a different industry. Brownlee ought to know that better. Had she used gross profit then both GE and Walmart would have profits more than twice Pfizer's. In any case it should not be the government's job to keep track of companies' profitability in a capitalistic system.
In all fairness to Brownlee, US Healthcare system is very complicated and perhaps she should not have tackled solutions at this point. I look forward to a sequel where she has more thoughtful solutions with solid microeconomic foundations. In any case, this is a must read and she has done an excellent job (until the final chapter).
Raises Serious Issues That Must Be Fixed!,
November 21, 2007
Politicians constantly tell us we have the best health care in the world. Yet, our life expectancy lags that of other developed countries, and a recent study of heart attack patients found Canadians did just as well as Americans - despite spending far less than we do. Waiting for elective surgery or an MRI in other developed nations doesn't account for the difference in spending - the 15 procedures and tests accounting for the vast majority of waiting in other nations only account for 3% of costs in the U.S.
Brownlee goes on to say we devote nearly 33% of spending to administrative costs and profits (I suspect she is high - other sources limit this figure to for-profit health care) - while failing to provide insurance for nearly 50 million, vs. 16% for administrative costs in Canada, which covers everyone. The average cost/day in a U.S. hospital is 4 times the average in the rest of the developed world. The biggest issue, however, is that between 20 and 33% is spent on unneeded care (per a widely quoted study) that often harms the patient (eg. needless radiation, infections).
Why so much extra treatment? Lack of information, a system that pays more for doing more, and cutting back on care smacks of rationing and an overemphasis on economy. Probably the biggest factor, however, is that supply creates demand in health care (Roemer's Law) - the more technology, hospital beds, and specialists available, the more they will be used, and the higher costs will rise. On the other hand, most major surgeries hardly vary between regions - eg. colon cancer, hernia repair; these are the the problem.
Legislation that doubled the number of medical school graduates (especially the number of specialists) between '60 and '80 assumed this would lower costs. Instead, utilization of expensive technology and procedures increased; meanwhile, Medicare reduced or eliminated the incentive to hold down prices, especially for those with limited funds. Regions with fewer specialists and more primary care physicians have better overall health.
Consumer-driven health plans (including health savings accounts) make the absurd assumption (per some health care experts) that patients or their families will monitor and make decisions about their own care when in the hospital - even when a family member is a physician. There is too much practice variation, too many hand-offs between specialists, and too much missing information - eg. drug companies withholding or providing misleading information, and a dearth of randomized clinical trials to scientifically evaluate various alternatives (one expert estimates only 15% of medicine is backed by such research, and that much "research" is seriously flawed - eg. selection bias).
Malpractice fears doe not explain high costs of medicine either - comparisons between states with limitations vs. those without find only a 15% difference in unneeded tests.
One major concern with "Overtreated" is that I suspect its estimates of excess costs and deaths are overstated. Examples include the previously referenced instance of overhead costs in the U.S., and the estimates for deaths caused by errors - eg. the 80,000 quoted in the well-known Institutes of Medicine, PLUS another 400,000 for drug errors, PLUS thousands more for excessive chemotherapy administered to breast-cancer patients, etc. However, the book's basic assertions are soundly backed up.
I've noticed that programmers tend to have unhealthy lifestyles (eating, exercise). Do you agree with these observations? If so, do you believe that programming careers lead to poor eating habits ("programmers love junk food") and a downward spiral?
If you have the time, I posted my full question and observations here: http://alinktothepast.wordpress.com/
look deeper into the mindset of coders, programmers, and designers. We don't always live in the material world as others do, and we are driven by our own ambitions, not to get money, or fame.
Sure money is nice, and everyone likes it. But ask yourself this, if you didn't have a job as a programmer or designer, would you still code or design on your spare time. And do you think someone in sales or marketing would practice sales or marketing if they did not have a job in sales or marketing.
I'm pale, and my hair is shaggy, because I would rather learn this new API, rather than get a hair cut and go tanning.
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