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In early January a friend mentioned that his New Year’s resolution was to beat his chronic depression once and for all. Over the years he had tried a medicine chest’s worth of antidepressants, but none had really helped in any enduring way, and when the side effects became so unpleasant that he stopped taking them, the withdrawal symptoms (cramps, dizziness, headaches) were torture. Did I know of any research that might help him decide whether a new antidepressant his doctor recommended might finally lift his chronic darkness at noon?
The moral dilemma was this: oh, yes, I knew of 20-plus years of research on antidepressants, from the old tricyclics to the newer selective serotonin reuptake inhibitors (SSRIs) that target serotonin (Zoloft, Paxil, and the granddaddy of them all, Prozac, as well as their generic descendants) to even newer ones that also target norepinephrine (Effexor, Wellbutrin). The research had shown that antidepressants help about three quarters of people with depression who take them, a consistent finding that serves as the basis for the oft-repeated mantra “There is no question that the safety and efficacy of antidepressants rest on solid scientific evidence,” as psychiatry professor Richard Friedman of Weill Cornell Medical College recently wrote in The New York Times. But ever since a seminal study in 1998, whose findings were reinforced by landmark research in The Journal of the American Medical Association last month, that evidence has come with a big asterisk. Yes, the drugs are effective, in that they lift depression in most patients. But that benefit is hardly more than what patients get when they, unknowingly and as part of a study, take a dummy pill—a placebo. As more and more scientists who study depression and the drugs that treat it are concluding, that suggests that antidepressants are basically expensive Tic Tacs.
Begley, “The Depressing News About Antidepressants” (via newsweek)
And again, please read The Truth About Drug Companies
Drug companies understand that most drugs help 1/3 of people, don’t do anything for 1/3 of people, and harm 1/3 of people. But the cost and time required to get FDA approval means that drug companies can’t afford to find the 33% of people for whom a drug will work very, very well. That would cut their potential market, and potential revenue, by 66%. So they treat everyone the same. The future of the pharmaceutical industry is genetically matching super low cost generics up with the perfect people for whom that 5 cent pill works like magic.
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Whole Foods Puts Its Mouth Where the Money Is
Whole Foods CEO John Mackey, who recently published a controversial op-ed on health care, announced that the company will soon offer higher store discounts for healthier employees. The company will consider blood pressure, cholesterol, smoking status, and body mass index (BMI) in determining the discount level. “Our intention for all of these lifestyle programs is that they are empowering and fun for Team Members who enjoy a challenge,” Mackey wrote in a letter to employees. “In offering the higher discounts to Team Members who choose to participate, we take nothing away from Team Members who choose not to do so…”
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New patients--- Are you prepared for your visit? What does your physician want to know ? What should you ask?
Physicians are under pressure to see patients in a timely, effective, and efficient manner. Take a little time, organize your thoughts, come prepared and your visit could be much more productive.
What to bring:
- Pad and pen… you will likely receive recommendations and many patients forget them as soon as they leave the office.
- A list of your medical problems
- A list of your medications
- A list of your prior surgeries
- A copy of pertinent studies (MRI, X-ray, etc)
- A copy of pertinent medical records (valuable for second opinions).
Dress appropriately. The physician will need to see the area of concern.
Organize your thoughts: A new orthopedic history will include…
- When did the problem start?
- What were you doing?
- Have you started taking any new medications?
- Have you changed your exercise program?
- What makes the pain worse?
- What makes the pain better?
- Do you have pain at night?
- Does it awaken you?
- Any numbness, tingling or weakness?
- Any morning stiffness?
- Pain getting up from a seated position?
- Pain walking on hills?
- Shoulder patients consider what motion causes your symptoms.
- Do you have any mechanical symptoms (catching, locking, clicking, etc)?
- Do you have any instability (does the joint feel loose)?
- Do you have any swelling?
- How does the pain affect your quality of life?
- What have you tried so far to obtain relief (physical therapy, injections, medications, exercise, etc)?
After the exam and discussion of the findings, your doctor will likely present you with alternatives….some thoughts you should have.
- What are the possible diagnoses?
- Is further testing necessary (If the test will not change the plan of care, then it is possible that you do not require further tests)?
- Is an MRI or expensive imaging necessary (many times it is not)?
- What are the non-surgical, surgical alternatives available to treat my condition?
- What are the possible risks, side effects of the treatment?
- What will happen if I choose not to have surgery?
- What does the literature or research recommend (many physicians still practice based on anecdotal experience [which might be appropriate, depending on the situation])
Specific considerations for surgical patients.
- What are reasonably forseeable risks of the surgical procedure?
- What are the realistic goals of the procedure (relief of pain, functional improvement, etc)?
- What is my “expected recovery time (recovery means different things to different people… be VERY CLEAR about your goals)
- When can I use my arm/leg?
- When can I l use my arm/leg for activities of daily living?
- When can I use my arm/leg against resistance (lifting objects or putting weight on your leg)?
- When can I drive?
- Do you know what I do for a living? When can I return to work?
Hopefully this will help you on your next visit….
of course you understand that this does not constitute medical advice and you should only use this as a guide to improve your preparation for a visit to an orthopedic surgeon or any physician for that matter.
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Doc Who Tied Vaccine to Autism Ruled Unethical
This is very good news. The doctor who scammed the world and the celebrities into thinking there was some connection between vaccines and autism has finally been punished. Rational scientists all over the world are now waiting to see if he’s kicked out of the rational circle and losing his license.
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Women, the best freaking firewall in the world!
One human cell contains 75MB genetic information.
One sperm contains a half of that; that is 37.5MB.
One ml of semen contains 100 million sperms.
In average, ejaculation lasts for 5 sec and contains 2.25 ml semen.
This means that the throughput of a man’s member is equal to (37.5MB x 100,000,000 x 2.25)/5 = 1 687 500 000 000 000 byte/second = 1,6875 Тerabyte/secThis means that the female eggcell withstands this DDoS attack at 1,5 terabyte per second, and only lets through one(!) data package, thereby being the best freaking hardware firewall in the world!
The downside of it is that this only small data package that it lets through, hangs the system for the whole of 9 months!
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Lawrence Lessig outlines why money + politics ≠ democracy for his Change Congress group back in 2008. After searching for news and opinions in the wake of the Citizens United v. FEC decision, I’ve found that this speaks to me more than anything else. (I love Lessig’s presentation style, so I’m already predisposed to like this.)
Like I’ve said in the past, Lessig is one of my heroes. Solve the first problem before you can solve anything else. And that first problem is money buying votes in our legislative branch of government. Our legislative branch is supposed to represent the people of our country. When that fails, and the people lose trust in Congress, power shifts to the Executive and Judicial branches, which don’t by nature reflect the interests of the people. And when money from the few controls the interests of the many, democracy fails.
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Its not the size of your market, its what you do with it that matters.
One of the most pedestrain of questions that arise in many VC meetings is that of market size. How big is your market? Really. I’ve found that should this question arise more than once over a series of meetings, you’re better off looking elsewhere for funding than the blue shirt and khaki MBA staring at you pointedly from across the table.
If history is a guide you will not be able to answer this question with cleverly constructed Excel spreadsheets or elegantly cascading waterfall projections. For seed and early stage investors I’ve found that you either fundamentally and instinctively believe that something is a big market or you don’t. Because, often, the most interesting companies are operating in as-yet-undefined markets or are attacking and existing market from some niche that the large incumbents dismiss as not being big enough to warrant their attention and resources.
I posted a link a graph sizing the mobile ad market today at $215M. Now, most VCs say they won’t even look at markets that aren’t well north of a billion dollars in size. Also note that AdMob was funded pre-iPhone which seems to be making mobile ad networks a more reasonable bet. That market barely exists today and was even less obvious for the VCs who wrote the original checks to back a company in an undefined and, wait for it, small market.
The same could be said of the VCs who wrote the first checks for Facebook (social graph, wha?), Twitter (no, what you doing?) Zynga (a niche inside a niche) and many others.
Of the two new investments I made last year, I believe the current market sizing for each would be some approximation of zero. And that’s the point. Its not about the size of today’s market its what you do with it that really matters.
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TicketMaster And LiveNation Get Approval As One Giant Music Monster
Excellent. Our music experience made even better. I’ve recently been paying more in fees than ticket prices.
“We’ve been taught that our government, ostensibly a representative democracy, is effectively neither. We’re powerless. We’ve had the civic engagement beaten out of us. Friedman’s assumption that we think our job is done is condescending and incorrect. We’ve been shown by all three branches of the federal government that they’ll do whatever they want regardless of popular opinion, that common sense and the people’s best interests don’t matter, and that there’s absolutely nothing we can do about it.”
-via marco
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http://feltron.com/index.php?/content/2009_annual_report/
Each day in 2009, I asked every person with whom I had a meaningful encounter to submit a record of this meeting through an online survey. These reports form the heart of the 2009 Annual Report. From parents to old friends, to people I met for the first time, to my dentist… any time I felt that someone had discerned enough of my personality and activities, they were given a card with a URL and unique number to record their experience.
I kept track only of who I gave survey invitations to, the number of the card and where it was given. The surveys answers were submitted via text forms, allowing the respondee to write whatever they desired, and leaving the task of making comparisons between the data up to me. I have used only this information to create the report, however accurate it may be. I have strived to sort and collate the data in a clinical and repeatable manner that could be reproduced by someone looking for the same stories I have selected.
The data set itself was messy and overwhelming, and filled with enough information for several more reports. There are inherent shortcomings (like the unrepresentative amount of water recorded), and endearing strong suits (like the exploration of mood). I used several tools to make this task a more manageable, including Processing, which allowed me to map and explore alternate layouts much more quickly than previously, and Amazon’s Mechanical Turk.
The printed edition of the report is being letterpressed by Swayspace in Brooklyn, New York. It is 16 pages and printed using 4 colors on 80 lb. French Durotone cover stock, and will be individually numbered, signed and mailed in March.I’m one of those dots! Nice work Nicholas.
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[Flash 9 is required to listen to audio.]
The xx - Hot Like Fire
snippets from this excellent article in The New Yorker:
The xx are, in the purest sense, a modern band: their music could not exist without the machines that make the noises and the machines that record them.
I can’t think of a working band that is as genuinely minimalist.
These are songs to be sung inches from someone’s ear, preferably with the lights off.Play the album a few times and all of a sudden other pop music sounds abrasive and overstuffed and shouty. The lyrics are where the age of the band shows. Madley Croft and Sim exchange lyrics on iChat, and never discuss what they mean. The two share the vocal duties on most songs, though the effect is rarely that of a duet. They’re singing at the same time, but in parallel, not necessarily to each other. (They met when they were three, after all.) It’s as if they’re looking through the same window at different people.
And I don’t need these young musicians to have figured anything out. How much do teen-agers know about love? Not much. Desire? A lot. Anxiety, anticipation, regret, frustration, delight, fear? More than most of us, maybe.
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More (Steve) Jobs, Jobs, Jobs, Jobs - NYTimes.com (via fred-wilson)
The best way to counter the Tea Party movement, which is all about stopping things, is with an Innovation Movement, which is all about starting things. Without inventing more new products and services that make people more productive, healthier or entertained — that we can sell around the world — we’ll never be able to afford the health care our people need, let alone pay off our debts.
Obama should bring together the country’s leading innovators and ask them: “What legislation, what tax incentives, do we need right now to replicate you all a million times over” — and make that his No. 1 priority. Inspiring, reviving and empowering Start-up America is his moon shot.
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Fritz Kahn (1888-1968) took his lead from the industrialised urban environment of Berlin during the Weimar Republic. In his illustrations he explained human biology in purely mechanical terms.
I’m a pediatrician and preventive medicine specialist with a masters in public health. Fast Company calls me The Doctor of the Future and one of The Top 10 Most Creative People in Health Care. Esquire Magazine calls me one of 2009's Best and Brightest Radicals & Rebels Who Are Changing the World.
I co-founded Hello Health and now have a creative firm, The Future Well. We design health innovations.
Read more about me here.
