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What Your Body is Telling You:

It's a very interesting article on personal health in the Personal Journal section of the WSJ today, all about looking for various signs of illness or disease from things like skin changes, nails and hair, teeth and gums .... However, though no doubt designed to be inflammatory or at least to sell some papers, the front page headline for the story is:

How to Diagnose Yourself,

the which, I admit, does give me a certain pause.

Sarcastro (www):
Diagnosis: Awesome!
6.23.2009 2:37pm
ys:
Mark Twain revisited
6.23.2009 3:51pm
wfjag:

the front page headline for the story is:

How to Diagnose Yourself,

the which, I admit, does give me a certain pause.

Or, maybe it's a prediction of what you'll soon need to be able to do.
6.23.2009 3:51pm
jccamp (mail):
This post got me thinking. I found something similar that might be of help.

The Obsessive Compulsive Disorder Self-Assessment Questionnaire

Just follow the directions...

1. Read through the statements listed and note the ones that are true for you.

2. Read through the statements listed and note the ones that are true for you.

3. Read through the statements listed and note the ones that are true for you.
6.23.2009 4:03pm
Gaius Obvious:
The "How to diagnose yourself" pdf link is behind a subscription-based paid firewall. :(
6.23.2009 4:17pm
Bruce_M (mail) (www):
I think it's a fallacy to presume that everyone is per se incompetent to do anything that requires a license to do for profit.

There are a lot of horrible lawyers out there, I'm sure a few people could do a better job pro se. I don't see why the same wouldn't apply to doctors. Quite often you can go to 10 different doctors and get 10 different diagnoses.

To put it another way, I don't think Daubert should apply to general public discourse.
6.23.2009 4:18pm
Redman:
Hey, here's a new national health care plan: Every Man a Doctor!

/s/ Huey Long
6.23.2009 4:44pm
Brian S:
Why doesn't Jim Lindgren allow comments when he makes an entry?

I don't like Obama and oppose his health care plan, but his claim that Obama is "breaking his campaign promise" is really pretty tiresome and disingenuous.

I mean, can't we come up with a better way to criticize the plan than to try to argue that if any company exits the insurance business this means that Obama's campaign promise that "you can keep your doctor and your plan" was somehow a lie?

What next? If your doctor retires, Obama didn't keep his promise? If your doctor is hit by a bus and dies, Obama lied because he said you'd keep the same doctor? If an asteroid hits the earth and all insurance companies close when the surface becomes uninhabitable and covered with rock vapor, Obama misled us? Come on, pull the other one.
6.23.2009 4:52pm
neurodoc:
Bruce_M: I think it's a fallacy to presume that everyone is per se incompetent to do anything that requires a license to do for profit.
OK, we won't presume that everyone is per se incompetent to do anything that requires a license to do for profit.
Bruce_M: There are a lot of horrible lawyers out there, I'm sure a few people could do a better job pro se. I don't see why the same wouldn't apply to doctors. Quite often you can go to 10 different doctors and get 10 different diagnoses.
OK, there are some horrible lawyers and some horrible doctors. How often have you or someone you know gone "to 10 different doctors and (gotten) 10 different diagnoses"? (Different diagnoses because there were that many co-morbidities or that many misdiagnoses, and what would you count as a "misdiagnosis"?) Most importantly, when would you advise people to turn to licensed physicians for their medical problems and when should they go the pro se route medically?
Bruce_M: To put it another way, I don't think Daubert should apply to general public discourse.
Does Daubert have any application outside a courtroom? In public discourse, aren't people free to say the most stupid things imaginable about anything they wish?
6.23.2009 5:01pm
neurodoc:
Sarcastro: Diagnosis: Awesome!
Have you changed your modus operandi or dispensed with brackets for signaling purposes?
6.23.2009 5:04pm
Dan Ensign (mail):

I think it's a fallacy to presume that everyone is per se incompetent to do anything that requires a license to do for profit.


I think that's exactly right, and part of the real approach to reducing health care costs which lead to better 'coverage' for everyone.

Why not attempt to self-diagnose, decide whether spending money on more information (MRI, etc.) is needed, prescribe the appropriate medication and buy it, again if you decide that it's worth the cost? No middle guy with a medical degree required, although having the option to purchase one's services would be excellent.

Of course, people could misdiagnose and hurt themselves. Then again, I hold the unpopular view that people are generally smart enough to ensure their own self-preservation. (If they weren't, and require government health care to survive, then how the heck did the human species get so far?)
6.23.2009 5:05pm
RPT (mail):
JL's posts are generally comment-free because they are indefensible.
6.23.2009 5:16pm
one of many:
Hmm, outside of some oddball OCD or self-mutilation I wonder how useful nails are as diagnostic tools, well we'll just have to see what the DSM-V says first. While self-diagnosis may be useful I do think self-medication is a recipe for trouble (although abdicating responsibility for monitoring the meds one is on are is also a recipe for trouble, is a tough balance).

Oh wait, this is physical health not mental health. I wonder why my mind immediately went to mental health when I saw the word "diagnosis".
6.23.2009 5:19pm
Daniel Chapman (mail):
Re JL's comments: If you're one of the people complaining about it, you're probably the reason.

I sure don't blame him.
6.23.2009 5:20pm
RPT (mail):
"DC:

Re JL's comments: If you're one of the people complaining about it, you're probably the reason."

Good point, although he could simply ban all critical commentors; sort of like a North Korean election.
6.23.2009 5:30pm
Eli Rabett (www):
Eli's body is telling him that he is getting older and it sucks. This is exactly the same and exactly opposite of when he was 12.
6.23.2009 5:33pm
Daniel Chapman (mail):
Given the choice between selective banning of obnoxious (note: not "critical") commentors or just shutting them all down, I'd make the same decision.
6.23.2009 5:50pm
John Powell:
The system is designed to make some of this difficult.

I will spare everyone the long story, but as a diabetic I would like to check my cholesterol and a sugar-related test called an A1C quarterly rather than just at my annual physical.

But, these tests require a prescription, and the results can only be released to a doctor! WTF? I can understand requiring a prescription for drugs, but for a basic blood test?

There used to be a major lab that would contract with a doctor to order the tests and deliver the results through, but it appears the doctors put the squeeze on them and they discontinued the service.

I guess pro se doesn't fly in the medical world!
6.23.2009 6:00pm
Bruce_M (mail) (www):
neurodoc, I'm simply saying that there is nothing wrong with people being educated and empowered to do things for themselves when the prevailing wisdom, or even objectively intelligent thing to do, would be to hire a licensed professional.

I think people should always have the option of treating themselves medically, reprsesenting themselves in court, doing their own plumbing, cutting their own hair... whatever, so long as they are not putting anyone other than themselves in jeopardy.

With respect to medicine, people are forced to see a doctor because of our "war on drugs" and the requirement of doctor-approved, doctor-signed permission slips, a/k/a prescriptions, in order to acquire medicine (whether it be penicillin or morphine). People should be able to walk into a pharmacy and buy whatever medicines they want for themselves, though this goes into the topic of ending drug prohibition. And don't tell me that overuse of antibiotics will cause drug-resistant strains, because antibiotics are already overprescribed by physicians.

Does Daubert have any application outside a courtroom?

It shouldn't. But when people say or imply that only "qualified experts" can do something, that's forcing Daubert onto applications outside of courtrooms. But I hear it argued all the time that someone's understanding of "Who Framed Roger Rabbit?" is absolutely superior than someone else's because one person has a B.A. degree in film, while the other does not. And the person with the MBA's opinion about the stock market is per se better than the guy without the MBA. We're too caught up with degrees and licenses. A degree in X should just be a presumption (and an extremely rebuttable one at that) that the person with said degree has a general understanding in the subject of X. Same with licenses.
6.23.2009 6:10pm
Randy R. (mail):
The interesting thing is that people already self-diagnose. Some people may object, but there is a whole world out there of alternative medicines, practices and therapies that people are using. Sometimes they use it in conjunction to regular medical care, others are not.

And let's face it, for the majority of medical cases, self-diagnosis occurs anyway and we take care of ourselves. Have a runny nose, aches and pains, general feeling of malaise? Diagnosis: Probably the flu. Medical treatment: bed rest and plenty of fluids. Aspirin for regular aches and pains. Tea with lemon. Your favorite teddy bear close at hand.

You don't need years of residency to cure that one....
6.23.2009 6:26pm
Randy R. (mail):
Dan: "Of course, people could misdiagnose and hurt themselves. Then again, I hold the unpopular view that people are generally smart enough to ensure their own self-preservation. (If they weren't, and require government health care to survive, then how the heck did the human species get so far?)"

Well, this cuts both ways. One could say then that we could do away with the entire medical establishment, because after all, we somehow survived for eons without them. But we actually didn't -- life span was shorter, diseases were often fatal, and people had miserable lives. I, for one, would have hated to have the primitive dental care that existed before the 20th century.

And many people do self-diagnose and hurt themselves. Oh, that lump on your chest? It'll go away. That mole on your face? Getting bigger, but it's just old age, right? Too late, you find out it's cancer, and boom -- you're dead!

I think the more information people can have about health, the better off we all are. And the more that we can do for ourselves, the more we save. You don't have to run off to the doctor for every sniffling nose. Nonetheless, everyone should get an annual physical (a real one, with all the tests), so that we can prevent as much as we can.

And so much of our health care is devoted to issues that we can cure ourselves: Stop smoking, lose weight, eat better, exercise more. If we all did that, heart disease and diabetes would plummet, and the savings would be enormous. Why don't we invest in prevention and good health? I like the old fashioned Chinese way -- you only pay your doctor when you are well, and you stop paying him when you are sick.
6.23.2009 6:34pm
Bruce_M (mail) (www):
Oh, I meant to add that a lawyer I worked with when I first started practicing law - she was quite young - was always itchy. She went to several dermatologists, who told her she was fine (some said it was dry skin, some said the itching caused more itching), she went to neurologists, and even psychiatrists, who said the itching was all in her head.

Finally, after I'd known her for about a year (she was already itchy when I first met her), she was diagnosed with lymphoma, had a huge tumor in her chest, and after radiation and 3 rounds of chemo, she finally died about 2 years later. Had one of the 15 or so doctors she had seen properly diagnosed her when she first went in with the one symptom of strange itchiness with no apparent cause, she would probably still be alive today. She was a great lawyer and a great person.

Maybe if she'd been encouraged to diagnose herself, she would have figured it out - or at least suspected it with enough certitude to ask a doctor about it and get formally diagnosed for lymphoma.

Why is "self-medicating" a negative thing? It's gotta be the only "self-xxx" phrase with a negative connotation. Even self-representation in court doesn't have so negative a connotation.

"Alternative" medicines (i.e. snakeoil) is a different topic. Whatever medicine is to be used, regardless of who decides to use it, it should be shown to be more effective than a placebo in repeatable double-blind tests.
6.23.2009 6:41pm
Harry Eagar (mail):
John, you need to change doctors. If you are a diabetic, you need more than an annual physical.

Mine insists on an A1C quarterly. I rely on him to tell me what the results mean I should do.

I have been instructed in what the test is and what it means, but I do not keep up with the current research on it, as my physician does. He adjusts treatment according to changing understanding of the disease.

I believe a lot of people file Chapter 13 bankruptcies pro se, but I don't suppose anyone would think GM could do its bankruptcy without outside counsel.

Or would they?
6.23.2009 6:41pm
ASlyJD (mail):
I know GM doesn't do its patent work in house.

I rather like this, as it's paying my bills this summer . . .
6.23.2009 6:49pm
FantasiaWHT:
Maybe it's the time shift for me (just got back from vacation), but was the "pause" you got, Kenneth, that technically you don't diagnose people, but rather diseases? I thought that the headline literally meant that "yourself" was a disease.
6.23.2009 6:53pm
interruptus:

I have been instructed in what the test is and what it means, but I do not keep up with the current research on it, as my physician does. He adjusts treatment according to changing understanding of the disease.

A lot of doctors actually don't keep up with current research, though, which is one area in which an intelligent person can gain some advantage by not totally abdicating responsibility for their own health. Probably the easiest kind of decision a person can make on their own (since it requires no permission) is self-non-medicating: keep up with recent research to see if there's a changing opinion about whether common procedures are worth doing at all. More modern medicine than we'd like to think is basically traditional medicine that's never been subjected to good empirical confirmation. If evidence for efficacy is weak to nonexistent, and risk of complications and/or expense are non-negligible, the patient might want to consider declining the treatment/procedure.
6.23.2009 7:04pm
Bruce_M (mail) (www):
Even if GM did use its own in-house counsel, it would still be using a licensed attorney.

I'm sure they would be going to outside counsel as I doubt any corporation would keep in-house bankruptcy attorneys on staff. Talk about sending a negative message to your shareholders....
6.23.2009 7:05pm
Le Messurier (mail):
interruptus said:

"A lot of doctors actually don't keep up with current research..."

Evidence? That's a pretty broad statement, and one which I doubt. At least the "A lot" part.
6.23.2009 7:16pm
Brett Bellmore:

I guess pro se doesn't fly in the medical world!


Well, duh! The practice of medicine is a modern day craft guild. If they let just anybody do it, they'd get paid a lot less.

Ditto for the practice of law, of course.

Both these fields are ripe for the use of expert systems. Especially medicine, where the detail you really need to do a competent job has expanded beyond the capacity of a normal person to absorb.
6.23.2009 7:40pm
Harry Eagar (mail):
'the detail you really need to do a competent job has expanded beyond the capacity of a normal person to absorb'

Maybe. Doesn't that suggest that self-diagnosis would be an even bigger shot in the dark?

Anyhow, I am bemused to find people like Dan and Bruce here, on a libertarian blog, who seem to think that Adam Smith was all wrong and that each of us should know all 18 steps and make our own pins.
6.23.2009 8:23pm
interruptus:

"A lot of doctors actually don't keep up with current research..."

Evidence? That's a pretty broad statement, and one which I doubt. At least the "A lot" part.

There's a whole sub-field of the medical literature that more or less takes that as a premise, and is trying to figure out what sorts of interventions are effective at pushing research to practice more quickly. As far as I know, it's not hugely controversial that something is needed; the debates are over what. Here is one short survey article, giving a few examples of areas where widespread practice remains stubbornly out of accord with evidence, and a survey of some of the methods that have been proposed to speed up practical adoption of research findings. I can't find it free online, but this is another recent survey.
6.23.2009 8:57pm
J.R.L.:
More people should self-diagnose. I believe that studies show that 85-90% of things that people go to the doctor for are self-healing. That is, there is nothing the doctor can do to help them. Imagine if even a third of them never went to the doctor to begin with.
6.23.2009 9:02pm
Bruce_M (mail) (www):
Harry that's so far off from what I (and Dan) are saying I don't know where you'd even get that idea. I'm not challenging the efficiency of the assembly line, I'm challenging the frequently-employed notion in modern American discourse that (a) only certified, qualified, licensed "experts" with all the necessary academic credentials can offer a valid opinion on a particular matter, and (b) that such a person's opinion on something is per se superior to the opinion of someone without those credits/licenses/certifications/qualifications/etc.

How you equate this with a challenge to Adam Smith is beyond me.
6.23.2009 9:09pm
David Hardy (mail) (www):
Sometimes self-diagnosis is easy. For example: you are a bald anglo in the Southwest. Diagnosis: you have skin cancer or kerotosis.
6.23.2009 9:11pm
neurodoc:
Bruce_M: she was diagnosed with lymphoma, had a huge tumor in her chest, and after radiation and 3 rounds of chemo, she finally died about 2 years later. Had one of the 15 or so doctors she had seen properly diagnosed her when she first went in with the one symptom of strange itchiness with no apparent cause, she would probably still be alive today.

Maybe if she'd been encouraged to diagnose herself, she would have figured it out - or at least suspected it with enough certitude to ask a doctor about it and get formally diagnosed for lymphoma.
Yes, pruritus (itching) can be a symptom of Hodgkins lymphoma. But what lesson should we learn from this anecdote, that diagnoses are sometimes missed by more than one doctor, even by a great many doctors, and not always incompetent or negligent ones? I just don't get the logic of "maybe if she'd been encouraged to diagnose herself (go to the library rather than seek medical attention?), she would have figured it out..."
John Powell: I would like to check my cholesterol and a sugar-related test called an A1C quarterly...
If your diabetes came under perfect control today, your A1C wouldn't fully reflect it for about 120 days, since that this the average life of a red blood cell, which carries the hemoglobin that becomes glycosolated, and only when the red blood cell is finished does its hemoglobin get broken down. So 60 days after a A1C determination, you would, in effect, have something like a 50% "dilution" or contribution from the hemoglobin contained in newer red blood cells.

I think that there would be no good reason to repeat A1Cs every 90 days after satisfactory diabetes control had been achieved. Before satisfactor control had been achieved, one certainly ought not go a year without another A1C, because the results will be used to readjust the treatment regimen. I expect that the American Diabetes Association has guidelines for treatment management you can look to, and if you are not fully confident in the physician you are seeing, then consult an endocrinologist, since they are the ones with the most expertise. (There would be even less reason to repeat cholesterols every 90 days, since that value does not fluctuate intra-day the way that blood sugars do.)
6.23.2009 9:24pm
methodact:
Happy Birthday Alfred Kinsey (1894)
6.23.2009 9:33pm
Ben P:

Ditto for the practice of law, of course.


If you read Above the Law you'll note that they do seem to pretty much let anybody do it.

In 1904 there were 160 Medical Schools in the US, Today there are 130, and basically no unaccredited ones.


In 1910 there were 124 Law Schools in the US. Today there are 199 ABA accredited law schools and a few more unaccredited ones.
6.23.2009 10:01pm
MS (mail):
neurodoc,

I don't think he was suggesting that she should "go to the library." A simple Webmd search for "itching" would have pointed to lymphoma as a possibility. If she'd read the other symptoms for lymphoma, who knows?

The lesson I take from this is that doctors, like lawyers, range from excellent to terrible, and if you don't have access to the very best, you should aggressively research and speak up.
6.23.2009 10:12pm
MS (mail):
Jim Lindgren = Andrew McCarthy = Crazy
6.23.2009 11:51pm
interruptus:

Jim Lindgren = Andrew McCarthy = Crazy

A milder comment is that turning Volokh into a general partisan political blog, rather than a legal blog, would probably be a mistake. That's not its strength, and other area-specialist blogs that have gone the "general politics blog" route have almost invariably gone downhill, because the general-politics-blog thing is a saturated market. Volokh is a very good legal blog, probably in the top 3, but it would be a very middle-of-the-road anti-Obama blog.
6.24.2009 12:30am
Ricardo (mail):
I'm unaware of what Lindgren has been writing since I've been reading VC with the following URL for several months:

http://www.volokh.com/?exclude=jim,davidk,davidb

It's just as well that Lindgren doesn't allow comments: he's not interested in what others have to say and I'm not interested in what he has to say.
6.24.2009 12:37am
SFH:
Thanks, Ricardo. That does improve the blog immensely. Although for me excluding Lindgren is enough.
6.24.2009 12:51am
rick.felt:
And don't tell me that overuse of antibiotics will cause drug-resistant strains, because antibiotics are already overprescribed by physicians.

Overprescription is a problem that we should be trying to eliminate. We shouldn't be making it worse. I have a lot of libertarian impulses, but something with a real social cost, like antibiotic overuse, is one of the few things I'm willing to let the state regulate. If you want to smoke yourself stupid all day long, fine. If you want to drink yourself to death, fine. At least with pot and booze the abuser pays the price for his abuse. But the abuser doesn't bear the cost of his antibiotic abuse.

Anyway, I'm sympathetic to the idea that more self-medication is preferable to the status quo. We'd probably see fewer people clogging up emergency rooms and primary care facilities with colds and rashes if they had access to a fuller range of self-help remedies.
6.24.2009 12:54am
http://volokh.com/?exclude=davidb :

I'm unaware of what Lindgren has been writing since I've been reading VC with the following URL for several months:

http://www.volokh.com/?exclude=jim,davidk,davidb

Do I get any credit for this, or did you happen upon the technique without reference to my moniker? It's all about me, you know.
6.24.2009 2:16am
Bruce_M (mail) (www):
I think the anecdote about my former law associate speaks for itself vis a vis the subject we were talking about.


rick.felt:

I would agree that there is a more legitimate argument for regulation of antibiotics than there is for "controlled substances" (i.e. drugs with pleasant side effects that people desire to use for recreational purposes). While I think all drugs, from valium to cocaine should be sold over the counter (in pure, measured quantities not cooked up and adulterated by some criminal) and taxed by the government, I'd concede that a plausible argument can be made that one person's unnecessary use of an antibiotic can harm other people, thus satisfying the one and only true element for legitimate government regulation.

I still think antibiotics are just as overused by doctors now as they would be by people allowed to buy them OTC for their own use. Right now you and I could both get antibiotics if we wanted, just go to a doctor and cough up some phlegm. Better safe than sorry, don't want to be sued for not writing a simple Rx for a simple everyday antibiotic. If we made antibiotics schedule-II controlled substances, required doctors to write their prescriptions in triplicate with one copy sent to the government, with a few dozen doctors sent to prison for life each year for "overprescribing" of antibiotics (controlled substances) we would certainly see more restraint in their use, as the chilling effect of prosecution and trouble with state medical boards is quite strong - as is seen with the current trend of opiophobia and the severe undertreatment of pain (especially chronic pain). But more gov't regulation is the last thing I'd want to see.
6.24.2009 4:49am
Brett Bellmore:
I'll think doctors are serious about antibiotic abuse, when they do something about inadequate sterile procedure in hospitals. Antibiotic use might create resistant strains, but it's cross-infection in hospitals that puts them together into multiply resistant strains. It's not like the medical community doesn't know how to prevent cross-infection, they just stopped bothering after antibiotics were invented.
6.24.2009 6:57am
DeezRightWingNutz:
Neurodoc and any other doctors out there...

If you had to put money on it, would you take an intellegent lay person (say 2 Sigma above mean IQ) with an internet connection or an average GP to make a correct diagnosis?

Whenever I've seen intellegent people research their symptoms on the Internet, they've seemed to do as well as the doctors in diagnosing themselves, and they've known about the various treatment options that would be offered.

It seems to me like doctoring and lawyering are similar in that it's hard to be an expert in anything more than a narrow area, so when operating outside your specialty, what you need to be is an "issue spotter," not necessarily a repository of answers.
6.24.2009 7:43am
Mikeyes (mail):
OK, I'll bite. Here is the "Uptodate" paragraph on pruritis as it applies to Hodgkin's Lymphoma (there are hundreds of causes for this kind of itching.)This is the most up to date service for physicians.

Remember, this is only one of several pages of information that you would have to go through:

"Hodgkin lymphoma — Itching as a primary symptom is commonly seen in patients with Hodgkin lymphoma, developing in approximately 30 percent of cases, sometimes preceding the clinical presentation of lymphoma by up to five years [16]. It is typically burning in quality and most often located on the lower extremities. It is often more severe in older patients and patients with more advanced disease"

Now, with this information, could that Plus Two Sigma person make the right diagnosis? I doubt it as that person would not have the experience or vocabulary much less the ability to parse out what the itching means especially since it may have been the only symptom and there would have been no signs of disease in the several years prior to the diagnosis.
6.24.2009 8:08am
Mikeyes (mail):
Incidentally, if this was a Non-Hodgkin's Lymphoma, the itching would have only occurred 3% of the time. Then there is Polycythemia vera, Mycosis fungoides, Gastric carcinoid, multiple myeloma, the many leukemias, Sezary syndrome ... You get the picture.

One of the reasons that she was not diagnosed right away was that the starting point for diagnosis with only one symptom is huge and the most likely diagnoses were the ones stated. In order to have diagnoses a lymphoma on only that information probably would have required a Plus 40 Sigma brain. (Hyperbole)
6.24.2009 8:35am
Bruce_M (mail) (www):
Oh I'm not saying anyone, not even Dr. Gregory House himself, would have instantly diagnosed her as having N-H Lymphoma merely from itching.

The problem was that no doctor was able to eliminate other more likely possibilities and think to test for such a deadly, serious condition - which can cause this symptom, a symptom with no other apparent cause.

If I've implied that I think the cancer should have been the initial, walk-in diagnosis from any reasonably competent doctor, then I'll clear that up now (I don't think I've implied that at all, quite the contrary). She was ultimately told that it was all in her head - final diagnosis. Maybe if society didn't put such a stigma on self-diagnosis, she would have taken more time to research it herself and get the information to get lymphoma ruled out by medical tests (which would have confirmed the disease). Clearly lymphoma was not one of the many possible causes any of the doctors she went to looked for.
6.24.2009 10:10am
neurodoc:
DeezRightWingNutz: If you had to put money on it, would you take an intellegent lay person (say 2 Sigma above mean IQ) with an internet connection or an average GP to make a correct diagnosis?
If "an intelligent lay person (say 2 Sigma above mean IQ)" were to have legal problems, do you think they should rely on their own analysis of those problems or at least get the thinkng of an average general practice attorney? In most instances I would advise them to consult an attorney, and in almost all, if not all, instances I would advise low and high IQ individuals, with and without internet access, to consult a physician, whether a general practitioner or a specialist, with anything more than trivial health concerns. (I'm not sure what is to be understood by "average GP," but I think it probably reflects unwarranted disparagement.)

My late father, a surgeon, told me many times to get the best legal and accounting advice always. He reasoned that physicians buried their mistakes, whereas people had to live with the mistakes of attorneys and accounts. He was being sardonic, of course, and in truth was very much against bad medical care too.
6.24.2009 10:16am
wfjag:

If you had to put money on it, would you take an intellegent lay person (say 2 Sigma above mean IQ) with an internet connection or an average GP to make a correct diagnosis?

Well, I typed in the symptoms and found the following:


Bras and the Breast Cancer Cover-up
October 15th, 2008 by admin

"Whom can you trust when your culture is the biggest enemy of your health? Can you trust your culture's leading authorities? Can you trust your culture's government? Can you trust your culture's private industry?"

We asked those questions in 1995, at the end of our book, Dressed To Kill: The Link Between Breast Cancer and Bras. Before writing our book, we sent details of our research to the National Cancer Institute, American Cancer Society, President's Cancer Panel, American Women's Medical Association, National Organization for Women, National Women's Health Network, and National Women's Health Resource Center. There was no response. Not one. Given the lack of interest, we decided to publish our findings in a book, getting the information directly to the women who needed to hear it.

But are women getting the message?

It has been 13 years since our book was first published. Over that time, more than 500,000 women in the US alone have died from breast cancer, with another 2,000,000 having been diagnosed with this terrible disease — a disease that is in most cases preventable by simply loosening up or eliminating the bra. And yet, this lifesaving information has been actively suppressed and censored by the medical and lingerie industries.

Examples of Suppress and Censorship

You can read the rest of this quite entertaining article at www.healthordisease.com/category/cancer/

You can find lots of interesting "information" on the internet. Whether you want to bet your life on it is a different question.
6.24.2009 10:19am
Careless:


It has been 13 years since our book was first published. Over that time, more than 500,000 women in the US alone have died from breast cancer, with another 2,000,000 having been diagnosed with this terrible disease — a disease that is in most cases preventable by simply loosening up or eliminating the bra. And yet, this lifesaving information has been actively suppressed and censored by the medical and lingerie industries.

I always enjoy learning about previously-undiscovered bunches of lunatics. Thanks, wfjag.
6.24.2009 10:25am
neurodoc:
Mikeyes, your contribution was a good start, but only a start, to an answer. If one were to go further, one would have to summarize a great deal about making medical diagnoses. Bayes theorem figures in. (I have in mind a book published within the past couple of years that does an excellent job of it. Unfortunately, I can't think of the title, nor the author's exact name. He is a physician, last name starts like "gro...," first initial might be "J," does either oncology or AIDS, either at Harvard or UCSF...).
J.R.L.: More people should self-diagnose. I believe that studies show that 85-90% of things that people go to the doctor for are self-healing. That is, there is nothing the doctor can do to help them. Imagine if even a third of them never went to the doctor to begin with.
I see no logic to engage with in that.
6.24.2009 10:34am
Chem_Geek:
ASlyJD:


I know GM doesn't do its patent work in house.

I rather like this, as it's paying my bills this summer . . .


As a former Tier I supplier, I say that I hope for your sake you got paid up-front.
6.24.2009 11:10am
Mikeyes (mail):
Bruce_M,

Patients should strive to know as much as possible about their illness. I always ask mine to look up my diagnosis on the net - I do warn them that there are a lot of unreliable sources out there - and to come back with any questions that they might have. I try to explain why I made certain diagnoses and in many cases why I am still looking for the possibility of an alternative diagnosis. Medicine is not an exact science, in fact it is not a science at all, rather it is a application of science. We don't have all the answers all the time.

Your colleague was unfortunate. She may have had a poor choice of physicians, she may have never had a definitive sign or symptom until it was too late, and she obviously didn't meet a doctor with a Tri-Corder. Bad things happen in medicine all the time, some avoidable, some not.

There is nothing wrong with people trying to self diagnose. Their catch rate will be much less than someone who diagnoses it for a living but it is cheaper. There are plenty of things that can be done to improve diagnosis, but there are also cost-benefit (usually the benefit is to the insurance company, however) analyses that limit the how far someone can go. In addition there is no way to determine who the best doctor are (although there should, in theory, be a limit on incompetence) even if you are a physician yourself. You are more likely to find someone at Mayo Clinic who will find the obscure illness but they are not 100% either.

Neurodoc brings up a good point when he talks about Bayesian analysis in medicine. Few physicians use it as a way to parse out diagnoses and it can be a help. But even here there are limitations. (Bayesian analysis will give odds as to the type of disease you have and help with determining how the diagnostic pattern should proceed - whne to do the expensive testing, etc. But if you have a 1.3% chance of having cancer and an MR will tell you for sure, would you forgo the test just because it is unlikely? Unlikely.)
6.24.2009 11:18am
rosetta's stones:

"As a former Tier I supplier, I say that I hope for your sake you got paid up-front."


That won't help, if the courts claw it back, which they will if they take a notion, during bankruptcy.
.
.
.

If Bruce M's case study sets up as he's described it, that does seem to be a medical diagnosis miss. Doctors shouldn't send somebody out of their office without handing them all the potential causes of their condition. Heck, I get that sorta printout when I go to the vet, with my dogs.
6.24.2009 11:19am
Bruce_M (mail) (www):
Rosetta stones: I don't think it would have done her much good to give her a list of the 15,692 medical conditions that can cause rashless full-body itchyness, either.

Mikeyes: I agree. I think the nuts and bolts of what I'm trying to say is that, as a whole, professionals want to keep their monopoly and do all they can to discourage individuals from doing the work for themselves. Surely the majority of the time, they would in fact be better off with a professional. I know that most doctors go nuts when a patient comes in to the office already having diagnosed herself on the internet, with a huge stack of pages printed off google, webMD, doctor.com, whatever. As a lawyer, I always get annoyed when clients tell me they read on the internet this and that.... because the signal to noise ratio is pretty low, i.e. there's a lot of bad info out there. I'm sure it's the same for all professions. But I don't let my annoyance show (unless the client argues with me about it) and say that the info is either wrong, right, or that I'll look into it. And I wouldn't tell someone to not research and read about the law concerning their particular situation. I sure hope that I could do a better job than they could representing themselves pro se. But who am I to make that determination? Pro se litigants are held to a different standard by both judges and juries than those with counsel. And I really hate how so many criminal defense lawyers play it too safe and nearly always tell their client not to take the stand, even if there's no good reason (i.e. "you may seem nervous and the jury will see that as guilt" - that's a bad reason not to testify... practice and get the client ready, and even if they do seem nervously guilty it won't outweigh the appearance of guilt shown by not getting up there and defending yourself, despite all jury instructions to the contrary).
6.24.2009 11:52am
rick.felt:
Right now you and I could both get antibiotics if we wanted, just go to a doctor and cough up some phlegm.

True, but first I'd have to go to the doctor, and I don't have time for that noise right now (and I have a flexible schedule), plus I don't feel like shelling out my copay. I can't imagine that people who actually have to burn sick time to leave the office for two hours during the day would be any more interested than I am in leaving work if antibiotics are available OTC. Remove the pain-in-the-ass barrier currently standing between the public and antibiotics and you'll start to see everyone popping them at the slightest throat tickle.
6.24.2009 12:13pm
wfjag:

I always enjoy learning about previously-undiscovered bunches of lunatics. Thanks, wfjag.

Welcome Careless. When I need a laugh, I check for conspiracy theory websites. Actually, I was attracted to VC due to the name. And, even here -- although overwhelmingly the comments are tethered at least somewhat in reality -- there are some that trigger the Twilight Zone theme music. Lunatics of the World Unite!


Dear Bruce_M: A place it seems to me that your analogy between law schools and med schools breaks down is the cost of establishing and maintaining one. I read somewhere a few weeks ago (sorry, can't find the link) that the cost of establishing a med school is around $100 Million. Operating costs, which are substantial, are on top of that.

When the limiting factors for student numbers are things like classroom size, access to computer stations and internet hook-ups -- which are limitations for law school class sizes -- the factors are relatively easily overcome. The limitations for med schools are laboratory sizes, equipment (i.e., MRIs, fMRIs, CTs, etc., as well as microscopes, etc.), cadaver availability, and factors like those. Although they can be overcome, they are not easily or quickly addressible, and they are expensive to address. Consequently, the planning for a med school is more important, since it is much more difficult and expensive to make changes.

With a law school, to hold down tuition increases, the school can squeeze in 10 or 20 more students into an incoming class, and maybe keep 10 or 20 in the 2L class that in prior years would have been advised to consider a different career. Med schools don't have that option.

Even assuming that there are a significant number of potential qualified applicants for MD and DO schools who do not attend because there aren't enough med schools, and assuming that foreign med schools and foreign-trained doctors are not coming to the US to fill any shortfall in needed MDs and DOs, it is still an expensive, multi-year effort for a university either to open a new med school or expand an existing one. Accordingly, I don't think that one can conclude that the costs or availability of med care in the US is significantly related to the AMA trying to maintain a monopoly and limit the numbers of MDs and DOs licensed. Rather, the costs of estabilishing and maintaining med schools do that.
6.24.2009 12:49pm
rosetta's stones:

I don't think it would have done her much good to give her a list of the 15,692 medical conditions that can cause rashless full-body itchyness, either.


Of course it would have, particularly if the list was grouped, categorized and statistically analyzed, as are the printouts my vet gives me for my dogs.

Certainly, not every patient would or could make use of that information, and it doesn't absolve the professional of any potential undiagnosed illness, as the case study here might indicate. But, it engages them, and it forces the professional to be fully engaged as well.

At minimum, that woman should have walked out of that professional's office with that list, and a discussion of it at least in general terms... rather than just an admonishment that it was all in her head. This particularly after multiple visits, as appears to have been the case.

I'd consider this merely a part of a solid communicative relationship with a client. You always bring them into the process. Always. And that requires more than just saying "trust me".
6.24.2009 12:51pm
anon2345 (mail):
Did you notice Lindgren polluting the blog with posts all around you?
6.24.2009 1:06pm
Fub:
neurodoc wrote at 6.24.2009 10:16am:
My late father, a surgeon, told me many times to get the best legal and accounting advice always. He reasoned that physicians buried their mistakes, whereas people had to live with the mistakes of attorneys and accounts. He was being sardonic, of course, and in truth was very much against bad medical care too.
Heh. Reminds me of an old joke, which I'll adjust apropos of Bruce_M's story at 6.23.2009 6:41pm.

Patient Patience: Doc, I've suddenly got this burning itch all over my feet and ankles.

Doc: It's probably psychosomatic. You just think your feet itch. Just apply some OTC local anesthetic soothing ointment. Try some anti-fungal Athlete's Foot cream just in case. It'll go away.

Patience (six months later): I applied all kinds of OTC goo. I've still got this burning itch.

Doc: Now I know it's psychosomatic. You just think it itches. Don't scratch it and inflame the area. It'll go away.

Six months later, Doc meets Patient's friend on the street.

Doc: How's Patience? I haven't seen her in a while.

Friend: She thinks she's dead.
6.24.2009 2:20pm
interruptus:

You can find lots of interesting "information" on the internet. Whether you want to bet your life on it is a different question.

You're going to have to, whether you want to or not, because physicians are increasingly looking up info online.
6.24.2009 2:32pm
Bruce_M (mail) (www):
wfjag, with all due respect, I'm not making any analogy between law schools and medical schools. I'm just talking about expert opinions in general, and the presumption of correctness that they are due (if any, or to what extent).

I'm not making any comments about healthcare in general, or the costs of any professional services.

rosetta's stones, ehh maybe so. You may be right. It could have pointed her in the right direction. Itchiness in and of itself, without more, is just an extremely vague and general symptom of so many things. That's why it was so important to rule things out, do tests, and do more when those came back negative. Standard differential diagnosis. There's no excuse not to find cancer in someone. But going to a dermatologist, they don't see a rash so they say it's all in your mind. Go see a shrink and they say it's gotta be a skin problem. I don't know exactly how many or what types of doctors she had seen, but I know she got multiple opinions and not one ever looked into lymphoma until it was too late.

And then there was the prescribing of darvocet and other worthless, pissant painkillers to her, a dying cancer patient, because the doctors were too chickenshit to break out the triplicate pad and write a Rx for a real C-II painkiller.... that's an equally egregious form of malpractice IMO. I mean, if you're not going to give Oxycontin to someone in horrible pain from terminal cancer, who are you going to give it to?
6.24.2009 2:36pm
neurodoc:
Jerome Groopman, How Doctors Think. I've only read reviews, but am certain it does a much better job than I could hope to do here.
6.24.2009 3:05pm
neurodoc:
Bruce_M: There's no excuse not to find cancer in someone.
Categoric statements are generally (allows for exceptions) a bad bet, and yours isn't the exception here. (Nor, do I suspect is the one about letting criminal defendants take the stand. If the best of the criminal defense bar often do not put their clients on the stand, I assume they are exercising good professional judgment. Do you think the late Johnny Cochrane should have let OJ testify?)
6.24.2009 3:21pm
neurodoc:
Mikeyes: You are more likely to find someone at Mayo Clinic who will find the obscure illness but they are not 100% either.
Personally, I'm partial to Hopkins, designated the best hospital in America by US News &World Report for the past 10+ years. (If you visit Hopkins, you will see large posters of the magazine's covers lining the walls. And yes, I appreciate that one should bracket those rankings for hospitals, law schools, colleges, restaurants and whatever else they may rate with fairly wide confidence intervals.) Someone I have known for more than 35 years was seen by a world-renown expert in a narrow medical subspecialty, spending a week there in Rochester, MN. The diagnosis he got there was incorrect, and the correct one was made promptly by the department chair and a colleague at Hopkins. Undoubtedly, it has gone the other way in other cases between those two excellent institutions, as well as between/among others of outstanding caliber, to say nothing of lesser ranked ones.

Mikeyes, you didn't say at first that you are a physician. (Internist?) But not necessary to know that to appreciate why some of the things said here are so wrong. And I will add that computers for all they have and will contribute to medicine, especially in areas like imaging, have not reduced the need for physicians, nor will they in the course of many, many years, if ever. (I wrote a long class paper >15 years ago in law school on the "doctor-computer-patient relationship." Should have polished and published it, but didn't.)
6.24.2009 3:51pm
rosetta's stones:
Computers bring a lot, if you let them. My wife's doctor was stumbling into the exam room with paper folders as recently as 2 years ago. I like the woman, but eventually they all need to break the seal on this technology thing.

My doctor was wireless before wireless was cool. Of course, he also built his own med center building, lab and pharmacy, with self referrals abounding I'm guessing, and may be running roughshod on the system in all kinds of other clever ways, but that's another story.
6.24.2009 4:20pm
Bruce_M (mail) (www):
neurodoc: I agree, my statement was overly broad... I meant it in the context of my story, where she found her first symptom over a year before being diagnosed. Would you agree that it should not take a year to diagnose cancer? I know that's not what I said, and I concede my categorical statement was too broad - I'm sure there are cases where there are plausible reasons why cancer was not found.

I didn't make a categorical statement about criminal defendants taking the stand - and there were very good reasons why OJ should not have taken the stand - too much evidence he'd be forced to explain himself. Based on my experience, even though a defendant has the right not to testify and has the right not to have that held against him, the jury will always hold it against the defendant nonetheless. There is no way to get past the "if he were innocent he'd get up there and tell his side of the story" factor. So, it's extremely important that, if possible, a defendant take the stand. There are many good reasons for advising a defendant not to testify, and there are a lot of bad ones. It's my opinion that a lot of crim def attorneys advise their clients not to testify for bad reasons, which many times results (or exacerbates) the conviction. Obviously it's impossible to collect any data to prove this... it's just my opinion.

You can accept my opinion without question knowing that I'm a licensed attorney who has practiced criminal defense, or you can question my opinion, give it a rebuttable presumption of being correct - whatever you like. That's my overall point on this thread. I don't think credentials should be the sole factor in judging someone's opinion. People can pull facts out of their ass and be 100% correct.

I'm sure you can find some attorney who would disagree with my premise that juries hold a failure to testify against a criminal defendant, even when they're told by the judge not to do so.

For every expert opinion, there is an equal and opposing expert opinion....
6.24.2009 4:38pm
rosetta's stones:
Some jurors will listen to a judge's instruction on that, Bruce. I was challenged by a few fellow jurors once, because I held my hand flat on the table to indicate the amount of testimony evidence presented by a defense attorney, whose client didn't testify, with my other hand held up off the table, to indicate the prosecutions' testimony evidence, who had the victim testify. My only point was that something was greater than nothing, if you believe that testimony. A few jurors cautioned me on the judge's instruction, and I responded that he also told us to weigh all the evidence as well, and I was.

It could go either way, I guess, but I can see things going awry if your client is guilty, and not nimble enough to talk through tough questioning, with other evidence on the table. But if they're that guilty, cut a deal!
6.24.2009 5:08pm
Bruce_M (mail) (www):
Some evidence does not equal proof beyond a reasonable doubt... I hope you didn't convict just because it was some versus none - especially since the defendant has no duty to put on any evidence. And even if it does cause a few jurors to listen - and not be swayed by the other jurors - it will cause a mistrial and the prosecutor can get as many re-do's as they need until there's either a conviction or an acquittal.

Only when a criminal defendant does put on evidence does "weighing" come into play. And if the prosecutions evidence is only more likely than not true, it should not be a conviction.

But yeah, some jurors will listen. Or they'll say they listened. It's hard to contradict human nature merely by telling people to do so. Jurors want a defendant to explain his side of things, and when he fails to get up on the stand and do so, there is a somewhat logical presumption that he's doing so because he has something to hide. Very dangerous in a criminal case.

I have very little faith in juries in criminal cases. The jury system only works where the citizens are inherently critical of and distrust the government. When citizens see the prosecutor and cops as the "good guys" there is no point to the jury system (I'm talking about criminal cases here... I think juries work quite well in civil cases). It's even worse when the average juror spends 5 hours a day watching TV shows where cops save vulnerable victims from 100% guilty defendants (the viewer is a fly on the wall who gets to see the defendant commit the crime and knows he/she is absolutely 100% guilty, zero doubt at all). In the real world, there is and should always be doubt about any allegation or conviction. Even when there's a confession.

But I don't want to change the topic of this thread to juries.
6.24.2009 5:27pm
Dan Ensign (mail):
Randy R.:

Dan: "Of course, people could misdiagnose and hurt themselves. Then again, I hold the unpopular view that people are generally smart enough to ensure their own self-preservation. (If they weren't, and require government health care to survive, then how the heck did the human species get so far?)"

Well, this cuts both ways. One could say then that we could do away with the entire medical establishment, because after all, we somehow survived for eons without them. But we actually didn't -- life span was shorter, diseases were often fatal, and people had miserable lives. I, for one, would have hated to have the primitive dental care that existed before the 20th century.


For millenia, we've had something along the lines of a "medical establishment," which one way or another people used to make themselves at least marginally healthier than they would have been otherwise, at least on average. It's not any different now, except that the quality of medical knowledge and hence care has become super kick ass. The point is not that we don't need a medical establishment, but that it's not the medical establishment necessarily that makes us healthier--rather, it's increased medical knowledge.

Armed with this knowledge, I believe, people can themselves do in most cases equally as well as a trained expert. Of course, if an expert's services are required, then an expert can be hired. Mainly, having the option makes things cheaper, and therefore more people healthier.
6.24.2009 6:01pm
rosetta's stones:
Bruce, the cop shows likely help the defense as much as the prosecution. You get some 19 year old girl on your jury, who's an expert forensic investigator, quoting chapter and verse from CSI or whatever, and then talk to me. I had one on the above trial. The prosecutor whimsically queried us whether we believed in alien intervention, during pretrial. He was prescient, 'cause I think she did.

Always choose 19 year old girls on your panel. If anybody can get your guy off, it's them!
6.24.2009 6:06pm
Bruce_M (mail) (www):
rosetta's stones: there is certainly a "CSI effect" on juries, I don't deny that, but that's quite easy to alleviate in voir dire. Nearly all prosecutors I've seen tell the jury pool that in real life, they don't have all the fancy pseudo-science they show on TV (except of course when they intend to use such evidence, i.e. "bite mark analysis"). Plus, I have personally never really bought the logic that just because TV shows and movies show all kinds of futuristic, unavailable, borderline ridiculous means of forensic analysis (in "The Dark Knight" Batman somehow managed to pull a fingerprint off of a fired, shattered bullet taken out of a cement wall) that juries will acquit a defendant unless they get to see that type of evidence. I've never heard a juror say they would not convict a defendant without evidence of a DNA hydrodynospectroscope with UV filter cross-referenced though a world-wide database. I don't really get the logic... I think it's something like "because of CSI etc., the jurors expect to see certain types of evidence, and if they don't see that evidence then they will acquit the defendant." I don't buy that. Juries are more than happy to convict anyone. It's the default position - presumption of guilt. Better to lock up 1000 innocent people than let one guilty person go free (so he can snatch and rape a cute white blond-haired child and give Nancy Grace something to talk about for a month). The innocent people who are locked up in prison won't hurt anyone.

It used to not be that way. It used to be a real presumption of innocence. It used to be that convicting an innocent person was the worst possible thing our justice system could do - it was better to acquit 1000 guilty people than to wrongly convict one innocent person.

If I were a prosecutor I'd probably want a stupid girl who believes in alien abduction - it means she is prone to believing fantastic claims without sufficient evidence. Why would the party with the burden of proof not want such a person on their jury (all else being equal)?
6.24.2009 6:54pm
Harry Eagar (mail):
Long as we're telling jokes, here's my favorite. (Full disclosure: I was fired for insulting a chiropractor. My punishment was to be forced to take the best job I ever had.)

This is a story chiropractors like to tell on doctors:

A man's feet hurt. He went to physician after physician, and they all charged him a lot of money, prescribed expensive and dangerous drugs, and still his feet hurt.

After months of agony, a friend recommended he go see his chiropractor.

The man did, and the chiropractor told him, "Buy shoes one size bigger," and the pain went away.

Chiropractors tell this story to impugn real doctors, but the moral I draw from this story is that the perfect chiropractic customer is somebody so stupid he has to pay someone to tell him to wear shoes that fit.
6.24.2009 7:01pm
neurodoc:
"if he were innocent he'd get up there and tell his side of the story"...
Forgive me for going still further OT, but...

That is the subjunctive there ("if he were..."), right? Does that use of the subjunctive carry any implication of "not innocent," because the subjunctive is used for statements "contrary to fact"? The subjunctive also expresses "possibility," so is there no implication of "not innocent," this use of the subjunctive just implying uncertainty as to "innocent" or "not innocent"? A fastidious grammarian would go with "were" rather than "was"? (Again, sorry for going further OT, but I can't answer this for myself.
6.24.2009 8:24pm
neurodoc:
Harry Eagar, I can't readily imagine the circumstances under which you were fired for insulting a chirpractor (or chiropractic?). Glad it turned out for the good, though.

I think your interpretation of that chiropracter joke is the right one. The man in the joke can be counted lucky that his presenting complaint was sore feet, not something for which a chiropractor might have manipulated his neck, something that has resulted in some very serious neurologic injuries. (Yes, someone will jump up to say that it is not unknown for medical interventions to produce disasterous results. Those medical interventions, though, are not as often follies from the start as are chiropractic manipulations of the neck.)
6.24.2009 8:32pm
Bruce_M (mail) (www):
Statements contrary to fact are just one use of the subjunctive. Subjunctive is also used for expressions of uncertainty, possibility, wishes, and some other things. You note that it's also used to express possibility.

I used the subjunctive to give the possibility of "not innocent" in that sentence.

I do think I should have put a comma after "innocent" though.
6.24.2009 10:35pm
Eli Rabett (www):
Are there not annual training requirements for physicians (often held at golf resorts with sponsorship from pharma)? They should be up to date, or at least have a clue about changing practices.

Further, much of the discussion is a validation of the Obama administrations proposals for evaluating the effectiveness of medical practices including diagnosis and making physicians aware of the results.
6.25.2009 9:38am
rosetta's stones:

"If I were a prosecutor I'd probably want a stupid girl who believes in alien abduction - it means she is prone to believing fantastic claims without sufficient evidence. Why would the party with the burden of proof not want such a person on their jury (all else being equal)?"


Bruce, I obviously haven't had the trial experience you've had, but the few run-of-the-mill cases I've been exposed to have never involved "fantastic claims" from prosecutors. That guy must have some budget, if he's able to concoct cases like that, and be consistently appearing in front of judges with them.

The defense is trying to create reasonable doubt, and alien intervention and other fantastic claims have the potential to introduce doubt, which is why this tactic would tend to favor the defense. It may be anecdotal, but I've seen this dynamic in action. Not to mention, accompanied by defense opening statements about a "corrupt cop", unaccompanied by evidence during trial.

I think we're both talking about the natural tensions that our system operates within. You say you don't trust juries, and maybe you're right, but what else should we do? Ask for a bench trial, I guess, but then you give up the 19 year old girl factor, and if you get in front of the wrong judge... sayonara.
6.25.2009 10:20am
wfjag:

Further, much of the discussion is a validation of the Obama administrations proposals for evaluating the effectiveness of medical practices including diagnosis and making physicians aware of the results.

You're describing establishing standards of care -- something the medical profession, and the many subspecialties of medicine, have been doing for well over a century. The Obama administration proposals -- or, more exactly, since the Obama administration has punted on drafting anything, so the proposals should be regarded as the Democratic Party Leadership in both Congressional Houses Proposals -- mainly will undermine the effectiveness of the process that now exists by introducing layers of government bureaucracies into the process and placing a heavy emphasis on cost as a more important consideration than effectiveness. Quite telling was the President's refusal in the townhall to pledge to have his own family's med treatment bound by the same standards as others will be bound. He stated that for his family, he will do whatever is necessary to ensure that they receive the "best" medical care. In countries on which the Congressional proposals appear based, such as the UK and Canada, you get the medical care that the government makes available. In the UK, if you go elsewhere to obtain care that is not available through the national system, you can lose the right to receive any care through the national system. Under the Canadian system, if you can afford it, you can go elsewhere, at your own expense, to obtain care -- which is why many Canadians with the means to do so, come to the US.

As, according to the CBO, under the current proposals, the costs over 10 years will be $1.6 Trillion, some 23 million people with private insurance will lose that so that they are forced to obtain coverage under the government system, and some 25 to 36 million (of the asserted 47 million) people who are uninsured will remain uninsured, it's difficult to see any merit to the proposals. There are flaws in the current way health care and insurance or government payment coverages are provided. However, the current proposals backed by the Dem. Congressional Leadership appear neither to correct those flaws nor offer a better alternative. If you believe there are significant advantages for the current proposals, please explain them.
6.25.2009 12:37pm

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