Sad that people can’t see past their ideological bubbles. Tech spaces used to be dominated by people who saw free speech as an imperative. Now their own political biases have them supporting censorship.
I feel like hackernews has been getting astroturfed by the same people that ruined reddit. Over the past few months, there have been increasingly one sided political stories and comments. It's a shame.
> Any average citizen would be arrested and detained.
yes, ICE thugs would probably behave equally lawlessly towards any civilian challenging them for a warrant. that doesn't make what happened less horrifying.
> They are not "thugs". They are federal officers.
are they? maybe they should identify themselves as such with names, badge numbers, and warrants?
> They are upholding federal law.
they clearly aren't given the number of court cases the Trump administration is rapidly losing related to its deportation activity.
> This constant manipulation of words is tiring
this constant sanewashing of cruelty is tiring. you should find it horrifying.
but I'm not going to go in circles with you. I hope you eventually look back on this part of your life with shame about your beliefs and who and what you defended.
Searching around a bit, this fork does seem to meet the criteria I was looking for (plus a few hidden ones like project age; it's a couple years old and still being updated, which means the dev is willing to put the work in as opposed to abandoning it when they get bored). The blocker on widevine being Googles fault (while still supporting L3 out of the box) rather than deliberate "we're not even going to try" is much more acceptable than the Librewolf one.
> The blocker on widevine being Googles fault (while still supporting L3 out of the box) rather than deliberate "we're not even going to try" is much more acceptable than the Librewolf one.
I don't know, I think not caving in to support some proprietary BS is pretty justifiable.
Proprietary or non-proprietary isn't something I particularly care for (maybe 10 years ago I'd have cared, but I'm just a good deal more cynical these days I suppose). I just want a browser that works and doesn't actively try to screw me over.
There's nothing stopping Mozilla's current descent into stupidity just because Firefox is non-proprietary free software; they have enough engineers and manpower on their end to overtake any forks in development speed (which limits any forks to trying to stay in sync with either upstream or ESR.) Chromium is as a browser non-proprietary too, but that didn't stop Google from getting rid of declarativeNetRequest, leaving the forks mostly powerless to do anything about it because they can't hard fork Chromium.
5. This has been brought up so many times by in the past few years and is very unlikely to pass scrutiny.
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The federal government has the ability to tax "income." Unrealized gains are not income as gains have not been clearly realized.
The closest legal definition for "income" comes from:
The Glenshaw Glass case
In Commissioner v. Glenshaw Glass Co., 348 U.S. 426 (1955), the Supreme Court laid out what has become the modern understanding of what constitutes "gross income" to which the Sixteenth Amendment applies, declaring that income taxes could be levied on "accessions to wealth, clearly realized, and over which the taxpayers have complete dominion". Under this definition, any increase in wealth—whether through wages, benefits, bonuses, sale of stock or other property at a profit, bets won, lucky finds, awards of punitive damages in a lawsuit, qui tam actions—are all within the definition of income, unless the Congress makes a specific exemption, as it has for items such as life insurance proceeds received by reason of the death of the insured party, gifts, bequests, devises and inheritances, and certain scholarships.
Look at how many times NHS is referenced and how it is viewed by those utilizing the system. In my opinion, socialized medicine tends to fail as the overall demand for healthcare will usually exceed the available supply in most societies.
I'm sure there are counterexamples to be provided; however, I think the benefits of a capitalist healthcare system are underappreciated.
Your point is “we have too many sick people, let some of them die so the rich can keep their ease of access” and it’s gross.
That’s what “demand” represents in this equation. Not people who want faster cars or different colored Stanley cups, but access to life saving drugs and treatment. I’m not saying para-socialized systems are better (it’s capitalism with a wig) but the “benefits” of capitalism are nowhere near equally shared and in fact highly concentrated at the top. The benefits are in fact over-appreciated by those who have them and they will do anything to keep the dirt people away from their stash.
I don’t have a solution, but my point is praising mass death for the squalid masses is tacky and I personally wouldn’t do it on public forums.
I am a physician, and I am also entitled to my own opinions. You can take a moral highground if your want. But, I feel I know more about healthcare than most people on this public forum. I tend to deal in practicality.
And where do you see me praising mass death?
Further edit:
I would go far enough to say you lack any understanding of our current healthcare system besides meaningless feelings on how it should be in a utopian society. Resources are not limitless. There is a continual shortage of healthcare providers which there are no good solutions for currently. If you don't want to address this reality, there is really nothing to address at all.
A good start to fixing the shortage of healthcare providers would be to permit more medical schools, allow more students in per year, and reduce the cost of an MD. Because medical school costs so much, more and more graduates are going into specialties because they won't make enough to cover their loans and live comfortably as a family doctor or general practitioner.
> I think the benefits of a capitalist healthcare system are underappreciated
What benefits? The benefit of mortgaging your home to pay for cancer treatment? The benefit of having your access to healthcare directly tied to your employment (especially considering that many wage workers are kept from working more than 35 hours a week lest they become eligible for employee sponsored health plans)? The benefit of having folks like Martin Shkreli corner the market on generic drugs and raise the prices, not because manufacturing costs have risen but because they are seeking windfall profits?
Seriously, what benefits? We have this silly notion that capitalism provides us with choice, and that this choice is a desirable good in itself. Choice is overrated. Health care is a commodity. You walk into any doctor with a broken arm, diabetes, COVID, pneumonia, depression, or any one of hundreds of other maladies, and the treatment for those will be the same regardless of the physician or the hospital or the clinic.
It's not just choice but access. The access to see a specialist without waiting months. The access to see a different provider if you don't like your care. The access to pay cash for services. Choice is also underrated.
Those same people you say can't afford healthcare are the ones that are heavily subsidized by others through ACA, free community health plans, or Medicaid.
Healthcare is not a commodity despite your claim. It requires labor.
It seems most people are generally satisfied with their health insurance in the USA as opposed to the UK (see links below). In fact, the satisfaction from employer provided healthcare was much higher pre-ACA than it is currently. The middle class got shafted with increased premiums and deductibles to help subsidize those with low income. This has led to lower healthcare utilization rates in the middle class. The rich don't care since it's a marginal cost relative to their income/wealth. And, the biggest spenders (elderly) don't care since they are mostly on Medicare.
Most of the countries that report high satisfaction with their socialized medicine are both rich and have a low population count.
I agree. It's not hard to make an account to "lurk". I'm sure most of those complaining have accounts at various other social media websites. It may cost some privacy, but I find the content more than worthwhile.
There is content on Twitter that is not available anywhere else. It frequently breaks news faster than any other source, and there are many high profile posters who use it as their only broadcast source. Some memorable examples include the FTX and OpenAI fiascos.
The website isn't stellar, but it is functional. Lists are a great feature to separate content into custom feeds.
Maybe there will be something in the future that can serve as an alternative, but there is none currently.
I don't know why some people on hackernews have such a bias for deriding physicians. If you don't like the care you get, go somewhere else and get another opinion. Of course the bell curve of probabilities exist in medicine...just like it exists in every other field or more broadly the universe.
This article is about the potential downsides of radical transparency...not just the default level of transparency. For many years/decades, records have always been available to patients upon request. This new immediate availability is something entirely different and brings about another set of problems.
Imagine having 15 minutes to see a patient, document on the chart, order labs/imaging, and provide disposition to a patient. Then, they have free reign to message you regarding some irrelevant piece of data in the chart or labwork that you need to respond to. Too much patient access does have problems, and I can provide you some mundane examples. I documented about an excoriation in one of my charts, and the patient calls back complaining that I called them a skin picker and wanted me to change my documentation. If you google excoriation, you do not get the medical definition or understanding of the word but a link to excoriation disorder. Another patient wonders why their eosinophil percentage is 0.1% above the upper limit of normal.
To me, the chart serves more as a note to colleagues who have the relevant understanding to piece together what happened during the visit. Giving patients immediate access to their charts will have very little benefit in my opinion given the high prevalence of EMRs and easy access to charts for anyone that actually cares.
To say that most doctors are terrible is one of the worst takes I've read. Most doctors are probably average, and their average medical knowledge is likely a standard deviation or two above the average patient.
> The whole death by medical error thing is also of uncertain evidence. See: https://www.mcgill.ca/oss/article/critical-thinking-health/m...
I've read the McGill article before; what it fails to mention is that the analysis has been performed multiple times by multiple parties and the results have repeatedly converged on the same point: somewhere between tens of thousands of human beings to one hundred fifty thousand human beings (at the very least) have their lives cut short because someone messed up. These statistics are for the US alone. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070928/https://effectivehealthcare.ahrq.gov/products/diagnostic-err...
It is perfectly reasonable to argue that the estimates are wrong. In that case, the solution is quite simple. Record data on misdiagnosis and physician failure, but that's a solution that the AMA has opposed (while talking about the ethical duty of disclosing medical error, of course).
> The AMA and the American Hospital Association vehemently opposed an attempt by President Bill Clinton to create a mandatory reporting system for serious errors. The groups launched a multimillion-dollar advertising campaign that said mandatory reporting would drive medical errors underground. From 2000 to 2002, they spent $81 million on lobbying efforts, according to campaign statistics collected by the Center for Responsive Politics.
> Mandatory reporting was dead on arrival.
There is no other civilian profession where death at this wide a scale is acceptable. Or, is taken as a matter of due course.
There is no other civilian profession where this has been the norm for centuries.
Every time a plane crashes, we perform investigations, improve, and fix. Every time there's a loss of crew on a human-rated spacecraft (or a loss of an autonomous vehicle), there's an investigation to fix what happened. Every time a bridge or a building collapses due to structural deficiencies, there's an effort to study what went wrong and how to fix it.
These reflexive investigations are pervasive everywhere. Except medicine.
Every single time the veil has been lifted, there has been something deeply ugly underneath. For example, doctors are the reason why so many women end up falling prey to Goop, because medical professionals fail — at a systemic level — to take their concerns seriously. The problem exists everywhere from the GP level to surgery,
> While associations were consistent across most subgroups, patient sex significantly modified this association, with worse outcomes for female patients treated by male surgeons (compared with female patients treated by female surgeons: aOR, 1.15; 95% CI, 1.10-1.20) but not male patients treated by female surgeons (compared with male patients treated by male surgeons: aOR, 0.99; 95% CI, 0.95-1.03) (P for interaction = .004).
The problem is fractal and replicates across societal out-groups (and to a lesser degree for in-groups). For example, doctors saying things like, "black people have thicker skins,"
Pick your out-group for a given society and you'll find systemic medical failure. The in-group is rarely much better off; they're still subject to the same capriciousness, merely to a lesser degree. See: the systemic failure of doctors to diagnose heart disease, https://www.bhf.org.uk/informationsupport/heart-matters-maga...
> It looked at NHS data over nine years, which involved 243 NHS hospitals, and about 600,000 heart attack cases. Around one third, 198,534 patients, were initially misdiagnosed.
If you're on the receiving end of care, it becomes very clear, very quickly that there's something wrong with the picture.
When a field is this deficient, radical reform is necessary to save lives.
> I welcome the day artificial intelligence makes most doctors obsolete.
Guess you deleted this part.
When this becomes reality, let me know. If a better system existed given the current set of parameters, I believe it would have come into existence. Give me any medical condition, and I would take my chances in the US healthcare system over any other option.
My argument is not that physicians are error proof or that they don't cause harm through errors. It is to refute your claim that "most doctors are terrible".
Your AI system would only be accurate at diagnosis if it has all the pertinent data and unlimited resources. Patients often provide an unclear history, their symptoms are not common for their underlying condition, and there are not enough resources to do a full workup for every complaint.
Regarding your second link regarding misdiagnosis in emergency rooms, you just need to look at the PERC rule or the HEART score that ED physicians use for evaluating for pulmonary embolus or acute coronary syndrome to get a somewhat clearer picture of the deviation. Even with scores of zero, there will be a substantial amount of missed diagnoses. Not everyone who goes to the emergency room is going get a full cardiac evaluation or a CT angiogram of the chest if their symptoms don't suggest the illness. There are not enough resources to do this.
Of course other civilian professions don't have death rates this high. They don't deal with dying people every day. Again, I'm not claiming that the medical field is perfect as it is. I just believe you are mischaracterizing data for which there are many intricacies.
You are also throwing out a lot of strawmen regarding race and sex which bears little relevance to your initial claim.
Regarding your final piece of data about the amount of misdiagnosed heart attack cases, look at the following sentence in the same article
> It estimated that, if heart attack patients were correctly diagnosed initially then – over the decade of study – over 250 deaths per year might have been prevented.
250 * 9 = 2250 preventable deaths over a 9 year period.
Far less alarming than the data you present of 198,534 missed diagnoses.
Healthcare still follows the basic supply/demand curve, and demand is at record levels. It's just as capitalist as much of the rest of the economy. State regulations regarding professional licensure do serve as a limiting factor for supply, but many fields also have similar licensing requirements before being able to practice.
Most doctors do not make more the sicker you are. The majority are salaried though some organizations do provide extra depending on volume seen or RVUs. They also have very little say on the volume as it is mostly decided by managers.
Some examples:
- patients with falls/trauma
- millions of obese individuals seeking treatment with GLP-1 receptor agonists for weight loss
- cancer
Certainly, these individuals were not made sick just so the healthcare industry could make a profit. Also, I don't believe there will ever be a perfect system.
It detracted from the overall point. But yes, I do look forward to the day artificial intelligence mostly replaces humans in this industry. I think the benefits are self-evident.
> If a better system existed given the current set of parameters, I believe it would have come into existence.
One of these "parameters," as your call them, includes the AMA and doctors restricting the number of new doctors who can be trained in the past https://usatoday30.usatoday.com/news/health/2005-03-02-docto... , actively fighting against allowing Nurse Practitioners and other trained providers from providing routine services that would lessen the requirement of doctors https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope... , fighting against collection of misdiagnosis data (as mentioned above), lobbying against banning pharmaceutical companies from giving money or gifts to doctors (in fact, the majority of doctors say that accepting these gifts is OK, despite research repeatedly showing that these nudges change behavior and lead to practises like overprescribing opiates — https://www.statnews.com/2020/12/04/drug-companies-payments-... ), refusing to adopt practises that reduce mortality (see: the checklist example from above) and on and on.
This trend is not unique to the US. Similar efforts exist everywhere doctors do. The profession was associated with status in the past (and still is). Doctors are fighting and have fought tooth and nail to preserve the benefits they accrue from this status.
As you're a physician, I think you should take a moment to put yourself in the shoes of a third party. Imagine there's a Profession X. Members of this Profession X, and organizations that represent Profession X, have fought to make outcomes of people who interact with them worse in measurable ways. What would you think if a member of Profession X made an equivalent claim? Would you give it equal weight?
> Your AI system would only be accurate at diagnosis if it has all the pertinent data and unlimited resources
No, it doesn't need unlimited resources. Just better sensors and more data. We'll get there sooner or later. It's an inevitability. There are too many smart people working towards this end because of the reasons outlined above.
> Patients often provide an unclear history, their symptoms are not common for their underlying condition, and there are not enough resources to do a full workup for every complaint.
Medicine is the only profession I know of where its practitioners fight against gathering more data points. The argument goes that the more you look, the more you find and that's bad etc.
If you take some time to reflect on it, these fairly common claims make no sense. The more data we collect, the more data we have to understand what the true distribution of human biology looks like. The more data we have, the more information we can gather to better understand how to treat when needed, and distinguish between things that are critical and aren't.
As to the claim that there aren't "enough resources," the truth is that we can create the resources. Lateral flow tests, for example, have dropped significantly in price and what we can test with them has greatly increased. We can also automate how these tests are read — an effort I've been peripherally involved in. We can build labs on chips and mass produce the silicon, https://en.wikipedia.org/wiki/Lab-on-a-chip . We can take commodity sensors and use better algorithms to detect subtle things — for example, using IMUs on a patient's bed in an ER setting as a type of ballistocardiograph to passively monitor their heart function.
We have the technology to do all of this and more. We also have the capability to invent new things that do more. But we choose not to. This status quo is a choice.
> Regarding your second link regarding misdiagnosis in emergency rooms, you just need to look at the PERC rule or the HEART score that ED physicians use for evaluating for pulmonary embolus or acute coronary syndrome to get a somewhat clearer picture of the deviation. Even with scores of zero, there will be a substantial amount of missed diagnoses. Not everyone who goes to the emergency room is going get a full cardiac evaluation or a CT angiogram of the chest if their symptoms don't suggest the illness. There are not enough resources to do this.
> 250 * 9 = 2250 preventable deaths over a 9 year period.
> Far less alarming than the data you present of 198,534 missed diagnoses.
With all due respect, I feel like you've validated my argument in these paragraphs. Medicine is a safety critical industry that doesn't behave like it's a safety critical industry.
If a process had a 33% rate of failure, for any other safety critical system, there would be a sustained effort to research and develop a better alternative.
Perhaps we need better sensors — maybe we could embed a dozen or so IMUs around the patient and measure the forces to see the performance of their heart https://journals.biologists.com/jeb/article/225/10/jeb243872.... Perhaps we need to expand the metrics we look at. Perhaps the way things are measured at the bedside should be changed. There are many things we can do to reduce the absurdly high process failure rate of 33%.
Detecting and treating disease early leads to better outcomes. 198k people were denied this better outcome.
> 250 * 9 = 2250 preventable deaths over a 9 year period.
The data is for the UK. As the population is roughly a fifth of that of the US, let's do some rough math and multiply that number by 4 (instead of 5, to be conservative). That's 1,000 lives per year, or a death every 8 hours.
What does this rate look like when compared to other safety critical systems? The one I'm most familiar with is aerospace. Within civilian aerospace, parts are rated to 1 failure in 1 billion hours of operation. Or, more broadly, safety critical systems are designed to hit the goal of 1 death per 1 billion hours. https://dl.acm.org/doi/10.1145/332051.332078
> Of course other civilian professions don't have death rates this high. They don't deal with dying people every day. Again, I'm not claiming that the medical field is perfect as it is. I just believe you are mischaracterizing data for which there are many intricacies.
All of the statistics I've given were for people killed via mistake. These are people who would have otherwise lived. They died because a medical professional made a mistake. That's an important distinction.
Furthermore, although medicine deals with the sick and the dying, it's not the only industry where a very small mistake could equal death.
Small mistakes, like a bolt not being tightened correctly, on an airplane can lead to catastrophic failure (and have!). And yet, an upward of 2.3 billion person trips occur safely every year via airplanes. Between 2012 and 2021, in seven of these ten years, no airliners crashed. No catastrophic failures occurred.
By contrast, the total number of ER visits is 131.3 million. As I've stated, tens of thousands of these visits lead to death for the patient via error. Per year.
Why are these fields so different?
I believe that the difference is in the margins. One has a culture of excellence. The other has the culture of shrugging. The smallest change in outcome probabilities adds up for processes. Improving a process by 0.5% to 0.05% per case doesn't seem like much, but it adds up.
Interestingly enough, great doctors recognize this. The very best doctors fight in these margins,
> “Let’s look at the numbers,” he said to me, ignoring Janelle. He went to a little blackboard he had on the wall. It appeared to be well used. “A person’s daily risk of getting a bad lung illness with CF is 0.5 per cent.” He wrote the number down. Janelle rolled her eyes. She began tapping her foot. “The daily risk of getting a bad lung illness with CF plus treatment is 0.05 per cent,” he went on, and he wrote that number down. “So when you experiment you’re looking at the difference between a 99.95-per-cent chance of staying well and a 99.5-per-cent chance of staying well. Seems hardly any difference, right? On any given day, you have basically a one-hundred-per-cent chance of being well. But”—he paused and took a step toward me—“it is a big difference.” He chalked out the calculations. “Sum it up over a year, and it is the difference between an eighty-three-per-cent chance of making it through 2004 without getting sick and only a sixteen-per-cent chance.”
From the cystic fibrosis piece.
Medicine has failed to broadly adopt this culture.
> You are also throwing out a lot of strawmen regarding race and sex which bears little relevance to your initial claim.
They aren't treated seriously by their doctors. That leads to poor outcomes.
Ideally, medicine should take every possible cause of process failure seriously, especially if that cause is observed to be this common.
A small piece of stone fell off the facade of a building in NYC, killed someone like 50 years ago, now we spend billions up-keeping buildings every year. How the hell is anything in the medical industry not held to at least that standard.
And then people wonder why mask mandates don’t work, and there is a mistrust of vaccines and doctors.
Pretty sure FTX was not a US corporation and catered to non-US customers. FTX.us, which was a minor branch that catered to US customers, was thought to be relatively solvent but ultimately collapsed like most things associated with FTX. Not saying that the SEC would have prevented anything in the fallout, but blaming them for failing to regulate seems somewhat incorrect.
Though, I am unclear why FTX filed bankruptcy in Delaware. Someone please correct me if I'm wrong.
https://www.thetimes.com/uk/crime/article/police-make-30-arr...