Great quotes - military action

"The President does not have power under the Constitution to unilaterally authorize a military attack in a situation that does not involve stopping an actual or imminent threat to the nation. As Commander-in-Chief, the President does have a duty to protect and defend the United States. In instances of self-defense, the President would be within his constitutional authority to act before advising Congress or seeking its consent. History has shown us time and again, however, that military action is most successful when it is authorized and supported by the Legislative branch. It is always preferable to have the informed consent of Congress prior to any military action."

- Senator Obama,  in an answer to the question: "In what circumstances, if any, would the president have constitutional authority to bomb Iran without seeking a use-of-force authorization from Congress?"

Of course, this did not stop him unilaterally authorizing military action in Libya... and it looks like Syria is next. A 'road to Damascus' conversion en route to the Presidency?

Random charts - cancer

Source: A Snapshot of Brain and Central Nervous System Cancers (NCI)

Random chart - competitiveness

Source: IMD releases its 25th Anniversary World Competitiveness Rankings

The highlights?  'The US has regained the No. 1 spot in 2013, thanks to a rebounding financial sector, an abundance of technological innovation and successful companies.

China (21) and Japan (24) are also increasing their competitiveness. In the case of Japan, Abenomics seems to be having an initial impact on the dynamism of the economy.

In Europe, the most competitive nations include Switzerland (2), Sweden (4) and Germany (9), whose success relies upon export-oriented manufacturing, diversified economies, strong small and medium enterprises (SMEs) and fiscal discipline. Like last year, the rest of Europe is heavily constrained by austerity programs that are delaying recovery and calling into question the timeliness of the measures proposed.

The BRICS economies have enjoyed mixed fortunes. China (21) and Russia (42) rose in the rankings, while India (40), Brazil (51) and South Africa (53) all fell. Emerging economies in general remain highly dependent on the global economic recovery, which seems to be delayed."

Random picture - taxes

Source: Twitter

Random charts - guideline panels

Source: Expanding Disease Definitions in Guidelines and Expert Panel Ties to Industry: A Cross-sectional Study of Common Conditions in the United States 

Its conclusion? "For the common conditions studied, a majority of panels proposed changes to disease definitions that increased the number of individuals considered to have the disease, none reported rigorous assessment of potential harms of that widening, and most had a majority of members disclosing financial ties to pharmaceutical companies." Note that "... these findings do not establish a causal link between industry ties and proposals to change disease definitions"

Follow-up (lessons learned)

The June 9th, 2013 blog entry, 'The right lesson?', took issue with some of Atul Gawande's musings in the wake of the Boston marathon bombing, especially his contention that the hospitals there were "ready." This blogger noted that : "... although the medical response was a success, clearly the emergency response systems of the various Boston hospitals were found to be wanting...  Some work is clearly needed there to ensure that they are more responsive and will work in any future emergencies."

Now, with the passage of time and further reflection a realization has been made that not all went quite so smoothly - "The day’s utter chaos made missteps inevitable, but in the months since, the hospitals have found lessons to be learned from the moments of confusion and occasional miscommunication...  In particular, the bombings brought forward a problem that has vexed trauma hospitals for years: the identification of victims." As exemplified by an unfortunate case where the family of a deceased victim was told that she was alive and in the hospital...

However, lessons are being drawn and preparations made to do better the next time there is an emergency - "... The trauma centers are developing strategies to more accurately identify patients and reunite them with families faster...   the city is working with hospitals to standardize the reporting of patient identities to a central office that works to reunite victims with families. Hospitals did not all provide the same information and some lagged in reporting on April 15th..."

This blogger also observed that sometimes an element of luck is involved, and that processes need to be made robust for the occasions when this is not the case - "OK, so  one really can't complain about success and things were done extraordinarily well resulting in the optimum outcome... as is very often the case in healthcare.  From Katrina to Sandy, and many incidents before, in-between and after, extraordinary efforts by ordinary (and extraordinary) people have often 'saved the day.' However, it is a realization that this has usually been the case (i.e. a reliance on extraordinary efforts plus often a good measure of luck) rather than planning, processes, and systems that has led to the adoption of systems and processes to respond to emergencies."

Apparently this was the case in Boston. However this has been recognized and s being taken into consideration while looking to improve the system - "Trauma doctors said Boston was fortunate that the bombs exploded at an event where dozens of medical and public safety personnel already were stationed, and at an hour when shifts changed at the hospitals, nearly doubling the number of medical staff on site. But next time might be different, said Walls, of the Brigham. “We are analyzing every step now,” he said, “and trying to eliminate the element of luck.’’

Follow-up (Raking it in)

The June 26th, 2013 blog entry "Raking it in..." rightly pointed out the incredible shallowness of some of the reporting in a ProPublica report - 'Top Medicare Prescribers Rake In Speaking Fees From Drugmakers' - that looked at pharma payments to physicians...

Now an article, 'Data Dive Finds Doctors For Rent'  references an analysis "First, Do No Harm: Financial Conflicts in Medicine" that does some real number-crunching. Its conclusion?

"... Using data from twelve drug companies, more than 330,000 physicians and nearly one billion prescriptions, we find that when a drug company pays a doctor he is more likely to prescribe that company's drugs... A payment from a pharmaceutical company corresponds to, on average, an additional 29 Medicare prescriptions per year, and this number rises to nearly 100 prescriptions if the payment is at least $1,000."