Lucille: How's my son? Doctor: He's going to be all right. Lindsay Funke: Finally some good news from this guy. Doctor: That's a great attitude. I got to tell you, if I was getting this news, I don't know that I'd take it this well. Lucille: But you said he was all right. Doctor: Yes, he's lost his left hand. So he's going to be "all right." Lucille: [Jumping on the doctor] You son of a removed! I hate this doctor!

My favorite running gag, love the literal doctor

Looks like this drug has multiple on going trials. Here is a phase II/III trial ongoing that's probably the direct successor to the trial in the article. It's currently recruiting, they expect to be done some time in 2025.

https://classic.clinicaltrials.gov/ct2/show/NCT05723562

Clinicaltrials.gov makes it really easy to find pretty much any trial.

As the article points out prion diseases are still extremely rare. There's also no proof yet that the deer prion can make a jump and cause disease in humans. I rationally know this, and yet having seen prion disease before in person, I irrationally (rationally?) avoid venison now just in case.

I've never heard of urgent care requiring referral from a pcp, that wouldn't make any sense as the whole point of urgent care is being seen more urgently than your primary physician can accommodate. And seeing people who don't have a primary physician and keeping them out of the ed if not necessary. I would ask your insurance for that policy in writing, that can't be right. And if it is it should be reported to that state insurance commission because that's totally asinine. I mean never underestimate the dumbness of insurance companies but I think something might be being lost in translation here.

This is mildly infuriating, I can give you a little more context though if you're interested. I don't know exactly about contracts between insurance companies and CVS so I can't speak to that definitely. Probably something related to how much insurance is willing to pay minute clinic for such a short visit, and what things are feasible to address in such a short visit (hence CVS only allowing certain complaints).

I think this is something to do with the concept of "uncomplicated" vs "complicated" uti. Complicated utis are when there's an increased danger of serious complications from a uti or increased likelihood of failing a typical antibiotic therapy. Utis in men are much much rarer than women, and are considered to be an automatic "complicated" uti by many. The greater length of the urethra in men helps prevent bacteria from being able to travel up to the bladder, whereas in women the short distance allows for this to happen much more frequently. So when a male has a UTI there is a much greater chance there will be complicating factors like prostate issues, structural problems, kidney stones, kidney infection, catheter use, atypical bacteria, etc. If you look more into their info on utis, they also state if they suspect any of those things, even in women, they won't treat it and will just refer you to someone else, probably the Ed or a real urgent care clinic. Since the odds of that are much greater in men, they probably aren't allowed to have longer appointments in minute clinic based on what insurance will pay for what they're providing, they just decided to not see that at all in minute clinic. Looks like they do see men for sexually transmitted infections though, which are actually the most common cause of utis in young men, so if that's a concern looks like they would be able to see people for that.

But I totally agree with you, fuck insurance companies in general.

My donations lately have been focused a lot on the LGBT community. Things like lambda legal, local LGBT advocacy groups, and community health efforts. While discrimination from society as a whole and the health system in particular have been leading to worse health outcomes for, well since forever basically, this recent backsliding, especially rampant hate towards Trans individuals and laws preventing them from getting health care has been especially worrying for me.

I agree with this. The area of medicine I'm most involved in has had a crazy rate of new medications approved and innovations with a giant pipeline of possibilities on the way. The article focuses on crispr a lot, which is cool and always get the headlines, but I think in the nearer term oligonucleotide therapies or even viral vector gene therapies are already here. Oligonucleotide therapies use rna to affect gene expression, usually decreasing it. Theoretically it can be used in any toxic gain of function mutation, which covers a lot of genetic diseases. It's not really a question of do we have the ability to treat genetic diseases anymore, it's more getting all the time, money, expertise, and prerequisite natural history work done on the sheer number of them so these tolls can be tested in all these diseases and brought to patients.

The importance of high quality natural history studies and biomarker development cannot be overstated too. When you design a clinical trial you need to know how many patients need to be in it and how long it needs to run, or else you might accidentally throw out a treatment that works by designing the trial incorrectly. Natural history studies are where you get that information. Biomarkers can help provide more sensitive measures of change so you can more quickly figure out if a treatment has potential or not (ideally followed up by proving efficacy with clinical measures too).

The availablity of the these tools for making new treatments but limited resources for testing them is also leading to ethical issues and inequality. For instance there have been a number of "N of 1" trials where treatments were made specifically for a particular patient. I hope that benefit would then flow to other patients eventually too, but it does raise a lot of questions.

Yet another disastrous effect of restricting abortion access. The many harms from restricting reproductive care need to keep being hammered on in the media. Thanks for posting this.

But we can't go NSFW! It's not the Jedi way!

The material is also a little rough in terms of how easy it would be to adapt into a show I think. It's not like the expanse or something very plot heavy and tight where you can pretty much just turn the novels into a script and it'll go at least decently well. So I'm skeptical because it's going to need a lot of skilled work to make the story function well as a TV show. D&d have not shown that the adaptation part is their strong suit though. Definitely a wait and see for me before watching.

Yeah, sometimes you're just innocently watching an anime and you're like, oh no, this just went all facist imperialist Japan didn't it. Lookin at you attack on titan.

Wait I'm lost, I did some calculus with my girl and now I can't tell if she's a wave or a particle

It was me, Dio!

Really interesting animal model, but holy crap does knocking out neurotransmitter receptor genes in a brain in vivo sound terrifying.

Yeah, basically if you work for a paycheck you're probably not the 1%. The venture capital firms buying up all the medical practices and hospital? Those guys are the 1%

Totally, like if you were an alien trying to study a computer, you can look at an individual transistor all you want but at some point you need to look at how all the different complex network systems work together to make a software program.

The language of computer programming has worked it's way more and more even into clinical neurology. I talk about motor programs for instance when trying to explain dystonias, where the brain activates a set of movement patterns that's not at all what the person was trying to do. You might find functional neurologic disorders interesting. Super common problem that needs a lot more research. Many patients have trouble grasping the idea of a "software" problem in the brain so don't talk about it and don't realize just how common it is. Fmri has started to help uncover the abberant patterns that lead to these disorders.

Appreciate the funny post, but for anyone reading too much into this it's misleading at best (also just barely passing at 60% only correct). It's referencing a portion of the test with multiple choice questions. So that's relatively easy for a language model, since it can predict an answer from a focused question. Please don't ask chat gpt individualized questions about your health. It does decent for giving out some general information about medical topics, but you'd be better off at going to a reputable site like mayo clinic, Cleveland clinic, or all the resources at national library of medicine who maintain free very nice medical knowledge databases on tons of topics. It's where chat gpt is probably scraping it's answers from anyways, and you won't have to worry about it making up nonsense that looks real and inserting it into the answer.

And if chat gpt comes up with sources in an answer, look them up yourself no matter how convincing they seem on their face. I've seen it invent doi numbers that don't exist and all sorts of weird stuff.

Well that's enough internet for today. Geeze. So glad these people are being tracked down so they can be brought to justice.

On the instances where hot is working, I think it does work pretty nicely for this. Hopefully it'll be up and working everywhere very soon with the next update. When I'm on an account with an instance where it's not working, I tend to switch between top-day and new. Going into individual communities as well you can easily see what was popular.

Nice, I like the premise, gives me some Lovecraft vibes

I think as an end user of a platform like reddit, it's easy to just want to browse a site and look at some interesting content when you have a few minutes downtime and not think much of it. The vast majority of people on the site aren't even really contributing to content in any way. I barely ever did until hearing about the fedverse.

What got me to care and take the effort to start up here wasn't even really the recent reddit move specifically, like sure this was a crappy thing to do on their part and they've done a lot of bad stuff before too. But it was seeing all these social media platforms and web services in general go one after the other becoming worse and worse for the users and ever more invasive. I think it's just clear now that a centralized social media isn't sustainable and going to work, and will always have that end result.

What's so appealing about the fedverse is I think it's a model for how these problems can be avoided and services can still go forward. I think the best we can do is be active on the fedverse, make it an appealing place to be by contributing, with programming skills if we have them or fresh content if we don't, and continue to point out how these big web companies continue to fail us.

Well that's it, I'm gonna add compulsive turning on faucets in hospital rooms to the constant compulsive hand washing.

Totally agree. It's so tough to be on the clinical side too, and have drugs with really marginal data get approved and then have to counsel patients and families on them. FDA needs to enforce the companies actually gathering definitive efficacy data in a timely manner if they want to stay on the market. Especially at the eye watering prices they are often charging for new therapeutics that often have no good relation to the value they're actually supposedly bringing.

Archive links get rid of the paywall but it doesn't play nice with some dns settings apparently. Here is the actual link but it does have the paywall: https://www.nytimes.com/2023/06/19/business/gop-disinformation-researchers-2024-election.html:

This is true, and the problem extends to many areas of neurology and psychiatry. The brain doesn't know or care that we threw up some artificial divide and decided some things are "mental" and some are "neurological." The brain is the brain is the brain. Functional neurologic disorders for instance are one of the most common reasons people see a neurologist, and most people recover really well. But the conversation can go terribly if not done well even though it's good news and the prognosis is good. Having a careful conversation and introducing the concepts well is so important to get buy in so they can get access to therapies and get better.

Yeah don't ask chat gpt medical questions, it's pretty bad at those. Better than someone off the street maybe, but still bad. And apparently using outdated racially biases stuff too.

It is good at writing insurance appeals letters though, cause it can fill in all the vapid fluff and make the letter writing fast. It needs the doctor to heavily guide it still though and put in the arguments for why the insurance company is wrong. Also if asked to put in citations it will sometimes make up really convincing fakes. So you really need to give it real references yourself so it doesn't do that. It basically a fancy Microsoft office clippy in practice right now.

One of those things that you figure, we're probably gonna find out this was terrible for us down the road right?

No that was super funny. Crashing the UK economy seemingly overnight all in a bid to save the richest people in the country a few bucks? Now that's not funny

Yes, it's a medical emergency that can be very dangerous or even deadly. It can lead to seizures or a devestating condition called osmotic demyelination syndrome, which can cause a "locked in syndrome" or total body paralysis. There are certain medications that can make it more likely to happen. Severe psychiatric conditions make it more likely. It tends to happen pretty frequently to people with alcoholism too. It's pretty rare for it to happen to people without risk factors for it because your kidneys are pretty good at keeping everything balanced even if you're drinking a decent amount of water. Though one infamous example of that is the wee for a wii radio contest where people deliberately drank tons of water and were not allowed to pee to try and win a Nintendo wii. I believe someone died from the contest, and the organizers hadn't realized how dangerous this was. In short, drink water when you're thirsty, and pee when you need to pee.

Resurrecting this old thread here in case some scroll down just to highlight this excellent video that people really need to see. So many patients get very frustrated or wonder why doctors do things stepwise and don't just "run all the tests." Just like in basic science, where "p-hacking" can result in a positive study no matter what, you could just run 30 or so tests and you'll probably find something "positive." But does it have anything to do with why the patient actually has symptoms? Every individual is different and no test is perfect, so medicine is probabilistic. It's why basic bayesian statistics are an essential part of medical school curriculums and tested in medical licensing exams.

Starter comment: pharmaceutical industry reps in the article had the nerve to call drug price negotiations extortion? Meanwhile you have companies like biogen bragging to investors about how their ridiculously priced drugs could bankrupt Medicare. Maybe if they didn't spend the vast majority of their revenues on marketing and saved a higher percentage for actual r&d they could have more reasonable pricing.

This is a really interesting finding. There's precedence too. Pelvic inflammatory disease, classically caused by sexually transmitted bacterial infections like chlamydia or gonorrhea, is associated with a higher risk of developing endometriosis. There also does appear to be a genetic component, but that might have to do with determining how your body responds to infections in a way that's more likely to cause endometriosis. Hopefully finding this new bacterial association can lead to more treatment options.

Totally reasonable concern, fuck Russia but Pravda does have a bit of a vested interest in their reporting to say the least. In this case they're just actually reporting what was said on a Russian propaganda outlet. Disclaimer, I know zero Russian, but a Google translate of the Russian propaganda news networks seems to confirm that Pravda is being factual and this is what Russia is saying.

https://tass-ru.translate.goog/politika/18051163?_x_tr_sl=auto&_x_tr_tl=en&_x_tr_hl=en&_x_tr_pto=wapp&_x_tr_hist=true.

Turn of the century medicine was wild, you just can't make this stuff up. Also interesting how they were grappling with problems we're still trying to understand better today, like CNS sensitization to pain.

Yeah not sure what that headline is about, I enjoyed splatoon and thought it was a pretty unique game. More games in the genre is good, spurs innovation and new ideas. No sleep lost unless someone has some toxic brand loyalty. I hope this game does well.

End-stage enshitification of Twitter

Well I did use sync, now using jerboa of course. Would be neat if sync or other apps could be remade for the fedverse. An app that could bridge different fedverse apps more easily like lemmy and mastadon for instance but keep everything easily readable and sortable would be cool.

Seems to be a bug, I think it happens most frequently when trying to subscribe to a community on a busy instance. It doesn't seem to affect functionality though, I see new posts, vote and comment, etc. Sometimes if you refresh the page or try again it goes away and says subscribed, but I wouldn't worry, doesn't seem to change anything right now. Just assume it means subscribed. I think for this community right now it says "sub pending" for me actually.

Thanks! I'll remember that trick for next time

The Reuters article is a little light on what's included. Wanted to post a free article anyone could access. Lots of good information, multiple lines of evidence, and interesting soviet history of the dam in the actual article Reuters is citing.