The problem from the perspective of many Jews (including myself) is that these kinds of protests and protestors tend to focus on Israel to the exclusion of any other state. Where is the protest of Google's relationships with dozens of other countries accused of major human rights violations? The double standard when it comes to Israel calls into question the motivation behind the protest and makes many Jews reasonably wonder if it is actually anti-semitic (even when coming from fellow Jews).
The problem is that Israel is seen as a "friend state" and Israel claims to be a democracy. So we expect higher standards of ethics than most other countries. The other reason is that we (western countries) could have a strong influence to make the crimes stop.
Of course, "evil states" like Russia or China are not expected to behave well. And anyway, we (western countries and western companies) don't have much influence on them. So it's easy to abundantly criticize them.
Some "friend states" are clearly dictatorial and commit mass crimes, but we (western government and western opinions) don't expect much of them on human rights. Saudi Arabia started the Yemen war which killed 380,000 people (according to UNO), mostly Yemeni civilians, but who cares? Slaughtering a journalist in Turkey got more attention, because it was more spectacular.
Other "friend states" are less openly dictatorial (they have polls, even if often rigged) and only slaughter their political opponents. Then it's easy to just look elsewhere. Most African countries are in this category, from Egypt to Gabon, etc.
But Israel? Is it a democracy when its blocus of Gaza puts millions of people in a sort of giant jail? When hundreds of civilians are killed every year? When people can be thrown in jail by the administration for no public reason, and kept in for years without seeing a judge? In the same way, in 1945 there were far worse violations of the human rights outside of India than inside India, so why would anyone care for the way UK was ruling over India? And was France a democracy in 1960, when it ruled over Algeria with millions of second-class citizens and with a systemic use of torture?
> and Israel claims to be a democracy. So we expect higher standards of ethics
Just because a state is "democratic" does not mean it is ethical, and just because a state is not "democratic" does not mean that it is unethical. That being said, Israel is definitely a murderous regime and they're getting away with any atrocities they want.
Another good example of bad science related to water is "water memory" (published in Nature!): the idea that water could hold onto the "shape" of molecules with which it was mixed. Fun times.
https://en.wikipedia.org/wiki/Water_memory
Emails from a stamped individual could be "whitelisted" so as to no longer require a stamp to show up in your inbox. For instance, the first time you get an email from Amazon Prime (which they pay $0.001 cent to send), a box shows up saying "add this email to a whitelist so they don't have to spend money emailing you?"
I remain cautiously pessimistic because there are two main possibilities: (1) there is one product (or a series of products manufactured/purified in the same way) that causes respiratory failure in many or all users, (2) all vaping products have a low level risk of causing respiratory failure. I don't think there is enough data to make a conclusion yet, but I am worried this will end up being a low-level persistent problem with vaping products—bootleg or not—for the rest of our lives.
Maybe the culprit truly is dirty oil based extraction of THC... but if so, that will remains a problem for as long as there is no regulation of the official market as well as an operating black market.
OTOH we may end up with a situation like we have in the world of muscle builder / hormone supplements where most people are fine but some users get really sick (e.g. deer hormones sold at regular stores causing severe kidney injury), but not enough of them get sick to get the CDC/FDA involved. I've seen those cases in the hospital and the patients are always confused as to how this could happen because they got the supplement from a vitamin store.
With respect to some of the European posters below who have been using vape products for years: I would not be surprised if there were health consequences to those devices that had not been identified in Europe. The US has one of the best disease identifying-apparatuses in the world (the Centers for Disease Control) and a tradition of surveillance and reporting that is unparalleled. If a substance is harmful to health, it's got a better chance of being found here than anywhere else.
I haven't done a deep dive here... but this makes no sense for multiple reasons.
1. It will have a chilling effect on physicians giving informal ("curbside") consults to colleagues. That leads to worse patient care overall. For instance if your doctor doesn't know what's up with you, he/she may not be able to curbside consult phone a colleague to get a 2nd opinion. This happens all the time in medicine and is one of the advantages of being at a medical center with lots of doctors: you can double check weird cases with your colleagues.
2. Direct admission to the inpatient ward are no longer common because outside physicians don't run hospitals anymore. Hospitals are run by teams who specialize in inpatient medicine -- and they almost always function best if the inpatient admission is preceded by an ED visit because the ED can rapidly get tests, imaging and collateral to figure out what's wrong—and if the problem needs inpatient management or not. Direct admissions, in bypassing this step, often put patients at risk by skipping the rapid information gathering process that the ED employs.
The "admitting privileges" they discuss in this article are a relatively meaningless and outdated practice in medicine today (with certain exceptions, such as obstetricians and some other surgeons).
The case is limited to hospitals which only admit patients through doctor recommendations, and where the consultation is about admitting the patient to that specific hospital. If a doctor doesn't know what's up they can curbside consult phone a colleague to get a 2nd opinion.
In my view, intention and context is what dictate most legal outcomes. That narrows decision usually down to very specific situations.
Where does it say that? This NP was practicing independently and the Fairview hospital has an ED. There is no reason that if the NP was concerned she should not have sent the patient to the ED.
Asssuming the article is accurate, I think you're mis-characterizing what happened here. Simon wasn't calling a colleague for a second opinion before making a decision; she decided Warren needed to be admitted, called a senior hospitalist to expedite that admission, and was clearly and repeatedly refused.
The OP's title "doctors can be sued by patients they don't treat" is not accurate. A better one might be "doctors can be sued by patients they refuse to allow treatment."
This situation happens in EDs as well. For example: ED attending thinks admission is warranted but patient does not meet criteria (“please come see the patient because he/she looks worse than labs suggest”). This is why the ED exists and the correct move here should have been for the NP to send the patient to the ED for evaluation instead of relying on the opinion of an MD over the phone. The physician at the hospital should have suggested this as well—but to think that the MD is culpable for malpractice without laying eyes on the patient is lunacy.
Not with this approach. It's easier to add a gene to one cell lineage (in this case, the blood cell forming hematopoietic lineage) than to remove a gene from every single cell in the body.
But there are other strategies in development to help some patients with autoimmune disease. This is one of my favorite papers in that vein: https://www.ncbi.nlm.nih.gov/pubmed/27365313
The incredibly vast sphere of gene-to-gene interactions is very poorly understood.
Anything changed in the DNA can have completely unforeseen consequences because genes and their products influence expression of other genes.
Which genes does each gene influence? Directly or indirectly? To what extent (strength of up- or downregulation)? Only under specific conditions? Only if 3 other genes are present and not regulated in a different manner?
I have done some computational gene interaction analysis by building regulatory interaction networks in Cytoscape using sequencing and expression data based on specific research [1].
My subjective impression is that messing with genes is little but an unpredictable endeavor at this point. The gamble may pay off but I don't think anyone can honestly tell you something about long-term effects in each individual.
It doesn't really matter whether you would or would not take the gamble; it depends on whether the FDA would be willing to let you.
(I'm not saying this as some kind of rrrgh-gubmint-bad thing. It's pretty normal for the government to have authority over what gambles are acceptable to offer in what circumstances, and which ones are exploitative and detrimental to even offer; this is the logic behind, for instance, regulations of actual gambling.)
Yes of course, but think about gene therapy for far less intrusive health issues.
If more common and widespread health problems are tackled with gene therapy and we wouldn't know the consequences long term (we really don't) then this aspect becomes far more problematic.
Like you, I would also take the gamble if it's a Hail Mary attempt at surviving or making a somewhat normal life possible. But that's not the point I was trying to tackle.
Not all of it is just targeting the right sites - IIUC the last time we tried gene splicing for this, the splices worked, everything looked great for a little while, but the sites had oncogenes right next to them that got activated by the splicing.
I'm hopeful that this is a panacea for this class of problem the likes of which we rarely see, but I will not be surprised if something tragic happens.
So let's examine a setup with three cages, with two parent mice having a litter of 6 every 45 days. So every 45 days we have a new batch of 90-day-old mice, and they cost $135 or $23 each. Add a couple more dollars to sustain the ancestor mice, add enough inefficiencies to double the cost, that's still only $50 per mouse. Rearing costs aren't even going to hit 1% of $17000.
In practice you need to maintain large colonies in order to reliably have enough mice for experiments. Also you need to keep gender in mind because females can be housed together but males cannot and generally experiments are conducted in either one gender or the other.
So, let's say you need 20 female mice for an experiment (e.g. 4 groups of 5). That means that you need to have >40 offspring in order to get enough female offspring. That's at least 7 breeding pairs (assuming you're not harem breeding) and you've got to maintain them for 6-8 weeks until you can use them. That's >$1,000 in breeding costs before you get to the actual experiments.
>Mice are so easy to keep, they could be entitely mechanicly reared, and an experiment involving 1000 mice should be a simple matter of a few clicks on a computer.
I invite you to go visit a laboratory that works with rodent models for a few days and see if you still think this is true. I would love to be proven wrong, but in my experience animal experiments are as non-automatable as human clinical trials. As a simple example, in my PhD I spent months injecting mice with cancer cells, measuring the tumor outgrowth, then harvesting the tumors, grinding them up and sequencing them. You can see the schematics of some of those experiments in one of my manuscripts (https://elifesciences.org/articles/41090 -- free to access). Each one of those experiments relied on dozens of different techniques (from cloning to making viruses to culturing cells to animal husbandry), most of which are not easy to automate because they vary from experiment to experiment. For instance, just to grow the cells for injection into animals, you need to monitor plates of cells growing in a sealed 37º incubator, wash and re-feed them as necessary over a period of days to weeks. Then, on the day of injection, you need to wash and spin them down, resuspend in an injection solution, put them on ice, go down to the mouse house, shave the mice, anesthetize them and then inject them. You don't want too much time to elapse between when you prep the cells and when you inject them or they might die. At every step there are biosafety constraints that limit your movements and how you dispose of garbage which would be challenging to scale up to a totally automated system. Every different cell line/type you inject has different kind of growth requirements and idiosyncrasies in how they like to be handled. I suppose you could program machines to do this for one cell line, but it would be a monumentally difficult task to do it for every cell line and get good results. Then there's the matter of just handling the animals. I would love to see a machine that could do this (and maybe one day there will be) but for the moment you need training in how to carefully and safely grab mice, restrain them, inject them and so on.
The costs of maintaining mice is also much larger than it seems (perhaps compared to mice kept as pets). A major cost is the daily tasks associated with husbandry, like cleaning cages, sick checks, genotyping, etc. At least at my institute it was ~$1.50 per day per cage (up to 5 mice) in support costs, not including the ~$30-50 it costs to raise a wild-type mouse to the point where you could do the experiment (more for some genetically modified mice). An experiment with 500 mice (100 x 5 conditions) would cost you $15-20k, which would massively balloon the cost of research.
Finally, there are major ethical concerns with using more animals than necessary for any experiment. Animal work is carefully regulated by internal and external ethics committees and oversight of all ongoing experiments. The number of animals to be used for any given project must be justified with statistical analysis suggesting that you are using no more than necessary and will indeed be able to show the expected results. If you propose experiments using large numbers of animals you must have a good explanation for why you need such numbers.
Anyway, it's not really that simple or cheap to do animal experiments, especially at large scale.
To add on to this... I was at HHMI Janelia for a while which has an automated rodent cage cleaning contraption with two robot arms. They have all the automation money can buy. It's still __extremely__ labor intensive.
Beyond all the routine things... consider that, at least in neuroscience, you often need to perform surgery on each mouse...
(Sorry for the elementary questions, but this process sounds interesting and I'm curious how it works)
> I spent months injecting mice with cancer cells
How do you inject cancer cells? Is it just a syringe that goes into the blood stream or is it intramuscular? Basically, do you have to find tiny veins on the mice using a small syringe tip?
> you need to wash and spin them down
Are you referring to the animal here or prepping the injection?
Also, I'd imagine it would be hard if you had to paralyze a mouse/rat for research on physical disabilities or other more invasive things than just injecting cancer.
Many things that are done in biology (and medicine to some extent) are way simpler than they seem because much of it was figured out a long time ago using tools that scientists/doctors had at hand.
We grow cells in what is essentially sugar water + some growth factors that we get from cow serum (b/c America has lots of cows). Google tissue culture 101 videos on youtube to get an idea of how it all works. You can't (and don't want) to inject the animals with all that fluid + protein (it can be liters), so you transfer the cells into tubes and spin them in a centrifuge (~300 x g). Spinning them will bring them to the bottom of the tube and they will form a pellet. The pellet sticks to the bottom as you literally dump the fluid out. Now you can resuspend the cells in a few microliters of a saline solution and inject them into the mice.
For example, cells growing in an incubator usually need to be at a density of 200k-1e6/ml so that they have enough nutrients and waste doesn't build up too quickly. For 5e6 cells, that would be 5-25ml of fluid, which is WAY too much to inject into a mouse, so you have to concentrate the cells into a much smaller volume before you can inject. I will typically inject mice with 100µl of fluid containing 5e6 cells.
In terms of injection, you can google subcutaneous injections in mice to see how it's done. It's the same as if you've ever had a tuberculosis skin test or a minor operation where they injected you with lidocaine locally (or what your dentist does). The cancer cells are injected into the space right under the skin.
Right, I should have figured you meant centrifuge when talking about spinning. And interesting re: subcutaneous injections, I watched a video, seems pretty straight forward.
