Mbioguy

History may not repeat but it does rhyme. Harappan civ thought to have declined due to less water. Petra once thrived due to a system of dams, cisterns, and water conduits, but never-repaired damage after an earthquake and increasing aridity meant it less and less supported urbanism and so declined. The Soviets overexploited the Aral Sea which has yet to (and will likely never) recover. It is now spoiling the surrounding region with dust storms carrying with them pollutants from industry that settled in the drying lakebed. Owens Lake in California once fed LA, but when it dried up it too caused polluting dust storms. Gov't has not learned from this history. The western US's water rights are outdated to the point of creating utterly backwards incentives. For example, Utah has use-it-or-lose-it water rights and the lion's share of water in the Great Salt Lake's watershed gets used to grow alfalfa. Alfalfa itself isn't necessarily a bad choice if you're going to grow stuff in an arid region, the issue is more how much of it is grown and in a wasteful way (little to no drip irrigation and no incentive to start using it, instead farmers are incentivized to flood areas during times of heavy rainfall or risk losing water rights). However even city and residential water use (a much smaller %) is still per capita wasteful compared to nearby Vegas which has done a much better job of becoming efficient in its water use. Utah got lucky this year in its snowpack, potentially buying some time to change, but is that gonna happen? No, they're praying for moisture and thinking their prayers got answered. Any guesses how long it'll be before the Great Salt Lake becomes the US/capitalism's Aral Sea? 5 years, 10, 15? Any techies wanting to move out here might think twice, homes without water and with seasonal arsenic-laden dust clouds probably won't have much resale value.

Note: if you want a meaningful discussion about physician salaries, you need to be discussing lifetime income after tax and after debt repayment, and compare this metric to other professions. Comparing the yearly salary of a vascular surgeon with 10-15 years of post-high school education, training, and compounding debt interest to the yearly salary of a junior developer ignores the very different lifetime shape of the careers.

Any substantial change to the pay structure for physicians needs to address the cost of education and training, and not screw over a large cohort of physicians saddled with debt who see a massive pay cut. They will significantly oppose any attempted changes that don't address these two things.

Doctors in Europe are paid a good bit less than here in the US, but their education is paid for (and then some) by the state.

Wow, lots to unpack here. First off, MAs are not remotely comparable to PAs or physicians. MAs typically earn a certificate, and salary is 20-30k. They are typically office or clerical workers with a medical support role. They are not diagnosticians or prescribers, like physicians, PAs, or NPs are. So talk of MAs 'practicing medicine' is weird, they don't, that's not the job role. We need them, they aren't well paid... nice work punching down there mate.

Frankly, this comment just sounds like you have an axe to grind with PAs. (Hence conflating MAs with PAs.)

PA is a Master's degree. They diagnose, treat, and prescribe. Unlike MDs, who are board-certified independent practitioners, PAs are not trained to work independently but as part of a team. In some cases that means they function as physician extenders, freeing up physicians to focus on more complicated cases. In other areas they focus on tasks delegated to them, for example central lines or other procedures, wound care. Some are used as First Assists in surgery, others are used for pre and postsurgical care, which helps surgeons do more surgeries. In any case, while the roles for physicians and PAs are much more similar, the condescension remains in your comment.

Punching down on MAs is inconceivably poor form. Punching down on PAs is still bad. Conflating the two gives away your game. You suggest harm... have any evidence to back this up?

Hint: you won't find any. There aren't a ton of studies, and quality could be better, but mid-levels (NPs and PAs) who stay within their roles have comparable outcomes to physician colleagues. How can this be, given the difference in training time? Easy. The roles are different. The subset of pts managed by PAs/NPs is different than MDs, because professionals consult and transfer care when appropriate. It's no different than a family practitioner or hospitalist consulting specialists. Nobody does everything, healthcare is a team effort.

Trash talking other professions, especially without evidence, is unprofessional.

Azores, Canary Islands, Madeira

You've got it backwards. This has nothing to do with mandatory reporting laws. You are assuming something is said about person B during person A's confessional. That isn't what is being described.

A student confesses to their religious leaders that they have done some sin. Fine, go through the religious repentance process. That's how things normally work in other religions too. A religious leader doesn't have authority to academically punish someone. What doesn't normally happen, is that this info gets shared with a school authority that does. And then the school authority shares info with campus police, from where it can also go into state or federal databases.

Or it goes the other way, where info given to city police ends up in the hands of academic or religious folks who use it abusively.

A student like Madi Barney is assaulted, she goes to city police. City police share detailed info with campus police, who share it with title ix and honor code office, who share it with religious authorities. She was not the assaulter, she was the victim. Yet, because a part of the police report includes a history of some breaking of the honor code, even though as in my original response predators manipulate folks into doing this, she ends up being investigated and punished academically and religiously. City PD ends up functionally an investigation and enforcement arm of academic and religious authorities. That is ABSOLUTELY institutional abuse of power.

I didn't share much of my personal experiences, just enough to rebut the claim that religious attendance is not mandatory, that was the purpose of paragraphs 1-2 so I don't know what you are going on about. The rest of the response was what detailed the abusive system.

I didn't even touch on how this is used against LGBT students.

This article falls prey to a myopic view of capitalist vs communist 'econ'. The reality is that the 19th and early 20th centuries were abuzz with economic tinkering and innovation. Rather than a simple left/right dichotomy, there is a whole color palette of possibilities, if only only we can remember them, and then imagine them in a modern context.

Proudhon early on imagined a world without capitalist ownership, but with a free market. He expounded the idea of Mutualism, building from earlier writers like John Gray. This libertarian-socialist vision has little in common with either the state socialism of the USSR, or the internationally-corporate world we live in today. Socialism as social ownership of the means of production, either by workers (agricultural or factory coops), communities (in our time, municipal fiber), or users/consumers (credit unions are a descendant of mutualist credit systems).

Later socialists argued over the recompense owed to individual labor vs the community as a whole (Bakunin v Marx), over the methods to reach their aims (through socialist parties, or revolution and establishment of a proletarian state, or through direct expropriation as the syndicalists and anarchocommunists did in Spain).

Later writers and revolutionists fought against imperialism, against racism and apartheid, for feminism and LGBT rights, and now for the rights of animals and the environment.

We have always allowed some few to take the lion's share of our collective efforts. To run our mutual efforts like their private fiefdoms. We tolerate in privately-held companies what we never would in public democracy.

And now, now that the world has been globalized and new markets exhausted, they look to privatize our public lands, our schools, prisons, thoroughfares, and every other system held in common.

Programmers are waking up to their exploitation. There is more talk of forming coops and unionizing than I have ever heard. However, I hope you all (and we) keep in mind that our affluence, now or future, also rests on the inherited exploitation of others in our past and around the world. Let's not be like the white American socialists who were exclusionary towards others' struggles (and whose efforts were broken when the capitalists brought in those they excluded as scabs). Let's not repeat the mistakes of the past. But to do that, we need to know them.

Boy are you in for a surprise. Medical school lectures are mostly optional these days and are entirely skipped by a significant proportion of med students in favor of resources like Strong Medicine (literally a YouTube channel), gigantic Anki digital flashcard decks (see reddit.com/r/medicalschoolanki), UWorld, First Aid, Sketchy, Pathoma, etc. 'High Yield' is the buzzword for resources that are a better use of time. So yes, you almost certainly will trust a doctor someday who was educated at least in part by YouTube or comparable online resources. You just won't know it, since the paper on the wall will say "University of X". And as long as they pass the boards and make it through residency, does it matter?

Nothing in evolution is inevitable. Granted some things are more likely (oxygen-binding hemoglobin has independently evolved several times from its related non-binding globin family). Brains, nervous systems, even multicellularity are not inevitable. The specific combination of astronomical, geological, and biological features that lead to our development might not lead to similar outcomes if ran a million times.

As other responders have pointed out, brains are just one possible substrate for intelligence. We can't account for other systems (biological or otherwise) that could lead to the development of intelligence, so of necessity any probability estimate based on us has to be a lower bound of possibility.

One bit of our earth history that is worth noting is that the conditions when life presumably arose are hostile to multicellular life as we know it. Earth's early oceans were hot, anoxic and reducing, and under heavy pressure from far thicker atmospheres. The great oxidation event essentially turned earth's atmosphere into a bacterial waste dump, the waste being oxygen produced by early cyanobacteria. Life had to evolve ways to cope with oxygen or learn to hide. This is still true of our own cells. While we need oxygen to survive, it is still and will always be toxic. Free radical damage such as from reactive oxygen species is a constant threat, and is the ultimate form of irrecoverable information death when we die.

Might it be that the conditions under which life can arise, and under which intelligent life can arise, are different? We got lucky that earth traversed from the first to the second. Add this to the list of a million things that had to go right for us to exist at all. The same might well be true of any other intelligences out there. And the odds of two arising close enough in time and space to contact each other would be far less common than lonely civilizations looking out into the dark.

This. I'm gonna cut to the chase: that line is probably the most fascist thing I'm going to read all day, and excepting you, Hacker News has failed to call it out. This idea that war can somehow mythically rejuvenate the ethos or spirit of a country isn't unique to fascism though. It was also common in the jingoist imperial western european powers, and partly used as justification for aggression against neighbors and abroad.

This is disgusting to see at the top of the comment thread. Anyone who upvoted that comment needs to engage in some serious introspection.

This tactic, of identifying a problem that may have some real validity, but then making logical leaps into absurdity, is typical of postmodern types like Bannon. How exactly does war solve the problem identified? Who are we to watch against?

It's not always about the words that are said. There's a subtext or more than one. The given justification isn't always the real justification, it just has to be plausible enough to get the real message out, seen in that last line. The overton window opens, and those on the sidelines who might have kept similar thoughts to themselves can now be drawn in and engaged. And that last sentence creeps closer to becoming real.

Oppose these ideas and these tactics, HN.

Utilities are natural monopolies. Not exactly the best fit for a market solution, especially when, as in this case, they are negative externalities borne by the public that the company is trying to avoid paying for.

Yes, it's impossible to convince a large number of people to switch, which perfectly explains why Maine is still using FPtP despite the large push for RCV a few years ago.

/s

Proof by contradiction, mate. It's not impossible, just hard. There's plenty of things that once we're said to be impossible, and the data agreed... until they happened. Everything had to have had a first time.

I like Approval voting for single positions that are supposed to represent a community rather than a faction: mayor, governor, county commissioner, etc. Mixed member for legislative bodies and Ranked Choice for anything else.

"They thoughtlessly order tests and thoughtlessly obey the results."

Hacker News, come on. You're better than this.

Taking it from the top: The obvious take is that the new tools this is referring to is EMR and things like Watson. Will return to this in a moment.

Subjective and objective data both a play a role in medicine. The eye of an experienced person can often see in a blink what would be missed by someone looking only at numbers in a chart. Gestalt, or the fast system of Kahneman, is invaluable when time is a serious concern. But noone starts out that way. The slower, methodical plod of consciously using bayesian thinking is how the art is learned. Hear hoofbeats, think horses, not zebras... trying to weigh all available data and attempting to chart a course that gives patients the best outcomes at the most reasonable costs. Nowadays additional hoops must be jumped through: laws constrain, institutions have policies that must be followed, and most of all care is dictated by what is allowed by the insurance company. Rather than an invisible hand, this is an invisible supervisor robbing much autonomy and initiative from a sense of worthwhile work. Furthermore the ever-present fear of litigation pushes towards a course with more testing than might be suggested by treatment and diagnosis alone: how would this course be defended if things go wrong, as they will for a certain number? All of these things individually stood to reason, but we as a society must keep in mind the cumulative weight of it all. Emergent phenomena isn't just a thing of programs and physics, it's a thing of human systems like healthcare.

Back to the article. A happy picture is painted of modern CT scans, yet it neglects the downsides. In 1980 the average per capita dose of radiation was 3.0 mSv, with 0.5 coming from medical imaging. It is now 5.5 mSv and rising, with medical imaging alone exceeding 3.0 mSv. Medical imaging is now a larger source of ionizing radiation than all other sources combined, with particularly high risks for those in utero or pediatrics. Like any other test or treatment, there is a risk/reward ratio. As technology improves, it is more likely to be adopted, not because earlier physicians were anti-technology Luddites, but because the improved technology changed that risk/reward ratio. We are more likely to use imaging with less exposure, or better yet use a modality without that risk.

Back to the Bayesian part of thinking... testing isn't perfect. I'd love to see a test that is 100% sensitive and 100% specific. But there are inevitably false positives and false negatives. Tools and tests need to be used in an appropriate situation. For example: I have a test that is 99% sensitive. Great! It'll catch someone with the disease, 99% of the time. So I can thoughtlessly order tests and thoughtlessly obey the results, right? Wrong. What happens if you use it to test for a rare disease that only 0.1% of the population will have? It depends on how specific the test is. How many false positives does it let in? If I test it on 1,000 folks indiscriminately, I'll end up with a basket of folks, only one of which actually has the disease. How many false positives got treated (and possibly harmed by that treatment)? Mammograms work this way (which have fallen a little out of favor in younger demographics without risk factors like the BRCAs), necessitating imaging and invasive biopsies that, upon further collection of data and review, seem not worthwhile for those under 40 and of questionable value under 50.

Tools are great! They need to be used appropriately though. Things have a cost, not just financial but physical and temporal. Indiscriminate use of tests and tools is the last thing anyone should want.

Nothing to add in a world of advancing technology? Bah. Most would love for its promises to come to fruition. EMR for example. We were promised time savings, with cross-talk between systems for better availability of data and improved patient safety. Mostly what has happened is administrators now have data used to push docs to see more and more patients (and spend less and less time with any one of them), all the while the paperwork stacks up. Somehow the paperwork never quite seemed to go away.

Maybe doctors don't reject tools that make their jobs easier. The article is full of tools that were eventually adopted, after all. I can point to many in development that have their ardent advocates, like point-of-care ultrasound among many others. Maybe they don't like tools that were sold as making their jobs easier but mostly don't, and instead benefit insurance companies and conglomerate administrators.