High risk of melanoma for airline crew
High risk of melanoma for airline crew
A SYSTEMATIC review and meta-analysis involving more than 250 000 people has found that pilots and air crew have twice the incidence of melanoma compared with the general population. The review, published in JAMA Dermatology, of 19 studies published between 1990 and 2013 reporting data from 1943 to 2008, included more than 266 431 participants from 11 countries. Fifteen of the papers reported data on pilots and four on cabin crew. The researchers found the standardised incidence ratio of participants in any flight-based occupation was 2.21 — 2.22 for pilots and 2.09 for cabin crew. The standardised mortality ratio of participants in any flight-based occupation was 1.42 — 1.83 for pilots and 0.90 for cabin crew. The researchers speculated that cosmic radiation could be a risk factor, saying “UV radiation is a known risk factor for melanoma, and the cumulative exposure of pilots and cabin crew compared with the general population has not been assessed”. They wrote that their findings had “important implications for occupational health and protection of this population”.
https://www.mja.com.au/insight/2014/33/news-brief
Early Computers Took Up Whole Rooms
Adyashanti on Enlightenment
Enlightenment is a destructive process. It has nothing to do with becoming better or being happier. Enlightenment is the crumbling away of untruth. It’s seeing through the facade of pretence. It’s the complete eradicatin of everything we imagined to be true. Adyashanti
Plato: wise men speak because they have something to say; fools, because they have to say something
Plato: wise men speak because they have something to say; fools, because they have to say something
Terry Barnes: Doctors have a fat co-payment scheme of their own
Another cracking, clean head shot from Terry… totally concur with this one!
http://www.afr.com/p/business/healthcare2-0/doctors_have_fat_co_payment_scheme_g9tVCa7kjp7RkGhXIHh3tN
TERRY BARNES
Doctors have a fat co-payment scheme of their own
PUBLISHED: 13 AUG 2014 00:05:00 | UPDATED: 20 AUG 2014 11:53:54
Even if Medicare rebates don’t cover the full cost of medical services plus a reasonable margin, their subsidies make costly specialist services accessible and affordable to most Australians on low to middle incomes. Photo: Glenn Hunt
TERRY BARNES
While relentlessly attacking the federal budget’s $7 co-payment on bulk-billed GP services measure as unfair, neurosurgeon and Australian Medical Association president Brian Owler asserts doctors’ rights to charge co-payments generally. His specialist members certainly do with gusto, and presumably he does too.
If he but realises it, Health Minister Peter Dutton is ideally placed to drive a hard bargain with the AMA on containing excessive out-of-pockets, especially given the doctors’ trade union is pressuring the government to dump the $5 cut to Medicare rebates intended to drive GPs to charge the co-payment.
The ace up Dutton’s sleeve is that doctors, particularly surgeons and specialists, depend on Medicare income like a smoker depends on his nicotine fix. Even if Medicare rebates don’t cover the full cost of medical services plus a reasonable margin, their subsidies make costly specialist services accessible and affordable to most Australians on low to middle incomes, especially the pensioners and fixed-income retirees who dominate the demand for medical services.
Given this financial reality, the government should use its domination of purchasing by Medicare on behalf of patients to bring the AMA to heel on excessive specialist charging. Doctors are entitled to a fair and reasonable fee above the Medicare schedule fee, and there’s no cap on what doctors can charge, but too many specialists have assumed this is carte blanche to gouge poor paying punters.
To end specialist billing rorts, the government can and should impose out-of-pocket capping that is simple, elegant, and transparent, using the AMA’s own benchmarks against it.
The AMA has its own private fee schedule, in which it determines what it considers appropriate prices for specific Medicare service items. AMA fees have long been an unofficial benchmark for doctors, the association stressing that it is staying on the right side of competition law by offering general advice to its members rather than giving them direction. The government’s published Medicare schedule fee observance and out-of-pocket data indicate that a great many doctors, notably GPs, apply the AMA recommended fee when they don’t bulk bill.
‘FAIR AND REASONABLE’
What’s more, specialist association submissions to the current Senate inquiry into patient out-of-pocket expenses repeatedly cite AMA recommended fees as being fair and reasonable, especially when compared with what they depict as woefully inadequate Medicare rebates.
With this in mind, the government should take doctors at their word and insist, as a condition of specialists’ access to Medicare, that patient contributions for any billed service that exceed AMA recommended fees will be prohibited. If doctors exceeds this cap, they could be fined have their Medicare billing rights suspended or cancelled, and be required to refund gouged patients their contributions plus credit care-level interest. The current but secret AMA recommended fee schedule would be published as a baseline, and subsequently indexed annually under a formula agreed by the government and the profession.
Recommended fees for future new items would be set by the AMA and relevant specialist colleges in consultation with the government.
Should a doctor want to be more competitive on price, there would be no prohibition on their charging a fee lower than the AMA’s recommendation.
But they would not be permitted to exceed it if they bill Medicare as their patients would expect.
Further, private health insurers should be permitted to cover the gap between specialist Medicare rebates and AMA recommended fees. This would be fairer to patients than current arrangements in which insurers have no gap, or no known gap deals with some specialists but not with others. It would also tackle those GPs and specialists, most notoriously anaesthetists, who blatantly ignore their patients’ rights to be informed of and consent to fees before a service is provided.
Private insurers also should be able to advise their members on the comparative performance of doctors, especially in relation to price. In a market for health services bedevilled by information asymmetry, insurers have a wealth of consumer knowledge that can be shared without compromising the privity of the doctor-patient relationship. Let them share it. For too long, medical specialists have got away with ripping off patients through excessive charging practices. Dutton, therefore, should use his negotiations with the AMA to take a stand for patients, call Owler’s bluff, and wield his own market power to bring the AMA to heel over specialists’ stubborn, arrogant and contemptuous disregard for their patients as customers. If the minister does take on the AMA over blatant fee-gouging, he’d be onto a political winner.
Terry Barnes authored the Australian Centre for Health Research’s $7 GP co-payment proposal.
The Australian Financial Review
Nearly half of all Americans will get type 2 diabetes
http://www.theguardian.com/society/the-shape-we-are-in-blog/2014/aug/13/diabetes-usdomesticpolicy
Nearly half of all Americans will get type 2 diabetes, says study
Type 2 diabetes, linked in 90% of cases to overweight and obesity, is soaring. New research shows 40% of Americans and 50% of Hispanics and non-Hispanic black women will get the disease at some point in their life and the numbers are unlikely to be much different elsewhere in the developed world
A patient undergoes a blood test for diabetes, a condition which brings icnreased risk of stroke and heart failure. Photograph: Hugo Philpott/PA
How much worse can the type 2 diabetes epidemic get? Shockingly, a new study published by a leading medical journal says that 40% of the adult population of the USA is expected to be diagnosed with the disease at some point in their lifetime. And among Hispanic men and women and non-Hispanic black women, the chances are even higher – one in two appear to be destined to get type 2 diabetes.
As Public Health England spelled out in a recent report urging local authorities to take action, 90% of people with type 2 diabetes are overweight or obese. There is no mystery behind the rise in diagnoses – they match the soaring weight of the population. The climb dates back to the 1980s and is associated with our more sedentary lifestyles and changing eating habits – more food, containing more calories, more often. It is those things that will have to be tackled if the epidemic is to be contained.
The new study in The Lancet Diabetes & Endocrinology journal, from a team of researchers from the Centers for Disease Control and Prevention in Atlanta, shows that the risk of developing type 2 diabetes for the average 20 year-old American rose from 20% for men and 27% for women in 1985–1989, to 40% for men and 39% for women in 2000–2011. The study was big – involving data including interviews and death certificates from 600,000 Americans.
Americans are generally living longer, which is a factor in their increased lifetime chance of developing type 2 diabetes. They are also not dying in the same proportions that they were, because of better treatment. However, that means they are going to spend far more years of their lives suffering from type 2 diabetes, which can lead to blindness and foot amputations as well as heart problems.
This is very bad news for the US healthcare system, says Dr Edward Gregg, study leader and chief of the epidemiology and statistics branch of the Division of Diabetes Translation at CDC:
As the number of diabetes cases continue to increase and patients live longer there will be a growing demand for health services and extensive costs. More effective lifestyle interventions are urgently needed to reduce the number of new cases in the USA and other developed nations.
Both he and Canada-based Dr Lorraine Lipscombe, who has written a commentary on the study, point out that the situation in the US is unlikely to be much different from that elsewhere in the developed world. Dr Lipscombe, from Women’s College Hospital and the University of Toronto, writes:
The trends reported by Gregg and colleagues are probably similar across the developed world, where large increases in diabetes prevalence in the past two decades have been reported.
Primary prevention strategies are urgently needed. Excellent evidence has shown that diabetes can be prevented with lifestyle changes. However, provision of these interventions on an individual basis might not be sustainable.
Only a population-based approach to prevention can address a problem of this magnitude. Prevention strategies should include optimisation of urban planning, food-marketing policies, and work and school environments that enable individuals to make healthier lifestyle choices. With an increased focus on interventions aimed at children and their families, there might still be time to change the fate of our future generations by lowering their risk of type 2 diabetes.
Schlimmbesserung
schlimmbesserung: An attempt to make things better that ends up making them a lot worse.
Galbraith on people of privilege
http://www.themonthly.com.au/issue/2014/june/1401544800/richard-cooke/people-versus-political-class
“People of privilege will always risk their complete destruction rather than surrender any material part of their advantage.”
JK Galbraith
Eisenhower’s Farewell Address – The Military-Industrial Complex
President Dwight Eisenhower’s Farewell Address to the nation January 17, 1961
In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.
We must never let the weight of this combination endanger our liberties or democratic processes. We should take nothing for granted only an alert and knowledgeable citizenry can compel the proper meshing of huge industrial and military machinery of defense with our peaceful methods and goals, so that security and liberty may prosper together.
….
The prospect of domination of the nation’s scholars by Federal employment, project allocations, and the power of money is ever present and is gravely to be regarded.
Yet, in holding scientific research and discovery in respect, as we should, we must also be alert to the equal and opposite danger that public policy could itself become the captive of a scientific-technological elite.
It is the task of statesmanship to mold, to balance, and to integrate these and other forces, new and old, within the principles of our democratic system-ever aiming toward the supreme goals of our free society.
Transcript of President Dwight D. Eisenhower’s Farewell Address (1961)
My fellow Americans:
Three days from now, after half a century in the service of our country, I shall lay down the responsibilities of office as, in traditional and solemn ceremony, the authority of the Presidency is vested in my successor.
This evening I come to you with a message of leave-taking and farewell, and to share a few final thoughts with you, my countrymen.
Like every other citizen, I wish the new President, and all who will labor with him, Godspeed. I pray that the coming years will be blessed with peace and prosperity for all.
Our people expect their President and the Congress to find essential agreement on issues of great moment, the wise resolution of which will better shape the future of the Nation.
My own relations with the Congress, which began on a remote and tenuous basis when, long ago, a member of the Senate appointed me to West Point, have since ranged to the intimate during the war and immediate post-war period, and, finally, to the mutually interdependent during these past eight years.
In this final relationship, the Congress and the Administration have, on most vital issues, cooperated well, to serve the national good rather than mere partisanship, and so have assured that the business of the Nation should go forward. So, my official relationship with the Congress ends in a feeling, on my part, of gratitude that we have been able to do so much together.
II
We now stand ten years past the midpoint of a century that has witnessed four major wars among great nations. Three of these involved our own country. Despite these holocausts America is today the strongest, the most influential and most productive nation in the world. Understandably proud of this pre-eminence, we yet realize that America’s leadership and prestige depend, not merely upon our unmatched material progress, riches and military strength, but on how we use our power in the interests of world peace and human betterment.
III
Throughout America’s adventure in free government, our basic purposes have been to keep the peace; to foster progress in human achievement, and to enhance liberty, dignity and integrity among people and among nations. To strive for less would be unworthy of a free and religious people. Any failure traceable to arrogance, or our lack of comprehension or readiness to sacrifice would inflict upon us grievous hurt both at home and abroad.
Progress toward these noble goals is persistently threatened by the conflict now engulfing the world. It commands our whole attention, absorbs our very beings. We face a hostile ideology-global in scope, atheistic in character, ruthless in purpose, and insidious in method. Unhappily the danger it poses promises to be of indefinite duration. To meet it successfully, there is called for, not so much the emotional and transitory sacrifices of crisis, but rather those which enable us to carry forward steadily, surely, and without complaint the burdens of a prolonged and complex struggle-with liberty at stake. Only thus shall we remain, despite every provocation, on our charted course toward permanent peace and human betterment.
Crises there will continue to be. In meeting them, whether foreign or domestic, great or small,there is a recurring temptation to feel that some spectacular and costly action could become the miraculous solution to all current difficulties. A huge increase in newer elements of our defense; development of unrealistic programs to cure every ill in agriculture; a dramatic expansion in basic and applied research-these and many other possibilities, each possibly promising in itself, may be suggested as the only way to the road we which to travel.
But each proposal must be weighed in the light of a broader consideration: the need to maintain balance in and among national programs-balance between the private and the public economy, balance between cost and hoped for advantage-balance between the clearly necessary and the comfortably desirable; balance between our essential requirements as a nation and the duties imposed by the nation upon the individual; balance between action of the moment and the national welfare of the future. Good judgment seeks balance and progress; lack of it eventually finds imbalance and frustration.
The record of many decades stands as proof that our people and their government have, in the main, understood these truths and have responded to them well, in the face of stress and threat. But threats, new in kind or degree, constantly arise. I mention two only.
IV
A vital element in keeping the peace is our military establishment. Our arms must be mighty, ready for instant action, so that no potential aggressor may be tempted to risk his own destruction.
Our military organization today bears little relation to that known by any of my predecessors in peace time, or indeed by the fighting men of World War II or Korea.
Until the latest of our world conflicts, the United States had no armaments industry. American makers of plowshares could, with time and as required, make swords as well. But now we can no longer risk emergency improvisation of national defense; we have been compelled to create a permanent armaments industry of vast proportions. Added to this, three and a half million men and women are directly engaged in the defense establishment. We annually spend on military security more than the net income of all United State corporations.
This conjunction of an immense military establishment and a large arms industry is new in the American experience. The total influence-economic, political, even spiritual-is felt in every city, every state house, every office of the Federal government. We recognize the imperative need for this development. Yet we must not fail to comprehend its grave implications. Our toil, resources and livelihood are all involved; so is the very structure of our society.
In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.
We must never let the weight of this combination endanger our liberties or democratic processes. We should take nothing for granted only an alert and knowledgeable citizenry can compel the proper meshing of huge industrial and military machinery of defense with our peaceful methods and goals, so that security and liberty may prosper together.
Akin to, and largely responsible for the sweeping changes in our industrial-military posture, has been the technological revolution during recent decades.
In this revolution, research has become central; it also becomes more formalized, complex, and costly. A steadily increasing share is conducted for, by, or at the direction of, the Federal government.
Today, the solitary inventor, tinkering in his shop, has been over shadowed by task forces of scientists in laboratories and testing fields. In the same fashion, the free university, historically the fountainhead of free ideas and scientific discovery, has experienced a revolution in the conduct of research. Partly because of the huge costs involved, a government contract becomes virtually a substitute for intellectual curiosity. For every old blackboard there are now hundreds of new electronic computers.
The prospect of domination of the nation’s scholars by Federal employment, project allocations, and the power of money is ever present and is gravely to be regarded.
Yet, in holding scientific research and discovery in respect, as we should, we must also be alert to the equal and opposite danger that public policy could itself become the captive of a scientific-technological elite.
It is the task of statesmanship to mold, to balance, and to integrate these and other forces, new and old, within the principles of our democratic system-ever aiming toward the supreme goals of our free society.
V
Another factor in maintaining balance involves the element of time. As we peer into society’s future, we-you and I, and our government-must avoid the impulse to live only for today, plundering, for our own ease and convenience, the precious resources of tomorrow. We cannot mortgage the material assets of our grandchildren without risking the loss also of their political and spiritual heritage. We want democracy to survive for all generations to come, not to become the insolvent phantom of tomorrow.
VI
Down the long lane of the history yet to be written America knows that this world of ours, ever growing smaller, must avoid becoming a community of dreadful fear and hate, and be, instead, a proud confederation of mutual trust and respect.
Such a confederation must be one of equals. The weakest must come to the conference table with the same confidence as do we, protected as we are by our moral, economic, and military strength. That table, though scarred by many past frustrations, cannot be abandoned for the certain agony of the battlefield.
Disarmament, with mutual honor and confidence, is a continuing imperative. Together we must learn how to compose difference, not with arms, but with intellect and decent purpose. Because this need is so sharp and apparent I confess that I lay down my official responsibilities in this field with a definite sense of disappointment. As one who has witnessed the horror and the lingering sadness of war-as one who knows that another war could utterly destroy this civilization which has been so slowly and painfully built over thousands of years-I wish I could say tonight that a lasting peace is in sight.
Happily, I can say that war has been avoided. Steady progress toward our ultimate goal has been made. But, so much remains to be done. As a private citizen, I shall never cease to do what little I can to help the world advance along that road.
VII
So-in this my last good night to you as your President-I thank you for the many opportunities you have given me for public service in war and peace. I trust that in that service you find somethings worthy; as for the rest of it, I know you will find ways to improve performance in the future.
You and I-my fellow citizens-need to be strong in our faith that all nations, under God, will reach the goal of peace with justice. May we be ever unswerving in devotion to principle, confident but humble with power, diligent in pursuit of the Nation’s great goals.
To all the peoples of the world, I once more give expression to America’s prayerful and continuing inspiration:
We pray that peoples of all faiths, all races, all nations, may have their great human needs satisfied; that those now denied opportunity shall come to enjoy it to the full; that all who yearn for freedom may experience its spiritual blessings; that those who have freedom will understand, also, its heavy responsibilities; that all who are insensitive to the needs of others will learn charity; that the scourges of poverty, disease and ignorance will be made to disappear from the earth, and that, in the goodness of time, all peoples will come to live together in a peace guaranteed by the binding force of mutual respect and love.
Transcription courtesy of the Dwight D. Eisenhower Presidential Library and Museum.