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Misrepresentation of data and poor reporting

No, medical error is NOT the third leading cause of death, and no, Emergency Department misdiagnoses are NOT killing 250,000 people a year in the U.S. As an emergency physician, the widely publicized AHRQ report is particularly painful because it has numerous flaws, and like the Institute of Medicine /BMJ  study, is guilty of completely unwarranted extrapolations.  The authors, for instance, looked at a Canadian study on 503 patients discharged from EDs, one of who died within 14 days of the ED visit (it’s not clear whether this actually represented a diagnostic error; the study was looking at outcomes after the visit, not misdiagnoses).  The AHRQ study then took this single death from a single study to establish a 0.2% (1/503) death rate due to ED diagnosis and multiplied it by the 130 million total annual ED visits to get the purported death numbers.  They went on to concoct arbitrary confidence intervals for this extrapolation:

“The rate of misdiagnosis-related deaths in the one high-quality, prospective study (0.2 percent, n=1 of 503) is 217-fold higher than the weighted mean from the three retrospective studies (0.0009 percent). Although the rate of 0.2 percent is based on just a single death (so is imprecise, with a wide 95% CI 0.005 to 1.1), the value is the best estimate from this study and matches data from other sources. However, the confidence interval from the Calder study alone is implausibly wide. Based on data from other sources, we have assigned a +/- 2-fold plausible range to the 0.2 percent estimate (0.1% to 0.4%).”

This is not good science.  For more, see:

2023-01-18T15:51:01-05:00January 18th, 2023|Home, Musings|

On Childhood Vaccinations

Zeke Emanuel and Matthew Guido write in the NYT about declining childhood vaccination rates in the US, leading to inadequate levels of population “herd immunity” and therefore increasing the risks of outbreaks.  They advocate eliminating nonmedical exemptions for vaccinations and allowing children 14 or over to get immunized without parental permission.   I agree.

2022-12-29T18:13:55-05:00December 29th, 2022|Home, Musings|

An American Tragedy, Indeed

German Lopez, writing in the NYT’s “The Morning” newsletter, writes on the toll of firearms on child mortality in the U.S.; an excerpt:

“Guns are now the No. 1 cause of deaths among American children and teens, ahead of car crashes, other injuries and congenital disease.

In other rich countries, gun deaths are not even among the top four causes of death, a recent Kaiser Family Foundation report found. The U.S. accounts for 97 percent of gun-related child deaths among similarly large and wealthy countries, despite making up just 46 percent of this group’s overall population.”

The NY Times Magazine has a story on the lives some of the children killed by gun violence lived.

2022-12-15T17:53:50-05:00December 15th, 2022|Home, Musings|

Fusion!

Very cool stuff; about a megajoule’s worth of net positive energy output from a lab fusion experiment at the Lawrence Livermore National Laboratory.  We have ignition!  Not ready for steady state energy production (likely not for several decades), since it took 300 megajoules of electricity from the grid to power the relatively inefficient lasers’ delivery of 2.05 MJ to the target —  but a promising demonstration.  Read about it in the NYT here.

2022-12-13T12:38:21-05:00December 13th, 2022|Home, Musings|

More excellence from Matt Levine on the crypto crisis

Matt Levine delivers another excellent Money Stuff piece on the house of cards known as crypto exchanges; an excerpt, where Matt is comparing this crisis to the 2008 financial crisis:

“A quick summary of 2008 is that there was a lot of demand for safe assets, for bonds with AAA ratings. The financial system obligingly manufactured those assets, taking risky assets — mostly subprime mortgages — and packaging and slicing them to achieve AAA ratings. There was so much demand for safe assets that the manufacturing process got sloppy: The subprime mortgages got ever more subprime, the slicing and repackaging got less effective, and ultimately some of the safe assets turned out not to be safe. 

Something like that seems to have happened in crypto but there is a critical difference. In crypto, there are no mortgages to speak of. You cannot really start by taking some somewhat risky cash flows and tranching them to make some of the cash flows safer. There are no cash flows. The safe assets in crypto — interest-bearing accounts at Voyager or Celsius or BlockFi or Gemini — are created by making unsecured billion-dollar loans, negotiated in a single phone call, to arbitrage trading firms that are actually just making long-term bets on the marketing abilities of blockchain entrepreneurs. Crypto shadow banks did not manufacture safe assets out of risky investments; they just relabeled the risky investments as safe assets. There were people taking wild speculative risks on brand-new, sentiment-driven crypto projects, and there were people who wanted to invest safely and earn 8%, and they were the same people.”

2022-12-05T15:48:58-05:00December 5th, 2022|Home, Musings|

Bouie and the “woke capitalism” nonsense

Jamelle Bouie again does a nice job in the NYT demolishing the inconsistencies in the right’s professed disdain for “woke capitalism.” An excerpt:

“I wrote last year about this notion of “woke capitalism” and the degree to which I think this “conflict” is little more than a performance meant to sell an illusion of serious disagreement between owners of capital and the Republican Party. As I wrote then, “The entire Republican Party is united in support of an anti-labor politics that puts ordinary workers at the mercy of capital.” Republicans don’t have a problem with corporate speech or corporate prerogatives as a matter of principle; they have a problem with them as a matter of narrow partisan politics.”

 

2022-12-03T16:48:43-05:00December 3rd, 2022|Home, Musings|

On the benefits of universal masking in the face of a pandemic transmitted by aerosols

A study by Cowger and colleagues appearing in the Nov. 9 issue of the NEJM provides new evidence that the removal of universal school masking policies in Massachusetts was associated with an increased incidence of Covid-19.

From the accompanying editorial by Raifman and Green:

“The study used difference-in-differences methods, a rigorous form of causal inference for policies that are infeasible or unethical to assess in a randomized trial. During a 15-week period (March to June 2022), Covid-19 cases in school districts that had ended universal school masking policies (70 districts for most of the 15-week period) were compared with cases in school districts that sustained universal masking policies (2 districts for most of the 15-week period). The removal of universal school masking was associated with an additional 2882 Covid-19 cases among 46,530 staff (an estimated 81.7 cases per 1000 staff) and an additional 9168 Covid-19 cases among 294,084 students (an estimated 39.9 cases per 1000 students) during the 15 weeks. In school districts that had ended universal masking, approximately 40% of 7127 staff cases and 32% of 28,524 student cases were associated with the removal of universal masking policies.”

2022-11-13T15:01:26-05:00November 13th, 2022|Home, Musings|
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