haldujai

31 ms·

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by haldujai 3y ago
Also worth noting that not every resource and instance type is covered by a BAA so there’s a bit more to it than just signing an agreement and doing whatever you want. The responsibility remains with the user rather than the cloud provider
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by haldujai 3y ago
You’re missing at least an order of magnitude of complexity here. For starters the data generated by a single hospital EHR is something like 10-20 TB/year. The data is stored (essentially indefinitely) in multiple databases of varying
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by haldujai 3y ago
I’ve lived through 2 hospital transitions to Epic. Everyone hates it for the first two years and then when they learn it they generally love the benefits it provides (much faster chart review, documentation and billing). As a physician, usi
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by haldujai 3y ago
This. Every hospital I’ve worked at has used Epic and every one has a different “custom” version with different UI and user role configuration. Even within the same hospital the UI and default displays widely varies based on context and rol
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by haldujai 3y ago
Not sure why this comment is dead. You’re partially correct that a fair bit of health software is stagnant and fixing bugs takes time (although not years) but when discussing EMRs, especially the biggest player (Epic), they fairly regularly
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by haldujai 3y ago
> I guess the way I presented thoughts looked like I was saying NSS are bad for you. I don't have the evidence for that claim. But I don't think the balance of evidence is in favour of NSS either. Thanks for the clarification,
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by haldujai 3y ago
Why? Plenty of teratogenic drugs are approved and in routine use in non-pregnant patients.
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by haldujai 3y ago
This isn’t a medication it’s a mechanism study. I would expect not many and certainly far less than the number of medications that worked in animals but did not work or harmed humans.
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by haldujai 3y ago
Astute observation as to why most nutritional studies and claims are entirely bs and should be ignored.
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by haldujai 3y ago
Respectfully, overstated conclusions you’re drawing from these limited studies. Ref[1]: Of the few studies identified for each outcome, most had few participants, were of short duration, and their methodological and reporting quality was l
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by haldujai 3y ago
I really want to laugh at this but I can’t suspend my disbelief that a nutritional study in this vein actually has a control group.
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by haldujai 3y ago
I’m sorry to hear that. Best wishes for Jake and your family.
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by haldujai 3y ago
“The Right to Try Act is one way for patients who have been diagnosed with life-threatening diseases or conditions who have tried all approved treatment options and who are unable to participate in a clinical trial to access certain investi
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by haldujai 3y ago
> Should we at least demand more specific criteria than "X _might_ save their life", like threshold of suggestive evidence? There will always be lots of stuff that hasn't been closely studied, the effects of which we can o
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by haldujai 3y ago
> Antipsychotics are incredibly important medications for a lot of people. Agree. > It really matters that amisulpride is not available. Not sure about this, I'm not a psychiatric expert but my cursory lit review shows conflictin
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by haldujai 3y ago
It depends what you consider the outcome to be, by virtue of being a 39 y/o with early recurrent and possibly oligometastatic disease he is in the definitively palliative-intent treatment category so everything is a long shot. Really t
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by haldujai 3y ago
> Do you know what else sounds like a recipe for killing people? Not allowing people to access therapeutics that might save their life because it hasn't yet gone through regulatory approval yet for whatever reason (delays, too expen
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by haldujai 3y ago
> Category B - approved by some other established regulatory body (EU). Comes with all the warnings, doctors can write it off-label, insurance companies may not cover it but doctors can ask for a variance We can already prescribe off-lab
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by haldujai 3y ago
Actually the Moderna trials are recruiting metastatic and treatment resistant disease. From his description he has not met inclusion/exclusion criteria for the studies due to treatments received and not received rather than being too a
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by haldujai 3y ago
No problem. I appreciate the discussion, it's good for me (and medicine in general) to be challenged on held beliefs as things tend to devolve insidiously in this field.
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by haldujai 3y ago
> Unfortunately, the best I can point to is a series of blog posts and informal discussions, I'm not aware of any formal published evidence. I remember a blog post on ACX post aducanumab ( https://astralcodexten.substack.c
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by haldujai 3y ago
Please note I am speaking only for the world of oncology as that's my practice focus and what I know best. > But I'd like to hear your thoughts on the broader argument of being more aggressive with trials in general. What stic
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by haldujai 3y ago
> Most drugs fail. But getting the drugs that do work to patients even a year earlier may be a much larger benefit than the cost of giving people with serious diseases broader choices, in addition to the current best known standard. This
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by haldujai 3y ago
I’m ignoring that part because it is nearly impossible to prognosticate prior to initiation of systemic therapy, with the exception of some phenotypes but we don’t have the pathology report in this case. My point is that he doesn’t even mee
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by haldujai 3y ago
Current standard of care includes experimental therapy. What you are describing is once again how novel cancer treatments are being implemented today. Furthermore, Step 1 of the NCCN treatment guidelines for these kinds of cancers (i.e. adv
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by haldujai 3y ago
> Indeed, as he stated, he wants into two that are underway, but that he is probably too far along for. The author is incorrect on this, he’s not too far along but he does not meet inclusion criteria for either of the studies he cited as
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by haldujai 3y ago
Excellent explanation, parent is also correct. I think the author’s position is misinformed. The FDA doesn’t hold back researchers on inclusion/exclusion criteria. Inclusion for the Moderna trial he linked to: > Must have primary re
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by haldujai 3y ago
> While most new drugs indeed fail (the large majority of them), in diseases with very poor prognosis like OP's cancer, I think we would benefit from still looking at the tradeoff as a decision under uncertainty, instead of a comple
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by haldujai 3y ago
Wall Street dinged them because Gilead is a one trick pony and the street overestimated revenue, not because Gilead cured HCV rather than just treating it. Additionally, if their drug didn’t work as well they wouldn’t have gotten away with
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by haldujai 3y ago
Most vaccines only require 1-3 injections. This example is poorly chosen for a different reason explained in my comment. Alternatively, we can look at novel curative intent therapies for cancer like focal ablation or stereotactic radiation.

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