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Skeptical Debunker

Controversial Studies Trigger Dropoff in Osteoporosis Treatment - 0 views

  • The North American Spine Society and the Society of Interventional Radiology have pointed to flaws in both studies. And earlier studies, published over 15 years, found major benefits to kyphoplasty and a related procedure called vertebroplasty. "We're missing opportunities for patients to receive a safe and effective treatment that can significantly reduce their pain and disability," said Malamis, an interventional radiologist. The procedures are used to treat vertebral compression fractures in patients with osteoporosis and other conditions that result in brittle bones. In a vertebroplasty, an acrylic cement is injected into a fractured vertebra. In a kyphoplasty, a balloon-tipped catheter first is inserted into the fracture. The balloon is inflated to restore the height and shape of the vertebra before the cement is injected. Neva Nelson, 74, of Naperville, Ill., said a kyphoplasty that Malamis performed in October, 2009, has greatly reduced her pain in a vertebra in her lower back that she fractured after falling on ice. Before her kyphoplasty, Nelson had to sit on cushions. Walking, and especially standing, were painful. "I had to do something," she said. "I could not go on like that." Nelson said that since undergoing her kyphoplasty, "I don't have to worry about my back any more." In the controversial studies, patients were randomly assigned to receive a vertebroplasty or a placebo-like "sham" procedure. In the sham procedure, patients received an injection of anesthetic, but no cement. However, patients in severe pain are reluctant to enroll in a trial where there's a 50 percent chance of receiving a sham treatment. In one of the studies, researchers had to screen 1,813 patients to enroll just 131 subjects. In the other study, only 78 of 219 eligible patients were enrolled. This low enrollment rate raises the possibility that the patients who did enroll were not representative. Patients experience the greatest pain during the first three months after a compression fracture. Thereafter, pain gradually subsides. Thus, a vertebroplasty or kyphoplasty provides the greatest benefit when performed within a week or two of the fracture. But the studies enrolled patients up to 12 months after fractures. In addition to reducing pain and disability, a kyphoplasty can reduce the risk of subsequent fractures by improving the angle and height of the spine. The studies evaluated vertebroplasty alone, and did not include the more innovative and very different kyphoplasty procedure. Malamis suggests the medical community wait for the results of additional studies now underway before passing final judgment on vertebroplasty or kyphoplasty. In the mean time, he notes that Medicare still covers the procedures.
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    Dr. Angelo Malamis says that 90 percent of his patients who have undergone a treatment called balloon kyphoplasty for vertebral fractures report significant reductions in pain and disability. But the number of kyphoplasty referrals Malamis has received from primary care doctors has dropped sharply since two controversial studies were published last year in the New England Journal of Medicine. In findings that have been disputed by two medical societies, researchers reported that a procedure related to kyphoplasty was not significantly better than a placebo-like procedure in reducing pain and disability.
Skeptical Debunker

Lawrence Lessig: Systemic Denial - 0 views

  • So in coming to this meeting of some of the very best in the field -- from Elizabeth Warren to George Soros -- I was keen to hear just what the strategy was to restore us to some sort of financial sanity. How could we avoid it again? Yet through the course of the morning, I was struck by two very different and very depressing points. The first is that things are actually much worse than anyone ever talks about. The pivot points of our financial system -- the infrastructure that lets free markets produce real wealth -- have become profoundly corrupted. Balance sheets are "fictions," as Professor Frank Partnoy put it. Trillions of dollars in liability hide behind these fictions. And as expert after expert demonstrated, practically every one of the design flaws that led to the collapse of the past few years remains essentially unchanged within our financial system still. That bubble burst, but we can already see the soaring profits of the same firms that sucked billions in taxpayer funds. The cycle has started again. But the second point was even worse. Expert after expert spoke as if the problems we faced were simple math errors. As if regulators had just miscalculated, like a pilot who accidentally overshoots the run way, or an engineer who mis-estimates the weight of cargo on a plane. And so, because these were mere errors, people spoke as if these errors could be corrected by a bunch of good ideas. The morning was filled with good ideas. An angry earnestness was the tone of the day.
  • There were exceptions. The increasingly prominent folk-hero for the middle class, Elizabeth Warren, tied the endless list of problems to the endless power of "the banking lobby." But that framing was rare. Again and again, we were led back to a frame of bad policies that smart souls could correct. At least if "the people" could be educated enough to demand that politicians do something sensible. This is a profound denial. The gambling on Wall Street was not caused by the equivalent of errors in arithmetic. It was caused by a corruption of the system by which we regulate those markets. No true theorist of free markets -- and certainly none of the heroes of even the libertarian right -- believe that infrastructure markets like financial systems can be left free of any regulation, including the regulation of rules against fraud. Yet that ignorant anarchy was the precise rule that governed a large part of our financial system. And not by accident: An enormous amount of political influence was brought to bear on the regulators of these core institutions of a free market to get them to turn a blind eye to Wall Street's "innovations." People who should have known better yielded to this political pressure. Smart people did stupid things because "the politics" of doing right was impossible. Why? Why was their no political return from sensible policy? The answer is so obvious that one feels stupid to even remark it. Politicians are addicts. Their dependency is campaign cash. And in their obsessive search for campaign funds, they let these funders convince them that for the first time in capitalism's history, markets didn't need the basic array of trust-producing regulation. They believed this insanity because it made it easier for them -- in good faith -- to accept the money and steer financial policy over the cliff. Not a single presentation the whole morning focused this part of the problem. There wasn't even speculation about how we could build an alternative to this campaign funding system of pathological dependency, so that policy makers could afford to hear sense rather than obsessively seek campaign dollars. The assembled experts were even willing to brainstorm about how to educate ordinary Americans about the intricacies of financial regulation. But the idea of changing the pathological economy of influence that governs how Washington governs wasn't even a hint. We need to admit our (democracy's) problem. We need to get beyond this stage of denial. We need to recognize that until we release our leaders from a system that forces them to ignore good sense when there is an opportunity for large campaign cash, we won't have policy that makes sense. Wall Street continues unchanged because the Congress that would change it is already shuttling to Wall Street fundraisers. Both parties are already pandering to this power, so they can find the fix to fund the next cycle of campaigns. Throughout the morning, expert after expert celebrated the brilliance in Franklin Roosevelt's response to the Nation's last truly great financial collapse. They yearned for a modern version of his system of regulation. But we won't get to Franklin Roosevelt's brilliance till we accept Teddy Roosevelt's insight -- that privately funded public elections tend inevitably towards this kind of corruption. And until we solve that (eminently solvable) problem, we won't make any progress in making America's finances safe again.
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    Everyone recognizes that our nation is in a financial mess. Too few see that this mess is not simply the ordinary downs of a regular business cycle. The American financial system walked the American economy off a cliff. Large players took catastrophic risk. They were allowed to take this risk because of a series of fundamental regulatory mistakes; they were encouraged to take it by the implicit, sometimes explicit promise, that failure would be bailed out. The gamble was obvious and it worked. The suckers were us. They got the upside. We got the bill.
Skeptical Debunker

Hold vendors liable for buggy software, group says - 0 views

  • "The only way programming errors can be eradicated is by making software development organizations legally liable for the errors," he said. SANS and Mitre, a Bedford, Mass.-based government contractor, also released their second annual list of the top 25 security errors made by programmers. The authors said those errors have been at the root of almost every major type of cyberattack, including the recent hacks of Google and numerous utilities and government agencies. According to the list, the most common mistakes continue to involve SQL injection errors, cross-site scripting flaws and buffer overflow vulnerabilities. All three have been well-known problems for
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    A coalition of security experts from more than 30 organizations is urging enterprises to exert more pressure on software vendors to ensure that they use secure code development practices. The group, led by the SANS Institute and Mitre Corp., offered enterprises recent hacks of Google draft contract language that would require vendors to adhere to a strict set of security standards for software development. In essence, the terms would make vendors liable for software defects that lead to security breaches. "Nearly every attack is enabled by [programming] mistakes that provide a handhold for attackers," said Alan Paller, director of research at SANS, a security training and certification group.
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    Of course, a more general way to address this and other "business" generated problems / abuses (like expensive required "arbitration" by companies owned and in bed with the companies requiring the arbitration!), is to FORBID contract elements that effectively strip any party of certain "rights" (like the right to sue for defectives; the right to freedom of speech; the right to warranty protections; the right to hold either party to public or published promises / representations, etc.). Basically, by making LYING and DECEIT and NEGLIGENCE liability and culpability unrestricted. Or will we hear / be told that being honest and producing a quality product is "anti-business"? What!? Is this like, if I can't lie and cheat being in business isn't worth it!? If that is true, then those parties and businesses could just as well "go away"! Just as "conservatives" say other criminals like that should. One may have argued that the software industry would never have "gotten off the ground" (at least, as fast as it did) if such strict liability had been enforced (as say, was eventually and is more often applied to physical building and their defects / collapses). That is, that the EULAs and contracts typically accompanying software ("not represented as fit for any purpose" more or less!) had been restricted. On the other hand, we might have gotten software somewhat slower but BETTER - NOT being associated with or causing the BILLIONS of dollars in losses due to bugs, security holes, etc. Others will rail that this will merely "make lawyers richer". So what if it will? As long as government isn't primarily "on the side" of the majority of the people (you know, like a "democracy" should be), then being able to get a individual "hired gun" is one of the only ways for the "little guy" to effectively defend themselves from corporate criminals and other "special interest" elites.
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