Jumat, 01 April 2016

"There is no place for the surgeon myth in modern medicine" says writer Alexis Sobel Fitts in Aeon Magazine.

Having a sister in medical school apparently qualifies Ms. Fitts to critique the specialty of surgery.

She starts with an old joke "An internist can figure out what’s wrong with you, but he can’t fix it. A surgeon has no idea what’s wrong with you, but he’s happy to fix it." If you read it carefully, you should note that it’s not that funny, and it’s wrong on both counts. No surgeon would ever fix something unless she knew why, and internists have these things called pills which can successfully treat a number of diseases.

She goes on, "After all, fixing problems is corporeal, often removed from the more intellectually nimble task of diagnosis." Apparently she is unaware that surgeons often make diagnoses—occasionally even correct ones, and I’ve written before about the misconception that doing an operation doesn’t require thinking [here and here].

"Surgeons are descended from the barber or the butcher," she says. That was hundreds of years ago. Nowadays, surgeons complete four years of medical school just like her sister and all the other doctors.

"Any missteps might incite devastating consequences, as the surgeon navigates around the vagus nerve, which dictates facial response…" I hope her sister didn’t give her that information. The vagus innervates many structures, but the face isnt one of them.

"Before anaesthesia and antibacterials, a patient undergoing surgery could be assured of two things: immense pain and the likelihood of infection and death." That’s actually three things. Of course without surgery, patients experienced immense pain, infections, and death anyway.

"Since the 1950s, laboratory science has increasingly been the origin of medical innovation. Which is why, over the past four decades, merely a 10th of the articles published in The New England Journal of Medicine have covered surgical innovation." Or maybe its because The New England Journal is a medically, not surgically, oriented journal.

Here’s the winner. "Surgery’s place at the bottom of the medical hierarchy can be attributed to the crude cruelty of early surgical procedures." Other than Ms. Fitts, who has placed surgery at the bottom of the medical hierarchy? It’s certainly not US medical students who make the surgical specialties among the most competitive of all.

In the 2015 resident match, surgical specialties filled their first-year positions with 80% or more US medical school graduates. In fact, orthopedics matched with 94.3% US grads. Compare those numbers to internal medicine and family medicine, which filled their first-year positions with 49% and 44% US graduates, respectively.

Heres what Wikipedia has to say about its Aeon Magazine entry:

This article has multiple issues. Please help improve it or discuss these issues on the talk page.

The neutrality of this article is disputed.

This article contains content that is written like an advertisement.

This article contains weasel words: vague phrasing that often accompanies biased or unverifiable information.


That pretty much describes the Aeon essay about surgeons too.


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I received this question from an entrepreneur last week.

Question: Id like to find a way to make money in the pet supplies market. Im watching other people do it, and I think I can do it much better. Please send me your thoughts on this market.
L.R. Atlanta GA


Hi L.R.:

Thanks for the question and post.

I like the pet supplies market......a lot.

Ive also helped a lot of businesses and entrepreneurs in this market too.

Funny thing though........

One of the most sucessful entrepreneurs in this market started out with one of the most pathetic websites Ive ever seen!

So....dont base everything on a "fancy" website.


Look......in my opinion were in a Depression....we passed the so-called "recession" several months ago.

But the pet supplies market online is still going strong. People will always take care of their animals and pets.

This goes for pet sitting, pet walking and pet spas (Im not kidding!).

Heres part of an article I wrote for Early to Rise on the topic:

____________________________________________

Dear Entrepreneur:

People are crazy about their pets. I see it in our house every day. We spent more money this year on special pet food, toys, and treats than we spent going to the movies ... but I didnt realize this was a $34 billion market!

There are several ways to profit in this market. One of the best is by selling pet supplies, toys, and/or specialty foods directly to consumers.

Youll make even more money by targeting pet lovers who regularly shell out big bucks for these items without hesitation.

In todays issue, Ill focus on three opportunities that will enable you to take advantage of this incredible "pet lovers market."

Heres a short list of products and services that are hot sellers (online and off):

* Pet Pages (pet websites and hosting)

* Toys (Forget about squeaking bones, PetCo.com has more than 10,000 different toys to choose from.)

* Pet Insurance (Im not kidding. Premiums start at $1 a day.)

* Pet Yellow Pages

* Pet Adoption Services

* Pet E-mail Newsletters

* Pet Charities

* Pet Grams (sent via e-mail)

* Pet Gift Cards (huge!)

* Pet Shows (Everybody knows how big dog and cat shows are - but horse and bird shows are even bigger.)

* Pet Vitamins and Supplements

* Organic Pet Food (Our cat wont touch it - but its a hot rising trend.)

If you want to launch a business and profit from this market in the offline world (via direct mail), here are 3 simple steps to take:

1. Obtain a mailing list of recent repeat buyers who have purchased pet supplies via direct mail that are in the price range of the products you want to sell.

2. Obtain the names of a pet food manufacturer and/or supplier who is willing to process your customers orders and drop-ship them for you. Here are two such companies: CarefreeVet and Great Eastern Pet Supply.

3. Obtain preprinted catalogs that you can send to qualified prospects. Most pet supply wholesalers, drop-shippers, and affiliates make these available for you to use.

If you dont want to handle telephone orders yourself, you can retain a call center to do it for you. Youll find dozens of call centers that specialize in this type of thing at DMNews.com, or you can do a quick search on Google.

If you prefer to market pet products and services online, Ive got great news. It has never been easier to sell these things on the Internet. Neeps.com, for example, is a specialty pet products retailer that has been very successful in "niche retail." They are ranked among InternetRetailing.coms Top 500.

The primary mechanism for selling pet products and services online is to attract or drive qualified traffic to your website.

You dont have a website? No problem! There are hundreds of companies online that offer instant e-commerce sites or storefronts.

Whats more, sites like eBay, Yahoo! Marketplace, and Amazon.com Marketplace can deliver mind-boggling targeted traffic to your site. Or you can just post an instant mini-store on these traffic monsters.

Pet supplies affiliate programs are another great option.

Affiliate programs offer one of the fastest and easiest ways to profit from the pet products bonanza.

With an affiliate program, all you do is post a unique URL link in search engine keyword advertisements, on targeted high-traffic websites, or in targeted e-mail newsletters. When someone clicks on that link, theyre brought to a pet supplies website. If that person makes a purchase on the website, you receive a commission.

The Petco.com affiliate program pays an 8% commission on sales up to $3,000 per month, and a 14% commission on sales over $15,000 per month.

PetsMart.com pays 15% on monthly sales over $16,000.

The beauty of an affiliate program with strong companies like Petco and PetsMart is they usually stick by their commission structure. (Unlike many small-time operators that revise the commission structure once you start selling like crazy.)

Whats more, companies like Petco carry name brands and offer thousands of products.

Be sure to check out affiliate management companies like Commission Junction and Linkshare too. These guys make it super-easy for entrepreneurs like you and me to make money. Think of them as one-click affiliate superstores.

Two other concepts in the pet market that I like are pet insurance and pet pages (websites for pets).

PetCarePals.com offers pet insurance for $1 a month. You could either start your own company or joint venture with PetCarePals.com as an affiliate. If you choose to go the joint-venture route, your job would be to drive traffic and qualified prospects to their website via your unique pet insurance URL.

And heres the deal with pet websites ...

You could offer your customers dozens of website templates. You can design these pet pages yourself, obtain copyright-free templates on the Web, or hire a freelance designer to do them for you.

You could give the templates away to pet lovers but charge a small annual hosting fee. Or you could give the hosting away and charge for the templates. Its up to you.

If you give the hosting away, reserve the right to post advertising on the pet websites to get extra income.

And thats just for starters ...

Take a look at MyPetPages.com. They offer free pet websites and memorial pages to an active community of like-minded pet lovers. Plus, they make money on advertising by selling pet products as affiliates and with other value-added services.

As you can see, the profit opportunities in the pet lovers market are enormous - online and offline - and nearly endless.

***Fast-Start Tip***

Determine which niche of the pet market you want to sell into.

If you want to sell pet food, products, insurance, and/or toys online, youll need to build a simple (e-commerce friendly) website. Use successful websites as a guide.

If youre not making or developing your own products, youll need to locate a manufacturer or supplier that will process and drop-ship the orders for you. A quick search on Google will provide hundreds of pet supply drop-shippers.

Your marketing efforts will be concentrated on attracting and driving qualified prospects to your site. And there are many ways to do this. You can advertise your products in pet-related e-mail newsletters and on high-traffic pet-related websites. You can also purchase keywords and phrases in the top search engines (like Google, Yahoo!, Lycos, MSN, AOL, and LookSmart).

Hot Tip: Prepaid keyword advertising is becoming even more popular than pay-per-click (PPC). PPC can be very expensive - especially when youre testing dozens or hundreds of keywords. Prepaid keyword ads enable you to determine the cost of your ads upfront. Two leaders in the prepaid keyword advertising area are ExactSeek and ISEDN.org.

Another option is to become an affiliate with a company like Petco.com. Petco.com offers thousands of brands, a streamlined affiliate program, brand recognition, and a good reputation with customers and affiliates.

If you prefer an offline direct-marketing approach, youll need to get your hands on mailing lists of recent repeat pet-product buyers, a manufacturer or supplier to process your orders and drop-ship your products, and a full-color catalog that you can mail to prospects.

As I said, most pet supply wholesalers, drop-shippers, and affiliates make preprinted catalogs available for you to use. Just make sure the order form in the catalog includes a key code so you are credited for all sales.

You could also partner with veterinarians and provide them with pet products on a wholesale level. You can purchase thousands of top-quality pet products from China for pennies on the dollar.

Check out my Importing Fortunes 2015 while youre at it. This is the best program of its kind on the market - bar none!

If you live near a top pet supplies direct marketer, consider going to work for them on a temporary basis. If youre lucky, that will put you in a position to receive a million-dollar hands-on education. There may also be an opportunity for you to start or develop a new channel for the company, whereby you would receive a percentage of the profits if its successful.

There you have it!

Now you have everything you need to know in order to profit from the $34 billion+ Pet Lovers Market!

Additional Resources:

Responsive mailing lists

Pet Products Affiliate Programs

Doctors Smith and Foster

1800 PetMeds.com

PupLife

Petco.com

Linkshare

DirectPetSuperstore

PetSmart

Pet Supply and Food Manufacturers (that offer drop-shipping)

Worldwide Brands

PurfectPaw

Exotic Nutrition

Purina Mills

RetailPets.com

Asian Products.com

Free Hosting - DotEasy
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What’s your view on social media and science? For example, the role of science blogs in critiquing published papers? "Those who can, publish. Those who can’t, blog," says Jingmai OConnor.

According to Cell.com, Dr. O’Connor is a professor at the Institute of Vertebrate Paleontology and Paleoanthropology of the Chinese Academy of Sciences, and her comment was part of an interview published last month.

Dr. OConnor says, "It often seems those who criticize or spend large amounts of time blogging are also those who don’t generate much [sic] publications themselves." She thinks comments should be peer-reviewed and published only in journals. She worries about the public who may not realize "a published paper passed rigorous review by experts, which carries more validity than the opinion of some disgruntled scientist or amateur on the internet." She adds, "criticism in social media is damaging to science, as it is to most aspects of our culture."

Apparently she isnt aware that peer review is under fire from a number of respectable sources.

"If peer review was a drug it would never be allowed onto the market," said Drummond Rennie, a contributing deputy editor of JAMA. Richard Smith, former editor of the BMJ agrees "because we have no convincing evidence of its benefits but a lot of evidence of its flaws."

In 2015, 107 scientific papers were retracted by several journals because their authors, nearly all of whom were Chinese academics, had performed fraudulent peer review by creating fictitious names and email addresses of suggested reviewers so they could write glowing reviews of their own work. Some of these charlatans are from Beijing, where Dr. OConnor is based.

Australian bloggers found an error that had somehow been missed during "rigorous review by experts" regarding the number needed to treat in a New England Journal of Medicine paper on targeted vs. universal decolonization to prevent ICU infection. They contacted the papers corresponding author who acknowledged the mistake within 11 days. It took five months for a correction to appear online in the journal.

Whether Dr. OConnor likes it or not, the future will involve more immediate feedback about research papers. For example, PubMed and PubPeer already allow comments, and the BMJ also has a section for online rapid responses.

Blogger Marc Bellemare, an associate professor of economics at the University of Minnesota, cites David McKenzie, an economist/blogger at the World Bank who thinks that blogs play an important role in disseminating information to the public and "raise the profile of bloggers and their institution."

But Bellemare feels blogging might not be for every academic He quotes Tyler Cowen of George Mason University, who when asked why dont more economists blog replied, "I believe it is because they can’t, at least not without embarrassing themselves rather quickly, even if they are smart and very good economists. It’s simply a different set of skills."

Maybe Dr. OConnor doesnt have the skill set to blog. I say, "Those who can, blog. Those who cant, insult those who can."
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The first female Speaker of the Ondo State House of Assembly, Jumoke Akindele and her Deputy, Fatai Olotu have been impeached. They were impeached by 18 out of the 26 lawmakers. The impeachment took place at one of the lawmakers quarters in Akure, the Ondo state capital at about 10pm yesterday March 8th.



Iroju Ogundeji from Odigbo local government was elected as the new Speaker while Ayo Arowele from Owo local government was elected as the Deputy speaker. The reason behind the impeachment is yet unknown.
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Lol. These people are not serious!
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Code Black Part II It gets worse

Last week, I reviewed the premier of the new medical television series "Code Black" and pointed out several flawed or impossible scenarios. I didnt think Id watch another episode.

But I was alerted to a rather shocking error on last weeks installment. I had to see it for myself.

On this typically chaotic day in the emergency department, a young woman was brought in after a car crash which occurred while she was in her way to the ED because of abdominal pain. A CT scan of her abdomen and pelvis was negative, but her serum lactate level was elevated. They then decided to examine her abdomen and noted tenderness. A bedside ultrasound done in the ED revealed a left ovarian torsion (twisting of the blood supply to the ovary which if not rapidly corrected, could cause irreversible damage). The patient had already had her right ovary removed. Further heightening the drama was that her husband died of lymphoma but had banked his sperm, and the patient wanted to have his baby.

She needed immediate surgery, but all of the hospitals operating rooms were busy. As the window of opportunity to correct the problem was closing, an operating room opened up. But alas, there was not a single gynecologist or surgeon available to do the case. According to the back story about Dr. Neil Hudson, hes a fully trained surgeon who decided to work in emergency medicine. One of the new ED residents begged Dr. Hudson to do the case, and he resisted for a while until it was almost too late.

Despite admitting to having no operating room privileges and surely no malpractice insurance coverage for surgery, Dr. Hudson finally acquiesced. Just before beginning the case, he explained to the OR staff what he was going to do.

Then the egregious error occurred. While scrubbed in the OR and wearing a sterile gloves and gown, he calmly reached up to pull his unsterile mask over his nose and mouth. Thats a no-no.

PS: I could find no reference mentioning an elevated lactate associated with ovarian torsion. The organ is likely too small for ischemia to have any effect on the that lab value.

Some other highlights. For a patient with multiple facial lacerations, Dr. Hudson ligated the maxillary artery—quite a feat in an emergency room without an OR light or any retraction. As you can see from the figure below, the maxillary artery is deep to the jawbone. Not shown are branches of the facial nerve which lie above the artery.

Dr. Leanne Rorich, the all-knowing equivalent of Dr. House, stopped a nosebleed by inserting Foley catheters in each nostril, a well-known trick. However she inflated the balloons with the closest liquid she had on hand—coffee, and the patients blood pressure normalized within seconds.

If the convoluted story of the woman with the ovarian torsion wasnt enough, the patient with the nosebleed happened to be a 14-year-old blind boy on Coumadin who fell while rock climbing with his father.

Stay tuned for the next episode featuring a bus that tumbles off a narrow mountain road while carrying non-compliant hemophiliacs.


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Is 50 Cent really a fraud or is he messing with the courts? Last month he was ordered before a bankruptcy judge to explain the multiple Instagram posts that showed him flaunting cash while claiming he is broke. 50 Cent claimed in court that the money he flaunts on social media is fake.

The rapper filed for bankruptcy after he was ordered to pay Rick Ross baby mama $7 million in damages for posting her sex tape online...
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