Elsewhere on the Interweb (4/1/08)

Encephalon is up at Of Two Minds, Paris Hilton-style.

Automatic External Defibrillators (AEDs) do not improve mortality at home. This contrasts AEDs in public places. The authors of the paper, in NEJM, attribute the difference to a much larger population who can use them in public spaces and greater training in their use. Covered in the NYTimes here. The paper is here.

Chris Anderson writes in the Boston Globe about the consequences of the Massachusetts health care plan (Hat-tip: Kevin, MD):

With its massive cost overruns and missed deadlines, the healthcare reform law is quickly becoming the Big Dig of the next generation, an ambitious and beneficial but deeply flawed public initiative with back-breaking costs to the taxpayers. Unlike the Big Dig, Massachusetts taxpayers, not Congress, will pay most of the healthcare tab.

Massachusetts embodies all the problem with the US healthcare system in miniature. If you increase access without decreasing cost, this is what happens.

Nature details the debate over whether drugs should be approved on the basis on improvement of markers or on actual health outcomes:

After dozens of clinical trials, millions of people now take drugs to treat their hyper tension. High blood pressure has become an accepted surrogate marker for cardiovascular disease, meaning that a fall in blood pressure can be used as an endpoint in clinical trials for drug approval. An advantage is that blood pressure can be measured quickly and cheaply, so a drug can be approved for use without the need to wait for its effect on distant and infrequent clinical outcomes such as heart attacks.

Drugs that lower blood pressure are now regularly approved for cardiovascular disease on the basis of their ability to fight hypertension alone -- in the United States and Europe, for example, regulatory agencies do not require additional clinical trials to determine whether such drugs also reduce heart attacks or strokes. Drugs for other conditions, from cancer to diabetes, are also often approved on the basis of such surrogate outcomes as reduced tumour size and a drop in blood-sugar levels.

But a recent spate of disquieting clinical trials involving high-profile drugs such as Avandia (rosiglitazone) is prompting researchers to re-evaluate this reliance on surrogate markers..."It's been a watershed year," says Harlan Krumholtz, a cardiologist at Yale University. "It's shaking assumptions about how we should be evaluating these drugs."

Razib looks at when in history there were more Muslims than Catholics:

It is after 1500 that Roman Catholicism "broke out" of its European ghetto. But at the same time that Catholic missionaries were leaving for the New World and Asia about 1/2 of Catholic Europe became Protestant. 2/3 of the German speaking lands, most of the British Isles and Scandinavia left the fold. In much of Austria, Poland and Hungary there was an initial erosion which it took two centuries of Counter Reformation work to undo. Meanwhile, in the New World the nominally baptized indigenous populations were dying; so the compensation for the loss of Europe would take centuries as a mixed-populations expanded across the American frontiers.

I will admit that I think that at some periods it may well be that Catholicism was the more numerous faith than Islam, right before the Black Death for example. Medieval Western European agriculture could usually obtain a high yield because of improved techniques in comparison to antiquity (mouldboard plow, 3-field rotation, etc.), but I suspect Muslim expansion into very densely populated regions of Asia easily outstripped this (Catholic Christians put more technological inputs into land, while Muslims simply increased the amount of land). 10% of South Asians at any time is far more numerous than all of Scandinavia or the Baltic; expansion within Europe is always outclassed by expansion within Asia because the latter has always had a larger population.

Read the whole thing.

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AEDs have been the last decades' supreme medical ripoff. Manufacturers cahrge 2500-4500 dollars for those babies and very few people can figure out how to use them though they are supposedly idiot proof. I have had two bystanders seen in the ER because they were shocked by them (they didn't back away when they went off).
We have a "shiny new toy" tendency in medicine that merely raises costs and rarely improves outcomes--CPR is now mandated without mouth-to-mouth making it more palatable to bystanders. That technique is way cheaper and reasonably equally effective in cardiac arrest. A cost benefit analysis should be included in any new shiny thing that enters the market. We can't afford not to measure cost against outcome improvement.