Don't test the thyroids of generic obese children, says Choosing Wisely
The endocrine section American Academy of Pediatrics has listed its five "Choosing Wisely" tests to avoid. TSH levels in obese kids is one of them. I completely, completely agree. But telling a mom or dad that is equivalent to malpractice in their eyes. It really illustrates one of the central problems with the way we practice medicine: order the test, make mom happy, keep the family as patients, but cost the system some extra money that could be better spent on something else. Refuse the test and you make mom unhappy (sometimes very unhappy), you lose the family as patients, and the family simply goes somewhere else with a provider that will comply with their wishes. Sure, you can have a prolonged conversation with the family about why you're not doing it, but the cost of physician time exceeds the cost of the lab test pretty quickly. Whew. OK. Rant concluded.
The title of "Blade Runner" comes from an obscure physician-penned novel about a future dystopian society that has eugenics as the core of its national healthcare strategy.
It follows the adventures of a young man known as Billy Gimp and his partner in crime, Doc, as they navigate a health-care dystopia. It’s the near future, and eugenics has become a guiding American philosophy. Universal health care has been enacted, but in order to cull the herd of the weak, the “Health Control laws”—enforced by the office of a draconian “Secretary of Health Control”—dictate that anyone who wants medical care must undergo sterilization first. As a result, a system of black-market health care has emerged in which suppliers obtain medical equipment, doctors use it to illegally heal those who don’t want to be sterilized, and there are people who covertly transport the equipment to the doctors. Since that equipment often includes scalpels and other instruments of incision, the transporters are known as “bladerunners.” Et voilà, the origin of a term that went on to change sci-fi.
The name Blade Runner actually came not from the story itself, but from the title of a nearly incomprehensible adaptation by William S. Burroughs, The Blade Runner: a Movie.
The team delved into whether ride-hailing affected crash rates in four cities: Las Vegas, Portland, Ore., Reno, Nev., and San Antonio, Texas — American cities in which Uber, the nation's largest ride-sharing company, launched, ceased, then resumed operations. And the results were mixed. Crashes involving alcohol decreased as Uber resumed services in Portland and San Antonio, but not Reno. And in no case did Uber's resumption of service result in fewer total injury crashes or serious crashes overall.
It's easy to look at this kind of story and be really, really disappointed. But I think it's just further proof that changing human behavior is complex. It is not a matter of greater knowledge = better decisions. If it were, the smoking rate and the rate of texting while driving would both be nearly zero. I'm optimistic for ride sharing and autonomous vehicles' role in reducing drunk driving deaths.
Citi bikes have so penetrated New York City that over 50% of peak-hour taxi trips would be faster if taken by Citi bike.
See graphic above. No word on how the bikes compare to ride sharing, though. This statistic kills me. But then again, I'm from the least congested city in America.