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lschmidt

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  1. Depends on what's a "reasonable time frame". The time frame I see most often in the media is 12-18 months. It's hard not to be doubtful of that claim. From what I at this point we have the knowledge and capability to pretty much make any (most?) vaccine in 12-18 months. So I'm not so worried about the time frame. What I'm worried when it comes to the vaccine is: 1. Will it be any good? 2. Will the moron internet people actually get vaccinated? If you were under age 40 and in good health, would you pursue a covid vaccination? I wouldn't. The mortality rate and morbidity does not justify the time and the risk of side-effects for people of that age. If you are over 50 or 55, it starts to become a real risk and the vaccine might offer some real value. I hope we will see a vaccine developed, but I am not particularly optimistic about the adoption rate or the efficacy of the vaccine. SJ Do you think it is possible that you're thinking would be swayed if the government was able to put forth an effective message that, as with masks, getting vaccinated is an act that is beneficial to the health and safety of the more vulnerable members of your community and Country?
  2. RNA vaccines are new technology and haven't been rigorously tried and tested yet. If the question is whether there are vaccines against other RNA viruses, yes there are a bunch: influenza, Ebola, polio, measles, mumps. rubella, rotavirus, off the top of my head. SARS vaccine research was terminated because there was no longer an epidemic but there likely would have been a vaccine given enough time and trial and error. Most vaccine experts think that a vaccine is very plausible here.
  3. These are good points regarding the difficulty keeping up to date, the lack of diffusion of new information, and the difficulty changing one's opinion. I would add a note of caution that a true medical expert has a more nuanced picture of the research. Seems studies are better done than others, some are more biased than others, some are more generalizable than others, some should care more weight than others, some should be discarded. It may be very, very hard for laypeople not immersed in a research field to be able to abstract a context from a set of research results.
  4. I've had excellent experience through the Amex Premium Car Rental Insurance (purchased as an option above the standard insurance for only something like $25. It was wonderful. I was up against a fraudulent claim in a foreign country known for legal chenanigans. The moment I forwarded the claim to them, they took over for me, and I didn't hear another peep. The claim was wiped off the face of the Earth, and I wasn't involved. The only caveat is that the car rental agency has to take Amex for the service to activate.
  5. The Sequoia Fund is open, but not through Fidelity. You can invest with them directly or through other brokerage platforms.
  6. All of the above is true. However, saying that the establishment of pain as a vital sign is a product of first-order thinking. Second-order thinking brings us to the question of "how did pain become a vital sign?" The answer to this takes you through another slew of organizations and influence in medical education and physician oversight, from the AMA, various professional physician pain medicine organizations, patient advocacy groups, CMS (Centers for Medicare and Medicaid services), and the Joint Commission. There was a lobbying and influence compaign that accomplished its goal. You will find that the cascade of influence that introduced the importance of pain monitoring may have been a chain of self-serving biases with another set of players at the root. Some of it was pharma (influencing the physician and patient groups) and some of it was misguided beliefs on the part of physicians and patients, blieving much would be relieved with more use of opiates. Multiple groups were blinded to the risk of addiction, with some contributions from the misinformation compaigns from pharma. Complicated web. "UNF explained it well, the root cause was making Pain as a vital sign. But there were several forces at play to make it worse: 1) Unscrupulous docs who practice general medicine, but keep operating a pain clinic in disguise. I personally know docs who make millions until they are caught. 2) Medical reps who push docs hard and give them incentives to prescribe more opiods 3) The legal system that criminalizes drug addiction 4) Pharma companies (insys in particular) that push the boundaries. Take fentanyl, that is 100 times more addictive than cocaine. it is given to end stage cancer patients who live for few months only. Slowly it creeps into broader population 5) FDA that takes years to get a drug approved. Any anti-addiction medication will take billions to develop and 10+ years to get approved. 6) Stupid politicians who enacted laws that made medicine like Ayahuasca illegal. Ayahuasca can cure a person of opiod addictions. It is used in Amazon regions for 1000's of years. 7) Society that looks down on addicts, this is a medical issue not a moral one. PS Not to mention, most Americans dont have a safety net when they lose a job. In the last 20 years we witnessed a tremendous upheaval all over small towns, where jobs were lost due to automation, outsourcing, offshoring etc. "
  7. A variety of factors, but in short - both. Personally, I think the "health care sucks" hypothesis is more important: 1) The continuing ~30 year trend of intrusion of payers in the delivery of health care continues to make the practice of health care less attractive, with a steadily declining patient satisfaction. This does not become clear until late in medical school or residency, causing many people to change their minds. 2) medical school debts are rising (typically around $200K or more), and the age at which physicians enter the workforce (typically between 30 and 36 years old), there is great pressure to accelerate family life/ buy a home/settle down, etc. Major cities have dramatically higher housing costs, of course. This is daunting to many. 3) envy - the wages of doctors have been fairly stagnant (this mainly applies to primary care docs, as salaries for certain specialists having risen quite a bit due to local pockets of distorted markets), and the wages of their colleagues and classmates who have gone into finance or tech have risen dramatically. Envy takes hold. Is it difficult to see colleagues who have much less training make significantly highter salaries (and stock options, etc.). New doctors find it strange that their college roommates are doing much better than they are financially.
  8. Whether doctors will "lose their shit" entirely depends on the system in which they work. If in a private system, yes, they will lose revenue. If in a public or salaried system, they benefit from seeing patients less often. The key to understanding why the U.S. system is so expensive is incentives, on many levels.
  9. Speaking to the original article, it is more than a little ironic that an online piece that decries the corruption of science due to corporate and political bias makes use of cherry-picked examples and an intellectual agenda to selectively spin a narrative. Basically, an intellectually biased article is crying foul that science suffers from intellectual/financial/political bias. This is an indication that we should step back and be aware of the human nuances in scientific research. Statistics are imperfect, clinical trials cannot prove a hypothesis very easily on their own, and conflicts of interest are very difficult to avoid in the scientific process given the immutable nature of human psychology. But each scientific study is a small brushstroke in a larger canvas, and there is no better method of moving closer to the true canvas in time. Patching together a story (such as this article did) to promulgate an ideological agenda doesn't serve the truth well, but a more nuanced view of the ultimate direction of science and medicine might. That being said, the confluence of biases and conflicts of interest are ever-present, with such articles being far from an exception. BTW - all of tripleoptician's points are insightful and worth reading (this post written by someone who IS an expert in clinical research studies)
  10. I would buy Fannie/Freddie preferreds/commons as a Trump hedge. One of his main economic advisors is John Paulson, whose fund owns a significant amount of GSE stock: http://www.cnbc.com/2016/08/05/trump-unveils-economic-policy-team-includes-john-paulson.html http://www.wsj.com/articles/bets-on-fannie-and-freddie-get-help-from-lobbyists-1463087581 One might guess that Trump may be influenced by Paulson and others to settle the lawsuits and/or recapitalize Fannie/Freddie.
  11. Bank rates have been very competitive for Jumbo loans lately. Bank of America's current rate for a Jumbo loan 30y fixed in California (no points) is 3.375%. Hard to beat that.
  12. These seem like typical dilemmas among physicians between different tiers of semi-academic and academic hospitals. I'm a physician contemplating similar dilemmas and have friends who have fallen on either side of the fence. I'm in a public hospital with similar advantages but also wonder what it would feel like to work in a high-quality organization where the system and the people are, as a whole, effective. That is not currently the uniform case for me at the current hospital. Good luck - no correct answer there. Feel free to PM me. - Mike
  13. Thanks, guys, for the Interactive Brokers idea. That seems very promising.
  14. I am still logistically trying to figure out how to cheaply convert USD to CAD for a Canadian equity purchase. The problem is the currency spread. My bank has a 4-5% currency spread, Fidelity has a 3% currency spread, CIBC in Canada charges 2.5% plus a 3.5% spread. These fees are hefty! I notice there are currency brokers such a USforex.com and Oanda.com that facilitate conversion and transfer with smaller spreads (1%). Has anyone used these? Are they trustworthy? Appreciate any input. - Mike
  15. Yes, that's possible. But then I would be subject to the exchange rate of the Canadian bank, which may have a currency exchange spread worse than my bank (it's unknown).
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