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86
British Man Critically Injured in Russian Roulette Incident After Drug & Gas Use in Pattaya
I think the point bluemoon and myself were referring to may have gone over your head. -
64
Routine in a expats life
The difference is ,you were getting paid ,it was a workplace -
2
China’s Biotech Advances Threaten U.S. Dominance, Warns Congressional Report
China has declared in the next 5-10 years or so, it wants Chinese companies to hold about 90% of the domestic market. Its also signaled it doesn't want these companies to be merely fronts for foreign enterprises (JVs) and so in that respect, its giving accelerated approval times for Chinese companies with genuinely innovative solutions (how they define innovative is another thing), which is very similar to the FDA's "De Novo" approval scheme. One of the upshots is that medicine improves for everyone. It might threaten American, German, British, French. Japanese market share, but I'm not sure that is a terrible thing if the result for patients is better healthcare. I think most here can appreciate the philosophical differences between Western medicine (based on studying the dead) and Eastern medicine (studying the living). Chinese hospitals are split between "Western" medicine hospitals, offering treatments and diagnostics much like and hospital in the West, and so-called "Traditional Chinese Medicine" hospitals (their term) which probably should be called Eastern Medicine hospitals, because what they practice isn't necessarily old fashioned nor brackward. I've seen some medtech out of China which genuinely is eye-raising innovative, in ways we would describe as lateral thinking ("why didn't we think of that"). There are a huge number of Chinese medical companies; gargantuan in fact. Which means most are tiny. Yes, there are some big Chinese companies looking to export into Western economies, and competition is good. But most of these companies have zero interest in exports. Many don't have even much interest outside of their province. And curiously, they are not interested in competition in the way we would think of it (ie they don't have competitors, they just have customers, the hospitals). Hospitals tend to become loyal customers, and no one would dare to upset those relationships through discounts, incentives and the suchlike. There are also 3 tiers of hospitals, plus the private ones. Top tier and the private hospitals are full of the latest equipment, doctors trained in the West etc. The bottom tier do not, with increasingly reliance on domestic brands and Eastern medicine. China has quite a strong tradition of health insurance; the Chinese save money, massively. That staeted in Mao's day, when he established schemes, which were contributory, for farm workers and for factory workers, with the farmers, who were always the poorest, getting the better scheme. Back then, it was about farm collectives and factory collectives. So factories built their own hospitals. Those collectives have long gone, and in the modern China, it means a job for a company comes with a strong health insurance scheme, with farm workers paying into a state scheme. In the West, for medicines and medical devices, we have a lot of contradictions. The FDA was established in the wake of the first batches of polio vaccine going wrong; basically one of the vaccine manufacturers didn't understand how to make the formaldehyde that inactivated the polio virus, with awful results. The FDA was established so that companies did understand how to make the things they were making. And over the years, rules and regulations grew, with the objective of safeguarding the patient, but not necessarily meaning the patient had access to the best technology, just the safest. Europe regulatons were a bit of a mess, ranging from a precautionary approach in countries like the UK, to zero regulation in Eastern Europe. With the EEC, and later the EU, the UK, France and Germany played a pivotal role in establishing common standards; for Western countries, that was easy, because they all tool a similar approach. In the Common Market, there was emphasis on supporting business. So Directives were developed to establish the standards by which companies could market their products. Getting anyone to buy them was another matter, and member states always had the last word about reimbursement, and conducted their own efficacy studies. In the US, industry pays for the trials, in Europe, governments mostly pay (or did pay). Typically, it was a lot quicker for companies to get things to market in the EU than the US; on average, European patients could access new technologies 7 years before those in the US. That might sound a surprise. But the difference is US approvals essentially includes the technical assessment, allowing the CMS, and therefore the insurance companies, to take faster decisions whether they were going to pay for it or not. In the 1980s, the first cracks started to appear, because the regulatory authorities in the US couldn't keep up. First it was genetic tests; loads of them appeared, and they were taking too much time to approve. So the FDA created the "CLIA waived" status; essentially they trusted a regulated lab to understand the test they were carrying out, so approval could be expedited. 40 years on, labs are now doing next gen sequencing tests that they don't understand; they don't understand the results, and depend on the manufacturer interpreting that for them. Another thing is "substantially equivalent"; a medical device is pretty similar to something alreadhy on the market, and so didn't have to jump through all the hoops. That failed in the case of hernia meshes which has left thousands of women with lifelong chronic pain (to do with scarification around the mesh put in to fix a hernia; everytime they move, it feels like they are being stabbed. Removal requires major surgery, and results in disability). In Europe, Directives over time become Acts. A Directive is essentially a broad set of instructions to a memberstate how to change their legislation, but there is no time frame. An Act is mandatory. But by the time a Directive becomes an Act, everyone is already aligned; going back to the US, France, and Germany; all 3 countries had already developed similar standards, and it was never a bit deal in trade as a result. But with medical regulations, the change from Directive to Act was an opportunity to pug gaps in safety, so there was huge change. Moreover, the new regulations were no longer about the safest healthcare, but now the "most advanced" healthcare. That line is now causing issues, especially with grandfathered products. Anything new must be better, because the regulation says so. As a hospital, are you really going to purchase products that are not as good as the latest ones...... In Europe, the new regulations now include technical assessments, meaning member states can take reimbursement decisions more quickly. So timelines are getting longer, kind of. the 45th President did say he wanted to deregulate the FDA, but didn't get around `to it. In theory, the FDA deregulating, and the EU regulating means standards should get similar, allowing better trading; US products can be more readily purchased in Europe and vice versa, given that approvals are mutually recognised. This is what happens with cars. A car made for the US market isn't all that different from those in Europe; DOT marks are seen as equivalent to E-markes, and the same for Japanese JIS marks. In the current idiom. FDA deregulation is being achieved by sacking them all. This will mean increased approval times; already happening. The FDA response will likely be to simplify what they do, and get to what Europe used to do. Under the old European approach, manufacturer essentially self-regulate through audits they pay for. Insurance companies though aren't going to pay for some shonky device thats had a rubber stamp approval. That deranged individual who murdered the health insurance executive; he had undergone unecessary spinal fusion surgery (because the doctors told the insurers so) that did nothing for him, but cost a lot of money (the insurance companies are now increasingly pushing back against spinal fusion claims). I suspect the constant pain left him lacking mental capacity. So they will develop their own assessment processes, at a cost passed on to the customer (increased rates), or they will view more favourably, products that come with their own technical assessments for scrutiny, from Europe, and from China. As for scientists seeking employment. Consider the modern history of the passport. The modern passport was introduced in WW1, as a means to STOP people leaving the country. Only with a passport, could you leave, so in that way they stopped engineers and scientists switching sides. Now, we think of a Passport as a Right. That can be taken away. -
55
Please don't tell me that you pronounce the 'T' in "often"... Or, do you?
I view spoken American English as a free-for-all having no real limits of what can be included or distorted. It's a consequence of extreme freedom of speech. You'll find adoptions of foreign words in English, commonly from the community of the Romance languages (Latin, Spanish, French) and "street lingo." Certainly written English is more formalized for exactness and compliance for formal publication or presentations. Hasta con vista. -
13
Trump Rejects EU’s ‘Zero Tariffs’ Offer, Vows to Erase $350bn Trade Deficit With Energy Sale
MAGA people really do need a reality check; refer below... The European Commission says it charges an average tariff of just 1% on US products entering the EU market, "considering the actual trade in goods". It adds that the US administration collected approximately €7 billion of tariffs on EU products in 2023 compared to the EU's €3 billion on US goods. -
28
Bee Removal
Yup, and it needed to be topped-off with Freon and the drain needed clearing.- 1
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