Month: March 2022

Medical School 2020, Year 4, Week 8 (Urology elective Week 1)

by philg

I meet my attending, Coach K, in the four-urologist private practice at 8:30 am. The radio is tuned to the sports channel as he signs paperwork before the first patients are ready. “If I can get you to not consult urology when you cannot pass a Foley, you have had a successful rotation.”  (A Foley catheter drains urine directly from the bladder.) His new nurse is a friendly 63-year-old. Nancy retired after working 25 years in a family practice office, but returned to work because “my husband was driving me crazy with us both sitting at home with our kids out of the house.”

Nurse Nancy explains that Coach K likes to stay busy. He usually double- or triple-books each 15-minute appointment slot. This is plenty of time if Nancy is able to get a urine sample and the post-void residual bladder scan in a timely manner because most visits take less than five minutes. For example, if following a patient for elevated prostate specific antigen (PSA), Coach K will ask if there are any changes since the last visit, and then recount the options of biopsy versus active surveillance (PSA every three to six months). He says farewell, while Nancy draws blood for a lab company rep to pick up at the end of the day. 

Urologists see a wide spectrum of ages. Most patients are between 50 and 75 years old referred for either elevated prostate-specific antigen (PSA) or difficult-to-manage benign prostate hypertrophy (BPH). We see patients of all ages for kidney stone management. Young couples come in for vasectomy referrals. A vasectomy is a 10-minute office procedure done under local anesthetic. Coach K offers a valium to take beforehand in which the patient has to have someone to drive him home. I see a 29-year-old male accompanied by his wife and the mother of their five children. Coach K asks if they are sure they do not want any more children. When they learn that he could come in alone, the wife responds, “Oh no, I’ll be here. I have to make sure he goes through with it!” Coach K explains, “You will need to use protection for three months. After that he will drop a semen sample off here so we can test it to ensure there are no sperm present.”

[Editor: See also “Hamptons bachelors are getting vasectomies so gold diggers can’t trap them” (New York Post, May 27, 2017). “‘There’s a spike in single guys’ who get the procedure in spring and early summer, said Dr. David Shusterman, a urologist in Midtown. ‘This extortion happens all the time. Women come after them. [They get pregnant and] want a ransom payment,’ said Shusterman. ‘Some guys do an analysis of the cost — for three days of discomfort [after a vasectomy], it’s worth millions of dollars to them.'”]

We see roughly eight benign prostate hypertrophy (BPH) patients per day. Coach K: “10 percent of men at 50 will have obstructive symptoms, 100 percent by 80.” When asked about symptoms of obstruction, patients lights up as if saying with their face, “Finally, someone understands what I am feeling!” Obstructive urinary symptoms include: sensation of incomplete emptying, double voiding, dribbling, and decreased force of stream. A lot of men report having to get up in the evening. I learn that this is more related to irritative symptoms or excess urine production from mobilizing fluid while laying flat. Coach K explains, “Put your feet up 30 minutes before bed so you can pee off this fluid before getting into bed.” Most men’s BPH can be managed with medicine, either an alpha-1 blocker and, if needed, finasteride. Finasteride takes 3-6 months to have an effect as it lowers DHT levels that drive the growth of the prostate. Coach K explains, “The main side effect of finasteride is decreased libido, but most people are fine.”

[Editor: Reduced male libido may not be a problem: “Only 48% of married women want regular sex after four years.” (Good Housekeeping)]

My attending continues, “One controversial topic is whether finasteride increases the incidence of aggressive prostate cancer. The jury is still out.” If these medicines do not control the symptoms, Coach K discusses surgical options including transurethral resection of the prostate (TURP, pronounced “terp”) or a green light ablation. In theory, a primary care provider should be able to manage BPH, but several patients report it is easier to schedule an appointment with a specialist. “The earliest appointment was in four months for my PCP,” states a 62-year-old.

Patients are cheerful during their one-week post-op visits after TURP. “Doc, I feel like a teenager again!” exclaims an 80-year-old man. “Doc, one more question. Do our balls sag when we get old? Every time I sit on the toilet they touch the bowl!” His wife slams her hand on her face. Coach K responds: “Everything sags when we get older.” Another post-TURP patient exclaims, “Finally, I can go on my dream trip to the Canadian Rockies.”

A common complaint during office visits is the cost of erectile dysfunction medications. Although generics have been available since 2017, our older patients can’t figure out how to avoid being charged $300. Coach K: “I tell patients to always ask for the cash price and use GoodRx. In a study of the five most commonly-prescribed urologic medications, CVS was by far the most expensive. Walmart and Kroger were in the middle of the pack. Mom and pop pharmacies were the cheapest.” What about the Aetna-CVS merger? “It’s been terrible. Our office gets called by Aetna all the damn time telling us to switch a patient’s medication [to a cheaper generic-available drug]. The patient could be on the med for the past 15 years.” He is adamant. “No, I am not switching them, there is no medical reason.”

We see a 62-year-old patient whom I cared for six months earlier in the surgical ICU. A tractor rolled over him and fractured his pelvis. It was nice to get to know him as a person since he’d been delirious for his week-long ICU stay. Since discharge, he has been working with physical therapy, and is now able to use a walker. His wife asks if there is anything to help with control of his bladder. When he does any activity, e.g., rises from sitting, coughs, or laughs, he leaks urine. For two months he also had fecal incontinence, but this has slowly resolved. Coach K instructs me to perform a digital rectal exam (DRE). He has no rectal tone, and no bulbocavernosus reflex (squeezing head of the penis should lead to squeezing anus). He has damage to his pelvic floor muscles. “This might get better, time will tell and there is really nothing for us to do to make it go quicker.” We prescribe him Sudafed, a stimulant that can improve urethral sphincter tone. “It’ll make you feel jittery, but take it 30 minutes before you work with PT. It should help with leakage.” We also see several bed-bound patients that need a Foley exchange. 

Twice a day we see a child for bedwetting. Coach K explains that secondary nocturnal enuresis, in which the patient at one point did not wet the bed, is almost always a result of trauma, e.g., sexual abuse or parental divorce. “There is nothing we can do for them except try to reduce their stress level,” he says.  Most of the time this is for primary nocturnal enuresis (bedwetting since birth), for which Coach K explains that we are also without medical interventions.

[Editor: But not without an ICD-10 code and an insurance reimbursement!]

A 7-year-old female who has been potty-trained since 2.5 is brought in for bedwetting. “You’ll hear the same spiel as last time,” says Coach K. He explains to the family that this is a common issue due to immaturity of the connections between the brain and the bladder. The condition is strongly heritable and usually at least one parent recalls having been a bedwetter. Deep sleepers are more vulnerable to this condition. Do you have trouble waking her up in the morning? “Oh yes, she is such a deep sleeper. She won’t wake up from anything.” Coach K explains, “Bedwetting gets better with time. Only one percent of 18-year-olds are still wetting the bed, but the improvement will be gradual, coming down from 4-5 times per week to 2, to once per week to once per month.” Behavioral modifications, such as decreasing fluid intake between dinner and bedtime and restricting caffeine, will decrease the amount of urine produced at night, but won’t reduce the number of events per week. He hands the family a small pamphlet for a bed alarm. The bed alarm senses fluid and wakes the patient up. “It won’t stop the bedwetting,” Coach K explains, “but will make it more manageable for motivated children.”

Why not offer them medications? Coach K later explains to me that the success rate of DDAVP (desmopressin) is so low that parents get more discouraged when it fails. 

Later, I see a one-percenter: a fit 19-year-old freshman sporting a well-groomed large beard followed for primary nocturnal enuresis for over a decade.  Coach K asks how college is going. “I’m studying construction engineering. Math was always easy for me in high school, but I am struggling to stay afloat for some of these classes.” He’s in a “Live and Learn” community that should be supportive. In high school he tried imipramine, an antidepressant (TCA) that has side effects of bladder retention, which did the trick. He went from 5 events per week to 1 per week. He gave up the drug due to its side effects and now wets the bed 3 times per week. “I am sure this is a killer to your social life,” says Coach K. The patient asks to go back on the medicine and Coach K prescribes him a half-dose, emphasizing, “Keep in mind alcohol will make this worse. It puts you into a much deeper sleep.”

We see five bladder cancer surveillance patients per day, all of whom are former or current smokers (a big risk factor due to irritation of the mucosa). Bladder tumors are mostly diagnosed after gross hematuria (visible blood in urine) or persistent microscopic hematuria on urine dipstick testing. As long as the tumor is superficial, and does not invade the smooth muscle, treatment is removing it in the OR through cystoscopy (fiber optic scope with a cutter at the end). After the initial diagnosis, the patient is screened for recurrence every three months for one year, followed by six months for four more years, and then yearly. “I have patients that I find a recurrence every six months, and I have patients that are clear for a decade, and one pops up.” The first cystoscopy is alarming for both men and females. The patient is prepped in the procedure room with a drape over their exposed genitalia. Coach K inserts numbing gel into the urethra, followed by a flexible scope. When he sees an interesting finding, he signals me over to look into the scope.

[Editor: Bladder cancer patients seem to generate annuities for urologists. In 2012, Forbes noted that “These specialists earn an average of $461,000, not including production bonuses or benefits.”]

Statistics for the week… Study: 3 hours. Sleep: 9 hours/night; Fun: 2 nights. Taco and tequila bar with Straight-Shooter Sally and her boyfriend, an engineer for a green energy design firm.

The rest of the book: http://fifthchance.com/MedicalSchool2020

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The Science of abortion

by philg

“What Quantum Mechanics Can Teach Us about Abortion” (Scientific American):

As light can exist as both a particle and a wave, an abortion provider can honor birth and fight for a person’s right to give birth when it’s right for them

Quantum mechanics, a discipline within physics, has demonstrated that both are true. Sometimes light acts like a particle, sometimes a wave. This duality explains all the characteristics of light that have been observed experimentally, and has allowed scientists to explore the cosmos in previously unimaginable ways. That these two seemingly irreconcilable beliefs could come together gives me hope that similar harmony could be achieved in the discussion of other deeply polarizing topics, including abortion.

Instead of either/or, imagine both/and. We recognize the value placed on a desired and loved pregnancy by families and understand that ending a pregnancy is the right decision for some people some of the time. Individuals may have ethical objections to abortion and recognize that anti-choice laws can harm people. We can value human life and recognize the complexities of reproductive decision making. Attending thousands of births has been a great joy in my career and has cemented my belief that forcing a person to give birth against their will is a fundamental violation of their human rights.

Generally, the article takes the scientifically correct position that those who identify as “men” are just as likely to get pregnant and give birth as those who identify as “women”. But then the author and editors for some reason slip into distinctly unscientific (and hateful) language:

Given that one quarter of women in the U.S. have an abortion, many Americans have benefitted directly or indirectly from abortion care. I implore readers to emulate previous generations of scientists who changed our understanding of the universe by their willingness to consider seemingly opposite empirical truths: Particle and wave, abortion providers and ethical physicians, pro-life and pro-choice.

Scientific American says that correct political and moral decision regarding abortion (legal right through 37 or 39 weeks in Maskachusetts so long as one doctor thinks it will help the birthing person) can be established scientifically, in other words, and therefore anyone who has a different opinion is factually and scientifically incorrect.

Is this idea new? A Duke econ professor‘s 2007 introduction to Nobel-winner F.A. Hayek’s The Road to Serfdom:

The British were not Continental socialists, but still, the danger signs were there. Clearly, the nearly universal sentiment among the intelligentsia in the 1930s that a planned system represented “the middle way” between a failed capitalism and totalitarianisms of the left and right was worrisome. The writings of what Hayek called the “men (and women!) of science” could not be ignored. Look at this message from the weekly magazine Nature, taken from an editorial that carried the title “Science and the National War Effort”:

“The contribution of science to the war effort should be a major one, for which the Scientific Advisory Committee may well be largely responsible. Moreover, the work must not cease with the end of the war. It does not follow that an organization which is satisfactory under the stress of modern warfare will serve equally well in time of peace; but the principle of the immediate concern of science in formulating policy and in other ways exerting a direct and sufficient influence on the course of government is one to which we must hold fast. Science must seize the opportunity to show that it can lead mankind onward to a better form of society.”

The very next week readers of Nature would find similar sentiments echoed in Barbara Wootton’s review of a book on Marxism: “The whole approach to social and political questions is still pre-scientific. Until we have renounced tribal magic in favour of the detached and relentless accuracy characteristic of science the unconquered social environment will continue to make useless and dangerous our astonishing conquest of the material environment.” Progressive opinion was united behind the idea that science was to be enlisted to reconstruct society along more rational lines.

From the same 2007 intro, potentially of interest now that we’re in Year 3 of a “National Emergency” (see “Notice on the Continuation of the National Emergency Concerning the Coronavirus Disease 2019 (COVID-⁠19) Pandemic” (whitehouse.gov, February 18, 2022))

Another theme, evident perhaps more explicitly in this introduction than in specific passages in Hayek’s own text, but nonetheless very much a part of his underlying motivation in writing the book, is Hayek’s warning concerning the dangers that times of war pose for established civil societies—for it is during such times when hard-won civil liberties are most likely to be all-too-easily given up. Even more troubling, politicians instinctively recognize the seductive power of war. Times of national emergency permit the invocation of a common cause and a common purpose. War enables leaders to ask for sacrifices. It presents an enemy against which all segments of society may unite. This is true of real war, but because of its ability to unify disparate groups, savvy politicians from all parties find it effective to invoke war metaphors in a host of contexts. The war on drugs, the war on poverty, and the war on terror are but three examples from recent times. What makes these examples even more worrisome than true wars is that none has a logical endpoint; each may be invoked forever. Hayek’s message was to be wary of such martial invocations. His specific fear was that, for a war to be fought effectively, the power and size of the state must grow. No matter what rhetoric they employ, politicians and the bureaucracies over which they preside love power, and power is never easily surrendered once the danger, if there ever was one, has passed. Though eternal vigilance is sage advice, surely “wartime” (or when politicians would try to convince us that it is such a time) is when those who value the preservation of individual liberty must be most on guard.

Related:

  • “Governor Newsom Signs Legislation to Eliminate Out-of-Pocket Costs for Abortion Services” (gov.ca.gov, 3/22/2022): “In the face of nationwide attacks on reproductive rights, California has taken action to improve access to reproductive care by removing financial barriers to this essential health care,” said First Partner Jennifer Siebel Newsom. “In the Golden State, we value women and recognize all they shoulder in their dual roles as caregivers and breadwinners. California will continue to lead by example and ensure all women and pregnant people have autonomy over their bodies and the ability to control their own destinies.” SB 245 prohibits health plans and insurers from imposing a co-pay, deductible, or other cost-sharing requirement for abortion and abortion-related services. The legislation also prohibits health plans and insurers from imposing utilization management practices on covered abortion and abortion-related services. California is one of six states that require health insurance plans to cover abortion services, but out-of-pocket costs for patients can exceed a thousand dollars.
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Medical School 2020, Year 4, Week 7 (Interview Prep)

by philg

Interview season has commenced, which means we get days, weeks, or even a month off to travel to residency programs. With the exception of a few specialities such as urology and ophthalmology, the Match starts when the Electronic Residency Application Service (ERAS) opens at the beginning of September and interview offers start shortly after the end-of-September application deadline. The application includes volunteer and professional experiences, research publications, and letters of recommendation from attendings. A letter from one’s medical school dean is required, but we are told that this is ignored by programs. We also have to submit a personal statement. Popular topics include challenges overcome [Editor: a victimhood narrative!] and motivation for becoming a doctor (“earn money” will not appear here). The less competitive programs will send their interview invitations first.

Students apply to as many as 90 programs and even more if they are applying to multiple specialities. Our Dean of Student Affairs sent an email out overviewing the process, highlighting that we are nearly guaranteed to match into a chosen speciality if we interview at 12 or more programs. “If by December 1st you do not have that many interviews, contact me.”

Most programs email four interview dates that fill up within hours. The Dean of Student Affairs recommends giving login information to a trusted family member to accept interviews as they come in case you are in the operating room and don’t open the email soon enough. One program sends more interview offers than slots. Lanky Luke responded within 30 minutes, but “I was waitlisted because they already filled.” Sarcastic Sally empathizes: “This happened to me too! I just don’t understand why a program would leave it to chance to decide who they interview. Select the better candidate. I don’t buy it that someone who responds within 30 minutes shows more interest in coming than someone who doesn’t respond for an hour.”

Every specialty and program has different interview date ranges. Our dean explains that around 2010 there was a movement to cluster interview dates by region to allow for decreased travel costs. For example, southwestern surgery programs would have their interviews clustered around one week but coordinated to avoid overlap. “They no longer do this,” said the dean. “Expect to spend $7,000 to $10,000 during interview season on hotels, cars, and airfare. This has been budgeted into the MS-4 cost of attendance so you can borrow more money if needed.”

I’m applying to general surgery, which requires 4 recommendations. Mine are from three surgeons, a research mentor, and, unconventionally, an internist with whom I worked frequently.

Statistics for the week… Study: 5 hours. Sleep: 7 hours/night; Fun: 2 nights. Dinner party with Lanky Luke and Sarcastic Samantha.

The rest of the book: http://fifthchance.com/MedicalSchool2020

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An internal hard disk disappears from Windows, but is still apparently working

by philg

Here’s a riddle that I hope the Windows experts among us can help solve. I have an internal Seagate Exos 16 TB drive that is dedicated to Windows File History. It was installed in July 2021, assigned to R:, formatted as NTFS, and functioned just fine through mid-March. Now it doesn’t show up under “My Computer”.

Device Manager says it is “working properly”:

Disk Management can see it, but thinks that there is no partition on it:

Following Paul’s steps from the comment:

The two internal hard drive peers are shown (disks 1 and 2, but not the 16 TB drive that is the subject of this post).

Seagate offers free “SeaTools” software that could see the drive and blessed it with a green status check, but then failed it on a “short self test”.

I could start over and reformat it, but I don’t want to lose 9 months of file history. And I would like to know how the disk lost its memory of having an NTFS partition (not a good sign considering that the disk’s job is to hold a memory of my beloved files).

What should my next step be?

For the foreseeable “throw it out and buy a Mac” comments…

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Professor Krugman’s Nobel-grade thinking about inflation

by philg

Six months ago, the New York Times’s in-house Nobel-winning economist wrote “Wonking Out: I’m Still on Team Transitory” (9/10/2021):

if we finally get this pandemic under control, the inflation of 2021 will soon fade from memory.

Professor Krugman was correct about Joe Biden getting the pandemic until control. When the Science-rejecting Donald Trump was in the White House 350,000 Americans died with/from COVID-19 in 2020. Due to President Biden’s leadership and the vaccines that He developed, we’re on track to suffer only roughly a third of a million deaths in 2022.

Professor Krugman also seems to have been correct in predicting “the inflation of 2021 will soon fade from memory”, but maybe that is because the inflation of 2022 has been so much more dramatic?

The Nobel laurate is back this week with “How High Inflation Will Come Down”. He starts by doing what my former hedge fund manager friend says nearly all analysts do, i.e., extrapolating from recent events:

Rising prices will get worse before they get better.

Something new for an American journalist or politician… He blames Russia:

Russia’s invasion of Ukraine has caused the prices of oil, wheat and other commodities to soar.

This time it is different:

Forty years ago, as many economists will tell you, inflation was “entrenched” in the economy. That is, businesses, workers and consumers were making decisions based on the belief that high inflation would continue for many years to come.

Things are very different now. Back then almost everyone expected persistent high inflation; now few people do. Bond markets expect inflation eventually to return to prepandemic levels. While consumers expect high inflation over the next year, their longer-term expectations remain “anchored” at fairly moderate levels. Professional forecasters expect inflation to moderate next year.

If the professional forecasters are good at their jobs, why aren’t they absurdly rich via trading on their own previous forecasts and, thus, retired from forecasting?

Nobel-grade thinking… Prices will go down as soon as prices go down:

A lot of recent inflation will subside when oil and food prices stop rising, when the prices of used cars, which rose 41 percent (!) over the past year during the shortage of new cars, come down, and so on. The big surge in rents also appears to be largely behind us, although the slowdown won’t show up in official numbers for a while. So it probably won’t be necessary to put the economy through an ’80s-style wringer to get inflation down.

Professor Krugman agrees with what Chauncey Gardiner pointed out, i.e., that there will be growth in the spring:

The inflation of 2021-22 looks very different, and much easier to solve, from the inflation of 1979-80.

What if it takes a few springs for inflation to subside?

Related:

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Should Disney sell a planned itinerary?

by philg

Disney supposedly has cut its maximum capacity, but the new maximum still results in multi-hour waits for rides, up to a one-hour wait to get through security before even reaching the ticket booths, no way to get food without waiting in an epic line, etc.

We stayed at a hotel near Disney Springs in mid-March and would not have been able to go to Disney if we’d wanted to because all of the reservation slots had been taken. The guests who had planned months in advance and who did go to the hotel reported having a mediocre or bad experience. They paid extra for the Genie+ system that is supposed to enable getting on rides without waiting in line, but using the app was a huge hassle. We heard about some folks paying an out-of-park planner $1800 to manage their Disney app interactions and then text them with instructions for where to go.

Disney obviously has captured 100 percent of the market for people who want to plan their vacations three months in advance, including which rides they’ll do and where they’ll eat, etc. They also have an offering for people who have an extra $850 per hour to spend on a VIP guide. The guide can’t get guests into restaurants, however, as explained in my 2019 review of this experience. In that review, I posted the following idea:

Plainly the mobs are buying a lot of hotel rooms, food, and souvenirs. But I wonder why Disney doesn’t have “Crowd-hater Days” in each park to capture the market of people who would be willing to pay a lot more to have the 1990s experience. There are four core parks within Disney World. Why not say that every Monday through Thursday one of these parks will be designated “Crowd-hater” and tickets will be sold at whatever price it takes to keep max line length down to 15 minutes? If ticket prices were doubled, for example, I think Disney would actually make more money in ticket revenue since demand should not be cut by more than 50 percent. By using a high price to limit admission to only one park at a time they should still be able to keep all of their hotels filled (tourists who don’t value the less-crowded experience will still go to the other core parks and/or the water parks).

Apparently, Disney is never going to do this. So I have a new idea… a pre-planned itinerary that includes reserved meal stops. It will be like Genie+ except that the guest doesn’t have to plan, think, or do anything other than show up at the pre-planned times and pay for whatever is ordered at the meals. The Disney in-house expert figures out in which order all of the rides should be done so as to minimize walking time. I think that this could easily be sold for 2X the price of a regular park ticket plus Genie+ and the cost to Disney and impact on the park should be the same as if someone diligently used Genie+ as designed. Perhaps there is a risk of cannibalizing the VIP guide sales, in which case the price would have to be higher.

How crowded is Walt Disney World now that Americans don’t need to go to work? Disney Springs, which is essentially just an outdoor shopping mall, had 45-90-minute waits for tables at the various restaurants on a Wednesday night in mid-March. Then people would wait in line for another 45 minutes to get a generic ice cream from Ghirardelli. Here are the lines to check out of the Disney trinket shop with $40 T-shirts, to get some BBQ, and to go into a LEGO store that sells the same sets as the LEGO store in your local shopping mall:

The Road to Serfdom is dedicated to “socialists of all parties,” reflecting Hayek’s view that love of central planning is near-universal. Why not a centrally planned no-line Disney vacation?

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Who has ordered Jeremy’s Razors?

by philg

A reader sent the following:

The product can be ordered at jeremysrazors.com.

Based on the photos, it doesn’t look like this is yet another private-label Dorco (the Korean experts behind the marketeers at Dollar Shave Club).

The commercial is fun and the product description includes “It identifies as the best shave kit ever assembled and its preferred pronouns are Buy/Now.” However, I’m not convinced it is worth $60 (8 blades, handle, and some shaving cream in a “socialism-resistant bag”). The comparable Dorco product has a trimmer on the back, a “3D Motion” handle, and is available on Amazon for $23 (then every time you stop at CVS for a COVID-19 vaccine booster pick up some Edge, which is no doubt superior to Jeremy’s cream). Dorco hasn’t taken any position on American politics as far as I know. If you’re in Maskachusetts and need to disguise the fact that you’re not using Gillette anymore, put all of the above in this zippered pouch:

Update: for those who wondered about where razors are made, I did some exhaustive Scientific research (i.e., drove to CVS). I found Gillette products made in China (the latest and greatest “GilletteLabs” razor) and Germany (the core Fusion5 cartridges).

Related:

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Your health insurance and Medicare tax dollars in the Wizarding World of Harry Potter

by philg

We overlapped in Orlando last week with an electronic medical record expert friend who was attending HIMMS 2022, a conference for 20,000 senior hospital executives and the software companies trying to sell them stuff (the first round of digital stuff was paid for partly with $30 billion of taxpayer funds showered on hospitals by the Obama administration). Attendees had to be vaccinated against a 2.5-year-old version of SARS-CoV-2:

Due to the cruel tyranny of the Florida Legislature, they were forced to add a test option:

Our Right of Entry Policies were specifically designed with consideration of relevant Florida regulations. Our policies allow an attendee to voluntarily show validation of their vaccine status if that is their preference (Option A), or to voluntarily show proof of a negative COVID-19 test within one day of badge pick up, if that is their preference instead (Option B).

How about using a saliva-soaked bandana to cancel out the effects of sharing indoor space for five days with 20,000 other people?

Masks are highly encouraged but not required on the HIMSS22 campus.

What happened in practice? My friend: “I didn’t see a single mask.” (Most of these experts on health care and, therefore, avoiding COVID-19, had brought their families to share the hospital-paid hotel rooms and roam the packed-for-spring-break theme parks during the day.)

How rich have hospitals and their vendors become off the river of tax-subsidized health insurance and tax-funded Medicare/Medicaid? They had sufficient $millions to pay Universal to close Islands of Adventure’s doors to the general public at 5:00 pm, clear the rabble out of the park, and run all of the rides exclusively for the HIMMS attendees starting at 7:30 pm. How was the party? “It was awesome! I got on every ride with no line!”

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Could a Black judge have obtained consideration for the Supreme Court job by identifying as a woman?

by philg

I haven’t been following the Supreme Court confirmation hearings for Ketanji Brown Jackson (CNN) closely, but it seems that nobody could apply for the job unless he/she/ze/they identified as a “Black woman”. From state-sponsored NPR:

PRESIDENT JOE BIDEN: The person I will nominate will be someone with extraordinary qualifications, character, experience and integrity. And that person will be the first Black woman ever nominated to the United States Supreme Court. It’s long overdue in my view.

A person who switches racial identity from white to Black may be condemned (see Nkechi Amare Diallo, formerly “Rachel Dolezal”), but we celebrate those who change gender identity from “man” to “woman” (see Rachel Levine, for example).

If a Black judge who previously identified as a “man” had, after Dr. Biden’s husband announced his hiring policy, said “I identify as a woman and am proud to be a member of the 2SLGBTQQIA+ community”, would that judge then have become eligible for the Supreme Court position?

William Thomas, for example, who was nominated by President Obama (see “Rubio Withdraws Support for Gay Black Judge’s Nomination to the Federal Bench” (NYT)) and who continues to serve as a judge in a Florida state court. Judge Thomas was already identified by the newspaper of record as “Black” and, under our prevailing theories of gender, only Judge Thomas can pick his/her/zir/their gender ID. What would have stopped Judge Thomas from being considered for the Supreme Court job as a “Black woman”?

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