Category: Health

Why would Luigi Mangione blame an insurer for the ineffectiveness of modern medicine?

by philg

“Luigi Mangione’s pals say CEO shooter ‘went crazy’ and fled to Japan after giant screws put in spine” (The Mirror):

The Ivy Leaguer accused of murdering a top CEO may have spiraled into madness following a botched back surgery that required ‘giant screws’ in his spine, according to friends.

Luigi Mangione, the alleged killer, had shared X-ray images on social media showing his misaligned spine, which was reportedly worsened by a surfing accident.

Some of those looking into the 26-year-old former high school valedictorian believe that this severe back injury, which required screws in his spine, led to a concerning decline over the past year.

Former classmates of Mangione suggest that the failed surgery could have pushed the Maryland man to the edge.

It’s a shame that current medical technology isn’t sufficient to fix the typical back problem, but why is United Healthcare to blame? Luigi Mangione was inspired by Harvard’s Ted Kaczynski, educated at Penn and Stanford, and presumably gifted with a high degree of rational reasoning. How did he come up with a model of the world where his back would have been fixed by surgery if United Healthcare had done something different?

Separately, given that people have so much familiarity with the inability of medicine to fix what ails them, their friends, and their family members, why do people accept uncritically the idea that a doctor can transform a man into a woman or vice versa? Who looks at the photo below and says “doctors have never been able to solve half of the seemingly simple health issues that I’ve brought to them, but they seem to be great at gender reassignment surgery”?

Finally, is Luigi Mangione further proof that mask orders can’t work? He had a huge incentive to keep his mask in place and might well be a free man today if he had done so, but his mask discipline wasn’t perfect, even in an all-Democrat city that encourages mask-wearing, which resulted in a security camera getting an image of his full face and then some McDonald’s workers recognizing him.

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A standard day in the American health care system…

by philg

Here’s an August 2024 bill for a walk-around heart monitor that was used by a patient in February 2024:

The price to an uninsured person would have been more than 10X the real price of the service ($3985 vs. $331).

I still can’t understand how it is legal for health care providers to lie in wait for the unwary uninsured patients and hope that someone slips through the cracks somehow and becomes liable for more than 10X the regular price for a service.

I’m convinced that more than 90 percent of the medical bill bankruptcies and disputes in the U.S. would be eliminated if the Feds established a “If you want to feed from the Medicare/Medicaid trough, you can’t bill an uninsured patient more than a 15 percent premium over the Medicare price” rule.

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American Vaccine Inflation

by philg

I can’t figure out why Science hasn’t converged on opposite sides of the Atlantic regarding vaccines. Let’s leave COVID aside for the moment since one’s level of coronapanic is inevitably a political decision. Let’s look at the respiratory syncytial virus (RSV) vaccine. The technocrats in the UK say that Science told them this is for people 75-79 and for pregnant people of any age:

(Of course, by Massachusetts standards, the best protection for a 28-week-old baby is abortion care, legal at every stage of pregnancy and “on-demand” through 24 weeks.)

What does Science say on the western side of the Atlantic? The RSV vaccine is for people aged 60-130+ (CDC):

The NHS says that the flu vaccine is for those 65+. The CDC?

Everyone 6 months and older in the United States, with rare exception, should get an influenza (flu) vaccine every season.

An indestructible 15-year-old is, therefore, never more than a year away from a flu shot in the US while he/she/ze/they is 50 years away from his/her/zir/their next flu shot in the UK.

Let’s turn now to coronapanic. In the U.S., Science says to get one shot at age 6 months and then keep getting injected regularly:

In the UK, the Sacrament of Fauci starts at age 75. In other words, a person must be 150X older in the UK compared to in the US to receive a COVID-19 vaccine. There are usually some error bars in Science, but does anyone know of an example where there is a factor of 150X between a Scientific result in the US versus somewhere else in the world?

Related:

  • Lost in the coronapanic shuffle, an April 2020 paper from the Annals of Internal Medicine: “The Effect of Influenza Vaccination for the Elderly on Hospitalization and Mortality” (Anderson, Dobkin, and Gorry). They looked at the UK where hardly anyone gets a flu shot under age 65 and almost everyone gets one at age 65. “Turning 65 was associated with a statistically and clinically significant increase in rate of seasonal influenza vaccination. However, no evidence indicated that vaccination reduced hospitalizations or mortality among elderly persons.” (in other words, the flu shot might prevent a few days of illness, but it doesn’t reduce the death rate)
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Bad Pharma, 2024 edition

by philg

Ten years ago… Book review: Bad Pharma:

Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques which are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies don’t like, they are perfectly entitled to hide them from doctors and patients, so we only ever see a distorted picture of any drug’s true effects. Regulators see most of the trial data, but only from early on in a drug’s life, and even then they don’t give this data to doctors or patients, or even to other parts of government. This distorted evidence is then communicated and applied in a distorted fashion. In their forty years of practice after leaving medical school, doctors hear about what works through ad hoc oral traditions, from sales reps, colleagues or journals. But those colleagues can be in the pay of drug companies – often undisclosed – and the journals are too. And so are the patient groups. And finally, academic papers, which everyone thinks of as objective, are often covertly planned and written by people who work directly for the companies, without disclosure. Sometimes whole academic journals are even owned outright by one drug company. Aside from all this, for several of the most important and enduring problems in medicine, we have no idea what the best treatment is, because it’s not in anyone’s financial interest to conduct any trials at all.

The book notes that the British government refuses to pay more for a new drug than the value added by that drug in terms of quality adjusted life years compared to cheap generics or other existing treatments. In the U.S., by contrast, the government and private insurers pay whatever the pharma company asks or, perhaps, a discount off whatever the pharma company asks.

Our ruling elites (I hesitate to say “the Biden administration” because it is unclear what role Joe Biden has been playing) have been touting a recent scheme to pay a little less for some drugs. This scheme is analyzed by Professor Vinay Prasad in “Price negotiation does not save money when keep you paying for drugs that don’t work”:

The Biden Administration saves 6 billion and then loses tens of billions with bad drug policy

They lowered the price of a drug that has no good evidence it is better than older drugs. Consider Entresto (above). Entresto— sacubitril valsartan 160mg BID— beat enalapril 10 mg BID in PARADIGM. Since then it failed in post MI and in HFpEF. It’s one the few drugs that ‘works’ in HFrEF but not post-MI. The dose tested in Paradigm was the MAXIMAL Entresto dose with a dizzying dose of ARB. But few people get this dose in real life. There is NO EVIDENCE that the prescribed doses in the US in 2024 (lower than maximal dose) are better than ace-s, which are dirt cheap.

You can lower the price of drugs, but you lose when you spend billions on covid drugs that have no evidence of efficacy. In recent years the Biden administration approved COVID boosters for toddlers, and spent 10 billion on Paxlovid. There is no evidence either of these interventions work in the current climate. So congrats on your 6 billion in savings, too bad we blew 10 billion on unproven products. (Net impact -4 billion dollars)

For every drug you negotiate prices on, the FDA is approving at least 5x as many new drugs based on poor evidence.

Summary: some things never change!

(The relative cost efficiency of the British health care system combined with the descent into Third World status for Britain is kind of confusing. The U.S. plainly wastes at least 10 percent of GDP via health care (closer to 15 percent if we compare to Singapore). How is it that we’re still so much more prosperous than the UK and most European nations?)

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The $27,321 MRI

by philg

How do Americans go bankrupt after seeking health care?

A friend’s child had some back pain after a fall. A hospital billed $27,321.50 for an MRI (it says “4 services” below, but it was really just one encounter with the MRI machine; some different body parts and contrast). That’s what an uninsured person (“a mark”) would have been chased for, eventually into bankruptcy if necessary. What’s the real price of this service? I.e., what does the hospital actually expect to get paid from a typical patient (insured either privately, via Medicaid, or via Medicare)? About $1,287:

(And, of course, the results were inconclusive, so the value of the $27,321 MRI was $0.)

Related:

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Book recommendation: Cook County ICU

by philg

A well-done Audible recorded book and, probably, a good book in print/Kindle form: Cook County ICU. A few things that I learned from it…

The modern insurance/Medicare/Medicaid system requires that hospitals seeking to get revenue give each patient a concrete diagnosis prior to hospital admission. This results in inferior care because the doctors treating the patient become anchored to the initial diagnosis, which is often merely a guess.

Never agree to be a consultant to Hollywood. The author accepts a request to work as a medical advisor for The Fugitive (Harrison Ford plays a vascular surgeon) and puts in a huge number of hours on the project. Money is never discussed. He eventually gets a check for $1,100 (in pre-Biden money) for his work on a film that earned almost $370 million (pre-Biden dollars) at the box office.

From the author’s point of view, there were huge advances in medical technology over his 40 years of practice. The electronic medical record wasn’t one of them, however. It has delivered few benefits, in his view. The practice of having a physician look at a screen and type at a keyboard while interviewing a patient is particularly harmful.

Being sued for divorce is a common way to transition out of the middle class and into the free clinic where the author worked after retiring from the big hospital.

HIPAA is ridiculous, making it easy for insurers, hackers, and the government to get your medical information, but not you or your family members.

Cold is far more deadly to humans than heat. Although we are assured by Science that a warmer climate will result in near-term extinction of humanity, in Chicago it is the cold winter that kills people, not the hot summer.

Not every anecdote is equally rewarding, of course, but there are a lot of great ones!

Related:

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Gerald Ford and the Swine flu panic of 1976

by philg

An Ordinary Man: The Surprising Life and Historic Presidency of Gerald R. Ford reminds us of the 1976 panic regarding a respiratory virus: a strain of influenza called “swine flu”. This was the genesis of the modern muscular CDC. Congress appropriated $500 million in pre-Carter/pre-Biden dollars. The CDC said that every American should get vaccinated (Republican Ford publicly accepted the sacrament; Democrat Jimmy Carter refused it). The vaccine was rushed to the market, greatly enriching four pharma companies who also were indemnified from any liability. This indemnification turned out to be useful. The vaccine was at least 10X more likely to cause Guillain-Barré Syndrome (paralysis) than it was to protect the injected person from death due to influenza (contemporary CDC page on the subject).

Abram Saperstein, who changed his name to Albert Sabin, was recruited to sell the idea of universal vaccination. Sabin was famous at the time for having created the oral polio vaccine. After a few months, however, Sabin concluded that the rushed-to-market swine flu vaccine was more likely to harm than help and that a 1918-style epidemic was unlikely.

Speaking of Jimmy Carter, the book notes that his campaign promises were similar to Javier “Chainsaw” Milei’s in Argentina. Candidate Carter promised to reduce the number of federal agencies from 1,900 to 200, for example. What did President Carter deliver? A brand new Cabinet-level Department of Education that kicked off decades of tuition inflation at American colleges and universities via subsidized student loans and grants.

Personal health anecdote: Following the example of Jimmy Carter, the greatest president in our nation’s history, I ignored CVS’s constant reminders of flu vaccine availability. In early January, embedded in Boston with the nation’s smartest and most assiduous mask and vaccine Karens, I got a truly horrible cough/flu. I cursed myself for ignoring CDC advice. After limping home on JetBlue (I actually wore a mask in hopes of protecting fellow passengers!) I went to a German-trained physician here in Palm Beach County and tested negative for both COVID and influenza.

Related:

  • “The Effect of Influenza Vaccination for the Elderly on Hospitalization and Mortality” (Anderson, et al. 2020; Annals of Internal Medicine): “Turning 65 [the age at which people in the UK become eligible for flu vaccines from the NHS] was associated with a statistically and clinically significant increase in rate of seasonal influenza vaccination. However, no evidence indicated that vaccination reduced hospitalizations or mortality among elderly persons” (in other words, the flu shot might help some people avoid a brief illness, but it doesn’t reduce the chance of being killed by the flu)
  • “Carter’s Flu‐Shot Plan For the Ill and Elderly Termed Short of Goal” (NYT, 1979): [the CDC director] also defended the program against criticism by Dr. Albert B. Sabin, who developed the oral vaccine for polio. Dr. Sabin, who is associated with the Medical University of South Carolina, said that he did not believe that the influenza vaccine would help many people because new virus strains kept cropping up. and required changes in immunization formulas. He said that vaccines containing major new strains became available only after the new strains already had their major impact.
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Socialists run out of other people’s hospital beds in Massachusetts

by philg

“The problem with socialism is that you eventually run out of other people’s money,” said Margaret Thatcher. She didn’t count on the U.S. Congress and Federal Reserve being willing to print however much was deemed necessary to achieve the ruling party’s goals.

One thing that the technocrats couldn’t print, however, is hospital beds. With just a trickle of undocumented immigrants over the past couple of years (compared to the flood that Texas has received), it seems that Massachusetts is running out of health care system capacity.

“‘Capacity disaster’: Mass. General Hospital says it needs more beds to combat ‘unprecedented crisis’” (Boston News 25):

Massachusetts General Hospital in Boston announced Friday that it has been dealing with an ongoing “capacity disaster” and that it’s in desperate need of more beds to help combat the “unprecedented crisis.”

The hospital has been operating every day for the past 16 months in “Code Help” or “Capacity Disaster” status, despite the worst days of the COVID-19 pandemic being a thing of the past, a spokesperson for the medical center said.

According to the hospital, “Code Help” occurs when inpatient beds and monitored hallway stretchers are full, and “Capacity Disaster” is triggered when the emergency department is full, all hallway stretchers are being used, and there are more than 45 inpatients boarding in the emergency department awaiting a hospital bed.

What do the technocrats have to say about this kind of situation? It can all be fixed with a technocratic solution. “How to keep people out of the emergency room; Help for immigrants in arranging primary care visits leads to substantial drop in ER visits and costs, a new study shows.” (MIT News, 9/23/2023):

“This program is fairly low-touch and minimalist, yet it had a meaningful effect,” says MIT economist Jonathan Gruber, co-author of a new paper detailing the study’s results.

Separately, as the authors note in the paper, extending formal health insurance to undocumented immigrants “remains politically untenable” for the most part. On the other hand, jurisdictions might examine if other approaches increase care while, in this case, lowering emergency room traffic.

“There’s this tendency with health care to think that if you give people health insurance, you’re done,” Gruber says. “This study is saying the right system combines insurance as financial protection with other kinds of [tools].” He adds: “There is just huge potential to use data and science to get people to where they need to be in terms of getting the most efficient care.”

With data and science, all problems can be solved!

From the hospital itself…

Related:

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Sterile gloves are as effective as masks

by philg

2015, Journal of the Royal Society of Medicine, “Unmasking the surgeons: the evidence base behind the use of facemasks in surgery”:

overall there is a lack of substantial evidence to support claims that facemasks protect either patient or surgeon from infectious contamination

2023, Injury, “Risk of wound infection with use of sterile versus clean gloves in wound repair at the Emergency Department: A systematic review and meta-analysis”:

No evidence of additional protection against wound infections with the use of sterile gloves for wound repair in the ED compared to clean gloves was found.

Let’s ask Dr. ChatGPT:

Speaking of wounds, we can remember as we light the kinara this evening, for the second night of Kwanzaa the likely headwounds of the women who were hit on their heads with toasters by Professor Dr. Dr. Maulana Karenga, Ph.D., Ph.D., the creator of the holiday.

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Randomized controlled trial of therapy for teenagers

by philg

“These Teens Got Therapy. Then They Got Worse.” (Atlantic, by Olga Khazan; paywalled, but readable in the Google cache):

Researchers in Australia assigned more than 1,000 young teenagers to one of two classes: either a typical middle-school health class or one that taught a version of a mental-health treatment called dialectical behavior therapy, or DBT. After eight weeks, the researchers planned to measure whether the DBT teens’ mental health had improved.

The therapy was based on strong science: DBT incorporates some classic techniques from therapy, such as cognitive reappraisal, or reframing negative events in a more positive way, and it also includes more avant-garde techniques such as mindfulness, the practice of being in the present moment. Both techniques have been proven to alleviate psychological struggles.

The author and editors forgot to capitalize “Science”!

This special DBT-for-teens program also covered a range of both mental-health coping strategies and life skills—which are, again, correlated with health and happiness. One week, students were instructed to pay attention to things they wouldn’t typically notice, such as a sunset. Another, they were told to sleep more, eat right, and exercise. They were taught to accept unpleasant things they couldn’t change, and also how to distract themselves from negative emotions and ask for things they need. “We really tried to put the focus on, how can you apply some of this stuff to things that are happening in your everyday lives already?” Lauren Harvey, a psychologist at the University of Sydney and the lead author of the study, told me.

But what happened was not what Harvey and her co-authors predicted. The therapy seemed to make the kids worse. Immediately after the intervention, the therapy group had worse relationships with their parents and increases in depression and anxiety. They were also less emotionally regulated and had less awareness of their emotions, and they reported a lower quality of life, compared with the control group.

Most of these negative effects dissipated after a few months, but six months later, the therapy group was still reporting poorer relationships with their parents.

Last year, a study of thousands of British kids who were put through a mindfulness program found that, in the end, they had the same depression and well-being outcomes as the control group. A cognitive-behavioral-therapy program for teens had similarly disappointing results—it proved no better than regular classwork.

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