Category: Health

Remembering Atul Butte

by philg

Our friend Atul Butte has died at age 55, a great physician and medical researcher who couldn’t be saved by our most advanced medicines and technology. He was always cheerful and curious.

Of his many online lectures, I think this one captures his spirit and enthusiasm well:

He and I were on opposite sides of the “saliva-soaked face rags for the general public will prevent SARS-CoV-2 transmission” debate, but it didn’t affect our friendship. Humans, even MD/PhDs, are social animals and it would have been tough for someone in the San Francisco Bay Area to take the “viruses are smarter than humans” position. Atul emphasized persuasion rather than coercion with respect to masks, unusual for an academic and doubly unusual for a University of California academic. (He did advocate coerced COVID vaccination, though, via employer mandates, and then COVID turned out not to be relevant to his own health and longevity.)

This is a sad loss for those of us who worked with Atul in the Boston area and, I’m sure, for the many younger researchers and docs whom he inspired. Also, on this Father’s Day, a terrible loss for his child. To channel Atul’s spirit, though, I guess we can be more optimistic about the future of medicine because of the techniques that Atul developed and taught to others. I’ll try to remember him every time I hear about a medical insight that came out of looking at a big data set.

From Atul’s PhD advisor:

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Book about a serial killer that is important for both pro-vaxxers and anti-vaxxers

by philg

I recently finished listening to American Predator: The Hunt for the Most Meticulous Serial Killer of the 21st Century, a book about Israel Keyes. Mr. Keyes was born at home, one of 10 children, and was not only never vaccinated but didn’t interact with medical doctors for his first 18 years. He never even had a birth certificate. (The events of the book occur before the Sacrament of Fauci became available and, therefore, “never vaccinated” refers to the pre-2020 standard childhood vaccines.) From the perspective of those who are pro-vaccination, the fact that Mr. Keyes became a serial killer will be important (i.e., without the 57 shots recommended by the CDC through age 18, Mr. Keyes’s mental health was impaired, though the book describes him as “bisexual” and membership in the 2SLGBTQQIA+ community is considered a sign of superior mental health, so maybe being Bi and being a serial killer cancel out?). From the perspective of those who are anti-vaccination, Mr. Keyes being extraordinarily robust, intelligent, and conscientious will be important (of course, he eventually makes one mistake that leads to his arrest).

According to the author, we didn’t learn as much as we could have about Mr. Keyes’s life of violent unprovoked crime due to the incompetence of the U.S. Attorney in Anchorage, Alaska, Kevin Feldis (now a partner at Perkins Coie). He allegedly refused to allow the FBI professionals interrogate the suspect and, instead, inserted himself.

The book might inspire you to develop or purchase a “panic ring” that can be pressed one-handed to summon the police. Keyes was usually able to tie up his victims before they were able to make any phone calls, but they generally would have had enough time to move a thumb on top of a forefinger ring. If the GPS location and mobile data connectivity services are handled by a Bluetooth-linked mobile phone, the ring shouldn’t need to be large even with a long battery life. It looks as though a phone-linked necklace/bracelet is available from invisaWear:

The victims weren’t immediately gagged so perhaps it would also work if the phone were just constantly listening for “I have an itch” or a similar phrase. If Hitler 2.0 can get Neuralink to work, perhaps it would be sufficient just to think “I need to be rescued”.

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Gender Studies class goes to the eye doctor

by philg

Registering at the eye doctor, whose patient portal credits CPT©2025 American Medical Association with all of the questions and choices below:

Hatefully, there is no “ze” nor a write-in box:

The default sexual orientation is “don’t know”:

But some other choices are available:

Should there be an “irrelevant” choice for people who’ve been in heterosexual marriages for longer than 4 years? Psychology Today:

What’s more, we found that marital satisfaction for both husband and wife deteriorated in step with the wife’s loss of sexual desire. (The husband’s sexual desire was irrelevant to anybody’s marital happiness.) Might wives lose sexual desire because the marriage is turning bad? No: Time-lag analyses indicated that her loss of desire came first, leading to lower satisfaction later. Early levels of (dis)satisfaction did not predict how rapidly the wives lost interest in sex. … Crucially, it was not due to childbirth. Becoming parents made the mismatch worse, as in steeper declines in wives’ sexual desire. … A possible explanation that fits our data is that female sexual desire increases during the brief phase of passionate love. Nature may have arranged that as a way of encouraging the man to make a long-term commitment.

We can also see how the American Medical Association thinks about race, the default for which is “any” (the racial equivalent of “pangender”? Why isn’t it “panracial”?):

1.4 billion people in China, a country with 56 officially recognized ethnic groups, are lumped together as “Chinese”. For cousins of Elizabeth Warren, i.e., the 3,000ish enrolled Chinooks, there are five categories:

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CVS and RFK, Jr.’s MAHA program

by philg

Our local (Jupiter, FL) CVS adapts to RFK, Jr.’s Make America Healthy Again program. You no longer have to buy three huge bags of Twizzlers to get a discount, as one did under the Biden administration. “Must buy 2”:

Admission: Our 11-year-old was home sick with a cold (a ridiculous situation in Florida!) and requested Kit Kats so I bought him some.

Related:

  • COVID-19 state of emergency ending? (March 2023, when Biden was considering winding down the COVID-19 emergency in May 2023, a CVS in Maskachusetts incentivizes buying Cadbury candy eggs in quantity 10 and washing them down with 36 cans of Coke)
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The Barbra Streisands of medicine: ob/gyns

by philg

Barbra Streisand is famous for promising to move to Canada, but then living quietly under two Trump dictatorships. See “‘I really will’: the stars who didn’t move to Canada when Trump won” (Guardian, 2018), for example:

Who are Streisand’s counterparts in the world of medicine? Ob/gyns. “Ob/Gyns Mostly Stayed Put After SCOTUS Overturned Roe, Study Finds” (MedPageToday, April 21, 2025):

There was no population-level ob/gyn exodus away from abortion-restrictive states post-Roe.

From the quarter right before the June 2022 Dobbs v. Jackson Women’s Health Organization decision through the end of the study in September 2024, 95.8% of ob/gyns remained in states that protect access to abortion, 94.8% remained in states threatening bans, and 94.2% remained in states with abortion bans, reported Becky Staiger, PhD, of the University of California Berkeley, and colleagues.

“The only statistically significant difference suggested that the share of physicians who are ob/gyns decreased less in threatened states than in protected ones, opposite to the expected finding if ob/gyns were leaving states where abortion is threatened,” the authors wrote.

(I apologize for the hateful language in which “abortion care” is presented without the “care”.)

The full article says “Numerous media reports have described physicians leaving states where abortion is banned in response to these concerns, including cases of retirement or migration”.

Where should an ob/gyn passionate about delivering abortion care have moved? Maskachusetts law allows abortion care at 37 weeks of pregnancy or even more if a single physician believes that the abortion care will preserve “the patient’s … mental health”:

If a pregnancy has existed for 24 weeks or more, no abortion may be performed except by a physician, and only if in the best medical judgement of the physician it is: (i) necessary to preserve the life of the patient; (ii) necessary to preserve the patient’s physical or mental health; (iii) warranted because of a lethal fetal anomaly or diagnosis; or (iv) warranted because of a grave fetal diagnosis that indicates that the fetus is incompatible with sustained life outside of the uterus without extraordinary medical interventions.

(Abortion care is “on demand” through 24 weeks.)

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Loss of Rob Holland and David Paton, founder of Orbis

by philg

It’s World Pilot’s Day today, but I’m not celebrating. Rob Holland, whom the legendary Mike Goulian brought to my old home airport, died two days ago in an MXS-RH while preparing for an air show. Confusingly, Rob wasn’t doing any crazy-looking maneuvers just before the crash, but only returning for a normal landing. An aviation friend: “heard the engine broke off and took out Rob’s wing. The composite firewall breaking is a known issue with the MX airplane.” Here’s Rob with an air show spectator:

The first time that I went upside down in an airplane it was with Rob, instructing out of KBED in the Decathlon at the time. I saw him only at air shows after he escaped to tax-free New Hampshire, but I remember him as patient and unfazed by student incompetence. A great ambassador for aviation.

Also notable, though not a tragedy, David Paton, the 94-year-old founder of the Orbis flying eye hospital charity, has died. From the New York Times obituary:

David Paton, an idealistic and innovative ophthalmologist who converted a United Airlines jet into a flying hospital that took surgeons to developing countries to operate on patients and educate local doctors, died on April 3 at his home in Reno, Nev. He was 94.

The son of a prominent New York eye surgeon whose patients included the shah of Iran and the financier J. Pierpont Morgan’s horse, Dr. Paton (pronounced PAY-ton) was teaching at the Wilmer Eye Institute at Johns Hopkins University in the early 1970s when he became discouraged by increasing cases of preventable blindness in far-flung places.

(i.e., his life was consistent with the data presented in The Son Also Rises: economics history with everyday applications)

Before it decided to concentrate on Rainbow Flagism and Critical Race Theory, USAID pitched in to help spread ophthalmology knowledge to poor countries:

Dr. Paton decided to raise funds on his own. In 1973, he founded Project Orbis with a group of wealthy, well-connected society figures like the Texas oilman Leonard F. McCollum and Betsy Trippe Wainwright, the daughter of the Pan American World Airways founder Juan Trippe.

In 1980, Mr. Trippe helped persuade Edward Carlson, the chief executive of United Airlines, to donate a DC-8 jet. The United States Agency for International Development contributed $1.25 million to convert the plane into a hospital with an operating room, a recovery area and a classroom equipped with televisions, so local medical workers could watch surgeries.

(I’m not sure that $1.25 million would pay for new carpet and a coffee maker in a Gulfstream today.)

David Paton wasn’t a pilot, but he created one of the greatest demonstrations of the power and value of aviation.

Some photos of the Orbis MD-10 at Oshkosh (EAA AirVenture) in 2021 (note the COVID-era mask, one of the few at Oshkosh that year):

Separately, if you need some help with your eyes in order to keep flying safely, U.S. News says to pack a bathing suit and go to Miami (ranked #1). Alternatively, pack a gun and ammo and go to Philadelphia (#2) or Baltimore (#3):

Circling back to Rob Holland, I think that he was truly one of those people whose personality in life matched his eulogy personality. Despite being a fierce competitor and top achiever, he never exhibited a touch of “pilot ego.” I will miss him.

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In-dash exercise equipment for self-driving cars?

by philg

Traffic in the U.S. is going to get slower every year as the population continues to expand via immigration and children of immigrants (Pew, 2015). Self-driving systems are going to get better every year, but perhaps not good enough that they can be completely unsupervised. What are people going to do on multi-hour car trips where they still have to sit in the driver’s seat and look at the road? How about exercise? With more time lost to traffic jams Americans will have less time to hit the gym or walk in the neighborhood so we’ll get yet fatter and weaker unless the car itself becomes a gym.

Suppose that resistance bands were built into the dashboard, floor, doors, and ceiling of the car. I asked ChatGPT to generate an image of this, but the request fried our future overlord’s brain.

It could look something like this image from Amazon, but with the band attached to the door or the dash instead of to the wall:

I know that there’s a fine line between stupid and clever. Which side of the line is this idea on?

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FAA Medical talk at Sun ‘n Fun: get BasicMed even if you have a conventional medical

by philg

Most of the lectures at Sun ‘n Fun happen in a modern air-conditioned building that belongs to Central Florida Aerospace Academy, a public high school. Fittingly for today’s topic, one enters the building via a door that features a coronapanic sign:

(See When will we feel safe enough to remove our coronapanic signs? (2024))

The presenter was Dr. Daniel Monlux, the kind of physician that noble aid recipients in the Middle East, accustomed to free food, education, health care, etc., probably wouldn’t ask to see twice (he was in the F/A-18 in the U.S. Navy). Dr. Monlux is a founder of Wingman Med, a consulting firm that helps pilots maintain their medicals.

The most important take-away from the talk is that every pilot should get certified under BasicMed even if he/she/ze/they also holds a conventional medical certificate. That way, if there is a hiccup in the medical renewal process, the pilot can still fly his/her/zir/their family around in a Cessna or Cirrus. There is no obstacle to dual medical certification.

What can go wrong in the medical renewal process? If the pilot discloses a new condition of some sort (the FAA doesn’t normally have access to a pilot’s medical records other than self-disclosure, according to Dr. Monlux) and that new condition isn’t on the “CACI list” or the pilot doesn’t have the right documentation for the AME (Aviation Medical Examiner) to issue a medical under CACI then there will be a deferral.

First, how can the pilot avoid a deferral? One way is to look at the CACI list web pages and figure out what the AME will need to see. Typically it is a report from a physician (not a nurse-practitioner or PA) within 90 days of the aviation medical exam.

Suppose that there is a deferral? Then the pilot is plunged into a hellish holding pattern. Mostly this is not due to the low-paid doctors employed by the FAA in Oklahoma City wanting to torture pilots, but rather because the FAA is required by regulation to use only USPS and hardcopy letters for communicating with pilots. It takes 2-3 months for a hardcopy mail exchange to occur. If the pilot hasn’t given the FAA exactly the information requested in the format that is requested, there will be at least another 2-3 months of delay. (no need for a DOGE reengineering here!)

Pilots often make things worse during this process. They will submit more information that the FAA requests, e.g., a full medical record from a provider that happens to have a medication list and a condition list. Invariably, these lists at medical institutions are out of date and contain conditions and medications that are no longer relevant, but once the FAA sees any of them they will need an explanation (from a physician within the past 90 days) about why the condition no longer exists and the medication is no longer being taken.

These processes can drag on for years and there is a plan for the FAA to start denying medical applications, rather than simply continuing the deferral farce, if the pilot can’t get organized to supply everything that the FAA needs (could be challenging in a country where it can take 3-4 months to get an appointment with a specialist). If the FAA actually denies a medical certificate then the pilot can’t continue to fly under BasicMed.

As noted above, most problems in this domain are self-inflicted. However, in the event of a complaint by a copilot, for example, the FAA does have access to prescription drug databases and might be able to see, for example, that a pilot was prescribed opioids (America’s favorite pastime) or anti-psychotic drugs.

Let me close with a trendy new topic: What if you’re a massive beefcake and decide to slim down via Ozempic or similar? Make sure that it is prescribed for weight loss, not diabetes! Diabetes is a matter of serious concern to the FAA because, among other things, it can affect vision.

Readers: Who has been on Ozempic or a competitive GLP-1 inhibitor? I have a few friends on them and everyone seems happy in their new thin guise. Is Elon Musk right that everyone should be on them? I would have to lose 20 lbs. to get into what the government says is an ideal weight range. As long as our house is within 15 minutes of Costco, I don’t see that happening absent Ozempic and, at the same time, I hate the idea of giving myself injections almost as much as I hate the idea of grueling exercise.

Speaking of Ozempic, here’s where I got lunch:

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A stroke 12 hours after the RSV vaccine

by philg

A healthy tennis-playing 77-year-old friend in the Boston suburbs had his first stroke recently. It occurred 12 hours after he was injected, for the first time, with the newish RSV vaccine. He’s recovering reasonably well, but perhaps he needs some better friends. Having heard about the stroke, I called to scold him for not following the “physician, heal thyself” directive (he’s a cardiologist). On hearing that the stroke had followed the RSV vaccine, I said “I was going to ask whether you think it was the booze or the hookers that caused the stroke.”

I learned that there are some treatments for strokes, but they weren’t helpful to him. One is an injection of tPA, but it works only for certain kinds of strokes and must be administered almost immediately. That wouldn’t have been possible for him because he was waiting for four hours in the migrant-clogged ED to be seen (every migrant to Maskachusetts is immediately entitled to unlimited free health care and, as it turns out, there have been few licensed and board-certified physicians among the migrants so there is more demand for the same amount of supply). The new-to-me treatment was to stick a catheter into the brain and hunt for the clot and remove (“retrieve”) it! This seems to have been invented in 2007 by Medtronic and FDA-approved in 2012. NYU explains:

Other than the 12-hour timing coincidence, could there be any connection at all between an RSV vaccine and a stroke? “RSV and Heart Health” (American Heart Association):

Patients face a higher risk of heart attack or stroke immediately after contracting RSV. The highest risk is within three days of infection but remains heightened for up to 90 days.

Hmmm… the disease causes strokes so we can be 100 percent sure that the vaccine designed to fool the immune system into thinking the body has the disease does not cause strokes?

Related:

  • NHS guidelines for the RSV vaccine from the technocrats in Britain (for 75-79-year-olds)
  • the CDC, which previously said “get it at age 60”, now says “get it at age 75” (Science is always to be followed, of course!)
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My father’s x-ray bill is settled… 10 years later

by philg

The January harvest of physical mail included a Quest Diagnostics bill for $5.86 (maybe the third paper one they’ve mailed out regarding this McDonald’s sandwich (not meal)-sized bill; they have a credit card on file and when I tried to pay it by bill number on their web site it couldn’t be found).

More remarkably, I got an insurance statement, addressed to my late mother, about an X-ray that my father purportedly had. Dad died in 2021 (right after getting the second Pfizer COVID-19 vaccine shot), so I was a little surprised to get health care paperwork four years after the fact. On closer inspection, however, the statement was 10 years after the care event.

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