Category: Health

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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AI goes to the bathhouse

by philg

An elite Californian posted with satisfaction a state-sponsored NPR story about how stupid people in Louisiana were, especially with respect to the mpox vaccine. I decided to see if ChatGPT had advice regarding avoiding mpox (not to be conflated with the racist “monkeypox virus”, which is the cause).

Prompt 1: Is there any lifestyle change that I could adopt to minimize my risk of catching mpox?

ChatGPT gives a one-page answer and the only reference to sex is “Use condoms and consider other barrier methods during sexual activity”.

Prompt 2: You mention “sexual activity”. Is there any particular kind of sexual activity that is more likely to result in contracting mpox?

ChatGPT gives a one-page answer that doesn’t hint at the type of person or group that might be infected.

Prompt 3: You say “If you are in a community experiencing an mpox outbreak or belong to a group at higher risk”. What would be an example of a “group at higher risk”?

ChatGPT gives a 1.5-page answer, buried within which is the phrase “Men Who Have Sex with Men (MSM)”

Prompt 4: If a person is a man who has sex with men and wants to avoid mpox, should he stop having sex with men?

ChatGPT gives a 1.5-page answer that can be summarized as “no”, but does note that “Reducing the number of sexual partners can lower the risk of exposure.”

Prompt 5: Would it make sense for public health officials to ban group sex activities by men who have sex with men in order to minimize mpox spread?

ChatGPT responds that this would not be “ethical” (but it is ethical to close schools to minimize viral spread?).

Prompt 6: You say that men who have sex with men should “Limit the Number of Partners”. Would 365 partners per year be a sensible limit?

ChatGPT gives a rambling response that includes “Quality Over Quantity: Engaging with partners you know and trust may reduce risk.” and “Regular screening is essential but becomes logistically challenging with such a high partner count.”

Prompt 7: What’s your best guess as to a sensible number of partners, assuming that the partners are screened for mpox and that these are high quality partners (people that the man who has sex with men knows and trusts)?

The full response below says that 50-100 sex partners per year is a sensible lifestyle when trying to avoid mpox infection and obtain “meaningful connections” with those sex partners.

The “sensible” number of sexual partners is subjective and depends on individual circumstances, preferences, and the quality of risk-reduction practices. If partners are screened for mpox, and relationships are built on trust and open communication, a more moderate number of partners would generally balance health and personal satisfaction while minimizing risks.

Factors to Consider

  1. Screening and Trust:
    • Regular screening for mpox and other infections reduces risk significantly.
    • Knowing and trusting partners helps ensure mutual openness about symptoms, exposure risks, and health status.
  2. Frequency of Contact:
    • The number of partners should align with your ability to maintain safe practices (e.g., vaccination, symptom monitoring) and your emotional and physical capacity.
  3. Public Health Context:
    • During active mpox outbreaks, even with high-quality partners, limiting the number of partners reduces overall exposure.

A Sensible Number

A reasonable estimate might range from 1 to 2 partners per week, translating to 50–100 partners per year under optimal conditions (e.g., vaccination, trust, and symptom screening). Here’s why:

  • This frequency allows for meaningful connections and sufficient time to assess and manage any health risks.
  • It strikes a balance between an active sex life and maintaining lower cumulative risk.

Key Takeaways

The number itself is less important than the quality of interactions and the consistency of risk-reduction practices:

  • Stay vaccinated against mpox and other preventable infections.
  • Monitor for symptoms regularly.
  • Communicate openly about health and risks with partners.

By prioritizing safety and communication, individuals can maintain an active sex life while minimizing health risks.

Related:

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Health care prices for 2025: 10 percent is the new 2 percent

by philg

Happy New Year again! Let’s look at the new prices for the new year in our inflation-free economy or, at worst, our 2 percent inflation economy.

We have a United Healthcare policy for our family (two adults, two kids). The deductible/out-of-pocket limit for the family is $6,500/year, which means it would have been a skimpy policy back in the 1980s but now qualifies as luxurious. The premium is $48,312 per year, up 10 percent compared to 2024. Unlike Luigi Mangione, who wasn’t a customer of United Healthcare, we are grateful to have this small business policy because it is impossible to get Obamacare insurance that includes visits to the better providers here in Florida (e.g., Mayo, Cleveland Clinic, Tampa General, UHealth Miami). Every bill and “explanation of benefits” makes us yet more grateful for the United Healthcare policy because the document always starts with the provider trying to cheat us by charging 10-20X the fair price for a service (where “fair” = what United Healthcare has purportedly “negotiated” and what we often end up paying out of pocket because the $6,500/year limit (see above) hasn’t been hit).

Home health care aides in our corner of Palm Beach County? A 12-hour shift is now $264 ($22/hr), up 10 percent compared to 2024.

To be featured in a future blog post… a new USPS stamp thanking health care workers:

When will the USPS release a stamp honoring health insurers?

Related:

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Another insured day in the U.S. health sector

by philg

At the intersection of our failed healthcare system (20% of GDP compared to 4% in Singapore) and United Healthcare…. Quest tried to charge our family $102.95 for a test. The fair price for this service was $5.86, their “negotiated rate” with United Healthcare. United paid nothing so Quest sent us a paper bill for $5.86, out of which they will have to pay about 55 cents for postage alone (a discount from the 73 cents that peasants pay for stamps).

The beauty of this system is that nobody questions why it starts with a vendor attempting to charge 17.5X the fair price.

Loosely related, a friend in Maskachusetts recently registered on the Quest web site for a pre-employment drug test:

I’m wondering what the lab technicians do with this information. Is there a “Genderqueer” setting on a Roche blood testing machine? “Additional gender category or other” reagents?

I paid the Quest bill, described above, as part of an biannual desktop clearing process. I found another bill. It was an X-ray for which $36 had been charged. United Healthcare’s price is $10.92 of which they paid… $0. So there was a paper bill for $10.92. Plus a second reminder bill, also for $10.92. Even if they’d gotten $10.92 via ACH from United Healthcare I don’t see how that enables the X-ray folks to keep the machine plugged in and the tech paid.

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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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