Category: Health

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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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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