Will masks for the general public work as well against monkeypox as they did against SARS-CoV-2?

“New Yorkers told to mask up again after local patient tests POSITIVE for same genus virus as monkeypox” (Daily Mail):

An NYC patient has tested positive for the same genus virus as monkeypox sparking calls from the health department for residents to wear masks indoors – just as New Yorkers were finally returning to mask-free normalcy after COVID-19.

The health department is encouraging New Yorkers to wear face masks to protect against the new virus outbreak, as well as COVID-19 and the flu. Monkeypox primarily spreads through physical contact but can also be transmitted through respiratory droplets in the air.

Why isn’t the best advice “Leave New York City, which is one of the world’s most crowded places”? The Science is strong with the NYC health department, but ordinarily a scientific conclusion is supported by evidence. What is the evidence that a monkeypox outbreak can be stopped by ordinary residents of a city wearing masks?

In a world obsessed with avoiding viral infection, I can’t figure out why cities like New York make sense (or why boosting population density in already-crowded cities via low-skill immigration makes sense). I have a lot more confidence that someone living in the suburbs can avoid monkeypox compared to someone living in a Manhattan studio apartment and going out to the stuff that used to make Manhattan attractive.

Combining these topics, a photo from June 2021:

Full post, including comments

Colorado Supreme Court forces hospital to deal with a consumer in a semi-reasonable way

News on one of my pet topics, the ability of hospitals to hit the unwary with bills for 5-10X what a service actually costs (i.e., what 95 percent of customers pay via insurance)… “She Was Told Surgery Would Cost About $1,300. Then the Bill Came: $229,000.” (NYT, May 21):

When Lisa Melody French needed back surgery after a car accident, she went to a hospital near her home outside Denver, which reviewed her insurance information and told her she would be personally responsible for paying about $1,337.

But after the surgery, the hospital claimed that it had “misread” her insurance card and that she was, in fact, an out-of-network patient, court papers said. As a result, Centura Health, which operated the hospital, billed her $229,112.13. When she didn’t pay, Centura sued her.

“I was scared about it,” said Ms. French, 60, a clerk at a trucking company, who eventually filed for bankruptcy. “I didn’t understand because I kind of relied on the hospital and my insurance company to work out what I needed to pay.”

This week, after a yearslong legal battle, the Colorado Supreme Court ruled that Ms. French did not have to pay nearly $230,000 for the spinal fusion surgery she underwent at St. Anthony North Hospital in Westminster, Colo., in 2014.

It took 8 years of litigation to shut down the conventional scam for this particular patient. How come?

Before her surgery, Ms. French signed two service agreements promising to pay “all charges of the hospital.”

Centura asserted that, because Ms. French was an out-of-network patient, those service agreements required her to pay the full rates, listed in a giant health system database known as a chargemaster — a catalog of the cost of every procedure and medical supply Centura provided.

In Centura’s view, the service agreements “were unambiguous and French’s agreement to pay ‘all charges’ ‘could only mean’ the predetermined rates set by Centura’s chargemaster,” the court said.

But the court found that Ms. French wasn’t responsible for paying those rates because she didn’t know the chargemaster even existed and hadn’t agreed to its terms.

Justice Gabriel pointed out that courts and commentators have noted that hospital chargemasters have become “increasingly arbitrary and, over time, have lost any direct connection to hospitals’ actual cost, reflecting, instead, inflated rates set to produce a targeted amount of profit for the hospitals after factoring in discounts negotiated with private and governmental insurers.”

“They have no basis in reality,” said Gerard F. Anderson, a professor of health policy and management and a professor of international health at Johns Hopkins University Bloomberg School of Public Health.

“The hospital cannot explain to anyone why they charge the prices they charge,” he said. “They are not based on costs. They are not based on accounting principles. They are fictitious instruments created by somebody in the hospitals.”

I still can’t figure out how the hospital’s behavior, despite being conventional nationwide, was ever considered legal in any state. It wouldn’t work for a car dealer to not tell a customer in advance how much a brake repair was going to cost and then charge that particular customer 5-10X what everyone else pays.

Some detail from the opinion:

Based on its understanding of the information that French had provided, Centura estimated that her surgeries would cost $57,601.77 and that after French’s insurance payment, she would personally be responsible for $1,336.90 of that amount.

Thereafter, and notwithstanding the fact that Centura had told French that her surgeries would cost $57,601.77 and that she would personally be responsible for $1,336.90 of that amount, Centura billed French $229,112.13, reflecting its full chargemaster rates. Centura did so because it determined that it had misread French’s insurance card and that she was, in fact, an out-of-network patient. Centura calculated the amount due after subtracting from the total charges the payment from French’s insurer of $73,597.35 and French’s payment of $1,000.00 (thus, the total amount that Centura charged was over $300,000.00, notwithstanding its pre-procedure estimate that the surgeries would cost $57,601.77)

The hospital’s victimization of this lady was far worse than the NYT article reports, in other words. Her insurance company actually paid the hospital more than the originally estimated fair cost of the services provided. But the hospital decided that it had found a clever opening to go after the patient for $229,000 extra.

Full post, including comments

Should we take the neighbor’s 5-year-old in for a COVID-19 vaccine booster?

From the Journal of Popular Studies: “FDA Grants Emergency Use Authorization of Pfizer COVID Booster for Kids 5 to 11.” Children are facing an “emergency”, according to the scientists at the FDA. If there weren’t an emergency, by definition, the shots wouldn’t be available until completely tested and approved via normal procedures.

If a child in the neighborhood is facing an emergency, you’d be morally obligated to take him/her/zir/them to the local hospital, right? You wouldn’t let a 5-year-old bleed out on the sidewalk in front of your apartment when you could simply load the injured kid into the minivan (or Tesla if you’re a douche and/or dog lover!) and zip over to the ED.

Suppose that we suspect some of our neighbors (most of them physicians or dentists) are deplorably failing to respond to the emergency facing their young children. Are we obligated to snatch up the neglected children and rush them to to the nearest healing center for an injection? If not, why not?

If you’re at Disney World in the sexual orientation and gender identification dark ride for kindergarteners and discover that a child in the next car hasn’t received his/her/zir/their booster…

Full post, including comments

How’s the miracle drug Paxlovid doing against COVID-19?

“Paxlovid is a miracle drug,” says a primary care doc whom I know, “because it is a miracle when I can prescribe it. Anyone who is sufficiently vulnerable to serious consequences from COVID-19 is already on drugs that have interactions with Paxlovid.” The other docs with whom I’ve talked about this drug, especially cardiologists, are generally negative regarding the drug. In their view, it will interact badly with other drugs, have bad side effects, and/or result in SARS-CoV-2 attacking the patient as soon as he/she/ze/they stops taking Paxlovid.

Chinks in the miracle drug’s armor are beginning to be described in our otherwise cheerleading media. Example from the NYT, March 25:

Certain medications or supplements, including painkillers, statins and even St. John’s Wort, may have adverse interactions with Paxlovid. So you may be advised to hold off on taking them for a week while being treated, Dr. Gandhi said. But for some medications, like drugs that regulate heart rhythm, abstaining for a week may not be possible. In those cases, your doctor may recommend molnupiravir for Covid-19 instead.

From Yale, where they understand medicine if not accounting, “13 Things To Know About Paxlovid, the Latest COVID-19 Pill”:

The FDA authorized Paxlovid for people ages 12 and older who weigh at least 88 pounds. But in order to qualify for a prescription, you must also have had a positive COVID-19 test result and be at high risk for developing severe COVID-19.

That means you must either have certain underlying conditions (including cancer, diabetes, obesity, or others) or be 65 or older (more than 81% of COVID-19 deaths occur in in this group). The more underlying medical conditions a person has, the higher their risk for developing a severe case of COVID-19, according to the CDC.

Since Paxlovid is cleared by the kidneys, dose adjustments may be required for patients with mild-to-moderate kidney disease, explains Dr. Topal. “For patients with severe kidney disease—or who are on dialysis—or those with severe liver disease, Paxlovid is not recommended; the levels of the drug can become too high and could cause increased side effects,” he says.

There is a long list of medications Paxlovid may interact with, and in some cases, doctors may not prescribe Paxlovid because these interactions may cause serious complications.

The list of drugs that Paxlovid interacts with includes some organ anti-rejection drugs that transplant patients take, as well as more common drugs like some used to treat heart arrhythmias. Paxlovid also decreases the metabolism of anticoagulants, or blood thinners, that many older adults depend on, driving up levels of those medications in the body to a point where they are unsafe, Dr. Topal explains.

It also interacts with cholesterol-lowering medications like Lipitor, but that’s less challenging for patients to overcome. “If you stop taking your Lipitor for five days, nothing bad is going to happen,” he adds.

If you are pregnant or breastfeeding, the FDA recommends discussing your options and specific situation with your health care provider, since there is no experience using the drug in these populations. If you could become pregnant, it’s recommended that you use effective barrier contraception or do not have sexual activity while taking Paxlovid.

So the ideal Paxlovid patient is morbidly obese with the blood pressure and heart health of a 22-year-old tennis star.

Pfizer wants you to take your Paxlovid every day… “FDA rebukes Pfizer CEO’s suggestion to take more Paxlovid if COVID-19 symptoms return”:

The FDA rebuked Pfizer CEO Albert Bourla’s proposed solution to reports that some patients experienced a relapse of COVID-19 symptoms after treatment with the company’s antiviral Paxlovid.

After reports said some patients who took Paxlovid rebounded and started feeling symptoms again, the CEO told Bloomberg that patients can take another course, “like you do with antibiotics.”

“There is no evidence of benefit at this time for a longer course of treatment … or repeating a treatment course of Paxlovid in patients with recurrent COVID-19 symptoms following completion of a treatment course,” John Farley, M.D., director of the Office of Infectious Diseases, said in a post.

Science is complex!

Full post, including comments

Should the COVID-19 injections be renamed to something other than “vaccine”?

When coronapanic hit and various public health prophets went on television calling themselves “scientists,” friends who are medical school professors said that, when the predictions of these physicians and public health bureaucrats inevitably failed the public’s confidence in medicine would be reduced. They cringed every time Anthony Fauci was in the spotlight, for example.

I wonder if the same thing could be happening with the shots that are currently marketed as “vaccines”. People who’ve had 3 or 4 shots are regularly getting sick with COVID-19. Some are being hospitalized and, in the long run, nearly all of the COVID-19 deaths will be among this heavily-jabbed population. By contrast, the childhood vaccines that we desperately want people to apply to their kids, e.g., the measles vaccine, actually stop humans from getting sick with measles.

Now that we know that COVID-19 vaccines don’t work like “regular vaccines” is it time to rename them so that their ineffectiveness doesn’t tarnish the reputation of the “real vaccines”?

Ignoring any serious harm that the COVID-19 vaccines might cause, the closest analogy that I can think of to the situation is what we call “the flu shot”. Americans don’t usually say “I am vaccinated against influenza.” We say “I had all of my childhood vaccinations and this year I got a flu shot.” The flu shot is put in a “can’t hurt; might help” category. When a person who had the flu shot gets the flu anyway, that doesn’t result in him/her/zir/them or his/her/zir/their social network to lose confidence in “vaccine vaccines.”

Readers: What do you think of the idea? Half of the hardest core Mask and Vaccine Karens whom I know seem to have gotten COVID-19 within the past few months. Wouldn’t the overall image of vaccines be improved if we said “They had a COVID-19 shot, which was good prep for their COVID-19 infection” rather than “They were vaccinated against COVID-19 three times and then got COVID-19 anyway”?


Full post, including comments

Young doctors should move to Florida?

May is Skin Cancer Awareness Month. What better time to talk about health care in the Sunshine State?

The Great Plains are traditionally the best places for doctors to work when salaries offered are compared to house prices and overall cost of living. But not everyone wants to live in the Dakotas, which, presumably is why a dermatologist can get paid $600,000 per year for showing up.

We’ve noticed that it is tough to get an appointment with almost every kind of doctor in Palm Beach County. Concierge medicine, in which people pay $3,000 or $5,000 per year to a primary care doctor to get the kind of service that was standard in the 1950s (pre-Medicare/Medicaid), seems to be much more common here than it was in the Boston area. Getting in to see a dentist can also be tough, with the high-rated providers backed up for 1-2 months. A physician neighbor who moved here less than a year ago and joined a private practice says that he is already busy.

I’m wondering if the Great COVID Migration has opened up a lot of opportunities for young doctors to establish themselves in Florida. The migration to Florida from the lockdown states wasn’t a randomly selected group. The first element of selection was a love of freedom. Doctors get half of their income from the government and nearly all of the other half is heavily regulated by the government. Doctors get paid more when low-skill migrants are admitted to the U.S. (a larger population leads to larger Medicaid payments, if nothing else). The typical doctor, therefore, is not aligned with “small government” state politics in Florida. The second element of selection was an ability to work from home. It was a lot easier for someone in engineering or finance to move than a doctor who sees patients in person. Finally, there is the question of state licensing and regulation. It is illegal for a doctor to move from one state to another and hang out a shingle. He/she/ze/they must first get licensed in the new state. A dentist friend who might otherwise want to escape Massachusetts says “It is very tough to get a license in Florida. They make it next to impossible for dental.” A cardiologist friend said that it would take her six months to get a license in Florida.

If the above list of selection effects is correct, there should be a smaller percentage of physicians in the group that migrated to Florida from California and the Northeast in the past two years than the percentage of doctors in the general population. In other words, the state has been flooded with new patients but hasn’t received too many new doctors.

What do readers think? Is Florida a good place for a doctor finishing residency/fellowship?

Some inspiration for docs… our minivan (Bugs and Daffy covering the massive holes left by the Maskachusetts front license plate installation) at a nearby strip mall next to a $400,000+ Rolls Royce SUV.

I don’t think that the lady who owns this marvelous (other than the severe door ding from our Odyssey) machine will quibble about $5,000 per year for concierge medicine.

Full post, including comments

Pandemic increases the wealth, power, and prestige of doctors and public health officials even when their remedies are ineffective

I recently finished After the Plague, a lecture series by Simon Doubleday, a professor at Hofstra. The pandemic of the lectures is the Black Death of the 14th century. As with the physicians of spring 2020 who harmed COVID-19 patients by putting them on ventilators (today we realize that most would have done better if they’d stayed home with an oxygen bottle), doctors in 1349 often made plague patients worse and certainly had no effective treatment to offer. As with the fanatical sanitizers of today, public health officials back then tried to stop the pandemic by cleaning up the filthy streets. Ultimately, just as with SARS-CoV-2, the pathogen killed nearly everyone that could be killed despite the best efforts of the doctors and officials.

Professor Doubleday relates that the lack of effective remedies did not reduce public confidence in the experts. In fact, physicians made more money, officials got more power, and both classes of health experts got more prestige even as 50 percent of the population was being felled by Yersinia pestis.

In common with other scholars, Professor Doubleday relates that the reduction in population resulted in a tremendous increase in wages for the survivors (see Immigration is the Reverse Black Death?) due to the reduced supply of labor.

Full post, including comments

Massachusetts Marijuana Billboards

To celebrate World Health Day, let’s look at a state where long-term public health was optimized by closing schools for more than a year while keeping the marijuana stores open. Every retailer of healing cannabis in Maskachusetts requires a permit to operate from the government. These permits are limited and, generally, political connections are required to obtain one. Thus, the dope trade is so lucrative that these shops have outbid Verizon, Apple, McDonald’s, et al. for billboard space on the Massachusetts Turnpike. Our heroic reader/commenter Alex has done a drive-by photo project for us. The following photos are from the Pike, I-91, and some of the “poor mine” towns near Springfield, MA.

First, remember that consuming alcohol and psychotropic drugs 24/7 “is not a choice; it’s a disease.”

(Yet it is a disease that can be cured by giving people money on condition that they stop being diseased? See “Financial Incentives for Adherence: Do They Pay?” (Psychiatric Times 2017) and “California Wants To Become The First State To Pay People With Addiction To Stay Sober” (state-sponsored NPR 2021))

This one might be my favorite, the old religion of Christianity represented by a church right next to a billboard for the new religion of weed:

Dazed and Turning Leaf:

For every 200 billboards promoting the consumption of scientifically proven healing cannabis, there is 1 that is part of a disinformation campaign (in this case, disseminating misinformation that marijuana does not improve driving skills; Facebook Fact Checkers rate this claim “Missing Context”).

The Mercedes logo gets some added class by appearing right next to a weed shop billboard:

The implication is that Mercedes is better with cannabis. This concept is made explicit in the next billboard: “Springfield is better with cannabis”.

Who says that Republicans and marijuana don’t mix? A big portion of the Springfield Republican‘s building will now be devoted to cannabis retail.

The INSA “cannabis for real life” shop, right next to the Basketball Hall of Fame:

A proven-by-Science Theory of Wellness:

Illustrating the challenge of taking pictures while driving….

What if phone camera use leads to an accident? A personal injury lawyer stands ready:

Happy World Health Day to everyone and I hope that everyone stays healthy this year by following CDC guidance (to test and not to test, that is the Science).


  • “Welcoming Refugees” (Jewish Family Service of Springfield, MA): For us social justice is rooted in the Jewish commandment to remember the experience of slavery and the Exodus from Egypt. … JFS resettles refugees fleeing their homelands in partnership with HIAS (formerly the Hebrew Immigrant Aid Society) and the State Department. In the past five years JFS resettled over 500 refugees from around the world to Western Mass– their new home. Well before a family’s arrival, staff secure housing, furniture, and household items for new families. We then provide comprehensive support, including support for school-aged children, comprehensive employment services, and help navigating their new community. JFS continues to serve New Americans long after initial resettlement — for up to five years and beyond in many cases. [Remember that there is no archaeological evidence to support the Passover victimhood narrative. Despite the extensive body of written history from Ancient Egypt, there is nothing to suggest that Jews were ever enslaved in Egypt, that a large group of Jews lived in Egypt, or that a large group of Jews fled Egypt.]
  • “Poverty in Springfield, Massachusetts” (from Welfare Info): The poverty rate in Springfield is 28.7%. One out of every 3.5 residents of Springfield lives in poverty. … 21.1% of Black residents of Springfield, Massachusetts live below the poverty line. 26.7% of Asian residents of Springfield, Massachusetts live below the poverty line. 13.3% of White residents of Springfield, Massachusetts live below the poverty line. 43.5% of Hispanic residents of Springfield, Massachusetts live below the poverty line. Enrolled in Elementary School(Grades 1-4) in Springfield, Massachusetts have a Poverty Rate of 46.1%.
Full post, including comments

A young child killed by a new vaccine

Averros may find this of particular interest… The Last King of America: The Misunderstood Reign of George III (Andrew Roberts):

On 20 August 1782, the King and Queen were devastated to lose their youngest son, ‘dear little Alfred’, who died at Windsor Castle shortly before his second birthday. He had been taken to Deal by the royal governess Lady Charlotte Finch in the hope that he would recover from a fever through fresh sea air and bathing, but to no avail. The Court did not go into formal mourning as Alfred was not fourteen, but the royal couple were utterly grief-stricken. The Queen gave Finch an amethyst and pearl locket, and a lock of blond hair from ‘my dear little Angel Alfred’. She wrote to her brother Charles two days after Alfred’s death, ‘I am very grateful to Providence, that out of a family of fourteen children, it has never struck us except in this one instance, and so I must submit myself without a murmur.’ The cause was probably too high a dosage of the smallpox inoculation. The King and Queen were staunch advocates of this treatment, which was spearheaded by Edward Jenner, although they believed that Providence still played a large part in medicine.

When Edward Jenner finally perfected his vaccination technique in the mid-1790s, the King knighted him and became patron of the Jennerian Society which advanced the practice. In his enlightened way he did not allow personal tragedy to affect his rational appreciation of the great benefits of science.

If the U.S. had not traitorously rebelled, Americans might have funded a lot more scientific research during the 19th century.

Early in 1751, Frederick and Augusta settled the twelve-year-old George and eleven-year-old Edward at Savile House, adjoining Leicester House. It was the Hanoverian practice to give princes their own establishments early, and Savile House, built in the 1680s, was to become George’s London home for the next nine years. His mini-Court there consisted of a governor, preceptor (responsible for teaching), sub-governor, sub-preceptor and treasurer, with part-time teachers for languages, fencing, dancing and riding brought in from outside. He studied algebra, geometry and trigonometry. He was the first British monarch to study science, being taught basic physics and chemistry by Scott. He was receiving a good, all-round, enlightened education.

(But maybe not, since the British never taxed anyone in North America to fund government operations in England. Any taxes raised in the 13 colonies were spent in the 13 colonies. On the third hand, a British-governed North America led by a scientifically educated king might have funded local research labs.)

And we might have been spared the partisan politics that are often decried.

Contrary to the Whig imperative of minimizing royal power, The Idea of a Patriot King argued that the role of a constitutionally limited hereditary monarchy was important. Bolingbroke fully accepted that such seventeenth-century notions as the Divine Right of Kings had ‘no foundation in fact or reason’, and he believed ‘a limited monarchy the best of governments’. The limits on the power of the Crown, he maintained, should be ‘carried as far as is necessary to secure the liberties of the people’ and enough to protect the people against an arrogant (by which he meant Old Whig) aristocracy. Bolingbroke’s patriot king would revere the constitution, regard his prerogatives as a sacred trust, ‘espouse no party’ and ‘govern like the common father of his people’. A key message of the book was that government by party inevitably resulted in a factionalism disastrous to the state. ‘Party is a political evil,’ Bolingbroke wrote, ‘and faction is the worst of all parties. The king will aim at ruling a united nation, and in order to govern wisely and successfully he will put himself at the head of his people,’ so that he can deliver them ‘tranquillity, wealth, power and fame’.

Circling back to the vaccine… the situation is not directly comparable, of course. George III and Queen Charlotte were trying to vaccinated their child against a disease that regularly killed children.

Full post, including comments

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

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!”


Full post, including comments