Question for readers who are old and genetically defective (progressive lenses)

Because I voted for Bernie I wear progressive eyeglasses. These fix a touch of adolescent myopia and astigmatism (for distance vision) and old-guy-needs-reading-glasses on the lower portion. To show my support for our 2SLGBTQQIA+ brothers, sisters, and binary-resisters, these are “Transitions” lenses that darken when I venture out with Mindy the Crippler. The dark glasses ensure that we aren’t recognized by the Paparazzi.

I recently got an updated prescription and things have changed a bit since my previous exam (pre-coronapanic). My frames are in good shape (hard to damage your eyeglasses when you’re ordered to stay at home) so the place that did the exam suggested that I replace the lenses… for about $780:

If memory serves, which it probably doesn’t, the complete frames+lenses back in 2019 were about $400 each. Now the lenses alone are over $600 for the ghetto version. As Californians have recently discovered, living one’s progressive ideals isn’t always cheap. What’s the difference among these three options within the Varilux line? The optician says that it is all about the field of view. This sort of makes sense if you consider eyeglass lenses to be like binoculars, but I’m not sure why they should be.

Muddying the waters to some extent is the fact that Varilux is made (in China?) by Essilor, a French company. They were the pioneers in this area and the French have some history with optics, e.g., Angénieux makes some great lenses for cinematography. Nonetheless, France is not one of the nations that comes to mind when great optics are being discussed. What do the Japanese have to offer? Nikon has a web page, but hardly any retailers in the U.S. Canon and Sony don’t seem to be in this product area at all. Seiko makes eyeglass lenses. Asahi-Lite offers progressives in the U.S. It looks as though Tokai and TALEX are also Japanese companies. I can’t figure out which of these is the best or if any of them compete with Varilux. How about the Germans? Leica offers “Variovid Superior Progressive Lenses”. Zeiss seems to be the big competitor to Varilux in the U.S. market for high-end progressives. Rodenstock, the view camera photographer’s favorite, makes progressives starting from an individual eye scan:

(Sadly, this is available only in Europe and the UK. Is it U.S. regulations or the U.S. legal environment that are keeping this amazing company out of our purportedly competitive market? As noted in the comments, I talked to a Dutch optometrist who sells Zeiss lenses and isn’t all that impressed with the Rodenstock idea. The best Zeiss photochromic lenses over there are €1220 for a pair. For the fancy Rodenstock it would be €1358. Then add a little something for frames!)

I can’t find good information about any of these products, though. I’ll be getting two pairs of lenses, so we’re talking about potentially $1500+ in spending plus 7 percent sales tax (6 percent to support the fascist tyranny of Ron DeSantis and 1 percent to keep Palm Beach County’s luxurious services going).

Readers: Have you ever gone from “basic progressive” to “premium progressive” and noticed an improvement in field of view? Have you figured out which brand of high-end progressive lenses is the best? (I guess there is always the option of assuming that Costco has figured this out and rolled it into their optical shop.)

Update: As part of my two-year boycott of the Jupiter, Florida Target, I stopped into the Jupiter, Florida Walmart. The optical department there sells Nikon wide-field progressive lenses for $$280 plus $85 for the Transitions feature. If you want to show your support for the 2SLGBTQQIA+ community without glasses that darken in UV light, Elton John-brand frames are available:

Nikon seems to be playing the same game that the mattress companies use. The Nikon wide-field progressive lenses at Walmart are branded “Nikon Focus”. At independent opticians, Nikon offers “Presio” and “Seemax”. Is this an alternative to the Essilor Empire? The web site has a copyright banner across the bottom that references Essilor:

It’s a little confusing, but it might be because Nikon is using the Essilor TotalShield anti-scratch anti-reflective coating. That’s confusing because Nikon has been coating lenses since at least the 1950s (some mostly-peaceful Germans developed modern A-R coatings in 1935).


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Should everyone buy a home AED now that we’re all vaccinated?

Science proves that cardiac arrest cannot be caused by a COVID attempted vaccine. But Science also proves that we can never be killed by COVID-19 if we have been injected with at least 4 (or 5? or 6?) COVID shots. Therefore, we can move on to worrying about ways to die other than via SARS-CoV-2…. e.g., cardiac arrest!

A friend is a police officer and recently went through recurrent CPR training. Americans who get shot have a 90 percent survival rate, but those who suffer a sudden cardiac arrest survive only about 10 percent of the time. The automated external defibrillator (AED) is the key to survival, not CPR, according to the nurse who provided the training. Why not buy a home AED? They’re compact and available for as little as $700 “recertified”. The refurbished units are typically never-used machines that run out of their 4-year battery certification and the recertification process may be as simple as putting in a new battery.

Will the home AED definitely save you? The nurse training my friend explained that it probably won’t save a married man. “The wife would rather get the insurance money than provide resuscitation.”

“The AED in Resuscitation: It’s Not Just about the Shock” (2011):

Newer guidelines have simplified resuscitation and emphasized the importance of CPR in providing rapid and deep compressions with minimal interruptions; in fact, CPR should resume immediately after the shock given by the AED, without the delay entailed in checking for pulse or rhythm conversion.

Although CPR predated the development of the modern automated external defibrillator (AED), the technique seemed to be relegated to a lower priority after introduction of the modern AED. Recently, CPR has been increasingly recognized as a critical factor in treating cardiac arrest, in combination with the AED.

Readers: Do you have an AED in your house? If not, why not?

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The latest research from Harvard Medical School

If you were wondering where the forefront of medical research is…

A screen shot in case the above is memory-holed:

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Quantifying our incompetence at government-run health care

Almost everything having to do with health care in the U.S. is controlled by our government. A doctor cannot practice unless approved by a state government (can take 6-12 months here in Florida, so the supply of doctors always lags the demand from patients who have moved). Once he/she/ze/they is approved, half of his/her/zir/their salary will be paid for directly by government (Medicare/Medicaid) while the other half comes from government-regulated and government-subsidized “private” health insurance. Bureaucrats often talk about their heroic efforts in controlling costs. Without them in our corner, we would pay 40 percent of GDP for health care instead of 20 percent.

Every now and then we get a window into our own incompetence via an international comparison either for price or quality. “Have Eggs, Will Travel. To Freeze Them.” (New York Times, April 8):

Milvia found that in the United States, the entire process — including the medications, the doctor visits and the average number of years of egg storage — costs about $18,000, and most women can’t count on health insurance to cover it. As of 2020, less than 20 percent of U.S. companies with more than 20,000 employees had health insurance plans to cover the procedure, according to Mercer Health News, though that figure rose from 2015 to 2020.

(Why does the NYT speak of “women”? Men may also want to freeze their eggs!)

Hotels, restaurants, and other labor-intensive services aren’t cheaper in Europe than they are here in the U.S. what about egg-freezing?

Many countries have clinics that are much cheaper. In the Czech Republic and Spain, for example, you can get one round of egg-freezing done for under $5,400, according to the website of Freeze Health, which provides information on egg freezing around the world.

Milvia is taking its first women to Britain, where prices hover in the $7,000 range, because “we wanted to start in a place where there is no language or cultural barrier,” Mr. Ghavalkar said. “We also want to make sure we’re in a place where all clinics operate at very high standards.”

So it is 14X the cost of a decent hotel in London to freeze an egg in London. If we assume that a decent hotel room in a typical U.S. city is now $250 per night, egg-freezing is 72X the cost of a hotel here in the U.S.

How about running a refrigerator? Where electricity is more expensive, cold storage for eggs is about 1/4 the price:

Women who freeze their eggs abroad can choose to keep their eggs in that country where storage costs are usually cheaper. In Canada, for example, it can cost under $200 a year to store your eggs. In Spain you can do it for a little over $200. In Los Angeles, by contrast, a year of storage costs about $750. In New York City, it’s more than $1,000, according to Freeze Health.

(Again, note the hateful anti-2SLGBTQQIA+ assumption that it is “women” who freeze eggs.)

Vaguely along the same lines, the NYT also recently published “In Search of Romance? Try Moving Abroad.”:

For some American women, relocating outside of the United States has improved their dating lives. But some warn that finding love involves more than a change of address.

Now, Ms. Margo is living a dream [having sex with a wide variety of French guys] of many American women who are seeking relationships abroad, some of whom cite the toxic dating scene in the United States.

If you thought that Americans were insufficiently passionate about geriatric parenthood and/or a lifetime of Tinderhood…

Cepee Tabibian, who moved to Madrid at 35 from Austin, Texas, felt similarly. She was excited to meet people in Spain, where she noticed a culture of getting married or having children later in life than in the United States, or not getting married at all. “When I walked into the room, I wasn’t the oldest person,” Ms. Tabibian said. “I wasn’t the only single person.”

Is there a market for successful American divorce plaintiffs?

For Cindy Sheahan, meeting people outside of her circles in Denver was momentous. She started traveling solo shortly after ending her 30-year marriage in 2016.

She found the men she dated in Denver after her divorce to be unadventurous. She said she went on 60 dates in 2017.

“It was like a comedy show,” she said.

At the end of 2017, she quit her job and traveled throughout Southeast Asia for leisure, and she started using Tinder.

“Because they were out there living their life, there was a lot more energy to the dates,” Ms. Sheahan, 61, said about the people she met while traveling. “It wasn’t just somebody meeting after their work at the bank, on their way home to let out the dog in Denver.”

In 2018, she met her partner of five years, Jean-Marie Mas, a 61-year-old professional tandem paraglider from Dordogne, France, in Nepal.

Apparently the divorce lawsuit freed her from ever having to work!


  • Time is ripe for Cubans to become Medicare vendors (2014)
  • A modest proposal for the Carnival Triumph (2013): The Triumph would leave every morning at around 8:00 am. Medicare clients would enjoy a Cracker Barrel breakfast on board the ship. The ship would arrive in Cuba at 12 noon. Those who were well enough to walk could enjoy a stroll around Havana. The Triumph would pick up patients returning from hospital care in Cuba and anyone who’d been enjoying the sights, then depart around 2:30 pm. An early bird special dinner would be served on board starting at 5 pm, with an arrival back in Key West at 6:30 pm.
  • Carnival Sunrise (instead of doing something innovative with international healthcare, the cruise line simply renamed the fire-and-sewage-plagued vessel)
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New book on ChatGPT in medicine

Some friends have put together The AI Revolution in Medicine: GPT-4 and Beyond, a thought-provoking book released today. Health care is nearly 20 percent of our economy (compare to 4 percent in Singapore) and a higher percentage of our tax dollars (Happy Official Tax Day, though April 18 is the deadline this year; the opioid makers thank you for your efforts in the workplace). The book asks the important question “What will LLMs do for an industry to which Americans have decided to devote one working day per week?”

First, let’s ask why we think GPT-4, famous for its writing talents, might matter for doctors. Doctors aren’t primarily writers, after all. Many physicians, however, spend time attempting diagnoses and this is an information processing activity. The patient describes his/her/zir/their symptoms and the doctor matches these to known patterns, possibly asking follow-up questions or ordering tests to confirm or reject explanations. In other words, exactly what computer programs have traditionally done.

Second, let’s ask GPT-4 for its own opinion: “Explain why GPT-4 will change the practice of medicine and the experience of patients.” Our future overlord’s response:

GPT-4 has the potential to significantly change the practice of medicine and the experience of patients in various ways. Here are some key areas where it can have a transformative impact:

  1. Enhanced medical diagnosis: GPT-4’s advanced language processing capabilities enable it to understand complex medical information and provide diagnostic suggestions to doctors. This can help in the early detection of diseases, improving patient outcomes, and potentially saving lives.
  2. Personalized treatment recommendations: GPT-4 can analyze an individual’s medical history, genetic data, and other relevant factors to provide personalized treatment recommendations. This can lead to more targeted and effective therapies for each patient.
  3. Streamlining administrative tasks: GPT-4 can help automate and streamline various administrative tasks, such as scheduling appointments, managing patient records, and handling insurance claims. This will allow healthcare professionals to focus more on patient care and less on paperwork.
  4. Health education: GPT-4 can act as a virtual health educator, providing patients with accessible and accurate information about their conditions, medications, and self-care strategies. This will empower patients to take a more active role in managing their health.
  5. Mental health support: GPT-4 can serve as a virtual therapist, offering support to individuals struggling with mental health issues. It can engage in conversation, provide coping strategies, and help track mood and behavior patterns. While it cannot replace human therapists, it can be a valuable supplemental resource.
  6. Telemedicine: GPT-4 can enhance telemedicine platforms by providing real-time language translation services and facilitating communication between patients and healthcare providers across different languages and cultures. This can expand access to healthcare services for patients in remote or underserved areas.
  7. Research and development: GPT-4 can assist in the analysis of large volumes of medical data, identifying patterns and relationships that may be difficult for humans to detect. This can help accelerate the development of new treatments and technologies in the medical field.
  8. Ethical considerations: The integration of GPT-4 in healthcare can raise various ethical concerns, such as data privacy, algorithmic bias, and the potential for overreliance on AI. However, addressing these challenges and ensuring the responsible use of GPT-4 can lead to a more equitable and effective healthcare system.

Overall, GPT-4 has the potential to revolutionize the practice of medicine and improve the experience of patients by enhancing diagnostic accuracy, personalizing treatment, streamlining administrative tasks, expanding access to healthcare services, and more. As with any new technology, it is essential to address ethical concerns and ensure the responsible and equitable use of AI in medicine.

(Note ChatGPT’s passion for equity! If we put ChatGPT in charge, it might read “Racial Disparities in Maternal and Infant Health” (KFF), learn that “Black and American Indian and Alaska Native (AIAN) women have higher rates of pregnancy-related death compared to White women” and decide to euthanize 15 percent of white pregnant people who come to the hospital. That would be the simplest and fastest way for the AI to accomplish its equity goals of health outcomes based on skin color.)

A primary care doc neighbor says that he uses ChatGPT every day and would pay $1,000 per month for it if he had to. When confronted with a massive hospital discharge note that he is required to summarize in order to get paid, he will ask ChatGPT to summarize it, for example. He also uses ChatGPT to draft follow-up instructions. He says that ChatGPT is surprisingly good at interpreting blood tests. It is interesting to reflect that ChatGPT is useful to him describe the fact that he can’t feed it his institution’s electronic medical record. So the AI doesn’t already know each patient’s full history.

Let’s return to The AI Revolution in Medicine: GPT-4 and Beyond… starting with “Chapter 4: Trust but Verify” from the doctor (Isaac Kohane) and “Chapter 5: The AI-Augmented Patient” from the science journalist (Carey Goldberg).

In “Trust but Verify,” the question of how we would put GPT-4 through a clinical trial is explored. Other computer programs have passed clinical trials and received government approval, so why not GPT-4? The typical clinical trial is narrow, Dr. Kohane points out, while GPT-4’s range of function is wide. Just as an FDA trial probably couldn’t be done to approve or disapprove an individual doctor, it seems unlikely that an FDA trial can approve or disapprove a LLM and, therefore, AI programs are most likely destined to be superhuman partners with human docs and not replacements. The chapter contains a couple of concrete scenarios in which the doctor compares his own work in some difficult cases to GPT-4’s and the AI does fantastic.

In “The AI-Augmented Patient”, the journalist points out that the people who’ve been asking Dr. Google for advice will be the heavy users of Dr. GPT-4. She highlights that the “COVID ‘misinfodemic’ shows[s] that it matters which humans are in the loop, and that leaving patients to their own electronic devices can be rife with pitfalls.” Implicit in the foregoing is the assumption that public health officials are the best human decision-makers. What if the take-away from coronapanic is the opposite? Credentialed Americans refused to read the WHO pandemic management playbook, refused to process any information coming from Europe unless it fit their preconceived ideas about lockdowns, school closures, and mask orders, and refused to consider population-wide effects such as risk compensation. A computer program wouldn’t have any of these cognitive biases.

What happened when people expanded their sources of information? One notable example: Marjorie Taylor Greene turned out to be a better virologist than Dr. Fauci. In August 2021, MTG was suspended from Twitter for noting that the available COVID-19 vaccines did not prevent infection by and spread of SARS-CoV-2 and that masks were not effective. Virologist Greene’s statements were labeled “false” as a matter of Scientific fact by the journalists at the New York Times in January 2022 and then proven correct soon afterwards with a huge study in Spain and the Cochrane review. Plenty of those killed by COVID would be alive today if they’d listened to Marjorie Taylor Greene’s advice rather than the CDC’s. The elderly/vulnerable would have stayed safe at home, for example, instead of entering public indoor environments with masks on.

I’m optimistic that GPT-4 will do better in many areas than American medical officialdom because its judgment won’t be tainted by groupthink and “we’ve always done it this way”. We’ve often had standard of care disagreements with the Europeans, for example, and the Europeans have ended up being correct. The latest discrepancy in Science is that Denmark suggests a newborn get his/her/zir/their first COVID shot at age 50 (in the year 2073) while the CDC suggests four shots over the next 12 months. We might know who was right in 5-10 years, but an orthodox American MD isn’t supposed to question the CDC and would never ask “Are the Danes right?” while GPT-4 surely would be aware of the Danish MD/PhDs’ conclusions.

As long as we’re on the subject of every American’s favorite disease… later in the book, Kevin Scott, the CTO of Microsoft whose degree is in computer science, talks about the epic stupidity of physicians in rural Virginia. Not only did they fail to immediately prescribe Paxlovid to his tested-positive brother, but they actively refused to prescribe it when the life-saving experimental drug was asked for by name (cue the Super Bowl ad for the still-not-FDA-approved drug). Here’s a photo of the West Coast computer programmer who claims to know more about preventing death-by-COVID than doctors in Virginia’s Trump Belt:

Given the scattered nature of American medical records, I think that a patient who is diligent about saving all of his/her/zir/their tests and logging symptoms then running a local copy of GPT-4 will be way ahead in the diagnosis Olympics. There is a limit to what a doctor can do in a 15-minute visit and the typical doctor can see only a fraction of a patient’s medical record (because tests and treatments have been done at other institutions and the $trillions that Americans have spent on electronic health records have not yielded any practical integration).

What will this do to demand for medical services? The chapter quotes “Dr. Jim Weinstein, a leading expert on health equity now at Microsoft” that “[GPT-4] could be a particular valuable partner for the 100 million Americans on Medicaid, and it could cut unnecessary cost and waste across the board by helping patients understand more about their options.” Personal guess: GPT-4 will drive demand and therefore costs in the opposite direction. GPT-4 already covers its ass by providing the worst-case scenarios. Patients will learn that their “options” include aggressive rare cancers and calling 911.

Let’s try a concrete example. Suppose that you live in Maskachusetts and your female-led Social Equity marijuana home delivery was running late so you drink half a bottle of rum while waiting for the daily one-ounce high-potency bong refill. The next morning, despite all of the healing cannabis that you consumed, you wake up on the bathroom tile not feeling your best and ask GPT-4, “I have a lump on my head. What are the possible causes?” Here’s what it says:

There are several possible causes of a lump on the head, including:

  1. Head injury: A bump or lump on the head may be the result of a head injury, such as a concussion, hematoma, or skull fracture.
  2. Scalp infections: Infections of the scalp, such as folliculitis or cellulitis, can cause swelling, redness, and lumps on the scalp.
  3. Cysts: A cyst is a sac filled with fluid or other material that can develop under the skin on the scalp.
  4. Lipomas: A lipoma is a slow-growing, benign tumor made up of fat cells that can develop under the skin on the scalp.
  5. Bone deformities: Certain conditions, such as Paget’s disease or fibrous dysplasia, can cause abnormalities in the bones of the skull that may lead to lumps or bumps on the head.
  6. Tumors: In rare cases, a lump on the head may be a sign of a cancerous tumor.

It’s important to have any new lumps or bumps on the head evaluated by a healthcare provider to determine the cause and appropriate treatment. If the lump is the result of a head injury and you experience symptoms such as loss of consciousness, dizziness, or severe headache, seek emergency medical attention immediately.

The patient who didn’t talk to GPT-4 might wait a few days before seeking healthcare services. After all, plenty of Looney Tunes characters recover quickly from head lumps.

The patient who reads the GPT-4 output, however, is explicitly told that he/she/ze/they must be “evaluated by a healthcare provider” and that injury from an alcohol-and-cannabis-assisted encounter with tile is just 1 out of 6 possibilities. The idea that “the 100 million Americans on Medicaid”, who have $0 copays for going to the emergency room, will ignore GPT-4’s explicit

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Make an appointment to see the doctor to get your opioids

April 5 email from Mass General, below. Customers are reminded that coronapanic officially ends next month and that, to keep the OxyContin flowing, it will be necessary to actually see a physician before taxpayers will pay for the pills. (i.e., for more than three years you’ve been able to get Oxy the same way that Californians with a sniffle get their Paxlovid: an audio or video call from the comfort of your sofa). Given that it takes a month or more to get in and see a physician in the U.S. (the miracle of open borders for the low-skilled and closed borders and onerous re-licensing requirements for qualified European physicians), I’m providing this reminder as a public service.


  • Focusing on race and racism just makes the problem worse. (true or false?) (there is one answer that will enable a person to continue receiving a paycheck from Mass General Brigham)
  • Should you wear a mask when going to the doc to get your opioid prescription? “Were masks in hospitals a waste of time? Hated NHS policy made ‘no difference’ to Covid infection rates, study finds” (Daily Mail, April 7): Researchers from St George’s Hospital in south-west London analysed routinely collected infection control data over a 40-week period between December 4, 2021 and September 10, 2022. … Researchers found removing the mask policy in phase two did not produce a ‘statistically significant change’ in the hospital-acquired Covid infection rate. Equally, they ‘did not observe a delayed effect’ in the Covid infection rate once the policy was removed. … Lead author Dr Ben Patterson said: ‘Our study found no evidence that mandatory masking of staff impacts the rate of hospital SARS-CoV-2 infection with the Omicron variant. … Fellow researcher Dr Aodhan Breathnach added: ‘Many hospitals have retained masking at significant financial and environment cost and despite the substantial barrier to communication.
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Is the government lying to us about gas stoves?

From the Environmental Protection Agency:

We have an Italian natural gas range of doubtful quality. I am willing to bet that it has not been adjusted at any time in the past 5 years. I spent $200 on a low-level CO meter with 0.1 ppm resolution (not for this project, but to verify proper sealing of the piston-powered airplane’s heater). The meter arrives pre-calibrated at least at the 5 ppm level, which is supposedly the minimum we can expect near our health-destroying kitchen appliance, and says it has a range of 0-100 ppm.

What did it read parked right next to the range with two burners going? 0.0 ppm. Maybe it was broken. I walked around to various other parts of the house and got readings between 0.1 and 0.3 ppm. I went to the garage and started a car without opening the door. Within about 10 seconds the meter began to register 5 ppm then the alarm went off at 10 ppm (a home CO detector will trigger quickly at 400 ppm; see below from Kidde).

The garage air hit about 50 ppm in less than 60 seconds of running the car without the door open and the meter then showed a gradual downward trend after the was shut off and the door opened.

The EPA says that we should have expected a best case of 5-15 ppm in our kitchen, where two burners of the stove had been in use for an hour or so and we were reading 0.

Readers with CO meters: can you please test your house? How can we account for the discrepancy between what Science (the EPA) says and what a humble engineer measures?

Note: I would support a tax on non-induction ranges, both electric and gas, to fund hospital burn units and if I were building a house I would choose induction rather than a showy faux-commercial gas range.


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The bureaucratic end of gender-affirming care for children in Florida

Yesterday was the last day on which a child could receive “medically necessary” gender-affirming care, the end of a one-year bureaucratic process (even in Florida, government does not move at Amazon speed!). From April 2022… “Gender-affirming care, a ‘crucial’ process for thousands of young people in America” (CNN):

The Florida Department of Health now says a vital kind of medical care known as gender-affirming care should not be an option for children and teens, even though every major medical association recommends such care and says it can save lives.

The department’s new guidelines suggest that children should be provided social support from peers and family and should seek counseling. But it says they should be denied treatments that can be a part of this care, including calling the child or teen by the name and pronoun they prefer and allowing them to wear clothing or hairstyles that match their gender identity.

Gender-affirming care is medically necessary, evidence-based care that uses a multidisciplinary approach to help a person transition from their assigned gender – the one the person was designated at birth – to their affirmed gender – the gender by which one wants to be known.

The gold standard of care
Major medical associations – including the American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics and the American Academy of Child & Adolescent Psychiatry – agree that gender-affirming care is clinically appropriate for children and adults.

The regulators of Florida’s MDs began to shut down the gold standard in September 2022 (source):

The final rule:

64B8-9.019 Standards of Practice for the Treatment of Gender Dysphoria in Minors.
(1) The following therapies and procedures performed for the treatment of gender dysphoria in minors are prohibited.
(a) Sex reassignment surgeries, or any other surgical procedures, that alter primary or secondary sexual characteristics.
(b) Puberty blocking, hormone, and hormone antagonist therapies.
(2) Minors being treated with puberty blocking, hormone, or hormone antagonist therapies prior to the effective date of this rule may continue with such therapies.

The regulators of Florida’s DOs went off the gold standard effective today (source) with an identical rule.

And on the other coast… “California Becomes First Sanctuary State for Transgender Youth Seeking Medical Care” (from state-sponsored media):

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“Do you feel safe at home?” in Maskachusetts versus Florida health care settings

One constant feature of health care in Maskachusetts was the provider asking, often as the first question of an encounter, “Do you feel safe at home?” A fit 6’2″ tall 25-year-old who identified as a cisgender heterosexual man would be asked this question just the same as a frail slight person identifying as female.

A memorable example of this was the delay of care being provided to Senior Management after I had taken her to a community hospital in Cambridge, MA at 5 am. Getting to the bottom of the “Do you feel safe at home?” question was more important than asking about the labor pains that had occasioned the hospital visit (the same hospital where she had been receiving prenatal care, so it wasn’t a new-patient situation). In order that she would be free of coercion, the person who got up at 4:30 am to do the hospital drive had to removed into a separate room so that the 9-months-pregnant person could answer this question freely before moving on to whether abortion care (perfectly legal at all stages of pregnancy in Maskachusetts) or delivery was desired.

An example in miscommunication occurred when the question followed me telling the doctor that I had recently returned from a trip to Israel. This was early in the adoption of the “Do you feel safe?” question so I heard it as “Did you feel safe?” and launched in a long explanation of security risks in Israel, the lack of street crime compared to big U.S. cities, etc. The doc then had to explain that she didn’t care about Israel but about whether Senior Management was physically abusing me.

Because I’m in possession of a mostly timed-out body, I’ve had quite a few encounters with physicians here in Florida since August 2021. What did these encounters have in common? Never once was I asked if I felt safe at home. Nor are patients asked to wear masks, even inside the full-service hospitals with operating rooms, etc.

Separately, I’m noticing that a remarkably high percentage of doctors in Florida are private jet charter customers. The specialist who toils for peanuts in MA and pays 5% income tax (9% under the new “millionaires’ tax” if there is a rare good year) will pay 16% estate tax on finally dying. He/she/ze/they can bask in the glory of institutional prestige, e.g., at MGH, even if prestige doesn’t come with a lot of money. The counterpart in FL seems to earn twice as much, pays 0% income and estate tax, and spends the extra on a luxurious lifestyle.

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Don’t throw out your masks (NYT)

“An Even Deadlier Pandemic Could Soon Be Here” (New York Times, today):

Bird flu — known more formally as avian influenza — has long hovered on the horizons of scientists’ fears. This pathogen, especially the H5N1 strain, hasn’t often infected humans, but when it has, 56 percent of those known to have contracted it have died. Its inability to spread easily, if at all, from one person to another has kept it from causing a pandemic.

But things are changing. The virus, which has long caused outbreaks among poultry, is infecting more and more migratory birds, allowing it to spread more widely, even to various mammals, raising the risk that a new variant could spread to and among people.

The U.S. government has a small H5N1 vaccine stockpile, but it would be nowhere near enough if a serious outbreak occurred. The current plan is to mass-produce them if and when such an outbreak occurs, based on the particular variant involved.

There are several problems, though, with this approach even under the best-case scenarios. Producing hundreds of millions of doses of a new vaccine could take six months or more.

Worryingly, all but one of the approved vaccines are produced by incubating each dose in an egg. The U.S. government keeps hundreds of thousands of chickens in secret farms with bodyguards. (It’s true!) But the bodyguards are presumably there to fend off terror attacks, not a virus. Relying on chickens to produce vaccines against a virus that has a 90 percent to 100 percent fatality rate among poultry has the makings of the most unfunny which-came-first, the-chicken-or-the-egg riddle.

Will no one rid us of this turbulent virus? (source) It’s Pfizer and Moderna to the rescue:

The mRNA-based platforms used to make two of the Covid vaccines also don’t depend on eggs. Scott Hensley, an influenza expert at the University of Pennsylvania, told me that those vaccines can be mass-produced faster, in as little as three months. There are currently no approved mRNA vaccines for influenza, but efforts to make one should be expedited.

The public, of course, doesn’t want to hear about another virus, and Congress isn’t even willing to keep funding efforts against the current one.

If you spend $20 trillion fighting Virus A your ability to grapple with other health issues, including Virus B, is impaired? Who knew?

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