Category: Health

Make an appointment to see the doctor to get your opioids

by philg

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.

Related:

  • 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?

by philg

From the Environmental Protection Agency:

We have an Italian natural gas range of doubtful quality. It is 15 years old. I am willing to bet that it has not been adjusted at any time in the past 5 years and, very likely, not at any time since its 2008 installation. 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. 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. [Update: After the reader comment below regarding pacemakers and insulin pumps, I might have to reconsider my love for induction (or wear foil-lined garments once I reach pacemaker age?). It would be a horrible shame to have to convert from induction back to an old-school electric cooktop. On the the third hand, https://acadiacenter.org/hot-topic-dispelling-the-myths-about-induction-stoves/ says “There has never been a recorded instance of pacemaker interference with induction cooktops.” Maybe this is superstition like booster seats for 5-year-olds!]

Related:

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

by philg

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

by philg

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)

by philg

“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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Shopping for health insurance on healthcare.gov

by philg

Our government has decided that it is okay for a doctor or hospital to charge an uninsured customer 10X what an insurance company would pay for a service. Thus, an American who doesn’t want to pay 10X the fair price and risk bankruptcy has no choice but to sign up for health insurance. He/she/ze/they cannot pay the $25,000 that an insurance company would pay for a serious issue and defer the purchase of a new car. Instead, he/she/ze/they must deal with a bill for $200,000 and aggressive bill collectors and lawyers from the hospital.

I recently decided to see if it would make sense to get a policy from healthcare.gov for our family. There are three big providers in eastern Florida: Mayo Clinic, Cleveland Clinic, and University of Miami. The site has a way to enter these providers and see if they’re in the network for the plan. Here are some of the quotes:

The consumer is supposed to evaluate 174 alternatives, build a spreadsheet and run a Monte Carlo experiment to figure out which is likely to result in minimum spending? You’d be a fool to have insurance that didn’t cover these three networks, as we discovered to our chagrin last year with Humana. Healthcare.gov offers to help you register to vote, but it doesn’t offer to limit results to insurance policies that will pay these essential providers.

I thought that Blue Cross had deals with everyone and yet this $66,000+/year policy ($72,000 including the out-of-pocket maximum) is presented as not covering any of the places that you’d want to go if you needed a specialized specialist:

Perhaps we could work it from the other side? Here’s what Mayo Jacksonville says they’ll take:

The consumer is supposed to recognize, therefore, that Mayo takes “Aetna” and “Blue Cross Blue Shield” but not the versions of “Aetna” and “Blue Cross” that are sold on healthcare.gov? How many people are this sophisticated? Mayo Jacksonville takes “Cigna EPO”, but, according to healthcare.gov, not “Cigna Connect 900 EPO”:

As Obama said, if you like your doctor you can keep your doctor so long as your doctor doesn’t work at any of the good clinics or hospitals in the nation’s third largest state. I scrolled through all of the 174 plans and never found one that covered more than University of Miami (and that was rare).

Maybe this is peculiar to Florida? Friends in Maskachusetts who had been paying $30,000 per year to Blue Cross (in pre-Biden dollars) switched to MassHealth (Medicaid; there was an income test, but no asset test on the MA signup web site) and found that their choice of doctors was much wider. That seems to be the case in Florida as well. Mayo Clinic is happy to accept Medicaid. Cleveland Clinic says they take Medicaid. University of Miami takes Medicaid. In other words, Americans have voted to set up a system in which a person who works and pays $72,000 per year for health insurance has inferior access to health care compared to what someone who has never worked enjoys.

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Breakthrough technology according to MIT: “Abortion pills via telemedicine”

by philg

The smartest people in the world have put together their list of the 10 most important “breakthrough technologies” of 2023. This appears in the Jan/Feb 2023 issue of Technology Review, published by MIT:

There’s been no change to how life-saving abortion care is delivered into a pregnant person’s body, but being able to get abortion care pills after a text message conversation is a “breakthrough technology.”

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The CDC supports my neo-prohibitionist philosophy

by philg

Loyal readers will remember that I’ve long been an advocate of alcohol prohibition:

The increased power of government that I noted in 2016 was tremendously amplified between 2020 and 2022. Americans are much less tolerant of the negative effects of alcohol (sexual assault, other violent crimes, death) than ever before and coronapanic showed that there is almost no price that Americans are willing to pay in an attempt to save even one life.

Readers have heaped scorn on my dream. Yet this month fair Science is on my side. “Estimated Deaths Attributable to Excessive Alcohol Use Among US Adults Aged 20 to 64 Years, 2015 to 2019” (CDC employees are the first two authors).

The estimates in this cross-sectional study of 694 660 mean deaths per year between 2015 and 2019 suggest that excessive alcohol consumption accounted for 12.9% of total deaths among adults aged 20 to 64 years and 20.3% of deaths among adults aged 20 to 49 years. Among adults aged 20 to 64 years, the proportion of alcohol-attributable deaths to total deaths varied by state.

These findings suggest that an estimated 1 in 8 deaths among adults aged 20 to 64 years were attributable to excessive alcohol use and that greater implementation of evidence-based alcohol policies could reduce this proportion.

(Note that this doesn’t cover the lockdown years in which Americans pounded back way more alcohol in response to governors making it illegal to work and “essential” to sell and buy liquor. Presumably the percentage of young people killed by this chemical menace is even higher now.)

The death count is shocking:

an estimated 12.9% (89 697 per year) were attributable to excessive alcohol consumption

In terms of life-years lost, this is far more than are taken away by SARS-CoV-2 because a person 20-64 has many more years of life expectancy than a person whose death was tagged as COVID-19-related (median age 80-82). And this CDC study didn’t even look at those over 64 who are killed by alcohol consumption. I’m sure that there are plenty! (A CDC web page says more than 140,000 total among all ages.)

I trust and hope that everyone had a safe and alcohol-free Thanksgiving!

And if Thanksgiving depressed you because you learned that some of your relatives do not support President Biden’s inflation reduction system, his transfer of student loan obligations to those who did not attend college, and his support for Science-based COVID policies… “Tequila Fixes Everything,” a Jupiter, FL restaurant reminds us:

As a reminder of the potential economic savings of Prohibition, discount red wine at Costco (Waltham, Maskachusetts 2013), below. Note that these are pre-Biden prices:

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The Brits don’t love the world’s best health care system

by philg

From a bookstore in Kensington:

A Guardian review says it is all about the death panels:

Side Effects forces us to face up to – rather than ignore or deny – the realities of balancing the vast sums that can be spent on a single, seriously ill patient against the “distressing conditions in which many frail and elderly people live out their final years, often as a result of lack of adequate funding”. It is all too tempting, Haslam recognises, to dismiss as abhorrent the act of attaching a price tag to a person – as though their worth can be measured in pounds and pence. A human life, surely, is priceless? No amount of mere money or stuff comes close? But anyone who is actually involved in the real, messy world of healthcare knows full well this is nothing but rhetorical posturing.

Later that afternoon I was talking to a guy who is married to an emergency medicine doc in London. With the cost of living adjustment, she can expect to earn 80,000 pounds per year (i.e., $80,000!) after 15 years of slavery for the NHS (age 40). “A train driver will earn more,” he noted, “because their union is actually effective.”

Who is smarter than the Brits for running a universal health care system that doesn’t bankrupt everyone? Africans! “Middle class Nigerians who need any kind of advanced medical treatment will come here on a tourist visa,” my friend explained, and go straight from Heathrow to an NHS hospital. Once they’re in the system they get treated just like anyone else. After consuming what might be hundreds of thousands of pounds in services and recovering, they go back to Nigeria.”

What else did they have in the bookstore? It’s “smart thinking” to fight structural racism:

An American hero who inspires Biden voters can also inspire the British:

Although the age of consent in the UK is 16 (e.g., a 16-year-old could consent to have sex with a rich guy after a Gulfstream flight to somewhere luxurious) and prostitution is a legal career for an 18-year-old, the British are apparently shocked about what Jeffrey Epstein was allegedly up to:

Anyone who isn’t a cisgender heterosexual white male is in trouble:

England was saved from German invasion by women of color who were willing to risk their lives in combat while white men relaxed in the safety of their country homes:

Despite the fact that some heroines exist, the entire Earth is, literally, toast because of those who Deny the Science (i.e., unlike World War II, this is not a war that can be won by women alone):

An entire section of the front of the bookstore was devoted to a personage who by right should have been King of England and was denied this position purely on account of her gender ID:

Circling back to the British health care system… if we aren’t willing to use death panels or at least a quality-adjusted life year calculation the way that the Brits do, how are we going to keep health care from growing to consume 25 percent of American GDP (a shrinking quantity in the aggregate and, since the population continues to grow via immigration, an even more dramatically shrinking quantity on a per-capita basis)?

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Science in the US, Denmark, and the UK

by philg

The US has a history of enthusiasm regarding whatever is new and shiny from the pharmaceutical industry (see Book review: Bad Pharma, about a book by a British doc). So it isn’t surprising that the CDC recommends emergency use authorized COVID-19 booster shots for anyone 5 or older:

People ages 5 years and older are recommended to receive 1 bivalent mRNA booster dose after completion of any FDA-approved or FDA-authorized monovalent primary series or previously received monovalent booster dose(s). This new booster recommendation replaces all prior booster recommendations for this age group.

Note that the difference between FDA-approved and emergency use authorized is now irrelevant. The CDC also recommends flu shots for all Americans 6 months and older.

Let’s check in with Science in Denmark. The COVID-19 shots are recommended for those age 50 and older. What about the flu vaccine, that cornerstone of American public health? Denmark says it is for the old and the young:

We recommend influenza vaccination for everyone aged 65 and over as well as for persons with certain chronic diseases, children aged between 2 and 6, pregnant women in the second and third trimesters and staff in the healthcare and elderly care sector and selected parts of the social services sector.

Let’s go to the UK and see what Science has decided there. The flu vaccine is for those 65 and older and also children from 2 to the end of “primary school” and, depending on how much they have left over, maybe some child in secondary school (Science is all about the leftovers!). How about the miracle COVID shots? A “1st booster” for those 16 and older and “seasonal booster” for those over 50.

As a humble engineer, of course, I cannot say which of the policies described above is best. But I am capable of noticing that they’re different, which is not what one would expect for policies for which a Scientific basis is claimed.

Maybe we should celebrate diversity, as London did in 2015:

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