Category: Health

Cost of being continuously stoned: $7,400 per year

by philg

From “Medical marijuana patients just got huge win as N.J. court says company must pay injured worker’s bills” (nj.com):

The New Jersey Supreme Court dealt medical marijuana patients a big victory Tuesday, ruling unanimously that a construction company must pay for an injured employer’s medical cannabis bills.

The decision upheld an Appellate Division ruling from January 2020. That court said Vincent Hager’s former employer, M&K Construction, must foot the monthly bill for medical marijuana he uses to treat injuries he sustained on the job in 2001. As of early 2020, those costs were about $616 a month, according to court documents.

New Jersey’s medical marijuana patients have long complained of high costs. Prices have averaged between $350 to $500 an ounce. The law allows them to purchase up to 3 ounces each month, though most use less.

Only in America could we figure out a way for a literal “weed” to cost $7,400 per year per person!

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Pharma ads on TV will turn our kids into the biggest hypochondriacs in human history?

by philg

I like to limit my TV viewing to content targeted at 5-year-olds, generally streaming and ad-free. However, the kids sometimes hear about a big tennis tournament that is going on and ask to see parts of it. What do they see? About 30 percent of the ads seem to be for drugs that treat medical conditions afflicting older adults. Perhaps this isn’t surprising in a country where health care is 20 percent of GDP (and 40 percent of profits?). Each of these ads leads to a question: “What’s that for?” So they’re getting a much earlier education in all of the ways that the human body can fail than we Boomers did (we saw ads for cars, packaged food, toys, beer and wine, etc.).

I know a lot of people who are 10 to 30 years old and are afraid to leave their homes because of a virus that kills 82-year-olds. I wonder if these folks were already preconditioned to be anxious about their health by the preponderance of TV ads for medication.

I’m thinking that it will be even worse for kids currently 0-10. The only world that they’ve known looks like an Ebola clinic and, in addition to all of the masks, gloves, face shields, obsessive surface cleaning, and shutdowns of which they’ve become aware, they’re spent a lot of time at home seeing TV ads for all of the conditions that were considered serious prior to coronapanic.

Here’s an example…

Lots of good questions for an early reader… “What’s HIV?”, “What’s getting HIV through sex?”, “What’s people assigned female at birth?”

A still frame from the above in case it disappears from YouTube:

Another example:

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Medicare focuses on end-of-life because we do too?

by philg

The death of my father was sad, but it was also illuminating. Relatives who hadn’t paid much attention to my parents for years suddenly sprang into action, on hearing that my father had gone sharply downhill (perhaps coincidentally, but it was one week after the second Pfizer Covid vaccine shot).

People were desperate to show up in person, get on Zoom or FaceTime, or talk on the phone. The neglect of the elderly in America reached a state of perfection starting in March 2020. People who hadn’t visited relatives in retirement homes suddenly had a perfect excuse: #AbundanceOfCaution #BecauseCorona. Even when the inmates were released to meet friends and family on outdoor terraces in masks, the Coronarighteous refrained from visiting (often while posting on Facebook photos of themselves enjoying various activities with other potentially infected humans, going out to get food at/from restaurants #BecauseTooLazyToCook, etc.). All of that changed once my dad slipped toward unresponsiveness.

Apparently I am always out of step with my fellow(?) humans. I was happy to have talked on the phone with my parents every day or two for the preceding 10 years. I was happy that we’d been able to visit them (from Boston to DC) every few months, including amidst “the global pandemic”, over the same period. As it happened, I was also able to be there during my father’s final week, but I didn’t consider that essential or important compared to what had transpired over the preceding 10 years.

Folks often decry the huge expenses that Medicare is willing to incur even when it is obvious that death of the beneficiary is imminent (see “Medicare Cost at End of Life” for some data; as much as 25 percent of spending is during the last year of life). But now I’m thinking that this is a feature and not a bug. If Medicare is a reflection of ourselves and what is important to us, it actually make sense for Medicare to pull out all of the stops when the end is near and certain.

Readers: What have you seen in your own families when the end is plainly near for an older relative? Do folks who’ve not been interested in the soon-to-be-deceased suddenly come out of the woodwork?

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The idiots who said that marijuana legalization would be the gateway for harder drugs…

by philg

For those fools who objected to legalizing marijuana because it would open the door to social acceptance of more harmful drugs…. “This Heroin-Using Professor Wants to Change How We Think About Drugs” (New York Times, April 10, 2021):

Carl L. Hart, a neuroscientist at Columbia University, … confides that he has used heroin regularly for the last four years and describes the time he took morphine daily for three weeks in order to experience withdrawal.

Dr. Hart argued that most of what you think you know about drugs and drug abuse is wrong: that addiction is not a brain disease; that most of the 50 million Americans who use an illegal drug in a given year have overwhelmingly positive experiences; that our policies have been warped by a focus only on the bad outcomes; and that the results have been devastating for African-American families like his own.

Unlike past academic advocates for drug use, like Timothy Leary and Baba Ram Dass, who both experimented with L.S.D. at Harvard University, Dr. Hart rejects as “self-serving” the distinction between so-called good drugs, like psychedelics, and more maligned substances, like heroin and methamphetamine. All, he said, have their place.

What to do with all of the COVID vaccination sites once smart humans have shown the dumb virus who is boss?

A next step, Dr. Hart said, should be setting up testing sites nationwide where users can determine the purity and strength of their drugs — anathema to researchers like Dr. Madras, who say that anything that “normalizes” drug use leads to more use by adolescents — but essential for saving lives, Dr. Hart said.

He held out little hope that such sites would appear any time soon.

But he noted a twist during his time in the field. When he started, his students wanted to explore the dangers of drugs. Now they see more harm in drug prohibitions, he said.

(For the record, I am personally against the War on Drugs because it leads to an expansion of the government in general and the police state in particular. But I do think that alcohol should be cut way back (see Reintroduce Prohibition for the U.S.? and Use testing and tracing infrastructure to enforce alcohol Prohibition?) and I wouldn’t be telling folks to pick up heroin at the Safeway.)

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Public health, American-style: Donuts at the vaccine clinic

by philg

Public Health 101: When confronted with a virus that attacks the obese and unfit, lock people next to their refrigerators for a year.

Public Health 102: When the local government runs a COVID vaccine clinic, make sure that it is amply supplied with donuts.

From a town-run COVID-19 vaccine clinic in the Boston suburbs:

Readers might reasonably ask how many of these health-enhancing items I consumed personally. Answer: zero. I was merely there as driver for a 92-year-old and therefore did not feel that I had earned one. Separately, what’s the process for becoming a volunteer driver in our all-white all-heterosexual town? Look for the rainbow flag and “Black History Month” stickers to find the “Council on Aging” door. Knock and receive a Criminal Offender Record Information (CORI) form to fill out and also a form in which one must supply one’s pronouns and gender ID.

The vaccination process itself was efficient. We arrived at 11:55 am for a noon appointment and were fully checked out by 12:25 pm. My old-but-fit neighbor noted that she hated wearing a mask, but otherwise was happy with her experience.

Readers: Who has vaccination stories to share?

Related:

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Should a rich person on Medicare buy supplemental insurance?

by philg

A friend is turning 65. If he can easily afford the co-pays (20 percent for most things), does it make sense for him to buy insurance to supplement Medicare?

From a reasonably wealthy consumer’s point of view, the main advantage of health insurance in the U.S. is that the insurance company will defend against the providers’ attempts to steal via fake rates. See America’s Efficient Health Care System: my $15 bill for a checkup (2010), in which the doctor charges a fictitious $510 fee for a checkup that is actually valued at $83 (the insurance company’s “negotiated rate”). If you don’t have insurance, you will be attacked by the health care industry with rates that are 5-10X higher than what 95% of patients are paying. No other part of the U.S. economy works like this and I am not even sure how it is legal. The fictitious prices aren’t quoted to the patient in advance. How can it be legal to hit someone with a bill for 5-10X the real price after the visit? If you take your car in for dealer service and the dealer can’t reach you to get authorization for replacing the bald tires, the dealer can’t charge you $5,000 for a set of tires that 95 percent of the dealer’s customers are paying $500 for, right?

[Related question: Why is the uninsured rate only $510 for an $83 service? Why isn’t it $5,100, for example? The insurance company will still pay $83 and the uninsured can be pursued for $5,100. There isn’t a better rational basis for $510 versus $5,100 or vice versa.]

So… if this guy and his wife will be on Medicare, which is doing the negotiation dance with providers, if he doesn’t buy supplemental coverage is there any circumstance in which he’ll be exposed to this kind of systemic crime by the U.S. health care industry? Or will Medicare always negotiate a normal rate for him even if he ultimately has to pay whatever Medicare has negotiated? (In the latter case, it doesn’t make sense for him to buy insurance because he doesn’t need the insurance part of the insurance.) Is there any convenience benefit to having supplemental insurance, e.g., one doesn’t get annoyed via mail with $10 or $15 hardcopy bills?

A couple of Medicare beneficiaries and their pup, enjoying a misty day at the beach in Hilton Head, South Carolina (January 2021):

And the South Carolina license plate motto (“While I Breathe, I Hope”), perfect for the Age of COVID-19:

Also of interest from Hilton Head…

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Why you can’t get vaccinated by your local dentist

by philg

A dentist friend (yes, even dentists need friends!) looked into becoming a COVID-19 vaccination center. She’s amply qualified to inject people (“so is a janitor,” says a med school professor friend). She earns her high income by serving a low-income high-risk population so it would make perfect sense for the parents of her patients to come in and get stuck.

What’s stopping her? “It costs $12,000 for the fridge and I don’t think I’d be able to get reimbursed for giving shots. I’m set up to bill for dental services and being able to bill for medical is a whole different procedure.”

(How is it possible to prosper when the patients are poor? Medicaid doesn’t pay quite as much as private dental insurance for any given procedure, but it is common for children on Medicaid to need $10,000+ in dental surgery due to candy+lack of brushing. An upper middle class child might yield a slightly higher payment for a cleaning, but that is the only revenue that can be obtained from treating the upper middle class child.)

Marketing to MassHealth (Medicaid) customers in Worcester, Maskachusetts, a city whose entire economy consists of mining poor people (medical, dental, criminal prosecution and divorce/custody/child support litigation in a magnificent brand new courthouse).

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Is it ethical for a physician to vaccinate a healthy 20-year-old against COVID-19?

by philg

Doctors take the Hippocratic Oath, in which they promise, depending on the version, to “do no harm”, do what will benefit their patients, and avoid “overtreatment.”

Suppose that a healthy slender 20-year-old calls up to a doctor’s office and says “By governor’s order, I am not allowed to leave my house unless you stick me with a COVID-19 vaccine.” Is it ethical for the doc to vaccinate him/her/zir/them?

A healthy slender 20-year-old is more likely to be killed in a car accident driving to/from the doctor’s office than he/she/ze/they is to be killed by COVID-19. Can the doctor ethically and consistently with the Hippocratic Oath intervene in this person’s body? Even if we had years of data proving these brand-new vaccines safe, they are unnecessary for a 20-year-old with no health conditions that would render him/her/zir/them vulnerable to COVID-19. A doctor isn’t supposed to do unnecessary things to patients.

How about the argument that sticking Patient A with a vaccine with help Patients B, C, D, and E? That’s a fine public health argument, and maybe a technician working for the state could do it, but it doesn’t seem consistent with the physician’s oath.

I asked a medical school professor friend for his thoughts on this. He couldn’t think of any other situation in which doctors apply procedures to patients for whom there is no medical benefit with the justification that others will benefit. He did not believe that vaccinating the young/healthy against COVID-19 was consistent with the Hippocratic Oath.

Readers: Are we breaking new ethical ground here? Is there an ethical problem? (If the answer is that there isn’t an ethical problem, can we start harvesting organs out of young people in order to keep old people alive? Common sense organ control tells us that young people don’t need two kidneys and a full-size liver, right?)

Ethical question #2: Is it ethical to throw out vaccine doses because you’re too lazy to post on Facebook or Twitter or call a few friends? From “CEO of Health Center Explains Why COVID Vaccine Doses Had to Be Thrown Out” (NBC Boston):

The CEO of the Brockton [Maskachusetts] Neighborhood Health Center says doses of the COVID-19 vaccine were thrown away on Christmas Eve while they were vaccinating health care workers, due to some of those workers not showing up for their inoculations.

“Since the vial is only good for six hours after we start using it, there was no way we could put it in your fridge like we do the other vaccines and just use it in the morning,” Joss said. “There was just no way to salvage the remaining doses.”

“For our staff, that vaccine is just like gold. They’re protecting it like nothing else,” said Joss. “And yet, I think, at the same time, just by the fragility of the vaccine, I think it’s probably, it’s probably going to happen here and there.”

It’s like gold, but sometimes we need to throw gold away because it is too tough to find additional humans in thinly settled eastern Maskachusetts (Brockton itself has a population of roughly 100,000 and a continuously raging coronaplague among its low-skill immigrants). (Of course, in New York “providers who knowingly administer the vaccine to individuals outside of the state’s prioritization protocols may face penalties up to $1 million, as well as revocation of all state licenses” by governor’s order, but our governor hasn’t issued any new orders since #59 on December 22 (the “emergency” declared nearly a year ago continues, but we’ve had no new orders for two weeks).)

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Travel to get an adenovirus-based COVID-19 vaccine?

by philg

One of my instrument flying students recently traveled back to his native Russia and got the Sputnik V vaccine (his wife had it too and the result was two days of fever for her, no significant negative effect for him). Although the U.S.-approved Pfizer-BioNTech and Moderna vaccines are supposedly quite effective, they’re also brand new technology that has never previously been tried in humans (see, from 2018 Nature, “mRNA vaccines — a new era in vaccinology”).

What about the idea of traveling to a country where a vaccine based on more conventional adenovirus technology is available? In addition to the Russian vaccine, the Oxford/AstraZeneca product meets this definition (explanation of function in NYT).

Why not take a trip to a Mexican beach resort, for example, and pay a private clinic for a dose of the AstraZeneca product? (produced and/or packaged in Mexico) Then go back a month or two later for some more poolside margaritas, a stop at a UNESCO World Heritage site, and the second dose?

(Why not get one of these vaccines here in the U.S.? The FDA might not approve it before 100 percent of Americans are infected (roughly half are already if we use the 8X multiplier that the CDC suggests). Even if the FDA does approve it, the centrally planned distribution strategy might make a adenovirus-based vaccine impossible to obtain as a practical matter.)

Readers: Which would you rather have? A leading-edge mRNA vaccine or a slightly-more-conventional adenovirus vaccine? (or no vaccine at all?)

[A medical school professor friend: “The adenovirus vaccine is more likely to have a known side effect than the mRNA vaccine. The mRNA is much more likely to have an unknown side effect.” Why did he prefer? “I don’t want to feel bad for a day or two and the probability of a significant negative effect from the mRNA vaccine is small, so I’d rather have the mRNA vaccine. In reality, it doesn’t matter because so many Americans will have been immunized by a COVID infection by the time I get my vaccine that my actual protection will come from herd immunity.” He does work in a hospital, but seldom sees patients and therefore is not likely to get a vaccine before March.]

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If COVID-19 vaccines weren’t tested on likely COVID-19 victims, how do we know that they will reduce COVID-19 deaths?

by philg

Sweden, in which coronaplague was allowed to rage while the population continued sending children to school, sending adults to work, restaurants, the gym, etc., will have about the same death rate in 2020 as compared to 2010 (stats; be sure to adjust for population growth of 9.5 percent from 9.34 million in 2010 to 10.23 million today). This suggests that most of the people whose deaths were tagged to COVID-19 were, as the Swedish MD/PhDs said, on track to die from some other cause at some point in 2020. In other words, COVID-19 kills humans who are already 98-99 percent dead (watch out, Joe Biden, even if you do have a Dr. in the house).

What we’ve heard so far from the vaccine trials are the following:

  • the vaccines don’t stop people from getting infected or spreading the infection to others
  • the vaccines cut down on symptoms and severity of an infection

So… the vaccines might actually make an epidemic worse, in terms of the percentage of the population infected, because people who are infected won’t feel sick and therefore won’t #StayHomeSaveLives.

Maybe this would be fine if we can be sure that vaccinated people won’t die with a COVID-19 toe tag. But do the clinical trials tell us that? Did they go to nursing homes and find the sickest oldest most machine-dependent humans? Given that nursing homes are completely locked down, even if they had found such trial subjects, what could be learned from folks who, by design, are shielded from all exposure?

Let’s have a look at the Moderna FDA paperwork. Only 3 people in the vaccine group, out of 15,208 total, died during the study (approximately 3 months; see pages 17 and 18), which tells you that Moderna picked a much healthier population with a much longer life expectancy than the kinds of people who have been tagged on death with COVID-19 positive test result. (If we assume that a typical COVID-19-tagged death is among those with a life expectancy of 4 years, we would have expected at least hundreds of deaths during a similar study of vaccination among people who really need the vaccination. Note that the Swedish data suggest that 4 years is an overestimate.)

Table 6 says that 4 percent of the study participants had “two or more high risk conditions” and that 25 percent were over 65 years of age, but here in Maskachusetts before the state pulled the age-related data, the median age of a “COVID-19 death” was 82 and more than 98 percent of those had an “underlying condition.”

It is nice that a healthy out-and-about 66-year-old develops a good immune response from these injections, but does that tell us that an extremely unhealthy 82-year-old with just a year or two of life expectancy will develop a similarly good immune response?

So… is it fair to say that we can hope, but not expect, these vaccines to stop the kinds of “COVID-19 deaths” that have been Americans’ consuming obsession?

(A med school professor friend: “Good question, probably not.”)

Loosely related…

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