Archive for the ‘Medical’ Category
Suspicions confirmed: How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them
Patrick Rucker, Maya Miller, and David Armstrong report in ProPublica:
When a stubborn pain in Nick van Terheyden’s bones would not subside, his doctor had a hunch what was wrong.
Without enough vitamin D in the blood, the body will pull that vital nutrient from the bones. Left untreated, a vitamin D deficiency can lead to osteoporosis.
A blood test in the fall of 2021 confirmed the doctor’s diagnosis, and van Terheyden expected his company’s insurance plan, managed by Cigna, to cover the cost of the bloodwork. Instead, Cigna sent van Terheyden a letter explaining that it would not pay for the $350 test because it was not “medically necessary.”
The letter was signed by one of Cigna’s medical directors, a doctor employed by the company to review insurance claims.
Something about the denial letter did not sit well with van Terheyden, a 58-year-old Maryland resident. “This was a clinical decision being second-guessed by someone with no knowledge of me,” said van Terheyden, a physician himself and a specialist who had worked in emergency care in the United Kingdom.
The vague wording made van Terheyden suspect that Dr. Cheryl Dopke, the medical director who signed it, had not taken much care with his case.
Van Terheyden was right to be suspicious. His claim was just one of roughly 60,000 that Dopke denied in a single month last year, according to internal Cigna records reviewed by ProPublica and The Capitol Forum.
The rejection of van Terheyden’s claim was typical for Cigna, one of the country’s largest insurers. The company has built a system that allows its doctors to instantly reject a claim on medical grounds without opening the patient file, leaving people with unexpected bills, according to corporate documents and interviews with former Cigna officials. Over a period of two months last year, Cigna doctors denied over 300,000 requests for payments using this method, spending an average of 1.2 seconds on each case, the documents show. The company has reported it covers or administers health care plans for 18 million people.
In the two minutes and 45 seconds you’ve been on this page, Cigna’s doctors could have denied 198 claims, according to company documents.
Before health insurers reject claims for medical reasons, company doctors must review them, according to insurance laws and regulations in many states. Medical directors are expected to examine patient records, review coverage policies and use their expertise to decide whether to approve or deny claims, regulators said. This process helps avoid unfair denials.
But the Cigna review system that blocked van Terheyden’s claim bypasses those steps. Medical directors do not see any patient records or put their medical judgment to use, said former company employees familiar with the system. Instead, a computer does the work. A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments. Company doctors then sign off on the denials in batches, according to interviews with former employees who spoke on condition of anonymity.
“We literally click and submit,” one former Cigna doctor said. “It takes all of 10 seconds to do 50 at a time.”
Not all claims are processed through this review system. For those that are, it is unclear how many are approved and how many are funneled to doctors for automatic denial.
Insurance experts questioned Cigna’s review system.
Patients expect insurers to treat them fairly and meaningfully review each claim, said Dave Jones, California’s former insurance commissioner. Under . . .
Biden Plan to Cut Billions in Medicare Fraud Ignites Lobbying Frenzy
As Dan Froomkin notes, “Health insurers are spending millions to protect their ability to overbill billions to the government. Doesn’t that make you angry?” Reed Abelson and Margot Sanger-Katz report in the NY Times:
“How’s the knee?” one bowler asked another across the lanes. Their conversation in a Super Bowl ad focused on a Biden administration proposal that one bowler warned another would “cut Medicare Advantage.”
“Somebody in Washington is smarter than that,” the friend responded, before a narrator urged viewers to call the White House to voice their displeasure.
The multimillion dollar ad buy is part of an aggressive campaign by the health insurance industry and its allies to stop the Biden proposal. It would significantly lower payments — by billions of dollars a year — to Medicare Advantage, the private plans that now cover about half of the government’s health program for older Americans.
The change in payment formulas is an effort, Biden administration officials say, to tackle widespread abuses and fraud in the increasingly popular private program. In the last decade, reams of evidence uncovered in lawsuits and audits revealed systematic overbilling of the government. A final decision on the payments is expected shortly, and is one of a series of tough new rules aimed at reining in the industry. The changes fit into a broader effort by the White House to shore up the Medicare trust fund.
Without reforms, taxpayers will spend about $25 billion next year in “excess” payments to the private plans, according to the Medicare Payment Advisory Commission, a nonpartisan research group that advises Congress.
The proposed changes have unleashed an extensive and noisy opposition front, with lobbyists and insurance executives flooding Capitol Hill to engage in their fiercest fight in years. The largest insurers, including UnitedHealth Group and Humana, are among the most vocal, according to congressional staff, with UnitedHealth’s chief executive pressing his company’s case in person. Doctors’ groups, including the American Medical Association, have also voiced their opposition.
“They are pouring buckets of money into this,” said Mark Miller, the former executive director of MedPAC, who is now the executive vice president of health care at Arnold Ventures, a research and advocacy group. Supporters of the restrictions have begun spending money to counter the objections. . .
The Oatmeal Diet for diabetics — a surprise
The brief video below describes rigorous testing of the oatmeal diet and what those tests reveal. This video is third in a trilogy: first, Is Oatmeal Good for People with Diabetes?; second, How Does Oatmeal Help with Blood Sugars?; and third, Oatmeal Diet Put to the Test for Diabetes Treatment, the video below.
When Greger refers to “oatmeal,” he seems to mean old-fashioned rolled oats. I’m going to try this, but I think I’ll cook up a batch of oat groats (intact whole-grain oats) and see what that does.
This Georgia County Spent $1 Million to Avoid Paying for One Employee’s Gender-Affirming Care
Aliyya Swaby and Lucas Waldron report in ProPublica:
When a sheriff’s deputy in Georgia’s Houston County sought surgery as part of her gender transition, local officials refused to change the department’s health insurance plan to cover it, citing cost as the primary reason.
In the years that followed, the central Georgia county paid a private law firm nearly $1.2 million to fight Sgt. Anna Lange in federal court — far more than it would have cost the county to offer such coverage to all of its 1,500 health plan members, according to expert analyses. One expert estimated that including transition-related care in the health plan would add about 0.1% to the cost of all claims, which would come to roughly $10,000 per year, on average.
Since at least 1998, the county’s plan has excluded coverage for “services and supplies for a sex change,” an outdated term to refer to surgeries or medications related to gender transition. In 2016, the county’s insurance administrator recommended changing the policy to align with a new federal nondiscrimination rule. But Houston County leaders said no.
The county argued that even if the cost of expanding its insurance coverage to include transition-related health care was low on average, it could amount to much more in some years. The county also claimed that expanding the plan’s coverage would spur demands to pay for other, currently excluded benefits, such as abortion, weight loss surgery and eye surgery.
“It was a slap in the face, really, to find out how much they had spent,” said Lange, who filed a federal discrimination lawsuit against the county. “They’re treating it like a political issue, obviously, when it’s a medical issue.”
Major medical associations recognize that access to transition-related care, also known as gender-affirming care, is medically necessary for transgender people, citing evidence that prohibiting it can harm their mental and physical health. And federal judges have consistently ruled that employers cannot categorically exclude gender-affirming care from health care plans, though prior to Lange’s suit, there hadn’t been a ruling covering Georgia. The care can include long-term hormone therapy, chest and genital surgery, and other services that help transgender people align their bodies with their gender identities.
But banning gender-affirming care has become a touchstone of conservative politics. At least 25 states this year are considering or have passed bills that would ban gender-affirming care for minors. Bills in Oklahoma and Texas aim to ban insurance companies from covering transition-related health care for adults as well.
At the same time, state and local government employers are waging long legal battles against covering gender-affirming care for their employees. With recent estimates showing that 0.6% of all Americans older than 13 are transgender, these employers are spending large sums to fight coverage for a small number of people.
ProPublica obtained records showing that two states — North Carolina and Arizona — have spent more than $1 million in attorney fees on legal fights similar to the one in Houston County. Both have claimed in court filings that the decisions they made not to cover the care for employees are purely financial and not discriminatory.
But budget estimates and real-world examples show that the cost of offering coverage of gender-affirming care is negligible. When the state of North Carolina briefly covered gender-affirming care in 2017, the cost amounted to $400,000 — just 0.01% of the health plan’s $3.3 billion annual budget. . .
Continue reading. There’s much more.
Emergency rooms seem to be heading toward trouble
Kevin Drum points out what seems to be an emergency room emergency:
The Washington Post has a story today about the demise of ER physicians. It used to be a coveted position for residencies, but now senior doctors are warning against it:
They warn of burnout after covid and patients’ increasing suspicion of doctors. The pay is not as good, they say, especially as hospitals rely more on nurse practitioners and physician assistants to staff emergency departments. And job prospects may be grim, they caution, as emergency medicine residency programs aggressively expanded in recent years.
….Emergency departments are under strain as they become congested with patients waiting for beds, veteran providers quit and violence against the remaining staff grows. These factors are damaging the emergency room’s reputation as an ideal place to learn by caring for a steady stream of patients with a wide range of problems.
Every year, graduating students apply for residencies and are matched with programs that are interested in hiring them. [see chart above – LG]
Emergency medicine was in the SOAP in 2023. That is, there weren’t enough applicants for all the open positions, which means that some ER residency programs had to hire doctors from the Supplemental Offer and Acceptance Program, a sort of second-round draft for everyone who didn’t get an offer from the first round of matching.
Of course, it’s worth noting that . . .
California tackles the greed of Big Pharma
and
California Gov. Gavin Newsom announced on Saturday that the state will cut insulin costs by 90% and that it will start manufacturing naloxone, a nasal spray used to reverse opioid overdoses.
The lower insulin cost results from a collaboration between CalRx, a California Department of Health Care Services program, and the non-profit drug manufacturer Civica Rx, according to a news release from the governor’s office. A 10-milliliter vial of insulin will be available for no more than $30, pending approval by the US Food and Drug Administration, says the release.
Though insulin was discovered more than a century ago and costs little to make, brand-name insulin is often sold for roughly $300 per vial, CNN has reported. The high cost has forced many people with diabetes to ration or skip drug doses, which help the body manage blood sugar.
Civica Rx is a non-profit generic drugmaker that focuses on manufacturing drugs that are in short supply or may experience price spikes. The organization is backed by hospitals, insurers, and philanthropies.
“People should not be forced to go into debt to get life-saving prescriptions,” said Newsom in the release. “Through CalRx, Californians will have access to . . .
Price-gouging on life-saving drugs like insulin highlights the moral depravity of capitalism in general and Big Pharma in particular.
A Sandwich Shop, a Tent City, and an American Crisis
The US — and Canada, I have to say — seem to lack the competence or perhaps the will to deal with the crisis at hand. I believe that part of the problem is that the ruling oligarchy doesn’t really care about such problems, being focused instead on how to extract more money from the people and not really concerned about the consequences.
Eli Saslow reports in the NY Times:
He had been coming into work at the same sandwich shop at the same exact time every weekday morning for the last four decades, but now Joe Faillace, 69, pulled up to Old Station Subs with no idea what to expect. He parked on a street lined with three dozen tents, grabbed his Mace and unlocked the door to his restaurant. The peace sign was still hanging above the entryway. Fake flowers remained undisturbed on every table. He picked up the phone and dialed his wife and business partner, Debbie Faillace, 60.
“All clear,” he said. “Everything looks good.”
“You’re sure? No issues?” she asked. “What’s going on with the neighbors?”
He looked out the window toward Madison Street, which had become the center of one of the largest homeless encampments in the country, with as many as 1,100 people sleeping outdoors. On this February morning, he could see a half-dozen men pressed around a roaring fire. A young woman was lying in the middle of the street, wrapped beneath a canvas advertising banner. A man was weaving down the sidewalk in the direction of Joe’s restaurant with a saw, muttering to himself and then stopping to urinate a dozen feet from Joe’s outdoor tables.
“It’s the usual chaos and suffering,” he told Debbie. “But the restaurant’s still standing.”
That had seemed to them like an open question each morning for the last three years, as an epidemic of unsheltered homelessness began to overwhelm Phoenix and many other major American downtowns. Cities across the West had been transformed by a housing crisis, a mental health crisis and an opioid epidemic, all of which landed at the doorsteps of small businesses already reaching a breaking point because of the pandemic. In Seattle, more than 2,300 businesses had left downtown since the beginning of 2020. A group of fed up small-business owners in Santa Monica, Calif., had hung a banner on the city’s promenade that read: “Santa Monica Is NOT safe. Crime … Depravity … Outdoor mental asylum.” And in Phoenix, where the number of people living on the street had more than tripled since 2016, businesses had begun hiring private security firms to guard their property and lawyers to file a lawsuit against the city for failing to manage “a great humanitarian crisis.”
The Faillaces had signed onto the lawsuit as plaintiffs along with about a dozen other nearby property owners. They also bought an extra mop to clean up the daily flow of human waste, replaced eight shattered windows with plexiglass, installed a wrought-iron fence around their property and continued opening their doors at exactly 8 each morning to greet the first customer of the day.
“Hey, bro! The usual?” Joe said to a construction worker who always ordered an Italian on wheat.
“Love the new haircut,” Joe said a few minutes later to a city employee who came for meatballs three days each week.
Debbie arrived to help with the lunch rush, and she greeted customers at the register, while Joe prepared tomato sauce and weighed out 2.2 ounces of turkey for each chef’s salad. Their margins had always been tight, but they saved on labor costs by both going into work every day. They remodeled the kitchen to make room for a nursery when their children were born and then expanded into catering to help those children pay for college. They kept making the same nine original house sandwiches for a loyal group of regulars even as the city transformed around them — its population growing by about 25,000 each year, inflation rising faster than in any other U.S. city, housing costs soaring at a record pace, until it seemed that there was nowhere left for people to go except onto sidewalks, into tents, into broken-down cars, and increasingly into the air-conditioned relief of Old Station Subs.
“I need to place a huge order,” a woman said as she walked up to the counter wearing mismatched shoes and carrying a garbage bag of her belongings. “I own Dairy Queen.”
“Oh, wow. Which one?” Debbie asked, playing along.
“All of them,” the woman said. “I’m queen of the queen.”
“That’s wonderful,” Debbie said as she led the woman to a table with a menu and a glass of water and watched as the woman emptied her bag onto the table, covering it with rocks, expired bus passes, a bicycle tire, clothing, 17 batteries, a few needles and a flashlight. “Would you like me to take an order?” Debbie asked.
“You know why I’m here,” the woman said, suddenly banging her fist against the table. “Don’t patronize me. The king needs his payment.”
Debbie refilled the woman’s water and walked behind the counter to find Joe. For the past several months, she had driven into work with stomach pain and stress headaches. She had started telling Joe that she was done at Old Station, whether that meant selling the restaurant, boarding it up or even moving away from Phoenix for a while without him. She had begun looking at real estate in Prescott, a small town about 100 miles away with a weekly art walk, mountain air, a few lakes.
“What am I supposed to tell this lady?” she asked him. “I can’t keep doing this. Every minute it’s something.”
Joe reached for her hand. “It’ll get better. Stick with me,” he said, but now they could hear the woman tossing some of her belongings onto the floor.
“The king needs his ransom!” she shouted.
“I’m sorry, but it’s time to go,” Debbie told her.
“You thieves. You devils,” the woman said.
“Please,” Debbie said. “This is our business. We’re just trying to get through lunch.”
Their restaurant was located a half-mile from the Arizona State Capitol in . . .
The “highly processed food” equivalent in social media
A good insight into the social media equivalent of manufactured snack foods.
Trump Lawyer Tacopina Says Trump Didn’t ‘Lie’ About Stormy Daniels Payment, He Just Said Stuff That Wasn’t ‘True’
“A distinction without a difference” is the phrase that springs to mind. Liz Dye reports in Above the Law:
On Monday, Donald Trump’s lawyer Joseph Tacopina went on Good Morning America to explain that his client, a man who was notorious for his infidelities even before he got caught on tape bragging about grabbing women by the genitals, did not have sexual relations with that woman, Miss Stormy Daniels. In fact, he went so far as to say that Trump had been a “victim of extortion,” paying the porn star $130,000 to keep quiet about a sexual encounter that never happened to avoid embarrassing his family.
It was merely a coincidence of timing that Trump tried to bury Daniels’s story of their 2006 encounter — and at least two other stories as well — just months before the 2016 election. And thus, the lawyer insisted, the hush money payment cannot be seen as an excessive, undisclosed contribution to Trump’s presidential campaign.
The problem with that theory, aside from being fundamentally ridiculous, is that there are a whole bunch of witnesses who can testify otherwise, including: former National Enquirer publisher David Pecker and editor Dylan Howard, who conspired with Trump and his campaign to “catch and kill” embarrassing stories; Stormy Daniels’s first lawyer, Keith Davidson, who negotiated the hush money agreement; Trump’s former lawyer Michael Cohen, who pleaded guilty to lying to Special Counsel Robert Mueller about the deal, as well as several other illegal tax schemes; and Trump’s former campaign manager Kellyanne Conway, who discussed the payment scheme with Cohen at least once. And every one of those people has testified to the grand jury impaneled by Manhattan District Attorney Alvin Bragg to investigate the payment.
Donald Trump has not testified, although he was invited to do so. But, as the Daily Beast’s Jose Pagliery points out, Trump was not given the automatic grant of immunity provided to grand jury witnesses, indicating both that he is the target of the investigation, and that this process is speeding toward its inevitable close.
There are lots of reasons to be skeptical that an indictment will be forthcoming here, not least of which is that . . .
Can Particles in Dairy and Beef Cause Cancer and MS?
A whole-food plant-based diet looks better and better. Angela Speth, MD, reports in Medscape:
In our Western diet, dairy and beef are ubiquitous: Milk goes with coffee, melted cheese with pizza, and chili with rice. But what if dairy products and beef contained a new kind of pathogen that could infect you as a child and trigger cancer or multiple sclerosis (MS) 40-70 years later?
Researchers from the German Cancer Research Center (DKFZ) suspect that such zoonoses are possibly widespread and are therefore recommending that infants not be given dairy products until they are at least age 1 year. However, in two joint statements, the German Federal Institute for Risk Assessment (BfR) and the Max Rubner Institute (MRI) have rejected such theories.
In 2008, Harald zur Hausen, MD, DSc, received the Nobel Prize in Medicine for his discovery that human papillomaviruses cause cervical cancer. His starting point was the observation that sexually abstinent women, such as nuns, rarely develop this cancer. So it was possible to draw the conclusion that pathogens are transmitted during sexual intercourse, explain zur Hausen and his wife Ethel-Michele de Villiers, PhD, both of DKFZ Heidelberg.
Papillomaviruses, as well as human herpes and Epstein-Barr viruses (EBV), polyomaviruses, and retroviruses, cause cancer in a direct way: by inserting their genes into the DNA of human cells. With a latency of a few years to a few decades, the proteins formed through expression stimulate malignant growth by altering the regulating host gene.
Acid Radicals
However, viruses — just like bacteria and parasites — can also indirectly trigger cancer. One mechanism for this triggering is the disruption of immune defenses, as shown by the sometimes drastically increased tumor incidence with AIDS or with immunosuppressants after transplants. Chronic inflammation is a second mechanism that generates acid radicals and thereby causes random mutations in replicating cells. Examples include stomach cancer caused by Helicobacter pylori and liver cancer caused by Schistosoma, liver fluke, and hepatitis B and C viruses.
According to de Villiers and zur Hausen, there are good reasons to believe that other pathogens could cause chronic inflammation and thereby lead to cancer. Epidemiologic data suggest that dairy and meat products from European cows (Bos taurus) are a potential source. This is because colon cancer and breast cancer commonly occur in places where these foods are heavily consumed (ie, in North America, Argentina, Europe, and Australia). In contrast, the rate is low in India, where cows are revered as holy animals. Also noteworthy is that women with a lactose intolerance rarely develop breast cancer.
Viral Progeny
In fact, the researchers found single-stranded DNA rings that originated in viruses, which they named bovine meat and milk factors (BMMF), in the intestines of patients with colon cancer. They reported, “This new class of pathogen deserves, in our opinion at least, to become the focus of cancer development and further chronic diseases.” They also detected elevated levels of acid radicals in these areas (ie, oxidative stress), which is typical for chronic inflammation.
The researchers assume that infants, whose immune system is not yet fully matured, . . .
In Nebraska, Big Brother is watching you
Martin Kaste reports for NPR:
A 41-year-old woman is facing felony charges in Nebraska for allegedly helping her teenage daughter illegally abort a pregnancy, and the case highlights how law enforcement can make use of online communications in the post-Roe v. Wade era.
Police in Norfolk, Neb., had been investigating the woman, Jessica Burgess, and her daughter, Celeste Burgess, for allegedly mishandling the fetal remains of what they’d told police was Celeste’s stillbirth in late April. They faced charges of concealing a death and disposing of human remains illegally.
But in mid-June, police also sent a warrant to Facebook requesting the Burgess’ private messages. Authorities say those conversations showed the pregnancy had been aborted, not miscarried as the two had said.
The messages appear to show Jessica Burgess coaching her daughter, who was 17 at the time, how to take the abortion pills.
“Ya the 1 pill stops the hormones an rhen u gotta wait 24 HR 2 take the other,” read one of her messages.
Celeste Burgess writes, “Remember we burn the evidence,” and later, “I will finally be able to wear jeans.”
According to police investigators, medical records show the pregnancy was 23 weeks along. A Nebraska law passed in 2010 forbids abortions after 20 weeks, but that time limit wasn’t enforced under Roe v. Wade. After the Supreme Court’s Dobbs v. Jackson ruling overturned Roe in June, Madison County Attorney Joseph Smith brought charges against Jessica Burgess.
It’s not clear the illegal abortion charges against Burgess will stand. In his concurring opinion to Dobbs, Justice Brett Kavanaugh wrote, “May a . . .
This is an example of the Republican idea of “limited government.”
And it’s not just the government: “Three Texas women are sued for wrongful death after allegedly helping friend obtain abortion medication.”
Physics Girl and Covid (not like the flu)
Our government seems to have decided just to let Covid (an airborne virus) go unchecked, apparently assuming that vaccines for those who want them will be enough — but of course, many have been infected with severe misinformation and do not want vaccines. And in many states, conservative legislatures are undermining and restricting public health officials to prevent any outbreak of effective information and public health programs.
The idea that seems prevalent on the Right is that Covid is just like the flu — you get it, and sure, some die, but on the whole, it’s a brief unpleasant illness, and then things go back to the way they were.
That idea is, unfortunately, false. Covid damages the body in ways that scientists still are learning, and each repeated illness extends the damage and increases significantly the risk of dying from diseases triggered by Covid.
And for some, that first infection kills them or leaves them struggling with Long Covid. Physics Girl is one of those.
Watch this brief video, then ponder those who believe that Covid is the flu and will not mask and will not get vaccinated.
Your brain could be controlling how sick you get — and how you recover
Diana Kwon has an interesting article in Nature:
Hundreds of scientists around the world are looking for ways to treat heart attacks. But few started where Hedva Haykin has: in the brain.
Haykin, a doctoral student at the Technion — Israel Institute of Technology in Haifa, wants to know whether stimulating a region of the brain involved in positive emotion and motivation can influence how the heart heals.
Late last year, in a small, windowless microscope room, she pulled out slides from a thin black box, one by one. On them were slices of hearts, no bigger than pumpkin seeds, from mice that had experienced heart attacks. Under a microscope, some of the samples were clearly marred by scars left in the aftermath of the infarction. Others showed mere speckles of damage visible among streaks of healthy, red-stained cells.
The difference in the hearts’ appearance originated in the brain, Haykin explains. The healthier-looking samples came from mice that had received stimulation of a brain area involved in positive emotion and motivation. Those marked with scars were from unstimulated mice.
“In the beginning we were sure that it was too good to be true,” Haykin says. It was only after repeating the experiment several times, she adds, that she was able to accept that the effect she was seeing was real.
Haykin, alongside her supervisors at the Technion — Asya Rolls, a neuroimmunologist, and Lior Gepstein, a cardiologist — are trying to work out exactly how this happens. On the basis of their experiments so far, which have not yet been published, activation of this brain reward centre — called the ventral tegmental area (VTA) — seems to trigger immune changes that contribute to the reduction of scar tissue.
This study has its roots in decades of research pointing to the contribution of a person’s psychological state to their heart health1. In a well-known condition known as ‘broken-heart syndrome’, an extremely stressful event can generate the symptoms of a heart attack — and can, in rare cases, be fatal. Conversely, studies have suggested that a positive mindset can lead to better outcomes in those with cardiovascular disease. But the mechanisms behind these links remain elusive.
Rolls is used to being surprised by the results in her laboratory, where the main focus is on how the brain directs the immune response, and how this connection influences health and disease. Although Rolls can barely contain her excitement as she discusses her group’s eclectic mix of ongoing studies, she’s also cautious. Because of the often-unexpected nature of her team’s discoveries, she never lets herself believe an experiment’s results until they have been repeated multiple times — a policy that Haykin and others in her group have adopted. “You need to convince yourself all the time with this stuff,” Rolls says.
For Rolls, the implications of this work are broad. She wants to provide an explanation for a phenomenon that many clinicians and researchers are aware of: mental states can have a profound impact on how ill we get — and how well we recover. In Rolls’s view, working out how this happens could enable physicians to tap into the power of the mind over the body. Understanding this could help to boost the placebo effect, destroy cancers, enhance responses to vaccination and even re-evaluate illnesses that, for centuries, have been dismissed as being psychologically driven, she says. “I think we’re ready to say that psychosomatic [conditions] can be treated differently.”
She is part of a growing group of scientists who are mapping out the brain’s control over the body’s immune responses. There are multiple lines of communication between the nervous and the immune systems — from small local circuits in organs such as the skin, to longer-range routes beginning in the brain — with roles in a wide range of diseases, from autoimmunity to cancer. This field “has really exploded over the last several years”, says Filip Swirski, an immunologist at the Icahn School of Medicine at Mount Sinai in New York City.
Some parts of the system — such as the vagus nerve, a huge highway of nerve fibres that connects the body to the brain — have inspired treatments for several autoimmune diseases that are currently being tested in clinical trials. Other studies, investigating how to recruit the brain itself — which some think could provide powerful therapies — are still nascent. Rolls, for one, has just begun examining whether the pathways her team has found in mice are also present in humans. And she has launched a start-up company to try to develop treatments based on her findings.
Although these developments are encouraging to researchers, much is still a mystery. “We often have a black box between the brain and the effect we see in the periphery,” says Henrique Veiga-Fernandes, a neuroimmunologist at the Champalimaud Centre for the Unknown in Lisbon. “If we want to use it in the therapeutic context, we actually need to understand the mechanism.”
A tale of two systems
For more than a century, scientists have been finding hints of a close-knit relationship between the nervous and the immune systems. In the late nineteenth and early twentieth centuries, for example, scientists demonstrated that cutting nerves to the skin could curb some hallmarks of inflammation2.
It wasn’t until the late 1990s that researchers in this field began drawing connections to the body’s master conductor, the brain. Neurosurgeon Kevin Tracey . . .
Big media is covering up Trump’s terrifying incoherence in a time of emergency
Dan Froomkin writes in Press Watch:
Here is some of what Donald Trump had to say Wednesday evening at a briefing intended to inform and reassure the American public about a public-health emergency:
This will end. This will end. You look at flu season. I said 26,000 people. I never heard of a number like that: 26,000 people, going up to 69,000 people, doctor, you told me before. 69,000 people die every year — from 20 to 69 — every year from the flu. Think of that. That’s incredible. So far, the results of all of this that everybody is reading about — and part of the thing is, you want to keep it the way it is, you don’t want to see panic, because there’s no reason to be panicked about it — but when I mentioned the flu, I asked the various doctors, “Is this just like flu?” Because people die from the flu. And this is very unusual. And it is a little bit different, but in some ways it’s easier and in some ways it’s a little bit tougher, but we have it so well under control, I mean, we really have done a very good job. [Watch video.]
Before and after knowledgeable public-health officials had made clear that a further spread of the coronavirus in the U.S. is inevitable:
I don’t think it’s inevitable. It probably will. It possibly will. It could be at a very small level or it could be at a larger level. Whatever happens, we’re totally prepared. We have the best people in the world. You see that from the study. We have the best prepared people, the best people in the world. Congress is willing to give us much more than we’re even asking for. That’s nice for a change. But we are totally ready, willing, and able to — it’s a term that we use, it’s “ready, willing, and able.” It’s going to be very well under control. Now, it may get bigger. It may get a little bigger. It may not get bigger at all. We’ll see what happens. But regardless of what happens, we’re totally prepared. [Watch video.]
On the stock market declines:
I think the financial markets are very upset when they look at the Democrat candidates standing on that stage make fools out of themselves, and they say, “If we ever have a president like this” — and there’s always a possibility, it’s an election, you know, who knows what happens? I think we’re going to win, I think we’re going to win by a lot — but when they look at statements made by the people standing behind those podiums, I think that has a huge effect.
Reporter: You don’t you think it had to do with the coronavirus?
Well, I think it did, I think it did, but I think you can add quite a bit of selloff to what they’re seeing. Because they’re seeing the potential – you know, again, I think we’re going to win. I feel very confident of it. We’ve done everything – and much more — than I said we were going to do. You look at what we’ve done. What we’ve done is incredible, with the tax cuts and regulation cuts, and rebuilding our military, taking care of our vets and getting them choice and accountability. All of the things we’ve done. Protecting our Second Amendment. I mean, they view that, the Second Amendment, they’re going to destroy the Second Amendment. When people look at that, they say “this is not good.” So you add that in. I really believe that’s a factor. But, no, what we’re talking about is the virus. That’s what we’re talking about. I do believe that’s — I do believe in terms of CNBC and in terms of Fox Business, I do believe that’s a factor, yeah. And I think after I win the election, I think the stock market is going to boom like it’s never boomed before. Just like the last time I won the election. The day after the stock market went up like a rocket ship. [Watch video.]
On the Democrats, in between asking for their cooperation:
I think Speaker Pelosi is incompetent. She lost the Congress once. I think she’s going to lose it again. She lifted my poll numbers up 10 points I never thought that I would see that so quickly and so easily. I’m leading everybody. We’re doing great. I don’t want to do it that way. It’s almost unfair if you think about it. But I think she’s incompetent.
I think she is not thinking about the country and instead of making a statement like that where I have been beating her routinely at everything instead of making a statement like that she should be saying we have to work together because we have a big problem potential only and may be it’s going to be a very little problem. I hope that it’s going to be a very little problem but we have to work together. Instead she wants to do that same thing with crying Chuck Schumer. [Watch video.]
On his devastating budget cuts to the Centers for Disease Control: . . .
How to Grow Re-enchanted with the World: A Salve for the Sense of Existential Meaninglessness and Burnout
An interesting (albeit for me overwritten) review of a book by Katherine May on re-awakening one’s sense of wonder and awe at the flow of life. Maria Popova writes in Marginalia:
There are seasons of being when a cloak of meaninglessness seems to slip over you, over everything, muffling the song of life. It is not depression exactly, though the two conditions make eager bedfellows. Rather, it is a great hollowing that empties you of that vital force necessary for moving through the world wonder-smitten by reality, that glint of gladness at the mundane miracle of existence. A disenchantment we may call by many names — burnout, apathy, alienation — but one that visits upon every life in one form or another, at one time or another, pulsating with the unmet longing for something elemental and ancient, with the yearning to see the world as beautiful again and feel its magic, to find sanctuary in it, to contact that “submerged sunrise of wonder.”
Katherine May explores what it takes to shed the cloak of meaninglessness and recover the sparkle of vitality in Enchantment: Awakening Wonder in an Anxious Age (public library) — a shimmering chronicle of her own quest for “a better way to walk through this life,” a way that grants us “the ability to sense magic in the everyday, to channel it through our minds and bodies, to be sustained by it.”
May — who has written enchantingly about wintering, resilience, and the wisdom of sadness — reaches for the other side of that coma of the soul:
This life I have made is too small. It doesn’t allow enough in: enough ideas, enough beliefs, enough encounters with the exuberant magic of existence. I have been so keen to deny it, to veer deliberately towards the rational, to cling solely to the experiences that are directly observable by others. Only now, when everything is taken away, can I see what a folly this is. I don’t want that life anymore. I want what [the] ancients had: to be able to talk to god. Not in a personal sense, to a distant figure who is unfathomably wise, but to have a direct encounter with the flow of things, a communication without words. I want to let something break in me, some dam that has been shoring up this shamefully atavistic sense of the magic behind all things, the tingle of intelligence that was always waiting for me when I came to tap in. I want to feel that raw, elemental awe that my ancestors felt, rather than my tame, explained modern version. I want to prise open the confines of my skull and let in a flood of light and air and mystery… I want to retain what the quiet reveals, the small voices whose whispers can be heard only when everything falls silent.
To lodge herself out of this existential stupor, she turns to . . .
This desire to escape an existential stupor may be for some what drives the desire to drink. (See previous post.)
A review of the alcohol debate
From what I’ve read, the evidence strongly indicates that in terms of health, the ideal intake of alcohol is zero drinks per day, even though some guidelines say as many as four drinks a day are fine. (I think that recommendation must come from the Wine and Spirits Wholesalers of America.)
Peter Weber in The Week has a good summary of current knowledge:
o drink or not to drink, that is … actually not the question most healthy adults should be asking. There is, after all, general agreement that binge drinking and heavy drinking are bad for your health and life more generally. And few alcohol experts argue that abstaining from alcohol is bad for you. But there are very mixed messages, based on imperfect studies, about the health risks — or benefits — of moderate drinking. Public health guidance is veering toward temperance, but with some important caveats. So is it better to tipple or teetotal? Here’s what you should know.
What is ‘moderate’ drinking? And binge drinking?
Moderate drinking can mean anything from one to four drinks a day — a drink, in this case, being a 5-ounce glass of wine (12 percent alcohol by volume), a 12-ounce serving of beer (5 percent ABV, low for craft brews), 8 ounces of 7 percent ABV brew, or 1.5 ounces of hard liquor (40 percent ABV). The Centers for Disease Control and Prevention’s (CDC) U.S. Dietary Guidelines advise no more than one drink a day for women and two drinks a day for men.
Binge drinking, as defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), is four or more drinks in a two-hour period for women and five or more drinks in two hours for men. Heavy drinking is eight or more drinks a week for women and 15 or more drinks a week for men.
To get the observed rewards of moderate alcohol consumption, “drinking 10 drinks Friday and Saturday nights does not convey the benefits of two or three drinks daily, even though your weekly totals would be the same,” Stanton Peele, an addiction/public health specialist, cautioned at Pacific Standard. “Frequent, heavy binge drinking is unhealthy.” If you have a history of alcoholism, one drink may be too many, and those with an alcoholic liver disease — alcoholic fatty liver, hepatitis, or cirrhosis — risk death when they drink.
Is it safe to drink any alcohol?
“Sorry to be a buzz-kill, but that nightly glass or two of wine is not improving your health,” Dana G. Smith writes at The New York Times. Decades of research “indicated that moderate alcohol consumption has protective health benefits,” the CDC says, but “recent studies show this may not be true.” The Global Burden of Diseases study, a sweeping global study published in 2018, suggested that no alcohol is good alcohol.
The research looked at the effects of alcohol use in 195 countries from 1990 to 2016, analyzing disease risks but also driving accidents, self-harm, and other factors in alcohol-related deaths. The possible heart benefits of moderate drinking were assessed to be outweighed by cancer and other diseases. “Our results show that the safest level of drinking is none,” the report said. “This level is in conflict with most health guidelines, which espouse health benefits associated with consuming up to two drinks per day.”
Some countries took note. New guidelines in Canada, unveiled by the Canadian Centre on Substance Use and Addiction (CCSA) in January, advise no more than two drinks a week, and less would be better. “The main message from this new guidance is that . . .
Full disclosure: Yesterday I bought a 12-pack of de-alcoholized beer. There are a number of brands I’ve seen recently in grocery stores — Sober Carpenter, for example, offers a variety of excellent full-tasting brews: Lager, IPA, Red Ale, and so on.
It turns out to be quite pleasant to enjoy a beer without getting slightly buzzed and dunderheaded.
I’ll probably try some of the de-alcoholized wines as well since the beers have turned out to be so good.
I did not make a decision to stop drinking. I just drifted away, and then discovered I liked not feeling tipsy. As my life improved, I felt less like drinking — perhaps causation goes the other way.
US is averaging one chemical accident every two days
Carey Gillam reports in the Guardian:
Mike DeWine, the Ohio governor, recently lamented the toll taken on the residents of East Palestine after the toxic train derailment there, saying “no other community should have to go through this”.
But such accidents are happening with striking regularity. A Guardian analysis of data collected by the Environmental Protection Agency (EPA) and by non-profit groups that track chemical accidents in the US shows that accidental releases – be they through train derailments, truck crashes, pipeline ruptures or industrial plant leaks and spills – are happening consistently across the country.
By one estimate these incidents are occurring, on average, every two days.
“These kinds of hidden disasters happen far too frequently,” Mathy Stanislaus, who served as assistant administrator of the EPA’s office of land and emergency management during the Obama administration, told the Guardian. Stanislaus led programs focused on the cleanup of contaminated hazardous waste sites, chemical plant safety, oil spill prevention and emergency response.
In the first seven weeks of 2023 alone, there were more than 30 incidents recorded by the Coalition to Prevent Chemical Disasters, roughly one every day and a half. Last year the coalition recorded 188, up from 177 in 2021. The group has tallied more than 470 incidents since it started counting in April 2020.
The incidents logged by the coalition range widely in severity but each involves the accidental release of chemicals deemed to pose potential threats to human and environmental health.
In September, for instance, nine people were hospitalized and 300 evacuated in California after a spill of caustic materials at a recycling facility. In October, officials ordered residents to shelter in place after an explosion and fire at a petrochemical plant in Louisiana.
Among multiple incidents in December, a large pipeline ruptured in rural . . .
Long-neglected chronic conditions finally come into the spotlight
POST-VIRAL syndromes received little medical attention for decades, until the covid-19 pandemic triggered tens of millions of cases of long covid, leading to massive research efforts.
This week, we report on the growing evidence that long-term conditions like myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are caused, wholly or in part, by viral infections (see “We’re starting to understand how viruses trigger chronic conditions”). Researchers have drawn links between ME/CFS and some herpes viruses, which infect us at a young age and stay in the body for the rest of our lives. There is also evidence that viruses play a role in fibromyalgia, a little-understood form of chronic pain.
Any improvement in our knowledge of these conditions is good news for those affected, of whom there are millions around the world.
How did such life-altering conditions come to be so neglected? It may be significant that they are more common in women than men, especially middle-aged women. One can’t help but suspect that there was some sexism, however inadvertent, in doctors’ tendencies to dismiss symptoms as psychosomatic. Even today, people with autoimmune conditions like multiple sclerosis, which are also far more common in women, often wait months or years for a diagnosis.
One reason long covid garnered so much attention was that many of the first to get it were medical workers. It seems doctors who might have dismissed strangers with hard-to-explain symptoms were less likely to ignore their colleagues. There is a lesson here about the importance of trusting a patient – one many doctors, happily, are taking to heart.
The media must also take its share of the blame. When ME/CFS was defined in the 1980s, it was casually dismissed by many journalists as “yuppie flu” or hypochondria. This wasn’t just cruel, it was ill-informed: as early as 1994, New Scientist reported research indicating that viruses were the key to ME/CFS. Nearly three decades on, the message is finally getting through.
New Study Confirms Extremely Low Regret Rates for Gender-Affirming Surgery
Giulia Castagnaro reports in Gender GP:
A new study has shown incredibly high levels of satisfaction with gender-affirming surgery. The study, published in ‘Plastic & Reconstructive Surgery’, the Journal of the American Society of Plastic Surgeons, says that 99.7% of trans people who had undergone such surgery experienced a degree of satisfaction with the outcome, an incredible figure in the context of any healthcare outcomes.
Regret rates of gender-affirming surgery
The Transgender Health Program ‘Regret and Request for Reversal’ released a new study focusing on the regret rates of gender-affirming surgery. They found that 99.7% of trans individuals were satisfied with their surgery.
A workgroup including cis, trans and gender diverse professionals met for a duration of 14 months. Their study consisted of patients who underwent gender-affirming surgery during a five year period between 2016 and 2021.
In total the Transgender Health Program examined 1989 trans patients. Only 6 patients (0.3%) requested reversal surgery or transitioned back to their sex assigned at birth. The study also concluded that an environment that normalises authentic gender expression, affirming each individual’s surgical goals without any judgement, are foundational to mitigating against regret.
What the findings suggest about regret
This study validates the results of previous research on regret rates. For instance, a 2022 Lancet study done in the Netherlands found that 98% of trans youth who went through gender-affirming healthcare continue their treatment into adulthood.
The 0.3% regret rate of our newest study is much smaller compared to other, common yet serious surgeries. Interestingly, knee replacement surgery has a dissatisfactory rate of 6-30%. [emphasis added – LG] The rate is up to 100 times that of gender-affirming surgery. However, knee replacement surgery does not go through the same scrutiny as trans healthcare does.
The evidence is overwhelming in showing that fears around ‘transition regret’ are blown out of proportion. Conservatives cling onto this myth in order to justify their anti-trans bills banning gender-affirming healthcare. Instead we focus on the joy that gender-affirming healthcare brings, and the positivity of so many people being able to live freely as themselves, celebrating who they are.
Research demonstrates the benefits of gender-affirming healthcare
Another 2022 study also found that . . .
I wonder what the regret rate is for back surgery. I bet it’s greater than 1%.
Update: I did find this:
Self-reported decisional regret was present in about 1 in 7 surgical patients. Factors associated with regret were both patient- and procedure related.
“1 in 7” = 14% (which is 47 times the regret rate for gender-affirming surgery).
For back surgery, the regret rate is 21%, 70 times the regret rate for gender-affirming surgery. Maybe we should stop people from getting back surgery (and knee surgery, etc.) if we are going to use regret rate as the criterion.
UPDATE: An interesting report in Medscape that learned more about de-transitioning.
Bari Weiss Is Full of Shit
Katherine Krueger writes in Discourse Blog:
Recently, Bari Weiss’ blog published an account from a “whistleblower” who used to work at a transgender healthcare clinic associated with Washington University’s children’s hospital. Unsurprisingly, the story depicted the clinic as a house of horrors.
Equally unsurprisingly, when some actual reporters examined the deeply alarmist, one-sided story Weiss was pushing, they found it to be total nonsense. It’s just the latest in a long pattern that proves one incontrovertible fact: Bari Weiss is completely full of shit, and you shouldn’t trust a thing she publishes.
The original first-person story, written by Jamie Reed, a former case manager whom Weiss pointed out is a “progressive” and “a queer woman married to a transman,” was published earlier this month by the Free Press, a site founded by the disgraced ex-New York Times opinion writer.
Reed portrayed the trans clinic as unrelentingly barbaric: “mentally ill” children misguidedly looking to transition rather than treat the root causes of their issues, a trans kid’s gender transition weaponized as part of a custody dispute between parents, children being prescribed hormone blockers and other medications willy-nilly and with little regard for side effects, both long and short term, and much more.
Reed wrote: “I left the clinic in November of last year because I could no longer participate in what was happening there. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to ‘do no harm.’ Instead, we are permanently harming the vulnerable patients in our care.”
But a deeply reported story published on Monday by the St. Louis Post-Dispatch—which involved interviews with some two dozen parents whose children sought treatment at the center—painted a starkly different picture, one that runs completely counter to Reed’s account.
Here are just a few highlights from the reporting (emphasis mine throughout):
Explosive allegations made public last month about a St. Louis clinic that treats transgender children have flung parents into a vortex of emotions: shock, confusion, anger, fear.
Kim Hutton, among those confused by the reports, views the treatment her son, now 19, received from Washington University’s Transgender Center at St. Louis Children’s Hospital as vital to making him the outgoing college freshman he is today.
“The idea that nobody got information, that everybody was pushed toward treatment, is just not true. It’s devastating,” Hutton said. “I’m baffled by it.”
Patients recounted that the staff explained procedures using both medical and everyday vocabulary.
“The doctor reached out to me after hours to answer my questions and make sure I understood what my treatment plan was,” said a 16-year-old from the St. Louis area.
Rather than the “rapid medicalization” and “poor assessment of mental health concerns” that Reed cited in a complaint sent to Bailey in January, parents reported a well-defined, step-by-step approach that could be halted at any time.
Slow, methodical adjustments began . . .
Later On 