Archive for the ‘Health’ 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 . . .
Rapini (aka Broccoli Rabe) Stew
Just from looking at the photo, you can tell that this recipe calls for my 6-qt wide diameter pot. I got a nice bunch of rapini (aka broccoli rabe) the other day and last night I thought up this recipe:
• 5 Cambray onions, sliced including leaves
• 10 or so medium-large mushrooms (all I had on hand), halved & sliced thick
• 2 cups cooked hulled barley (cooked yesterday, refrigerated overnight)
• 1 block extra-firm tofu, pressed overnight in TofuBud, diced medium-large
• 2 seedless lemons, diced
• 2 tumeric roots, minced (+ 2 tsp Georgia Gold turmeric paste)
• 1 large section ginger root, minced
• 18-20 smallish garlic cloves, chopped small
• 4 large red Fresno peppers, sliced
I added about 2 Tbsp extra-virgin olive oil to the pot, and I added the above to the pot as I prepped it. That filled the pot pretty well, so I turned the induction burner on to “4” and started cooking it to get more room by wilting the vegetables. I used my wooden spatula to mix the veg and then again to stir them occasionally as they cooked.
When I detected a little sticking (the barley, I imagine), I added:
• about 1/3 cup Pagoda 8-year-old Shaoxing wine (haven’t had this for a while)
• about 3 tablespoons Marukan rice vinegar
• about 2 tablespoons Kikkoman soy sauce
• about 1/4 cup veggie broth
I stirred to mix — and also deglaze the bottom — then covered the pan and cooked at 225ºF for 5 minutes. That reduced the volume in the pan. I then added
• 1 large bunch rapini, rinsed and chopped
• 2 teaspoons Spanish smoked paprika
• about 1/4 cup dried marjoram
• about 3 tablespoons freshly ground black pepper (for turmeric)
I cooked that for a while, stirring frequently, and then covered the pan and cooked at 225ºF for 10 minutes. I then added:
• 1 bunch asparagus, chopped in 1″ sections
I stirred to mix that in, then covered the pot and cooked at 225ºF for 7 more minutes. Then I turned off the heat and stirred in:
• about 2 cups shredded raw red cabbage.
• 1/2 cup roasted pumpkin seeds
I’m having a bowl now, and it’s tasty — somewhat spicy, due mainly (I think) to the black pepper.
The dish measures up pretty well to Greger’s Daily Dozen:
• Beans – tofu
• Whole Grain – hulled barley (an intact whole grain)
• Cruciferous Vegetable — rapini, red cabbage
• Greens — rapini, red cabbage
• Other Vegetables — onions, garlic, asparagus
• Herbs & Spices — paprika, majoram, ginger, pepper
• Fruit — lemons
• Nuts & Seeds — pumpkin seeds
Not included: Flaxseeds — but I did add 1 Tbsp ground flaxseed to the bowl I had. Mushrooms might be put in “Other Vegetables” even though a mushroom is not even in the plant family, much less a vegetable.
This will be meals for a few days.
The first bowl I ate plain and liked it, but I also like a little sauce, so I used a small whisk to mix together in a small bowl:
• Amano Mugi Miso (barley)
• Soom Tahini
• Smooth peanut butter from For Good Measure (peanuts and nothing else)
• Maple syrup
• Marukan rice vinegar
• Smak Dab Beer-Chipotle Mustard
• Lea & Perrins Worcestershire sauce
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.
Spring awakens
Back for a walk, still at 2 miles (36 minutes today). The effort required is clearly dropping. It’s a mild and sunny day, and some streets have trees really into blooming. My street — see photo at right — is one that comes into its own in April and some of May.
Very nice to see the back of winter.
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 . . .
Mouth tape — new to me
I was going to write “Who knew?”, but clearly a great many know since many brands of mouth tape are listed online. At right is a photo of the box I received yesterday, whose catalog entry reads:
KACEEY Mouth Tape 120 Pcs, Mouth Tape for Sleeping, Anti Snoring Devices for Better Nose Breathing, Less Mouth Breathing, Improved Nighttime Sleeping and Instant Snoring Relief
I learned of these via a comment by reader Tucker. I seem to be a mouth breather while asleep, waking up with a very dry mouth from time to time during the night, to the degree that I keep some water by the bed. I don’t notice that I snore, but of course, I wouldn’t.
At any rate, they were relatively cheap — 9¢ a night in US$ for one-time use of each — so I thought I’d try them. Last night was the first try.
The package says that they are “barely noticeable.” I assumed that was marketing hyperbole, but it is absolutely true. I could not tell that the tape was in place — I could not feel it all, except that I could not open my mouth. (No yawn possible.) But I slept easily — in fact, noticeably better than my normal night’s sleep. And this morning the tape peeled painlessly and easily away. It doesn’t resist being pulled off, but it fairly strongly resists being pulled sideways.
I’m impressed. The tape comes on little squares of nonstick paper — you peel off one to apply. I returned last night’s tape to the paper from which it came, curious to know whether it would stick for another night. [Tried it for a nap. It didn’t stick well enough to use a second time. – LG]
Thanks, Tucker.
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, . . .
Brain-healthy foods to fight aging
I naturally looked up the foods highest in lutein. The top 5 in order: cooked spinach, cooked Swiss chard, cooked mustard greens (cannot find it up here), cooked turnip greens (ditto), and cooked collards. Spinach is high in oxalic acid, though, so I wouldn’t eat it every day. I can get collards reading, and chard as well.
Greger also has a blog post worth reading: “Can Lutein Supplements Benefit Our Brain Function?“
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 . . .
The Game Changers is back on Netflix
The Game Changers is a very watchable movie about the effects of a whole-food plant-based diet on athletic performance and one’s health in general — and now it is again available on Netflix. The Game Changers has its own website, which notes:
Presented by James Cameron, Arnold Schwarzenegger, Jackie Chan, Las recewis Hamilton, Novak Djokovic, and Chris Paul — a revolutionary new film about meat, protein, and strength.
The site also has recipes for the foods seen in the movie.
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.
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 . . .
Excellent thread about reporters who have a block against trans kids
This thread by Isaac Bailey is very much worth reading in full. Click the date to see the whole thread.
Why Bret Stephens is a poor source of information — in this case, medical information
Thomas Pueyo writes in Uncharted Territories:
Recently, I stumbled upon some chatter against masks, and I thought it would be useful to dive into it for a couple of reasons:
Should we update our beliefs?
What can we learn about knowledge 1 from this debate?
This article encapsulates the debate:
But twitter threads are not a great way to be nuanced. This article is an in-depth and nuanced look at the studies, along with some criticism of my take, and my takeaways.
Jefferson et al. Main Results
This is the study that the articles reference (long version here).
This is a Cochrane systematic review. This is a strong point, as systematic reviews take in much more data, and the fact that it’s Cochrane reduces many of its potential biases. And it keeps results from 78 studies. Impressive!
Now let’s look at the studies themselves. The first thing I note is this: . . .
It’s a very interesting article. For starters, of the 78 studies, only 6 seemed relevant (7 if you include one study that was not reported). And then further inspection reveals that in fact, only two studies were relevant.
Read the article for other ways Bret Stephens seeks to deceive.
The Useful Idiots Fueling the Right-Wing Transphobia Panic
Ryan Cooper reports in The American Prospect:
Former New York Times columnist Bari Weiss recently founded a publication called The Free Press, and several weeks ago it published an account from a woman named Jamie Reed. Reed, who worked as a case manager at a Washington University gender clinic in St. Louis, made inflammatory accusations (with more in a sworn affidavit) that numerous children at the clinic were being carelessly shoved into irreversible gender treatment en masse.
Reed’s article went viral on social media, and was cited by numerous conservatives and transphobes as conclusive proof that too many kids are getting transition care. A couple of prominent liberals joined in as well. Matthew Yglesias cited it as credible on Twitter and Substack. “The picture she paints of the clinic’s treatment of children is ghastly. The affidavit she signed is even worse,” wrote Jonathan Chait at New York magazine. (It’s of a piece with an ongoing trend in liberal and centrist publications of writing anxious articles raising questions about youth transition care.)
There is just one problem. Reed’s account is a pile of garbage.
Even when it was first published, any sensible person should have seen some obvious red flags. Reed was not involved either in treatment or management, and her lawyer founded an openly transphobic organization. As Evan Urquhart pointed out at Assigned Media, she made several wildly mistaken claims about the side effects of some gender treatments. In her affidavit, Reed claimed that children came into the clinic identifying as “mushroom,” “rock,” or “helicopter,” only to be quickly given puberty blockers or hormones. This is not only facially preposterous, but in the last case suspiciously lines up with a common right-wing transphobic “joke.”
Sure enough, subsequent reporting has demolished Reed’s story. A woman named Danielle Meert whose child worked with Reed told a local NBC affiliate: “Saying that kids walk in and get hormones right away has not been our experience. It was about nine months until we had a puberty blocker implanted.” Another trans boy treated at the clinic contradicted her assertion that hormones were prescribed after just a couple of meetings with a therapist: “That’s not possible at all because a therapist has to see a patient for six months consistently, before they can even start writing the letter [of recommendation].” The Missouri Independent also interviewed numerous patients, who reported “any treatments were only undertaken after long consultations with doctors and mental health professionals.” Finally, the St. Louis Post-Dispatch recently interviewed numerous parents whose children had gone to the clinic, who “reported a well-defined, step-by-step approach that could be halted at any time.”
Reed’s intention, which she admitted on the record, was to shut down the gender clinic entirely. Indeed, the outrage prompted the Missouri attorney general to demand that the university shut down the clinic pending several state investigations, though it refused and is doing one itself.
As our recent Left Anchor podcast with Michael Hobbes and Urquhart goes into in detail, the United States is currently in the grip of a full-blown transphobic moral panic. Dubious, unrepresentative, or entirely made-up anecdotes are trumpeted across right-wing media, prompting conservative legislatures to place strict limits on transition care for minors, or ban it entirely—or in the case of a bill that recently passed the Oklahoma House, ban transition care entirely even for adults. They are attempting to shove trans people back into the closet, if not prevent them from existing.
Many centrist and liberal journalists are doing the same thing, only in a passive-aggressive fashion. The repeated front-page investigations in The New York Times over the past year are, just like Reed’s article, based almost entirely on anecdotes—some of them from openly transphobic organizations that are not identified as such—rather than actual studies, which have overwhelmingly found that transition is quite rare, detransition relatively unlikely, the regret rate of gender affirmation surgery low, and treatment difficult and expensive to access.
There are always risks and trade-offs with any health treatment, . . .
Later On 