Should you get that bivalent booster shot?

October 4, 2022 • 12:00 pm

My primary-care physician, Dr. Alex Lickerman, discusses the question everyone’s asking: should you get that bivalent booster? (For most people it would be their third booster and the fifth Covid shot). You can access Alex’s post by clicking on the screenshot below. (Be sure to look at the graphs and read it all.)

Alex always looks at the science before he decides what’s to recommend, and by that I mean the primary literature. When I first asked him about whether to get a booster, he said he didn’t know because the data hadn’t been published, and all the existing studies were on antibody levels in mice. Now he looks at more data. I’ll give his conclusion below but do have a look at his post.

My own decision was to get the booster simply because I’m traveling tomorrow, but, as always, consult your own doctor or decide from the data themselves. People tend to get covid on airplanes these days (a friend who just returned from Boston said only 5% of the passengers on her Southwest flight wore masks), and Alex said that it couldn’t hurt me to get one before traveling—but it might not help me much, either.

CONCLUSION: Should you get the bivalent booster? In the absence of human trial data, we might think about this question as follows: We can be reasonably certain that the bivalent booster will produce a level of neutralizing antibodies that diminishes the risk of infection from COVID. We don’t know how long that protection will last, but a fair guess would be from 3 to 6 months. If there is some reason you feel the need to reduce your risk over the next 3 to 6 months, say, for travel, getting the bivalent booster would seem reasonable. On the other hand, if in addition to being vaccinated, you’ve had COVID recently (meaning you’ve been infected with an Omicron variant), likely the same level of protection accrues, obviating the need for the bivalent booster. If your main concern is dying from COVID and you’ve already received the primary series and one or two boosters, your risk is so low that getting another shot would seem superfluous. If you are at high risk for dying from COVID, while there is no data to suggest the bivalent booster might further reduce your risk beyond levels afforded by the primary series and one or two boosters, there is also likely little risk of getting it. In the absence of data to guide us, this would then be a personal decision.

Often Alex answers questions in the comments, so if you have any, put them below. I’ll tell him that he might look at the comments.

The biomedical importance of sex (and its binary nature)

September 15, 2022 • 12:00 pm

One might almost think, with widespread denial of a sex binary of men and women—a denial that in most animal groups is both fatuous and ideologically motivated—that there are no average biological differences between men and women. “Blank slaters” tend to outright deny the existence of behavioral or cognitive differences between men and women, often doing so on the erroneous grounds that “some women are in the range of men’s scores and vice versa”. In such cases the concept of averages seems to have slipped their minds.

But as the dogs bark, the caravan moves on. Increasingly recognizing the biological and medical differences between men and women—note the implicit recognition of dividing up the species into two sexes— funding institutes and journals dealing with illness and medicine (as well as  are increasingly recognizing the importance of studying men and women separately (or partitioning the data by sex) in biomedical work. That includes using model organisms such as mice, which may show related sex differences. This is the topic of the new feature in the journal Nature shown below. Click on the screenshot to read (it’s free).

 


First, some indicators that dividing up test subjects by sex can give useful and potentially lifesaving results:

Many of science’s gatekeepers — granting agencies and academic journals — feel the same way. Over the past decade or so, a growing list of funders and publishers, including the US National Institutes of Health (NIH) and the European Union, have been asking researchers to include two sexes in their work with cells and animal models.

Two major catalysts motivated these policies. One was a growing recognition that sex-based differences, often related to hormone profiles or genes on sex chromosomes, can influence responses to drugs and other treatments. The other was the realization that including two sexes can increase the rigour of scientific inquiry, enhance reproducibility and open up questions for scientific pursuit.

When studies do include two sexes, the results can be important for health. For example, sex is known to affect people’s responses to common drugs, including some antibiotics. . .

And here are some important biomedical differences already detected:

. . .Despite the bumpy ride, the federal guidelines that were put into place in the early 1990s have led to some important medical discoveries, perhaps a signal that key revelations could emerge from basic research in a few years.

For instance, there are sex-based differences in the heart’s electrical response to several classes of drug, including antidepressants and antibiotics. As a result, sex-based dose adjustments are now recommended for some drugs.

Steroid hormones such as oestrogens and androgens are thought to be primary actors in many of these differences between men and women. For example, women metabolize propranolol, a blood-pressure drug from a class known as beta blockers, more slowly than men do. Researchers think that sex-related steroid hormones acting on the liver can exert these effects. Other factors could include body size and composition, such as the fat:muscle ratio, which tends to be higher in women.

The cut-offs for risk might also differ between men and women. A 2021 analysis of cardiovascular risk related to systolic blood pressure shows what happens if data for two sexes are pooled rather than analysed appropriately. The authors found that when data were pooled, the range for increased risk was a systolic pressure of 120–129 millimetres of mercury (mmHg). But the sex-specific analyses showed that for women, the risk actually begins to climb when systolic blood pressure tops 110 mmHg. If other studies solidify these findings, the result would be a sea change in risk calculation for cardiovascular disease.

That study, as it happens, “was very much inspired and motivated by an NIH request for applications” about sex differences in health outcomes, says Susan Cheng, a cardiologist at Cedars-Sinai Medical Center in Los Angeles, California, and senior author on the report. Without that call for studies specifically designed to look for sex differences, she says, “we had a lot of ideas, but not a thematic focus”. Their findings that men and women differ in risk cut-offs “was actually a real ‘eureka moment’”, Cheng says. “I was like, ‘how did we not see this before?’.” She attributes the results to the NIH’s challenge. “They made it all happen.”

And good for the NIH!

Now surely you can’t attribute all these differences to “socialization,” as the disparity in hormones is based on genes that are differently activated in men and women. Of course, differences in biology due to any factor, like the Patriarchy, still need to be studied for their biomedical effects. But it’s foolish to attribute everything like the above, including the response of the heart to drugs, to environmental influences.

And, of course, if there are no differences between the sexes with respect to a biological trait or response, we need to know that too! This is true for any groups that a priori may differ biologically, but men and women are the most obvious and least ambiguous grouping.

The article highlights some problems with past research, including an apparent lack of knowledge by investigators about how to use statistics to judge the effects of sex, including the simple dictum of using half men and half women in a generalized test on “the population”.  Below is one chart from the paper partitioning 147 biomedical studies starting in 2019. As you see, more than third of them (55) didn’t even consider sex as a factor to study (and that’s dead easy), more than a third (60) didn’t look for interactions between sex and treatment (essential if you want to know if a treatment works differently in men than in women), and only 32, or about 22%, looked for interactions between treatment and sex (16 of these reported a significant interaction, and 10 a nonsignificant interaction).

Finally, even when sex differences were found, as in the red group that didn’t look for interactions, most studies that found a difference didn’t test that difference statistically. The blue group is the one that used statistical tests, but even in that moiety, 6 tests didn’t report the results and one non-significant result was erroneoously reported as a difference.  I thought biomedical researchers would be more savvy than this.

Now there’s a few gestures in the paper toward the “sex isn’t binary” trope by bringing in gender. For example:

The publishing community is pushing for similar clarity. In 2016, it published the Sex and Gender Equity in Research (SAGER) guidelines, which set out how to report sex-based differences in published research. Individual publishers, including Springer Nature (which publishes Nature), have their own policies encouraging researchers to report results by sex, defined as a cluster of biological traits, and sometimes also gender, which is socially defined.

Since “gender” is a social construct, and progressives say there are a gazillion of them, I don’t see how you can report results by gender unless you lump everyone besides men and women as “other”. (I won’t quibble with “sex defined as a cluster of biological traits”, which is technically incorrect but good enough for the purposes of biomedical research.)

And this is thrown in as well, seemingly out of nowhere:

Defining sex as a crude binary, predicated on the chromosomes present, or on specific anatomy, could be too limiting. Some species, such as the nematode worm Caenorhabditis elegans, have one sex that makes only sperm cells and one that makes both sperm and egg cells. And in a vast assortment of species, sex is determined environmentally rather than chromosomally. And still other species can change sex during their lifetime. Placing cells, tissues or even whole organisms into a pair of categories takes on layers of difficulty in these contexts.

Note the pejorative adjective “crude,” meant, I think, to disparage the binary.  Once again they send in the clownfish, nematodes, and turtles, but these don’t refute the idea of separate sexes. Nematodes can be either males or hermaphrodites, the latter being both male (making sperm) and female (making eggs), some clownfish can change from male to female if the alpha female dies—but there are still two sexes, and temperature-specific sex determination, as occurs in many turtles, still gives you males and females. In that case the two sexes are developmentally channeled via an external stimulus rather than via chromosomes and genes, but there are still men turtles and women turtles. (Why some species do this is still not well understood).

 

The fact remains that these species do not show more than two sexes, that they are in the minority of vertebrates and in an even smaller minority of birds and mammals, and, in the end, humans aren’t clownfish, turtles, or nematodes.

Besides emphasizing the valuable lesson that men and women are biologically different in ways that can be important for medical treatment, this article also shows us that where it really counts, where the rubber meets the road—that is, when lives are at stake—the palaver about the binary of sex being a fiction vanishes.

None of this, of course, is intended to ignore those who have disorders of sex determination or transsexuals who have had hormone therapy or surgery, for those patients may need separate study rather than lumping them into one sex or another. That will be hard to do given the paucity of such people, but everyone deserves the best treatment that science can offer.

Are advocates of “affirmative therapy” pulling back?

September 13, 2022 • 12:45 pm

The other day I got an email from a reader suggesting that perhaps extreme “affirmative-care” activists for transsexuals are backing off of some of their more extreme claims—most notably that some adolescents who demand to transition from one sex to the other might be influenced, perhaps to their detriment, by social pressure.  I have little doubt that this occurs, and that it has influence some young people, for it’s been amply documented. Abigail Shrier’s book Irreversible Damage gives some examples, but that’s not the only source. Some trans people as well as authors have recounted this kind of pressure.

What I don’t know is how many transitions or requested transitions would have occurred without social pressure (which is often intense and always “affirmative”), nor are there much data about transsexuals who bowed to social pressure and then had regrets. (As far as I know, the vast majority of adult transsexuals do not have regrets.

The online impetus to transition is, of course, only part of the “affirmation” of this species of therapy, which involves a rah-rah-go-ahead concatenation of treatment from parents, doctors, and psychiatrists.  These people don’t mean to do harm by giving puberty blockers to children or adolescents; they think they are not only doing good, but are also adhering to what many in the therapeutic community see as the “best practice” for children or adolescents with gender dysphoria. Those standards are promulgated by an organization mentioned below.

Many of these with gender dysphoria”suffer from mental problems, are confused, or might really be gay, which behooves everyone to ratchet back on the instant affirmation. I’ve reported before that European countries are beginning to pull back on affirmative therapy, employing puberty blockers only in clinical trials, and practicing a more objective and watchful therapy whose purpose is to analyze and support rather than to affirm.  The U.S., however, seems to be digging in its heels, holding onto practices that in some cases could be harmful.

Let me emphasize that I don’t object to “affirmation”, but only after rigorous psychological (and medical) investigation shows that transitioning sexes would be the helpful thing to do. What you can’t do is put kids on a treadmill that involves medical intervention merely on the word of the patient and his/her desires alone. The patient much surely be old enough and mature enough to give rational consent.

And while I think there should be age limits for taking hormones (probably 16 or 18, but surely after puberty), I don’t approve of puberty blockers, whose long-term safety (despite the claims below) is not known. On the other hand I also don’t approve of states banning “gender affirming care” unless they specify exactly what they’re banning vis-à-vis psychological therapy and medical practice. Like abortion, such a complex medical issue should not be put in the hands of the state.

But I digress. Here’s the email I got from the reader, who referred me to the NBC article shown below:

Did you know that in the Standards of Care Version 8 released in July this year, the World Professional Association for Transgender Health, or WPATH, they give credence to the possibility of the social contagion hypothesis. Plus, NBC actually covered it. Notice how CHILDREN and trans activists suddenly poo-poo WPATH (previously considered to be the eminent authority on trans health issues). Also, the significance of 4,000+% increase in FTM [female to male] transition is because the majority of transitions prior to around 2015 were MTF. I think it’s important to pay close attention to the Tavistock situation and I’m glad you are.

The Tavistock Gender and Identity Development Service (GIDS) in London practiced hardcore affirmative therapy, often on adolescents, for several decades, treating thousands of young people and helping them transition. But it was closed after a scathing report on poor practice written by an external reviewer, Dr. Hilary Cass. Tavistock is now closed and its activities, made less “affirmative”, are being farmed out to clinics in London and Manchester (see this NYT article for details).

But when you actually read the NBC piece, from June, there’s not much reason to be heartened. Yes, there’s some pulling back from outright rejection of the “social contagion” hypothesis, but otherwise it’s a mess of contradictory claims and anecdotal testimony from patients. Click to read:

But the pulling back doesn’t consist of much,, and even that is drawing criticisms from activists (emphases below are all mine):

The World Professional Association for Transgender Health, or WPATH, a nonprofit professional association devoted to transgender health, will release its Standards of Care Version 8 in July. The last time the standards were updated was in 2012.

The nearly 400-page guidelines, which the association’s president, Walter Bouman, described in an emailed statement as “the most comprehensive set” of guidance ever produced for health care providers who support transgender people, include many significant changes, according to a copy of the guidelines that WPATH shared with NBC News.

The change that is drawing the most criticism is a new chapter dedicated to adolescent care, which was previously part of the chapter on care for children. The chapter presents conflicting statements on support for adolescents: It gives credence to the claim that more young people might be coming out as trans due to “social influence.” It also notes that there’s limited longitudinal research on the effects of gender-affirming care for adolescents, but a growing body of recent studies show it’s beneficial enough that withholding care would be unethical. 

Well, the second sentence seems to be a grudging admission, while the last one I don’t know how to interpret.  What does the growing body of studies say? And surely there can be hardly any data on “gender affirming care” versus “other kinds of care that are more objective and less affirming”! I suspect the data show that gender affirming care is better than no care, which it probably is in terms of self-assessment of patients, but the real question is of the relative efficacy of different kinds of care, some of which may result in out homosexuality rather than gender transition, and for that comparison I would bet shekels to donuts that there are no data.

WPATH is even more grudging about social contagion (my emphasis), devaluing the idea using the words “anecdotal evidence” and “small percentage”.

WPATH’s new chapter on adolescence also states that there has been a “sharp increase in the number of adolescents requesting gender care,” and that anecdotal evidence from a small percentage of people who have changed their minds about being transgender shows that some young people might believe they are trans due to “social influence.” 

But the biggest hedge is to point out that “social contagion” is just one result of social influence:

Regarding criticism of the information in the adolescent chapter about social influence, WPATH said in a statement that, “When discussing social influence, it is important to discuss that it is only one aspect of social development for adolescents, which should also include a discussion of the positive aspects of social connectedness and a feeling of belonging.”

. . . Ducar added that painting transness as a “social contagion” propagates “this myth of ‘grooming’ that the right wing has really been spreading,” even though there’s no data to support it.

(Dallas Ducar is “a psychiatric nurse practitioner and co-founder and CEO of Transhealth Northampton, a trans-led organization that provides health care to trans and gender diverse patients in western Massachusetts.”) But social contagion is not the same thing as “grooming”, and taking the former seriously doesn’t mean you accept the latter. And I don’t know of gender dysphoric youth going online and having their peers tell them that transitioning is a bad idea. It’s nearly always “affirming”, for the advice is often given by those who have transitioned and are seeking post facto affirmation.

According to WPATH, a bunch of peers on the internet telling you to go ahead and have puberty blockers (and telling you where to get them), surgery, and hormone treatment gives you a sense of belonging, which is good. In the abstract, a sense of belonging is good, but probably not when you’re looking for people to tell you to change sex, and how to do it.

There’s more:

Advocates say that language is evidence that WPATH has been influenced by the culture war debate created by some Republicans over the last few years, and it ignores the lived realities of transgender youths themselves.

“We know trans childhood is not a trend,” said Dallas Ducar, a psychiatric nurse practitioner and co-founder and CEO of Transhealth Northampton, a trans-led organization that provides health care to trans and gender diverse patients in western Massachusetts. “We know that gender diversity is part of the human experience. It’s been documented since the Neolithic period and the Bronze Age.”

OF COURSE it’s a trend, whatever its cause. Below are referral rates to Tavistock in just ten years. If you can’t see a trend, you’re blind. As for the Neolithic and Bronze age, well, ten to one we have early historical examples of people of one biological sex saying that they feel like they’re of another, but from these early periods? I’d like to see the  specific claims.

Not only that, but WPATH seems to be making the standards for transitioning more relaxed:

WPATH will make a number of changes to its recommendations for adolescent care in the new chapter. The group will lower the minimum recommended age that providers can prescribe hormone therapy to 14, from 16, if an adolescent has parental consent and meets a list of other criteria, including undergoing a comprehensive evaluation regarding their gender identity.

The association will also lower the minimum recommended age for some surgeries such as chest masculinization and breast augmentation to 15 and 16, respectively, down from 18 in the previous guidelines.

What about PUBERTY? Is that a criterion? And what about puberty blockers? Hormone therapy at fourteen? Is a child capable of making decisions about her whole life at that age? (Parents, many whom have heard that they should be “affirming”, aren’t of much use here.) If WPATH have tightened the criteria for allowing transitioning, that is good, but lowering ages seems to me a precipitous thing to do.

In the end, the article seems to strive for balance by giving both a positive and negative views of “affirmative care”:

Here’s the negative, which isn’t really an attack on affirmative care, but a call for more evidence before it’s practiced:

Allowing adolescents to access treatments worries some advocates who say there isn’t enough research to ensure that the care is safe in the long term.

“The body of evidence to support (hormone replacement therapy) or surgery for anybody, really, but especially for people who are young, it’s extremely flimsy,” said Corinna Cohn, who had gender-affirming surgery when she was 19 and felt afterward that she was “never going to finish becoming myself.”

Cohn, now 47, testified in favor of an Ohio bill in May that would’ve barred gender-affirming medical care for minors and would have also prohibited medical professionals from referring a minor to a different doctor for such care. She said she supported the bill because it would have given people who received transition care as minors the ability to sue their doctors if they regretted the procedure as adults and believed they weren’t mentally sound enough to consent to treatment.

And the response by Ducar:

Ducar said the assertion that there isn’t enough research to support gender-affirming care for adolescents isn’t true.

She said puberty blockers and hormones have been prescribed to cisgender children and cisgender adults for decades, and the scientific research in those populations has shown that the treatments are safe.

“We need to be investing more research money into understanding long-term effects of hormones or blockers or surgery in specific trans populations” — something she said Transhealth Northampton is working on — but “the lack of a robust amount of studies in specific trans populations does not imply that it’s not a valid form of treatment.”

As far as I know, puberty blockers haven’t been used long enough to show that they’re “safe”, and while hormone treatment may be “safe”, it also has side effects like sterility. The side effects of “bottom surgery”, too, are often dire.

As for the last paragraph, let’s see it again:

“We need to be investing more research money into understanding long-term effects of hormones or blockers or surgery in specific trans populations” — something she said Transhealth Northampton is working on — but “the lack of a robust amount of studies in specific trans populations does not imply that it’s not a valid form of treatment.”

If we don’t understand the long-term effects of surgery, hormones, and puberty blockers, then how can they represent a “valid form of treatment”? To me, “valid” means “safe and has been shown to work”.  But maybe WPATH has a different understand of the term.

In the end, the article just shows me that WPATH only reluctantly admits that maybe a few kids have transitioned because of social pressure, but hey, social pressure can be a good thing! And they’re still making quasi-scientific statements that aren’t supported by data.

Until recently I thought that if wokeness was going to recede in America, the first place we’d see it would be in the transsexual controversy, with a greater insistence on proper experimentation and care. After all, wokeness in medicine has the potential to do far more actual harm than wokeness in, say, academia, so the price of getting it wrong is higher.  This is what the Europeans are realizing. But in the U.S., not so much. My bellwether of wokeness has lost its bell.

Uncle Joe doesn’t help:

The New Zealand government subsidizes spiritually based “traditional” healing, with no evidence that it works

September 2, 2022 • 9:30 am

I have nothing in general against “traditional medicine” so long as it’s efficacious.  But that’s the rub, for, as the old Q&A goes: “What do you call traditional medicine that works? Medicine.” Thus, if something is being touted, especially by the government, as a useful form of medicine, it should have been scientifically tested to ensure that it does what it does.

Many of our modern drugs do indeed come from plants, but not all of those were used in traditional or “indigenous” medicine: some were found simply by surveying plants by medical scientists looking for useful effects. And of course without testing—with the gold standard being double-blind testing—you can’t tell whether a plant-based drug is better than a placebo.

This lack of testing appears to be characteristic of Rongoā Māori (“RM”), the traditional healing used by Māori in New Zealand, as reported by the article from the University of Auckland shown first below. And that lack of hard evidence for efficacy, while it shouldn’t lead to the banning of Rongoā Māori, shouldn’t lead to its declaration as being equal to modern medicine, nor should it lead to the government’s funding of untested remedies. But it’s already too late.

Since this is New Zealand, testing of Māori claims isn’t needed: tradition and anecdotal health claims are enough. Indeed, criticism of such claims is seen as racist.

And so, as the article below reports, the Kiwi government is funding a $100,000 program to “support injury recovery through Rongoā Māori. The program is funded through the “ACC” (Accident Compensation Corporation), a government body established in the 1970s to oversee the provision of support, treatment and rehabilitation for people involved in accidents. What we have, then, is government support for traditional medicine used to heal accidents.

But this is only the camel’s nose, for as the article below implies, this is just the first step in insinuating traditional healing into regular medical practice guaranteed to all Kiwis by their government.

In fact, in several ways Rongoā Māori is similar to Mātauranga Māori, traditiional “ways of knowing” that I’ve written about at length.  Both systems contain a mixture of theology, spirituality, and practical knowledge, both are imbued with fact claims that can’t be tested, and both are touted by their practitioners as deserving equal treatment with modern science.

It is the “equal treatment” that worries me, as neither MM or RM are coequal with science. Parts of MM can be considered empirical truths—”practical knowledge” like how to grow plants or catch eels—but I have no idea whether RM is efficacious in healing, at least beyond having a placebo effect. Finally, both MM and RM involve the ubiquitous valorization of the ways of indigenous people. Traditional customs should of course be taught as aspects of anthropology and sociology, important parts of New Zealand’s history, but shouldn’t be valorized to the point where they’re considered coequal to science or medicine.

What is involved in Rongoā Māori? The two articles below (click on screenshots), as well as the short video, give you an idea.

 

A shorter explanation of RM is here.

Here are the major components of RM, considered “holistic healing” with a big dollop of spirituality. This list comes from the two articles above and a few others.

a.) Traditional plant remedies.  The second article above gives a list of which plants are used and for what ailments. They must be used in a proper way—not just in their preparation, but ensuring that they’re gathered in traditional ways. Here’s what the second article says

The use of plant remedies does not require regulatory approval as long as they do not contain a scheduled medicine. However, as some pharmaceuticals are derived from plants, it is possible that Rongoā may contain active ingredients. As long as these pharmaceuticals are not purposely added to a remedy no restrictions apply to the use of such plants. Note that some plants, for example St Johns wort, can interact with conventional medicines.

  •  Appropriate tikanga (customs and rites) must be observed during the collection, preparation and storage of Rongoā.
  • Plant material must be correctly identified, gathered from non-polluted areas and prepared safely and hygienically.
  • Plants are usually crushed or dried and mixed with water or ethyl alcohol.
  • Plant remedies should only be prescribed and dispensed by Tohunga [traditional healers] to individual patients. Tohunga will advise on appropriate use.
  • Plant remedies should not be labelled with therapeutic claims. Labels should contain the ingredient(s), instructions for use, date of preparation, expiry date and who the remedy is prescribed for.

But if they cannot make therapeutic claims, why is the government paying for them? The important question is whether all or any of the drugs are useful in healing the ailments they’re prescribed for. Before you say “they must be, as they’re based on tradition,” be aware that a lot of spiritually-based traditional medicines tested in the U.S. have been shown to be bunk.

I have found no mention of testing for any of these plants. While some of the traditional herbal medicines may be efficacious, I see no sign that they’ve been tested or compared to modern pharmaceuticals that must be and have been tested.

b.) Massage. Massage can be useful in temporary relief, and even chiropractic can be useful for back problems, but the idea of adjusting the body because it’s diseased or out of whack, as evidenced in the articles and the video above, is dubious (I’d say “bunk,” but I’m being kind here.) Look at the video and watch them adjusting the feet of a man with a lower back problem. This is called romiromi, or “body alignment”.

c.) Lunar calendar relationality (maramatka). I don’t know how this is implemented, but it’s a big red flag.

d.) Meditation.  Your mileage may very, but I haven’t been prescribed meditation for any accidents I’ve had.

e.) Spirituality. This site at Health Navigator New Zealand explains that the spiritual side of RM is its most important aspect. A quote:

The most fundamental part of rongoā Māori is the traditional spiritual teachings, which can be seen as the basis of all traditional medicine. For Māori, rongoā is a part of the Māori culture from Tāne (God of the forest) who retrieved the three baskets of knowledge from Io (God) with the knowledge and teachings to guide us in this world.

As Māori, we believe we are part of the children of Tāne, along with the creatures of the forest such as the birds, trees and plants and, therefore, we have a strong connection to rongoā rākau. To learn rongoā, people have to become apart of the world of Tāne. They become connected and immersed in the forest, learning about a relationship far beyond the physical elements of the trees and plants. To utilise Te Oo Mai Reia, the healer must become immersed in ancient spiritual teachings while becoming a vessel to achieve the healing through Io alongside the use of physical touch to create balance and shift energies.

This is a form of shamanism.

Now this is all well and good, and if people want to use RM for diseases or healing from accidents, that’s their prerogative. I wouldn’t, but that’s my choice. But what I dislike is the insistence of these articles and practitioners that RM is just as good as modern medicine and should be offered coequally by the government. Here are two quotes from the University of Auckland article:

Located in Dance Studies in the Faculty of Creative Arts and industries, Ngākau Oho will provide a personalised recovery programme for 20 ACC clients and their whānau. In the process, the programme aims to reclaim and normalise rongoā Māori as a viable and everyday healthcare practice.

Recent efforts to address Māori health inequities across the health sector have focused on increasing the number of Māori health professionals and Māori access to culturally relevant rehabilitation services, says Dr Reihana.

Why is this in a dance studio? But wait—there’s more, and this is the worrisome part (my emphasis):

The programme will provide ACC with evidence-based insight on how rongoā Māori would be embedded within established healthcare services.

“We believe the approach we develop will be an innovation that can be used within the health system, and importantly, by Māori health practitioners, providers and whānau, helping ensure that rongoā Māori practices can be a real and easily accessed option for Māori in wellbeing and recovery,” says Dr Reihana.

This implies that RM will indeed become part of the government-funded healthcare system of New Zealand.  But what is the “evidence-based insight” that is forthcoming, since there is no mention of controls?

Finally, Donna Kerridge, the RM practitioner shown in the video above, says this:

“I think the Western health and healing system is awesome; it’s not better, it’s not worse.”

This is the insistence on absolute equality that is ubiquitous in both MM and RM, and it’s just wrong. If you have diabetes, do you want traditional herbal medicine or insulin? If you have an infection, do you want plants or antibiotics? Now many Māori do avail themselves of modern medicine instead of or alongside RM, and those people are the savvy ones. But it seems risible to say that RM is exactly as good as modern medicine. It can’t be, because its “testing” is based on anecdotes instead of scientific studies with controls.

I want to add one bit about “alternative medicine” in the U.S. In 1991, the government established the National Center for Complementary and Integrative Health as part of the National Institutes of Health. Its goal was to scientifically study “alternative medicine”, using the kind of controls that all science-based medicine uses.  As Wikipedia notes:

NCCAM’s mission statement declared that it is “dedicated to exploring complementary and alternative healing practices in the context of rigorous science; training complementary and alternative medicine researchers; and disseminating authoritative information to the public and professionals.” As NCCIH, the mission statement is “to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care.”

Since the NCCAM’s founding, over two billion dollars have been spent testing stuff like coffee enemas, intercessory prayer, magnet therapy, and so on. Not one “alternative treatment has worked. You’ll be amused at the examples given in the article about the treatments tested and their outcomes. A screenshot is below (click to enlarge). NOT ONE WORKED! And for the others, no results were ever reported, which means that they didn’t work, either.

Two quotes from the article:

In 2012, the Journal of the American Medical Association (JAMA) published a criticism that NCCAM had funded study after study, but had “failed to prove that complementary or alternative therapies are anything more than placebos.” The JAMA criticism pointed to large wasting of research money on testing scientifically implausible treatments, citing “NCCAM officials spending $374,000 to find that inhaling lemon and lavender scents does not promote wound healing; $750,000 to find that prayer does not cure AIDS or hasten recovery from breast-reconstruction surgery; $390,000 to find that ancient Indian remedies do not control type 2 diabetes; $700,000 to find that magnets do not treat arthritis, carpal tunnel syndrome, or migraine headaches; and $406,000 to find that coffee enemas do not cure pancreatic cancer.”  It was pointed out that the public generally ignored negative results from testing, that people continue to “believe what they want to believe, arguing that it does not matter what the data show: They know what works for them.” Continued increasing use of CAM products was also blamed on the lack of FDA ability to regulate alternative products, where negative studies do not result in FDA warnings or FDA-mandated changes on labeling, whereby few consumers are aware that many claims of many supplements were found not to be supported.

I’ll take my coffee in the other end, thank you.

And here’s a skeptical take (there are other criticisms given of NCCAM by doctors and scientists):

A 2012 study published in the Skeptical Inquirer examined the grants and awards funded by NCCIH from 2000 to 2011, which totaled $1.3 billion. The study found no discoveries in complementary and alternative medicine that would justify the existence of this center. The authors argued that after 20 years and an expenditure of $2 billion, the failure of NCCIH was evidenced by the lack of publications and the failure to report clinical trials in peer-reviewed medical journals. They recommended that NCCIH be defunded or abolished and the concept of funding alternative medicine be discontinued.

That money hasn’t been completely wasted, for it’s debunked therapies that people insisted would work. And those therapies won’t be approved by the FDA or used by rational doctors. Still, therapies are usually tested clinically when there’s some preliminary evidence that it might work. The tests above were simply based on “folk claims.”

 

All I’m asking is that Rongoā Māori be tested the same way as the NCCAM tested its putative remedies. If RM treatments aren’t (and they surely aren’t), Kiwi taxpayers should be protesting loudly about wasting their money on subsidizing spiritually-based medicine 

Recent pushback on “affirmative care” and hormone blockers

July 31, 2022 • 9:15 am

I’m guessing that some day historians will look back at the mishigass surrounding “affirmative care” and wonder what the deuce was going on in America in the 2020s.

Now let me say at the outset that I have no objection to people with “gender dysphoria” changing their gender using drugs and surgery. But I also think that transitioning should not be allowed until after puberty, and for two reasons. First, we don’t know eough about the safety of “puberty blockers” used to stop the process while adolescents figure out their sexual identity, and second, because children who are too young to make mature judgments should not be allowed to make irreversible decisions about their bodies. Eighteen seems to me to be an appropriate age to begin a medical process of transitioning.

My objection to “affirmative care” is not that we shouldn’t treat young people repectfully when they have with a sincere desire to transition, or fail to support them. But in the U.S., and previously in the UK, the default option was “affirmative care”, with no real psychological probing to dissect the roots of gender dysphoria and see if it was a form of distress that might resolve into a child becoming gay. “Affirmative care”, in its most extreme form, pronounces children who question their sexuality as transsexuals, deems them ready to change sex, and encourages them to go on puberty blockers and then hormone therapy. (There are few adolescents who, once on blockers, decide to stop them and “de-transition.”)

I’m cautious because the huge rise in the number of adolescents who declare themselves transsexual (particularly biological women who want to change gender) could have a number of causes: a relaxation of the stigma against transsexuality, an increase in the genetic propensity to change gender (that’s impossible given the rate of the rise), or—as Abigail Shrier argues in her book Irreversible Damage, a sort of social contagion—a sense among young people that it’s far more cool to be trans than to be gay, and because such people get a lot of props and attention. (Shrier doesn’t claim that transition is always prompted by social contagion.)

Only the first and second hypotheses are supportable, and I think both are at play, but to deny that social contagion hypothesis plays any role in the temporal changes shown below is to deny reality. There are simply too many cases of seeing “detransitioners” (“desisters”) discuss the social pressure they were under, and of others seeing it at play in real life.

Below is an article by writer Lisa Davis you should read (click the screenshot). It’s on Bari Weiss’s site (and I don’t want to hear that Weiss is “alt-right” so that you can ignore it), and explains how several European countries, including the UK, Sweden, France, and Finland, are changing course on affirmative care, replacing it not with a refusal to let people transition, but with a more compassionate and psychologically-oriented inquiry into the roots of gender dysphoria.

The change in Europe comes from a realization of the weakness of the evidence supporting two assertions of trans activists: that puberty blockers are completely harmless and can be completely reversed if someone changes their mind, and that allowing medical transitioning reduces the rate of mental illness and suicide among those with gender dysphoria. We now know that the evidence for the first claim is wrong, and for the second is plagued by methodological weaknesses. We simply need a lot more data, and the Europeans are being cautious while Americans ignore the counterevidence. That’s unwise given the drastic and irreversible nature of many transitions.

Here’s a graph from the article above showing the increase in referrals to the gender-affirming Tavistock clinic, and this is just between 2009 and 2017 (original source here). Both the proportion of and the increase in biological females (compared to males) referred to the clinic for affirmation have increased substantially. If your hypothesis is that the rise reflects purely the de-stigmatizing of transsexuality, this discrepancy between the sexes must be explained. Of course, it also has to be explained if you hold a “social contagion” hypothesis.


 

I completely agree with Andrew Sullivan in his Friday column section called “Yes, the trans madness is real” when he says this:

I recall a few years ago having a heated conversation with some well-meaning trans activists who appeared completely aghast when I voiced some worries about the treatment of kids with gender dysphoria. What if the kid is gay, I asked? How do we know for sure if a pre-pubescent child really is trans and not just experimenting with gender the way many gay kids do? And are these nine-year-old children really mature enough to make life-long decisions that could make them permanently sterile, keep them on drugs for the rest of their lives, or permanently remove their capacity to have an orgasm? How could pre-pubescent kids even know what an orgasm was?

My activist friends were shocked. It seemed to me as if they had never previously been asked these questions. They were all very-well intentioned, and not entirely wrong — in a few extreme cases, there might be a reason to permanently change a child’s sex. But they assured me that no such errors were ever made, that the process was entirely ethical, and that all medical authorities backed it. They insisted that puberty blockers were harmless and fully reversible. The bubble is real.

I think it’s better to give kids with gender dysphoria extensive psychological counseling—NOT affirmative from the outset, i.e., not “affirming” that children who say they’re of another gender must be right—before giving them irreversible medical treatment, treatment that we now know can render people sterile, unable to enjoy sex, and, in the case of puberty blockers, cause other medical damage. Sullivan, who experienced dysphoria himself, says that many adolescents go through a period of confused sexuality, and perhaps would become gay were it not more fashionable to change gender.

Both articles detail some big changes in Europe about how to treat gender dysphoria. I’ll summarize what most of us know already (the first article above gives links):

  • Sweden has revised its guidelines for treating gender dysphoria in adolescents, arguing that gender-affirming treatment may be more harmful than good, and claiming that affirmative treatment “should be offered only in exceptional cases.”
  • Finland, using an evidence-based approach showing that many young people seeking transitioning had severe psychiatric problems, that there were risks to using puberty blockers (see below), both physically in in terms of sexuality, changed its protocol for treating gender dysphoria:

(From Davis’s piece): In Finland, for patients who fit the profile of participants in the Dutch study, after a prolonged period of evaluation, and with a multidisciplinary team including a psychiatrist, psychologist, social worker and nurse, puberty blockers may be started near the onset of puberty, and cross-sex hormones may be possible starting at age 16. Assessments take place at two gender identity clinics; gender surgeries are offered only at one center. Both Finland and Sweden now stress gathering data and extensive follow-up.

My own view is that giving puberty blockers “near the onset of puberty”, or at age 16, is too young.

  • The National Academy of Medicine in France has urged caution in proceeding with drugs and surgery in cases of gender dysphoria since some of it may be due to social contagion. It recommends more extensive psychological counseling of those with gender dysphoria.
  • The Tavistock clinic in London (a notorious place for affirmative therapy) is to be closed, replaced by a number of regional clinics practicing a different brand of care. This is the result of a critical review headed by Dr. Hillary Cass, commissioned to review Tavistock and its practices. Their recommendations, which the government accepted, was to de-centralize the clinics, adopt more “holistic care”, and ratchet back on the use of puberty blockers, which now appear to have possibly severe medical consequences.
  • The medical consequences of puberty-blocking drugs like Lupron, which according to Sullivan have been known for a while, include brain swelling and loss of vision, possible bone damage, and other irreversible effects. In fact, these blockers are used for other conditions, and I understand are always prescribed by doctors treating gender dysphoria “off label”, i.e., they’re not specifically recommended by the FDA for stalling puberty while a child ponders its gender.

This month the FDA added brain swelling to the warning labels of puberty blockers. The sample size is small, and these problems appear only in biological females (the most common sex experiencing gender dysphoria), but an FDA warning is nothing to take lightly. Here’s a tweet about the dichotomy between the American use of blockers willy-nilly in American “affirmative care”, and the warnings on drug labels. Clearly, more research needs to be done (that’s what Sweden and Finland concluded) before blockers are used so readily. But, in contrast to the caution about other new remedies, like Covid-19 vaccines, the standards for usage are very lax in the U.S., and were in the UK as well:

Nevertheless, as both Sullivan and Davis point out, the U.S., urged on by the Biden Administration, is going full steam ahead with affirmative care.

Sullivan:

In the US, however, as many states move in the European direction, the left is pushing harder. California has a bill offering sanctuary for any child seeking a sex change. The Biden administration still insists that “every major medical association agrees: gender-affirming care is life-saving, medically necessary, age-appropriate and a critical tool for health care providers.” The absolute certainty, compared with the second thoughts in Europe, is striking.

Davis, referring to Finland and Sweden’s revised guidelines in comparison to America’s (my emphasis):

Both guidelines starkly contrast with those proffered by the Illinois-based World Professional Association of Transgender Health, an advocacy group made up of activists, academics, lawyers, and healthcare providers, which has set the standard when it comes to transgender care in the United States. WPATH will soon issue new standards that lower recommended ages for blockers, hormones and surgeries. (WPATH did not respond to a request for comment.)

WPATH’s position is in keeping with an array of U.S. medical associations and activist groups across the country that insist gender-affirming care is “life-saving.” Assistant Secretary of Health Rachel Levine, who is herself a transgender woman, recently asserted that there is a medical consensus as to its benefits. Some activists and gender clinicians in the U.S. feel that WPATH doesn’t go far enough, asserting that any child who wants puberty blockers should get them, for instance, or claiming that a teenager who later regrets having her breasts removed can just get new ones.

In Sweden and Finland, this issue has been primarily a question of health and medicine. Here in the U.S. it is a political football.

Why the ignoring of evidence and lack of caution in the U.S. as opposed to Europe? Why are we not following the examples of countries that take an evidence-based approach to medical policy about gender dysphoria? Surely one of the reasons is “wokeness”: the idea that changing gender is to be admired as an act of courage, and that transgender people, or those who wish to become so, should be valorized as members of stigmatized minorities. And, sadly, the Biden administration has bought into the pronouncements of the extreme Left, which include unquestioning approbation for “affirmative care.”

Yes, there’s some stigma about transgender people, and yes, we should help those who, after intensive medical and psychological examination, are deemed to be serious about their gender misindentification rather than confused about their sexuality. And yes, we should treat transgender people in nearly all respects as equals to members of the biological sex they assume.  But what we should not do is, in the interests of seeming virtuous, rush children and adolescents into very serious and irreversible medical procedures without proper vetting.

Med students walk out on speaker because she’s “pro life”, but wasn’t talking about it

July 27, 2022 • 12:45 pm

The situation I’ll address here is summarized in an article on Bari Weiss’s Substack,  “The message America’s future doctors need to hear”  by Vinay Prasad, associate professor of Associate Professor, Epidemiology & Biostatistics at the University of California at San Francisco Medical School. It refers to a student mass protest of a speaker at the University of Michigan medical school’s “white coat ceremony.” In this ceremony, entering students don their white doctor’s coat for the first time and take a Hippocratic oath. There’s a speaker, too, but this one was the subject of protest because she is “pro life”, i.e. anti-abortion. The details:

Dr. Kristin Collier is an assistant professor of internal medicine at the University of Michigan, where she has served on faculty for 17 years. She also is the director of the medical school’s Program on Health, Spirituality and Religion and has been published in publications including the Journal of the American Medical Association and the Annals of Internal Medicine.

Many describe her as a consummate physician and superb teacher—deeply liked and respected by her peers. That’s why, out of some 3,000 faculty at Michigan, Dr. Collier was chosen by students and her peers to be this year’s White Coat Ceremony speaker. The White Coat ceremony is one bookend of medical school (graduation is the other), where students put on their white coats for the first time, take a modified Hippocratic oath and begin the long path to becoming a doctor.

The trouble is that Professor Collier has views on abortion that are out of step with many Michigan medical students—likely the majority of them. She has stated that she defines herself as pro-life, though she does not state the extent of her position (i.e. whether she allows exemptions for rape or incest). In that same interview, in which she talks about her personal transformation from a pro-choice atheist to a Christian, she laments the intolerance for religious people among medical colleagues. “When we consider diversity in the medical profession, religious diversity is not—should not—be exempt from this goal.”

I’m wondering why the students chose Collier if many didn’t want her to speak. Importantly, she wasn’t going to speak about abortion—that was made clear by the administration before the ceremony—but she was still deemed unacceptable for many students:

. . . hundreds of students and staff from [signed] a petition demanding Dr. Collier be replaced with another speaker. “While we support the rights of freedom of speech and religion, an anti-choice speaker as a representative of the University of Michigan undermines the University’s position on abortion and supports the non-universal, theology-rooted platform to restrict abortion access, an essential part of medical care,” they wrote. “We demand that UM stands in solidarity with us and selects a speaker whose values align with institutional policies, students, and the broader medical community.”

And when Collier rose to speak, many students simply walked out. This was not a spontaneous reaction to what she was saying, but a planned demonstration, which is legal but which I see as disruptive (nevertheless, I don’t think it should be banned). Here’s a video showing the action:

There are several issues here, including the students assertion that the University has an official position on abortion.  While the University can and probably does perform abortions, that’s different from taking an official stand on it, for that chills the speech of people who are “pro life”. As readers here know, I’m a hard-line pro-choicer, and so disagree strongly with Dr. Collier’s views on that issue.  But I would still go to her talk, and I wouldn’t walk out.

Further, there’s the idea that if someone expresses a view you don’t like, you should boycott that person. I don’t agree with that view, either. The proper way to deal with this talk would have been either not to go, picket outside, or write letters countering Collier’s views. Those are non-disruptive ways of addressing the disagreement. Walking out is intended to discombobulate the speaker (to express numerical opposition, just picket outside). But the students did have a right to walk out.

Finally, there’s the issue of free speech—not in the First Amendment sense, as nobody violated the Constitution here. I’m talking about the value of allowing people to speak with whom you disagree, on the chance that you might either change your mind, hone your own opposition, or (especially in this case) learn something. Remember, Collier was not going to talk about abortion.

This is free speech in the “On Liberty” sense as outlined by John Stuart Mill. These students clearly haven’t absorbed that, nor do they have any time to listen to anyone with whom they disagree on the issue of abortion.

The students here are the ones who lost out, and I feel sorry for them. Yes, they made their point, but the main point I absorbed is the Manichaean view that Dr. Collier is one of the “bad ones,” and thus is not worth hearing. If everyone holds this view, everyone will wind up walking out on everybody, for there is nobody with whom we’ll agree on everything. I’ll listen to Liz Cheney talk about Trump even though I’m opposed to many of her views as a Republican.

In the end, akk debates will end, and we’ll wind up having a fragmented, authoritarian society riven by adhering to one of Lukianoff and Haidt’s three great untruths: “Life is a battle between good people and evil people”.

The quick take: students plugged their ears and went “nyah nyah nyah nyah.”

American hospitals refuse to adhere to new price transparency law

June 8, 2022 • 11:30 am

UPDATE: To underscore the opacity of the present system, its greed, and the way patients are overcharged, read this NYT article from May, “She was told that surgery would cost about $1,300. Then the bill came: $229,000.” Lisa Melody was charged the “chargemaster” price, even though she didn’t agree to that and her insurance company told her otherwise. When she wouldn’t pay that outrageous price for spinal fusion surgery, the hospital in Colorado sued her. A jury found for Melody, and her final bill was only $767. (h/t Enrico)

_________________________________

In 2020, when I had hernia surgery, I posted the bill that my insurance company received from the University of Chicago Hospitals. It was nearly $64,000!  Europeans and Canadians were properly shocked at these prices, which indicated a big profit for the hospital. Now I didn’t pay nearly that much, as I have a good insurance plan, but the insurance company had to pay it (sometimes employers themselves foot part of the bill); but Americans without insurance would have be billed at that full price.

Shockingly, until last year, there was no way to find out these prices in advance so you could do comparison shopping. As I said in the earlier posts, almost no hospitals publicize the costs of their services or the medications they give you, so you don’t know what the bill is until after you’ve been treated. As I wrote at the time:

Now, can you know these prices in advance so you can comparison shop among hospitals? The answer is NO. While hospitals differ drastically in their costs, it would be nearly impossible to get a figure for the entire operation in advance. Some hospitals, like the Surgery Center of Oklahoma, will quote you a flat price (and for them, my redo surgery [the hernia operation had to be redone] would have been free), and that price, for hernia surgery similar to mine is, I’m told, about $4,500: only 7% of what the bill was above. Nor are these cheaper hospitals worse at what they do: there seems to be little correlation (or even a negative correlation) between the price of a procedure and the quality of the facility and the doctor. (My doctor at the U of C, by the way, was excellent and has a superb record, but more on doctor-shopping later.)

What about the costs above? Are those the sticker costs that then get discounted when billed to the insurance companies (i.e. are they they the so-called “Chargemaster list prices” for each item), or are they the already-discounted costs given to my insurance company?  I have no idea.  It’s as if you went to the grocery store and there were no prices on the food items, and then after a month you get a bill saying, “This is what you have to pay for groceries.

At the post above, Dr. Lickerman answered many readers’ queries (just search for “Lickerman”), which explained more about how dire health care prices were. Of course, other countries have single-payer insurance, but in many cases that results in a parallel series of private insurance because patients don’t want the long wait associated with many national single-payer systems. When I snapped a tendon in my finger in New Zealand, for instance, I could get treated for free, but it would be at least a five-hour wait in the hospital, or I could pay out of my pocket and get reimbursed in the U.S. I chose the latter, and fortunately my insurance company reimburses for medical treatment overseas.

The lack of transparency in pricing did two things: it prevented consumers from comparison shopping to find the cheapest price (especially important if you are paying out of your pocket or have a high deductible), and it generated huge profits for hospitals, which can adjust its “MSRP” prices as well as the discounts from those prices that are given to insurance companies.

This was supposed to be rectified when in 2020 Congress passed The Health Care PRICE Transparency Act, requiring hospitals to disclose the prices of 300 “shoppable” procedures as well as the billing costs for many drugs. It was supposed to take effect on January 1, 2021, and there were fines for violations.

As of today, almost no hospitals are complying, there is almost no transparency, and fines aren’t even being imposed. I heard about this on the NBC Evening News last night, and decided to see what’s going on. What’s going on is that hospitals, greedy for $$, are ignoring the law. And the Biden Administration isn’t doing anything about it. For laws can be enforced by the executive branch of the government.

Hospitals have four tiers of pricing, and all of these prices should be disclosed for each drug and service.  I quote my doctor, Alex Lickerman, here about these tiers:

Charge master price = this is like sticker price on the car. No insurance company expects to pay this. Hospitals create this because they know different insurance companies will be willing to pay different percentages of their charge master price. When insurance companies advertise that they have the biggest “discounts,” what they mean is reductions down off a hospital’s charge master price (which hospitals historically haven’t disclosed). So BCBS might get a 50% discount. Medicaid might get a 95% discount off the charge master price. Medicare might get an 80-85% discount. (I’m making these discounts up).

This is what the uninsured patient pays, and if they don’t pay (they must be treated), they will be dunned and their credit ruined.

The minimum negotiated price = this is the greatest discount, and therefore the lowest price, a hospital gives a third-party insurance payer.

The maximum negotiated price = this is the lowest discount, and therefore highest price, a hospital gives a third-party insurance payer.

Cash price = the price a patient would pay without insurance. Ironically—and horribly—this is often the full charge master price; that is, the price for the service WITHOUT a discount, which is then charged to people to have the least ability to pay it, i.e., the uninsured.

All these prices were suppose to be disclosed by hospitals on the Internet at the beginning of last year, but very few hospitals have obeyed. These sites (here, here, here, here, and here) give the story:

1). There’s a tremendous variation in prices among hospitals that do list them. The New York Times article from last summer is the best source of information:

The data show that the charge for a joint replacement can range from a low of $5,300 at a hospital in Ada, Okla., to a high of $223,000 at a facility in Monterey Park, Calif. Or within the same area, charges range from $21,000 to $46,000 to treat heart failure in hospitals in Denver, Colo.

Here are some disparate prices from that NYT article, and you can see more examples from the paper. Note that the vertical lines show four times what Medicare pays the hospital (for a colonoscopy) and TEN times what the government pays (for an MRI scan). Almost no insurance company pays anything near as low as what the government pays:

It holds for drugs too, which are often particularly inflated in price. This is for a rabies drug (text from the NYT):

Prices were still secret when Brian Daugherty went to an emergency room near Orlando, Fla., for a rabies shot after a cat bite last summer.

I tried to get some pricing information, but they made it seem like such a rare thing they couldn’t figure out for me,” he said.

He went to AdventHealth Orlando because it was close to his house. That was an expensive decision: It has the highest price for rabies shots among 24 hospitals that included the service in their newly released data sets.

The price there for an adult dose of the drug that prevents rabies varies from $16,953 to $37,214 — not including the emergency-room fee that typically goes with it.

Mr. Daugherty’s total bill was $18,357. After his insurer’s contribution, he owed $6,351.

2.) Few hospitals are complying with the law. 

“One year after this law making hospitals show prices came into effect, unfortunately, we found that only 14.3% of our country’s. . . hospitals are complying with this law,” PRA founder and CEO Cynthia Fisher said.

The NBC News last night reported only 15% compliance.

Yet hospitals are violating the law left and right, and are not being penalized, even though the penalties are trivial compared to the profits that hospitals rake in. Here’s the law:

The law required hospitals to post prices for all services, including gross charges and discounted cash prices.

In addition, the rule requires the information to be available in two formats, a machine-readable file that contains pricing data for third parties to compare between hospitals and a shoppable service list that displays specific services offered at the facility.

And the fines:

Under the final rule, for hospitals with thirty or fewer beds, the minimum civil monetary penalty will increase to $300 per day. For hospitals with more than thirty beds, the minimum civil monetary penalty will be $10 per bed per day, capped at $5,500 per day. This means the minimum amount for noncompliance with the rule would be $109,500 annually while the maximum amount is $2,007,500 annually. CMS is also requiring that the machine-readable files with pricing information be accessible to automated searches and direct downloads.

In response to a reader’s question after my post about why the bills were so much higher when insurance was involved, Dr. Lickerman said this:

Great question! The answer is, many providers will charge a lower cash pay price because payment is immediate. The bill is higher when insurance is involved because providers create a “chargemaster” which has prices that are like an MSRP when you’re buying a car. It represents a ceiling price–an initial price–in a negotiation that almost no one pays. Providers inflate their chargemaster prices because they know they’ll be forced to negotiate different discounts with insurers. So while private insurers get maybe a 50% discount off chargemaster rates, Medicaid takes maybe a 90% discount (which is why most medical systems consider Medicaid to be “bad” insurance: it reimburses them for a given service at the lowest rate). This is why, paradoxically, if you’re uninsured, you may pay more than even large insurance companies. For reasons that defy logic, medical systems will sometimes quote the uninsured their chargemaster rates–the highest price–rather than a true cash pay rate.

If you’re getting care from a small provider (vs. a large hospital system), you’re much more likely to find a reasonable cash pay rate that ends up being cheaper than going through your insurance (depends on your yearly out-of-pocket max and how far into it you’ve already spent).

Large hospital systems likely raise their chargemaster rates to meet revenue targets. Contrary to what you’d expect, insurers are happy to pay these rates because it enables them to increase premiums, which they want to increase because Obamacare imposed a medical loss ratio of 20% on most insurance plans. That means insurers must spend 80% of their revenues (premiums) on healthcare claims. If you’re limited to only 20% of the pie to make profits, what do you do? Find a way to make the pie bigger so that the absolute dollar amounts you bring in goes up. This is what the insurers have done, and it’s why premiums have gone through the roof since Obamacare was enacted. The unit cost of most medical care has increased mostly with inflation. Healthcare prices set by providers have increased by far more.

Even employers find it hard to determine what they will pay for an insurance plan, as they must hire lawyers and consultants to get around the great wall of secrecy. And sometimes even then it doesn’t work, so they’re buying a plan for their employees whose benefits they don’t know and, since employers must sometimes pay some benefits, they don’t even know how much they would be liable for.

This is greed, pure and simple, and it hurts everyone. Many Americans are impoverished by the cost of healthcare and their inability to do comparison shopping.

There are multiple solutions: Single-payer health, Obamacare for everyone, with government help in paying for private insurance, enforcement of transparency, negotiation of drug prices and so on.

Everyone usually prefers the system they have now, unless they have no insurance. I’m wary of the single-payer system just because it hasn’t worked out well in many places. Here’s what Dr. Lickerman said about it on my earlier post, and at the risk of reader ire in Canada and the UK I’ll present it anyway:

Great question. The idea of having a single payer for all healthcare (the government) definitely has its supporters here in the U.S. But it would likely lead to what we see in Canada (the system outside the U.S. I know best), which is untenable wait times for anything other than emergent care, which is all handled by already-burdened ERs. You won’t go broke getting healthcare in Canada like you can in the U.S., but you won’t have appropriate access to healthcare either. The single payer system there has resulted in a dearth of primary care physicians that’s even worse than in the U.S.

But whatever the solution, it’s not what the U.S. has now, and countries like Canada and the UK do have nearly free single-payer care, which does deal quickly with emergencies.  Here’s what the NYT got when it solicited “explanations” from hospitals in its article last August. Look at these Scrooges!

At the Biggest U.S. Hospitals, Few Prices Are Available

Six months after the new rules took effect, the Times reached out to the highest-revenue hospitals that had posted little or no data about their negotiated rates or cash prices. Here’s what they had to say:

We will not be providing a statement or comment.

N.Y.U. Langone has not published its negotiated rates or cash prices.

Services that do not have a fixed payer-specific rate are shown as variable.

Stanford Health Care has not published its cash prices. Of more than 300,000 possible combinations of insurance and medical treatment in its data file, it includes prices for 479.

We do not post standard cash rates, which typically will not reflect the price of care for uninsured patients.

Cedars-Sinai Medical Center, in Los Angeles, has not published its cash prices. The hospital initially posted a 2.5 GB data file composed almost entirely of more than one million lines that contained no data. After The Times inquired about the large file size, the hospital reduced it to a 1.4 MB file.

We have listed the fixed rates where possible and, where that is not possible, have listed them as ‘variable.’
U.C.S.F. Medical Center has not published its cash prices. Of more than eight million possible combinations of insurance and medical treatment in its data file, U.C.S.F. includes negotiated rates for 346. (U.C. Davis, which is part of the same system and has also not published its cash prices, sent an identical statement.)
Penn Medicine is committed to transparency about potential costs.

The Hospital of the University of Pennsylvania added cash prices to its price transparency file after The Times inquired about why that data was missing.

“The resources we provide ensure that our patients know what kind of assistance is available to them and, ultimately, what a procedure will cost them — not us.

Montefiore Medical Center, in the Bronx, has not published its negotiated rates or cash prices.

“V.U.M.C. offers a toll-free number which consumers can call if they have questions about what they may be charged for services.
Vanderbilt University Medical Center, in Nashville, has not published its negotiated rates or cash prices.
Orlando Health has worked hard over the past several years to deliver helpful pricing information to its patients.

Orlando Health has not published its negotiated rates or cash prices.

We are continuing to work on the machine-readable file that includes payer-negotiated rates. … It involves analyzing a daunting number of data points.

Long Island Jewish Medical Center has not published its negotiated rates or cash prices.

The largest hospitals were chosen based on gross revenue reported to the Centers for Medicare and Medicaid Services in 2018, the most recent year with full data available.

 

If you’re an American, you should be plenty mad about this, be you Democrat or Republican. Everyone needs healthcare, and the fat cats are bilking the government and medical patients, all the while knowingly and insouciantly violating the law.

 

Predicting ivermectin and hydroxychloquine use by political affiliation

February 20, 2022 • 1:15 pm

This is a strange paper, though it makes sense . But the rationale for publishing it seems to be to say: “See? The Republicans took the quack drugs.” That happens to be true, but how does documentation help public health? Well, the authors of this JAMA Internal Medicine paper give a reason at the end, but it’s hardly convincing.

The paper—rather, a “letter”—was meant to determine how prescriptions for various drugs, including the bogus Covid remedies hydroxyquinone and ivermectin—were correlated with both time and with the political sentiments of the region where the drug was prescribed. The patterns are interesting, but I suspect the authors (all from Harvard or affiliates) were Democrats and really wanted to show that quackery is higher among Republicans.

They did—at least after mid-2020.

 

 

The authors looked at prescriptions written under insurance for four drugs from January 2019 to Dec 2020. The drugs were, as I said, ivermectin and hydroxychloroquine, as well as as the two drugs specified below, which are in effect “control drugs” not used to treat (or rumored to treat) Covid-19. The sample size was huge: 18,555,844 adults, pretty evenly divided between men and women, with the mean overall age of 49.1

The hypothesis:

We hypothesized that the county-level volume of prescriptions for hydroxychloroquine and ivermectin—but not other, similar medications—would be associated with county-level political voting patterns in the 2020 US presidential election.

What they’re trying to say is, “We hypothesized that Republicans fell for quack remedies more often than Democrats.” (I bet the authors are all Democrats.) And their hypothesis was confirmed, except for one brief span of time (see below).

The methods:

In this cross-sectional study, we used deidentified medical claims for all outpatient visits by adults aged 18 years or older in counties with 50 or more enrollees from January 2019 through December 2020 included in the OptumLabs Data Warehouse, which includes medical claims for commercial and Medicare Advantage enrollees, as well as US Census data and 2020 US presidential election results. The institutional review board at Harvard University deemed the study exempt from review and waived the requirement for informed consent because deidentified data were used. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

We divided the county-level Republican vote share in the 2020 presidential election into quartiles. We assessed county-level rates of new prescriptions for hydroxychloroquine and ivermectin (ie, patients with no fills for the medication in the previous 6 months) per 100 000 enrollees and 2 control medications, methotrexate sodium and albendazole (which have similar clinical applications as hydroxychloroquine or ivermectin, respectively, but are not proposed as COVID-19 treatments).

The four plots below show drug prescriptions throughout the survey region over two years. The first two show both methotrexate and hydroxychloroquine.

Plot A) shows total prescriptions, plot C) new prescriptions. In both graphs methotrexate (in orange) doesn’t change over time, while hydroxychloroquine (in green) spikes around April, 2020, and then goes down almost immediately, except for new prescriptions, which also shoot up around July of 2020, nearing election time (more on that later). The April spike for hydroxychloroquine presumably reflects the FDA’s allowing emergency use of hydroxycholoroquine for Covid-19 on April 3 and then revoking that usage on June 15. (I’d forgotten about that!)

Remember that there was a time when people thought hydroxychloroquine might be useful. The graph below is for ivermectin (green) versus Albendazole (orange). Total prescriptions on top, new prescriptions on the bottom. Prescrptions for Albendazole don’t change over the two years, but Ivermectin shoots up beginning in August, 2020, both in terms of general usage and new prescriptions. As we’ll see below, this reflects a general increase in Americans trying to get prescriptions for ivermectin, but most of the rise is due to Republicans seeking prescriptions.

The next four graphs show only new prescriptions for drugs, and this time there are four plots reflecting four levels of Republican voting by country in which prescriptions were written. Orange shows the highest quartile of counties (most Republican) and then in descending order light blue, gray, and green (most Democratic). During the two months of hydroxychloroquine being allowed (period between numbers 1 and 2 on the first graph), people of all political stripes got more prescriptions, but in fact the more Democratic counties got more prescriptions. This presumably reflects Democrats following health guidelines a bit more assiduously than Republicans, though the difference is tiny.

Towards election time, though, new prescriptions for hydroxychloroquine again rose steeply, though much more steeply for more Republican than for more Democratic counties (remember, these are quartiles for Republicanism, so blue, green, and grey lines don’t necessarily mean “Democratic-voting counties”).

Ivermectin doesn’t show the April-May spike that hydroxychloroquine does, as the government didn’t allow and then disallow ivermectin, but there’s a huge spike in new presciptions towards election time, again much more pronounced in the more Republican counties. Note that in the second graph, the numbers 1-4 correspond to different events that might cause more usage of ivermectin. I’ve put the ivermectin key in bold in the paragraph below:

Here’s what the numbers on the X-axis mean:

Arrows show key dates for hydroxychloroquine: (1) announcement of the US Food and Drug Administration’s emergency use authorization on March 28, 2020; and (2) revocation of the emergency use authorization on June 15, 2020. Key dates for ivermectin include: (1) the initial in vitro study claiming a potential antiviral effect of ivermectin5 on April 3, 2020; (2) the National Institutes of Health recommendation against ivermectin use2 on August 1, 2020; (3) release of a now-retracted manuscript preprint that described a clinical trial claiming 90% efficacy of ivermectin against COVID-196 on November 13, 2020; and (4) a widely publicized hearing of the US Senate Committee on Homeland Security and Governmental Affairs that included testimony by Pierre Kory, MD, of St Luke’s Aurora Medical Center, who promoted using ivermectin to treat COVID-19 on December 8, 2020. . . . . .

Not much going on with the two control drugs:

 

The conclusions. If you’re a Democrat, you’ll want to say that the Democrats were following the science (including the April-May spike in hydroxychloroquine use, since the government said it was okay), but the Republicans followed the rumors against the science, accounting for the higher number of new prescriptions at election time. But, as the authors emphasize, what we have here are correlations, not causations.

Why a spike around election time? The authors don’t really say, but i suppose one could theorize that Trump was whipping up Covid-19 sentiments with his pronouncements, making his people more liable to go for quack remedies. Note that the rise in all four quartiles doesn’t really imply that Democrats were taking more ivermectin around election time; the spike could be caused by prescriptions for Republicans in counties that were more likely to vote Democratic overall. I could dig deeper into that, but I don’t think the paper’s worth it.  Here’s the authors’ brief discussion:

In late 2020, the number of new prescriptions for hydroxychloroquine and ivermectin was higher in counties with higher Republican vote share, whereas in early 2020, before revocation of the Food and Drug Administration’s emergency use authorization, prescribing volume for hydroxychloroquine was higher in counties with a lower Republican (ie, higher Democrat) vote share. These findings were absent before the COVID-19 pandemic and for 2 control drugs.

This study has limitations. In an observational study, we could not address the causality of the association between county-level political voting patterns and prescribing of 2 ineffective COVID-19 treatments. Also, we were unable to assess the specific contribution of patient, physician, or other factors to the prescribing patterns.

These limitations notwithstanding, our findings are consistent with the hypothesis that US prescribing of hydroxychloroquine and ivermectin during the COVID-19 pandemic may have been influenced by political affiliation. Because political affiliation should not be a factor in clinical treatment decisions, our findings raise concerns for public trust in a nonpartisan health care system.

Here’s what I think the authors are saying, translated into normal language:

We found what we thought: Democrats follow the science and Republicans follow rumors and conspiracy theories. This raises concern for the American system because it shows that the damn Republicans endanger everybody by mistrusting the government.

Now of course I’m a Democrat and have exaggerated the “translation”. But if you read the paper, don’t you think this is what the authors really want to say?

Once again: Ivermectin doesn’t work

February 20, 2022 • 10:00 am

The paper at issue today reports the most thorough and well controlled study of the effect of ivermectin on Covid-19 around, and it was just published in JAMA Internal Medicine. What it supports, contra the claims of Joe Rogan, Bret and Heather Weinstein, and a whole slew of Republican loons, is that the drug ivermectin—as already asserted by the FDA—neither prevents nor cures covid-19. Or rather, this study shows that once adults over 50 who get the virus and are hospitalized with comorbidities, Ivermectin doesn’t help them get better. (An earlier study published in BMC Infectious Diseases, both randomized and double-blinded, and including a placebo, showed that taking ivermectin had no significant effect on keeping people out of the hospital.)

The upshot is that every well controlled study shows that ivermectin is useless in helping you once you get the virus. Another meta-analysis of reasonably well done studies that included prevention concluded that there was no good evidence that the drug even prevented infection.  The only studies that may show value of ivermectin are those in which many participants have high loads of worms as comorbidities. In such studies (which don’t apply in the US or UK), the drug may, by helping you get rid of worms (see below), make recovery from covid more likely. But even in that case there’s no excuse not to get vaccinated.  And of course you wouldn’t take ivermectin unless there was evidence you had worms.

Ivermectin is used in humans to cure parasitic worms and head lice, but can be dangerous if taken in doses high enough to kill viruses in vitro. Nevertheless, in this age of conspiracy theories and general lunacy, even credentialed scientists like the Weinsteins have recommended ivermectin and criticized vaccines, even though it’s beyond doubt that the vaccines prevent severe illness and hospitalization. You’d have to be crazy or paranoid to pass up vaccination in favor of ivermectin But thousands do it, so there you are.

With luck, you should be able to get the new study by clicking on the screenshot below, especially if you have the legal Unpaywall app. There’s also a link to the pdf, and if all else fails, make a judicious inquiry.

First, the background: the authors summarize what’s know about Ivermectin in studies to date. As I and others have mentioned before

Although some early clinical studies suggested the potential efficacy of ivermectin in the treatment and prevention of COVID-19, these studies had methodologic weaknesses. In 2021, 2 randomized clinical trials from Colombia and Argentina found no significant effect of ivermectin on symptom resolution and hospitalization rates for patients with COVID-19. A Cochrane meta-analysis also found insufficient evidence to support the use of ivermectin for the treatment or prevention of COVID-19. [JAC: The meta-analysis is linked above.]

The new study was done in Malaysia (other studies are ongoing, I believe), and iswasrandomized with respect to patient condition and age, but there was no placebo control. That is, half the infected patients were given “standard of care” (none were vaccinated) and the other half were given “standard of care” plus Ivermectin. The outcomes were followed over time.  The result: not only did Ivermectin not work, but there was a slightly higher, though nonsignificant, risk of the ivermectin treated patients progressing to the phase that required supplemental oxygen. That is exactly the opposite of what you would expect if some patients were taking placebos, for you might expect that if there’s a placebo effect, then placebo-ingesting patients would do better than those not taking placebos (i.e., the patients in this study). But despite the absence of placebos, there was still no effect of ivermectin in this study using any measure of “disease progression”.

I’m not going to summarize the results in detail, because the authors do a good job of that themselves.

There are three summaries of the results. First, the “TL/DR” version:

Note below that the 490 patients observed were all over 50 and had documented comorbidities—factors that make them more susceptible to complications and death.  Here is the protocol (indented, bolding is mine except in headers).

The Ivermectin Treatment Efficacy in COVID-19 High-Risk Patients (I-TECH) study was an open-label randomized clinical trial conducted at 20 public hospitals and a COVID-19 quarantine center in Malaysia between May 31 and October 25, 2021. Within the first week of patients’ symptom onset, the study enrolled patients 50 years and older with laboratory-confirmed COVID-19, comorbidities, and mild to moderate disease.

Interventions  Patients were randomized in a 1:1 ratio to receive either oral ivermectin, 0.4 mg/kg body weight daily for 5 days, plus standard of care (n = 241) or standard of care alone (n = 249). The standard of care consisted of symptomatic therapy and monitoring for signs of early deterioration based on clinical findings, laboratory test results, and chest imaging.

Note again: no placebo pills were given. And here’s how they measured outcome:

Main Outcomes and Measures  The primary outcome was the proportion of patients who progressed to severe disease, defined as the hypoxic stage requiring supplemental oxygen to maintain pulse oximetry oxygen saturation of 95% or higher. Secondary outcomes of the trial included the rates of mechanical ventilation, intensive care unit admission, 28-day in-hospital mortality, and adverse events.

The results are below. Note that slightly more patients in the ivermectin-dosed group (4% more) progressed to severe disease (i.e., requiring supplemental oxygen than those in the group treated the same but without ivermectin. Incorporating still other measures of “progression to severe disease,” there was again no significant difference, although there was slightly more deaths (nonsignificantly more) in the ivermectin versus control group. Finally, the most common side effect, diarrhea, was found more often in the ivermectin versus control group,but I can’t find the statistics for that difference.

Results  Among 490 patients included in the primary analysis (mean [SD] age, 62.5 [8.7] years; 267 women [54.5%]), 52 of 241 patients (21.6%) in the ivermectin group and 43 of 249 patients (17.3%) in the control group progressed to severe disease (relative risk [RR], 1.25; 95% CI, 0.87-1.80; P = .25). For all prespecified secondary outcomes, there were no significant differences between groups. Mechanical ventilation occurred in 4 (1.7%) vs 10 (4.0%) (RR, 0.41; 95% CI, 0.13-1.30; P = .17), intensive care unit admission in 6 (2.4%) vs 8 (3.2%) (RR, 0.78; 95% CI, 0.27-2.20; P = .79), and 28-day in-hospital death in 3 (1.2%) vs 10 (4.0%) (RR, 0.31; 95% CI, 0.09-1.11; P = .09). The most common adverse event reported was diarrhea (14 [5.8%] in the ivermectin group and 4 [1.6%] in the control group).

And the upshot:

Conclusions and Relevance  In this randomized clinical trial of high-risk patients with mild to moderate COVID-19, ivermectin treatment during early illness did not prevent progression to severe disease. The study findings do not support the use of ivermectin for patients with COVID-19.

Here’s the entirety of the discussion (bolding mine); note that the authors, as is proper, point out the limitations of the work.

Discussion

In this randomized clinical trial of early ivermectin treatment for adults with mild to moderate COVID-19 and comorbidities, we found no evidence that ivermectin was efficacious in reducing the risk of severe disease. Our findings are consistent with the results of the IVERCOR-COVID19 trial,17 which found that ivermectin was ineffective in reducing the risk of hospitalization.

Prior randomized clinical trials of ivermectin treatment for patients with COVID-19 and with 400 or more patients enrolled focused on outpatients.16,17 In contrast, the patients in our trial were hospitalized, which permitted the observed administration of ivermectin with a high adherence rate. Furthermore, we used clearly defined criteria for ascertaining progression to severe disease.

The pharmacokinetics of ivermectin for treating COVID-19 has been a contentious issue. The plasma inhibitory concentrations of ivermectin for SARS-CoV-2 are high; thus, establishing an effective ivermectin dose regimen without causing toxic effects in patients is difficult.27,28 The dose regimens that produced favorable results against COVID-19 ranged from a 0.2-mg/kg single dose to 0.6 mg/kg/d for 5 days2932; a concentration-dependent antiviral effect was demonstrated by Krolewiecki et al.29 Pharmacokinetic studies have suggested that a single dose of up to 120 mg of ivermectin can be safe and well tolerated.33 Considering the peak of SARS-CoV-2 viral load during the first week of illness and its prolongation in severe disease,34 our trial used an ivermectin dose of 0.4 mg/kg of body weight daily for 5 days. The notably higher incidence of AEs  [“adverse effects”] in the ivermectin group raises concerns about the use of this drug outside of trial settings and without medical supervision.

Limitations

Our study has limitations. First, the open-label trial design might contribute to the underreporting of adverse events in the control group while overestimating the drug effects of ivermectin. Second, our study was not designed to assess the effects of ivermectin on mortality from COVID-19. Finally, the generalizability of our findings may be limited by the older study population, although younger and healthier individuals with low risk of severe disease are less likely to benefit from specific COVID-19 treatments.

Note as well the “limitatation” that placebos were not given. Another limitation is that this study didn’t assess the chance of getting infected in the first place when you take ivermectin, or of being hospitalized if you get infected, though other work (see above) has suggested no effect of ivermectin on either of these measures.

I was prepared to admit that my criticism of ivermectin was wrong had these properly-designed studies shown an effect, but of course because ivermectin is usually suggested as a substitute for getting vaccinated, the real thing you want to know is whether, compared to getting the jabs, you’re better off swallowing ivermectin.  Given the efficacy of the vaccines, which has now been conclusively demonstrated (and yes, the effects wane over time, so we may need a yearly booster), I was already pretty sure that those who touted ivermectin as a better substitute for vaccination were wrong.  But this study does nothing to convince me that I was wrong.

More studies will come out, and eventually we’ll have a pretty solid conclusion. And I’ll bet any reader $100 that it will show that ivermectin is no substitute for vaccination or the other new drugs that are being used to relieve symptoms and combat the virus.

The question now is whether people like Joe Rogan or, especially, Bret and Heather Weinstein will admit that ivermectin—at least in this study—has no effect. Ideally, scientists will admit when they’re wrong, and, as Richard Dawkins has emphasized, that is an admirable trait. Such admissions move science along faster than waiting for a generation wedded to an idea to die off and be replaced by those who have different ideas. Now I haven’t been wrong about ivermectin yet, but when I see a study showing it’s more efficacious than vaccines in keeping you out of the hospital, or alive, I’d like to think I’d say whose three words. Will the Weinsteins say them?

I predict no. We will see a lot of hemming and hawing frothe Quacksters, and perhaps qualifications like “well, the study showed X but didn’t show the real prediction, which is Y.” In fact, I don’t remember hearing anybody pushing quack remedies admit that they were wrong.

The reason I’m so dogged about this is because people who tout quack remedies when there are good ones can do harm. And it’s far worse if they push the quackery while wearing the mantle of science.

But listen up: STAY AWAY FROM THE DAMN IVERMECTIN!

 

h/t: Alex, Leslie

Vaccinations in school; why shouldn’t they be the parent’s “choice”?

February 12, 2022 • 12:20 pm

I have floated this question before, but want to raise it today to see if I can understand a distinction. And that distinction is between many people’s argument that they cannot be forced to get a Covid vaccination to stay on the job, but at the same time they allow their children to be forcibly vaccinated to attend public school.

Now there is no law in the U.S. saying that you must be vaccinated, period, though of course there are mandates specifying that you can’t work unless you’re vaccinated. New York City’s mandate for municipal workers went into effect today, after the Supreme Court turned down an emergency request yesterday to stall it. Up to 3,000 people might have lost their jobs this morning.  And yet many people still refuse to get vaccinated even if it means the loss of their livelihood. I see them on the news every night, making loud protests about their “rights” being violated by vaccine mandates. Along with that goes the mantra “this is my body and therefore it’s my choice.” And so they get fired, and some of them die, while others infect their fellow citizens.

This mass protest has culminated in the Great Truckers’ Protest of last week, and I hope it’s over now. (Did Trudeau show some moxie?) It was an act of civil disobedience, and therefore warrants punishment, but I had little sympathy for them.

What I don’t understand is this: these same people who assert their rights and bodily autonomy—and I see no “right” to be able to endanger the public safety by infecting others—make not a peep when they get shots for their kids to go to public school.

Not everyone understands that in the U.S., and presumably other countries, any child wishing to attend public school has to get a series of immunizations,

Here, for instance, are the vaccinations required for a child in to attend public school in Illinois.  I count 14 jabs needed to stave off ten diseases. That’s a lot of shots!

Click charts to enlarge:

 

 

Now why aren’t the parents protesting this forcible vaccination? Isn’t that a violation of either the parents’ or the students’ “rights”? If you’re one of the many who talk about “rights” and “my decision”, and yet still want to walk around in public, yes, it’s certainly hypocritical to not bring up “rights” for your children as well. But, except for a few fringe anti-vaxxers, or believers who want religious exemptions for their kids (I’m not sure these are even allowed for school vaccination), we hear no talk of rights for school immunization.

Is this hypocrisy? Well, I can think of several reasons why you could say “no”:

a.) The school vaccines have been proven safe and effective over years of trial, while, of course COVID vaccines have been around just a bit more than a year. The parents could say, “These vaccines work and don’t have bad side effects, so I won’t speak of “rights” But then you could ask them how much safety must be proven before vaccination becomes mandatory. As I recall, when the polio vaccine came out, it became mandatory within just a few years, and people were begging to get it.

b.) You could say that you have the right to decide for your own body, but not for the bodies of your kids, and therefore they should get vaccinated. But this doesn’t work because parents make decisions about the medical treatment of their kids all the time, especially before the kid is sentient enough to make its own choice, which is at a pretty advanced age. For school vaccinations, the parents have to agree by the time the child is five or six.  (Note as well that parents feel that have the right to decide their children’s religious beliefs before the kids are old enough to choose!)

c.) The parents could say that they have the alternative of no employment if they’re not vaccinated, but there’s no alternative for their kids if they’re not vaccinated. That’s not entirely true: there is homeschooling, which is free, and private (often religious) schools that don’t require vaccination. But The latter are often pricey.

d.)_ They are willing to risk getting Covid, but the children are too young to afford that risk. But this reverts back to a) above: if the vaccine isn’t risky for your children, why is it risky for you? (In fact, it’s more dangerous for adults to get Covid than for kids).

There is more to discuss here, but I won’t get into it. I’m just curious why parents who obediently let their kids be vaccinated (even with COVID shots for college!) turn into enraged don’t-tread-on-me” types when it’s their own jabs at issue.

If there’s a rational answer, I would say that a)—proven safety and effectiveness—would be the one, but of course the Covid data so far shows that the risk is minor compared to the effectiveness. Certainly we know that the chance of illness, hospitalization, and death is greatly reduced for adults if they get the shot (we’re talking about resistance of adults to getting vaccinated). Vaccination for adults is, without doubt, a net good save for those who are medically compromised.

But I suspect that more is at stake here—perhaps ideology.  People have largely lost control of their lives during the pandemic, and refusing shots is a way of getting control, and also of showing the government that they can’t control you. This is likely connected with a conservative or libertarian ideology that opposes government intervention. In the case of the truckers, it seems to me they’re pissed off about a lot of things, including  loss of jobs and rising prices, and protesting against vaccines is the nucleus around which these resentments coalesce.

But maybe I’m not asking a meaningful question. It’s just that when I see a bunch of angry people yelling about “rights” and “bodily autonomy” on television, it makes me wonder whey they go all quiet when the needle goes into the arms of their kids.