phobosanomaly

I recently worked as a physician in a Labor and Delivery unit at a county hospital where there is an extremely high rate of methamphetamine and fentanyl use among patients, I would like to provide a counter-point that I have never heard of anything like this happening. Even in patients who are admitted actively withdrawing from fentanyl we go out of our way to treat them with dignity and respect. Social work will be consulted following delivery, but I have never seen police get involved, and there will never be physicians and nurses present during CPS' discussion with parents.

Again, just from what I have seen at county where substance use is a pretty banal, common occurrence and CPS often placed children in foster care straight from the newborn nursery.

I'm sorry that you had such a negative experience. Maybe it was at a hospital that doesn't deal with substance use issues much?

Mucosa has vascular supply.

Naumova EA, Dierkes T, Sprang J, Arnold WH. The oral mucosal surface and blood vessels. Head Face Med. 2013 Mar 12;9:8. doi: 10.1186/1746-160X-9-8. PMID: 23497446; PMCID: PMC3639856.

It also has antibodies (humoral immune response).

Immunoglobulin A (IgA) is the most abundant antibody isotype in the mucosal immune system.

Li Y, Jin L, Chen T. The Effects of Secretory IgA in the Mucosal Immune System. Biomed Res Int. 2020 Jan 3;2020:2032057. doi: 10.1155/2020/2032057. PMID: 31998782; PMCID: PMC6970489.

And the vaccine triggers the development of those antibodies.

We evaluated the serum anti-spike (anti-S) IgG, anti-nucleocapsid (anti-N) IgG and anti-S IgA response following vaccination against SARS-CoV-2 in a cohort of first-responders. Among the 378 completely vaccinated participants, 98% were positive for anti-S IgG and 96% were positive for anti-S IgA.

Montague, B.T., Wipperman, M.F., Chio, E. et al. Elevated serum IgA following vaccination against SARS-CoV-2 in a cohort of high-risk first responders. Sci Rep 12, 14932 (2022). https://doi.org/10.1038/s41598-022-19095-7

If you don't have a strong electronics background, the XGameStation [1] with it's accompanying textbook The Black Art of Game Console Design [2] involves soldering up a primitive game console with a bunch of example game source code to go with it. The book starts with basic electronics theory and gets into some pretty bare-metal discussions regarding stuff like NTSC and VGA video output programming.

[1] http://www.ic0nstrux.com/products/gaming-systems/xgamestatio...

[2] https://www.amazon.com/Black-Video-Game-Console-Design/dp/06...

This group has put so much effort into the open letter, but it's probably not receiving particularly widespread circulation.

Perhaps it would be more effective if this group gathered the detailed knowledge of all the people who signed the letter and published a really detailed book on the current political, social, and economic state of Iran with all the juicy details that they have insider knowledge of included? Surely it would be a richer source of information than the trickle of articles from the single journalist they're upset with.

If it provided deep insights into the nature of the regime, and wasn't just a screed about how the government is awful, this hypothetical book could have a significant political and cultural impact outside of Iran.

Apparently not.

As psychologists worry that the coronavirus pandemic is triggering a loneliness epidemic, new Harvard research suggests feelings of social isolation are on the rise and that those hardest hit are older teens and young adults.

In the recently released results of a study conducted last October by researchers at Making Caring Common, 36 percent of respondents to a national survey of approximately 950 Americans reported feeling lonely “frequently” or “almost all the time or all the time” in the prior four weeks, compared with 25 percent who recalled experiencing serious issues in the two months prior to the pandemic. Perhaps most striking is that 61 percent of those aged 18 to 25 reported high levels.

https://news.harvard.edu/gazette/story/2021/02/young-adults-...

I'm excited to go back to work in-person. Working with my colleagues gives me a great deal of joy throughout the day.

Isn't this just basic antitrust regulation? I don't like to use the word 'propaganda' unless it's tongue-in-cheek, but ... "Ma’s assets have been stripped, shorn, and degraded" ... come on, give me a break.

I've tried breaking textbooks down into Anki cards, and it takes forever and afterwards I'm left feeling underwhelmed. But, if you're going to do it, I've found that my favorite method of review is TTS on the Anki app with swipe gestures, and I just go for loooong walks while grinding my flash cards, just holding the phone at my side and swiping with my thumb '1' or '3'.

One thing I tried that I liked was reading the entire textbook out-loud into a set of bluetooth headphones chapter-by-chapter. I then process the raw audio file using Audacity's 'truncate silence' tool, as well as increasing the tempo of the audio file by 1.5-2x speed. I read it mechanically, straight-through as quickly as I possibly can on the first run. Then I make 1-2 passes back through the entire book using the audio file of my own recorded voice sped up in order to pace myself.

That way I go through the entire book like 3 times. Once slow, twice fast. I might do my second or third pass months or years later. Doing it mechanically means that I can grind through nonfiction technical books that are hundreds of pages long pretty quickly, and I know exactly how long my reviews will take, since it's the length of my audio file. The largest book I've pulled it off with was 900 pages. It was a sufferfest, but if you smoke a little pot while you're doing it, you can get into a nice rhythm and it's kind of fun.

I don't remember every single detail of the book using this method, but I've found cranking through them relentlessly with some time in-between to be very, very effective from a practical perspective. It scratches the 'done is better than perfect' itch, and when I need a specific detail I know exactly where to look.

I think a lot of it has to do with the fact that the database guy actually implements things in an environment that can be manipulated at will.

Doctors don't implement things in an environment that they control. Patients come to them with a chief complaint, and the doctor tries to resolve or manage it to the best of their ability with a minimal intervention according to a set of guidelines someone else wrote down.

A doctor can't sit there and play with the diagnostic/treatment process in the same way a database guy can go play with the database software. At best the doctor can sit there with a textbook or medical journal and try to memorize more facts, or take notes, but it's not the same as pulling apart code, running it in different ways, and seeing how it behaves.

Medical school is a continuous process of memorizing shit off of flash cards culled from a textbook. You don't actually build anything, or implement anything, or do anything in a real-world sense that would make you an expert in the same way as someone who was working with a system that they were able to take apart and play with and manipulate. There's no real way to develop the kind of deep knowledge you're talking about in that environment.

A diesel mechanic can pull apart and engine. Hold every part in their hand. Drive a diesel-engine vehicle. Observe all the things that go wrong. Simulate, and innovate. An individual doctor can't really do any of that. Medical schools are even axing dissections, so med students are lucky if they get to see what the hell peritoneum actually looks like.

'Easy access' is scary for hospitals because it means increased possibility of HIPAA violations.

They can have multiple free-of-charge parking garages on the outskirts that are associated with a light rail system.

So you park, hop on the metro, and head into the city without having to worry about the nightmare of parking or the stop-and-go traffic.

I never, ever drive into LA. I use the free parking at an outlying metro station and ride the train in (20 min). You can even leave your vehicle overnight so you can go out for drinks and crash at a friends place (even if you don't train runs until 2am). It's a night-and-day improvement on having to sit in traffic on the freeway, spend 40 minutes finding street parking, worry if someone is going to steal your catalytic converter, etc.

An added benefit is that I go into the city much more often than I otherwise would because I know that the whole process is pretty stress-free.

You'd need boats in the area anyway to gather up the crew when the vessel started taking on water.

"In a legal context, a chilling effect is the inhibition or discouragement of the legitimate exercise of natural and legal rights by the threat of legal sanction."

https://en.wikipedia.org/wiki/Chilling_effect

If the cops are scrutinizing what you read, you might be discouraged from reading what you want to read.

Yes. They very likely did.

Kaiser Health News has a good roundup of articles on this very topic.

https://khn.org/morning-breakout/documents-reveal-just-how-i...

There are such gems as:

"That email and other internal Purdue communications are cited by the attorney general of Massachusetts in a new court filing against the company, released on Tuesday. They represent the first evidence that appears to tie the Sacklers to specific decisions made by the company about the marketing of OxyContin. The aggressive promotion of the drug helped ignite the opioid epidemic.

The filing contends that Mr. Sackler, a son of a Purdue Pharma founder, urged that sales representatives advise doctors to prescribe the highest dosage of the powerful opioid painkiller because it was the most profitable."

https://www.nytimes.com/2019/01/15/health/sacklers-purdue-ox...

"In a new 274-page memorandum, Attorney General Maura Healey details a chain of command that she alleges implicates eight Sackler family members, as well as nine Purdue board members or executives, in the nation's deadly opioid epidemic."

https://www.wbur.org/commonhealth/2019/01/15/healey-purdue-o...

Sackler family members seemed to have played a very hands-on role in the aggressive marketing of the drugs, and probably have their fingerprints all over internal company policies such as:

"...a copy of a confidential Justice Department report shows that federal prosecutors investigating the company found that Purdue Pharma knew about “significant” abuse of OxyContin in the first years after the drug’s introduction in 1996 and concealed that information."

https://www.nytimes.com/2018/05/29/health/purdue-opioids-oxy...

Unless I misread your comment and you just mean did they commit a crime in accepting the plea bargain, and then no I guess not in the letter of the law. Certainly the spirit of the law was not honored here, however, as no member of the Sacker family seems to have been brought up on criminal charges. They just wrote a check and walked away admitting.."no wrongdoing and will remain one of the wealthiest families in America."

The sources in the linked article seem to suggest that the San Francisco Walgreens are not being driven from business due to an overabundance of middle and working-class white girls shoplifting for fun. Although the parent to your comment did seem to be generalizing quite a bit from the article at hand, and so perhaps your response deviated in kind. Fair enough, I'm making the argument anyway.

I have no doubt that the phenomenon you mention certainly exists. I do, however question whether its prevalence is enough to be noticeable on an income statement.

There seems to be something else at work in San Francisco, and the question is how we should contextualize it morally (which will influence our preferred policy approach as voters). Is it people stealing because they are desperate for the necessities that one would encounter at a drugstore (something we should feel sorry about). Or, are they organized crime rings making a quick buck at someone else's expense due to loopholes in the legal system (something we should be pissed off about).

I alternate between the two perspectives based on my own experiences viewing urban poverty up-close, the discussions shared in the HN Walgreens threads, as well as some of the videos shared of organized groups of people clearly looting high-value items. It's something I don't really have a solidly-formed opinion on, and there seems to be an abundance of nuance.

You provided the example of the First Nations in Canada, which would be taken by any reasonable person as an implication that the United States is a better country to be impoverished in.

When combined with your refutation of the earlier poster's comments regarding the similarity of the poor in the United States to those in the developing world and your statement that the poor in the United States aren't worse off than the poor in other developed countries, it paints an argument that the poor in the United States are somehow in a better position than in other developed countries.

The totality of your statements would be interpreted by a reasonable person as implying that the poor in the United States are better off than in other developed countries.

If your point is simply that the poor in all developed countries are in the same position, and that the poor in the United States are in the same position as the poor in Denmark, that's an interesting take. I mean, you could have just dropped "poverty in the US isn’t unique among developed countries" in the first post where you brought up the First Nations.

I'm just out here trying to have a productive debate with strangers on the internet.

Ok, so what is your counter-metric (or reasoning) for why the United States is a better place to be poor in than other developed countries?

I guess it depends on what you're comparing.

I mean, compare the US Gini coefficient with other developed countries.

It's all good food for thought.

I was just responding to your assertion that poverty doesn't really exist in the United States. It's not as widespread as in Latin America, and tends to be more sporadic, but there are hundreds of thousands of people living in tents and improvised shelters with no access to running water or electricity and no hope for the future here. The United States is no more a homogeneous bloc of wealth and prosperity than Latin America is a continuous favela of poverty.

I read your core argument in this post to be that the form of poverty you describe is much more widespread in Latin America than in the United States. I'd be a fool to disagree with you on that. Yes, you're right.

I'm certainly not trying to win a pity contest and say that the United States is a horrible place where everything sucks. That would be absurd. But for many people, the United States is a much shittier place than you make it out to be.

As for the challenges of these places, they are daunting indeed. The United States is about as toxic a neighbor as one could ask for. Sending money and guns South, and bringing drugs North. Mounting coups. Stealing the best and the brightest from countries that desperately need that human capital. Putting children fleeing violence and poverty in cages. None of it should sit right with someone who has a modicum of conscience. But, as you have seen from our recent political battles, we barely know what to do to fix ourselves, let-alone help our neighbors. Our country is grappling with it's own reckoning as the rich get richer and the poor get poorer. Our Gini is 0.48 and growing. Mexico's is 0.5. With every passing year the homeless encampments get larger.

Perhaps the time will come when the fortunes are reversed?

There are plenty of First-Nations people in the United States without access to clean drinking water.

In your time in the US, did you get a chance to visit the Navajo reservation?

"Tribes without clean water demand an end to decades of US government neglect

US has broken promises as Indigenous Americans lack access to safe water, a crisis worsened by Covid-19"

"An estimated one in 10 Indigenous Americans lack access to safe tap water or basic sanitation..."

https://www.theguardian.com/us-news/2021/apr/28/indigenous-a....

Please check out this photo-essay on the homeless in Los Angeles.

https://www.latimes.com/california/story/2021-03-08/homeless...

What do these folks have that the poor in other countries don't? Food insecurity, outbreaks of disease, living in improvised structures, threat of violence, lack of access to health care are all present in the United States.

Did you get a chance to visit anywhere like the Imperial Valley?

"Two weeks ago, federal prosecutors filed a lawsuit intended to clean up or shut down Duroville, which they said was lacking in necessary permits but plentiful in horrid conditions: defective construction, faulty electrical wiring, unhealthful distribution of drinking water and a deeply flawed septic system. Those ponds of gray.

“The system itself leaks sewage under and around trailers and in common areas,” the government charged in court papers, leading to raw sewage being “tracked into trailers and elsewhere on the feet of residents and their pets.”

But everything about Duroville is hard, just as its name suggests.

It sits on the Torres Martinez Desert Cahuilla Indian Reservation, where Mr. Duro is a prominent member. Weary of the news media, he has hired a spokesman, Alan Singer, who stops short of equating Duroville with nirvana, but calls the tales of squalor overblown and racist.

Mr. Singer asks one question, though, that pricks like a cactus: If Duroville is shut down, where will these thousands live?

So far, no answer."

https://www.nytimes.com/2007/10/21/us/21land.html

The order of magnitude in numbers may differ, but there is plenty of grinding poverty in the United States.

The more you travel in the United States, the more you realize that it isn't the magical shining city on the hill people think it is.

There are actually many, many communities in the United States where people live on dirt roads. That's super common. I grew up on a dirt road, and my parents still live on one. Much of the rural US lives off of paved roads.

With food and stuff, the thing is that in the US, you can very quickly go from having not much to having nothing. Many people do suffer from hunger and live on the edge because the cost of living in the United States relative to incomes can be very high. It's much more difficult to set up a small stall selling goods or food or something, and if you don't have proper permitting the police will shut you down. Therefore, once you get to a certain point you are really trapped. There's much less of an informal economy in the US than in Latin America, so people's ability to earn money is much more restricted and regulated.

The correlate to the people you are describing in the United States are referred to as the 'homeless.' They live in small structures made of cardboard and wood and tarps. Some have tents. The police will occasionally come by and throw all of their possessions in a garbage truck. Homelessness is pretty widespread, and the degree to which it exists here is often shocking to people from other countries.

Here's a photo essay that gives you some idea of what is going on in the United States in terms of the homeless. These living conditions are pretty darn comparable to international poverty. I assure you none of these people have stocks.

https://www.latimes.com/california/story/2021-03-08/homeless...

Obviously the scale of the whole thing is different between the US and Latin America, but there's lots of pretty shocking poverty in the US.

What other profession says nonsense like this, imagine saying this to a doctor or accountant.

Med students have to jump through an unimaginable number of hoops to prove that they will put up with anything because they are supposed to be hungry to save the world, humble in the face of nature, and smart enough to get a top percentile on a never-ending series of standardized admission and licensing exams.

By the time they're actually working in the field, it's: Did you fill out that insurance paperwork so the hospital can get reimbursed? Good, here's the next stack of paperwork to fill out so the hospital can get reimbursed ad infinitum. How fast are you seeing patients? Any more than 20 minutes is too long. We don't have staffing levels to support that. Nurses are over-ratio, but try not to kill anyone with a mistake.

The whole thing smells like bullshit. The idea that under a timed medical school exam a student would spend 5 minutes rooting through Canvas to find an answer rather than just Googling it in 10 seconds is absurd.

Likely the faculty was too lazy to remove the material, too tech-unsavvy to understand the possibility that Canvas could have the ability to generate automated traffic, and too paranoid to give students the benefit of the doubt.

This is standard procedure for many medical school exams during COVID. Examsoft locks down your primary device, and you have a secondary device (smartphone/other laptop) pointed at you throughout the exam with a live video stream to the proctor. Each student does a 360 of their workspace prior to beginning the exam, and they are recorded throughout.

From the article: "To hinder online cheating, Geisel requires students to turn on ExamSoft — a separate tool that prevents them from looking up study materials during tests — on the laptop or tablet on which they take exams. The school also requires students to keep a backup device nearby. The faculty member’s report made administrators concerned that some students may have used their backup device to look at course material on Canvas while taking tests on their primary device."

I'm not sure what's going on here. The med school I'm affiliated with has students running the live video stream to the proctor through the secondary device. I guess Dartmouth wasn't doing that, but was having students keep it nearby only as a communication device in case WiFi went down or something?

Either way, the fact that they've taken students in one of the most competitive and stressful post-graduate programs in the country, told them to sit at home for a year-and-a-half and teach themselves medicine, and subjected them to a scored STEP 1 the year before it goes pass/fail is beyond fucked.

I personally support the crypto-anarchist take you're espousing, but assuming that most of this stuff isn't a predatory cesspool pushing unsophisticated retail investors off of a cliff by the force of isolation-induced FOMO seems a little naïve.

If enough people lose their life savings, it will be regulated.

Apparently the only options for diagnostic testing are brain biopsy and pulling CSF samples, both of which are probably a non-starter for screening purposes across a population.

Clinical Laboratory Tests Used To Aid in Diagnosis of Human Prion Disease Allyson Connor, Han Wang, Brian S. Appleby, Daniel D. Rhoads Journal of Clinical Microbiology Sep 2019, 57 (10) e00769-19; DOI: 10.1128/JCM.00769-19

https://jcm.asm.org/content/57/10/e00769-19

He's had 'several strokes.'

Who knows when his first stroke was? His sister's history of stroke as well could indicate that there is something more going on. He could have had multiple microinfarcts over the years leading to a mild form of vascular dementia with cognitive impairment or something.

He probably isn't holding the secrets of the universe in his noggin, but cut him some slack. I'd have tea with him. Sounds like a chill guy.

Practicing medicine must be lucrative because it costs an individual student around $240,000 in tuition for the M.D. itself, excluding cost of living.

Doctors are made out to be predatory vultures, but unless they come from money they must undergo massive debt burdens that they are not able to even begin paying down the principal on until they're well-into their thirties. Imagine the feeling of taking out half-a-million dollars in student loans to cover both undergrad, and graduate-level training. After that look forward to your 80-hours a week of residency making below hourly minimum wage. [1]

Make medical school free, and you'll have people lining up the door to practice for low-cost. Make it half-a-million pay-to-play, and you'll have people desperately clawing their way out of debt so that some day they can have a family and own a home after a decade of hellish training.

Cut the docs some slack. They're taking on unimaginable debt burdens for a job that often isn't in the same universe of cushiness as something at FAANG (inspecting that anal fissure in the ED at 3am with perks including, well, hospital food), but involves an tremendous service to society.

[1] https://www.mdlinx.com/physiciansense/is-it-better-to-be-a-d...

That must be understood in the context of the number of applicants to U.S. residency programs from Caribbean medical schools (which are well-known to be a little predatory).

From that article you cited: International medical graduates in particular have low match rates for residency programs. American medical students have a 94 percent match rate, according to the Times, which cites information from the National Resident Matching Program. However, Americans who study at international medical schools have a match rate of 61 percent."

Kids from the U.S. get sold on a Caribbean M.D. school, and spend thousands and thousands of dollars only to find out that things get really complicated when it comes time to do clerkship rotations or apply to residency.

An M.D. or a D.O. from a school on U.S. soil is definitely not useless, and your chances at matching a residency are extremely high, as cited above.

That really depends on what you mean by 'destiny.'

If you go to community college, work hard, and get decent grades you are more-or-less guaranteed a transfer spot at a good state school.

It's actually pretty easy to transfer from a California community college right into UCSD, UCLA, UCR, etc., and these are all excellent, affordable schools. Nowhere in that process do you have to take the SAT or the ACT. You just take college classes, and get college grades that show how you perform in college. You prove yourself by actually doing the thing the standardized test is supposed to evaluate.

I would propose that we look at tests not as the solution, but as another layer of bullshit hoops people have to jump through. Just get people bootstrapped into the damn thing at low-cost, and see how they perform. Evaluate them based on that. Being an SAT savant doesn't mean someone will actually be able to do anything meaningful in the real world.

Sure, that path may not guarantee you a spot at MIT, but if you come from a variety of backgrounds and have some humility about the whole thing you're going to be just fine and you will have more than enough control to steer your destiny in whatever direction your interests lead you.

Anecdotal, but all of my friends who make over $100k went to state schools for undergrad and grad school, and not going to Yale didn't seem to pose too much of an obstacle to them leading happy, productive, and fulfilling lives.