Quoted by the LA Times in an article about increasing costs to patients for generic drugs that have not actually increased in wholesale prices. Stated by Dan Mendelson of Avalere Health, a consultancy firm that studied generic costs. He found that the insurance companies have been holding down premium costs for Part D Medicare by moving generic drugs from “Tier One” to “Tier Two”, increasing out-of-pocket costs for drugs that have not actually increased in price from the manufacturer.
Isn’t this a contradiction of the idea of “insurance”– spreading out costs to everyone so they are affordable to everyone? After all, it’s not necessarily the patient’s fault (nor under the patient’s control) if they have a “chronic illness”– like type 1 diabetes, which is caused by genetic factors, not controllable by the patient, yet accounts for a huge proportion of overall medical costs. Higher costs to the patient for drugs might lead to less compliance– the patient saves pocket money by reducing the use of the medication, which results in higher complication rates and higher overall costs. It’s an example of how treating chronic illnesses with maximal preventive/treatment measures saves money in the long run by reducing complications– only in reverse.
According to an NPR article on May 17, 2018, the fertility rate in the US has dropped to a nearly unprecedented low. The article is based on a report by the Centers for Disease Control. There was, overall, a 2 percent decrease in the number of births in the US in 2017, and a 3 percent decrease in the fertility rate among 15-44 year old women– to 60.2 births per 1,000 women. The report, which is produced by the CDC’s National Center for Health Statistics (NCHS), has shown a fertility rate below the replacement level for the US since 1971.
The difference, and the growth in the US population since 1971, has been made up by immigration. The replacement rate is 2,100 births per 1,000 women over a lifetime– the “total fertility rate”. The rate for 2017 was only 1,764.5 births per 1,000 women, a 3 percent drop from 2016.
What this means is that, since 1971, if it were not for immigration, the population of the US would have declined. This is also true of a few other countries, such as Spain, Greece, Italy, and Japan, among others. At a very basic level, immigration is essential for the health of this country. Immigrants also compensate, by being much younger than the average American, for the increasing burden that Social Security payments make on the taxpayer.
The entire document (a *.pdf) from NCHS, on the Document Cloud, can be found here.
(photo courtesy of pixabay.com and MabelAmber)
Felix Sater to Michael Cohen: “I will get Putin on this program and we will get Donald elected…”
Felix Sater, in an email to Michael Cohen on November 3, 2015, wrote that he would get Putin to help have Donald J. Trump elected president. According to the New York Times (August 28, 2017):
“Our boy can become president of the USA and we can engineer it,” Mr. Sater wrote in an email. “I will get all of Putins team to buy in on this, I will manage this process.”
What more evidence do we need of Trump’s collusion with Russian Prime Minister Vladimir Putin?
(photo courtesy of pixabay.com and skeeze)
According to Lesley Stahl, Donald J. Trump told her (and her boss) in an unrecorded discussion before a recorded interview for “60 Minutes” that he attacks and demeans the press in order to plant disbelief in the minds of the public when the press writes “negative” (truthful) stories about him:
Stahl said she and her boss met with Trump in his office in Trump Tower in Manhattan after the 2016 election in advance of a recorded sit-down interview for “60 Minutes.
“At one point, he started to attack the press,” Stahl said. “There were no cameras in there.”
“I said, ‘You know, this is getting tired. Why are you doing it over and over? It’s boring and it’s time to end that. You know, you’ve won … why do you keep hammering at this?’ ” Stahl recalled.
“And he said: ‘You know why I do it? I do it to discredit you all and demean you all so that when you write negative stories about me no one will believe you.’ ”[CNBC article on Microsoft’s news feed for Windows 10, dated May 22, 2018]
(There is a recording of a discussion between Judy Woodruff and Leslie Stahl at the Deadline Club last night that contains this information here on Youtube)
(photo courtesy of the digital artist and pixabay.com)
This letter to Nature, submitted November 2016 and published January 2018, reviews a meta-analysis of existing and potential (without Man) stocks of carbon on the Earth and indicates that we have lost half of global biomass since humans began to change the environment by deforestation and cultivating crops. This suggests that, in order to prevent further deterioration of carbon dioxide atmospheric levels, we must apply reforestation on a giant scale. The apparent loss of global biomass indicates that we have lost respiring, carbon dioxide-fixing organisms, which leads to an increase in atmospheric carbon dioxide.
This surprising finding suggests that we are in a deeper hole than we currently believe. There is more evidence here than meets the eye, and it is bad news.
“When we as people, a free people, go wobbly on the truth, even on what may seem to be the most trivial of matters, we go wobbly on America,” Tillerson said. “If we do not as Americans confront the crisis of ethics and integrity in our society among our leaders in both public and private sector, and regrettably at times in the nonprofit sector, then American democracy as we know it is entering its twilight years.”
AP quote from Rex Tillerson, former Secretary of State to President Donald J. Trump, in speech given at commencement for Virginia Military Institute. According to the AP story, the invitation to speak at the commencement was given before Tillerson was fired by tweet.
The New York Times published an opinion piece by Nicholas Kristof a few days ago that described the miscarriage of justice surrounding a quadruple murder committed in 1983 in Chino Hills, California.
The victims, who were murdered in their own home, had ready access to several firearms, including a loaded pistol and a rifle, but were unable to reach these weapons to use them in their defence. One of the victims survived and described three white males as his attackers. Multiple witnesses reported seeing three white males in the car which they had stolen from the victims, in one case wearing bloody clothing.
Despite the fact that the murderers stabbed their victims numerous times and had to have had complete control of the crime scene while committing four murders, the police decided to prosecute a single black man who had been hiding in a house next door that was vacant. The police ignored the issue of how a single attacker could stab four victims while preventing them from reaching their firearms.
Despite all the really absurd inconsistencies, the prosecutor managed to convict Kevin Cooper of the murders and have him sentenced to death. The sentence was nearly carried out but for a last-minute stay. The only barrier to having Cooper declared factually innocent now is that the authorities refuse to test the blood on the murder weapon, a hatchet, which they still have.
Here is yet another example of the systemic racism afflicting our justice system. It is discouraging to see so many obvious cases of prejudicial behavior and yet have the authorities claim that they are objective.
New News: Saudi Arabia Helped Get Trump Elected So US Would Pull Out of Iran Nuclear Accord
The New York Times reported today that representatives of Saudi Arabia, the United Arab Emirates (UAE), and even Qatar met repeatedly with Donald Trump Jr. and members of his father’s campaign before the 2016 election– and that this relationship was reinforced after the election. These revelations are extremely complex and involve persons who have been Trump supporters for a long time but have managed to remain behind the scenes, as well as foreign individuals whose meetings and relations with Trump staff have not been transparent to the American public; thus I recommend close reading of the NYT story and other news sources to ascertain just who was involved and what their motivations and capabilities may have been. They may have done some significant things that remain completely opaque and will be difficult to expose.
The NYT story states that a “friend” of Donald J Trump Sr. , Erik Prince of Blackwater, facilitated these meetings and had a murky relationship with members of Trump’s campaign and two foreign data processing and internet “influencing” firms: Psy-Group of Israel and WhiteKnight of the Philippines. Mr. Prince has been a Republican donor for years and was close to Mr. Trump without being officially tied to him by an administration appointment– although he has been a big beneficiary of American and Saudi payments to the private security firm he founded, Blackwater (see below).
A proposal was floated within one of these foreign firms, Psy-Group, for influencing the presidential election in Mr. Trump’s favor with social media posts and the like; the estimated cost was $300 million. There is no definite confirmation that this proposal ever was carried out, but the other firm, WhiteKnight, spent a couple of million dollars on a presentation that showed how much social media had facilitated the election of Mr. Trump.
Erik Prince has a long and close relationship with the Saudi and UAE crown princes, in addition to being the brother of Betsy deVos, currently the Secretary of Education (who is bent on destroying the American public school system as well as ending investigation of shady “for-profit” schools like Trump University).
Fortunately, Mr. Mueller of the FBI special investigation unit is all over this information and has already interviewed the principals of the Israeli firm. There is some news that the Israelis may have recovered computers from the WhiteKnight [should be Psy-Group– they are the Israelis] offices in the process of liquidating it (presumably this is the Israeli equivalent of bankruptcy, which would be a neat way of folding up a company that illegally influenced the US election process and was no longer needed.)
This information leads us further down the rabbit hole of corrupt behavior by Mr. Trump and his associates. It appears that they were willing to do nearly anything to get assistance to “rig” the presidential election. They called upon Russian associates who had helped them with loans in exchange for turning a blind eye to money-laundering activities; they turned to Arabs who had offered to finance the white elephant buildings owned by President Trump’s son-in-law (he is now finalizing a deal with Qatari sources that was supposed to have fallen through last year due to bad publicity). They apparently even turned to Israelis who hated the Iranians (a feeling that was entirely mutual) and who wanted to support Mr. Trump to gain special advantages for Israel. There will be difficulty proving many of these suspicions because those who accept illegal assistance (say, from foreign nationals) in exchange for favors are unlikely to allow themselves to be definitely overheard saying so before the election, nor to put anything in writing that would reveal the corruptness of the bargain that they make with a nod of the head.
In the case of Mr. Trump and the Saudis, it is clear that they, like the Russians, disliked Ms. Clinton because of her foreign policy principles and were interested in facilitating the election of someone they could influence. Mr. Trump delivered with his abrogation of the Iran nuclear accord despite the pleas of numerous Americans and Europeans, many of them highly placed. It is quite possible that certain Israelis had the same attitude towards Ms. Clinton (those of a like mind with Mr. Sheldon Adelson of Las Vegas) and that they helped Mr. Trump, with the quid pro quo being the move of the American Embassy to Jerusalem.
Note that not all Israelis share the attitudes of Mr. Adelson; perhaps Mr. Netanyahu, who is himself neck deep in corruption allegations, would be a good example of the polarization of attitudes within Israel. Also note that American law prohibits foreign nationals as well as governments from helping partisans in elections– specifically, Americans are prohibited from “accepting anything of value” from foreign citizens in connection with election campaigns. The law was broadly written in an attempt to make any activity, from money donations to door-to-door canvassing, illegal for foreign citizens. Mr. Adelson, on the other hand, was free to contribute whatever he wished to political action committees, since he is an American citizen. Donald Trump, Jr. and his associates seemed to have been unaware of this law when they agreed to meet with Russian nationals, as we have previously seen, and they showed similar ignorance and/or unconcern when they met Saudis, Emiratis from the UAE, and Israelis.
(About Erik Prince and Blackwater: A security detail composed of employees of Blackwater committed the Nisour Square Massacre (see Wikipedia entry) in which 17 innocent Iraqis died on September 16, 2007– the upshot being that the firm had to repeatedly change its name and nominal ownership; it is now known as Academi and is one of a group of security companies owned by Constellis Holdings).
(The Nisour Square Massacre was a result of lax oversight of the private security details, composed of ex-special forces soldiers, which were used in Iraq to substitute for currently enlisted American soldiers to protect American and other civilians. Erik Prince was ultimately responsible for this and many other lesser incidents, some of which caused further loss of life for innocent bystanders, because he founded Blackwater (in 1997) and was its boss while Americans fought in Iraq. This laxness towards aggressive behavior by Americans was partially responsible for Iraq’s refusal to extend American soldiers’ immunity from prosecution in Iraq after 2011– which led directly to the complete withdrawal of virtually all US soldiers from the country and indirectly to the infiltration of Iranians into positions of influence in Iraq… which led to the current situation in this area, in which we are attempting to depose the ruling regime in Iran without invading the country or accepting responsibility for any of the potential consequences, like the current anarchy in Libya.)
(Those who wish to depose the current regime in Iran are looking for revenge (or justice?) for the takeover of the American Embassy in Iran by revolutionaries after the Shah of Iran was deposed in 1979 and the protracted hostage situation– although some cynical historians might allege that this incident facilitated the election of Ronald Reagan and weakened the campaign for re-election of Jimmy Carter… which directly or indirectly led to the Republican takeover of American local, state, and federal government over the last 40 years… and which may have led to widening income inequality and wealth inequality over the same period; which may have been associated with mass incarceration in the United States (the US has by far the largest prison population per capita in the world), the failure of US citizens’ life expectancy to increase, in fact the reduction of life expectancy in the last few years, the opioid epidemic and finally, the fact that my coffee is cold– which is due to the fact that the electric coffee cup warmer that I was given as a novelty present in 1982 (note the date) was manufactured in China to low quality standards instead of in the US and stopped functioning after only a year.)
Polycystic Ovary Syndrome Caused by Excess Anti-Muellerian Hormone in Utero– New Scientist
An article in New Scientist describes research published in Nature Medicine that describes the cause of polycystic ovary syndrome (PCOS) — abnormally high levels of anti-Muellerian hormone (AMH) while the patient is still in the womb. AMH is absent in the normal female embryo and when it is present it causes relative masculinization– a precursor to PCOS.
Normally, in the male embryo, AMH produced by the embryonic gonads suppresses the growth of the Muellerian ducts (which grow into the uterus and adnexa) on the same side as the gonad. If AMH is absent, the ducts grow automatically.
In the adult female, AMH rises at puberty and is expressed to regulate the formation of follicles. In the male child, AMH production by the Sertoli cells of the testis is high; in puberty, AMH levels fall. AMH receptors are also present in the brains of embryonic mice and are thought to relate to dimorphic brain development and the regulation of gender-specific behaviors.
The New Scientist article suggests treatment with Gonadotropin Receptor Antagonists, such as are used in infertility, may work. The article says that a trial of cetrorelix, used during in vitro fertilization (IVF) procedures, is contemplated. Relief of the symptoms of PCOS may be accompanied by restored ovulation and fertility.
“The significance of the intimate personal relationship between physician and patient cannot be too strongly emphasized, for in an extraordinarily large number of cases both diagnosis and treatment are directly dependent on it.”–1927, Francis Peabody, Harvard Medical School professor.
“…1996 study in The American Journal of Public Health. …estimated that more than a third of Americans on Medicare who were 65 and older and who had a regular physician had been seeing him or her for a decade or more — and those with the longest ties had lower medical costs and were less likely to be hospitalized than those with the shortest… [authors] Linda J. Weiss and Jan Blustein, then of the Columbia College of Physicians and Surgeons: “…remarkably little is known about the actual value — in terms of health care processes, outcomes or costs — of long-term provider-patient relationships.” “–NYT, May 17, 2018, “Trying to Put a Value on the Doctor-Patient Relationship”
The article describes a study done by David Meltzer, a primary-care physician and economist at the University of Chicago, that directly compared hospitalists and primary-care physicians as sources of medical care for a panel of high-intensity Medicare patients. In one arm, the patients would be seen exclusively by the primary-care physician, even when they were in the hospital; in the other arm, care would be split between outpatient primary-care and inpatient hospitalists.
Patients were selected from among those who had been hospitalized in the past year and were therefore at high risk of being hospitalized again; most of them had chronic medical conditions that predisposed them to acute episodes of illness. Those who volunteered were randomly placed in one of two groups– a group that was assigned a doctor for outpatient care (most of the volunteers did not already have a primary physician) and another one for hospitalizations, and a group that was admitted to a new clinic that Dr. Meltzer established. In the new clinic, doctors were given a panel of patients whom they followed whether they were at home or in the hospital.
Of course, to make a long story short, after five years the panel treated exclusively did better and saved money over the split panel. The patients were hospitalized less, were more satisfied with their care, and had better mental health.
“The Mid-Atlantic [Kaiser] Permanente Medical Group, an organization of more than 1,400 primary-care physicians who serve members of Kaiser’s health plan, ran a pilot of the program in 2015. Two physicians were assigned to its 400 sickest patients. Unlike Meltzer’s team, which relies on hospitalists for after-hours care, Kaiser made the doctors available 24/7 and were surprised to find that patients very rarely called late or on holidays and weekends. Still, the number of times they were admitted to the hospital or E.R. fell drastically, by 80 percent, prompting Kaiser to expand the program to seven doctors and 800 patients.”
“To have a relationship,” Meltzer says, “is to mean that the big incentive is to want them to do well because you care about them and to have the time to really understand what that means and deal with it, because sometimes figuring that out just takes time…”
One of the reasons that increasing medical spending has not resulted in better outcomes in the United States is that care has been fragmented and assigned to multiple profit-making entities instead of being applied through an overall supervisor for each patient who has full knowledge of the patient’s circumstances, the authority to give directions, and also the patient’s trust.
Conrad Theodore Seitz 