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naraburns  nihil supernum  1yr ago (text post)   3364 thread views

Small-Scale Question Sunday for January 1, 2023

Happy New Year!

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

This is your opportunity to ask questions. No question too simple or too silly.

Culture war topics are accepted, and proposals for a better intro post are appreciated.

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Heat Recovery Ventilators

Does anyone have one? One drawback of rarely using the wood stove is fewer air changes, and I have to occasionally open the windows and blow fresh air through the house.

If HRVs aren't a scam I'd seriously consider getting one.

Tips for the GRE?

Study. It’s a pretty easy test.

Also, use adderall.

Here's a longshot: I'm trying to see if anyone else read (or wrote!) a comment on the National Review website ... from a few years ago.

A few months after Trump won the election, I started reading NR's investigation coverage. I stopped when they started paywalling Kevin Williamson, so the comment would have appeared somewhere between April 2017 and July 2021. The comment was an extremely persuasive compendium of offenses the mainstream media had committed against red America. In retrospect, I realize that it might have been copy/pasted from the motte, or perhaps written afresh by someone here (I didn't start reading the motte until 2020).

Does this sound familiar to anyone, or does anyone know of a similar resource?

Scott Alexander’s Paranoid Rant sounds like the type of thing you’re talking about, but it wasn’t posted on NR. I can’t find it online, but someone around here must have it saved.

Thank you. That is an excellent rant, but the comment I was looking for was a fairly long list of media statements that were clearly wrong and/or unfair, similar to "Rittenhouse the white supremacist", though the examples were generally less controversial, thus better for the project of persuasion.

It's still on archive.org.

I vaguely remember a comment here about how scientists were able to "rewire" microscopic creatures to become radically different shapes by modifying connectomes but I can't find anything about it. Can someone point me in the right direction?

I have a question that could turn into a culture war topic but I need some kind of sanity check before I flesh it out further:

Does anyone else feel as though, even as the general populace becomes less and less optimistic, the mainstream narrative has nonetheless converged on a message of unrelenting positivity?

It is hard to describe, but the best examples of what I'm talking about that spring to mind are The Rise of the "Corporate Memphis" art style and the seeming ubiquity of beauty filters as a default feature in smartphones.

Or in the way Youtube video comments have turned from a cesspit of trolls trolling trolls trolling trolls to basically a competition for who can heap the most bombastically hyperbolic praise on the subject video.

The common thread is that these techniques/styles end up minimizing the appearance of 'flaws' and 'ugliness' whilst also idealizing the subjects it examines so as to avoid... I don't know. Offense? Critique? Any possible negative emotional valence? Where before there might be depiction of ugliness as ugliness or actual examination of social and personal flaws in a way that risks causing offense, where before there were art styles that embraced ugliness (while still being aesthetic) and Cartoons like Ren and Stimpy could use unpleasant visuals for comedic effect now it seems like most products are produced with the intent of avoiding any unpleasant sensations on the viewer's part.

And this now seems to apply to every single product of modern culture, aside from some decrepit/degenerate corners of the internet. "Good vibes only" seems to be the accepted norm... with the exception of certain acceptable targets who may be used as punching bags.

I'm not even getting into possible causes, I'm literally just trying to see if this is an actual, noticeable phenomenon.

Have you felt as though mainstream/corporate-produced culture has reached increasing heights of 'toxic positivity' even as your own outlook on the state of the world has degraded?

I'm familiar with the phenomenon you're describing and I think it applies in the realm of UX, brand identities, graphic design etc., but I'm not sure how applicable it is beyond that.

If you compare any random film made in the last five years with a film made in the 90s, one of the first things that'll jump out at you is how washed-out, desaturated and visually dark modern films look compared to films from the 90s. Modern films tend to be filmed digitally rather than on film, which produces more washed-out, low-contrast visuals compared to film. They also tend to use VFX and CG extensively, and one of the most effective means of hiding imperfections in VFX work is just to make the whole image darker. Six years ago, Zack Snyder got a lot of stick for producing a desaturated high-contrast interpretation of the Caped Crusader; now, we're at the point where people are complaining that literal Disney films are too (visually, not tonally) dark. The same trend is obvious in prestige television.

10-15 years ago the big complaint in video games was that everyone was adopting the house style of Call of Duty and Battlefield and making everything brown or grey. The worm has turned and now lots of things are magenta instead, but it still isn't hard to find modern games which are washed-out, desaturated, dark and generally unpleasant to look at.

To my mind, most of the big trends in popular music in the last ten years have prominently featured a conscious embrace of ugliness and poor taste, whether it's the ear-splitting sonic assault of drill music; the self-aware tackiness and excess of hyperpop; the bored, amelodic, disaffected repetition of British and Irish sprechgesang bands; or the deliberate minimalism of modern trap and SoundCloud rap.

To my mind, most of the big trends in popular music in the last ten years have prominently featured a conscious embrace of ugliness and poor taste, whether it's the ear-splitting sonic assault of drill music; the self-aware tackiness and excess of hyperpop; the bored, amelodic, disaffected repetition of British and Irish sprechgesang bands; or the deliberate minimalism of modern trap and SoundCloud rap.

I don't see this as a fundamental lack of positivity and retreat to nihilism or misanthropy. At the risk of engaging in some serious "old man yells at clouds" style activities, I can't really emphasize enough how "irony" seems to have become the central social feature of Gen-Z. "Ugliness and poor taste?" No, I have great taste because I'm wearing this ugly outfit and my soundclap rap is mumbled gibberish. Kanye (before he want to planet Kanye) did this explicitly with one of his Yeezy lines that were specifically intended to look like dilapidated homeless people clothes. And have $1500+ prices per article.

But, wait, it gets worse! I'm seeing trends of irony-upon-irony. The embodiment of this is Pete Davidson who has made a career off of 1) Having a firefighter dad who died in 9/11 2) Joking about it 3) Talking about how it still makes him anxious and depressed 4) Making a horrible movie where he mixes both of these concepts 5) Being the heir to the Jimmy Fallon "I'm always breaking" role on SNL and 5) Dating megastars in Hollywood. That guy is incomprehensible to me because he doesn't ever seem to be serious even when he is professing huge sincerity. Again, the maybe-maybe-not self-awareness of that Taco Bell ad he's in where the extra says, at the end, "are you riffing or is this part of the bit?"

In my mind, I think pop culture, since about 2015 and the rise of real Gen-Z meme culture, has had a crisis of authenticity. It's now a rare commodity and, therefore, hard to reliable find and produce. The easy way is to double down on irony / sarcasm ... which further pollutes the message and so we get stuck into multi-layered cyclic irony. Trust disintegrates, people aren't sure if their emotions are common and understood or bizarrely unique personal hallucinations.

I don't see this as a fundamental lack of positivity and retreat to nihilism or misanthropy.

I think it certainly is in some cases. The dominant lyrical theme of drill music is "I am going to kill my rival drug dealers", while the dominant lyrical theme of cloud rap/emo rap/sadboi rap etc. is "I am abusing drugs because I am so miserable and depressed" (something which is acknowledged to be a stage persona in some instances, namely the late Lil Peep). Maybe these aren't nihilistic or misanthropic stances, but they're anything but "positive".

Hard disagree on Pete Davidson, I watched one of his recent Netflix specials and found him surprisingly candid and unpretentious. Perhaps a thick veneer of irony coated his earlier work but he seems to have grown out of it. Agree that, in the Anglosphere, ironic detachment is the air that we breathe (as a genre, the aforementioned hyperpop could not function without it).

"irony" seems to have become the central social feature of Gen-Z.

Posers just stole it from Gen-X. (Simpsons S07E24, May 1996)

The worm has turned and now lots of things are magenta instead

There's an interesting contrast to be made between the Call of Duty era where games went for 'gritty realism' and the, call it the Fortnite era where literally nothing needs to be taken seriously, and real life personalities and pre-existing characters are rendered as a perfected, cartoonish versions of themselves.

I won't even say one is better than the other, but Fortnite definitely represents the sort of unrelenting positivity, the hiding of ugliness, the avoidance of negative emotional valence that I'm talking about.

To my mind, most of the big trends in popular music in the last ten years have prominently featured a conscious embrace of ugliness and poor taste

On the other hand, I'd point at bands like Imagine Dragons and a lot of imitators that produce peppy and/or 'epic' sounding songs with aggressively positive/affirming lyrics that... also don't mean anything. They want to induce some positive emotional valence but without having any real 'message.' Other than a vague "YOU GOT THIS! YOU ARE UNSTOPPABLE, YOU CAN ACHIEVE ANYTHING YOU WANT" sort of statement. And these songs become MASSIVE HITS.

the mainstream narrative has nonetheless converged on a message of unrelenting positivity?

You mean the same narrative that tells us that

  • We live in a culture that systemically oppresses everyone who is not a white heterosexual male

  • Literally any person around us can be a hidden hateful bigot and we must be eternally vigilant to every word and action in case they slip and reveal themselves, and we can not let slide any offensive word, even if they were said by accident and without intent to offend, because it is worse than physical violence

  • Academic campuses and pretty much all major companies are permeated by rape culture and any woman can be - and often are - sexually assaulted at any moment there

  • Police are prowling all major cities looking for non-white people to kill for no reason at all

  • We are destroying our environment and the only way to avoid it is either massive depopulation or massive drop in the quality of life

  • At least half of the country are insane illiterate bigots who dream about murdering and enslaving anybody who does not look like them, and instituting a fascist dictatorship

  • We cannot ever show our faces in public ever again for the fear of dying in horrible agony

  • Convincing people to kill themselves is a viable solution to the problem of rationing medical care (and maybe other resource problems too) - this is only in some countries, but wait a bit

  • You can't eat a steak without feeling very guilty and you better learn to eat mealworms and crickets instead

  • Everything that exists around us was stolen from somebody, built by racists or enslaved people and every child that is born is born into the original sin and owes huge sums for that just for the fact of their birth into a wrong race

  • Internet is brimming with "misinformation" and only strict government-guided censorship can give us hope for the democracy to survive

That doesn't sound like a message of unrelenting positivity to me...

I agree with your post, but I also see where the OP is coming from.

I think it's mostly a process of infantilization. Corporations, states, media etc. behave towards the plebs more and more as if they were children. So yes, that means sometimes they will be extremely positive (you're a good kid!) and other times they will try to scare you (they're coming from you! you need our protection) or reprimand you (how dare you say that foo-ism, you disgusting bar-ist).

So I see OP as referring to the coddling, "nice" face that they adopt for well-behaved kids, which they (Cathedral people, not OP) probably would like to be the only face they have to adopt, because in their ideal world likely every pleb is a good child.

And it's not only about art styles, it's also about the language used and the patronizing, condescending or "overly cute" tone. For example, see the peppering of emojis in every online communication by many companies, states etc. Does anyone really need a finger pointing down to understand that "this image" refers, in fact, to the image shown below a post? To see the country flag after the name of the country? To see a snowflake after reading the word "winter"? (oh, babby understandy now, you mean time when it snowwy, thankies mommy!!) Etc.

An interesting exercise is to compare current textbooks to old textbooks. It's very salient in programming books. Most old programming books address the reader as if he were an intelligent, mature, adult person, even if they use jokes and puns sometimes; they show respect for the reader. Many current programming books try extremely hard to be "cute" and address the reader as a dumb, fragile baby. For example, compare Structure and Interpretation of Computer Programs to Learn You Some Erlang for Great Good!. SICP is not dry at all, in fact it's quite friendly and full of jokes and puns. But it clearly respects the reader and expects him to be mature and intelligent. The second one is written as a children's book, but meant for adults. This may be an extreme example, but the trend is definitely there.

The thing is, it seems that many people like to be addressed as children. Maybe because it "absolves" you from responsibility, thinking and anything else but "wanting" and "not wanting", being happy, sad or angry? I don't know.

That's what certain parts of the media are portraying, but notice the point that each of these is usually couched against some 'valid' target of ire, so there's always an outgroup to blame for the problem.

And the positivity tends to come from the general corporate/commercial messaging around a topic which simply frames any and every possible situation in the lightest way possible.

Let me zero in on a couple:

You can't eat a steak without feeling very guilty and you better learn to eat mealworms and crickets instead

This is often couched as "guess what! You can make an easy impact against climate change JUST by eating bugs!" as a positive, progressive viewpoint.

Convincing people to kill themselves is a viable solution to the problem of rationing medical care (and maybe other resource problems too)

There's a recent development of, again, framing this whole things as a positive in the marketing!!! This is what I mean! Rather than viewing the end of a human life as a generally tragic, possibly grim affair that should be viewed as a negative (discounting the afterlife). look at that fucking commercial portraying it as a beautiful event!

When did we hit the point where euthanasia was couched as a 'beautiful' thing rather than the ugly (sometimes) necessity that we try to avoid?

And likewise, can you find any corporation outside of the news media that allows any level of honesty, critique, or possible offense of any particular group in their corporate messaging?

If the group offended is not "woke people", then yes, easily. E.g. I have seen corporation sponsor "family friendly drag queen shows" (and publicly brag about it) - I'm pretty sure it is offensive to many people. It's just not the people that the Right Thinking People would care about offending.

But you don't see them sponsoring a Family Friendly Drag Queen show and depicting opponents to such a show as bigots.

Basically, they refuse to acknowledge that there's any negative side to it, and don't aim criticisms at any group. It's not their intent to offend, and part of that is to make it as annoyingly positive as possible.

Oh yes they do. Maybe not with drag queen shows (I can't say as I haven't witnessed specific communications to that effect) but certainly with other things. Example: https://www.usatoday.com/story/travel/airline-news/2021/03/31/georgia-election-law-delta-ceo-calls-new-voting-rules-unacceptable/4823216001/

I think it's pretty offensive for anyone who supported the law (2/3 of voters by some polls) but somehow Delta - and many other companies - do not care. They think they are too big to fail anyway, so offending somebody who does not hold the power (and these aren't consumers anymore in the American system, not for a long time - it's those who control government budgets and subsidies) is completely fine.

Seems to me that OP was talking about art, or at least about art suitable for mass consumption, not public discourse.

Can art stay "unrelentingly positive" if all other culture is steeped in negativity? We're not living in an environment where the art can (or wants to) stay away from politics and cultural context.

Yes! There are multiple different things. these are not particularly negative. They suck, despite being "positive".

This is not art, this is grift.

It's a grift of unrelenting positivity. here, here's some unpolitical, "positive" art. stable diffusion 1 is a much better artist than this quirky person

What is scarce today is proportionate authenticity in positivity and negativity.

A question I like to ask with my bi-coastal over-educated early 30s cohort is "Yes, of course Orange Man was very very bad, but how did you life get appreciably worse between 2016 and 2020, barring anything related to COVID?" As almost all of my cohort got into manager+ levels of mostly tech corporate work, completed a masters, and/or got married ... they can't really come up with anything concrete beyond "well ... my anxiety...blah blah blah." But that's just the point - negativity (in media sources or elsewhere) doesn't seem, to me, to be about real proportionate evaluation, but a kind of circular mood-affiliation. Even the less emotionally charged WSJ frequently has articles along the lines of "workers are worried the economy is real bad and whatnot." The body of the article amounts to "a bunch of online surveys indicate people are worried ... in general ... here's a few interviews with people who are worried ... in general."

Now, flip the coin the other way. Anybody here who routinely uses Slack or and other chat app in a corporate job will be familiar with the "EVERYDAY AMAZING" hyper-praise that a lot of front line managers HEAP on their employees for ... doing the basics. "Timmy and Janey ABSOLUTELY CRUSHED THEIR STANDUP THIS MORNING!!!!!" Followed with dozens of emoji responses. First, I think this is maybe the number one issue with career development today - front line managers are turning into weird cheerleaders until annual performance reviews where they absolutely gut these same folks. Consistent and honest feedback is really hard to come by and it's nearly impossible to calibrate the relative strength of feedback when you're getting the above (OMG YOU SHOWED UP TO WORK) on the one hand, and a muted "Hey, I think you could've delivered that report better..." on the other. Wait a minute, did I fuck up or not? If I did, how do I improve? What's the most important part of my job?

I know I mixed some topics up above here, but I don't think they're that unrelated. I think about this a lot as somehow who's moved into the Senior Manager / Director phase of the career and, looking down, see a lot of individual contributors who truly don't trust the feedback from the system. As a citizen who reads the news, I see something similar happening with your average man-on-the-street who's looking around and seeing "THE END IS NEAR" on a daily basis, but who goes home, orders from Uber Eats and isn't worried a stranger is poisoning his food.

What is scarce today is proportionate authenticity in positivity and negativity.

Oof, yeah the "authenticity" question has been banging around in my head too, and I'd write an essay on it if I can confirm someone smarter hasn't written it already and I get the time to do it.

This rings true: people want to hear positive affirmations if they come from a place of honesty, and maybe don't like it when it's a condescending sort of affirmation or obviously isn't sincere.

And when it comes to positive affirmations from large corporations, you can largely conclude that they're not sincere because it's all designed around getting you to spend money and they have no particular connection with you as an individual to 'authenticate' the affirmation.

Anybody here who routinely uses Slack or and other chat app in a corporate job will be familiar with the "EVERYDAY AMAZING" hyper-praise that a lot of front line managers HEAP on their employees for ... doing the basics. "Timmy and Janey ABSOLUTELY CRUSHED THEIR STANDUP THIS MORNING!!!!!

Agreed, although I do not have a large corporate job.

front line managers are turning into weird cheerleaders until annual performance reviews where they absolutely gut these same folks.

Also agreed, and funny enough oftentimes it seems like the performance reviews will gut someone for NOT buying into the positivity culture and being an overall 'downer' at work even if that's simply the result of trying to be honest.

But that's just the point - negativity (in media sources or elsewhere) doesn't seem, to me, to be about real proportionate evaluation, but a kind of circular mood-affiliation.

The comedian Dara O'Briain expressed this as "Crime is down, but the FEAR of crime is up!"

"Timmy and Janey ABSOLUTELY CRUSHED THEIR STANDUP THIS MORNING!!!!!"

Good Christ do I hate logging into LinkedIn for any reason.

I think you are correct to a large extent, but as someone who still subscribes to print media, much that focuses on politics, the economy and current events is very negative in tone. This is natural as these publications place focus on trying to warn readers about negative developments and things that need to be changed and improved. It is funny that when comparing the op-ed sections of the NYT to WSJ, the Spectator World to the Atlantic, or the New Criterion to Jacobin, the other side — whatever it is — is usually winning, as “things are going well for us” is less persuasive as a call to action.

but as someone who still subscribes to print media, much that focuses on politics, the economy and current events is very negative in tone.

Yes, I am not reading newspapers or watching cable news or indeed any mainstream news sources that don't bubble up through twitter, so I am definitely not exposed to the mainstream news messaging as much. Although it doesn't surprise me if they're still in 'fear and outrage mode.'

I think part of what I noticed, however, was how the messaging on inflation, supply chain issues, and energy prices seemed to focus on downplaying the severity of the situation and implying that it will be all fixed in short order. Part of that was due to the election year, to be sure.

Add on all the ridiculous puff pieces about Sam Bankman-Fried that ignore the thousands upon thousands that lost tons of money due to his actions.

I have noticed that a significant part of Reddit now seems to be "support talk". Instead of jokes and trolling, it's all people saying "terrible thing X happened to me" and all the responses are some variation of "oh my god I'm so sorry for you here's some hugs"

Interestingly enough I ran across discussion about this phenomenon just the other day. I sometimes watch a youtuber called Todd in the Shadows who talks about pop music (usually through a negative lens because most of anything is bad, but he appreciates good pop music). Every year he releases his "top 10 worst songs of the year" and he began this year's video with a diversion about how critic culture has morphed into fan culture. The discussion on reddit (on a similarly very "poptimist" subreddit) agreed how the culture of positivity is utterly cloying and suffocating. Specifically the genre of "self-empowerment/positivity" is called out as fake and saccharine.

I'm not really hooked into social media so I don't really have much else to add. I do know that RottenTomatoes and other kind of review sites have become utterly worthless as metrics of quality because big companies have realized how important internet cachet has become as an advertising mechanism, and the inevitable tyranny of Goodhart's Law follows. You do have to wonder how much of this endless positivity you talk about is organic. I don't think it's necessarily that all the comments are AI-generated or bots or whatever, but there's obviously corporate fingers tipping the scale. A simple example is youtube removing the dislike button so that the hoi polloi can't show their disdain.

A tangent:

I do know that RottenTomatoes and other kind of review sites have become utterly worthless as metrics of quality because big companies have realized how important internet cachet has become as an advertising mechanism, and the inevitable tyranny of Goodhart's Law follows.

Find a cinephile or three to follow on Letterboxd who’s taste you respect. You don’t even have to sign up for an account or visit the website as Letterboxd provides an RSS feed for each user account.

Is it possible to rate stuff and then get matched with someone like-minded?

That I don’t know. I’ve got three acquaintances I follow on there via their RSS feeds who are all cinephiles. I’ve not signed up for an account, myself, per my personal no social media policy.

I was going to mention the same video as a welcome change from the Pollyanna-isms.

I'm only a casual Youtube user but it's clear that they set up an aggressive automod for comments a few years ago and I assume people have begun conforming to the unwritten rules in order to have their comments posted instead of being shadow-banned. I suppose it was necessary and probably a net improvement, it gets a bit uncanny though when I watch the videos from SoftWhiteUnderbelly interviewing the by turns desperate and criminal denizens of LA's Skid Row and then read the comments and see they're full of glib praise and hollow platitudes for pimps, addicts and proud gang bangers (in both senses of the term).

I run a youtube channel just for fun with small viewership (~ 1k subscribers). I can tell you that even I (with no youtube partnership or monetization) have a whole bunch of automod options to filter out negative/aggressive comments. I imagine a lot of channels have this on by default, and have even more powerful options at their disposal

Wouldn't surprise me because I can remember when Youtube comments were, as mentioned, a cesspit.

But Youtube has just gone so far in the other directly, including removing the dislike count to prevent negative views/opinions becoming visible that people have adapted by becoming so aggressively positive that you'd think it was sarcasm.

I remember watching years ago on a guy who reviewed each episode of My Little Pony complaining that his videos that were positive always got a way better reception than his videos that were negative, regardless of the actual quality of the episode. He was pretty deeply upset it seemed that he couldn't honestly review shows, which his channel was supposed to be about, without crippling his channel.

At the same time "hate channels", whose purpose is to shit on stuff seem to do very well.

Yeah, I think in this case the novelty of a grown man liking MLP may have something to do with things.

I had some thoughts about how both the major films being produced, themselves, seem to play into this and as indicated the average mainstream critic seems to think their job is to validate whatever product is currently supposed to become the latest hit and look for any reason people should enjoy it rather than making an honest assessment of quality.

Critics finding as many reasons as they can to 'like' a work and downplaying obvious flaws seems like a far cry from the days of Siskel and Ebert.

minimizing the appearance of 'flaws' and 'ugliness' whilst also idealizing the subjects it examines so as to avoid

George Carlin was talking about this decades ago - Euphimisms

IMO, the content distribution has stayed the same, but content discovery has changed a lot. There is more of every thing. More flawed/yucky/ugly stuff and more sanitized garbage. It's just that when the recommendations systems don't know what you like, the sanitized garbage is pushed in your face more often than it used to be. The flipside is once you get into the ugly-offensive-flawed content, the recommendation systems will overwhelm you with that too.

It is about how content discovery changed. You can now eat straight sugar from the sachet, or straight black coffee. Our experiences aren't attenuated by having to all see the same 5 channels on network TV.

I think there are definitely still shows out there like Big Mouth which use ugliness for comedy. And you of course still see the news reporting on wars and terrorism. There are definitely some areas that are now optimizing for minimizing offense like social media algorithms, but I don't know if I'd say if society as a whole is significantly moving in a direction like this.

I think there are definitely still shows out there like Big Mouth which use ugliness for comedy.

I'd have to think pretty hard if this is the kind of 'ugliness' I'm talking about, but then I'm reminded of the whole subplot where one of the characters got his pillow pregnant and it had a little pillow baby and yeah, that's definitely a counterexample.

Asking for a friend... How would one go about hiring Aella's sexual services? It seems to be the case that she still works as an escort. Price is not an issue.

Her escorting alter-ego's page is still out there. I should've bookmarked it for you, because now I can't find it.

I dunno but 37 showers a year is pretty nasty. Find yourself someone that at least showers between guys.

https://www.theatlantic.com/health/archive/2016/06/i-stopped-showering-and-life-continued/486314/

https://twitter.com/Aella_Girl/status/1589690655965872128

I don't know how valid these are but I think seeing her justifications is at least relevant

If your microbiome is hopelessly damaged by a bit of water you've got bigger problems.

Oh wow, I hadn't realized that was actually Aella when I saw it posted elsewhere. The rationalist obsession with that woman is really one of the movements biggest red flags to me.

It's odd to me that she's made it this far on what's really, really common schtick. Go to any literary-debate club or half-serious political discussion group at an Ivy-Or-Similar school and there will be at least half a dozen girls making an absolute killing doing the exact same thing.

I don't think there's any obsession, but she's maintaining pretty active media profile and she's more interesting than most of public rationalists (come on, situation report about mosquito nets in Africa or interview with a rationalist escort/camgirl - what are you clicking on?) for most of the public. I think if it's the biggest red flag, they're doing ok so far.

Ive heard her mentioned more times in places that shit on rationalists more than from rarionalists. Or just dont use twitter.

I don't think rationalists talk about Aella enough for it to be 'one of the biggest red flags'? I never see her mentioned on lesswrong, and only occasionally on SSC. She's more often seen on twitter of course.

I wouldn't say I'm the most rationalist community person, but I've been around this scene for over a decade, and I've never even heard her mentioned (or maybe I never noticed her being mentioned) before this very thread.

Probably the latter - she's all over rationalist twitter, and definitely has been mentioned in at least five scottposts.

I guess it's just that Scott sometimes talks about her in a way that kind of implies she's are very cached reference, throwing out her name in such a way that implies we're all pretty familiar.

No group is immune to e-girl bullshit.

(except explicitly gay groups)

Do they have e-guy bullshit, or does the easy availability of sex to gay men immunize them?

I was wondering if there was a gay equivalent to Aella. I suspect not because they lack enough reach and potential audience to start becoming known for things other than camwhoring.

You know some guys are gonna pay extra for that. 😂

Why are fast food french fries so dogshit?

They are literally billion dollar companies that literally made their billions making fried shit. Yet most fast food fries are limp dicked excuses of a french fry.

I am irrationally infuriated just sitting here thinking about the sad state of mcdonalds fries. Maybe the real social decay began when mcdonalds stopped frying using beef fat and switched to whatever mystery hydrocarbon they are using now. I am just offended how can you have a commercial deep fryer at your disposal and produce this soggy shit, like what level of not giving a shit about anything do you need to be in aggregate to fuck up french fries.

Back in the 80s, most restaurants used lard or tallow for deep frying. But then vegans/vegetarians 'convinced' restaurants to move away from animal fats. Or at least that was the excuse many chains gave. It was likely a cost issue, along with the demonization of fat in those days.

IIRC, McDonald's spent a lot of time, money, and effort to maintain the flavour of their fries when they switched. I wouldn't be particularly surprised if McDonald's pushed the change, in order to get their competitors to follow along with inferior fries, thereby gobbling up marketshare (which they did).

In 2007, McDonald's began moving away from trans fats. I believe this was because of Fred Kummerow, who then went on to petition the FDA to ban trans fats, then sued the FDA, then the FDA decided to ban it. The ban went into full effect in 2019.

I know I've definitely found fast food to have absolutely plummeted in quality over the past decade or so.

Anyways, I'm surprised there's no 'lab-grown tallow'. You'd think that would be easier and cheaper to make than lab-grown meat. Maybe there is? I wonder if it'd even be legal.

Now there's a growing war on PUFAs. We're just whittling down a major component of our diet. It's strange how regulation after regulation, meant to 'help' keep people 'healthy', results in an allegedly 'unhealthier' ingredient taking its place, which becomes justification for more and more regulations. Fats are the greatest enemy of the food industry, since fats make you feel fuller and eat less. They are going to fight until they can eliminate every single gram of fat from our diets, so we can consume more and more food. They'll fight to eliminate animal proteins, and make us use whatever proprietary protein source they've developed. They are turning the people into bottomless pits.

My thoughts on fast food fries:

  1. Culver's: always hot and fresh. Crinkle cut supremacy.

  2. Five Guys: greasy in a good way.

  3. Wendy's: the best of the low-tier fast food fries.

  4. McDonald's. Too small and thin for my tastes.

  5. Taco Bell. Yes, TACO BELL has better fries than...

  6. Burger King. Consistency/texture issues. Sometimes not fresh or hot. Not very salty.

Honorable mentions to Chick-fil-a and Whataburger. I haven't been able to patronize these establishments since my move, but the former would land somewhere around Wendy's, and the latter above BK.

Culver's: always hot and fresh. Crinkle cut supremacy.

Sadly I have the opposite take on crinkle cut, though I agree that Culver's fries are otherwise excellent. I won't eat fries from any place that has crinkle cut, because that cut just ruins the fry.

They serve crinkle cut in prison, and prison food is designed to be awful.

Never speak to me again. 😁

But, really, the greater surface area and angular surface enables superior ketchup coverage.

True, but it also ruins the ratio of crisp exterior to tender interior. And let me tell you, I can glob ketchup on even the thinnest, most nebulous of fries. 😉

Burger King's are just straight vessels for salt, I've found. Which, as I like salt, isn't a bad thing.

I've never understood the Five Guys excitement, and I have to say, I found them not greasy enough for my tastes. The rest of your list I agree with, barring Culver's, which I've never tried.

You also didn't include Arby's curly fries, which I'd put near the top if not at it.

Five Guys might get old if you go there frequently but I always enjoy the fries. Arby's... I've been there maybe two or three times in my life. Like KFC or Hardee's, it's just been in the background for my whole life.

Burger king's fries seem like their onion rings; potato paste that's extruded into fry shapes and fried.

Most fast food fries are pretty good in my experience. Are you getting them delivered by chance? delivery fries are always much much worse, it's one of the foods that suffers most from being steamed in a bad and let cool for 15+ minutes

McDonald's fries can be good if you eat them when they're piping hot. Similarly, Chick-Fil-A fries are actually really good if you eat them right away. But with both of those, even 10-15 minutes of cooling off (like if you're grabbing them and then driving home) makes a world of difference.

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Transfats legislation killed the french fry, the hash brown patty, the corn dog.

When I was in fast food, we used peanut oil for the most delicious shoestring fries. Topped with ketchup, or chili and cheese, or even “everything,” they were practically a meal by themselves.

I have not since tasted their equal, though I have tasted their near lesser. If you ever pass through Albuquerque, go to Golden Pride, a local fast food chain. Their fries are delicious and crunchy, a real treat.

What does trans fats have to do with peanut oil?

I dont live in the US so no legislation where I live, but cost is a pretty good reason to use flavorless industrial oil products anyways. Mcdonalds and Burger King taste identical to the US.

I just dont understand why fries are so neglected, they are the second most important component in just about any fast food meal. I certainly would make the trip if I was offered half decent fries even at a respectable markup. Is no one else demanding better fries?

Honestly, Im contemplating just buying some beef fat and making my own, it feels like a distant memory since I had a good french fry.

Chic fil a and Five Guys still use peanut oil, Buffalo Wild Wings uses beef tallow, all of them charge a premium over their nearest competition, and all of them are known for somewhat better fries than the competition.

Whenever I fry pork belly, the leftover pork grease goes to making fries, and it's as good as or better than any restaurant fries I've ever had.

For someone who hasn't made fries at home. Explain like I'm five, please.

I'm not a great cook, but it's not a difficult dish. Wash and slice some potatoes. Heat a pot or pan of oil until it's hot. I'm not exactly sure how hot, probably around 150-175C. (It should be hot enough that if you drop one fry in, the fry should immediately bubble and float. But if the oil smokes, that's too hot. I've never actually measured the temperature, but you get a feel for it if you do it a couple times.) Drop your fries in the oil. The oil doesn't necessarily have to cover the top of the fries, but you need to stir so that everything gets cooked evenly. Cook about 4-ish minutes, or until it's your desired level of crispiness. The time will depend on the temperature of the oil and the thickness of your potatoes. Then take the fries out and let the oil drain off of them. Add toppings to taste.

You get a choice of the oil you use. You can't use olive oil because the smoke point is too low for good frying, but I like grapeseed oil because it has a neutral flavor. My above suggestion is to use the grease which is leftover from cooking pork. I also sometimes mix grapeseed oil and pork grease if I don't have enough grease, but it tastes better the higher the proportion of grease in the mix.

I had to visit the emergency room earlier this year for a nose bleed. At the time I was discharged (October 2022) I paid a 200$ bill to the hospital, foolishly believing that this was the entire cost of the visit. I subsequently received a 357$ physicians statement. This little episode in medical billing really irritated me since I felt that the hospital had hidden the actual cost of their services and because the amount was absurd for the services rendered (10 minutes for a physicians assistant to apply some topical TCX). As a result I have been thinking of not paying it and am trying to understand if recent changes to that the credit reporting agencies have made may allow me to get away with this without damaging my >800 credit score.

In particular it sounds like medical debts < 500$ will no longer impact a credit score starting in 2023 https://www.equifax.com/personal/education/credit/score/can-medical-debt-impact-credit-scores/ and I am trying to determine if this determination is made based on the date of the service(s) (october 2022) or the date that a bill is sold to a collections entity, which could occur in late January. I also discovered that paid medical debt collections haven't impacted a consumers credit score since 2022 (https://investor.equifax.com/news-events/press-releases/detail/1222/equifax-experian-and-transunion-support-u-s-consumers), so its my understanding that even if they are able to sell this bill to a collections entity, the worst that could happen is that I would simply have to pay the amount at a later time.

Does anyone know if this analysis is basically correct? Its my understanding that their only other recourse would be to try and sue me which is unlikely to happen over a 357$ bill.

Why would you have to pay it if they don't tell you the cost ahead of time? There's no contract.

Pretty normal to sign a document that says you are financially responsible for accrued charges.

Consider that when you walk into the ED with chest pain you can end up with a million dollar suite of cardiac surgery or thirty cents of tums and everyone has limited idea to predict which it is going to be ahead of time.

Wouldn't it make more sense for the hospitals to charge a flat rate for a given set of symptoms, tell you what that is upfront, and then take on the risk of whatever treatment you end up needing? The only downside is this gives the hospital an incentive to undertreat (although that's probably better than the current incentive to overtreat), but hospitals would have reputations and could potentially be sued for undertreating.

You'd think so and it's a fair question which is why I gave example somewhere else in this soup of comments. Elective procedures, stuff done at an outpatient surgery center, cosmetic things. Low rate of complications, low rate of fuck ups, pretty simple with a lower range of prices. Sure. Places will do that.

Hard to do for symptoms for so many reasons (is that headache a migraine, a stress headache, or a brain bleed? You are complaining about 8 things and the real problem is heart failure etc etc, the pain is referred and it's actually a very different kind of thing).

Once you've figured out what's going on it's feasible for some things, but the American population is really unhealthy and the one person where you open them up, find out it's bowel cancer and not appendicitis costs hundreds of times more than the regular appy.

It's the equivalent of those housing developments where everyone shares water fees but someone has a pool that they keep emptying and refilling every day.

Is this for real? The person billing OP wasn't even a doctor, and no PA, NP, or doctor is getting paid that much for that type of work. Blame the admin and the billing people for the number, the PA has no control over it and is making 1/10 of that sticker price.

Again, as stated elsewhere doctors have been lobbying for their own competition for years, who proceed to do the same job for cheaper, with less training, and do a demonstrably worse job.

I'm always flabbergasted at how little people seem to know about this in relation to how enthusiastic their beliefs are.

Also the NHS is collapsing.

Ah you took this a different angle than everyone which is a better one.

-Restrictions on open immigration are not unique to medicine, no field wants to import competition and generally countries don't want to fuck over their knowledge workers. While the U.S. is notable for you needing to redo residency, that doesn't mean it's actually possible to move over (Canada and Australia will happily take U.S. docs but Germany is incredibly hard) for other reasons.

-Related to that, most countries aren't excited about this because in many countries a lot of people want to move to the U.S. because it's the U.S. or because salaries are higher. If you offered everyone in the NHS the chance to move to the U.S. healthcare in England would collapse instantly. So both the push and pull are blocked.

-Despite this if you wanted to import family medicine doctors (the only area that has true real need) from other countries I don't think anyone would complain, including the family care doctors.

-Training is strictly controlled in the U.S. and is better than elsewhere (mostly by being harder, potentially for no reason) but is also very much so less variable. You picked good countries but you couldn't do this with say India because of the training programs are absolutely U.S. grade and some are incredibly deficient.

-We don't have much of a shortage of doctors in most specialties, we have an allocation problem. Most doctors want to live in a relatively small number of urban areas so those places are flooded and everywhere else is lacking. The reasons for this are complex but increasing supply is unlikely to fix it, but doctors for clamoring for an increase in supply (in the form of residency spots) ANYWAY and have zero control it - blame the government.

-Physician political influence is abysmal right now, we've spent decades propping up our own competition, everyone hates us (because of envy of salaries, political involvement with covid, accusations of racism etc etc) and what lobbying we do do is just left wing politics.

-Physician pay is not unbelievably excessive. The average family care doctor makes 220k. That's a lot of money, but the ceiling is low and it comes with unbelievable sacrifices to that point. When people think of ridiculous pay they think of the orthopedic surgeon making 750k but those guys are less than 1% of doctors, over 90% of doctors are in primary care in some form and those people aren't making the "real" money.

-Medicine in general can be described as a skilled trade, that's what nurses are. Physician work cannot. In the U.S. doctors get training in (and are expected to use these skills) teaching, leadership/management, and research science. Depending on the field soft skills vary from mandatory to almost all of the job (as in Heme/Onc, Psych, and Palliative). On top of that some fields do have the manual skills. That is not an upscale plumber. In the U.S. we've made many attempts to drop in people with less training and skills and they do a demonstrably worse job and unlike in emergency plumbing people actually die.

I'm just curious if you'll tell us about the severity of the nose bleed. I get them occasionally, but I have never had one so bad that required medical attention.

It was really bad (had gone on for about 3 hours). I recently moved to a much drier part of the country. I bought a humidifier and now use Vaseline a couple of time a week. This seems to have fixed the issue.

I live in dry, mile-high Albuquerque, a climate known as “high desert”. Were there no city here, it would be scrub grasslands as far as the eye could see. Relative Humidity is routinely 45%, as low as 30% in summer when temps reach 90F.

I stay hydrated by drinking water the moment I feel the least bit thirsty. This results in lips which never need Chapstick, and mucus membranes which are always moist. However, the nose still occasionally bleeds. I’ve gotten really, really good at avoiding nosebleeds lasting longer than a minute:

  • As soon as it starts, shove the nearest absorbent paper in the sanguine nostril: facial tissue (Kleenex), toilet paper, or paper towel in descending preferability.

  • Grab the nearest drinking water bottle, (unopened) press against nape of neck to chill. If summer, apply to front vessels as well. Water inside will be at most room temperature, usually cooler; shrink blood vessels and chill blood simultaneously. When neck flesh is chilled, apply to lower forehead/eyebrow ridge as well, and maybe sides of nose.

  • If no closed water bottle is nearby, apply cool tap water to neck and forehead, let evaporative cooling chill the flesh instead. Cool water on bridge of nose also.

  • Change out absorbent paper. Breathe out (never in) through both nostrils to help platelets clot via CO2 exposure. Always tilt head forward or upright, never back.

  • Repeat cooling if nosebleed lasts long enough for flesh to warm back up. Repeat nasal tampons until clotted.

scrub grasslands as far as the eye could see

It's fair to not count the Sandia forests, but what about the cottonwoods? "Bosque" might be a bit of an overstatement, but there's at least more than scrub and grass in that narrow strip next to the river.

True, the high desert is punctuated by a seasonal ribbon of water surrounded by gorgeous forest. Agriculture has attracted humans to the Rio Grande valley for millennia. Ancient red rock cliffs and multicolored rockscapes show ancient paths of much deeper waters, and towering mountains — the Sandias, Manzanos, Manzanitos, Sangre de Christos, and the giant cone of Mount Taylor — showcase the stunning variety of plant life our desert can boast.

But, as sure as the Rio Grande’s path down the heart of this vast state to become the border between Texas and Mexico, you can be certain that the mile-high dry air will yield nosebleeds.

  1. You should get insurance, this is what it is for. If you have a plan but it has a super annoying deductible....well yes that's how it works (if you don't and you were cash pay you should call the billing department as the other user pointed out, and then get insurance).

  2. I'm not sure if this will help but you should consider that (while it may appear superficially similar) medicine is not going to be like going to a mechanic. When you go to your dealership the work of analysis and diagnosis is often not paid for, then they'll tell you how much it is to fix the issue and you can take it or leave it. The cost is the labor and parts and replacement and repair. When you go to the emergency room you are paying the staff for the time and resources it takes to figure out what is going on. The treatment is often cheap (medicine, a splint, whatever) but the imaging, labs, and professional fees are time consuming and expensive. As a layman you aren't going to know what is going on under the hood (for instance in this case adults generally don't get nosebleeds that are bad enough to bring them to the hospital, so it could be because it's hella cold and dry outside, or it could be because the patient is having issues with clotting blah blah).

If you have chest pain and go to the ER, and after talking to you they give you tums and tell you to avoid spicy food the bill isn't for the tums it's for making sure you didn't have a heart attack.

You can see my responses below if you are interested in more details but I fundamentally don’t feel any moral obligation to a system where you have in network hospitals with out of network doctors.

Also it’s sort of stunning that americas credit bureaus appear to agree that the system is so exploitative that they simply ignore small

Amounts of medical debt when considering my probability of repaying other debt.

Do you believe health systems should be forced to provide care for someone who has no willingness and/or ability to pay? (They are - if you walk into an emergency room and say I will not pay for any care you provide me they are legally required to give you the same shit as anyone else).

If your response is "you know what I don't want any medical care" then my complaint is withdrawn, but otherwise it sounds like you want to "steal" because you don't like how the process works and don't have a lot of information about healthcare economics.*

*From your other post it sounds like you've been on the receiving end of a practice called surprise billing, which is controversial and legislated against in some jurisdictions but exists for a complicated and justifiable reason but is still annoying, as is usual the problem is health insurance companies being pretty much straight up evil and then blaming everyone else.

As for your frustration with medical debt, if people refuse to pay their medical bills all the hospitals go under and nobody gets medical care. I can understand you're frustrated but these things exist for a reason.

Having read through this whole thread, I wanted to say that I consider myself a strict capitalist in most things, but the whole industry of medical billing is so ridiculous for so many inscrutable reasons with everyone pointing fingers at each other that I find I'm unwilling to make any moral judgements at all for anything any particular patient chooses to do.

It is indeed pretty incredible that the situation is seen as ridiculous universally enough that the credit bureaus are now ignoring medical debt.

I don't know that I'm inclined or qualified to really defend any particular party in this mess. But I do notice that everyone seems to love to make the insurance companies the boogiemen. Aren't they all publicly traded though? If they're wildly profitable, can I invest in them and get some of that sweet healthcare cheat money? If not, well where's all the money going? What if they're just struggling to eke out some tiny profit while being constrained by an ever-changing maze of legislation and trying to juggle the conflicting demands of a dozen different groups, as the sole party with some responsibility to actually make the books balance somehow with the totality of everything that's going on?

Nothing about a market this regulated can really be described as capitalist. I don't understand how hard it is for people to draw the, to me, obvious line between level of regulation and dysfunction. Do people just think it's a coincidence that housing, medicine, schooling and banking are the industries everyone seems to constantly have problems with and costs seem absurd?

I agree, and that's why I don't consider the overall American healthcare market to be meaningfully capitalist from a consumer's viewpoint, and so in that case the morality of a capitalist system does not apply, in so far as owing the person doing a job for you a fair wage for the work that they performed.

Nothing about a market this regulated can really be described as capitalist.

That's only if one believes that capitalism and regulation are somehow opposite to each other.

This so where the scope creep of what counts as "capitalism" makes the conversation impossible. The previous post seemed moderately in favor of "capitalism" so I interpreted as "relatively free markets". If we're going to switch to using the "cabal of capitalists control everything" then the response is "of course that's bad but it's never existed and no one would ever claim to be usually in favor of that".

  1. Everyone has an opinion about healthcare, almost nobody expressing this opinion has the slightest idea what's going on and that often includes people in healthcare, often this is downstream of politics (ex: docs foaming at the mouth at anti-vaxxers, or advocating for "socialized" healthcare without knowing what that means) or arrogance (the "medicine isn't hard or complicated" crowd you see here frequently).

  2. Yes follow the money. Some high resource health systems are doing well, but many health systems are being bailed out or going under. Salaries are decreasing relative to inflation (or just overall), burnout is increasing and we've had a bunch of major major strikes/threats of strikes over poor pay and working conditions (like unsafe nursing staffing ratios). Meanwhile:

"The nation's largest insurers, UnitedHealth Group and Elevance Health, reported profits that were 28 percent and 7 percent higher than the same period last year, respectively. UnitedHealth raked in $5.3 billion, while Elevance took in $1.6 billion.

In contrast, some of the nation's largest health systems, HCA and Tenet, saw their profits fall dramatically compared to the third quarter of 2021. HCA reported $1.13 billion in profits, a decrease of 50 percent. Tenet took in $131 million, which is down 70 percent since last year."

Notably HCA and Tenet are both pretty evil companies (large for profit health systems) that will do WHATEVER to make a buck (and have been in legal trouble over it).

  1. Medical billing isn't "ridiculous" okay well it is, but it makes sense and is a well defined system that a lot of people don't understand... but again people don't understand it but everyone is forced to interact and therefore has opinions. Providers become the punching bag for appropriate medical decisions patients don't understand and administrative/billing decisions that providers have zero control or influence over (having being pushed out of medical leadership and admin for decades, sometimes by complicated government mandate).

  2. Speaking of which why is this shit so expensive? People like to blame salaries and labor shortages but that's a lack of understanding at best and jealousy at worst. Our population is getting less healthy (and other countries are catching up in costs as they become like us) and care is getting more complicated and expensive for good reasons. Additionally regulatory and administrative burden means lots of extra hands sucking at the teat. It's similar to academia (think professor to admin ratios, self-inflicted wounds like DEI staff etc).

"these things exist for a reason"

so what? whether something has a reason doesn't mean the reason is good or justifiable; you don't describe any of those reasons or justifications so there isn't anything to respond to here

trying to portray this as some sort of moral choice binary where you either never seek healthcare or you're stealing if you refuse to pay any bill any random biller in any random medical black box decides to send you empty moralizing and a bad argument

anyone who has legitimately tried to find out what services are going to cost in the medical industry knows how incredibly and intentionally dishonest and obfuscatory it is

As for your frustration with medical debt, if people refuse to pay their medical bills all the hospitals go under and nobody gets medical care.

lots of people refuse to pay their medical bills now (especially the full amount) and yet more healthcare is delivered now than ever before

the user isn't claiming no one should pay medical debts, but that at most people shouldn't pay ones which are the result of asinine practices intentionally designed for this outcome which is asinine

if more people refuse to abide by these asinine practices, then the practices would end not that no one would provide medical care to anyone else anymore as is the case in states and countries which ban this practice

If you have your car repaired and drive off without paying you are going to get reported, and you certainly don't get to come back and demand the next issue be fixed. It's absurd. Even in outpatient land you can't fire a patient (even with just cause like total refusal to pay or blatantly abusive behavior) without jumping through a ton of hoops.

Rural hospitals and suburban/urban hospitals with poor payor mix (in a lot of areas/for a lot of types of care medicare and medicaid pay less than cost) are going under left and right, and other places are closing their EDs in an attempt to stem the bleeding associated with most of the people least likely to pay. It's not getting a terribly large amount of attention outside the field because it's mostly poor whites and the media/left feels awkward about leaving healthcare out to hang after so much superficial support during the pandemic.

This specific practice (this explanation is abbreviated)* is driven by insurance companies refusing to negotiate with physician groups and just say lol I'm going to underpay you, fuck you. When providers try and negotiate the insurance companies label this "surprise billing" and lobby jurisdictions to ban, knowing that the result is professionals have to just not get paid or accept the lowball offer. It's a negotiating tactic. In the last few years providers and low resource health symptoms have seen total crashes in economic health while high resource systems and insurance companies are doing fantastic, but they don't replace the resources that are closing and retiring.

About half of the psychiatrists in the country are able to retire and they are just fucking right off instead of staying and during a time of sky rocketing mental health crisis. We have limited ability to train replacements if we even wanted to (for a number of reasons) and the stopgap (Psych NPs) are uniformly terrible and create more work for the leftover physicians (psychopharmacology is a lot more complicated than most management, as in diagnosis).

*Their are other explanations, you have stroke and the one neurologist on call doesn't take your insurance. Either they let you die, or work for free/try and bill your insurance anyway.

Do you think billing for car repair is in the same zipcode as medical billing? When I ask for how much something is going to cost to a car mechanic, they tell me how much it's going to cost. I don't find out a month later that, actually, a ringer car repair guy which costs $10,000 flew in town overnight and did the work. This isn't an appropriate comparison and it's why your attempt at moralizing in this way falls flat. When a person is complaining about a specific reason why this practice makes nonpayment justifiable, your analogy need to address that specific aspect of the justification.

leaving healthcare out to hang after so much superficial support during the pandemic.

the healthcare sector at every level delivers more care at higher prices and higher pay than ever before

given that context, a claim that people refusing to pay bills in situations the OP described is going to result in no services being offered is a stretch

Are places which ban the above practice more likely to suffer the effects you're talking about? If not, I don't really understand the relevance beyond a general criticism for nonpayment.

This specific practice (this explanation is abbreviated)*

when a patient criticizes a practice which is intentionally designed to extract more money in dishonest ways from patients, your response is to tell the patient they are morally obligated to either pay whatever bill is sent to them or not seek medical care at all and the real bad guys are those darn insurance companies

an easy response is for patients also not to pay, this is just "the system," tell you to whine into the wind at your congressperson, and blame those darn insurance companies

"we're getting screwed so we're going to screw someone else" doesn't magic some moral obligation on the part of the last screwed anyway

this justification is that you have more negotiating power over patients so you're going to use it to extract more money because you don't have that negotiating power against insurance companies; this aspect of the argument is even more true in the case of the individual patient vis-a-vis anything

you have stroke and the one neurologist on call doesn't take your insurance

okay, so what does this have to do with a physician's assistant in a non-emergency situation?

-Hospitals can't tell you how much things are going to cost because they don't know and insurances won't tell them they how much they'll reimburse. Insurance rules are complex, constantly changing, and do so with no notice, if a place says "it will be 500 dollars after insurance" they have no idea if that's accurate or enough, and that's when needs are static. And that's if you pretend cost of delivering care is static. It isn't. If a surgery costs on the median X a specific instance could be 0.8x (healthy thin young adult, 1.2x (obese 50 year old), or literally 100x (patient has a complication, crashes, ends up in the ICU). Is the hospital supposed to charge everyone 1.5x to cover for the one person who explodes? That's like involuntary insurance. Places will offer elective and simple procedures in a fixed price fashion but they are very very cautious with that.

-Healthcare in the U.S. is collapsing, many disciplines are moving out of public insurance (most OP specialties) or private insurance (psych, in a limited fashion). Hospitals and facilities are going under with enough frequency it is approaching a full blown crisis, but most of us live in big cities with a famous name brand academic hospital that just put up a 500 million dollar building and has a million billboards. Easy to miss the crisis.

-This process is not designed to extract money unnecessarily from patients, the insurance company is refusing to provide the paid for service and instead of refusing to pay the insurance company for sucking balls the patient is fucking a different victim who is also legally prohibited from retaliating. I don't understand how the hospital/practice management group (and keep in mind that no clinician at any point is involved with any of this) is the villain because the insurance company refuses to provide insurance.

-As is usual for legislation, surprise billing stuff has a tendency to be written by corporate interests that have a financial interest in making the stroke attending and the ED fast track PA the same situation on paper.

Hospitals can't tell you how much things are going to cost because they don't know and insurances won't tell them they how much they'll reimburse.

so how is this similar to the car mechanic bill situation?

besides, all sorts of other professions delivering all sorts of other services with non-fixed costs and complications manage to present agreed upon, known costs and estimates up front and don't send a surprise bill with an absurd amount attached

I've received healthcare at countries all over the world; there, despite the complications you describe w/re pricing, they're able to tell me an estimate which aligns with the bill I receive later. Even when there are complications. Even when a mechanic while looking at the drivetrain notices the transmission needs to be replaced. As far as I know, there is a single industry which does this and only in a single country in the world.

-Healthcare in the U.S. is collapsing

I am sure there are parts of the US which really struggle with medical services and have the problems you're describing, but on net no it is not or else it wouldn't be delivering more total healthcare, with higher salaries, and higher prices than ever.

Are places which ban the above practice more likely to suffer the effects you're talking about? If not, I don't really understand the relevance beyond a general criticism for nonpayment.

This process is not designed to extract money unnecessarily from patients

"Unnecessarily" doesn't have much explanatory weight, e.g., I promise to pay any bill I think is "reasonable," and I won't unnecessarily refuse to pay any bill I think it reasonable. This statement doesn't really mean anything.

Nothing about this is strictly "necessary" because if it was then it would be done in places which banned the practice except they don't and medical care is still delivered there. An accurate statement would be that they do it because they're trying to extract more money from the patient or their insurance, they don't have negotiating power with the insurance company, and so they're going to go after the weaker position patient.

I don't understand how the hospital/practice management group (and keep in mind that no clinician at any point is involved with any of this) is the villain because the insurance company refuses to provide insurance.

no one has to be the villain here, but it also doesn't mean by default it's just the patient who has some moral obligation to get screwed and fork over whatever amount some derp bureaucrat decides to send them

As is usual for legislation, surprise billing stuff has a tendency to be written by corporate interests that have a financial interest in making the stroke attending and the ED fast track PA the same situation on paper.

I don't doubt that. Judging by the ACA, insurance company lobbying groups will find a way to make it even worse. If the legislation is similar to efforts in my field, it may help some random person like the OP accidentally in certain situations but will mostly be used by megacorps to put them in better negotiating positions.

More comments

Fundamentally, it sounds like you perceive that the problem is that people don’t pay enough for health care (whether that is through private insurance or through Medicaid).

This means that the hospital/physician is trying to take advantage of me because I am easier to negotiate with than my insurance company or the government. In the recent past where they could fuck my credit score they had most of the leverage and this would have worked and people like me would have been responsible for propping up a broken payment system. How is this not absurdly predatory?

Now that this is more difficult perhaps the AMA or the hospital lobby or any number of absurdly powerful interest groups which exist to guarantee the welfare of the healthcare industry, can take action on this instead?

I suppose they might also just increase bills so they always meet the 500$ credit reporting threshold but this will probably take them a few years since it will need to at least look somewhat what organic to avoid being sued by some ambitious attorney general somewhere.

The hospital and provider/provider group are definitely not making decisions based off of some credit reporting threshold, they don't have the time or energy for it and charges and costs are too often pegged to other things. The insurance company might be, can't speak to that.

I also make no claims as to if people aren't paying enough, I just want people to actually pay like they said they would (especially in the case of the ED where 9/10 visits are inappropriate and make things more expensive for the people who actually need the ED resources).

Now is the government or insurance paying enough, that's a separate question. No for some aspects of healthcare, in a very demonstrable sense (that is, if your hospital is being paid mostly by medicaid it WILL go out of business without another funding source like being directly propped up by the state government).

Another different discussion is "are providers overpaid" and while that's a much more nuanced question, in a very practical sense the answer is no - if you want to see a specialist outpatient (especially in something like neurology) you are going to wait two months or have private insurance. The healthcare sector of the economy has been trying to slowly boil docs with decreasing salary for decades and it's starting to boil over and you just wont get good care (or care at all in some fields like psychiatry) if you aren't rich. I'd not be shocked if life saving surgery is simply not available within the next 10-15 years because surgeons will just refuse.

But in this case the issue is that you have a problem with the customer service and overall service offered to you by your insurance company, and you are taking it out on the health system. The problem is the health insurance product you purchased not giving you what you want (because of blah blah negotiating with what's probably a private equity owned practice management group with no clinicians in the leadership structure at all). At no point was anyone directly in healthcare involved in what fucked you except for the person who actually helped with the epistaxis.

Generally speaking health systems are very willing to negate with patients paying out of pocket because the charges are made up as part of some bullshit voodoo dance with insurance and the government. The unwillingness to negotiate def increases the likelihood of that professional fee going to a private equity group (the PA probably got paid like 50 bucks for 30-45 minutes of work that was mostly invisible to you).

I'm going to be a bit fiery here because this comment is top to bottom incorrect. It will never cease to amaze me how strong opinions on healthcare are with no experience, knowledge, or accuracy.

  1. The minimum amount (with room for a lot a lot more) of training for a physician to practice independently in the U.S. is 11 years (4+4+3), there are some exceptions but they are very rare.

  2. The person caring for OP who they are complaining about is a provider (a PA), not a doctor, and has a minimum (and essentially maximum) amount of training of 7 (4+3) years.

  3. Physician lobbying groups have spent the last 15-20 years heavily lobbying for people outside their "club" to able to provide healthcare (providers), because they could charge for it in a supervisory capacity. Now it's biting them in the ass because those providers are lobbying for independent care, providing inferior and infuriating care (often while identifying themselves as doctors) and increasing costs (PA/NP care costs more but it's in stuff that the hospital/ownership group gets to take a bite out of instead of professional fees, for example unnecessary lab testing).

  4. Fixing a nosebleed is harder than you think it is. A lot harder. A school nurse or a person at home can shove a tissue up your nose but that doesn't mean they are thinking about coagulopathy, and considering the risk of TSS, other infection, necrosis, know when to call ENT or to do a further work up and so on. Nasal packing for epistaxis is something requires a surprising amount of considering and critical thought, but you don't know that, the nurse doesn't know that, the PA probably doesn't know it, and an annoyingly large number of EM doctors don't know it. Ask a pediatrician.

  5. Physician professional fees are a small portion of the cost of healthcare.

If I wanted to read 10k (or more) words to learn how to be less wrong about healthcare, where might I start?

(and yes I know you asked for a general primer but the point is to build knowledge of the unexpected complexity).

Here's an example-

https://old.reddit.com/r/Residency/comments/104bwb4/why_was_damar_hamlin_in_the_sicu_after_his/

Why is Damar in a SICU (Surgical Intensive Care Unit) - some people are saying that's best practice, some people are saying that's best quality of care, some people are saying that's because of the resources specifically at UC and some people are saying it is because the case is high profile. And you can find someone saying the opposite for each of those. Everybody knows what they are talking about.

No way to know unless you work there and were involved and some combination of those answers is probably correct.

Stuff is very resource and facility dependent and a lot of things don't have strong consensus.

I learned how to effectively grade scientific literature by looking for places where you'd see the hordes of "SOMEONE IS SAYING SOMETHING WRONG ON THE INTERNET" types and seeing what they said, and then after years of that picking up the skills myself.

Go to /r/medicine or other similar places, look for the hot button stuff, see what people say and complain about. At first you'll be missing context but you'll pick it up. Bonus points if you also go to the other places with different levels of training like /r/residency.

Be aware of the biases of the various areas though (anything remotely political is DOA on meddit, it's appropriate to hate midlevels but the residency subreddit takes it a little far).

Very common for industry adjacent people to do this, you'll see consultants, tech people, and lawyers pop in with their expertise because they are following or work or because of a partner.

Most of the mistakes people make are pretty basic- assuming it's simple and easy, or because they are falling for one of the agenda pushers (including us).

If you look closely you'll probably see one of those situations where three people with over 20 years of training and who very are on top of it are articulately arguing over if something like if "is a bandaid is actually a good idea or not" and you'll be like Jesus this is a nightmare.

You're incorrectly imagining that competition to the medical industry would take the form of a smaller less trained private healthcare industry that otherwise operates entirely the same as the current dysfunctional system. In reality it could be something like going into a clinic staffed by a couple of people with bachelors degrees who go through a digital flow chart and either refer you to a full hospital if the flow chart says it's beyond their capabilities, with an estimate of how much the hospital will charge so that you can be an informed consumer, or solve issue using a step by step guide that comes up immediately from the flow chart. This whole process could cost nearly nothing compared to going into a hospital and paying hundreds of dollars to waste an MD's time and be perfectly transparent.

And yes, the idea that you need over a decade of training to do the majority of what people are paying for in the healthcare industry is absurd and broken.

And yes, the idea that you need over a decade of training to do the majority of what people are paying for in the healthcare industry is absurd and broken.

Just so so wrong. Even in other countries with faster tracking the thing that gets cut down is undergrad (which is fair but hard to do in America, has its own significant problems, and is logistically unfeasible without completely uprooting our system in a way that isn't happening, and only shaves off two years anyway). We have some good evidence for this in the highly limited care given by providers - the NP lobbying groups best data says that NPs outcomes in simple cases is about equal with physicians outcomes in complicated cases (of course they jazz it up but that's what their data says, never mind the MD studies). Keep in mind that doctors are also the only ones getting that much training, everyone else is considerably less....and it shows. Ask any psychiatrist off the record about how the NPs and PAs are doing and they'll be able to convince you to never send a loved one to either.

As for your other point, flow chart care just doesn't work, no matter how much the MBA types may want it to. Decision support tools are miles off, for some godforsaken reason you can replace artists with an "AI" but the EKG autoread (which is one of the most computationally simple tasks imaginable) would get people killed if put in charge.

In addition to the always underestimated medical complexity, you have the human element - patient entitlement these days is sky high (as exhibited in this thread), people are always demanding things that are not indicated or are outright bad for them (ex: antibiotics for viruses) and your flowchart clinic would be immediately going off the chart or burned down.

That's not taking into the account the unacceptability of failure and legal environment, as soon as someone dies because of an edge case (which happens all the time) flowchart clinic would get sued into oblivion.

If you accepted upfront that 10% of people are going to have an unnecessarily bad outcome and 1% of people are going to die unnecessarily you'd be able to do as you say, but nobody is signing up for that. We (rightly so) value human life too much for that.

If you accepted upfront that 10% of people are going to have an unnecessarily bad outcome and 1% of people are going to die unnecessarily you'd be able to do as you say, but nobody is signing up for that. We (rightly so) value human life too much for that.

Really? What are the numbers under the status quo?

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Ask any psychiatrist off the record about how the NPs and PAs are doing and they'll be able to convince you to never send a loved one to either.

I'm married to one, she disagrees. Most of her beefs have been with the embarrassingly dysfunctional nature of the hospitals she's been in that would never stand if there was real competition. EDs that either have no way of checking how many bed the psych department has open or for some reason refuses to believe either those tools or the doctors who tell them they have no beds. Spending countless hours on hold with pharma companies because for some reason totally inconceivable to me you need multiple doctorates to navigate call trees. The pure waste of it all has had me furious more than a few times.

If you accepted upfront that 10% of people are going to have an unnecessarily bad outcome

If by "unnecessarily bad outcomes" you mean their nose bleed takes longer to figure out then sure I think people would be more than happy to deal with that and save hundreds of dollars.

1% of people are going to die unnecessarily

No way this is accurate.

That's not taking into the account the unacceptability of failure and legal environment, as soon as someone dies because of an edge case (which happens all the time) flowchart clinic would get sued into oblivion.

Why yes, we're discussing the legal framework your lobbying group has been enmeshed in creating. "We'll crush your upstarts like the pathetic little bugs they are if they dare" is precisely the thing I'm arguing should be abolished.

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If this is cash pay, call the hospital billing department and ask them to cut it down if you'll pay cash.

If it's insurance, this is stupid but you just have to live with it.

It was insurance, apparently the hospital is in network but the physicians assistant was not so they won’t pay any of it. Also the physicians bill didn’t come from the hospital but from some other entity which refused to negotiate.

I've had this happen. The last town we lived in, the entire ER staff was out-of-network! Do you know if your state has a law against surprise billing? I am really happy that I now live someplace that does.

Surprise billing legislation (while superficially well meaning seeming) is a scam invented by insurance companies as a negotiating tactic, which is part of why its implementation is limited.

Can you point me to any support for this statement, or why this legislation would be undesirable for consumers?

https://old.reddit.com/r/medicine/comments/da5ccm/in_california_a_surprise_billing_law_is/

In general you can dig around on meddit just search for surprise billing.

Superficially this looks more like a problem for docs than for patients (well fuck you guys just take a pay cut) but in general you want doctors to have more leverage and control because while they want money (just like anyone else) they came into the field despite the opportunity costs because they wanted to actually help people. The other interests are just trying to extract value for the least costs (insurance companies, private equity firms that buy physician groups and so on).

Physician power and influence (and self-employment) has been plummeting for awhile now and they essentially minimal influence over care and costs in a lot of settings which generates the stuff that pisses people off.

A doc can provide free care (and many did) if they aren't owned (by a hospital, practice management group etc).

Shorter version: monopolistic competition = bad.

I agree that monopolistic competition is bad, which is why it's terrible that I can have one hospital in my city and their ER doesn't take insurance. What is the average person supposed to do in that situation? They can't shop around; they just have to eat whatever medical bill comes their way, on top of whatever they and their employer pay for insurance.

Emergency medicine is a place where the free market system really breaks down, and we need a different solution from what we have now. I don't know if the surprise billing legislation is the best situation, but what else is being proposed?

Why can't the insurer pay the customer directly?

Surprise billing pops up in two major places- the ED and for consult/pop-in needs.

The later is rarer, less obvious to patients, and harder to fix without big sweeping reform (I NEED EXTRA HANDS IN THIS ROOM RIGHT NOW or "is anyone at work right now who can help answer this question?" are hard problems) attempts at fixing the ED stuff break this process to and discourages those resources from being available. Nobody wants to risk not getting paid so community hospitals have an increasing dearth of specialists and then whole death spiral (for the health system) and poor quality of care things happens.

The issue with the ED is that the structure of American healthcare discourages physician self employment and physician owned practices, so one of the major driving factors here is that private equity groups have bought all of the ED doctors who aren't hospital owned and then start some fuckery with the insurance companies and this is one of the things that shakes out.

Realistically it's still a problem in physician lead healthcare but right now it's those large and connected industries fucking with each other.

Some breakthrough protection would probably help a lot "in case of truly emergent care needs the professional fees need to be covered by insurance but at no more than 110% of the fee schedule for the mean costs of in network professional fees" or something would fix the problem.

I'm sure that would have issues but the point is that the insurance companies aren't interested in fixing the problem they are interested in lobbying so that they don't need to pay for things and someone else gets the blame.

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What is reasoning behind only paying doctors that are in the network?

I truly don’t understand the moralizing, there is no universe where having an in network hospital with an out of network doctor is anything other than an attempt to obfuscate in an attempt to extract a higher price. Also I am surprised that you believe that complaining to congress about exorbitant healthcare costs is anything but a waste of time, the last 30 years of history would seem to contradict you on this.

Upon reflection it’s stunning that americas credit reporting agencies apparently consider healthcare to be so predatory that they don’t think medical debt is predictive of someone’s willingness to repay other kinds of consumer debt.

It doesn’t sound like anybody is trying to raise prices for you. It sounds like there’s inscrutable bureaucratic reasons for the bill getting passed on to you and not the insurer.

Yes, this is frustrating, but if you couldn’t pay a $350 bill you should have picked a different plan.

Happy New Year! So, what are you reading?

I'm on Korzybski's Science and Sanity. E-Prime has had a surprising effectiveness for me, and I have been interested in any links between Korzybski's system and Zen. I can already see that I'll find a lot that I won't agree with, but maybe I'll find some useful clues. General Semantics attempts a "non-aristotelean" way of thinking which is supposedly more harmonious with new sciences like quantum mechanics. It is one of those systems which didn't really take over the world, but did have influence, and seems to have generated some interesting people.

I just finished Harvey Sachs’ The Ninth about the historical context, both musically and politically, for Beethoven’s final symphony. It was a relatively short and enjoyable read, and nice to get more detail on the world and time in which it was composed.

I joined a book club, so I'm now reading Project Hail Mary though I hadn't really intended to. I read The Martian a while ago and thought it was fine.

I love the idea of book clubs, but hate how they require you to read certain books that might not otherwise be on your list. I know there's the argument that it helps you diversify your tastes, but there are just too many books out there that I won't live long enough to read that I hate spending time on one I'm not passionate about. So in my ideal world I have a book club, and I am the autocratic dictator who chooses every book.

Anyway, the book is interesting enough so far (I'm 1/5 in). It is a little weird to me though that it follows the same pattern of The Martian of "guy alone in space."

My book club is currently discussing short stories. It’s wonderful. I still get to discuss fiction, in person, with a group of people once a month. But the time commitment to prepare isn’t much more than an evening or two, to read, re-read and take down my thoughts.

Love that idea - and there are so many great short stories out there! I might suggest it when it's my turn to pick.

I was reading Project Hail Mary a while back myself but never really finished it.

I think the reason why I stopped is because Andy Weir's specific style of writing doesn't jive with me very well. The writing is very simplistic and is easier to parse than lots of other sci-fi, which is fine (perhaps even good) on its own. However, there's also a lot of very juvenile humour and characterisation, and this, along with the simplicity of the prose, ends up creating a goofy and immature vibe that feels particularly dissonant when it's contrasted with the extremely tense situations the main character is placed in.

Yeah, the writing feels very "informed by Internet culture." It's like it's trying too hard to be appealing to me, which I find off-putting. At least it's short and I can get back to my other books soon!

I've been reading Kim Stanley Robinson's Red Mars. Tracking the efforts of 100 scientists sent on a mission to set up a Mars colony, it's exactly the kind of sci-fi I love - very grounded, full of technical explanations, philosophical arguments, speculations on the psychology of this unique situation, and political intrigue. I don't have the scientific background to know how much of it is accurate (Would hydrazine engines be the preferred option for Martian tractors? Can we really bioengineer microorganisms to such an extent? Surely the extremely fine Martian dust would be an immediate health problem and not just something you can shrug off as "yeah this will probably kill us in a few decades but that's Mars for ya"?) but it all sounds good enough to my layman brain. Highly recommended to anyone with an interest in Mars or hard sci-fi.

Also, I would like recommendations anyone has for a good book on the Franco-Prussian War.

I'm reading The Goodness Paradox. It divides violence into two categories: Reactive and proactive, and says that humans, compared to every other species, have vastly lower amounts of intraspecies reactive violence(violence because of emotional triggers, like someone insulting you or to display dominance) but also have vastly higher amounts of intraspecies proactive violence(plotting murder, going to war).

With 3M phasing out production of PFAS (Per- and Poly-fluoroalkyl Substances) in the news, I'm reading a flurry of news about how these substances are found in human blood, break down slowly--if at all, and are linked to cancer, hormone disregulation, and immune disorders.

My question is: is this a health threat I should be worried about to the point that I should be replacing my Teflon cooking pans?

should be worried about to the point that I should be replacing my Teflon cooking pans?

I went down this rabbit hole previously. It's probably not a huge concern. However, I went carbon steel a few years ago back, and I find them far superior for taste and durability. Previously I bought the best teflon pans I could find, but they only lasted a couple of years at best before they began to fall apart (I cook a lot). The carbon steel pans had a small learning curve with regard to seasoning, cooking, and maintenance, but now its habit. The seasoning no longer requires any special care. I have a few De Buyer mineral b pro's with factory seasoning, and added more season at home. I cook the vast majority of my stuff in the 32cm fry pan. It'll live for decades if not centuries. Most people find it comically heavy, but it doesn't bother me.

My understanding is that most of the risk these substances pose comes from emissions created during the manufacturing process. Once the product is complete, though, it's pretty stable. I wouldn't heat up a dry pan to the point that it's fuming, but other than that they're pretty safe. The risk comes from living close to the plant where they're made.

If the pan is hot enough to say, sear meat, is that an issue?

Even if the chemical itself is stable (which AIUI is the root of the problem), is there a problem of the chemical leeching into the food?

First, the pan has to be ripping hot for that to happen and you will definitely smell the fumes. If you're already cooking with Teflon and haven't yet experienced any ill effects, I wouldn't worry about it. Even then, the problems it causes are temporary and not a chronic problem. With leeching, it's not so much that as it is flaking, as slick surfaces don't want to bond to anything including the underlying metal. But the inertness means that it's not reacting with your system, either, and should pass through without causing any harm. The problems caused during manufacturing are due to the precursor chemicals used in manufacture rather than the final chemical itself. Even if you're worried about Teflon, the pans should be the least of your concerns, since the same class of chemicals is used to coat a lot of food packaging (and other packaging) and is literally everywhere. The benefit of a good nonstick pan is well-worth the disadvantage of potentially marginally increasing exposure to a chemical that isn't known to be dangerous anyway.

The entirely reliable "compare the numbers in the first few google results" method says searing occurs at 150c / 300f and PTFE starts breaking down at 250c / 500f. That said, science is hard, interpreting things you don't know much about is hard, so idk. Reading the wikipedia article -

Most cases of polymer fume fever in humans occur due to smoking PTFE-contaminated tobacco,[62] although cases have occurred in people who have welded near PTFE components[62] or heated PTFE-coated cookware at 390 °C (734 °F) for at least 4 hours.[63] Teflon-coated cookware is unlikely to reach dangerous temperatures with normal use, as meat is usually fried between 204 and 232 °C (399 and 450 °F), and most cooking oils (except refined safflower and avocado oils) start to smoke before a temperature of 260 °C (500 °F) is reached

Going from "the gap is 150c / 250c, which seems fine", and then read "the gap is 230c / 390c, which seems fine", huh. (not that this proves or is even good evidence there is some sort of harm, but it is evidence it's quite hard to tell)

The abstract of a paper I skimmed, although the paper didn't seem that high quality:

PTFE is used as an inner coating material in non-stick cookware. This unique polymer coating prevents food from sticking in the pans during the cooking process. Such cookware is also easy to wash. At normal cooking temperatures, PTFE-coated cookware releases various gases and chemicals that present mild to severe toxicity. Only few studies describe the toxicity of PTFE but without solid conclusions. The toxicity and fate of ingested PTFE coatings are also not understood. Moreover, the emerging, persistent, and well-known toxic environmental pollutant PFOA is also used in the synthesis of PTFA. There are some reports where PFOA was detected in the gas phase released from the cooking utensils under normal cooking temperatures. Due to toxicity concerns, PFOA has been replaced with other chemicals such as GenX, but these new alternatives are also suspected to have similar toxicity. Therefore, more extensive and systematic research efforts are required to respond the prevailing dogma about human exposure and toxic effects to PTFE, PFOA, and GenX and other alternatives.

Summarized, "idk".

I've left a pan on max for four hours before, although it was metal, and was fine after cleaning. I'm sticking with metal pans.

TDLR is that for everyday cooking you're probably fine, but for blackening use cast iron?

Also I recall all the safety suggestions not to heat an empty ptfe pan.

I believe that Indian restaurants make food less spicy for non-Indian patrons and spicier (or at least regular spicy) for Indian patrons. This belief stems from a) Indian friends telling me that the white-washed Indian restaurants they've gone to aren't nearly as spicy as home, and b) me ordering the spiciest dishes (generally vindaloo) and not being phased by the spiciness.

I'd like to run some experiments to determine how true this is. I have practically zero experimental design experience and would like input/advice.

Here's my basic plan:

  1. Order vindaloo takeout under a white name and pick up

  2. Wait 30 min to prevent order batching

  3. Order vindaloo takeout under an Indian name and pick up

  4. Cool both in the refrigerator for two hours (this is to blind me to which dish is which by temperature)

  5. Mark both to distinguish white vs. Indian (do this in a way that doesn't allow me to see)

  6. Heat them both up evenly

  7. Randomize so I don't know which dish I am eating

  8. Sample one dish

  9. Cleanse my palate (to start at spiciness zero)

  10. Sample the other dish

  11. Compare the two dishes' spiciness

I think recruiting a friend or two would help to add more data points and make the blinding easier/less prone to failure.

Open to any thoughts. And if you're in the Dallas area and interested in participating, let me know!

I lived in India for a year and became obsessed with the food, which is comparatively bland in the States. So, I learned to cook it myself. Indian food is all about the spice - heat as well as flavor. The key is good recipes and quality spices (which I eventually bought in bulk or at import stores because supermarket price/quality/quantity ratio's are expensive. Fresh Indian food is totally different form the restaurant stuff. My Lamb Rogan Josh is well liked by my fellow western friends (the key is large cubes of lamb imo).

My guess is that you're probably right; they might add more chili to heat up dishes for an Indian sounding names. I know they do this in Thai take out places. But it'll pale in comparison to making it at home (which will indeed smell for a few days).

I'd love if you did a post on this. My lamb curries are... kinda ok, I guess. Although they've gotten worse and samey since I started doing big batches. I can't seem to make them taste different from each other...

I'm lucky to have basically infinite lamb shoulder for experimentation with plenty of bones, but there's something about the spices I can't get right.

Edit. My post is showing an erroneous strikethrough and I don't know why.

Interesting. My has been a huge crowd pleaser for people who don't necessarily like indian food. I'd say they're being polite, but they request it at subsequent dinner parties. I buy lamb leg; on or off the bone. I spend a lot of time cutting it into 3cm cubes (they are smaller when cooked). I use a razor sharp knife to remove as much excess fat and tendons as possible (anything I think will get chewy, lamb is rich enough). I do batches of 2-3kg's (6-8 people with leftovers I want) and I use approx 10-15% more of the primary spices (coriander, and, moreso, cumin). I get fairly fresh and quality spices from an indian import shop near me. Not essential, but its like 1/4 the price of the good stuff at the supermarket (look for saturated colors and uniform consistency. Some coriander looks like they put the seeds and stems in a coffee grinder).

I swear I had an Alton Brown recipe the first few times I made it, but I can't find it on the internet anymore. Ive used this one more recently:

https://www.recipetineats.com/rogan-josh/ (per 750g)

Oil or butter instead of ghee is fine IME

Tsp of cinnamon instead of a stick is fine

Cardamom is essential for lamb rogan josh, but I add 1tbs ground instead of pods when needed.

I go half-dose on the paprika, but that's my preference (I find the cardamom gives it a deep, rich flavor, whereas paprika is more bitter).

I don't bother with the fennel powder.

Sometimes I forget the garam masala.

I 1.5x-2x the onions.

I add cayenne or fresh red chilis for heat (which will intensify while cooking, but I like heat).

The Alton Brown recipe called for leaving it overnight in the fridge and re-heating. The flavors do intensify. Plus also helps get one dish out of the way.

I almost always serve with a minty raita (crucial), store-bought nan, jeera rice, this lentil stew (not the quinoa part, just the lentil curry and I never bothered with the coconut flakes), and maybe an okra masala. Its a feast.

With quality spices, large cubes of lamb, and a watchful eye, the lamb has never failed to impress. It can stick towards the end. The saltiness won't be obvious until the very end for some weird reason. If needed, salt can be added late, or when served. I tend to get the saltiness just under my perfect amount of salt while its cooling. I just tate/stir/repeat until its just under salted for me. The stock has salt, so additional salt may not be needed. I cook in one or two large braising pans, on very low heat. Nonstick is perhaps preferable, but either way it will require monitoring, and gentle stirring. My goal is to have every cube be the best cube: large, and tender enough to chew without teeth. I think this dish would be unprofitable in a restaurant. You lose ~15% of the lamb in the trimming process, and use slightly more high quality spices. But its incredible.

Both light red and light white wine are fine. So is cold beer.

Pre-dinner cocktails? A Long Vodka:

1 oz. Simple syrup of fresh lemon juice and honey (might need to heat the juice and honey to get honey to dissolve). To taste. Should be fairly sweet. 1-2 lemons per cocktail. The pre-squeezed stuff in the plastic lemon sucks ass; stuff in a bottle is okay.

3oz vodka form the freezer

3 oz seltzer

Dashes of angostura bitter.

Stir and serve in a high-ball or larger.

If you do some or all whenever, let me know how it worked out!

I've done all of the above several times for my Indian night, and can now autopilot enough of it to do it day-of but it def takes time (hence doing just the lamb the night before can be a good idea).

If you're going to be comparing between two things, you ought to do the triangle test. Three options, two are the same one is distinct. If you can't even tell which of the three is the odd one out, you have no business trying to guess which is which.

I'm a desi and I ordered desi food in the US a few times (over 10 different retaurants at varying prices across new york and new jersey). Its just bland across the board, way worse than what you get back home, tastes flat/lifeless in comparison. Id wager freshness of aromatics and spices is a factor in that as well. Spices have a flavor half life.

I think I'd have to agree with what @screye said, they probably go easy on all the spices/aromatics not only the chilli peppers.

generally vindaloo

There might be a couple of funny things happening here.

1. They aren't ordering Vindaloo

I have never once seen an Indian order Vindaloo ever (in USA/India). It's actually incredible when I think about it. A lifetime of eating Indian food with Indians (me included), and not a single Vindaloo that was ordered. (and I grew up on the western coast on India where the dish originates from).

Most Indians are likely ordering other familiar dishes like Chicken Tikka Masala and Butter Chicken. The American preparations for these 2 dishes are orders of magnitude sweeter and milder.

For reference. I'd say an Indian style Tikka Masala should land at a 7/10 in spice. A butter chicken should land at a 5/10. American versions are usually lagging on both by 2 points.

So it is likely, that your friends order the milder Tikka Masala or Butter Chicken and continue complaining about it.....while the actually spicy Vindaloo remains underexplored by the Indians.

2. 'Spicy' doesn't mean what you think it means.

Spicy & Mild in an Indian context can mean 3 different things :

I can mean the dish lacks a punch to its smell (aroma, garlic, onions, Kashmiri chilies), lacks khada-masala-heat (think coriander seeds, Kauri methi, or even black pepper. You feel this heat in your heart, not on your tongue) and lacks chilli-heat (Think straight habaneros or cayenne pepper).

In the sense, mild means under-seasoned more so than not-enough-chilies. So you might just be misunderstanding your friends.

American restaurants simply do not use enough aromatics or fresh-khade masale. So even when the food is chili-spicy, it tastes imbalanced. It is just heat for the sake of heat, no proper spiciness as we perceive it.

I believe that Indian restaurants make food less spicy for non-Indian patrons

3. Yes, they do discriminate based on color and accent

When I order spicy food (usually in Hindi or an obvious 1st gen immigrant accent) at Indian restaurants, they always ask me if I want it 'spicy' or 'Indian spicy'. And even if a white person asks for Indian spicy, they will like to see you handle a 7/10 in front of them, before they send out a 9/10 or a 10/10 for you.

Honestly, most Indians don't like a 9/10 or a 10/10 spicy dish either. We simply want our medium-spicy dishes to have fresh ingredients & attain the expected 6/10, instead of the Americanized 4/10s.

My recommendation:

  1. Order common authentic Indian dishes that are supposed to be spicy - Kolhapuri, Solapuri, Saoji, Gongura, Andra etc. They probably aren't popular enough to have multiple spice options. Also, if you know these dishes, it is good sign for the owner to trust that you know what you want with spice. Be warned, these are above what I can take. It can be a lot. There is 1 tier above these too, but they are novelty dishes that exist as a meme, not actual staples.

  2. Speak in broken hindi and enunciate properly. Say "tiKKKAa" instead of "TEEkuh" masala. Order by saying : "Bha-ee-yah, ayyk Chicken tiKKAa masala aaydum spicy kerr kay day-nah". (brother, give me a chicken tikka masala made spicy). That's enough to convince them.

  3. Just tell them you visited India and had Tikka Masala there. And to make it at that spice level. They will buy it.

You know, as a Cajun I can totally buy this explanation of the freshness of spices being a factor; restaurant Cajun food that's been topped up with hot sauce to bring it to the usual spice level just isn't the same as home-cooked food that's been made to be that spicy.

I am always surprised at how similar Cajun traditions seem to western-Indian traditions. I made Gumbo yesterday, and it almost felt like I was making an Indian curry. (The dark roux was obviously a new thing. though)

just isn't the same as home-cooked

This is true about so many southern American dishes. A fresh homemade-made Biscuits and Gravy always lives up to it's hype, and restaurant B&G tastes like goop on a golf ball.

I’ve heard indians in the south tend to buy seasonings and the like from Cajun grocers.

Interestingly, the guy who apparently invented chicken tikka masala in Scotland in the 1970s died just the other day; its Western origin makes me wonder whether it is widely eaten in India.

Knowing the Indian culinary tradition, I would not be surprised if Tikka Masala was simultaneously invented in many different places. That seems to be the current opinion of historic sources too. [1] [2]

However, there is no question that Mr. Ali Ahmed Aslam improvised the dish & popularized his version of it around the world. Tikka Masala is not as insanely popular in India, and the preparation is generally spicier, smokier & less tomato-forward. You will still find it on menus around the country though. Part of it's struggle is that once you have ordered Butter Chicken, you don't want to order another incredibly similar dish.

There is no 'right' way to make an Indian dish. It is all about techniques, feel and adapting it to your region. Tikka Masala shares every ingredient & technique with India's biggest culinary invention of the 20th century : butter chicken. It is likely that some places made it sufficiently spicier and tomato-ier to become Tikka Masala. But, I don't want to split hairs over how much culinary innovation is needed for naming rights.

I'm in DFW and vaguely interested in making this happen. But I am not particularly good at handling spicy food. I find standard "hot" wings to be enjoyable in small doses but not for a full meal, and I tend to order a 2-3/5 for Thai. Embarrassing, and I don't know that I would survive optimized vindaloo.

Your experimental design sounds good as long as you find somewhere that takes online orders. Doing it over the phone would likely confound the results. The other trick is palate cleansing since if one really is spicier, it may be hard to reset. I think Rov_Scam's design might mitigate this challenge?

Most of the Indian restaurants I've visited have an online ordering option. If not, I'd ask an Indian friend to order for me.

Agreed on the palate cleansing. I think a small dose of food plus milk will be fine. We'll see at the first try.

If it’s anything like Chinese restaurants, they probably have a secret menu in Hindi/Tamil/telugu/whatever and make it spicy for customers that order it in the Indian language off that menu.

This might not be a thing where you live, but every Indian (and Thai, for that matter) restaurant I've been to in Pittsburgh asks how spicy you want the dish on a 1–10 scale. As a white guy, 7 is usually the sweet spot (but may be a little tame), 8 is on the spicy side, and I couldn't imagine getting a 9 or 10. I've never ordered below a 7 but I imagine that the lower numbers are for more sensitive customers, like my mother who can detect the faintest hint of spice in something that seems bland to me. I'm doubtful that they'd dial back the relative spice level for "ethnic" customers if they're using such a scale, but I can see that they might do that to avoid offending gringos whose definition of spicy is a little less than the average Asian.

As for your experiment, I don't think the blinding and all the precautions are really necessary. For a relatively straightforward variable like spice level that manifests itself with obvious physical symptoms, if there's any real difference it should be enough to overcome any implicit bias you may have. If you really want to blind it, though, it's better to do it this way: Divide each order into, say, 10 bite-sized samples. Mark the bottom of each dish with a number and write down which number corresponds to which order. Refrigerate the samples for two hours and then renumber them without looking at the original numbers. Take a bite or two of each sample unblinded to establish a baseline. Taste each sample and write down your guess as to which order it is, under the assumption that the samples ordered under an Indian name will be spicier, and write down your guess next to the new numbers. After you're finished, look match the new numbers with the original number to see what corresponds and check to see how many times you guessed correctly. If you're in the neighborhood of 50%, you're just guessing and you can be sure that there's no difference to the orders. The closer you get to 100%, obviously, the more likely it is that there is a difference. If there's no difference, or only a subtle difference, though, you'll probably figure this out pretty quickly.

I've seen that at Thai restaurants, but not the Indian places in my area.

I do want to blind it. Thanks for the design suggestion!

Have you tried to ask them to make your food Indian spicy? It seems to work at Thai places reasonably well.

I have, but that's not the point of my experiment. I want to see if they are discriminating against non-Indians without being asked to increase the spice.

Aha, god luck, I'll be curious to see the results. Can you enlist a lab assistant to make the blind test a bit easier to manage?

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