domain:alexberenson.substack.com?q=domain:alexberenson.substack.com?page=4?page=2?page=2
Throwaway05
10m ago
I mean you are always going to run into study design limitations. In this case most of the money in medicine wants NPs to look good so there isn't good funding for this. The VA (generally) has pretty much the worst healthcare in the country and the quality of care in the ED is also pretty much the worst in the hospital (because of how it gets misused). This is likely to flatten the curve a little bit - good doctors almost never work at the VA.
Psychiatry is a better example - psychiatric interviews and pharmacology are the most complicated in medicine. Mental health care NPs are terrible at both of these things, give people unnecessary medications and incorrect diagnoses and are legible experienced as lower quality by patients and staff with some regularity. In general hospital medicine nurses line up each other and that includes NPs but in most mental health care settings nurses will say they think the NPs are shit.
However the bad outcomes are mostly increased lifetime mortality and risk of side effects 20 years down the line when the patient is seeing someone else. This becomes effectively impossible to study so we don't.
Now you could argue that you don't really care about those problems and if its not obvious their is a skill difference in outcomes lets save money, who cares if people have the wrong medication or diagnosis. But that goes back to the ED stuff - you have a difference in mortality and morbidity, it may be small but most Americans value "the best possible" not "good enough."
Also, since this is why people normally bring it up - if you magically paid all doctors NPs salaries and didn't really change anything else......healthcare costs wouldn't go down at all in any substantive way.
Well conveniently I explained what happened with my primary care physician elsewhere in this thread.
i.e., he's been 99% useless to me compared to the time and money cost, so urgent care is simply the better option.
Ultimately if you say, go to your lawyer and ask for accounting help, they may charge you for it and try and help but they aren't an accountant.
Ackshully, as a practicing lawyer, I can say that that may very well be malpractice, and its for this exact reason I keep a number of trusted accountant and financial advisors in my rolodex to send clients to rather than even risk that issue.
MotteAnon12345
24m ago
If NATO directly entered the war with large numbers of its own combat forces, it would defeat Russia's military and drive it out of Ukraine.
That was my assumption as well back in 2022. But then the Russia sanctions did nothing, Ukraine made some good advances and then got bogged down, and the West started running out of ammo. That last part is what got me. Because that's how the West won WWII against Germany (& Japan) and then the Cold War against Russia. We outproduced them until they couldn't afford it anymore.
Right now, the situation is reversed. It's Russia that enjoys a comfortable margin in artillery, tanks, and men. The West is giving Ukraine everything that isn't nailed down and it still isn't enough. Maybe the problem is a bloated inefficient military sector? Maybe the problem is political will? Maybe the problem is that we don't care enough about Ukraine? But those are all structural factors that are unlikely to change anytime soon. My current thinking is that the West can't challenge Russia in most of Europe and Russia can't challenge us in America proper. Africa is up for grabs and China will get the rest.
The Ukraine war has proven NATO to be a paper tiger.
anon_
24m ago
Instead of allowing (as engineers, bankers and lawyers do) a big gradation of physicians, all of whom can call themselves the prestige title doctor but who vary widely in terms of competence, pay and reputation in the profession, doctors have focused on limiting entry, reserving their title for themselves and therefore turning away many decent candidates.
This will lead to the same problem -- just in different terms.
The issue isn't the title -- it's the nature of the jobs. Bringing them all under the umbrella of "physician" just moves the status problem to intra-physician jockeying.
Throwaway05
24m ago
In order to learn the U.S. standard of care you must learn with a U.S. level of resources and training. Much of Europe can meet that standard but the third world cannot. This is magnified by the fact that the U.S. population is more challenging due to obesity and other factors.
Putting aside that general point, with surgery in specific we are talking about modern surgical modalities - I don't know how many da Vinci's are in the entire continent on Africa but I doubt it's more than a handful.
anon_
31m ago
But this isn't a lie -- Gaetz really did pay for sex on Venmo & PayPal. There are receipts.
"My opponent is going to lie so therefore the black-letter truth doesn't matter" is a take.
Corvos
41m ago
And I don’t think ambulances will take you to a private hospital, though I might be wrong.
bonsaii
53m ago
This may be true for some very common surgeries, but you still need the surgeons on staff to be trained in less common situations/surgeries as well. Otherwise, you have scenarios where you need a surgery but turns out the surgeon on shift has done that particular surgery once in his life and has to wing it.
bonsaii
58m ago
But who would pay for necessary infrastructure and surgical supplies. Where are the patients going to get the MRI and CT scans necessary for pre-operative planning? The places that already have resources for those things have their own surgeons to train.
My dad's theory of gifts has long been that the best gifts are something you'd want, but would never buy for yourself because you wouldn't spend the money. To this I would add things that the recipient wouldn't think of or know about, though this always has more danger of the recipient not actually liking it. There's a long theory of "buying experiences" but I generally try to avoid it unless I can personally take them there and know their schedule well enough to know they can go with me, I hate the gift card as a concept ever since I worked retail for a couple years and realized how few giftcards are ever actually used.
I broadly agree with both your dad's and your theory. The general issue with personalized gift-giving, is that often you end up muddling into subjects in which the gift-reciever is more knowledgable and idyosincratic than yourself: For example, I have a friend who really likes romantic novels, and I don't know much about them, should I gift her a critically acclaimed one? A silly, but popular one? Am I going to end up gifting something that she has already read?
My own advice, that doesn't overlap with what you've already said, would be:
- Look for things on the edges of the area of overlap of your interests: You might not be able to figure out which are the best rugby jersey to gift your rugby-obsessed cousin, but you might be able to find him a great rugby-related book.
- Rather than "gift experiences", gift consumables: Even if they're willing and able to buy it, a coffee-head will always appreciate a good bag of coffee.
- Contary to the neuroticism of my first paragraph, an obvious gift is often a good gift, most people aren't thinking too deeply about this: A lion plushie for your friend's newborn named Lionel is likely to stand out, the bar for thoughtfulness is that low.
phailyoor
1hr ago
Alot of the better students in my high school went to do nursing because it's easy money and has pathways to move up such as NP. Also anecdotally I've gotten good diagnosis and treatment from NP for stuff I couldn't figure out myself.
In fact doctors are the midwits saddling themselves with debt and a late start all in pursuit of prestige as seen by the PMC for a job that's not as lucrative as it looks.
EdgeCityRed
1hr ago
His family here in Florida have tens of millions of dollars. This grift would seem...unnecessary.
Shrike
1hr ago
The population in New York (39) and California (37) is older than the population in Texas (median age 35). With a national median age of 38, New York is actually slightly older than the country as a whole.
However, Florida's is much higher, at about 43 (which makes sense, they are long known to be a haven for retirees!)
FiveHourMarathon
Listen to Pierre
1hr ago
Obligatory reply with warmed over Jehovah's Witness nonsense that Christmas shouldn't be materialistic, or that such and such is a waste of money and you should give people I-Bonds or crypto or gold bullion or whatever.
FiveHourMarathon
Listen to Pierre
1hr ago
We're coming up on the holiday shopping season in America. So, mottizens, what are your recommendations for gifts for friends, children, parents, siblings, aunts and uncles, lovers, frienemies at work, etc?
Historically I am good for one (1) banger of a gift per year. I absolutely crush it with a large and thoughtful gift for one family member, and then the rest end up as "well I spent $25-50." Marriage has been great for me, because my wife is really good at getting gifts for everyone. But she'd like me to contribute more to the process, which is fair. So I figure it's good to start getting ideas together, especially for some of the people in our circle who are difficult to buy for.
My dad's theory of gifts has long been that the best gifts are something you'd want, but would never buy for yourself because you wouldn't spend the money. To this I would add things that the recipient wouldn't think of or know about, though this always has more danger of the recipient not actually liking it. There's a long theory of "buying experiences" but I generally try to avoid it unless I can personally take them there and know their schedule well enough to know they can go with me, I hate the gift card as a concept ever since I worked retail for a couple years and realized how few giftcards are ever actually used.
Thoughts I have this year:
-- For theory one, YETI items outside of the coolers. I've long been impressed by YETI's ability to essentially invent the status cooler as a market. Over time I've gotten a few of their other items, and I have to say they are all very nice. I got their espresso cups when they were on sale at Ace Hardware (an admittedly odd place to buy espresso cups), and I really like them. Their mugs come it fun colors, are objectively high quality, and are the kind of silly indulgence that most people won't buy for themselves.
-- For theory two, these emulators haven't achieved a ton of penetration in my social circles yet. I'm looking around for the best price/quality combo, and for ones that are easy to cleanse down to kid-appropriate games. Though to be fair, Twisted Metal 2 was the first game I got for PS1 and I turned out ok, I think.
-- For experiences, I have purchased rentals on Turo for a fun car for a day. Prices for something fun have been decent since the mid-engine vette dropped, and the cybertruck is a good option this year for something wild but fairly normal.
What are y'all doing? Especially for parents and women?
2rafa
1hr ago
There are women who find themselves in this sort of position too, but they're significantly more uncommon than their male counterparts.
Most friends are same gender (and most people heterosexual), though. Isolated men often aren’t even particularly ugly and lack of physical attractiveness (even if this is an issue for them) isn’t the primary reason they don’t have male friends. The reason men are more likely to be loners is likely biological, women make friends quickly but these friendships are more superficial, men have always had fewer friends but they tend to last longer and be ‘deeper’ in some ways.
into a poor Mexican cleaning lady
Is she hot, though?
EdgeCityRed
1hr ago
Donating blood also helps lower your microplastics levels (and donating plasma is even better!) https://pmc.ncbi.nlm.nih.gov/articles/PMC8994130/
Primaprimaprima
Bigfoot is an interdimensional being
1hr ago
There's a lot to unpack here.
You raise a valid point in that there are a lot of ugly/undesirable women who miss out on a lot of the benefits that conventionally attractive women get. But at the same time, I think the average woman (so, not outright ugly/disabled/etc, but decidedly not 95th percentile either) still underestimates how much attention she gets just for being a woman, because she's never had to experience the other side of things.
To put things in perspective: if you even have a "social circle", like at all, then you're already doing pretty damn well for yourself relative to the entire adult population. There's a non-trivial number of men, especially among the spergy AGP population we're talking about, that have essentially no friends or social connections of any kind. They got nothin'. There are women who find themselves in this sort of position too, but they're significantly more uncommon than their male counterparts.
If only the top 5% of women were experiencing substantial amounts of male attention, could feminism really sustain itself? It's a rare woman who doesn't have a story about a bad relationship, or at least an instance of catcalling or harassment, something. Clearly there are lots of women who are having lots of interactions with men! Otherwise the "gender wars" wouldn't be a political topic in the first place. For the type of isolated recluse who's been essentially invisible for his whole life, even the idea of negative attention like catcalling can become part of the erotic fantasy.
(I'll also just note that if you actually dive deep into AGP porn, you'll find a surprising number of "status loss" stories, i.e. rich white businessman gets transformed into a poor Mexican cleaning lady, things like that. It's not always a power fantasy of being in the top 1%).
2rafa
2hr ago
If this was truly the issue you think it is, a reasonable solution would be to have some of residency take place abroad in poorer countries where there is a need for healthcare; the local would likely appreciate it and residents would get more exposure to surgery.
2rafa
2hr ago
Right, and this is crucially true even if they do the same work for the same pay.
2rafa
2hr ago
The most elite speed runners are probably similar to the most elite board game players; very intelligent, but probably not the most intelligent. And even when they are, it still requires time Musk doesn’t have because there’s a huge amount of unavoidable pattern learning even if you’re great at extrapolation.
2rafa
2hr ago
is that they are as good as a GP within their scope of practice, as long as the understand the limits of said scope.
Have you stayed abreast of the current furore? The two examples I gave of NP/AP failures were actually both from the UK.
Is it still a waste if the doctor is someone with a 120 IQ who would have got into medical school in the alternative system but ends up as a replacement-level software engineer in the US system as it is?
Sure, and this is the point. The 120 IQ person has too much dignity to accept the title of “nurse practitioner” or “physician assistant” , but let him call himself doctor and put him through some more training and he’ll do the same work for the same pay happily.
2rafa
2hr ago
Other than possible extreme edge cases in some distant regions literacy doesn’t seem to be an issue for any major human population, certainly not Bantus, and can benefit almost anyone. So I would say your church is - if the money is not taken via corruption and actually goes toward education - doing a good and valuable thing.
Yep, we discussed that a bit not long ago, so I can't say I'm donating entirely out of altruism.
I don't know if they filter out the microplastics from the blood somehow (probably not) or if they just get passed along to become the next guy's problem.
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