Come for the politics, stay for the snark.

Tick tock motherfuckers!

Usually wrong but never in doubt

“The difference between stupidity and genius is that genius has its limits.”

It’s always darkest before the other shoe drops.

Well, whatever it is, it’s better than being a Republican.

My right to basic bodily autonomy is not on the table. that’s the new deal.

Republicans seem to think life begins at the candlelight dinner the night before.

You passed on an opportunity to be offended? What are you even doing here?

You know it’s bad when the Project 2025 people have to create training videos on “How To Be Normal”.

The unpunished coup was a training exercise.

I might just take the rest of the day off and do even more nothing than usual.

Today in our ongoing national embarrassment…

Trump should be leading, not lying.

“Just close your eyes and kiss the girl and go where the tilt-a-whirl takes you.” ~OzarkHillbilly

“They all knew.”

“Everybody’s entitled to be an idiot.”

Those who are easily outraged are easily manipulated.

Republicans don’t lie to be believed, they lie to be repeated.

Only Democrats have agency, apparently.

We can show the world that autocracy can be defeated.

Donald Trump found guilty as fuck – May 30, 2024!

We are builders in a constant struggle with destroyers. keep building.

If you voted for Trump, you don’t get to speak about ethics, morals, or rule of law.

Since when do we limit our critiques to things we could do better ourselves?

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Archives for 2014

Again, No Doubt This is Obama and the CDC’s Fault

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You won’t see any commercials like this:

“You’ve just handled an infectious disease, now what are you going to do?”

“I’m gonna go on a cruise!”

Sigh:

A Dallas health care worker who handled clinical specimens from an Ebola-infected patient is on a cruise ship in the Caribbean, with the worker self-quarantined and being monitored for signs of infection, the State Department said in a statement.

The unidentified female worker departed on a cruise ship from Galveston, Texas, Oct. 12 and was out of the country before being notified of active monitoring required by the Centers for Disease Control and Prevention, according to the government statement.

The monitoring was established as two nurses at Texas Health Presbyterian Hospital, Nina Pham and Amber Vinson, tested positive for Ebola.

The hospital worker on the Carnival Magic cruise ship did not have direct contact with patient Thomas Eric Duncan, but may have had contact with his clinical specimens, authorities said. The employee, who has not been publicly identified, has not had a fever or demonstrated any symptoms of illness, authorities said.

“The worker has voluntarily remained in the cabin and the State Department and cruise line are working to bring the worker back to the U.S. out of an abundance of caution,” the Department of State said in the release.

God bless Texas.

I really don’t think this person is actually contagious- I can’t imagine lab specialists are at a particularly high risk for catching Ebola, but for FFS, they do wear lots of protective equipment in labs for a reason, so why take the chance? You might have it.

And we’re dealing with a public confidence crisis and media generated hysteria. This kind of behavior is not helping. Even if the person is not contagious, it’s going to case a panic and at the very least, ruin a trip for how many other thousands of people. At the worst, well, we’ve now got a floating Ebola colony. For a couple of weeks, at least, until it burns itself out.

I doubt very seriously thatmuch will come of this in terms of actual health risks, but in our current media environment, it is going to be a disaster. Especially when you have idiots like this out there whipping up fear in an attempt to score points politically:

Sen. Rand Paul said Ebola is “not like AIDS,” offering what he says is a stark contrast from the White House’s message on the disease.

“[The Obama administration] has downplayed how transmissible it is,” Paul said in an interview with CNN on Thursday morning. “They say it’s the exchange of bodily of fluids. Which makes people think, ‘Oh, it’s like AIDS. It’s very difficult to catch.'”

“If someone has Ebola at a cocktail party they’re contagious and you can catch it from them,” Paul continued. “[The administration] should be honest about that.”

And then there is this idiot (and yes, I still maintain she is an idiot)

A nurse with Ebola may have shown symptoms of the virus as many as four days before authorities once indicated, meaning that she might have been contagious while flying on not just one, but two commercial flights, officials said Thursday.

Amber Vinson was hospitalized Tuesday, one day after she took a Frontier flight from Cleveland to Dallas. Tests later found that Vinson — who was among those who cared for Thomas Eric Duncan, the first person diagnosed with Ebola in the United States, at Dallas’ Texas Health Presbyterian Hospital — had Ebola.

Authorities indicated Vinson had a slightly elevated temperature of 99.5 degrees Fahrenheit, which was below the fever threshold for Ebola, but didn’t show any symptoms of the disease while on her Monday flight. This is significant because a person isn’t contagious with Ebola, which spreads through the transmission of bodily fluids, until he or she has symptoms of the disease.

But on Thursday, Dr. Chris Braden of the Centers for Disease Control and Prevention told reporters in Ohio that “we have started to look at the possibility that she had symptoms going back as far as Saturday. … We can’t rule out (that) she might have had the start of her illness on Friday.”

So, for the few health care workers out there handling Ebola related issues, is it too damned much to ask that you put off your cruises and wedding planning for a couple of god damned weeks? Keep this up, and the fearmongerers are going to have you all locked in cages like something out of a sci-fi movie. If we had a functioning Congress, we could even set aside ten million or so to reimburse you for nonrefundable travel.

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Because Swastikas Are Just Punk Rock Now

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“Too soon” doesn’t even begin to cover this one. Retailer Sears has recently found itself in hot water for marketing a ring with a giant swastika on it. You know, just a punk rock swastika ring. Perhaps the best part of this whole mess:

According to the description, the ring was “[n]ot for Neo Nazi or any Nazi implication,” but they “are going to make you look beautiful at your next dinner date.”

After pulling the ring from its site, Sears did its round of mea culpas in response to the outrage on Twitter, explaining that the ring was from a third-party vendor. Good to know that there’s no one at Sears with eyeballs doing quality checks.

Team Blackness also discussed more right-wing rants on how Obama brought forth Ebola, a racist Toshiba ad, and a terror threat against feminist Anita Sarkeesian.

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A good deal for HITECH?

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What is the value of Electronic Medical Records?

There are a pair of very interesting studies that I’ve seen recently that speak to different sides of this discussion. The first is a paper from Carnegie Mellon that looks at patient safety events in Pennsylvania and determines that electronic medical records are a major player in increasing safety:

We nd that the hospitals’ adoption of advanced EMRs has a bene cial impact on patient safety, as reported events decline by 27 percent. This overall decline is driven by declines in several important subcategories, 30 percent decline in events due to medication errors and 25 percent decline in events due to complications….

The study seems to have validated its results against common objections so the BS check is fairly strong. They were not looking for strong mortality impacts, but the impacts they found were notable but not statistically significant. But EMRs seem to improve safety and quality after adaption.

The Incidental Economist is passing along a study about the effectiveness of the HITECH Act of 2009 that looks at the impact of the Act which gave all providers incentives to implement EHR.

As of 2008, about 48 percent of independent hospitals and 55 percent of system hospitals had adopted at least one of two advanced EMR technologies, physician documentation (PD) and computerized practitioner order entry (CPOE). By 2011, these adoption rates for both independent and system members had risen to 77 percent. […]

Absent HITECH incentives, we estimate that the adoption rate would have instead been 67 percent. Thus, HITECH promoted adoption among independent hospitals by an additional 10 percentage points. While this may seem like a substantial effect, when we consider that HITECH funds were available for all hospitals and not just marginal adopters, we estimate that the cost of generating an additional adoption was $48 million, which is more than enough to cover the cost of a generous EMR system. We also estimate that in the absence of HITECH incentives, the 77 percent adoption rate would have been realized by 2013, just 2 years after the date achieved due to HITECH.

Now this raises a really interesting question — does $48 million dollars for an additional two years of EHR make sense? If the first study or studies like it can show that EHRs can gain between 100 to 480 Quality Adjusted Life Years in a two year period, then the HITECH Act was a great investment of social resources as the benefits would exceed the costs. The reason why the spread is so large is that there is a good deal of debate on what the US willingness to pay for a QALY is worth. Another way of looking at it is that most federal regulations assume a $6 million dollar cost in regulatory burden is a reasonable cost if it prevents one average death. With that view, if EMRs can prevent a few average deaths per year for the two years of accelerated adaption, then HITECH was a good deal.

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Thoughts on Arkansas

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As open enrollment is creeping up on us, I’ll be spending some time doing retrospectives on interesting policy experiments. The Arkansas model of premium support for most of their Medicaid population is a fascinating experiment. The basis of the experiment was for the Democrats to find someway to get more than half of the Republican caucus onboard for a Medicaid expansion. So they did not do expansion, they did premium support for private insurance on the Exchanges with supersized subsidies for the Medicaid eligibile population. The first year results are mixed. Access to care, utilization and enrollment are great. The problem will be cost, and that problem is an underlying issue with the Arkansas 1115 waiver.

First, the good news:

A decline in uninsured ED usage would have met everyone’s expectations as the population of the uninsured plummetted.  A smaller population, means, all else being equal, less utilization even if the declining population cohort is cherry picked as low utilizers.  I can’t say anything about the characteristics of the newly covered population.  The same logic applies to uninsured hospital visits, fewer uninsured individuals should lead to fewer uninsured hospital admissions.  These were expected results.

Now the total decline in emergency room visits was unexpected.  Massachusetts saw ER usage increase after insurance expansion.  This is utterly fascinating and meaningful as a 2% decline on a population of a couple million people is statistically significant and more importantly financially significant.  It may mean that there is successful diversion of acute care cases to lower, more appropriate levels of care such as urgent care clinics or primary care provider office visits.  More research is needed for that set of claims to be made.  If Arkansas can replicate the ER diversion and minimization for next year and figure out why it is working, this is something that should be taken to other states for replication.

Enrollment is good as well. Slightly more than 200,000 people are in the program. The net uninsured rate in Arkansas has been cut in half

Access to care is pretty good as well as Arkansas is using full commercial reimbursement (more on this later) for broad commercial networks.  Any doc who wants in is probably in.

And that is where there are problems lie. 

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Friday Morning Open Thread: Fear, Itself…

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ebola fear itself toles

(Tom Toles via GoComics.com)

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Yeah, I’m moderately obsessed, because Perfect Storm of Stupid. There are so many useful things we could and should be doing, and yet… from the Paper of Record:

President Obama raised the possibility on Thursday that he might appoint an “Ebola czar” to manage the government’s response to the deadly virus as anxiety grew over the air travel of an infected nurse.

Schools closed in two states, hospitals and airlines kept employees home from work, and Americans debated how much they should worry about a disease that has captured national attention but has so far infected only three people here…

Earlier in the day, lawmakers on Capitol Hill pummeled federal health officials for their response to the public-health emergency that erupted after a Liberian man, Thomas Eric Duncan, tested positive for Ebola last month…

Also in the NYTimes:

Adding a new and troubling dimension to the search for Americans possibly exposed to the Ebola virus, the State Department said Friday that an employee of Texas Health Presbyterian Hospital who may have had contact with specimens of the disease had left the United States aboard a cruise ship.

The employee and a traveling partner, who were not identified by name, had agreed to remain isolated in a cabin aboard the vessel, the State Department said, and “out of an abundance of caution” efforts were underway to repatriate them. A physician aboard the cruise ship had said the employee was in good health…

“The employee did not have direct contact” with Mr. Duncan, the statement said, “but may have had contact with clinical specimens collected from him.”…

Meanwhile, on the “might actually be of some use” front, per Slate:

Now that we’re all agreed that Ebola is everyone’s problem, we’re all totally going to do better fighting it, right? Right. Beyond simply getting hysterical about the widening web of cases in the U.S. and elsewhere, fighting the virus at its source would also seem like a good idea—for everyone. Exactly one month ago—on Sept. 16—the United Nations set up an Ebola Trust Fund seeking $1 billion to do just that. On Thursday, U.N. Secretary-General Ban Ki-moon offered a status report on which countries are ponying up cash and how much they gave.

It presumably didn’t take the U.N. too long to crunch the numbers on contributions. Of the $1 billion needed, only one contribution has been made, of $100,000—by Colombia. That means the U.N. is still, approximately, $9,999,900,000 short of what it thinks it will take to combat Ebola. As a barometer of global commitment, the U.N. trust fund isn’t all that encouraging…

Amy Davidson, in the New Yorker:

… “We know how to stop this,” Sylvia Burwell, the Secretary of Health and Human Services, said in a conference call with reporters. That is all well and good, but the C.D.C. and other health authorities, at every level, can’t just “know”; they also have to act. They can’t just keep repeating that simple competence, prudence, and sympathetic good sense are the answers, while exhibiting none of those traits. Those are the answers: but we have to live them.

The doctors and health workers of Médecins sans Frontières, or Doctors Without Borders, have done so, in heroic, lonesome fashion. The group has been fighting Ebola in the villages of West Africa, where the entire social structure has broken down, since well before the West cared, and with desperately few resources. Pierre Trbovic, an M.S.F. volunteer from Belgium, wrote a few weeks ago about taking on what was regarded as the most awful job at an Ebola center in Liberia: telling people that there were no more beds. “The first person I had to turn away was a father who had brought his sick daughter in the trunk of his car. He was an educated man, and he pleaded with me to take his teenage daughter, saying that while he knew we couldn’t save her life, at least we could save the rest of his family from her. At that point I had to go behind one of the tents to cry,” he said. The center couldn’t admit more without putting all the patients at risk; there was a constant struggle “to keep the tents clean of human excrement, blood, and vomit, and to remove the dead bodies.”

In August, M.S.F. had six hundred and fifty people in the field; now, it has three thousand, in six locations in Liberia, Sierra Leone, and Guinea. “Now we have reached our ceiling,” Brice de le Vingne, the director of operations, said on Tuesday, according to Reuters. The same day, the group noted that sixteen of its workers had tested positive for the Ebola virus, and nine had died. That here, with our bright hospitals, we would allow the disease to spread through simple carelessness feels like a betrayal.

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Apart from despairing that there’s no cure for stupid and it has an unfortunately high R0-value, what’s on the agenda as we wrap up the week?

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Late Night Open Thread: Who Lost China the WMDs?

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Eli Lake, accredited Wingnut Wurlitzer puke funnel, wrote the article:

… In an interview with The Daily Beast, former Senator Rick Santorum said he and his staff began receiving photographs of discarded Sarin and Mustard shells from U.S. soldiers in 2004. Two years later, when he was up for re-election, Santorum even went public with some of this information in a press conference disclosing a Pentagon report that found 500 chemical weapons shells had been found in Iraq…

But at least in 2005 and 2006 the Bush White House wasn’t interested. “We don’t want to look back,” Santorum recalled Rove as saying (though Santorum stressed he was not quoting verbatim conversations he had more than eight years ago). “I will say that the gist of the comments from the president’s senior people was ‘we don’t want to look back, we want to look forward.’”…

Santorum on Thursday stood by that claim. “There was no active chemical weapons operation in Iraq, that doesn’t mean there were no chemical weapons,” he said. “That was the point we were making. It’s clear from the New York Times article that the military as well as the administration didn’t want to have that conversation because they missed it.”…

… including a special guest appearance by our old friend Pete Hoekstra (see: Hoekstroika):

… In an interview Thursday, Hoekstra declined to name Bush administration officials with whom he spoke. But he said he felt stonewalled during his own investigation in 2005 and 2006 into the issue. “This was an active investigation by the intelligence committee and they chose not to answer our questions truthfully and fully,” Hoekstra said….

Tell me again how “nobody” takes Luzer Rih Sanctorum seriously. I’m just barely old enough to remember when RWNJs used the magical phrase Matsu and Quemoy un-ironically, and I seriously think Santorum is his generation’s Dick Nixon. Sure, he’s a twisted little sociopath that you wouldn’t want as a neighbor (much less an in-law), but there’s a negotiable bloc of American voters who want to be represented by a twisted little sociopath “they can count on” (to punish all the happy, successful, smiling folk who are not like them — and Rick Santorum).

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In Other Health News: Black Lung v. Shriveled Soul

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From Chris Hanby’s Buzzfeed article:

After working underground in the coal mines of southern West Virginia for almost 35 years, Steve Day thought it was obvious why he gasped for air, slept upright in a recliner, and inhaled oxygen from a tank 24 hours a day.

More than half a dozen doctors who saw the masses in his lungs or the test results showing his severely impaired breathing were also in agreement.

The clear diagnosis was black lung.

Yet, when I met Steve in April 2013, he had lost his case to receive benefits guaranteed by federal law to any coal miner disabled by black lung. The coal company that employed the miner usually pays for these benefits, and, as almost always happens, Steve’s longtime employer had fought vigorously to avoid paying him. As a result, he and his family were barely scraping by, sometimes resorting to loans from relatives or neighbors to make it through the month.

Like many other miners, he had lost primarily because of the opinions of a unit of doctors at the Johns Hopkins Medical Institutions that had long been the go-to place for coal companies seeking negative X-ray readings to help defeat a benefits claim. The longtime leader of the unit, Dr. Paul Wheeler, testified against Steve, and the judge determined that his opinion trumped all others, as judges have in many other cases.

Today, however, there is final and overwhelming evidence that Wheeler was wrong: Steve’s autopsy.

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