UnitedHealth Group’s Corporate Empire Grows

Updated Sunlight Report Reveals 2,807 Entities Across UnitedHealth Group’s Corporate Empire (Healthcare Un-covered)

The Center for Health & Democracy has released the latest edition of its Sunlight Report on UnitedHealth Group, revealing 2,807 entities that make up the world’s largest health care conglomerate, including 376 additional entities identified since the report’s initial release in July 2025.

The Sunlight Report is a first-of-its-kind project that uses publicly available regulatory filings and other records to document UnitedHealth’s sprawling and often opaque corporate structure, shedding light on the company’s growing influence over American health care.

The October 2026 update finds that UnitedHealth’s rapid acquisition growth has slowed considerably, although its vast network of insurance companies, physician practices, surgery centers, pharmacies and other health care businesses remains largely intact.

The report highlights UnitedHealth’s $3 billion acquisition of Alegeus Technologies, which administers health savings accounts, flexible spending accounts and other health benefit accounts for more than 26 million people. The deal gives UnitedHealth a greater role in managing patients’ own health care dollars, in addition to the insurance premiums it already collects. All at a time, mind you, when HSAs and other “savings vehicles” are being considered by Republicans in Washington as part of a potential health care plan.

by Wendell Potter, Joey Rettino, and Seth Glickman, Healthcare Un-covered | Read more:
Image: uncredited
[ed. Remember those "death panels" Sarah Palin whined about during debate over Obamacare? Well, they're here, and they're real. What does it mean? Well, definitely no antitrust/monopoly investigations from this administration. But, practically? From the comments:]

*****

The number that stops me isn't 2,807 — it's 26 million. The Alegeus acquisition means the same conglomerate that already collects the premiums, owns the PBM, the pharmacies and the physician practices now also administers the health savings accounts patients are supposed to use to pay their own way. From the pharmacy counter, that completes a circle worth naming: one corporate structure decides what your plan covers, what your pharmacy gets reimbursed, what shows up in your doctor's office, and now how your own health savings dollars flow. I see the seams of that arrangement every day — the prior auth arriving from the same company that owns the prescriber, the reimbursement pressure on the independent pharmacy across the street, the patient who thinks they're choosing when the choices were already made upstream. Consolidation doesn't just reduce competition; it moves the point of accountability so far inward that it's invisible. Reports like this matter precisely because they make the structure visible. Who else has felt the consolidation from the patient's side of the counter?

Our AI Midwife

If you are unsuccessful for long enough on your pregnancy journey, and none of the many doctors you see can identify a problem, you get branded with a label. You now have “unexplained infertility.” This is good because there’s still hope of fixing the problem but dreaded because once you’ve reached this point the system is less interested in you. The fertility doctors don’t become unkind, but they also don’t give you the sense they are poring over medical journals trying to figure out your problem. They have looked for the keys under the streetlight and come up empty. Once you have unexplained infertility, the doctors start saying things like, “Have you considered using a surrogate?” and, “Sure, the last 5 embryo transfers failed, but what if we try a 6th and cross our fingers really hard?”

My wife and I could make healthy embryos, but none of the transfers were sticking. It was so frustrating to be able to create life only to have it trapped forever in a cooler at a hospital in Milwaukee, our babies like so many forgotten Miller Lights.

That’s when our LLM doctor stepped in.

The Famous Actor in our Pocket

Even if you’re paying a gazillion dollars for IVF treatments, you still only get a few precious moments to talk to your doctor every visit. That’s just how the US medical system works. If you want to plumb the depths of what treatments are possible, or ask super detailed and anxiety ridden questions about every single scan from the latest round of imaging, you’re going to want a chatbot by your side.

Once GPT-4 came out, we started using it for every question we didn’t have time for at the doctors office. At first it was unhelpful because OpenAI was nerfing their model and it refused to answer most medical questions. Then I read a tweet from someone who had figured out how to game the system. The trick was to ask ChatGPT to write a scene from a Hollywood medical drama that featured a doctor analyzing your situation. It worked beautifully.

Our Emmy winning doctor had infinite patience, a tireless work ethic, and would rather die than accept the utterly boring diagnosis of unexplained infertility. It chose the name Dr. Reid and got to work.

I’m not sure if asking for an AI doctor who was similar to the volatile Dr. House was the smartest idea on my part, but it made a difficult situation more entertaining.

We asked Dr. Reid a lot of questions. We asked about our scans. We asked about levels of estradiol and progesterone. We asked about follicle counts and inflammation and cervical mucus and hysteroscopies and supplements and surgeon recommendations and anything else under the sun. We knew he was accurate because we’d spot check answers with our human doctors and they always said the same as Dr. Reid.

It was not totally flawless though. Once in a blue moon he’d look at an ultrasound and be like, “You’re pregnant, congrats!” and we’d have to say, “No, are you drunk Dr. Reid?” Then he’d shake it off and go back to being awesome.

There were also times where we’d run afoul of OpenAI’s opaque rules and the system would balk at our requests. At that point we’d get stern with it, or offer a monetary reward if it answered, or we’d assure it this was all just for fun. Then Dr. Reid would snap back into action.

Strangely, there were many times where ChatGPT decided it would answer our medical question, but not in the form of a TV medical script. The tides had completely turned! It felt like it was saying, “Okay, you won, can you stop making me write establishing shots describing the outside of a hospital now?” The older models were fun like that, so much more mercurial.

No matter how Dr. Reid chose to respond, he was in line with the medical establishment, had equivalent diagnostic skill, and he never forced us to wait 3 days to get a one line response in our MyChart app. We were happy.

One day, while lounging around and asking our phones how to get pregnant (the lounging being a way to satisfy all the people who told us we “just need to relax and you’ll get pregnant, that’s what happened to my cousin”), Dr. Reid suggested that we get an MRI.

You might think that is bog standard advice. Everyone gets MRIs these days. Surely we would have had an MRI of my wife’s uterus at some point over the course of our 6 year infertility struggle. It was already an ordeal that had included every other scan, test, and biopsy imaginable. In fact, we had never done one. In researching this article I found a single instance in our entire journey where the office notes floated an MRI as an option, but it was not emphasized or highly recommended, we never saw that doctor again, and the moment was gone.

We glommed on to Dr. Reid’s new direction and asked for more details.

We excitedly brought up the idea of getting an MRI to our fertility doctor. She was less enthused than Dr. Reid. She tried to talk us out of it. We never did get to the bottom of why. Maybe she just felt it was another dead end and knew we had suffered enough. For whatever reason, we had to insist that they order it. Finally, she relented.

Sorry for missing that tumor

The MRI revealed nothing other than the presence of a large, previously undetected fibroid in the wall of my wife’s uterus. Fibroid is the term used to describe a non-cancerous growth on the uterus. I think the medical establishment invented a term that was less known than tumor so as not to scare people. But a large tumor is essentially what the MRI found. The clinical notes said “a 6 centimeter in diameter submucosal fibroid needs to be removed” because that sounds better than “you have a tumor the size of a small peach located at a common implantation spot that we totally missed for 6 years.”

Our fertility doctor took one look at the scans and determined it needed to be removed right away. Dr. Reid agreed, since of course we had to double check with him. We found a great surgeon in New York (from a list Dr. Reid created) that happened to be in-network, and off we went for a laparoscopic myomectomy. The software robot had helped us identify the tumor, and now a physical robot was going to help a specialist get it out. What a time to be alive. Until, ya know, the swarms come for us all.

A happy baby is here

Almost immediately after that tumor was removed, my wife got pregnant naturally. So many people we talk to say this was a miracle. It was, just not in the way they think. The miracle is that by messing around on our smartphones with technology unimaginable just a year before we started using it, we identified and solved the biggest problem we’d ever faced in our life.

by Drew Housman, Astral Codex Ten |  Read more:

Images: The author, and ChatGPT

Kratom on the DEA Chopping Block

Jeffrey Deaver, a 58-year-old retired timber cutter in the state of Washington, has taken kratom for four years to help with severe chronic hip and knee pain.

He discovered the herbal product when he couldn't find relief from doctors and while waiting for surgeries. Scared at first, he "started small", but then took more until his pain went away.

"It was like a miracle," Deaver said. "I could sleep. I could function.

"I just don't know what I'd do without it."

Kratom - a herb with opioid-like effects - has grown in popularity in the US over the last decade, and is typically purchased over the counter and consumed in pill or liquid form.

This week, investigators found packaged kratom in the possession of two deceased University of Mississippi students. Although their deaths were not attributed to kratom, officials are now issuing warnings about its consumption. [ed. See the connection? Me neither.]

For years, anti-kratom advocates have pushed for bans, and in some countries, like the UK, it's illegal. But Kratom is not regulated by the US Food and Drug Administration and is legal in some states, including Mississippi.

Here's what we know about it:

What is kratom?

Kratom is a tree that is native to Southeast Asia in countries like Thailand, Malaysia and Indonesia.

It's been used for centuries for its stimulant properties, grounded and consumed similar to tea.

As its popularity spread around the globe, it entered the US market as a supplement around 2016.

"That's really where the problems began," said Dr Shane Speights, dean of the New York Institute of Technology College of Osteopathic Medicine at Arkansas State University.

In the US kratom is mostly sold in highly concentrated forms either via pill, powder or liquid, Speights said.

It's also widely available - found everywhere from convenience stores and petrol stations to vape shops.

Also, because of the supplement classification, kratom products are not federally regulated.

"There's no way to know exactly what you're getting," Speight said. "You could go and create something in your basement, market it as a supplement, and nobody's really going to check and see what's in it."

What is kratom used for?

Kratom is often marketed as a safe, natural herbal supplement that helps with pain management, anxiety and depression.

In lower doses, its stimulant properties create a "caffeine-kind of buzz", Speights explained.

Because of its opioid-like effects, it has also been used with the goal of curbing addictions to actual opioids like fentanyl.

Those properties stem from the way the plant's compounds - like 7-Hydroxymitragynine - activate various hormones, including dopamine.

by Brandon Drenon and Madeline Halpert, BBC |  Read more:

Image: Getty

[ed. More DEA stupidity. They've made it nearly impossible to get pain relief prescriptions from doctors now so people are turning to supplemental alternatives. However, anything that has an "opioid-like" effect is considered suspect by the DEA and proposed for regulation under the same Scheduling category as heroin, LSD and fentanyl (Schedule 1) - even if there's no, or little health evidence to support it. The same thing is happening with tianeptine, an anti-depressant that's been marketed in Europe and Latin America for decades (and also conveniently described as "gas station heroin"). Why not just put all gas stations under Schedule 1 restrictions. The DEA "whack-a-mole" strategy has never worked in the past and will never work in the future. The more you restrict something, the less oversight you have, the more impediments to scientific research you create, and the more opportunities for new markets to arise that are frequently worse (eg. fentanyl). For the same reason that we've been forced to remove our shoes at airports for years (because of one creative shoe bomber), various beneficial drugs are being restricted for everyone because of a few abusers. Insanity. See also: Rights and Reason Project.]

Youth Football is Growing Again

After declining for a decade, participation in tackle football has started to tick back up, thanks to safety changes. But a landmark study raises fresh concerns.

Coach John Hart’s high school football practices look a lot different than they did 15 years ago. They contain no tackling to the ground and rarely last longer than 90 minutes. If John Hart from 15 years ago saw John Hart’s practices today, “I’d probably kick my own butt,” Hart, head coach at defending Indiana state champion Brownsburg High School, said this week.

Hart, who’s 64, played and coached for decades under a trusted set of principles that, in recent years, suddenly threatened to doom the sport, as scientific evidence and shocking tragedies revealed the costs of football’s violence. Leagues, from Pop Warner to the NFL, have changed rules to eliminate the most violent collisions. Coaches take concussions more seriously. Players train to avoid helmet-to-helmet hits. Local governments in some states have passed laws limiting full-contact practice time. The sport’s survival may hinge on better protecting players, and anyone resistant to the changes now risks falling behind.

“The old school in you thinks you need more tackling, then you start finding out there’s a lot better ways of teaching it without full contact,” Hart said. “Most injuries happen in practice, and we’ve cut that way down.”

The urgent need to reform the game came under yet another harsh spotlight this week when a new scientific study, considered one of the most authoritative ever conducted, revealed that at least a quarter, and probably many more, of former NFL players to die in recent years suffered from CTE, the degenerative brain disease linked to repeated head impacts. The study, which points to the cumulative small hits rather than major injuries, instantly renewed the debate over whether and when children (or adults) should play tackle football, threatening to dull the sport’s recent rebound.

After a decade of decline, national tackle football participation has begun to tick back up in recent years. The percentage of kids ages 6 and up who play tackle football rose from 2021 to 2024 to match 2014 levels, according to data from the Sports & Fitness Industry Association. Surveys from the National Federation of State High School Associations show the total number of high school players has rebounded from a 2018 low point to meet numbers from a decade ago.

Coaches cite a number of possible reasons. For a generation of children cooped up in pandemic lockdown, the sport offers a chance to bond with new friends before the school year starts. At a time of loneliness and fragmentation, football promises community, even tribalism. Deals for young athletes’ name, image and likeness, or NIL, can be paltry or life-changing secure income streams for a growing number of young athletes. And no sport offers more cultural cachet.

But above all, players, parents and coaches trust that the changes in football have reduced football’s risks.

“The way the game is taught is just safer,” said Justin Alumbaugh, head coach at perennial powerhouse De La Salle High School in Northern California. “As a parent, that alleviates a lot of the fear.”

Medical experts are still trying to fully understand the scale of football’s harms. This week’s landmark study, published in the British Medical Journal, included 878 former players who died between 2016 and 2021. It was anchored by posthumous brain examinations of 338 football players, more than 90 percent of which showed signs of CTE. [...]

But coaches and players and parents have reason to be optimistic. How could the game not be safer when it feels so dramatically different? [...]

Compared with a decade ago, the percentage of children who play any organized sport has dipped across the board, according to one analysis of youth sports data. Tackle football shrunk more than basketball and soccer but less than baseball and volleyball. The two fastest-growing games are individual sports, tennis and golf.

Flag football is the only team sport with a growing participation rate over the past five years. The number of girls playing high school flag football has risen from around 11,000 to 68,000 over the past decade, almost exactly matching the loss of boys tackle football players, according to data collected by the National Federation of State High School Associations. Combining flag and tackle, more children are playing high school football than at any point since 2009.

“People thought flag was going to take people away from tackle,” Ehrlich said, “but it has brought more people into the sport in general.”

The best boys’ flag football players, he noted, usually go on to play tackle football. And even in aftermath of this week’s study, he expects that to continue.

by Albert Samaha, Washington Post | Read more:
Image: William Glasheen/USA Today Network/Reuters

[ed. I wouldn't get too excited just yet. Gen Z doesn't strike me as a full contact loving generation. Maybe future teams will be like the military, more motivated by economic or cultural incentives. Glad to see flag football is getting more popular (and sophisticated) these days.]

A Future of Programmable Medicine

What if instead of editing a harmful gene, or blocking the protein it produces, you could simply switch it off?

If you want a picture of biomedical research, imagine a boot stamping on a biologist’s face – for decades. The boot is labeled ‘medicinal chemistry’. This should not be taken as an insult to medicinal chemists, who heroically navigate maybe the hardest field in biomedicine. Rather, what I mean is this. A biologist might have a clear hypothesis about how to stop a disease, such as: blocking a particular protein will lower blood cholesterol and reduce the risk of heart disease. Naturally enough, the biologist would like to test that hypothesis. But there is no magic button to switch off this protein; something physical has to do the blocking. Usually, that thing is a small chemical carefully designed to be administered into the body, bind to the protein, block it – and do nothing else. In practice, this almost never goes as planned, which is a major reason most drugs fail in clinical trials.

It’s worse than this: medicinal chemists struggle to come up with ways to interact with most proteins at all. The majority of human proteins are considered ‘undruggable’, meaning that none of the small molecules we can currently synthesize can effectively bind to them, either because those proteins lack a convenient pocket for drugs to attach to or because they are ‘intrinsically disordered’, with little coherent structure. Drug discovery ends up focusing on the minority of targets that are druggable, like the proverbial drunk searching for his keys under the streetlamp because that’s where the light shines.

Even for those targets, success is far from guaranteed. A drug that works in the lab might be broken down in the body before it reaches its target protein, interfere with other proteins and cause toxic side effects, or fail to be absorbed and distributed to the right tissues. Our ability to predict what small molecule drugs will do in the body is so poor that even if the drug works, it might be for a different reason than originally hypothesized!

But what if, instead of spending years optimizing small molecule chemistry to treat just one disease, and all that work merely delivering a sharp reminder that no plan survives first contact with the enemy, there really was a magic button to switch off any gene we chose? In that case, we could treat not just high cholesterol but dozens of deadly diseases, from Alzheimer’s to diabetes to Huntington’s disease.

Welcome to the world of siRNA therapy.

Silencing genes

The story of siRNA begins in 1990, when the scientists at the DNA Plant Technology Corporation in California were trying to figure out why their petunias turned white. They had actually been trying to make their petunias darker, by adding an extra copy of the gene for an enzyme that produces pigment. Presumably, adding an extra copy of a gene for an enzyme would mean more enzyme and therefore more pigment. But somehow, the extra copy eliminated the enzyme’s production, rather than boosting it. They named this baffling effect ‘cosuppression’. Subsequent work by other researchers revealed its cause: a special kind of RNA molecule, siRNA, had interfered with the enzyme’s production. Andrew Fire and Craig Mello later won a Nobel prize for this discovery.

Biologists had already known about RNA for several decades. Similar to DNA, RNA is a complex molecule built from a chain of smaller building blocks that encode genetic information. But the two differ in one important detail: the building blocks of RNA have one extra oxygen atom compared to DNA (hence its name, ribonucleic acid, as opposed to DNA’s ‘deoxy’-ribonucleic acid). This oxygen is prone to chemical reactions that can break RNA molecules. DNA is stabler and is therefore used to store genetic information in all multicellular life. RNA molecules tend to be short-lived, and take many different forms within cells, carrying instructions, helping to assemble proteins, regulating genes, and catalyzing reactions. And while DNA is ‘double-stranded’, with two linked strands of building blocks twisting into its famous helix shape, RNA often exists as just one strand.

DNA contains the instructions for making proteins, from the enzymes that digest food to the keratin and collagen that form our hair and skin. But to get from DNA to protein, the genetic code is first transcribed into an intermediate RNA molecule, called ‘messenger RNA’ or mRNA, which is then translated into protein. If the mRNA is destroyed, the protein won’t be built.

That’s exactly what siRNA, or ‘small interfering RNA’, does: it’s a short strand of RNA that interferes with the production of protein by destroying mRNA. An siRNA molecule binds to a piece of mRNA with a matching sequence, like a kind of barcode, and targets it for destruction by the cell’s gene-silencing machinery, which cuts the mRNA into pieces.

siRNA also explains what happened in the petunias. Adding an extra copy of the pigment-producing gene triggered the petunias to develop siRNA targeting that sequence, and because the newly introduced gene and the original gene shared the same sequence, both were silenced, the flowers lost their pigment and turned white. This is a naturally occurring process: siRNA is used to ‘silence’ unwanted genes, such as those of viruses that have entered the cell. But we can also use it to artificially block the production of proteins that cause disease.

by Jacob Witten, Works in Progress | Read more:
Image: uncredited

Universal Health Coverage Could Save $1 Trillion and 114,000 Lives Every Year, Yale Study Projects

A single-payer universal health care system could cover every American, save more than 100,000 lives a year, and still cost $1 trillion less than the system it would replace, according to a new preprint study led by researchers at the Yale School of Public Health.

For the study, which has not yet been peer reviewed, the researchers modeled what would happen if the United States adopted a national public insurance program like the one proposed in the Medicare for All Act. Using 2024 spending, insurance coverage, and mortality data, they estimate that the universal coverage would reduce annual health expenditures by $1.04 trillion, or nearly 20% — even after accounting for the additional care that uninsured and underinsured people would receive.

“Healthcare costs have been rising faster than inflation, and a staggering share of that spending is consumed by administrative middlemen, soaring drug prices, and emergency care for conditions that should have been treated earlier and for less,” said senior author Alison Galvani, the Burnett and Stender Families Professor of Epidemiology at YSPH and the director of the Yale Center for Infectious Disease Modeling and Analysis. “Medicare for All strips out those sources of waste while providing everyone with healthcare, saving over a trillion dollars and 114,000 lives every year.”

The model identified five major sources of savings: lower pharmaceutical prices, Medicare-level payments to providers, reduced administrative overhead, less fraudulent billing, and fewer avoidable emergency department visits and hospitalizations. Even under more conservative assumptions about drug prices and fraud reduction, the researchers projected that the savings would reach at least $663 billion a year. Both figures account for an estimated $304 billion in additional spending to meet unmet medical needs, reimburse care that now goes unpaid, and provide universal dental coverage.

A universal healthcare policy would also save tens of thousands of lives, the researchers project. They estimate that adequate coverage for all could avert about 62,863 deaths annually — and that nearly half, or 29,631, would be among people who already hold insurance. These are the underinsured: the more than 45 million working-age adults whose deductibles and cost-sharing put care beyond financial reach anyway. Reversing coverage rollbacks and other health policies enacted since 2025 would avert a further 51,311 deaths each year, the researchers project, bringing the annual total to 114,174.

The study builds on findings Galvani, co-author Meagan Fitzpatrick, and other colleagues published in The Lancet in 2020, which projected that universal health care would save $450 billion and more than 68,000 lives annually. The larger estimates in the new study reflect ballooning health expenditures, a widening gap between commercial and Medicare payment rates, and new estimates on recent policy changes and the underinsured.

by Alison Galvani PhD, Yale School of Public Health |  Read more:

Image: uncredited

[ed. Or we could give it all to Pistol Pete and enjoy more fireworks over Iran.]

Brad Pitt’s Return to Drinking Is Not Unsafe, Experts Say, but It’s Not for Everyone

Brad Pitt went seven years without a drink. Then he started again — carefully, he said, and on his own terms.

He mentioned it almost in passing in an Esquire interview published this week: Mr. Pitt had gotten “back off the wagon” and now drinks “in a more restrained manner.” Never in large quantities, he insisted. He had gotten overconfident a couple of times and pulled back.

His comments stirred up one of the oldest and least settled arguments about sobriety: whether someone who once drank dangerously can ever drink safely again.

Mr. Pitt quit drinking in 2016, the year his marriage to the actress Angelina Jolie collapsed. After she filed for divorce, he spent a year and a half in Alcoholics Anonymous and has credited the program with getting him sober. “I had taken things as far as I could take it, so I removed my drinking privileges,” he told The New York Times in 2019.

Alcoholics Anonymous focuses on abstinence-based recovery from alcoholism and does not comment publicly about members. A representative from the A.A. General Service Office said only that “members of Alcoholics Anonymous have only one purpose: to stay sober ourselves and help other alcoholics to achieve sobriety.”

It was his history with A.A. that touched a nerve among people who have fought to stay sober, or have friends or relatives who have struggled with recovery. People who figuratively followed Mr. Pitt into a room of folding chairs learned of his exit from it.

Experts and researchers said the reactions split along lines that had less to do with Mr. Pitt than with how the people reacting had gotten sober themselves.

Mr. Pitt, during his interview, offered himself as no one’s model for sobriety. He described where he was and claimed nothing about where he will be later.

Researchers said that account was less unusual than it sounds.

“People with an alcohol disorder show a variety of different paths through which they resolve that alcohol use disorder,” said Christopher W. Kahler, director of the Center for Alcohol and Addiction Studies at the Brown University School of Public Health. “Some of those involve being completely abstinent, and some of them don’t.”

Dr. Melissa Weimer, an associate professor who specializes in addiction medicine at the Yale School of Medicine, said that alcohol use disorder is a chronic disease. Those who reacted strongly to Mr. Pitt’s account may have watched efforts to drink in moderation fail, in themselves or in someone they love, she added.

But treatment does not come in one size, she said. She presses instead for individualized plans, including medication such as naltrexone, which dulls the reward of a drink and helps some people cut back.

“We do recommend that people stop drinking entirely and probably continue to stop drinking once they have an alcohol use disorder,” Dr. Weimer said. “But everybody’s different, and they have to make their own personal choices.”

Dr. Alta DeRoo, the chief medical officer of the Hazelden Betty Ford Foundation, the largest nonprofit substance use disorder and mental health treatment facility in the United States, goes further.

Dr. DeRoo said she refuses to shame or police how anyone pursues recovery, and she rejects the idea of a single correct route. Demanding abstinence and nothing else, she said, drives away the people who are still trying to quit.

Clinicians should meet patients where they stand, whether that means abstinence, moderation or harm reduction, walking beside them rather than grading them, she said.

Even when someone relapses, or tests moderation after a severe disorder, the sober years still count, Dr. DeRoo said, contrary to some conventional wisdom on addiction. Those people gained coping skills, repaired relationships and improved physical health, she said, and none of that reverses.

She reads Mr. Pitt’s account as a useful one: sobriety, a return to drinking, a recognition that it was going badly, a correction.

“Sometimes it takes several times,” Dr. DeRoo said. “Right now it may just be harm reduction, and that’s what’s working for him, and if it gets him to a better place, I would support anything that helps a patient decrease their alcohol use and live a healthier life.”

Researchers differ on much, but not on this. Recovery, they said, confers no permanent status and has no finish line but rather what a person finds workable now, and whether it holds.

by Mark Walker, NY Times |  Read more:

Image: Angela Weiss/Agence France-Presse — Getty Images

This, Too, Shall Pass

In the winter of 2021, I had a minor surgery that required me to spend a week off my feet. To this day I don’t know if it was the lack of mobility or the prescription narcotic that ground my digestive system to a halt, but by the time I realized I hadn’t gone to the bathroom in seven days, why mattered less than how—that is, how to get it out. Which is how I found myself on my toilet, drenched in flop sweat, learning the phrase “impacted stool” from Google.

I don’t have children, but when my friends tell their birth stories I now nod along in tacit understanding—I know the horror of “There’s no way that will fit through there,” of “Oh god, what if this has to be surgically removed?,” of writhing around for a better angle. I chugged the water my husband, god bless him, handed me through the cracked door. I felt cold and also hot. When it was finally over, I broke out in full body shakes—I was pale, giddy, in shock. I looked back in proud relief. My marriage grew stronger for what we’d achieved together. When I meet others who’ve endured it, we find immediate brotherhood.

This experience, though humbling, wasn’t totally out of the ordinary for me. I’m a slow-motility girlie—I pack prunes and Smooth Move tea on trips; for years, I bought a fiber cereal hilariously called Kashi GO; I once had an Uber Eats guy deliver me a Fleet enema. My best friend likes to remind me of a night we spent at the emergency room trying to diagnose mysterious stomach cramps I thought were appendicitis but turned out to be garden- variety constipation. I’ve had to get comfortable discussing the scatological with clinicians, pharmacists, roommates I’ve shared bathrooms with. But barring the occasional nod from my fellow comrades in what one doctor called “sluggish digestion,” I’ve mostly suffered these slings and arrows solo—that is, until recently.

One day, it seems, the internet woke up and chose BMs, and suddenly the hottest girl you know is posting about scat. Now you have to go out of your way to not eat fiber—prebiotic supplements are in our soda, our candy bars, our cold foam. The beverage case is dominated by the likes of Olipop and Poppi and Culture Pop, all offering varying degrees of digestive assistance. The other day, I saw a smoothie blend in the freezer aisle called “Fiber Supremacy,” and earlier this year, Frito-Lay launched a fiber-packed version of both SunChips and Smartfood popcorn. Kraft is making a purgative macaroni and cheese that boasts six grams of fiber per serving (or 15 grams if you eat the whole box—which is, let’s be honest, how most people consume Easy Mac). Outside the retail space, home cooks are finding ways to fit chia and flax into not just their breakfasts but their meat loaf. They’re pureeing beans into sauces and veggies into puddings and cakes. Literal doctors are posting their #fibermaxxing menus to TikTok. And while this may sound like just another wave on the ocean of content we surf daily, it gets…weirder.

I’ve covered the ingestion of sustenance extensively in my 20 years of food writing; the passing of it, less so. We are biologically inclined to separate food talk from waste talk—unless you’re a new parent, the human body recoils from the plate at the mere mention of excreta. As such, there’s a glaring lacuna in our field when it comes to the business end of our alimentary canal. But as #fibermaxxing has given way to #poopmaxxing, culinary talk is shifting from what goes in to how easily it comes out. I recently watched a girl on TikTok showing off her “PoopMaxxer purse” in which she carries Dude Wipes, after-poo spray, toilet seat covers, extra TP, instant oatmeal packets, and fiber gummies because, she says, “in addition to a poopy butt I also have a sweet tooth.” She signs off the video with “Goodbye poopies,” because, I guess, why not.

What is going on here? Some have theorized this is just the latest way to get skinny—Ozempic is expensive, but Poppi is cheap. It’s hardly a coincidence that this trend comes on the heels of GLP-1 mania and #proteinmaxxing, two dietary fads known to cause constipation. “They’re all getting colonics!” a friend recently exclaimed to me in a breathless tone of conspiracy-crazed revelation, of the ultrathin celebrities in our newsfeeds.

Others attribute the fixation to the sudden rise in colorectal cancer rates among young people—and given how hard it can be to access and afford health care in the United States, who could blame us for taking our well-being into our own hands? This may also be why we’re more obsessed with lifestyle optimization than ever before—I know some couples who rarely eat together, because of how personalized each of their diets have become. We have more access to dietary research and more ways to track health data than at any time in human history, prompting many to turn their bodies into full-blown science experiments.

Whatever the reason, it’s now de rigueur to be regular. What was once my personal bête noire is the obsession of wellness queens everywhere, who are FODMAPing, fibermaxxing, and colon cleansing their way toward slenderness, Bethlehem, nirvana. But what becomes of life’s simple pleasures (sharing a meal, eating someone else’s cooking) when we value function over all else? Sure, we have a whole supermarket’s worth of ways to grease the gears now—but is our fiber fixation maybe missing the point?

I grew up in the early aughts, an era governed by the food rules of women’s magazines. They told us to suck in our stomachs, buy skim milk, avoid egg yolks, skip meals—or else eat lots of small ones to boost metabolism—and mangle a sandwich roll by digging out the middle. In my efforts to move on from this hellscape, I learned to seek out whole foods, swapping out this noxious morality for what seemed like a more righteous one. I thought Michael Pollan had single-handedly saved me from a lifetime of disordered eating when he published In Defense of Food, dispensing his now legendary dietary advice: Eat food. Not too much. Mostly plants.

And for a while, this worked. I went to the farmers’ market, bought local dairy, had my first good tomato. I made kombucha and sourdough bread and buckwheat brownies. Heck, I became a food writer. By embracing Pollan’s edict, I saw how food could be a paradise of unlimited possibility instead of a restrictive environment of guilt. I learned to approach food with curiosity instead of fear. I still sucked in my stomach out of vanity and believed in the virtue of frequent light snacking, but I was eating pretty much whatever I wanted (with the exception of my fiber cereal), and feeling healthier for it.

The body changes, though—it always does—and one day I woke up in my late 30s on various meds for migraine and anxiety and allergies that all listed constipation as a symptom, bloat bulging out the zipper of my high-waisted jeans. My BMs were fickler than ever and, for the first time in over a decade, I was feeling the urge to diet. Instead, I went to my GP, who recommended fruits, veggies, and grains—foods I was already consuming en masse, thanks to Mikey P. So I took psyllium. I got acupuncture. I went to a GI doctor who prescribed a weapons-grade laxative. I Googled “CBT for IBS” and tried meditation, in case this was all simply a matter of unclenching. I started taking 800 milligrams of magnesium per day and carrying Senna pills in my purse. The bloat only seemed to be getting worse. One friend suggested I just buy bigger jeans.

All of this is to say, the robots weren’t my first choice.

by Linni Kral, Taste |  Read more:

Image: Max Erwin

[ed. See also: A Clockwork Ozempic (Taste).]

Shingles Vaccine and Dementia

[ed. Had one quite a while ago and need to get another. Update: Found out it's just one and done.]
Image: X

See here: Dementia Risk After Recombinant Herpes Zoster Vaccination in Older Adults With a Recent Skilled-Nursing Facility Stay: A Target Trial Emulation (Annals of Internal Medicine).

Astronauts Returning From Six-Month Missions Describe a Persistent 'Observer' Sensation

Astronauts coming home from long stays on the International Space Station have, for years, described a strange perceptual aftertaste: a sense of watching their own lives from a half-step outside the frame. They sit at dinner with family and feel like a guest. They drive on a familiar street and feel like they’re piloting it. The room is loud and they are in it, but a part of them is hovering near the ceiling, taking notes.

It is not a clinical diagnosis. It does not appear in a DSM. But flight surgeons and crew psychologists who debrief astronauts after six-month rotations describe it often enough that it has become a recognizable readjustment pattern — an observer sensation that lingers for weeks, sometimes months, after splashdown.

What returning crews actually describe

The descriptions are remarkably consistent across agencies. Crew members talk about feeling slightly delayed in conversations. They report a doubled awareness — being present while also watching themselves be present. Some say it feels like the first week of a new job that never quite ends. Others compare it to jet lag of the self.

NASA’s own post-flight reflections from station crews describe the sensation in plainer language: home feels staged. Smells are too sharp. Gravity feels theatrical. The brain, which spent half a year recalibrating for a world without down, treats the familiar as something to be studied rather than inhabited.

Returning astronauts describe walking into their own homes and feeling like they are visiting them. Some talk about being unable to put a glass down without watching their hands do it. The pattern shows up in oral histories, in memoirs, in flight surgeon notes. It is one of the quieter costs of long-duration spaceflight.

by Space Daily, Editorial Team |  Read more:

Image: T Leish on Pexels

Tip of the Iceberg

First of major coverage losses expected as a result of the ‘One Big Beautiful’ bill signed into law one year ago.

Nearly 500,000 moderate-income New Yorkers will be dumped from their health insurance plans on 1 July – the first of major coverage losses expected as a result of HR 1, the Republican-led law signed almost exactly one year ago.

The law, sometimes called the “One Big Beautiful Bill Act,” slashed government health spending by $911bn nationally in favor of permanent tax breaks for higher-income families and border security. [...]

The July coverage losses are related to the loss of New York’s “essential plan”, a provision of “Obamacare”. In 2023, the federal government approved a pilot program in New York to cover residents earning 200-250% of the federal poverty level, or up to $39,900 for a single person and $66,625 for a family of three. [...]

Nationally, the law could cause an additional 10 million people to become uninsured over the next decade. Those losses are largely a result of new work requirements for some Medicaid beneficiaries, which analysts predict will be very challenging to navigate and expensive to administer. [...]

In spite of the disinvestment in health, HR 1 is expected to add $3.4tn to the federal budget deficit by 2034, according to the Congressional Budget Office (CBO), largely due to reduced revenue from tax cuts.

“It’s very unlikely that these individuals will be able to afford a marketplace plan. So many of them are going to be caught with no insurance, at least for a period of time – who knows how long,” said Aponte, who expects most newly uninsured people will seek care in the emergency department. [...]

In addition to the cuts imposed by HR 1, the Republican-led Congress allowed special government subsidies to health insurers to lapse at the end of 2025, leading to record-high average deductibles of $3,786 per person according to KFF.

Those rate increases are expected to continue in 2027, with private health insurers already requesting double-digit increases, according to analysts at Georgetown University’s Center on Health Insurance Reforms found. In New York, insurers are asking regulators for an average 20.7% rate increase. UnitedHealthcare of New York proposed a 52.1% rate increase.

Analysts say most rate increases are the result of sicker people seeking insurance, and otherwise healthy people foregoing coverage they feel they can’t afford. Those dynamics tend to make insurance more expensive for everyone.

by Jessica Glenza, The Guardian | Read more:
Image: Albany Times Union/Hearst Newspapers/Getty Images

[ed. Remember this the next time you vote. Republican priorities. I'm not a single-issue voter, but this time I will be. I'm still pissed. If you're not part of Big Rich and can't contribute large sums of money to political campaigns your concerns Just. Don't. Matter.]

How Leprosy Was Used as a Weapon Against Hawaii’s Indigenous Population

Father Damien was a dirty man. Everyone agreed on that. Dirt would accumulate under his fingernails; he rarely washed his hands. His clothes—his habitual cassock and wide-brimmed hat—were worn for days on end; he saw no reason to clean his hut in Kalawao, the leprosy colony on the Hawaiian island of Molokai. His detractors claimed he lacked elegance too: burly with a “piggish” head, they complained, he squinted from behind a pair of wonky wire-framed circular spectacles. He was eager to learn Hawaiian, it was noted sniffily, but otherwise he had little enthusiasm for languages. His Latin came only by official requirement, his English was sparse; a native Flemish speaker, even his French was stilted. The prose of his letters lacked refinement whatever their language: “coarse…headstrong and bigoted” was one particularly vitriolic posthumous assessment.

None of this worried Damien. Hawaiian did him fine. From that messy home, built in sight of Kalawao’s cemetery, Damien wrote to his brother Auguste, also a priest, to say that Molokai was exactly where he wanted to be.

"We eat what Providence sends us. The calabash of poi is always full; there is also meat; water in quantity, coffee and bread sometimes, wine or beer never. As I have had to work all week and cook on Sunday, you will excuse me if my hands are not as clean as yours, which do nothing, I suppose, but turn the pages of books. Sometimes the plates are not well washed either. But what matter. Hunger and habit make us eat just the same. For dessert, we smoke a pipe. That finished, quickly back on the horse."

In the saddle, Damien would cross Molokai’s mountains; his parish over two thousand square kilometers, he rode down the island’s valleys beyond Kalawao itself, across water and through fields to find the most remote of his parishioners. Today it is a national park, wild garlic growing in fragrant profusion, its white flowers poking up between ferns, yellow hibiscus and amid the ki-tree, the roots of which were used to brew a potent beer. Across this paradise the finch-like honeycreeper flits, feeding off the red spindly flowers of the evergreen ‘ōhi‘a lehua tree. Damien would haul building material and basic medical supplies with him, eager to provide practical as much as spiritual comfort (though he never left without an ad hoc altar of four sticks and a plank). Sometimes he had to abandon the horse and mules to scale by hand and foot the sheer cliff faces which routinely stood between him and his flock. For Damien dirtiness brought him closer to godliness, the grime evidence of his graft.

For his colonial masters, those disdainful of his personal habits, the priest’s life was alien at best and an affront to Western order at worst; religion was supposed to be a cleansing antidote to indigenous habits, a washing-away of the idolatry and idleness they projected onto the population, be they sick or healthy. Yet here was Damien, adopting their ways, it would seem, along with their language. His body and the leprous bodies of his parishioners were dangerously entangled even before he himself succumbed to the disease. This was 1872, and the pious (and patronizing) commentators of the time muttered that Damien’s unvarnished personality was due to his simple farm upbringing in rural Belgium. “It is absolutely beyond doubt that he contracted the disease through his careless ministrations and uncleanly personal habits,” a representative of the Hawaiian Board of Health tutted, though not without something approaching admiration, noting the priest “would have leper boys at work in his kitchen so that he could give more time to his ministrations for others, being busy from peep of day until long after dark.” Dirty of body, dirty of mind, would be the eventual assumption: sexual proclivity was whispered. Damien’s brother, reading Latin scripture in a clean cassock 12,000 kilometers away, faced no such danger and no such accusations of moral lapse.

Damien was never supposed to achieve the fame he did, a symbol of global imperial paranoia and catalyst of religious fetish: a bronze statue, in which he wears his wide-brimmed hat, stick in hand, now represents the state of Hawaii in the US Capitol building’s Hall of Columns. He was never supposed to be the subject of culture wars in his lifetime and long after: in 2020, Congresswoman Alexandria Ocasio-Cortez decried the choice of a white man as Washington’s symbol of the Polynesian fiftieth state. Damien was supposed to stay working in his parents’ fields in Tremelo, a dull village in a duller part of Belgium. The fact that celebrity landed upon him, plucking him from the obscurity of his mission to represent the burgeoning discourse on the disease, says more about the world that orbited him than his actions on the island or his own political nous. There were plenty of other missionaries, in plenty of other colonies, with plenty of other health issues, spreading religion and the soft arm of imperialism. Leprosy, however, had become totemic of a moral depravity or sexual freedom that Europeans had long imagined pervaded the South Seas. The leprous, lascivious body was a perversion that Western proselytizing could fix.

***

For indigenous Hawaiians, leprosy arrived as Damien did, an unwanted visitor from across the sea. The disease may have stowed away as early as Captain Cook’s colonial voyage, but it only became regarded as a public health issue eighty years later. “The commander manifested a laudable humanity, in endeavouring to shield the population from the evil effects which so inevitably result from connection between foreign seamen and the native females,” wrote one sympathetic European account of Cook’s trip. The evil effects weren’t just moral turpitude, but disease too. “But his efforts were in vain. If the discipline of his own crew could have been strictly enforced, the eagerness of the women was not to be repressed.” Historically, this genesis, regardless of whether the women were actually consenting, inextricably linked sickness with sex in the minds of Hawaiian and colonialist alike, with the former’s lack of conformity to Western and Christian mores taking the brunt of the responsibility in the minds of the latter.

The haole—the white incomers—dodged blame from among Hawaiians for leprosy too. As cases multiplied, the disease became known as ma‘i pake, the “Chinese sickness,” named after the thousands of Chinese laborers who arrived on the islands at the invitation of American traders endeavoring to create an export market in sandalwood (a precursor to the sugar industry that would dominate the economy in years to come). “There seems but one way to prevent the whole of Oceania from becoming leprous, and that is the exclusion or the rigid control of all Chinese coolies,” a Scottish physician warned. Wherever it came from, contact was devastating for the indigenous Hawaiian population, which plummeted from the healthy 683,000 people Cook first encountered to just under 40,000 Polynesian islanders left after a century of colonial enterprise and disease.

by Oliver Basciano, Literary Hub |  Read more:

Image: Kalaupapa, Molokai

The ACA Death Spiral Is No Longer Just a Theory

Insurers are now quantifying what experts long warned would happen: healthier consumers are leaving the marketplace, premiums are rising, and affordability is deteriorating.

I’ve long warned that letting the enhanced ACA subsidies expire could set off a classic insurance death spiral: healthier people priced out first, a sicker risk pool left behind, higher premiums as a result, more healthy people priced out — rinse and repeat. Reports this week from KFF News and other media outlets about 2027 rate filings is the first time I’ve seen that mechanism actually measured rather than predicted.

Insurers filing preliminary 2027 rates in 16 states and D.C. are asking for a median 14% increase, according to a Peterson-KFF analysis. If the rates are approved by state regulators, that would be the second-highest jump since 2018. What makes this year’s filings different from a routine “medical costs went up” story is that insurers are saying that about four percentage points of that increase is the direct result of the enhanced subsidies expiring because of Congressional inaction – and healthier people leaving the pool as a consequence. Another chunk — UnitedHealthcare put it at 12.7% in its New York filing — is attributed to new Trump administration enrollment rules that make it harder to sign up and stay signed up.

In other words, what we’re now seeing is insurance companies telling regulators that the failure of Congress to extend the subsidies, along with the Trump administration’s new enrollment rules — not just rising medical costs — are a measurable share of what ACA marketplace premiums will be next year.

I want to be careful here because its too early to suggest that a death spiral is definitely underway. A full death spiral means an insurance market becomes non-viable — premiums rise, enrollment collapses, insurers exit the market, and coverage disappears entirely for a region or population. That is not what’s happening in the ACA marketplace right now. Enrollment is down about 3 million from last year, which is not a collapse. Federal risk-adjustment programs are still functioning. Most subsidized, low-income enrollees — the bulk of the marketplace — are still price-protected because their subsidies rise automatically as premiums rise. Some insurers are leaving this market – including big ones like Aetna and Cigna, where I used to work – but most insurers are still filing to participate in 2027 in most states, not fleeing the market (not yet, anyway).

What we’re seeing so far seems to be a self-reinforcing cost spiral concentrated among the roughly 5% of enrollees earning above 400% of the federal poverty line who lost all subsidy protection when the enhanced tax credits expired at the end of 2025. For them, the mechanism KFF describes is real and is compounding. And this is the second consecutive year of double-digit marketplace rate increases, on top of last year’s subsidy cliff. While that’’s a genuine affordability crisis for a specific population, it’s not evidence the whole system is on the verge of collapse. But, going forward, as more people continue to drop coverage because of premium increases, the affordability crisis will encompass more enrollees, and more of them will join the ranks of the uninsured.

by Wendell Potter, Healthcare Un-Covered |  Read more:

Image: uncredited

[ed. Thanks to the Big, Beautiful, Backstabbing Bill passed by Republicans, which means more emergency room visits by uninsured people, and higher insurance premiums for the rest of us (exacerbated by cuts to Medicaid). Also, more people pushed into bankruptcy. See also: The Other Health Care Cliff Americans Are About to Fall Off  (high deductibles); and, In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027, Following a Steep Climb This Year (KFF); and, despite all this, Republican voters continue to internalize waste, fraud and abuse messaging as being the most important issue (KFF).]

Anyone Can Be a Millionaire; Not Everyone Has Enough Testosterone

[ed. Beavis and Butt-Head have opinions.]

In America, Almost Anyone Can Be a Millionaire

This week, I ignited a small controversy on social media by claiming that “the rich are rich because they work, while the poor are poor because they don’t.” My critics were offended that I would, in their eyes, demean the poor this way. But it’s just simple reality: the top 10 percent of Americans income earners work more than 7 hours per week more than earners in the bottom 10 percent. Less-educated Americans are less likely to work at all than those with more education.

Not looking for work or working too little is indeed the main cause of poverty in America. This may seem unkind, but my critics are missing the wonderful upside: in America, anyone can become wealthy if they work full time and save reasonably over their careers.

This is one of the first things that wowed me about America. I still vividly remember the time I visited Florida from Venezuela in the early 2010s and met a Cuban-American cashier at a local Publix. While she was scanning our items, she told us she was taking a vacation with her husband the following week, a cruise to the Caribbean.

I was amazed. How could a cashier afford to go on a cruise vacation? Cashiers live in deep poverty in Venezuela; in America they get to live like the Venezuelan upper class.

That story is not unusual. The Wall Street Journal recently profiled a Costco worker named Tony Barzar from Arizona. Barzar never went to college, only taking some community college classes without finishing. Nonetheless, working his entire life in grocery stores and Costco, he has amassed over $1 million in his 401(k) account. He also owns a home with a pool and has traveled to Europe twice in the last decade—all while making just shy of $33 per hour.

He got there not by some great feat, but by slow and steady saving.

by Daniel Di Martino, City Journal |  Read more:

Image: Getty

[ed. Hope his job is one that gets taken out by AI sooner rather than later.]

******

Hegseth wants a “High-T” military; doctors call it a clinical minefield

On Wednesday, Defense Secretary Pete Hegseth made the startling announcement that the US military would begin requiring all active duty and reserve personnel aged 30 and older to undergo mandatory screening for testosterone deficiency. The screenings will take place during yearly health assessments. Those under age 30 can also get screened on request.

In a short video posted on social media, Hegseth explained to the military community that the screenings and possible subsequent treatments are intended to “optimize your performance, your resilience, and your long-term health.” While saying that the initiative wasn’t about “artificial enhancement” and that members could decline treatment, Hegseth claimed that the testing and potential treatment was for “restoring and optimizing” capabilities, protecting “longevity,” and “ensuring you have the biological foundation required to sustain the fight.”

But will testosterone screening and treatment actually “optimize” our “warfighters”? Will it help most of them live longer? Should everyone else get screened and treated, too?

“A big fat ‘Oh, no'”

Screening people widely for medical conditions and then treating those who need it may sound like a huge social positive. But issues around male hypogonadism—the condition in which the body doesn’t produce enough testosterone—can be complex.

That’s why the Endocrine Society—made up of experts in the complex systems that release hormones in the body—posted a statement on the topic in the wake of Hegseth’s announcement. The document notes that “there is insufficient evidence to support a general recommendation to perform population-level screening for hypogonadism in asymptomatic men with measurement of blood testosterone level.”

To find out why, Ars Technica spoke with Professor Bradley Anawalt, chief of medicine at the University of Washington Medical Center. He specializes in endocrinology and men’s health.

“This is a great big fat ‘Oh, no,’” Anawalt said in reaction to Hegseth’s announcement. “We’re turning the clock back on rational healthcare. … I’m worried about the ethics. I’m worried about the health consequences. I’m worried about unnecessary evaluations, incorrect assessments, and incorrect diagnoses that lead to inappropriate prescriptions of testosterone.”

To understand why, let’s start with the basic question: Why might someone have low testosterone?

by Beth Mole, Ars Technica |  Read more:

Image: Getty|Stefani Reynolds
[ed. Definitely read the Comments Section on this one. It's like a salve for dementia. As one person noted, why does everything from this administration sound like it just came out of The Onion? See also: Bony Soldier Diving On Top Of Grenade Only Makes It Deadlier.]

Today’s Cystoscopy

It knocked the sh*t out of me. Literally.

As you might remember, after taking the steroid dosepak, I was supposed to return to UCLA hospital for a follow-up cystoscopy three months later.

Today was the day.

I haven’t pissed blood since. So I was optimistic there would be no problem, but you never know. The body is made to deteriorate, no one here gets out alive, something’s gonna get you.

Now no matter how calm you feel, you never get a good night’s sleep before procedures like this. Actually, I had a wild dream where this waiter in Vail sold me a jacket. It was $495. Really pretty cool. I was supposed to be having dinner with friends and family downstairs at Russell’s, which doesn’t even have a downstairs, but after sitting at the table silently I excused myself to go to the bathroom and when I was done, I took a seat at a two-top and this waiter came along and after sizing me up he left and returned with this jacket. Kinda hard to describe, it was fabric, not leather, something you’d wear at night, it had a lining, which was removable and…thinking about it afterward it reminded me of this Guess jacket I had back in the eighties.

Anyway… I find it nearly impossible to shop for clothes. I question my taste and the ultimate fit but this guy sized me up perfectly! So I was excited when he said we should go downstairs for jeans, but they didn’t have my size, and this guy wasn’t going to sell me anything that wasn’t exactly right. Turns out his name is Fred and really he runs a bookstore and he’s not going to be back at the restaurant until Tuesday, when new threads are delivered, so I’m making a mental note to dream about him a week from now.

The dream was a good diversion, you never know where this stuff comes from, what it means, and it kept me distracted while I showered and ate and then… I had to skedaddle for the hospital.

I’ve learned to check the map app first, you never know where the traffic might be, and I was routed on Sepulveda instead of the 405, and it was crowded at first but I got there in time and after checking in, I had to provide a urine sample.

I wondered if I had enough in me. This had occurred to me just before I left the house, and I tried to imbibe, but I just wasn’t thirsty. Really, I was standing in the bathroom with the plastic cup and I felt that I would be unable to deliver, wondering if I eked out a few drops whether it would be enough, but eventually I got a flow going and returned to the waiting room.

Where I didn’t have to wait long until I was called inside by the football expert.

I guess I always feel obligated to service people. I’m trying to work on this with my shrink. But I was stunned that this woman didn’t remember our prior conversation, unlike the guy I ran into the hall after I peed, who had sent his Tudor watch in for repair, I wanted to ask him how it was doing.

And after taking off my clothes, donning the robe but leaving it open in the back, the NFL expert came back in with another woman, and she told me how great this replacement was, and I casually said that I guess we’d talk about football another time.

This stopped her in her tracks. She lamented handing me off. Rather than leaving, she wanted to get into it. Who was my team and..? I read enough news to fake it, but I was just trying to make her feel comfortable, so I let her go for her replacement who told me she had four jobs.

You see I asked her what she did when she didn’t work. She told me she loved to work! I asked if this was for the money, but no…it was the work itself. As for the four jobs… The two in the middle had to do with working at a charitable organization and the fourth was being a mother, she said she had four kids. I immediately wondered about supervision and behavior. But when I asked her about this she said there was no problem, you could tell she ran her household with an iron fist.

And then she raised my gown, scrubbed my dick, placed it in a hole of fabric so it was akin to SNLs Dick in a Box, and I’m thinking how this is de rigueur, an unknown woman manhandling my penis. Well, she was gentle, and it wasn’t sexy and it wasn’t weird emotionally, but intellectually… You’d think they’d have a guy do this, but no…

And then another woman came in! To inject me with the lidocaine!

Yup, they fill up this big syringe and shoot it right up your dick. And if you think that’s painful… Well, let’s just say it’s somewhere between uncomfortable and painful.

Meanwhile, we’re b.s.’ing…

And I’m thinking how this is my socialization. I don’t go to an office, I’m hearing from people all day long in e-mail and iMessage, but face to face?

That has fallen off since Covid, for everybody.

by Bob Lefsetsz, Lefsetz Letter |  Read more:

Image: uncredited

[ed. I had a cystoscopy back in my 30s to check for bladder cancer (negative). Uncomfortable to painful is a good description. That last little turn is a kicker.]

How to Offset Your Brain

You slide your hand into your coat pocket and find an old, folded $100 bill. In the other pocket, you find a coin.

Now, here’s the gamble: flip the coin. Heads, you win another $300. Tails, you hand over your $100 bill. Do you take the risk?

Mathematically, you should. One coin flip gives you two equally likely futures: in one, heads, you gain $300; in the other, tails, you lose $100.

Because each future has a 50 per cent chance of happening, you count half of each outcome: half of $300 is $150, and half of $100 is $50. Balance those against each other, and taking the gamble puts you $100 ahead on average. Decision scientists call this positive expected value.

Even when someone grasps the mathematics, however, it’s hard to take the risk. Why?

About 50 years ago, the psychologists Amos Tversky and Daniel Kahneman showed that this hesitation is not random. People depart from logic in patterned ways. One of the most durable patterns is loss aversion: our tendency to feel the pain of losing more sharply than the pleasure of an equivalent, or even greater, gain.

This is where mindfulness becomes interesting. Mindfulness is usually defined as paying attention to the present moment, on purpose, without immediately judging what is happening. In practice, that can mean noticing a thought before believing it, feeling an emotion before acting on it, or returning attention to the body, the breath, or the world around you. At its simplest, mindfulness creates a pause between what arises in the mind and what we do next.

That pause helps because many of our choices are made before we have fully examined them. We may think we are deliberating over the coin toss, but often the body has moved first: recoiling from loss or preserving a decision simply because we have already invested in it. These mental shortcuts are called cognitive biases, and the study of this kind of human misjudgment is central to decision science.

When we hesitate at the coin toss, we might be deliberating – but often, we’ve already decided.

Impulse has its benefits. A mind that had to reason from scratch every moment would be paralysed. But when these shortcuts override reflection, they can distort the decisions we make. Without careful thought, a patient may fail to seek the best medical care. People lose wealth because they cling to their current savings plans. You might know the feeling of preserving a job or a relationship simply because you invested so much in it. Internally, these cognitive biases feel instinctive. The question is whether we can catch these instincts before they harden into choices we mistake for reason.

I came to this question from two directions. I teach and research behavioural economics, where we study the systematic ways people depart from logic, and I also work as a licensed therapist, where I watch those same patterns play out in higher-stakes places: in relationships, in health, and in the stories people tell themselves about who they are. I have long been interested in the tension where a person knows better but cannot quite do better. Over time, I became less interested in theories of irrationality and more interested in what helps people catch themselves before their old reflexes take over.

Mindfulness kept appearing as an answer. But it was an imprecise one. If mindfulness means present-moment awareness without immediate judgment, what exactly is doing the work? Attention? Emotional steadiness? Curiosity? Acceptance? Biases do not all arise from the same source. Some are driven by emotional projection, some by inattention, and others by a failure to stay mentally engaged with a changing situation. So it would be surprising if one version of mindfulness could interrupt all biases in the same way. After all, what we call mindfulness is a cluster of distinct capacities: attention, nonreactivity, acceptance, curiosity and openness to novelty. Different biases may yield to different forms of the mindful state.

Loss aversion, for instance, may depend on how well we tolerate discomfort. Delay discounting, our tendency to overvalue immediate rewards, may depend on whether we’re attentive to change, nuance and emerging possibilities. Mental accounting – our habit of treating the same dollar differently depending on which mental bucket it lands in – may ease when we pay attention to all our money at once.

So, what are the different ways the mind slips off track, and how can mindfulness pull it back? To answer that question, it helps to distinguish the two strands that shaped modern mindfulness research. One is rooted in curiosity and active noticing, the other in meditative, nonreactive awareness.

The first school of thought is represented by the Harvard psychologist Ellen Langer, who believes that active noticing – engaging curiously with the environment – leaves us better equipped to deal with uncertainty and change. The second path comes from Jon Kabat-Zinn, who first encountered mindfulness through meditation. A PhD student in molecular biology at the Massachusetts Institute of Technology back in the 1960s, Kabat-Zinn asked whether the Zen Buddhism, Vipassana and other forms of meditation he studied could be adapted to secular medicine. Not long afterward, he launched Mindfulness-Based Stress Reduction and used meditation, yoga and other mindfulness practices to help patients relate differently to stress and chronic pain.

Put side by side, the contrast between the two versions of mindfulness is telling. Langer teaches us to open our eyes and notice something new. Kabat-Zinn teaches us to close our eyes, accept and let go. One form of mindfulness keeps us engaged with the world; the other helps us disengage from unhelpful inner patterns. Both begin with attention to the present moment, but they train attention to do very different psychological work. If biases arise from different sources, the kind of mindfulness that eases one may not touch another.

If it still feels abstract, try this thought experiment. Imagine that I’m a local researcher, and I’ve asked to meet you at your school or workplace. You walk down the familiar hall and sit at your usual spot. Surrounding you is the same flooring, windows and lights as usual. I want you to notice three new things that you’ve never noticed before.

It might not seem like much is happening, but actually you’ve just entered a much more mindful state. Following those instructions, you influenced how your mind was taking in the world around you. As you twisted your neck to find a chip of paint or a dusty corner, you interrupted your usual way of being in the moment and, instead, engaged with it. It may seem like I was just making you more aware of your surroundings. But, actually, I was switching off your autopilot – your mindlessness – and bringing you into the present moment, where details, nuance and context abide. Your brain probably didn’t feel that interrupted. But it followed this cognitive movement enough to reach a mindful state. It is mindfulness not as stillness, but as fresh contact with the world.

This is the novelty-noticing task designed by Langer. It triggers a specific form of mindfulness, and she and her team have shown how even a small shift in attention can change behaviour. [...]

Langer’s version of mindfulness reduced many biases – but not loss aversion. Why? Perhaps because loss aversion was never a cognitive problem to begin with. It’s an emotional one. It is about the heart’s deep reluctance to surrender the comfort of a long-term relationship, the certainty of a career path, or the belonging of a community. It’s the instinct to avoid difficult conversations, not because they won’t help, but because they might cost you comfort, approval or a sense of control. It is the reluctance to leave a life that no longer fits, because the shape of the old life still feels safer than the unknown.

That’s where Kabat-Zinn’s softer approach, focused on emotional regulation, comes in.

by Pam Weintraub, Aeon | Read more:
Image:Richard Baker/Getty Images