Our deluded HHS Secretary Kennedy is at it again. Earlier this week he fired all 17 members of the Center for Disease Control and Prevention’s vaccine advisory committee and will replace them with new members. Have you read how he justified this change?
“Today we are prioritizing the restoration of public trust above any specific pro- or anti-vaccine agenda,” Kennedy said in a statement. “The public must know that unbiased science — evaluated through a transparent process and insulated from conflicts of interest — guides the recommendations of our health agencies.”
In an Op-Ed piece in yesterday’s Wall Street Journal, our deluded HHS Secretary Kennedy expanded on that point. “The U.S. faces a crisis of public trust. Whether toward health agencies, pharmaceutical companies or vaccines themselves, public confidence is waning. Some would try to explain this away by blaming misinformation or antiscience attitudes.”
Life-saving therapy
I PLEAD GUILTY TO BLAMING MISINFORMATION AND ANTISCIENCE ATTITUDES, MR. SECRETARY. To be more specific, you and your fellow anti-vaxxers are devoted followers of misinformation, much of it traceable to the faked data published in 1998 by Andrew Wakefield in the British medical journal. (For key information from Wikipedia about this dishonest man, and the resultant harm he has done, click here.) I’ve mentioned Wakefield here before (Click here.)
Are you aware of this, Mr. Kennedy? Britain’s General Medical Council found that Wakefield had been dishonest in his research, had acted against his patients’ best interests, mistreated developmentally delayed children, and had “failed in his duties as a responsible consultant”. Is that transparent enough for you? And do you know that a British court held that “There is now no respectable body of opinion which supports [Wakefield’s] hypothesis, that MMR vaccine and autism/enterocolitis are causally linked”.
But even the then, the disgraced Wakefield wasn’t finished. In 2016, he directed the anti-vaccination film: Vaxxed: From Cover-up to Catastrophe. Does this man have no conscience? Does he know the harm he is doing?
MAJOR SOURCE OF DECEPTION?
And here’s something I learned from the Wikipedia article mentioned above: In a 2025 interview with Democracy Now, investigative journalist Brian Deer identified Robert F. Kennedy, Jr., Andrew Wakefield, and Del Bigtree as the core leaders of the anti-vaccine movement. So, Mr. Secretary, will you stand by your claim that you are leading “a transparent process insulated from conflicts of interest?” Or will you admit you are a leading anti-vaxxer?
Just two months ago, Mr. Secretary, your department appointed David Geier, a purveyor of false theories linking vaccines to the so-called autism spectrum disorder (ASD) to head a national study on immunizations and neurodevelopmental outcomes. That is crazy.
For readers who aren’t familiar with Geier, he and his father have for years honked the discredited nonsense generated by Andrew Wakefield. Moreover, Geier was disciplined in Maryland for practicing medicine without a license. And he and his father were included in a list of top science deniers by the prestigious journal, Nature. And this man will head a study on immunizations and neurodevelopmental outcomes?
So the question arises: Does the appointment of David Geier represent another example of our deluded HHS Secretary Kennedy’s “transparent process” that is “insulated from conflicts of interest?”
Proven Method of Prevention
I am mentioning all of this, Mr. Secretary, because, although you may not know this, vaccines have produced almost unbelievable positive effects. In 1974, the World Health Organization launched a program to make life-saving vaccines available to all globally. On the 50th anniversary of that program, its effects were evaluated. (See the amazing results here)
Here is a summary of the findings that were published in 2024, Mr. Secretary. They are so impressive that I’ve colored them and enlarged the font. Please read about what you apparently are in favor of undoing.
Since 1974, vaccination has averted 154 million deaths, including 146 million among children younger than 5 years of whom 101 million were infants younger than 1 year. For every death averted, 66 years of full health were gained on average, translating to 10·2 billion years of full health gained. We estimate that vaccination has accounted for 40% of the observed decline in global infant mortality, 52% in the African region. In 2024, a child younger than 10 years is 40% more likely to survive to their next birthday relative to a hypothetical scenario of no historical vaccination. Increased survival probability is observed even well into late adulthood.
Those results, Secretary Kennedy, surely are worthy of serious consideration, regardless of one’s personal biases. Please peruse them with care.
HHS dumps successful vaccine developer. Do you remember Operation Warp Speed? During the first Trump administration that program led to the unbelievably fast development of Covid-19 vaccines by Moderna and Pfizer. Those companies used newly-developed mRNA techniques to produce their vaccines in record time. According to Dr. Ashish Jha, who coordinated the Covid-19 response in the Biden administration, “Those vaccines were administered nearly 2 billion times to hundreds of millions people around the world, making them one of the most widely studied vaccines in human history. They are safe and work well.”
Tell that to the Department of Health and Human Services! A couple of days ago, HHS cancelled its contracts with Moderna (worth about $700 million; see details here) Why the cancellation? According to HHS spokesman Andrew Nixon, “After a rigorous review, we concluded that continued investment in Moderna’s H5N1 mRNA vaccine was not scientifically or ethically justifiable. This is not simply about efficacy—it’s about safety, integrity, and trust. The reality is that mRNA technology remains under-tested, and we are not going to spend taxpayer dollars repeating the mistakes of the last administration, which concealed legitimate safety concerns from the public.”
Source: From HHS Website
Think of that! About 2 billion shots were given to hundreds of millions of people, and they’re under-tested? And they’re not scientifically or ethically justifiable? Please explain your thinking, Mr. Nixon. And answer these three questions. Has your boss, Robert F. Kennedy, Jr., received any of those two billion shots? If not, would he be willing to be vaccinated against Covid-19? If he did well, would you change your mind?
In my previous post (see that here), I mentioned a few of the remarkable benefits of vaccines, their success in ending smallpox, polio, and measles (until a fraudulent researcher and hysterical press stories instilled a fear of these protective mechanisms). The results of that deception? A growing number of individuals began avoiding the MMR vaccine for their children. And now over 1,000 cases of measles have been reported in the U.S. in 2025. At least three children have died.
The federal contract with Moderna was for work on strains of avian flu. At the moment that virus has attacked mainly wild birds, poultry, and dairy cows. According to reports I’ve read, over the last three months of 2024 some 20 million egg laying chickens had died of the virus or as the result of culling to prevent further spread of the disease. Have you noticed any change in the price of eggs?
Avian Virus
To come back to Moderna. The company has been testing a vaccine against four different types of avian flu. To date they have given the vaccine against a specific virus sub-type to some 300 healthy adults. Two injections of the trial vaccine have produced an increase in levels of antibodies needed for protection in 98% of the participants. Is such a vaccine needed now? Not really. A study of individuals who contracted the current strain of avian virus A(H5N1) from March through October 2024 was reported in the December 31 issue of the New England Journal of Medicine. See results below.
Of the 46 patients who were studied, only one was hospitalized, and none died. Their symptoms were mild. How did they get the disease? Twenty were exposed to infected poultry, 25 were exposed to infected or presumably infected dairy cows, and the one hospitalized with nonrespiratory symptoms had no identified exposure. No additional cases were identified among the 97 household contacts of case patients with animal exposures. (So far as I know there have been no cases of human to human transmission of this virus.)
Mutations
But viruses mutate, and having vaccines against previous versions (and the ability to rapidly modify those vaccines) would be helpful if the avian viruses do mutate, which they likely will. Having said all of that, I should add that I’m not a big fan of governmental funding of private enterprises. I suspect those Moderna contracts of roughly $700 million included a topping of unnecessary gravy. Nonetheless, I think HHS made the wrong decision here.
In summary, the first Trump administration funded Operation Warp Speed. That enabled Moderna to produce an effective vaccine against Covid-19 with astonishing speed. In the second Trump administration, HHS dumped its successful vaccine developer. By defunding Moderna’s effective program, it put the brakes on an important segment of vaccine research. Call that what you will.
Facts about vaccines? Here are some worthy of notice. One hundred years ago, on May 2, 1925, the Journal of the American Medical Society cited W. W. Keen’s personal experiences with three epidemics of “the most loathsome, nauseating, sickening disease,” smallpox. To summarize his experiences, JAMA reported that before the use of Edward Jenner’s protective vaccination, there were about 40,000 deaths in the Philippines every year from smallpox. Yet in the twelve months after a vigorous campaign of vaccination, not a single death occurred. It’s worth remembering that smallpox was no lightweight. About three of every ten people who got the disease died. Others were scarred, or suffered blindness. Thanks to vaccines, smallpox has been eradicated from our world (see here). A simple fact about vaccines.
In the 1940s and 1950s, epidemics of polio were an annual occurrence in the US and around the world. Fear of polio was so great that many people avoided crowds and public gatherings. I remember those days. Everyone seemed worried about getting polio. Many parents wouldn’t let their children play with new friends and regularly checked them for symptoms (see here). The worst outbreak, in 1952, resulted in over 3,000 deaths, and numerous cases of paralysis. However, with the development of effective vaccines by Salk (1955) and Sabin (1961), the number of cases was dramatically lowered. Thanks to vaccines, by 1994, polio was considered eliminated in North and South America. A simple fact about vaccines.
Syringes for vaccine injection
When I was in medical school in the 1960s, I was surprised to learn that a daughter of one of my professors had died of a complication of measles (she developed encephalitis). I had not known that measles could be lethal. I and nearly all of my friends had contracted the highly contagious measles virus and recovered with no problems. In year 2000, thanks to the measles, mumps, and rubella (MMR) vaccine, the U.S. declared that measles had been eradicated. What happened since then? Well, childhood vaccinations are down. This year, over 1,000 cases of measles have been reported in at least 30 states (see here). At least three children have died. Yes, all were unvaccinated.
What does our country’s top health official have to say about this? Well, he claims the outbreak of measles is “not unusual.” This is the same man who co-founded an anti-vaccine group and urged parents not to vaccinate their children. He even encouraged parents to use vitamin A and cod liver oil to treat or prevent measles. Where did that come from? His claim has been disputed by doctors, other experts, and health officials. And he’s in charge of our health?
Phooey! This is a dangerous opinion
Where did all of these silly anti-vaccine notions come from? Much of it undoubtedly can be attributed to Andrew Wakefield, the disgraced Brit who in 1998 published a fraudulent paper in the British medical journal, Lancet, claiming a link between theMMR vaccineand autism (see here).When his original paper was published, it was widely reported in the press, thus spreading his dishonest results to readers throughout the world. What many seem not to know is that the Wakefield paper was retracted in 2010. At the time Lancet‘s editor-in-chief Richard Horton described it as “utterly false.” The scientific consensus is clear: There is no link between the MMR vaccine and autism. The vaccine’s benefits greatly outweigh its potential risks. I’ve written about this issue before, because I believe it is important. Those posts, with slightly different slants, may be found here, here, and here, all simple facts about vaccines.
Trump’s jagged 100 days. It hasn’t been a serene beginning for our combative president. He’s ruffled more feathers in three months than a pair of wily foxes might ruffle when locked in a huge chicken coop for an equal duration.
President Trump has set records. As of April 25, he had signed 139 executive orders, more than three times that of the runner up in this area, Joe Biden, who had signed just over 40 over the same time frame.
Recent polls reveal how unpopular Trump has become. A CNN poll released yesterday (April 27) found 41% of respondents approve of his actions. Two days earlier, The Washington Post, ABC News, and Ipsos had him at 39% approval. Other polls have him down similar amounts, and all approval ratings have dropped several points from earlier polls. So, if those polls are accurate, I would guess that 4 out of every 10 readers of this post will be at least partly put off, but I urge them to read on. I do give our president well-deserved credit for some of his efforts.
Overall, the mood of our country is obvious. According to a recent survey of more than 900 voters conducted by the New York Times and Siena College Research Institute (see that here), 66% of those polled rated Trump’s term as “chaotic” while 42% said it was “exciting” and 59% called it “scary.”
Neither Party is popular
But democrats aren’t winning any popularity contest. Nearly 70% of voters have said that the Democratic party is out of touch with the concerns of most Americans. Some 64% of voters felt the same about the Republican party. Woe to us indeed.
Full disclosure: as I’ve said here before, my political orientation approximates that of a Jack Kennedy democrat (See here). I, like nearly 70% of the voters mentioned above, deplore how far leftward the democrats have drifted.
Two Unpopular Parties
Nevertheless, for the last election between Trump and Harris, I, along with a significant number of voters, was faced with two subpar candidates. I thought Harris’s program, which she said did not differ from Biden’s, (such as open borders and other programs I opposed), was too much to sustain, so I voted against her by pulling the lever for Trump.
My opinion now? I haven’t been particularly charmed by Trump’s beginning. I do give him high marks for closing the borders, which is now sealed as tightly as it has been for the past 60 years, and I appreciate his attempts to rein in the federal government, albeit not the slash and burn methods he and Elon Musk have used to accomplish that.
To date, some 75,000 government employees have taken a voluntary buyout. Less impressively, thousands of federal workers that have been summarily laid off (although many have been temporarily reinstated by court orders).
United States Capitol
On the other hand, what bugs me is the Bull in the china shop tactics by which Trump has insulted nearly all of our friends and allies throughout the world. His blabbing about Canada as our 51st state is nonsense and demeaning. As a result, many Canadians have made clear their disdain for Trump, and even for products from our country. Who can blame them? Another reason for Trump’s jagged 100 days?
In my opinion, and that of most Americans as well, Trump had failed badly in his stumbling efforts to end the Russian-Ukrainian war. Russia started it. Russia has ignored cease fire agreements, and the Russians continue their aggression. How can Trump favor Putin when faced with these obvious facts? And by siding with Russia he puts the USA against its former European allies. Talk about not backing your NATO friends. Another reason for Trump’s jagged 100 days?
Ukrainians in subway during Russian missile attack in Kyiv. (From AP)
Email from my Finnish friend
I think it is instructive to focus on Russia’s previous, similar invasions of neighboring countries. I was reminded of one such attack this morning when I received an email from my good friend Martti Hakumaki in Finland. I’ve mentioned Martti before in this blog, most recently in my last post (see here for more about him). Martti, among other topics in his email, told me that he and his fellow Finns are strongly on the Ukrainian side in the current war. And well they should be, because they too have been invaded by Russia as it attempted to take over land from Finland.
Specifically, on November 30, 1939, the Soviets invaded Finland in what became known as the Winter War. Although having overwhelming military strength, the Russians suffered major losses (thousands of Russian troops were killed in battles) and they made little progress. Without going further into history here, I’ll simply say that Russia soon backed off and suggested it was willing to negotiate, and the war (fought in temperatures hovering around -40 Celsius) ended some three months later. For Martti, that winter war led to an extremely personal and painful loss. His father was shot and killed in one of the battles of that war, a time when Martti was just over one-year-old. Because of that Russian aggression, he never had the privilege of knowing his dad.
Maybe, just maybe, Trump is beginning to wise up on the present war. Here’s what he said recently on his Truth Social platform. “I am not happy with the Russian strikes on KYIV. Not necessary, and very bad timing. Vladimir, STOP! 5000 soldiers a week are dying. Let’s get the Peace Deal DONE!”
Did you notice the speeding ships? Will history repeat itself again?
And this president of ours, this graduate of the Wharton School of Business, and this author of The Art of the Deal, what has he been doing to the US economy? And for the world economy? It hasn’t been pretty, has it? Soon after he threatened his huge increase in tariffs, Wall Street went bonkers. The S&P 500 index dropped from its record high reached in February and sank into correction territory (a drop of at least 10%). The Nasdaq had entered correction a week earlier. Another reason for Trump’s jagged 100 days? The market plunge clearly caught the attention of the White House. Maybe Trump will come to his senses, a debatable possibility.
Room for hope?
Trump did put a 90-day delay on his tariff plans after the markets tanked. The president obviously watches the markets, but he also is sadly unpredictable. Accordingly, the financial future of the entire world is impossible to predict as of now. It is important to note, I think, that numerous economists have suggested Trump’s proposed tariffs are similar to those in the infamous Smoot–Hawley Tariff Act passed in 1930. That act, signed by President Hoover despite objections from others on his staff, increased tariffs on more than 20,000 imported goods. The Smoot-Hawley Act sparked a trade war as European nations passed retaliatory tariffs. Does any of that history sound faintly familiar?
This may be the time to recall those famous words of philosopher George Santayana? “Those who cannot remember the past are condemned to repeat it.” Perhaps someone will pass that meaningful quote on to our president.
On to other topics
In my next few posts, I’ll switch to nonpolitical topics. Stay tuned.
Happiest Countries on earth. Have you seen the latest list? The top four happiest locations all lie north of the USA. I’ve been lucky enough to spend time in each of those easygoing nations, and I have no quibble with the results. I smiled a lot while in each country. I’ll mention a few reasons why below.
Finland is the happy nation champion once again. This is the eighth straight year that Finland has risen to Number One. Following the cheerful Finns are the Danes, the Icelanders, and the Swedes.
The “Happiness” research
Researchers determined the rankings based on answers people gave when asked to rate their personal lives, apparently using whatever criteria they thought appropriate. The researchers found that seemingly simple factors influence happiness. For example, sharing meals with others, having others to count on for social support, and believing in the kindness of others were much more closely tied to happiness than previously thought. If you would like to read the entire report, click here. (HEADS UP: with references, the report fills 249 pages.)
Those of us in the USA didn’t come out so well. We glumly sit at Number 24. This ranks us below such happier lands as Israel, Mexico, Lithuania, Slovenia, and the United Arab Emirates, to mention a few. This year’s ranking was our worst since the the World Happiness Report was created in 2012. What is going on?
Joys of Finland
I think everyone should travel to Finland. I love that country. It deserves being called one of the happiest countries on earth. Over several trips when I was still working, I lived in Finland for over half a year, doing research with my friend and colleague, Professor Martti Hakumaki, at the University of Kuopio. In our spare time we enjoyed the countryside. On one memorable weekend, we fired up his smoke sauna at his summer house and spearfished in the massive lake adjoining the summer house. Click here, and here for the full stories.
A trusty spear fashioned by Martti, the man in the cap.
On another longer trip, we drove up beyond the Arctic Circle in early summer when the sun never sets. While there we participated in a “nighttime” Reindeer Roundup. The reindeer that forage free in Finland are owned by various people. To properly identify the owner of each new generation, fawns are separated from mothers and then released one by one. When the youngsters naturally rush to their mothers, they are caught and tagged and carried to a brander who marks the calf with the brand of its mother. Martti and I were among the carriers. For more on this story click here.
2:15 A.M. on a June day in Finland. See that happy smile?
Denmark
Moving on the second happiest country, I’ve probably spent a couple of months in Denmark, much of it while working in the Panum Institute at the University of Copenhagen. Again, it was remarkably pleasant. The Danish people are welcoming, their food is great, and the city is charming, but I’ll stop there so this post doesn’t stretch overly long.
Iceland
I haven’t spent a lot of time in Iceland. I’ve been there only once, thanks to my daughter’s gift. Anne took me to that enchanted land for my 90th birthday. We loved the place. In fact, I personally would rank Iceland as the happiest country. Every day we were in that country, we met people who bubbled over with joy, many of them relatively young, and a fair number that had visited from other countries and were so enthralled by the place that they had returned to take up residence.
Readers who have been following my blog for some time may recall that I wrote a day-by-day travelogue of that trip to Iceland. If you’re interested, you can find that series by clicking here, here, here, here, here, here, here, and here.
It was a fascinating journey from when we arrived
First day in Reykjavik, Iceland. See the smiles?
to every day that followed.
Anne and I near the Seljalandsfoss waterfall (200 foot drop) on a damp day. See the smiles?
Sweden
Sadly, I’ve visited Sweden only twice, both for stays of only a day, once traveling up to Stockholm by train and flying out, and the second arriving and leaving the capital city by ferry boats. The citizens treated me kindly. They seemed to be content. The city center was welcoming. I trust the research team rating Sweden as the fourth happiest country had far more information than I do.
United States of America
Twenty-fourth happiest country on earth? Can’t we do better?
Trump’s atrocious behavior, a personal opinion. Readers following this blog may recall that I gave Trump a D- as his final grade for his first term in the Oval Office. He accomplished a few good things, I thought, but his personal behavior, embarrassingly non-presidential as it was, clearly deserved a flat-out F. Only some of his good actions made me nudge him up to a D-. (Click here for that post)
Now his behavior is undeniably much worse! Admittedly, I think he started his second term with some necessary and useful efforts, most importantly working to close the open borders of the previous administration, and to reduce our swollen governmental bureaucracy. But his behavior?
Any good his administration may be doing is overshadowed by his abysmal behavior, the most recent example occurring this morning when he and Vice-president Vance screamed at Ukrainian President Zelensky at the White House. The meeting ended badly, I am told, further straining relations between the U.S. and Ukraine, and certainly putting a huge blemish on our country in the minds of observers around the world.
Click hereto watch that fiasco, and grit your teeth.
Trump already had bothered me by cozying up to Putin and simultaneously calling Zelensky a dictator. And now this crude performance? Videos of Trump and Vance’s vicious attack-dog performance surely will be featured on every newscast around the world this evening. Our country will be diminished by their undiplomatic tantrums.
There is no need to say more, except to add that I am furious.
Our Little Irritations. I think most of us sense them, those petty events that set off little twinges, those inconsequential triggers that blip on our radar and cause us to respond as predictably as Pavlov’s dog (or at least I do) when our bell rings. For me, it’s usually a word, or phrase, that rings my bell.
I’ve thought of this because I’ve been digging into the amazing new evidence that exercise does far more for our health than we knew. Research has demonstrated that our muscles do astonishing things never before imagined. When activated, they secrete peptides and other chemicals that produce healthful changes in our brains, livers, bones, and our muscles themselves. I’ll write about that later, but here I’m focusing on something far less important: my little irritations.
In my reading of muscles I ran across “bicep.” That immediately tinkled my bell, as it has ever since I was a first year medical student. Many people, especially sports writers seem addicted to that word. They huff and puff about injuries to the right bicep, or the left bicep. Apparently they think the ending “s” on biceps denotes a plural, and since they’re writing about only one, they drop the s. Someone should remind them that thousands of singular nouns in the English language end with s (think of stimulus, apparatus, axis). Here are some basics for them: Biceps means that the muscle has two heads, as shown in the diagram below. Also, the muscle on the back of each arm has three heads and hence is called the triceps (which often comes out as tricep). Surprisingly the muscle on the front of our thighs, which has four heads, is more often written correctly as the quadriceps muscle. This issue of course has zero effect on our universe, but it causes little flutters near my diaphragm.
Left Biceps brachii
Another bell ringer:
For years I’ve given family members a Merriam Webster Word of the Day Calendar for Christmas, but I changed brands this year. On January 7 (of all days, my birthday, click here for earlier birthday post), the word a day in the new calendar was fulsome. And the definition? Full, abundant, plenteous. What? Impossible! Speaking of sportswriters, some decades ago a former Kansas City Star writer had used fulsome to mean something roughly equal to the new calendar’s definition. Well, I wrote to set him straight, giving him the definition in my American Heritage Dictionary: New College Edition, copyright 1980. “1. Offensively excessive or insincere. 2. Offensive to the senses; loathsome; disgusting.”
The sportswriter wrote back. He had found the fourth or fifth definition is some dictionary to be consistent with his usage, a definition that obviously had arisen because some people had stumbled upon the word, fulsome, and, not knowing its true meaning, broke down its parts and decided the word had to mean something good. I realize of course that the meaning of words can change over time (click here for examples), sometimes fairly quickly, but fulsome, when used to mean abundant and plenteous, still rings my bell.
Most of us have our little irritations. Do you? Is so, what rings your bell? I, and other readers, would like to know.
Medical topics for 2025. Happy New Year, readers! You may have noticed that I skimmed through the holiday season without writing anything here. Nevertheless, I have been thinking of topics to be considered in 2025. I plan to focus more on medicine, medical costs, and various methods believed to prolong lives, and to healthy living, among other subjects.
Today, I’ll focus on one of the more depressing related topics, namely the sad truth regarding certain healthcare costs. If you’ve read my previous post on absurd prescription drug costs, you know how Congress helped create the sorry tangle of prices we pay for our medicines, not to mention the huge profits made by companies acting as “middlemen” and who distribute our prescription medications (see here for that post).
Our health care costs are also screwed up. Yesterday’s Wall Street Journal published an extensive article on the medical insurance business, specifically Medicare Advantage programs. Its headline: UnitedHealth’s Army of Doctors Helped It Collect Billions More From Medicare (see here)
Medical topics for 2025 include insurance costs
Here’s some background: The government’s Medicare Advantage system makes use of private insurers to provide health benefits to seniors and disabled people. It works like this, the sicker the patients are, the more money the insurers collect from the government. But how does the government know how sick the patients are? Well, by how many illnesses they are diagnosed as having. In short, the more sicknesses diagnosed by doctors and submitted by insurers, the more money the government pays the insurance company. What could go wrong? Plenty, it seems.
As the WSJ article points out, in the case of UnitedHealth, many of those doctors work directly for UnitedHealth, an industry pioneer in directly employing large numbers of physicians. Its Optum unit now employs about 10,000 physicians, its top executive has said, making it one of the nation’s largest employers of doctors. It contracts with tens of thousands more. No other national insurer has acquired and hired doctors on that scale.
Checklist of potential diagnoses
The company frequently prepared its doctors with a checklist of potential diagnoses before they ever laid eyes on their patients, but only for those patients specifically covered by the Medicare Advantage program. One physician reported its software wouldn’t let him move on to his next patient until he weighed in on each diagnosis, some of which were exceedingly rare. How did this work out?
According to the WSJ article, sickness scores of patients were increased when they moved from traditional Medicare to Medicare Advantage, leading to billions of dollars in extra government payments to insurers. And patients examined by doctors working for UnitedHealth had some of the biggest increases in sickness scores when they made that specific move, according to the Journal’s analysis of Medicare data between 2019 and 2022.
Doctor reviewing patient’s medical history
Sudden increase in sickness scores in Advantage plans
Sickness scores for those UnitedHealth patients increased 55%, on average, in their first year in the plans, the analysis showed. That increase was roughly equivalent to every patient getting newly diagnosed with HIV, the virus that causes AIDS, and breast cancer, the analysis showed. That far outpaced the 7% year-over-year rise in the sickness scores of patients who stayed in traditional Medicare, according to the analysis. As described in the WSJ article:
Patients who both saw UnitedHealth doctors and were enrolled in UnitedHealth plans had the highest average sickness scores in the Journal’s analysis of claims from 2019 to 2022. Those higher sickness scores triggered about $4.6 billion more in Medicare payments than UnitedHealth would have received if those patients’ scores had been in line with the average for the company’s other Medicare Advantage patients. (My thought: That extra $4.6 billion came from the pockets of us taxpayers.)
UnitedHealth response
A UnitedHealth spokesman said that the company’s practices lead to “more accurate diagnoses, greater availability of care and better health outcomes and prevention, including less hospitalization, more cancer screenings and better chronic disease management.” The company’s approach, he said, helped to avert more serious health problems later, and to achieve Medicare Advantage’s goals of improving quality and reducing costs. The company also said Medicare’s system of paying for diagnoses was developed by the government, not any one insurer, “to help ensure fair and accurate payments.”
The WSJ piece also included this response from a spokeswoman for the Centers for Medicare and Medicaid Services which indicated the agency is studying relationships between Medicare Advantage insurers and medical providers, adding that Medicare Advantage insurers are required to ensure the accuracy of diagnoses they submit, and also that the agency had overhauled the list of diagnoses that trigger extra payments.
Medical topics in 2025: Interviewing patient
More tidbits from WSJ article
When Dr. Naysha Isom started working at a UnitedHealth medical group in the Las Vegas area in 2019, she said, she got two days of training on how to record diagnoses. At the training, a UnitedHealth employee suggested that Isom, who had practiced for more than a decade, should consider diagnoses she had never made before.
Isom said she was told that signs of bruising could be recorded as senile purpura, a condition that generated payments in Medicare Advantage but generally didn’t require treatment. Isom saw no point, since the finding didn’t change patients’ care: “OK, wear some sunscreen. Maybe stop bumping the wall.”
Bonus pay
A December 2023 compensation plan for one UnitedHealth-owned practice offered doctors bonuses of up to $37.50 a year for each of their Medicare Advantage patients if they confirmed or ruled out more than 90% of the suggested diagnoses. That means a doctor seeing 800 Medicare Advantage patients in a year could see a bonus of as much as $30,000 a year.
Like other Medicare Advantage companies, UnitedHealth also contracts with outside doctors in ways that can increase their payments when they diagnose more conditions. That includes arrangements where doctors receive a portion of the Medicare payments insurers get for their patients. . . In some contracts with independent doctors reviewed by the Journal, UnitedHealth linked bonuses to sickness scores and quality ratings derived partly from patient surveys. For patients with sickness scores 20% higher than average and good quality ratings, doctors could get an extra $40 per patient each month, one contract shows. Scores 50% above average and top quality ratings could yield $65 per patient a month. For a doctor with 100 patients covered by the contract, that would amount to a $78,000 annual bonus.
Final thoughts
The article that stimulated this post contains other shocks. Check it out if you’re interested (see here). In the meantime, stay tuned for more medical topics in 2025.
Absurd prescription drug costs! It is hard to believe that prices for a month’s supply of dozens of prescription medicines can differ by thousands of dollars, depending on where you buy them and what insurance plan (if any) you may use. Just last month TheJournal of the American Medical Association published “Strategies to Help Patients Navigate High Prescription Drug Costs (Nov 26, 2024),” an attempt to inform physicians how to help their patients who struggle to afford necessary medications.
Here’s a telling sentence from the JAMA article: “The patchwork of prescription drug affordability strategies outlined in this review illustrates the complex, fragmented, and inefficient prescription drug delivery and reimbursement system in the US.”
In this post I’ll take a brief look at how ridiculous the prescription drug scene has become, and I’ll end by summarizing tips from the above JAMA article, some of which may help you reduce your own absurd prescription drug costs.
A broken system:
Our broken pharmaceutical system is so complex that it would take a thick booklet to fully explain what a botched mess it is. Here I’ll give a few facts to demonstrate how zany our drug prices have become. If you would like to learn more about this tangled system, a good source would be the 46brooklyn website (click 1). This feisty organization seems determined to make drug prices more affordable.
Here are numbers from a recent study of Medicare data, these regarding patients using generic versions of the prostate cancer drug Zytiga. Believe it or not, these specific patients may be charged any of more than 2,200 prices for their drug, depending on where they live, and what drug plan they have. For example, a monthly supply of a generic of the drug in northern Michigan costs about $815, roughly half the cost in suburban Detroit, but it zooms up to $3,356 in a county along Lake Michigan. (See 2for details)
Prices vary widely
Do those differences make sense to you? How can drug prices vary so widely, even in a limited area such as the single state of Michigan? What happened to the principles of supply and demand that normally keep prices closer together? (The effect of supply and demand on prices is one of the basic tenets I learned while studying economics. I majored in that dismal science for my undergraduate degree at the University of Wisconsin.)
Apparently, Washington’s jerry-rigged drug-reimbursement system is the culprit that toppled old Supply and Demand. Both Medicare Part D and commercial insurance plans, which many of us have, employ middlemen (known as pharmacy-benefit managers or PBMs) to negotiate the price ultimately paid for prescription drugs. From there it gets really confusing. Medicare divides coverage into 34 regions around the U.S. and health plans must submit separate bids for each region. This seemingly was the match that ignited the explosion of absurd prescription drug costs.
Even more absurd examples
According to one study, some 61 drugs had monthly prices that diverged by at least $30,000! Yes, you calculated correctly, a difference of $30,000 per month comes to an annual difference of $360,000, right up there between a quarter and a half million dollars a year, not exactly chicken feed, as the old saying goes. The most egregious difference of all was the $223,037 range for nitisinone (brand name Orfadin), a drug used to treat a rare metabolic disorder (Type 1 Tyrosinemia). This inherited disorder is characterized by a deficiency of a critical enzyme, and it requires a restricted diet and lifelong treatment with an extremely expensive drug to survive. How in the world could there be such an unbelievable range in monthly costs of Orfadin? Or for the astonishing range of more than $30,000 per month for many other drugs?
The answer seems to be traced to our federal government and the ridiculous rules it set up to run Medicare Part D. In the past, I’ve blamed Washington for our unacceptable surge in college tuition costs (See here), and for dismantling (while institutionalizing) our medical care, where costs also have become absurd (See here). How can we reduce the flood of inanities coming from our nation’s Capitol? They have to stop. Could we induce our politicians to take a closer look of the Preamble of our Constitution and make them realize that much of their legislation rips up our domestic tranquility and erodes our general welfare. That’s not what our Constitution was set out to do. Here’s a reminder for our lawmakers.
Preamble to US Constitution
“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.“
Other opinions on our present situation
“The inconsistent and disconnected way that PBMs arrive at drug prices makes Medicare look less like a trustworthy marketplace intended to yield low, sober prices and more like a casino,” said 46brooklyn Chief Executive Antonio Ciaccia. (2)
“It’s a broken system. It’s really confusing for seniors. It’s really confusing for providers,” said Dared Price, owner of eight pharmacies in the Wichita, Kan., area, and he complains the stores are underpaid. “It’s costing the government way too much.” (2)
Who are these PBMs?
Critics, including 46brooklyn mentioned above, argue that the PBMs are making huge profits as middlemen. the largest PBMs are UnitedHealth Group’s Optum Rx, Cigna’s Express Scripts, and CVS Health’s Caremark. These companies manage about 80% of prescriptions in the U.S. I haven’t studied this group, but I assume they prefer to project a different image than the ones painted by the above quotations. Some PBMs have made efforts to protect their turf. Express Scripts has run a series of full page ads in The Wall Street Journal, attempting to portray a different sort of company. The top half of a number of these full-page ads contained the following, printed in bold type:
WE’RE PHARMACISTS.
WE’RE CLINICIANS.
WE’RE RESEARCHERS.
WE’RE NEGOTIATORS.
WE’RE CAREGIVERS.
THAT’S NOT
A MIDDLEMAN.
THAT’S AN
ADVOCATE.
I think important questions remain. Will an increasing awareness of these absurd prescription drug costs build pressure to dismantle this administrative nightmare? Will supply and demand once again determine the price and distribution of our prescription drugs? Will the newly named D.O.G.E. Commission (Department of Government Efficiency) look into this issue? I certainly hope so. If that happens, I wish Elon Musk and Vivek Ramaswamy and their advisory commission the best of luck.
Money saving tips from JAMA(Information condensed from the November 26, 2024 article). There are some real money savers here.
Co-payment Cards: Manufacturers of brand-name drugs frequently offer co-payment cards to off-set costs of prescription drugs. These cards lower out-of-pocket costs depending on the drug used and the patient’s prescription drug benefits, potentially to $30 per month or less. For example, manufacturer co-payment cards for the anticoagulant Eliquis can lower out-of-pocket costs to $10 per month with a maximum annual benefit of $6,400. But these co-payment cards, which are available from manufacturer websites, CAN BE USED ONLY by patients with private health insurance. (With my Medicare Part D insurance, I pay much more that $10 for my monthly supply of Eliquis.)
Patient Assistance Programs: Some brand-name drug manufacturers offer patient assistance programs to offset the out-of-pocket costs of expensive brand-name drugs for uninsured or under-insured individuals. Patient assistance programs also are offered by independent nonprofit organizations, including private foundations, which are frequently financially supported by brand-name pharmaceutical manufacturers. These programs are typically restricted to patients who meet specific needs-based eligibility criteria, such as a low family income. To be eligible for these programs, patients must submit documentation verifying financial hardship, and prescribers must certify clinical necessity of the prescription drug. Such programs are available across public and private insurance, but options for uninsured patients may be more limited.
Savings at Pharmacy
Pharmacy Coupons:When insurance plans charge substantial out-of-pocket costs, or do not include particular medications on their formularies, some patients may benefit from purchasing the prescription drug directly from pharmacies without insurance. Ordinarily, retail pharmacies charge high prices for cash-paying customers, but several organizations (eg, GoodRx, SingleCare, WellRx, NeedyMeds) offer coupons through which patients can access discounted prices negotiated by pharmacy benefit managers on behalf of insurers. These coupons are available to all patients regardless of insurance status. They can be particularly helpful for uninsured patients and those with high-deductible health plans who take generic medications. (Even though I have Medicare Part D drug insurance, I have used GoodRx and in one case paid almost $100 per month less for a medication than I would have paid as a co-pay on my insurance.) These coupons are typically are available online or through smartphone applications. They also can be useful for drugs that are frequently subject to coverage restrictions, such as generic medications for erectile dysfunction (eg, sildenafil, tadalafil), hair loss (eg, low-dose finasteride), and weight loss (eg, topiramate, phentermine).
Direct-to-Consumer Pharmacies: Thesepharmacies sell a selection of drugs at transparent prices if patients purchase them without insurance. These pharmacies are new entrants in the US prescription drug market, and they provide patients with the option to purchase a range of commonly used generic drugs at prices that may be lower than their insurance-required out-of-pocket costs. Some big-box chain retailers (eg, Walmart, Costco) have direct-to-consumer pharmacy programs with in-person pickup and mail-order options. Other direct-to-consumer pharmacies (eg, Amazon Pharmacy, Health Warehouse) are exclusively online. The Mark Cuban Cost Plus Drug Company primarily sells medications online but also partners with independent grocery store pharmacies for in-person pickup. In 2023, Amazon introduced a pharmacy program (RxPass) that offers unlimited access to several dozen commonly used generics for a $5-per-month subscription; this program is only available to those who subscribe to Amazon Prime.
Two more ways to save on drug costs:
Public Assistance Program: Several federal, state, and local programs help patients afford prescription drugs. The largest such program is Medicaid, which provided prescription drug coverage to more than 75 million individuals in the US as of March 2024. Medicaid drug coverage is generous, with 2013 federal regulations allowing co-payments of up to $4 for preferred drugs and $8 for non-preferred drugs for individuals earning less than 150% of the federal poverty level; these costs are even lower in many states. For patients who qualify, enrolling in Medicaid is one of the most effective ways to affordably access prescription drugs.
International Online Pharmacies: Prices for brand-name drugs in the US are 2 to 3 times higher than prices for the same drugs in other countries, leading some patients in the US to try to import these drugs. While drugs obtained from international pharmacies can be made in the same factories as those prescribed in the US and most high-income countries have regulatory agencies to oversee marketed prescription drugs, patients should be aware that these pharmacies fall outside of the authority of the US Food and Drug Administration (FDA). It is illegal to import a drug that is unapproved in the US, but the FDA permits patients to purchase FDA-approved drugs internationally as long as they are for personal use, for treatment of a serious condition, and the quantity does not exceed a 3-month supply. If patients choose to individually import drugs, they should choose a reputable pharmacy in a country with adequate drug regulation; pharmacies in low- and middle-income countries may be subject to lower quality standards, and rates of counterfeit drugs range from 9% to 41% compared with less than 1% in high-income countries. PharmacyChecker is an independent organization that verifies international online pharmacies and allows patients to compare prices across pharmacies, and possibly avoid the worst of our absurd prescription drug costs.
My Harris-Trump choice drained me. But I finally have determined which candidate I will vote AGAINST. My decision came in a flash, thanks to an unexpected epiphany that focused on factors I had not even considered earlier. An examination of those factors revealed which of these sorry candidates scares me more.
Like many of you, I’ve been obsessed with this election cycle, being worried about the direction of our country, and truly alarmed by what might lay ahead. (I’m still worried and alarmed, but at least I’ve made a decision.)
It has been a long process. Nearly a year ago I reported on this site my misgivings about the 2024 election as Biden and Trump prepared to slug it out (See here for that post). I saw no improvement after Biden was forced out and endorsed Harris. As I’ve followed these two candidates over the past few months, both seemed determined to dig themselves deeper into their self-made trenches.
Donkey versus Elephant Fiasco
Trump worries:
I initially worried less about Trump. The reason was simple. When I compared his term in office with the Biden-Harris term, Trump came out ahead. Biden’s disastrous withdrawal from Afghanistan still rankled me, as did the increase in inflation during his watch. (A CBS article earlier this month reported that groceries cost 26% more than than in January 2020.) And worst of all, Biden’s executive orders that opened the border and allowed millions of illegals to flood across our country (with Harris supposedly in charge of the border). All of these soured me on the present administration.
But Trump is Trump, and he appeared to have the larger shovel, throwing dirt on former associates, the mainstream media, and anyone else he came in contact with. He dug himself deeper and deeper as he ranted on and on. He made stupid comments and illogical allegations. At times he sounded deranged. He lied about practically everything. Not surprisingly, he kept sinking in my ranking.
Harris worries:
Harris too has had problems. After her post-convention bounce, and the resulting few percentage point lead over Trump, she’s bumped along with little momentum. Nonetheless, she gained a bit in my view, mainly I think by remaining well above Trump’s often uncouth level of behavior.
At other times I lowered her grade, partly because of the multiple times she seems to contradict herself. For instance, when asked if she would have done anything differently from Mr. Biden on any issue, she replied, “There is not a thing that comes to mind.” That suggests that she would continue the Biden administration’s policies. But hold on! Her current campaign message focused on “a new way forward.” Is she trying to confuse voters? Or is she confused?
Buying votes:
Both candidates are guilty here, each presumably believing that promising some extra dough for voters (by reducing their taxes, or giving them government handouts), might sway them to punch their ticket. Both Trump and Harris have proposed tax cuts on tips, seemingly to appeal to working-class voters in key states like Nevada, where tipped workers in hospitality and service play a major role in the economy. But Harris may lead the charge here. She has proposed a number of financial incentives to appeal to voters, especially ones focused on housing affordability and family support. She has proposed to provide a $25,000 down payment grant to first-time home buyers. That should get some votes, but at the same time it certainly would increase home prices across the board, just as the government-provided money for student loans and Pell grants ignited the explosion of college tuition (See my take on that here). Harris has also touted a $6,000 tax credit for parents of newborns.
These are just some of the developments I’ve been watching intently over the past several weeks while juggling my view on which of these two mediocre (at best) candidates might cause the most damage if elected. It’s sad to have such negative thoughts, but I see what I see. I’ve never felt so down in all my years of voting. I yearn for the days when I happily voted FOR John F. Kennedy, and later FOR Ronald Reagan.
But yearning does not alter reality. Soon I will need to vote (and you too, if you haven’t already). It may have been that realization that led me to focus sharply on recent events and jam them into the pro-con mish-mash swirling in my head. During this process, suddenly and unexpectedly, I knew how I would vote. My Harris-Trump choice!
My epiphany:
It happened as I zeroed in on both candidates, searching for their pulse if you will. In Greensboro, NC, Trump showed up and yelled at length with his typical hyperbole. “I’m here today with a message of hope for all Americans,” he said. “With your vote this election. I will end inflation. I will stop the invasion of criminals into our country. And I will bring back, as your president, the American dream. We’re going to bring it back. Our country is being crippled and destroyed by Kamala Harris, but it does not have to be this way. It won’t be this way for long, hopefully what we’ve put up with, with the two of them. What we put up with the two of them with your support on November 5th, America will be bigger, better, bolder, richer, safer and stronger than ever before.” He went on, as you might imagine, for nearly two hours. Blah, Blah, Blah.
At about the same time, Harris had a town hall meeting in Michigan that was hosted by Maria Shriver. A woman attending the event asked Shriver, “Are we going to be able to ask a question?” According to the Daily Mail, Shriver replied, “You’re not, unfortunately, we have some pre-determined questions.Hopefully I’ll be able to ask some of the questions that might be in your head,” She added.
What is going on? I thought. Kamala Harris has served in the United States Senate. She has been vice president for nearly four years, and she can only take “pre-determined questions” in a town hall meeting? Why won’t she answer questions? As I factored that into my mish-mash, I related it to Harris’s reluctance to be interviewed by a number of legacy media outlets. Newsweek cited one significant example (See that here), quoting the owner of TIME who said, “Despite multiple requests, TIME has not been granted an interview with Kamala Harris—unlike every other Presidential candidate.
Eureka!
At that instant I saw what I had missed. Donald Trump is in many ways a despicable character, but he has a backbone. He is brash and declares himself in uncertain terms. Kamala Harris, on the other hand has been timorous on the campaign trail, often sounding as if she has a thin spine. I’ve wondered why she behaves that way. Does she shy away from certain interviews, and set up pre-determined questions so that she will avoid saying what she actually believes? Does she fear her honest beliefs will turn off voters? Or is she simply unable to organize and gather her thoughts? These possibilities are the most likely to me. And they worry me.
I prefer someone with a strong backbone in the Oval Office. Although Donald Trump has character flaws galore, he appears to me to be the lesser of two evils as a presidential candidate. For those reasons, I will vote against Kamala Harris by placing an X next to her opponent’s name. I will feel neither joy nor optimism as I vote, and I will continue to worry about our country’s future, but I will know I made a reasoned decision. My Harris-Trump choice!
The personality issue:
Numerous individuals have told me they will not vote for Trump for the simple reason that they could never vote for such an abhorrent individual. I understand that emotion, but it is worth remembering that this election is more than about Trump. This election will greatly influence the future of our country. Shouldn’t that fact be part of a voting decision? After all, 60% of us think our country is heading in the wrong direction.
Here’s a question. Is the Donald Trump of today much different from the one who earlier occupied the Oval Office? I think he is pretty much the same vain, vulgar, insulting, boorish guy he was when president. Yet, despite his character flaws, and despite the battering he took from the mainstream media, and our legal system (over the now-debunked Steele dossier that was funded by Hillary Clinton’s 2016 presidential campaign), he somehow managed to get things done while in office. Another question. Would Trump be effective if elected for a second term? I do not know. He certainly would again be the target of most national media. Nonetheless, I fear him less than I fear Kamala Harris.
Final note:
Okay. This is it. I’m laying off of politics for a while. I intend to be silent on all subjects here until at least after November 5th. Beyond that, unless the unthinkable happens, I will avoid political comment until at least the end of 2024. I plan to clear my head and focus on other topics. Thanks for listening. And stay tuned.
