“Do No Harm” — not so harmless

The US health care system* fails people of color on several metrics, including maternal and infant mortality, rates of chronic illness in youth and adulthood, and overall life expectancy. 

Some of this is driven by poverty and lack of health insurance, which disproportionately affect Black Americans. Some is a result of decisions made by medical professionals, who are less likely to take seriously the symptoms of Black patients, especially Black women. 

And some is attributable to the corrosive stress of dealing, day in and day out, with racism, in its individual and systemic manifestations.

Into the breach? “Do No Harm,” a lobbying group and think tank that’s been in the news lately for opposing gender-affirming care.

But only for trans people.

They have no beef with teenagers who get labioplasty, breast augmentation or reduction, tummy tucks and thigh lifts, chin and cheek implants, and botox: a quarter of a million procedures in 2023 (pdf: page 17). That’s in a year. 

But trans teenagers, 13,994 of whom had gender-affirming care of any kind in the five years from January 2019 through December 2023 are the victims of “extreme gender ideology.” 

As if the pressure to conform to gender norms isn’t ideology, or gendered.

“Do No Harm” was founded by a retired nephrologist, by the way. A kidney doctor. With an axe to grind, and no specialized training in psychology, social work, endocrinology, pediatrics, or any other profession devoted to the study of gender, or ideology, or young people.

Doctor Kidney’s mission: to drive “discrimination and division” out of health care — by opposing any initiatives to address gender and racial disparities in health care outcomes, clinical trials, medical school admissions, and hospital policies. Developing and supporting anti-trans legislation got added to the mix a year later.

Put another way: they want it to be illegal to think about including a diverse sample of the population in clinical studies. If women are excluded because “menstruation might mess up the results” or “they might be pregnant” — fine. If Black women are ignored in recruiting channels — fine.

Do No Harm claims its members “physicians, nurses, medical students, patients, and policymakers.” But the 21 members of the (all-white) team only include five with medical training, only one of whom is certified in psychiatry. 

The director of outreach is an RN with a background in cardiac health, the gender ideology specialist is an oncology nurse, and the director of eliminating DEI is distinguished for getting fired when she refused to participate in bias training; her nursing experience includes home health care, hospice nursing, and emergency department work.

Just to be clear: diversity and inclusion efforts opened doors for women, Jews, African-Americans, Hispanics, and other members of the not-white-male majority to enter medical school. 

They work to provide access to medical students from impoverished backgrounds: male or female, white or Black, and to make sure LGBTQ populations are comfortable accessing health care. 

They push for including elderly people in clinical trials, so your grandpa won’t die from a medication that was only ever studied in young adults. 

And they seek to analyze disparities in care that lead to dramatically distinct outcomes among different populations. Demographics, like those cited above, make clear the rationale for this. It’s not rocket science.

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Should you be tempted to check out the “Do No Harm” website, please note that it is full of misstatements and outright fabrications, including the claim that Europe limits gender-affirming care; their report doesn’t even mention Germany, which has explicit guidelines about caring for trans youth.

Also of interest: repeated warnings on the site that its contents “should not be interpreted as medical or professional advice.”

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*Health care in the US isn’t really a system; it’s a collection of often-competing, poorly integrated entities that individuals in need of care attempt to navigate at their peril. It’s three vulture capitalists in a trench coat fighting to extract every last penny from the business of selling drugs, diagnostic procedures, and doctors’ time.

Air Quality Algorithms (Part I)

I’ve had the Air Quality Index forecast and current reports open in a browser continuously for the past few days: Canada is on fire again and the smoke is blowing slowly across the continent toward the east coast. But the air quality reports from different organizations are so varied that it’s hard to know what you’re looking at.

wunderground.com

Catherine and I keep getting quite different numbers from Apple, which gets its data from Google via Breezometer, and Weather Underground (owned by the Weather Channel, in turn owned by … well, more on that another day). 

At various websites shortly after noon today, I found readings ranging from 43 to 107: Weather Underground posted an AQI of 99, “moderate” per the EPA, while its parent company had 107, “unhealthy for sensitive groups.” IQAir similarly reported 104. Meanwhile, Weatherbug, part of the US-based nonprofit Ground Truth Project, posted a reading of 43 on a 100-point scale, corresponding to a rating of “moderate,” while AccuWeather reported 64 on a scale of zero to 250, and called it “poor.”

When I tried to figure out why, I learned that different governments, regional agencies, and commercial weather organizations measure different data, consider varying pollutant levels dangerous, and use different algorithms to set the air quality index. It was a long trawl through various kinds of documentation at different levels of specificity and clarity.

The EPA — which provides clear and detailed documentation not yet censored by the current administration — tracks ozone, particulate matter (both PM2.5 and PM10), carbon monoxide, sulfur dioxide, and nitrogen dioxide, and indexes them against a scale of zero to 500. Below 50 is good, more than 150 ranges from unhealthy to hazardous, and between 50 and 150 is moderate (“acceptable,” though potentially risky for “unusually sensitive” people) or “unhealthy for sensitive groups.” The AQI is based on the highest-level pollutant at any given time. 

But neither Weatherbug nor AccuWeather uses the EPA scale.

Weatherbug lists levels of each pollutant it tracks: the same as those monitored by the EPA. Tapping on “i” above current conditions yields a pop-up window with a 100-point. At “moderate” air quality, Weatherbug advises that “unusually sensitive people” should take precautions; at “low” and “poor” levels, ‘people with lung disease …, children, older adults, and outdoor workers” should limit outdoor time and exertion.

AccuWeather uses data from Plume Labs, which has a lot to say about how scientific and accurate its weather forecasting is, but doesn’t provide much in the way of detail. Plume says its scale is based on World Health Organization recommendations about length of exposure:

Each category represents the amount of time it is safe to spend in that level of pollution. For example: one year (PAQI < 20), one day (PAQI <50), one hour (PAQI <100).

But the actual scale doesn’t mention time: instead stating that “sensitive groups” and “healthy individuals” are at risk at different levels of pollution. 

It’s hard to know what substances Plume includes in its index: advertising for the company’s app mentions particulate matter smaller than 10 and 2.5 micrograms, ozone, and nitrogen dioxide. An article explaining Plume’s AQI refers to volatile organic compounds, but not ozone. Plume’s air quality sensor, according to promotional material, also measures particulate matter smaller than 1 microgram.

Meanwhile, different countries and regions consider widely different levels to pollutions to be a problem. More on that in a future post.

living while female

trying to remember to breathe, as i remember

i was crossing Delancey, legally in a crosswalk, and a dude in a big car honked at me, so i flipped the bird, so he pulled over and got out and came after me, so i walked as fast and as casually around the corner as i could and there was a couple with a little kid and i said please pretend to me my friend a guy is coming after me and they were like cool, hey, how’s it going … dude rounded the corner and saw me with them and turned tail and left

believe women

i got off the bus at the wrong stop someplace in the outskirts of denver and was trying to get a cab ... no map before iphones and gps so i had no idea where i was … a pickup truck passed and a bunch of male voices yelled threatening things i can’t remember and i kept walking trying to find an open bodega or gas station or something and they’d gone around the block and came back and slowed down by me and i casually-as-possible racewalked around a corner and hid in a hedge and watched as they drove by again and then again and then waited for a long time … i can’t remember how but i eventually got where i was going

i was out for a run and a bunch of young teenagers surrounded me, six or seven maybe, several pairs of hands reaching toward me …  i froze for a moment and then lunged for a gap between a couple of them and ran and one yelled voice cracking you have a nice ass lady … i have never since gone for a run in leggings

i was walking home from work down fifth avenue and suddenly a hoarse whisper in my ear, i wanna suck your titties, and i turned around with fist raised … he looked shocked and scuttled off

i was riding down east 6th street and there’s a dude with a guitar in the bike lane, i holler scuseme, he reaches out and grabs my boob while i ride by … at the end of the block there are a couple of cops and i stop and tell them what just happened … what did he look like? … white, medium height, short hair, not much of it … whaddya want US to do?

i was riding down the street and a guy wanted to cross so he grabbed my arm and tried to pull me off my bike and then cursed after me when i rode off

i said no, and i said no, and i said no again…

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i have so many other stories like this. so many women have experienced so much worse. all these situations could have escalated, but i was unhurt. yet i write about them with my heart pounding. BELIEVE WOMEN.

The DOE Just Trumpeted Its True Colors

Here we go. The Trump Department of Education wants you to help it “end DEI” by informing (confidentially) on “illegal discriminatory practices at institutions of learning.”

This submission form is an outlet for students, parents, teachers, and the broader community to … identify potential areas for investigation.

Students can snitch on their teachers, parents on their kids’ teachers, teachers on each other. And you don’t have to have any connection to a school: anyone else in the community is welcome to use the form. 

The DOE press release announcing the portal quotes Tiffany Justice: “Parents, now is the time that you share the receipts of the betrayal that has happened in our public schools.”

Justice, co-founder of Moms for Liberty, claims the group is bipartisan though it has ties to the Proud Boys, promoted Florida’s “don’t say gay” laws, seeks bans on books with LGBTQ+ or Black characters or themes (and sexy seahorses) and is closely linked with Republican leaders. M4L members have suggested that LGBTQ+ students should be taught in separate classrooms from straight kids and students with disabilities should be de-mainstreamed, and called a Pride event “perverse.”

If you’re a school librarian, a teacher, an assistant principal, if you’re gay or trans, Jewish or Muslim, a second-generation immigrant or a Black person with generations in the United States behind you — or not! — whether a report is even valid is not the point. 

Being investigated is exhausting and demoralizing. Being investigated alone will make some people think you’ve done something wrong. Targeting individuals, claiming they’ve violated the nation’s new speech laws, makes it harder for others to dissent. 

That is the point.

Gestapo. Securitate. KGB. Frumentarii. Stasi. Secret Police. Whatever you call it, encouraging people to rat on their neighbors is a key feature of authoritarianism. 

A Moms for Life chapter newsletter opened with a quote from Hitler (the writer then apologized). In an interview with Forbes, Justice said it was a mistake for a chapter leader to open a newsletter with Nazi propaganda. But at a M4L conference, Justice said, “One of our moms … quotes Hitler.” Someone in the audience whooped. “I stand with that mom,” she added, to many more cheers. 

It’s not just about trans people. By foregrounding Moms for Liberty in its call for informers, the Trump Department of Education just told us that, loud and clear.

Words Matter — Health Policy

The President says he wants to “make America healthy again.”

Who could argue with that? We lag behind other developed nations in life expectancy. The US maternal mortality rate is several times higher than in the European Union, and well over double Canada’s rate. On various other metrics, we live shorter, sicker lives than people in other high-income nations.

The causes are clear: inequities in access to health care and social services; government subsidies of sugar, grain, and seeds; food deserts and ultra-processed foods. Behind those: poverty, basically, enabled by a combination of government inaction and corporate greed.

But it turns out what really interests Trump’s handlers is that sick kids aren’t eligible for military service.

Take a minute with that. Trump has declared a “crisis” of chronic diseases in children because he is concerned about the drop in military recruitment rates. 

The three most common disqualifiers, per the Centers for Disease Control and the bipartisan Council for a Strong America: overweight, insufficient education, and a criminal record. 

Solutions? Spend more on pre-k programs. Good early childhood education gives kids cognitive and emotional resources that help them stay in school and ultimately reduces crime. Spend more money on K-12 education, especially in areas that have been underfunded since … forever. Spend more money to make sure kids get enough to eat: food insecurity is a significant driver of obesity in children (and adults). 

But Trumpist logic leaps past asthma and cancer to autism, ADHD, and mental health.

Executive Order, February 13, 2025

The cause of this crisis in youth mental health? “Over-utilization of medication” and the “threat” of SSRIs, antipsychotics, and stimulants, alongside electromagnetic radiation, corporate cronyism, Government policies, and corrupt science.

The proposed fix? Radical ideas. Things no one [in Trumplandia] has thought of before: nutritious food, “healthy lifestyles,” physical activity, “transparent data,” education.

Words have power. Promoting “lifestyle” and physical activity while simultaneously blaming childhood disease on medication is disingenous. 

In the context of Trump administration actions —sowing chaos by randomly firing civil servants, destroying social service agencies, deleting websites and databases, and hobbling scientific research — these words are empty.

Mendacious, misleading, meaningless: Trump’s words are dangerous.

The Anthropocene In Two Pie Charts

All the mammals in the world today weigh more than five times as much as ten thousand years ago. 

1greenblogger | ecologue

1greenblogger | visualcapitalist

Cattle alone (416 megatons) weigh more than twice as much as all of the mammals on earth before humans domesticated animals, and releases 12,283 megatons of carbon dioxide-equivalent greenhouse gases during the collective animals’ life span.*

Most of the rest of the world’s livestock animals are, like cattle, ruminants; they and their compartmentalized stomachs belch and excrete methane, whose wiggly molecules are 80 times more powerful at bouncing heat back to earth rather than letting it escape into the atmosphere.

Our pets are small in number, but mighty in impact: cats and dogs contribute almost another megaton of greenhouse gases every year, in large part because they eat a fifth of the world’s meat and fish (and a third of the food from animal sources) in the US — more, per capita, than many humans. 

In short: the livestock we breed is a huge contributor to human impacts on earth.

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* Approximately 42 percent of a cow or steer is edible (pdf, p. 11); 416 megatons of cattle yields 173 megatons of meat; beef production is responsible for 71 kg of CO2-eq per kilogram.

I Hope They Never Find Him

I saw a pulmonologist at the Post-Covid Recovery Clinic at Rutgers in February. When I made my $40 copay, I forgot to tell the hospital to submit the bill under my wife’s policy; I’d lost my own health insurance because I was too sick to work. (Thankfully — I could still be covered.)

The insurance company paid the bill by accident. Or rather, they paid $176, the amount they apparently considered appropriate for a 20-minute telehealth appointment with a medical resident and his supervisor. A few weeks later, they realized their mistake, called the hospital, and asked for their money back. 

The hospital got in touch with me: you owe us $842 dollars. Their price for the appointment, including the copay, was — IS — $882 dollars, if you’re paying the bill without insurance company mediation.

I asked them to rebill under the correct policy. They did. 

— Insurance company: that policy expired.

— Hospital billing office calls me back: your policy expired.

— Me: no, it didn’t. It’s current.

— Billing office: the insurance company says it expired.

— Me: …

— Me: … 

— Me: … what policy identification number was it billed under?

— Billing office gives me the number. It checks out.

— Me. That’s the ID number for the current policy. It’s not expired.

— Billing office: Oh. Well … you need to appeal the denial with the insurance company.

At this point, I should have gotten my butt in gear immediately. But I was already negotiating with the insurance company over several other issues.

• I’d been trying for months to get reimbursed for appointments with an out-of-network therapist. The therapist made a mistake on the bill, the insurance company rejected it. My job: find out from the insurance company what had to be on the bill; explain it to the therapist; get the bill from her; fill out a new claim form; send it to the insurance company.

• Another doctor’s office, another $40 copay. And then they ran my credit card for another $127. Why? “the insurance company says you have a deductible.” The doctor was in network. There was no deductible. I had to contact the insurance company and get them to pay the bill — and then get the doctor’s billing office to refund me the money. (I still have to check my bank statements and see if that money ever came back.)

• Long Covid messed up my vision; things double and blur, my eyes snap in and out of focus, the more tired I am, the worse it gets. The folks at the Long Covid clinic sent me to an occupational therapist who sent me to a neuro-optometrist who did a bunch of tests and prescribed glasses that helped … some … but it cost me $2,000 out of pocket. Insurance company: nah. 

And in the middle of trying to work through all of that, I had some kind of allergic reaction. I still don’t know what triggered it. 

My neck was so puffed up I felt like a toad trying to look big and unappetizing, my ankles and fingers were swollen, and I was short of breath; then I started having chest pain. The GP sent me to the ER, where they checked my blood pressure, listened to my heart, drew blood, looked worried … and repeated the procedure every hour or so. Eventually they found me a bed so they could keep waking me up all night for  more blood draws and more blood pressure readings. 

(I hate that cuff on the blood pressure machine. It’s so tight it makes my fingers tingle, every time.)

Morning. Someone brings breakfast for the lady in the bed next to me; I realize it’s been 24 hours since I called the GP. Could I possibly get some coffee? Nope: no food or drink until they can get me in for a nuclear stress test. Noon rolls around. 3 pm, the resident on the floor says I can have ice chips. 

Reader, I cheated. I let the ice melt and then gulped the water down.

Soon after, an orderly appears to wheelchair me to the test, but it was another two and a half hours before I could eat. 

The upshot: my heart is fine. They have no idea what’s wrong with me, but I’m not going to drop dead of a heart attack, so … I can go home.

Eventually I persuaded my GP to give me antibiotics. (I’ve ridden in this rodeo before.) I started to recover. Slowly. Many, many weeks of slow recovery, punctuated by functional capacity testing that left me even worse off.

Remember that bill I mentioned a few paragraphs upstream? It’s in collection now.

Since February, I’ve seen several other doctor in the same system as the Long Covid clinic. The billing office, instead of crediting those copays toward those visits, applied them to the bill for February. So in their minds, I’ve paid them $440.

Between my copay and the $176 insurance forked over, they called the bill settled for $216.

I’ve already paid $264 more than that. But they sent the bill to collection to scrape another $442 out of me. As much again as I’ve already paid. More than four times what the insurance company will pay.

Oh, and those other copays? The ones that they credited to this bill? Now I’m fielding phone calls about those. 

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On average, health insurers deny 17 percent of claims. United Healthcare, the biggest health insurance company in the United States, rejects claims a third of the time.

During the three-year tenure of the CEO who was assassinated two days ago, profits soared from 12 billion to 16 billion. 

I’m not proud of it — but yeah, I’m rooting for the guy who shot that CEO and hoping he manages to disappear forever.