Coffee Break: Healthcare and the State of Science, Plus Baseball and Abundance

Part the First. How Did the United States Get This Healthcare System?  I distinctly remember the first time this question occurred to me, because as the child of a union household a visit to the doctor or the Emergency Room (trees were made to fall out of) was never a problem.  I was twenty years old and had just gotten my first job-with-benefits as a laboratory technician at my university, which was the beginning of a long and productive apprenticeship.

Blue Cross in those days was still a co-op if I remember correctly, and a university with 10,000 employees had bargaining power it was not reluctant to use.  My share of the individual premium was low and the yearly deductible was $100.  Not inconsequential at the time when my rent on a one-bedroom apartment in an older building was $125 per month, but I had nothing to worry about.  It did occur to me, however, that employer-based health insurance with a tether for those unable to go it alone in the health insurance marketplace.  I was happy to be where I was, but others were not.

Later on, at a small conference sponsored by the predecessor of DSA in the wilds of West Virginia, I heard Michael Harrington give the name to job lock.  As described in this article at The Conversation, American health insurance began as:

Employer-based insurance emerged in the 1940s, not from a commitment to worker health but from a tax policy workaround during wartime wage freezes. The federal government allowed employers to offer health benefits tax-free, incentivizing coverage while sidestepping nationalized care. This decision bound health access to employment status, a structure that is still dominant today. In contrast, many other countries with employer-provided insurance pair it with robust public options, ensuring that access is not tied solely to a job.

American healthcare has gotten worse – mostly by design according to Big Medicine, Big Pharma, and the AMA.  I make sure my first- and second-year medical students understand this, although most, but certainly not all, of them are covered under their parents’ insurance through the age of 26.  That this is just another way of infantilizing adults can be ignored for today.

I do tell the same students that if they do not fix the system, one way or another, those strange sounds they hear in the dark will be me reminding them of my promise to haunt them if their patients have to decide whether to go to the doctor or eat, pay the rent, or buy their growing children new shoes for the coming school year.  I have faith that some of them will have persistent memories of a few things in medical school.  One of my long-term projects is to teach our students about the unknown Dr. Michael Shadid, who showed the way a long time ago (~20 min video and worth the time).

Part the Second. Update on the Alzheimer’s Caper.  This has been covered previously here and here, but while searching for something else I was reminded of this article (about Eliezer Masliah, previously relegated to a footnote in the “How Not to Study a Disease” post) from Charles Piller, who helped break the original story of Sylvain Lesné, previously of the University of Minnesota, and has published a book on Alzheimer’s disease research.  Why bring this up again?  Well, this kind of misconduct gives the current Secretary of Health and Human Services and his minions further leave to smear all scientists with the perfidy of the very few, although I have not seen this matter yet on the true bill:  The indictment:

After Science brought initial concerns about Masliah’s work to their attention, a neuroscientist and forensic analysts specializing in scientific work who had previously worked with Science produced a 300-page dossier revealing a steady stream of suspect images between 1997 and 2023 in 132 of his published research papers. (Science did not pay them for their work.) “In our opinion, this pattern of anomalous data raises a credible concern for research misconduct and calls into question a remarkably large body of scientific work,” they concluded.

MASLIAH IS THE SOLE common author on every paper in the dossier, usually taking the first or last position in multiauthor articles. Those positions imply he did the majority of the publication’s work or bears primary responsibility for it, although the others contributed.

The glove probably fits this time.  One thing is certain, scientists have been too oblivious and waited entirely too long to clean up when such a mess has been made.  Whether we, and yes that includes all of us, actually sowed this wind, my colleagues and I are reaping the whirlwind.  The damage has been done.  The political response has been overwhelming.  Recovery?  Well, I feel fortunate to be near the end of my career rather than the beginning, and I never expected that.

Note added in proof:  See Yves’s introduction to What if MAGA Has a Point About Science from this morning, and also the comments following.  The post itself is a bit gauzy and full of tropes itself (Universities and business schools outside of Chicago are not peopled with conservatives?).  I was present at the creation, so to speak, when the Bayh-Dole Act of 1980 precipitated the slide of biomedical science into abject Neoliberalism.  I was the young guy in the lab, and my reaction was met with bemusement.  The only thing I got wrong was how big the slide would be.  It did not take long before science for sake of science was supplanted with “How can we make money off this?”  Nothing wrong with money, but when that becomes the goal rather than the reward, corruption follows inevitably.  Gresham’s Law applied to academic research drove out the good.  I also saw that in my close orbit, and the denouement was very ugly.  An MIT in the provinces we were not.

Part the Third: How to Save Money on the Front End and Waste It on the Back End.  A few months ago, I called up PubMed one day and it was out of service.  My first thought was, “Well, that didn’t take long.”  Turned out to be nothing.  I am old enough to remember when text versions of Index Medicus, Biological Abstracts, Chemical Abstracts, and Current Contents were the way we found references and kept up with what other scientists were doing.  The Current Journals table in the Science Library was even better if you had one.  There was something to be said for analog back in those days…but the world seemed much smaller.  Actually, I think it is still about the same size at its core with a much higher noise-to-signal ratio today, mostly because of neo-predatory open-access “journals” and the attendant imperatives of “publish and still perish anyway.”

Come to find that the National Agricultural Laboratory has cancelled subscriptions that many smaller institutions cannot afford.  Seriously?  Now, it is true that Big Scientific Publishing is something of a very profitable racket, but the solution is not the inverse of tariffs to a problem that has developed over the long term, which what the NAL is doing.  The digital world is good at some things, and making information available at the click of a mouse and download of a pdf is one of them.  As an aside, when my graduate students complained about the papers we made them read for their classes or to write their proposals and papers, I reminded them that I did the same, at 10 cents a page in the copy room of the Science Library.  Anyway, without access to the NAL, how are our agricultural scientists expected to do their work?  Never mind.

The key paragraph in this article from the bee expert Madison Sankovitz of the University of Colorado is this:

Some might argue that access to a few high-impact journals is sufficient. But science doesn’t work that way — especially in agriculture. Pollinator health alone is influenced by factors such as soil chemistry, pesticide interactions, climate variability, and disease ecology. The best research often appears in specialized journals published by scientific societies — the same journals the NAL just cut off.

Precisely.  Scientists who live by the so-called “high-impact” journals eventually die by the same, if their goal is to discover something new and interesting and potentially useful one of these days.  The good stuff is always hidden away at first in the “stacks” and the only way to find it is to think, read, talk, think some more, and then do.  As Francis Crick put it, the most important task of a scientist is to understand what the next experiment should be.  This is how such “minor” things as the regulation of cell division cycle were figured out, long before Cell, Science, and Nature beckoned.  Most scientific progress – and all progress in biology – is incremental, even if that word means death in the review of a grant proposal.

Part the Fourth: Do You Really Need to Know Your Blood Pressure and Plasma Glucose Level at All Hours of the Day and Night?  No, actually, you do not.  But that doesn’t stop people from falling for the hype and the tropes of the Higher MAHA Movement.  Some people are catching on: Biohacking Backfires: When Self-Tracking Can Harm.  Before I continue, I must admit that my aversion to Fitbits, Apple Watches, and the like is strong, for at least two reasons.  The first is that absent a real need to monitor heart rate and rhythm and plasma glucose, they are superfluous.  The second is that putting that kind of data in the cloud seems to be an unnecessary risk in the Age of Total Information.  I also like to keep time with an analog watch and use a fountain pen.  Anyway:

Wearable smartwatches are associated with improvements in physical activity, self-management behaviors, and some surrogate health outcomes. A 2024 systematic review of smartwatch interventions found positive effects on outcomes such as foot ulcer recurrence, depression severity, healthcare utilization, lifestyle changes, medication adherence, unplanned hospital readmissions, atrial fibrillation diagnosis, and goal attainment for emotion regulation. The most used smartwatch was the Apple Watch. However, the review noted that the number of high-quality studies is actually quite limited, with only moderate quality: most studies were small and of short duration.

Other studies have found that using fitness trackers is associated with increased daily step counts and higher physical activity levels. A few randomized trials have shown small benefits for weight loss or cardiovascular risk factors. Direct impact on measurements like blood pressure or cholesterol are not as consistent. Effects are often modest, and long-term adherence tends to decline over time. While wearable technology shows promise for improving certain health behaviors and intermediate outcomes, persuasive evidence for long-term clinical benefit is still lacking. As “they” say, more research is required.

We do not give medical advice here, but according to wisdom of the ages and your grandmother: If you want to “get fit,” you should among other things, exercise moderately; eat well, also in moderation, real food as much as possible; get enough sleep, whatever is required for you; never smoke or do drugs, and drink alcohol in moderation.  Plus have your bloodwork done once a year to identify anything out of whack.  That will do better than obsessive biohacking for most of us most of the time:

(T)here is also evidence of wearables being associated with overuse or obsessive tracking. In some, wearable data may contribute to health anxiety, compulsive tracking behaviors, and even negative or maladaptive compensatory behaviors (e.g., disordered eating). Data overload, and the potential for misinterpretation of health data may negatively impact mental health, particularly in those that may be vulnerable. Obsessively checking heart rate, sleep scores, or recovery status may aggravate stress, especially when the reports provided seems at odds with subjective experience. While there are lots of anecdotes online, the negative consequence of wearable technology have been understudied.

Part the Fifth: Socialism for the Very Rich.  This is the only explanation for the Colorado Rockies, who are on pace to lose 125 games this season.  Baseball is the second greatest sport and it pains me to see what Big Money has done to it, so I will just let the essential Molly Knight tell the story We Found the Worst MLB Team Ever Assembled:

Rockies owner/Lord Dick Monfort can whine all he wants about a salary cap. Six teams spend less on player salary than the Rockies this year, and they’re all better than Colorado. A salary cap would not make the Rockies better. It would just be another anti-labor shiv from a billionaire who does not need the money. Monfort should have no place in the next round of labor negotiations, but since everything is f—d right now, I expect him to be driving the bus with A’s Lord John Fisher, straight off a cliff.

The Rockies are on schedule to win 37 games out of 162.  The rule in major league baseball is that you win 50 games and lose 50 games, because baseball.  What you do with the other 62 games makes the season.  Dick Monfort, he doesn’t care.  He still gets rich whether his team wins or loses.

Socialism for the very rich, it works!

Part the Sixth:  The Abundance Agenda and The Quiet Divide.  Abundance is all the rage these days.  I am not going to get into this at length because an assembled book from Ezra Klein that has been blurbed by David Brooks, Fareed Zakaria, and the Wall Street Journal (not that there is anything wrong with the WSJ outside of the editorial page) is best left for the Remainder Table.  This essay by the Oregon farmer Ben Henson at Front Porch Republic seems a better place to consider Abundance:  The Quiet Divide: The rift isn’t just about politics. It’s about pace, and place, and respect.  This piece is long, so you might need that cup of coffee when you have time.  And an open mind, because in places his message may cause friction.  But without friction there can be no movement and without movement, no progress.

As someone whose work is closely connected to the revitalization of our rural spaces, which provide much of what we need for the good life, Mr. Henson makes his case well, as in Section III of XII Are third graders taught Roman numerals anymore, as of today, VI/XX/MMXXV? Never mind:

III. The Stories Behind the Numbers

If you just look at the data, rural America doesn’t make a lot of sense. Lower incomes. Higher poverty rates. Less formal education. Fewer services. And yet—many of us stay. Not because we’re stuck. Not because we don’t know any better. But because there’s something here that doesn’t fit in a spreadsheet.

You want to talk about poverty? Alright. But define it first. Is poverty not having a lot of money, or not having anyone to call when your truck won’t start in the dead of winter? Because I know which one I’d rather live with.

But if you really want to talk about wealth, let’s start by asking what it actually means. Because out here, it’s not about income brackets or net worth. It’s about the air we breathe and the land we walk. I’ve got clean air, a river full of fish ten minutes from my house, and quiet trails where I can walk for miles and see elk, deer, maybe even a bear—but not another person. I’ve got wheat fields that ripple like water when the wind blows through, and mornings where the frost makes everything sparkle before the sun burns it off.

That’s not poverty. That’s a full life.

In town, I stop by the parts store and the owner knows my name. We talk about what’s going on—who needs help, who got married, who’s calving late this year. I walk into the bank and no one asks for ID because they’ve known me for twenty years. If I go into the hardware store, I’ll see a neighbor or a workmate. And if something breaks, someone shows up with tools before you’ve even called.

That’s wealth too.

We have kids who’ll mow lawns for a few bucks and feel proud of the work. Neighbors who check on each other when the power’s out. A quiet confidence that if you need something, someone will lend it—or help you build it. It’s not just the farms that hold value. It’s the towns too. The kind of places where you still get a wave from every passing pickup, and where nobody stays a stranger for long.

And yes, money matters. Of course it does. More and better jobs are a good thing. Economic opportunity is important. But not at the expense of what makes rural life rich in the first place. We’re not trading a life that fills our days with meaning for a paycheck and a parking garage. We’re not leaving land we know by heart for cities that promise more—but ask us to give up the very things that define who we are. Out here, we don’t measure success in dollars. We measure it in freedom, beauty, connection, and capability. And by those measures, we’re doing just fine.

Urban life can have exactly the same meaning, if we make it our goal.  I see this every day in my small city, where neighbors still exist in my neighborhood full of old houses.  Our connections may be frayed, but they are not beyond mending, person to person and place to place, one at a time.

See you next week, and thank you, again, for the opportunity to visit for a while.