Throwaway05
32m ago
Yes I'm sure. Your linked quote is just filler words in an abstract, we know plenty about the pathophysiology of Schizophrenia with specific gene targets (although it is not fully understood), asking a question about the nigrostriatal pathway is a med student level question. It's likely appropriate to say that we have a better understanding of Schizophrenia than Parkinson's, and it's 100 percent appropriate to say we have better treatments. We understand Schizophrenia more than most of the dementia types (including the billions of dollars in research for Alzheimer’s). We understand Schizophrenia infinitely better than depression, which is why depression is a common topic when complaining about this.
Now do we understand it enough? No. We can reduce the risk of conversion from genetic risk to illness (ex: avoid weed) but not stop it, which would be the goal. But we can't also do that with Type 1 Diabetes or MS, and while we have an elevator pitch for what causes those now it's by no means a solved problem.
Schizophrenia in particular is unique in that the vast majority of cases are essentially a lifestyle disease problem - reducing morbidity and mortality is a matter of social solutions and ethics, the treatments are what we need already.
Throwaway05
49m ago
"He dunks on the woke" has been absurdly motivating for 10+ years. I don't think its rocket surgery, at least for our cohort.
Throwaway05
17hr ago
High-quality care involves things like doing nothing, prescribing lifestyle interventions, and therapy as a first line and sometimes only line.
I know this happens. It really does, but -
Corporate medicine disincentivizes this - most physicians are owned now and most patients show up expecting medication and get mad if they are told to exercise to fix their mild depression.
The traditional model for mild to moderate pathology is that you sit down with a psychiatrist for 90-120 minutes, they get to know you, they talk through what you are experiencing and they try and address things without medication. Most physicians prefer this.
The current corporate model is that you show up, have a 20 minutes appointment, say you are depressed and want it fixed, and get prescribed Zoloft.
That absolutely does work for some people but it isn't great and it's something physicians don't have much control over and they do complain about.
Throwaway05
17hr ago
The conversation about SSRIs is more complicated than just "such and such recent paper says X." But that's not the point. The point is that their is a variety of pathology in Psychiatry and the Psychiatry adjacent fields and focusing your thoughts on SSRIs and low severity pathology misses dementia, autoimmune encephalitis, schizophrenia, bipolar disorder, and so on.
If you are lucky all you have to think about is depression/anxiety/adhd/"autism spectrum" but that's not all the stuff!
Throwaway05
18hr ago
Ultimately the point is that the people complaining about the scientific state of mental health research don't really seem to know anything about the state of mental health research.
It's easy to grab one specific thing (commonly: the trans issue) and assume it's representative of the whole field but that isn't a fair conclusion nor is it accurate.
I see the same thing happen all the time with general medicine, people here often complain about their doctor being a barrier to the medication they want, and that's a topic, and a high frequency topic because outpatient medicine is a lot of medicine by number of patient encounters, but it's a very small portion of medicine by the number of jobs or specialties or research topics. Insight into that one specific issue does not provide a lot of experience with respect to the whole field.
Throwaway05
20hr ago
I’m still fiercely critical of the “medical model” of mental health, and find much in contemporary “therapy culture” that is deeply disagreeable to me.
Keep in mind that tens of thousands of experts in a variety of fields over multiple decades and many paradigm shifts are actually thinking about this and working on epistemic certainty.
Not every therapist is academically minded (and many types of degrees don't engage with this at all) but despite anti-psychiatry people the field is more scientifically minded then you might imagine but it rarely comes out in frustrated opinions by people who are mad that things aren't going the way they them to.
For instance for nearly a hundred years, there was a pipeline from Psychiatry to neurology. Once medicine understood the disorder better (for example, Alzheimer disease) it moved fields. This means that Psychiatry is naturally left with the less understood stuff.
However diagnostic entities like Schizophrenia are pretty well understood with clear medical shit (such as direct identification of neurotransmitters and pathways).
The more common and less severe things (such as simple anxiety and depression) are less understood but you better bet that experts in the field have a decent enough understanding of what's a severe biochemically mediated depression and what's more likely to be SLS (shit life syndrome).
These conversations and investigations happen they just don't make it to you.
Throwaway05
2d ago
How is everyone's experience with janitorial staff post-COVID?
I work in a hospital that any US physician would recognize by name but half the time I show up at work in the morning and the staff bathroom looks like a bomb went off. Thankfully clinical areas are better, but it's unacceptable. Is this one of the classic hospital problems or is stuff still shittier in say, the Google offices too?
Throwaway05
2d ago
Are you me??????
Throwaway05
4d ago
Listening to politics inside baseball podcasts,
Any recs? I listen to 2Way.
Throwaway05
4d ago
I sometimes see him on reddit posting. The fact that he is a troll is easier to spot when he's posting on PCM blatantly trolling.
Throwaway05
4d ago
A zombie and a resident are indistinguishable.
Throwaway05
6d ago
I really think LeGOAT makes the team amazing, regardless of what happens. We all know the best predictor of future behavior is past behavior - random embarrassing bullshit or injuries is inevitable. But.
I mean the NFL let Brady and to a less extent Mahomes get away with shenanigans, if the star wants to bring greatness to the league and cost the owners millions less dollars? They'll allow it.
Maxey is great.
Throwaway05
6d ago
Bron is still so fucking good. If the knees stay blessed Sixers are going to go all the way.
Throwaway05
9d ago
Well, this is why it's good to get a second opinion. Thanks. I guess all this culture warring really has made me too sensitive.
N+1
I'm pretty tuned to be instantly turned off by CW bullshit but I didn't really notice.
Throwaway05
9d ago
Thanks for this.
It does sound like the guy was involved in a shooting and injured prior to his retirement, he probably has PTSD from that incident even if it wasn't diagnosed. Maybe they'll work that angle?
Throwaway05
9d ago
They can reduce the bill but they don't have to, and even if it goes to a debt collecting agency thats going to show up on your credit etc. which if you are a person of wealth can be a problem.
Throwaway05
9d ago
You can but they don't have to do that, and if you have a lot to lose and can actually afford to pay that can become a problem.
Throwaway05
9d ago
My knowledge of this is less intimate than I'd like because most of my career involves decreasing autonomy and the hospital does shit in the background with little involvement from me, but it's usually pretty obvious that someone can't pay. You can ask for a payment plan or pretend to be homeless or whatever but you have to convince them if they are going to adjust.
As others note the amount they charge the insurance company isn't going to be the same amount they charge you (or the insurance company pays) but that's only mostly. Private equity run physician groups will be aggressive about seeking professional charges even if you are homeless or other similar things can pop up. The hospital can refuse to negotiate and does do that.
Throwaway05
9d ago
Interesting, I do appreciate this correction and the detail.
Do you have any guess as to why the charges were reduced then? (apologies if you have address this elsewhere).
Throwaway05
10d ago
In general the psychology seems to be the people you'd expect and people who are stressed, often because of work, close proximity, frustration at their commute and so on.
If you are a normie and don't live in a congested area it won't make visceral sense, but if you live in a congested area with shitty driving and crazy people making getting home hard, you should be able to get a whiff of the thing.
Throwaway05
10d ago
I mean its not truly a "freak accident" but one shot, it being fatal, while driving on a bridge is pretty unlucky for the victim. Just firing one shot also adds to the claim, should he make it.
Throwaway05
10d ago
I mean as far as I can tell from the available news about the case manslaughter is the appropriate charge, the shooter fired one shot in a moment of emotion and it can be credibly claimed to be a freak accident it hit the guy at all.
They should probably throw the book at him because supposedly the road rage was triggered by basically nothing, but inappropriate charges will just let him walk.
Throwaway05
10d ago
Since I’ll be paying cash I’d expect a lower rate than an insured patient.
This is true to some extent, but it's mostly about an ability to pay. If you can afford to pay you will pay.
With respect to injustice and a corrupt system, you'll be using insurance (ex: Medicare) when you are older, not self-insuring. That's what you are supposed to be subsidizing now. That would make you the corruption you are complaining about.
Throwaway05
10d ago
I really don't recommend this. If you are rich then you are likely advancing in age and therefore inevitable comorbidity. If you have kids they can have complications. Also, if you are rich they will make you pay if something expensive happens.
Maybe you get cancer. Maybe you get T-boned at an intersection by someone running a red light and then you end up in an ICU for 4 weeks followed by another 6 weeks of various step down care and end up with a 450k medical bill. Which they will make you pay if you can pay.
If a half a mill in medical debt doesn't make you blink then you can afford to just pay for the health insurance.
It's just not a good bet. Sure, you will probably be fine, but the level of catastrophe that can happen is immense, and just assuming it will never happen to you is not wise.
So what happens with the filibuster now? Just as the Republicans appear to have not learned what cost Harris the election, it seems likely the Dems will make similar mistakes this time.
Is killing the filibuster one of them? Is it a mistake?
Personally I feel like it would hasten the end of the union, but plenty of people will argue it will improve deadlock and they may even be right.
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