I've worked in healthcare, and pretty much my whole family does in all the professional roles you can think of.
I have mixed feelings about this article and others like it because the motivation to strip the system of everything until profit is left is a serious problem throughout US healthcare. However, it's not unique to private equity — private regional monopolies, or even privately owned clinics and hospitals, can have a similar effect. These articles then have a way of shifting the focus away from the underlying administrative practices that result in these problems, and toward private equity per se.
The regulation problem is real too, and I can give lots of examples. It's unlike a lot of other fields too in the scope and how ingrained it is in the system. EHRs are just one example: although well-intended, they were mandated with no "organic" roll-out, and pulled what was in-house staff and services and pushed it outside into large monopolies like EPIC (who are now the subject of an antitrust lawsuit IIRC). This happens over and over with all sorts of aspects of US healthcare.
I also have problems with the focus of these types of articles — for whatever reason, they often start with or are centered around this kind of wistful new physician (or very old physician near retirement) longing for the romanticized old days where physicians were in charge and ran everything. Should that be the case though? Do we really need MDs to do and approve of everything? Aren't there things that are done as well by PAs, DNPs, and other types of providers that don't even exist yet because of how calcified the healthcare system is? Can't patients do more at home without a middleperson — e.g., needing to approve of some medication that the person has taken for decades without incident and is really truly pretty harmless in the grand scheme of things?
The problem you described is very real. It's overregulated, in ways that incentivize large monopolies, either of clinic and hospital owners, or provider rent seeking guilds, infrastructure providers, etc.
I guess I feel like these types of articles point to one type of problem, but then tend to implicitly suggest the solution is to just roll back time to some earlier era, not recognizing that that earlier era had a smaller patient population, with less regulation, less monopoly where there was no need to scrutinize whether a certain type of degree is really necessary, where there weren't huge hidden overhead costs of all these monopolies permeating down to the patient.
Fixing US healthcare is going to require a bunch of things that collectively will cause pain for a lot of entrenched players: lots of antitrust lawsuits and laws, lots of deregulation aimed at giving patients more choice and self-care options, more public payer options, lots of eliminating or restructuring licensing requirements to create more types of providers, and so forth. They don't map on easily onto current US political party platforms either.
This is where it gets murky. The algorithm could also recover a group without labeling anything — "Latent Group 7539".
Even then, how do you know the algorithm is recommending something "because" of the unlabeled sexual orientation class per se, and not because of some closely associated latent class?
MI always seems to me like a backup, a pragmatic substitute to get around software limitations or lack of an inferential framework that can handle missingness.
I think there's a continuum of good versus bad faith motivation in any discussion anywhere. The problem on social media I think is twofold: first, you often don't know where on that continuum things are because you might not know enough about who you are interacting with or why, and second, when you do know who you're interacting with, the public nature of the discussion incentivizes performative aims with regard to other possible readers, rather than working through some argument with you and the other person in particular.
Any argument has some aim I think, and it's often implicit. It may be to achieve some aim that depends on the other person, or it may be to repair a relationship, or it might be to inflict some outcome in an organizational setting, it may be to work out something in your head, or it may be to convince bystanders of a position.
Sometimes you end up with bots, sometimes you end up with PR people, sometimes you end up with highly politically motivated people, sometimes you end up with people who are trying to sell their own book or paper or whatever. You just don't know and even though I do think a lot of people — maybe most — are acting in very good faith, some of them are not, and it varies in degree.
I also think social media systems are fundamentally broken at the moment, and ideally we should be moving to highly decentralized and/or federated platforms. That's a slightly different issue probably but maybe not — I think the subtle aims of platforms tend to trickle down into this too, and nudge different types of behaviors. In any given case it might be a tiny effect, but it accumulates I think.
"Over the weekend, MV Ruby was also denied access to the Strait of Denmark, the entrance to the Baltic which would have allowed it to offload its dangerous cargo at a Russian port.
According to Danish news reports, on Friday a pilot was to be allocated the following day, but when the time came, authorities appeared to have changed tack.
'The ship is not going to have a pilot tonight, and the latest I’ve heard is that it’s in Norwegian waters,' DanPilot press officer Anne Heinze told DR Nyheder over the weekend.
Instead, MV Ruby is apparently making its way toward the Channel, with Malta-flagged anchor handler Amber II maintaining a distance of around one kilometre...
Though the vessel was able to limp some 1,600km around the Norwegian coast, it now faces a fraught voyage through the Channel, past Spain and the Strait of Gibraltar and onward to Malta through two of the world’s busiest shipping lanes.
And there are few good choices ahead for the vessel’s crew: should MV Ruby sink, the cargo will likely cause enormous environmental damage, including algal blooms which choke swathes of ocean life, and could lead to a shipping exclusion zone to contain the spread of pollution."
There's evidence that the turning point was in the 90s but I suspect the real underlying problem is indirect funds as a revenue stream for universities, combined with the imposition of a for-profit business model expectation from politicians at the state and other levels. The expectation changed from "we fund universities to teach and do research" to "universities should generate their own income", which isn't really possible with research, so federal funding filled the gap. This lead to the indirect fund firehose of cash, pyramid scheme labs, and so forth and so on. It sort of became a feedback loop, and now we are where we are today.
Translational research is probably part of it but I think it's part of a broader hype and fad machine tied to medicine, which has its own problems related to rent-seeking, regulatory capture, and monopolies, among other things. It's one giant behemoth of corruption fed by systemic malstructurings, like a biomedical-academic complex of problematic intertwined feedback loops.
I say this as someone whose entire career has very much been part of all of it at some level.
Good points, thanks. As I’m sure you’re aware, the indirect rates at some universities are above 90%. That is, for every dollar that directly supports the research, almost another dollar goes to the university for overhead. Much of this overhead is legitimate: facilities and equipment expenses, safety training, etc… but I suspect a decent portion of it goes to administrative bloat, just as much as the education-only part of the university has greatly increased administrative bloat over the last 30-40 years.
Another commentator made a separate point about how professors don’t always get paid a lot, but they make it up in reputation. Ego is a huge motivator for many people, especially academics in my observation. Hubris plays no small part in the hype machine surrounding too many labs.
I love the islands in northern Lake Michigan, especially the line that goes from Washington Island in WI to Rock Island north to St. Martin and then to Summer Island. It's always seemed so remote. I assume these are the "Huron Islands"? I've never seen them referred to as such and when I search for them I get links to islands in Lake Superior, which are also interesting but not the same.
I'm interested in the book now. Even if it turns out not to be the Griffon, it's an interesting story.
The fundamental problem imho is that standardized tests, which start out as well-intended, start to replace actual skills as a focus of interest. This is especially problematic when the tests are only correlated 0.1-0.4 with whatever is actually of interest. The tail starts to wag the dog.
One common example of this is in policy discussions about the tests, where figures tend to only present means, with no variances or scatterplots. I remember this, for instance, from a report at Dartmouth not too long ago arguing for the use of standardized tests, where the authors only presented means, and not the huge variances around them which is really the heart of the issue.
It starts to become especially problematic when people get canalized into lifetime paths based on essentially invalid measures, especially when the targets themselves are changeable. "Meritocracy" starts to become sort of a misnomer at that point.
Of course, relying on anything too heavily starts to be an issue, and tests are a source of information. But when you start to overrely on anything, or rely on it to an extent that is empirically unwarranted, you start to have problems institutionally and societally.
Given all the suppression and secrecy that was going on at the time of the outbreak, I'm never sure what to make of studies like this. It's impressive in how detailed it is but it's also been years and there's so many variables that could come into play.
The article even states that it "has been proposed that humans could have introduced the virus into the Huanan market. It is most likely that there were human infections of SARS-CoV-2 earlier than the first documented and hospitalized market cases, including unascertained market cases or contacts thereof."
Also, "The detection of SARS-CoV-2 RNA in the Huanan market in January 2020 could plausibly reflect deposition several weeks before sampling, compatible with estimated dates of the first human infections."
The authors have counterpoints but I sort of feel like anything is on the table at this point, and I'm not sure I find their counterpoints convincing.
In general, these epidemiological/public health-type studies of COVID19 origins have this tendency to assume a zoonotic origin, or a typical "natural origin" and then proceed accordingly, rather than to acknowledge it's one of many possible scenarios, and then proceed from that. For just one example, they add in their counterpoints "any hypothesis of COVID-19’s emergence has to explain how the virus arrived at one of only four documented live wildlife markets in a city of Wuhan’s size at a time when so few humans were infected." But this really should say "when so few humans were publicly known to be infected." It also assumes the data itself is sound, even though it is based on data first publicly published on in April 2023.
I suspect they take this approach because to consider the full range of options leads to too much uncertainty they can't address.
I hate being so skeptical but there's so much to be suspicious about, including the cover-ups by Daszak and colleagues, the Chinese government, American governmental institutions, and just the sheer amount of time that went by with nothing happening despite the historical import of this virus. It doesn't appear that people who were in a position to do anything about figuring out where the virus came from really wanted to know.
I've worked in healthcare, and pretty much my whole family does in all the professional roles you can think of.
I have mixed feelings about this article and others like it because the motivation to strip the system of everything until profit is left is a serious problem throughout US healthcare. However, it's not unique to private equity — private regional monopolies, or even privately owned clinics and hospitals, can have a similar effect. These articles then have a way of shifting the focus away from the underlying administrative practices that result in these problems, and toward private equity per se.
The regulation problem is real too, and I can give lots of examples. It's unlike a lot of other fields too in the scope and how ingrained it is in the system. EHRs are just one example: although well-intended, they were mandated with no "organic" roll-out, and pulled what was in-house staff and services and pushed it outside into large monopolies like EPIC (who are now the subject of an antitrust lawsuit IIRC). This happens over and over with all sorts of aspects of US healthcare.
I also have problems with the focus of these types of articles — for whatever reason, they often start with or are centered around this kind of wistful new physician (or very old physician near retirement) longing for the romanticized old days where physicians were in charge and ran everything. Should that be the case though? Do we really need MDs to do and approve of everything? Aren't there things that are done as well by PAs, DNPs, and other types of providers that don't even exist yet because of how calcified the healthcare system is? Can't patients do more at home without a middleperson — e.g., needing to approve of some medication that the person has taken for decades without incident and is really truly pretty harmless in the grand scheme of things?
The problem you described is very real. It's overregulated, in ways that incentivize large monopolies, either of clinic and hospital owners, or provider rent seeking guilds, infrastructure providers, etc.
I guess I feel like these types of articles point to one type of problem, but then tend to implicitly suggest the solution is to just roll back time to some earlier era, not recognizing that that earlier era had a smaller patient population, with less regulation, less monopoly where there was no need to scrutinize whether a certain type of degree is really necessary, where there weren't huge hidden overhead costs of all these monopolies permeating down to the patient.
Fixing US healthcare is going to require a bunch of things that collectively will cause pain for a lot of entrenched players: lots of antitrust lawsuits and laws, lots of deregulation aimed at giving patients more choice and self-care options, more public payer options, lots of eliminating or restructuring licensing requirements to create more types of providers, and so forth. They don't map on easily onto current US political party platforms either.
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