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Joel Eissenberg



Articles by Joel Eissenberg

Crocodile tears

7 days ago

Here’s Jerome Adams, MD, former Surgeon General, now outraged at the absurdity that is the American “healthcare” system:“Numerous Americans have found themselves ensnared in analogous predicaments while seeking medical attention, as evidenced by the myriad stories shared in response to my tweet. The opacity surrounding healthcare pricing makes it difficult for patients to ascertain the cost of their care upfront, engendering bewilderment, frustration, and financial distress when confronted with unexpected bills. Although the No Surprises Act (NSA) was passed to address just this issue, its implementation (beginning in 2022) has been contentious and some hospitals are still not in compliance.“In my case, had I been aware that I would be charged $10,000

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Tax the rich!

8 days ago

I was a graduate student in a STEM program when Reagan was elected and the Laffer curve was used to justify tax cuts. The problem that immediately stood out to me at the time was that neither the ordinate nor the abscissa in the Laffer graph had scales, so it was impossible to assess where, exactly, the inflection point occurred. Based on the symmetrical drawing, we’re meant to infer that a 50% tax rate is the point after which government revenue would fall, but Laffer wasn’t even willing to support that inference by showing the scale on the X axis!From the Wikipedia page on the Laffer curve:

” . . . however, the curve might not have only a single peak, nor must it peak symmetrically at whatever value maximizes tax revenue. . .”The Laffer

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Oh, Elon!

10 days ago

My wife drives a 21 year-old Pontiac Vibe (= Toyota Matrix). It could fail at any time, and the question of what she’ll replace it with is on our minds. EV or hybrid? I personally know some Tesla owners who are happy with their choice, but I remain concerned about range and charging stations. Thanks, Elon, for warning me off EVs!“The day before Elon Musk fired virtually all of Tesla’s electric-vehicle charging division last month, they had high hopes as charging chief Rebecca Tinucci went to meet with Musk about the network’s future, four former charging-network staffers told Reuters.“After Tinucci had cut between 15% and 20% of staffers two weeks earlier, part of much wider layoffs, they believed Musk would affirm plans for a massive charging-network

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Is China eating our EV lunch?

16 days ago

We are not the typical American car buyers. In 40 years, my wife and I have owned exactly five cars, two of which we still drive: one is 21 years old and just ticked over 100K miles, while the other is 10 years old and will soon hit 50K. But who knows how much longer the 21 year-old Pontiac Vibe will last? When it dies, we’ll consider an EV or hybrid. There are certainly a lot of Teslas on the road, and there are other EVs that are cheaper than Teslas. The future of EVs looks pretty bright. But apparently, the Chinese are leading the way. From a recent review:“I spent a week in China for the Beijing Auto Show, the country’s biggest car industry event. As a guest of the Geely Group along with a few other international journalists, I drove more than a

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Social Security and Medicare updates

20 days ago

Since many AB readers are either retired or about to be:“Looking solely at the trust fund that covers retirement and survivor benefits, Social Security will only be able to afford scheduled payments in full until 2033, roughly the same projection as last year. At that time, the fund’s reserves will be depleted, and continuing income will only cover 79% of benefits owed.”*snip*“As for Medicare, its hospital insurance trust fund, known as Medicare Part A, has a few more years before it runs dry. But in 2036, Medicare will only be able to pay 89% of total scheduled Part A benefits, which also cover hospice care, short-term skilled nursing facility services and home health services following hospitalizations.”Don’t look for the current GOP Congress to act.

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Economics of long-distance travel

22 days ago

A comment on an AB thread recently reminded me that I needed to update my understanding of the economics of long-distance travel by plane vs car:“In 1970, flying was twice as energy intensive as driving, but that has reversed. In 2012, the most recent year counted, driving one person one mile took 4,211 BTUs, while flying required just 2,033.“The numbers for driving are based on the average fuel economy of all light-duty vehicles (that’s passenger cars, SUVs, pickups, and vans, which averaged 21.6 mpg), using data from the US DOT. Sivak counted only cars with internal combustions engines—no plug-in hybrids and EVs, which comprise less than 1 percent of the American fleet. The flight figures count major, large national, and large regional airlines,

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One born every minute

April 25, 2024

And the grift goes on:“Jerry Dean McLain first bet on former president Donald Trump’s Truth Social two years ago, buying into the Trump company’s planned merger partner, Digital World Acquisition, at $90 a share. Over time, as the price changed, he kept buying, amassing hundreds of shares for $25,000 — pretty much his “whole nest egg,” he said.“McLain, the tree service owner in Oklahoma, said he believes the stock could “go to $1,000 a share, easy,” once the media stops writing so negatively about it and the company works through its growing pains. The company’s leaders, he said, are being “too silent right now” amid questions about the falling share price, but he suspects it’s because they’re working on something amazing and new.“McLain is an amateur

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It’s a start

April 24, 2024

In many capitalist European countries, college students do not have to pay tuition fees out of their own pockets. Here in America, most students have to fund their own college costs, which for many students means student loans. Whether or not they complete the degree, student loan borrowers can’t discharge these loans through bankruptcy.Of course, college isn’t free in Europe, it’s paid for by taxpayers. Presumably, those countries believe the benefits of an educated citizenry repays the investment. I guess Americans don’t.But in Massachusetts, they’re taking a small step towards the European model. MassReconnect offers free community college to any student over the age of 25:“Less than a year after the Healey administration launched the program,

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Managing risk

April 22, 2024

Decades ago, the artificial sweetener cyclamate was banned because it caused bladder cancer in rats. Later, it turned out that this was an artifact of (1) the tendency of cyclamate to form a precipitate with the male rat urinary globulin in the bladder, which leads to inflammation and promotes cancer, and (2) the fact that experiments were only done with male rats. Are cyclamates dangerous for humans? Who knows? The lesson here is not that we should ignore animal testing. The lesson is that we should be careful about extrapolating from animal testing.It has long been known that acrylamide, a neurotoxin and possible carcinogen, is generated by ordinary baking and frying. Studies in rat cells and whole rats implicate acrylamide in DNA damage of the sort

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Credit where credit is due

April 21, 2024

Look, Mike Johnson is a right-wing Christianist theocrat, but he did the right thing on Ukraine aid. I get it. This was partly a power play on his part to show that he, and not MTG, is in control of the House. And if the deal was that Democrats will vote against a motion to vacate in return, I’m OK with that transaction. Mike Johnson and the politics of compromise
Tags: Mike Johnson, the politics of compromise, Ukraine aide

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The dose makes the poison

April 20, 2024

When I was growing up in East Tennessee in the 1960s, there was a local grocery chain owner and right-wing politician named Cas Walker who railed about, among other things, water fluoridation. Water fluoridation was alleged to be a communist plot. If so, then God must be a communist, since water in some parts of the country is naturally fluoridated. In fact, that natural fluoridation, and its correlation with lower incidence of tooth decay, helped lead to the widespread use of artificial fluoridation.“The CDC maintains that community water fluoridation is not only safe and effective but also yields significant cost savings in dental treatment. Public health officials say removing fluoride could be particularly harmful to low-income families — for whom

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On student loans

April 16, 2024

Most students who attend medical school in the US do so with student loans. Yes, some have military scholarships and some have wealthy parents, but most don’t. I’m guessing that most students reckon they’ll easily pay off the loans with the income that an MD or DO degree commands, and so far, they’ll be right.But the immensity of these loans has negative externalities. Here are two:1. It affects the residency choices of graduates. Students with large loans (not just med school but college loans) are incented to choose highly compensated specialties like surgery, dermatology, cardiology and ophthalmology and not the less well-compensated fields of family medicine, pediatrics and geriatrics;2. It affects decisions about whether to promote academically

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Trump’s “Truth” Social meme stock plummets

April 15, 2024

I’m an investor, not a gambler, so I don’t own cryptocurrency, NFTs or shares in “Truth” Social. So the news that investors in DJT are being taken to the cleaners doesn’t faze me. “Shares of Trump Media plunged more than 15% on Monday after the company filed to issue millions of additional shares of stock.“Trump Media’s dramatic slide came as Donald Trump sat in a Manhattan courtroom for the start of his criminal trial on hush money-related charges. Trump is the majority stakeholder in the company.“Trump Media, which created the Truth Social app and trades under the stock ticker DJT on the Nasdaq, fell nearly 20% last week.“Since the company began public trading on March 26, its share price has fallen more than 62%, from an opening price of $70.90

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Tesla and the law of gravity

April 15, 2024

OK, Tesla isn’t Bitcoin and it isn’t Trump’s Pravda Social, but: “Tesla announced to Gigafactory Texas employees that it will shorten Cybertruck production shift amid rumors that it is preparing a round of layoffs.“We received several reports today from Tesla employees hearing rumors of an important round of layoffs happening this week at the company.“Some of them are talking about layoffs as high as 20% of the workforce, which would mean tens of thousands of employees.”Yes, Tesla actually makes something tangible, so it’s not just NFTs on wheels, but it’s hard to ignore the impression that some of the company valuation is linked to a cult of personality.Elon has not repealed the law of gravity
Tags: layoffs,

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The actual cost of college in America

April 12, 2024

I’m seeing the usual hyperventilating about college tuition. Look, there’s a lot of competition, particularly among the more competitive universities, to post exorbitant sticker prices for tuition because it makes them look valuable. The reality is that college tuitions are steeply discounted and most domestic students get “scholarships” that reduce the actual cost. “ . . .the actual cost of college for a family with an income of $100,000 has increased 16% since 1995 and hasn’t increased at all since 2007. This doesn’t change until your income exceeds $150,000. All of this is adjusted for inflation.

“The Brookings data shows a higher increase for public universities, but that’s because they include room and board. If you look at tuition and fees,

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How much should a life-saving drug cost?

April 12, 2024

My former chairman used to tell the story of when he was a resident on rounds in the 1950s, he would hear a pounding sound in some of the patient rooms. When he looked in to discover the source, it was a nurse pounding the back of a patient who was stretched across the bed with his/her head hanging over the edge. The nurse was trying to dislodge the mucus in the lungs of the patients, who had cystic fibrosis. While cystic fibrosis is a multisystem genetic disorder, the main life-threatening complication is pulmonary infections caused by a build-up of secretions in the lung.Enter Vertex, a Boston-based pharma company with a three-drug cocktail called Trikafta to treat cystic fibrosis. Trikafta works for about 90% of cystic fibrosis patients. Its

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The semaglutide camel’s nose under the Medicare tent

April 9, 2024

Obesity is a risk factor for cancer, heart disease stroke and diabetes. Thus, drugs like semaglutides (Wegovy, Ozempic) don’t just reduce weight in the obese, they also reduce risk of cancer, heart disease, stroke and diabetes, which are huge health care burdens. It’s good to see that Medicare is finally coming to grips with this obvious fact:“On March 8, 2024, FDA approved Wegovy (semaglutide) to treat cardiovascular disease risks — heart attack, stroke, and death — for obese or overweight adults with a history of cardiovascular disease, making it the first anti-obesity medication (AOM) to obtain such approval. Studies show that semaglutide reduces heart disease risks when accompanied by blood pressure and cholesterol management and healthy lifestyle

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Small scale carbon capture

April 9, 2024

EVs are certainly proliferating, not only here in East Providence but all over the planet. However, Hertz’ retreat from the rental market demonstrates the challenges facing companies with large fleets of vehicles.Hertz cuts EV fleet by a thirdTrucking companies have a lot invested in their diesel engine-powered truck fleets, and of course, many trucks are owner-operated.Enter Remora. Named after fishes that hitch rides on whales, sharks, rays, turtles and small boats, Remora builds devices that mount on the back of a truck, attach to the tailpipe and capture carbon emissions while driving. The driver offloads captured and compressed CO2 while refueling and the CO2 can then be sold or sequestered underground.In this way, an existing fleet of diesel

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Next generation mRNA vaccines

April 6, 2024

In 2020, I was a subject in the Moderna phase III trial for their COVID mRNA vaccine. At the same time, Pfizer-BioNTec trialed a similar mRNA vaccine. Both mRNA vaccines proved highly successful. In both cases, chemically modified mRNA encoding the SARS-CoV-2 spike protein is injected, programming cells that receive the mRNA to produce and secrete spike protein until the mRNA decays.Now, a innovative self-amplifying mRNA vaccine has been approved in Japan has been developed that requires far less modified mRNA:“Self-amplifying mRNA vaccines contain a gene that encodes the spike protein as well as viral genes that code for replicase, the enzyme that serves as a photocopier. So one self-amplifying mRNA molecule can produce many more.”This

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About grocery inflation

April 4, 2024

Kevin Drum has a timely post on grocery inflation. Overall, it’s at 1% now.“Why do so many people still think inflation is high? It’s because they don’t respond to averages. They respond to outliers.”*snip*“Frozen juice is up 27%. Baby food is up 9%. Ground beef is up 6%. When you shop for groceries, these things are going to stand out.“Now, it’s also true that eggs are down 17%. Apples are down 10%. Fruits, vegetables, chicken, and dozens of other items have been flat. But you don’t really notice that. You notice the occasional item that’s way higher than it used to be.”Frozen juice inflation is due to citrus greening disease in Florida and a poor Southeast Asian sugar crop. Egg prices are about to go up since 1.6 million hens have been culled because

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What Social Security isn’t

April 4, 2024

There has always been a lot of misinformation and frank dishonesty surrounding Social Security. Here are three things that Social Security isn’t:1. A retirement investment. Social Security is insurance. It is not meant to be your sole source of income after retirement (although for many Americans, it basically is). Social Security is not a substitute for a pension or 401k, or for personal savings. But if some calamity befalls you and you lose your retirement savings, Social Security can keep you from having to starve under a bridge. Comparisons between Social Security and, e.g., index funds are specious.2. Broke or bankrupt. Even if the Trust Fund runs out in ca. 2033, Social Security will still pay nearly 80% of projected benefits. As long as there

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Tobacco without smoking

April 3, 2024

When I was in college, I took up pipe smoking. I particularly enjoyed Turkish Latakia tobacco, smoked through a long-stemmed church warden clay pipe. But shortly after I got married, my wife told me to stop.Smoking is a particularly dangerous nicotine delivery system. Nowadays, there is vaping, which some see as safer. It may well be, but “safer” isn’t the same as “safe.”“People who self-reported ever having used electronic cigarettes (e-cigarettes) were 19% more likely to develop heart failure within 45 months than those who reportedly never did (adjusted HR 1.19, 95% CI 1.06-1.35). This was not affected by factors such as patient age, patient sex, and cigarette smoking . . .”Vaping and heart failureAlso too, smokeless tobacco is seen as a safe

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Jim Crow and American medicine

April 1, 2024

I grew up in the American South as the end of apartheid. I remember the first Black kid who showed up in my 3rd grade and how the teacher prepared us for his arrival the day before. I remember the race riots of the ‘60s and I remember where I was when I learned MLK had been assassinated at the other end of the state.Yes, we’ve now had a two-term Black president (although his legitimacy was questioned by many, including the current GOP candidate for President), and segregated water fountains, lunch counters and public schools are a thing of the past. But racist anachronisms still prevailed in medicine, and their consequences are seldom remediated:“Jazmin Evans had been waiting for a new kidney for four years when her hospital revealed shocking news:

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Record wind and solar power generation in Germany. No foolin’.

April 1, 2024

When I think of the places on the planet that seem optimized for solar and wind power generation, I think of deserts like the Sahara and the desert Southwest in the US. And yet Germany is generating a growing share of its electricity through these renewables:“Preliminary data by energy market research group AG Energiebilanzen (AGEB) showed that onshore wind turbines produced a record 114.2 terawatt hours (TWh) in Germany in 2023, while solar PV produced a record 61.1 TWh.”Germany is far from a desert in climate and geography, but it is still feeling the heat from climate change:“In January, the DWD had said that 2023 also marked Germany’s hottest year since records began in 1881, warning that the country had to “take intensive action to protect the

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Is it live or is it ChatGPT?

March 31, 2024

It’s hard to keep generating fresh content every day for your edification and entertainment here at Angry Bear. The temptation is to use Chat GPT to do the heavy lifting, but so far, we’ve foresworn AI to rely on our own in-house I. If you begin to suspect that we’ve betrayed our readers, here are the ten most overused words by ChatGPT*1. Explore2. Captivate3. Tapestry4. Leverage5. Embrace6. Resonate7. Dynamic8. Testament9. Delve10. ElevateWhen these start to appear regularly, you’ll know the bots have won.*h/t Kevin Drum over at jabberwocking.comTen overused words by ChatGPT
Tags: Artificial Intelligence, ChatGPT

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Pharmacogenomics and drug safety

March 29, 2024

New drugs go through clinical trials before they can be marketed. Phase I trials are for safety. Phase II/III trials are for efficacy. If a drug fails these trials, it can’t be sold.One challenge to drug testing is trial enrollment. Ideally, the subjects should be demographically representative. The problem is that there can be significant variation among trial participants that is not reflected in sex, age or ethnicity.Drugs have a half-life in the body—they are eventually excreted. Some people are born with a genetic makeup that makes them “fast metabolizers” or “slow metabolizers.” Fast metabolizers may achieve lower steady-state levels of the drug in their bodies for a given dosage, making it look like the drug isn’t working. Slow metabolizers may

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You can’t fool Mother Nature

March 28, 2024

Back when we lived in Chapel Hill NC, we made a few trips to the Outer Banks where my wife had an uncle who built fishing boats in Buxton NC. Back then, nobody was talking about sea levels rising because of global warming and yet it was obvious back then (early 1980s) that these sandy beaches were ephemeral and the buildings that overlooked them were at risk. The iconic Hatteras Lighthouse had to be moved away from the encroaching ocean back in 1999.Now, the Boston Globe has a piece about the slow-moving spectacle of real estate price collapse on Nantucket and Martha’s Vineyard as the totally predictable beach erosion claws away those scenic beaches between the water and the houses overlooking them. As the article notes, sea levels rose eight inches

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Is this true?

March 27, 2024

Whenever Elon Musk says a thing, I reflexively mistrust it. So when I saw a video clip of Musk making this assertion, I wanted to think I learned something about the auto industry, but then I considered the source:“Large incumbent carmakers sell their cars at low to zero true margin. Most of their profit is selling replacement parts to their fleet, of which 70% to 80% are past warranty. Like razors & blades.”What say you, Bears? Is he correct?

Tags: Incumbent carmakers, profit margins on new cars

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Pig-to-human kidney transplant

March 21, 2024

There will never be enough human kidneys available to transplant all the patients in renal failure who are on dialysis. While there has been considerable interest in xenotransplantation (sourced, in this case, from pigs), the barriers to sustainable transplant have so far proved insurmountable: these include immune rejection and activation of cryptic viruses. Now, thanks to genome editing, those barriers may now be overcome:“The pigs whose organs were used . . . came from the same company that supplied the organ for Saturday’s operation, run by Cambridge-based eGenesis, co-founded by the famed Harvard geneticist and bioengineer, George Church. The company has used the CRISPR-cas9 gene-editing technology to make 69 adjustments to the pig genome,

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Intertoobs: good or bad?

March 20, 2024

Let’s just start with the acknowlegement that most of the internet is porn. Make of that what you will. I ignore it. For the residual, well, there’s Facebook. I haven’t been sent to FB jail recently, so I am favorably disposed towards it. I get all my news online these days, so I like it for that. And thanks to my university, I have access to all the published scientific literature (and other journals) online, just a couple of clicks away. Don’t have to go to the library. And I download books to my Samsung ereader via the intertoobs, which is great for me and makes money for booksellers. But that’s just me. What about all those people who aren’t me (IKR?)? Also too, what about teh kidz? Well, Kevin Drum has got you covered:“Nevertheless, to the extent

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