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

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

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it’s hard to ignore the impression that some of the company valuation is linked to a cult of personality.Elon has not repealed the law of gravity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,

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,

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

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

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

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

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

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

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

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:

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

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

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

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

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

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,

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

To follow up on an earlier post on the future of artificial intelligence, AI has been making serious inroads in radiological imaging for a while. Unsurprisingly, histological imaging is the next frontier, and AI is conquering that as well.
A subset of lung cancer patients will see metastatic spread to their brains. A recent study reports that deep learning algorithms can distinguish which cancers will, and which won’t, metastasize to the brain based on histology of primary tumor sections. Furthermore, the computer predictions are more accurate than trained pathologists. From the abstract:
“The DL algorithm results were compared to a blinded review by four expert pathologists. The DL-based algorithm was able to distinguish the eventual development of

Noah Smith has a blog post arguing that AI won’t take away all the jobs from humans. It’s a clever and well-written post that deserves your attention.Here are some money grafs:“So as AI gets better and better, and gets used for more and more different tasks, the limited global supply of compute will eventually force us to make hard choices about where to allocate AI’s awesome power. We will have to decide where to apply our limited amount of AI, and all the various applications will be competing with each other. Some applications will win that competition, and some will lose.“This is the concept of opportunity cost — one of the core concepts of economics, and yet one of the hardest to wrap one’s head around. When AI becomes so powerful that it can be

Apparently, the National Association of Realtors has agreed to eliminate rules on commissions.“The NAR, which represents more than 1 million Realtors, also agreed to put in place a set of new rules. One prohibits agents’ compensation from being included on listings placed on local centralized listing portals known as multiple listing services, which critics say led brokers to push more expensive properties on customers. Another ends requirements that brokers subscribe to multiple listing services — many of which are owned by NAR subsidiaries — where homes are given a wide viewing in a local market. Another new rule will require buyers’ brokers to enter into written agreements with their buyers.”Some predictions are that commissions will fall by 25-50%,

If nothing is done, the Social Security Trust Fund is currently projected to run out in about 2033. At that point, projected benefits will fall by about 20%.The Boston Globe has an opinion piece about the coming Social Security crisis/crunch. It talks about how Canada deals with the problem. I have a subscription and so don’t know if the link below is paywalled, but here are the nut grafs:“Mechanically it works as follows. Every three years, Canada’s Chief Actuary estimates the minimum contribution rate required to finance benefits over 75 years. If this required rate exceeds the current rate — and if policy makers cannot agree on a fix — the backstop kicks in. Contribution rates are then automatically increased by 50 percent of the difference between

I thought this might make a fun follow-up on my post on 8th grade algebra. Over at jabberwocking.com, Kevin Drum discusses a proposal to make a semester of financial literacy a high school graduation requirement. He feels that this would fill a much-needed gap:“There are no long-term tests of financial literacy that I can locate, and overall financial indicators aren’t flashing any red lights. Over the past few decades, both mortgage delinquency and credit card delinquency are down. Retirement accounts are up. Installment loan balances are down. Foreclosures and bankruptcies are down. Savings are up. Overdrafts are down.”Drum addresses the trend lines. That tells you where we are relative to where we were, but are the current levels of these metrics

According to legend, King Canute tried to order the tide not to come in. Needless to say, he failed, divine rights of kings nonwithstanding.Back when we lived in North Carolina, we visited the Outer Banks a few times. There were many expensive homes on the shoreline. These were often casualties of hurricanes that would push ocean water up over the islands. Then, as the hurricanes moved up the coast, water that had been pushed into Pamlico Sound would rush back over the island. The Outer Banks were subject to constant erosion. I never understood why anyone would invest in a house there and why any insurance company would sell insurance on it.Now, it seems that property owners along Salisbury Beach MA squandered $600,000 after throwing 15,000 tons of

I took Algebra I in 8th grade. Algebra I and typing were the two classes I took in junior high that I can say I have used regularly for the rest of my life (so far).In the school system I was in, there was tracking. Some kids got to take 8th grade Algebra I. The rest took regular math. The ones who took Algebra I in 8th took Geometry in 9th, Algebra II and Trig in 10th, advanced pre-calculus in 11th and Calculus in 12th. I got off that bus after 10th grade and took regular pre-calculus in 11th grade, then probability and statistics in 12th, along with a full year of computer programming.I took four quarters of calculus in college and never used any of it outside of the exams for the courses. I took college physics that didn’t use calculus. I took

I grew up with the admonition that you always turn off the lights if you’re the last to leave the room. Or “close the lights,” as my grandma used to say. But home lighting technology has evolved considerably over the past couple of decades.1. Does it save money to turn out the lights when you leave the room?2. Does it shorten the life of the bulb by turning it off and on more frequently?If you have LED lighting, the answers are (1) not enough to notice and (2) not at all.A little more detail, courtesy of the NYT:1. “You could have a dozen of LED bulbs going 24/7, and they would still consume less energy than what a typical fridge uses in a day,”2. “The technology that makes LEDs glow is completely different than that of traditional incandescent bulbs,

This post uses material that a Facebook friend posted. I re-post it here with her permission.Any provider that uses a Billing Software (that has Change HealthCare integrated in their system as the main clearinghouse) can’t get claims to insurance companies once they medically bill for something/services in their software. Change Healthcare is the ‘bridge’. The claim goes from the provider, over the bridge, to the insurance company. Then once the claim and payment process, it comes back over the bridge and dumps into the software.The bridge has been blown up.Aside from not being able to get stuff over, there is a lot of money and explanation of payment/benefits that aren’t coming into the Billing Software from previous cut-off/adjudication cycles..

When we moved to Missouri in 1982, it was a purple state. In the last decade, it has become progressively more extreme right-wing. Now, in Missouri and more than 30 other states, each citizen is their own well regulated militia with the powers of judge, jury and executioner. Law-abiding citizens become collateral damage with no consequences. Sad.“The man accused of firing the first shots at the Kansas City Chiefs Super Bowl rally told authorities he felt threatened, while a second man said he pulled the trigger because someone was shooting at him, according to court documents.“Experts say that even though the shooting left one bystander dead and roughly two dozen people injured, 23-year-old Lyndell Mays and 18-year-old Dominic Miller might have good

Over at jabberwocking.com, Kevin Drum takes on Paul Krugman over his assertion that small-town America is aggrieved because the working-age men are more likely to be unemployed than their metropolitan counterparts. As usual, Kevin brings the charts and numbers to show that while Krugman isn’t wrong, the differences are small and don’t explain “white rural rage.” Kevin notes that while pay is less in rural areas, the difference is mostly compensated by the lower cost of housing.So whence the grievance and anger? Kevin points the finger at right-wing media:“So what’s really going on? I’d guess that part of the answer is economic, but not at the individual level. Main street shops have gone away. Rural hospitals have shut down. The nearest doctor may be