Culture of Cover-Ups: Implications for Pain?

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drusso

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Just started Original Sin book and it is outstanding--mostly confirming what many observers of the Democratic Cover-Up apparatus long-suspected. It hits hard, especially if you've been in the situation of seeing aging family members decline. I've also seen this phenomenon in medicine---aging KOLs and "policy makers" long out of touch with the realities of patient care, but still being enabled from positions of power by those around them...


"Just how much of this rigmarole was desperate rationalization versus deliberate scheming is never entirely clear. Tapper and Thompson identify two main groups that closed ranks around Biden: his family and a group of close aides known internally as “the Politburo” that included his longtime strategist Mike Donilon and his counselor Steve Ricchetti. The family encouraged Biden’s view of himself as a historic figure. The Politburo was too politically hard-nosed for that. Instead, its members pointed to Biden’s record in office and the competent people around him. The napping, the whispering, the shuffling — all that stuff had merely to do with the “performative” parts of the job.

Tapper and Thompson vehemently disagree. They offer a gracious portrait of Robert Hur, the special counsel who investigated Biden’s handling of classified materials and in his February 2024 report famously described the president as a “sympathetic, well-meaning, elderly man with a poor memory.” Biden and his team were incensed and tried “to slime Hur as an unprofessional right-wing hack,” but the authors defend his notorious line. They emphasize that it is incumbent upon a special counsel to spell out how the subject of an investigation would probably appear to a jury — and that what Hur wrote about Biden was true."

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There is nothing in Jake Tapper’s book that hasn’t already been glaringly obvious to anyone paying attention.

The Biden administration’s conduct represents a staggering level of deceit -approaching the criminal. It reflects terribly on his inner circle, especially his family (his wife mostly. That they enabled and perpetuated his exploitation for their own political and personal agendas is both shameless and morally bankrupt.

And the fact that Jake Tapper, one of the very people complicit in suppressing the truth, now presumes to cast himself as a chronicler of events rather than an active participant in the cover-up, is beyond parody. It’s an insult to the public’s intelligence and almost psy op level of gaslighting.

To your point about the pain world and KOLs… yeah. Prob true
 
So, who are the aging out-of-touch KOLs
 
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Biden’s aggressive prostate metastatic cancer raises the question if DRE should make it back to the yearly exam guidelines. Implications for Pain forum members?? Get that finger in there
 
Biden’s aggressive prostate metastatic cancer raises the question if DRE should make it back to the yearly exam guidelines. Implications for Pain forum members?? Get that finger in there
So you think he had a normal psa a year ago?
 
So you think he had a normal psa a year ago?
Sensitivity of the PSA level seems to be all over the place. Online docs are saying they can feel prostate nodules with a normal PSA level.

Anecdotally, a local urologist died fairly young of metastatic prostate cancer (66 yo and still practicing). I wonder if the DRE went away partly because we are not culturally comfortable with it.
 
no DRE went down because data suggests that they were not effective.


and PSAs are overused and do not not seem to correlate with mortality



finally, attaching "implications for pain" on a political post is just pandering.
 
joe biden's declining mental faculties and the cover up has no implications for pain.

if you want to make a political statement, do it in the politics forum

This kind of defensiveness is precisely what I'm talking about. There's a time and place for older leaders to step aside in politics and pain.
 
yes, agree. which is why he quit running for president/was forced out.


what about the other guy? why didnt he quit, as he is as incompetent as the former president was?
 
This kind of defensiveness is precisely what I'm talking about. There's a time and place for older leaders to step aside in politics and pain.
joe biden's declining mental faculties and the cover up has no implications for pain.
 
no DRE went down because data suggests that they were not effective.


and PSAs are overused and do not not seem to correlate with mortality



finally, attaching "implications for pain" on a political post is just pandering.
Talked to my friend the Urologist. Has a patient admitted for prostate CA. PSA normal, no exam until obstructed. It was sarcoma of prostate.
Get PSA and DRE. (I need my DRE)
 
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Annual palpated breast exams are no longer recommended either

I think doctors just don’t want to touch their patients anymore
 
Annual palpated breast exams are no longer recommended either

I think doctors just don’t want to touch their patients anymore
My tin-hat theory about this is so many "PCMs" are not physicians and not trained adequately to do these exams, so they changed the recommendations to limit liability for the supervising physicians.
 
Talked to my friend the Urologist. Has a patient admitted for prostate CA. PSA normal, no exam until obstructed. It was sarcoma of prostate.
Get PSA and DRE. (I need my DRE)
That's quite rare if you look into it (hence the recommendation against it).

Another issue is us PCP types just aren't good at picking up prostate nodules. This includes older PCPs who have probably done a thousand or more DREs checking prostates.
 
no DRE went down because data suggests that they were not effective.


and PSAs are overused and do not not seem to correlate with mortality



finally, attaching "implications for pain" on a political post is just pandering.
PSAs depend on which study you're using, there was a big European study that showed a pretty good mortality benefit. The AUA includes that one in their guidelines, the USPSTF does not.

That said, I don't know anyone who is still doing screening PSAs on 80 and older men. So Biden could have had a normal PSA at 79 and now has had 3 years of cancer growing in his prostate. Its unusual at his age but not impossible. Nice thing is the oncologists are doing amazing things with metastatic prostate cancer these days. I haven't had a patient die of this in the last 10 years and I've had at least a dozen with PSAs over 100 with bony mets.
 
Annual palpated breast exams are no longer recommended either

I think doctors just don’t want to touch their patients anymore
MRI is a noninvasive, risk free imaging study that can detect lesions before they are symptomatic.

But we're not supposed to get them because that might burden the "system"...
 
MRI is a noninvasive, risk free imaging study that can detect lesions before they are symptomatic.

But we're not supposed to get them because that might burden the "system"...
I mean, yes?

MRI machines are expensive. Running them is expensive. Maintaining them is expensive. The scans take a long time compared to every thing else. All of this makes getting/keeping an MRI expensive and harder to schedule since you can't run as many scans per day as say a CT.

You can buy an MRI and start using it yourself tomorrow if you can afford to buy one.

Not sure this is a hill worth dying on in your individualistic medicine crusade (and I don't mean that in a negative way, for what that's worth).
 
I mean, yes?

MRI machines are expensive. Running them is expensive. Maintaining them is expensive. The scans take a long time compared to every thing else. All of this makes getting/keeping an MRI expensive and harder to schedule since you can't run as many scans per day as say a CT.

You can buy an MRI and start using it yourself tomorrow if you can afford to buy one.

Not sure this is a hill worth dying on in your individualistic medicine crusade (and I don't mean that in a negative way, for what that's worth).
I can't buy an MRI scanner and offer it to people for cash because of the CON requirement in my state. As you know, CONs were mandated by Medicare in the past to protect the Medicare program. Some states have continued the protectionist practice.

At the end of the day, I have always said we need to separate socialized, population healthcare from a robust free market system. Instead what we have is a socialized system that suppresses and piggy-backs off an anemic quasi market system.

If we had a robust free market system, people would be getting MRIs and/or U/S at yearly screenings for reasonable cost and with intelligent guidelines to address findings.
 
I can't buy an MRI scanner and offer it to people for cash because of the CON requirement in my state. As you know, CONs were mandated by Medicare in the past to protect the Medicare program. Some states have continued the protectionist practice.

At the end of the day, I have always said we need to separate socialized, population healthcare from a robust free market system. Instead what we have is a socialized system that suppresses and piggy-backs off an anemic quasi market system.

If we had a robust free market system, people would be getting MRIs and/or U/S at yearly screenings for reasonable cost and with intelligent guidelines to address findings.
My state doesn't have CON laws anymore and no one is doing this.
 
I can't buy an MRI scanner and offer it to people for cash because of the CON requirement in my state. As you know, CONs were mandated by Medicare in the past to protect the Medicare program. Some states have continued the protectionist practice.

At the end of the day, I have always said we need to separate socialized, population healthcare from a robust free market system. Instead what we have is a socialized system that suppresses and piggy-backs off an anemic quasi market system.

If we had a robust free market system, people would be getting MRIs and/or U/S at yearly screenings for reasonable cost and with intelligent guidelines to address findings.
we will never get a robust free market system.

and pretty much any healthcare system that divides care based on their ability to pay is not a country you want to emulate.

heres a list of some of the countries that have no "financial" system for healthcare (which would mean free market):

1747742302280.png

from wikipedia.

fwiw, US in this chart was listed as mixed.

the "out of pocket" systems are listed as N/A.

there are 4 countries with private health insurance - Leichtenstein, Israel, Netherlands, Switzerland (which all have universal healthcare - for example Switzerland, the patient subscribes for healthcare, but if the patient cant afford, the government gives cash subsidy)

and you want the US to join one of these select groups .... huh.
 
we will never get a robust free market system.

and pretty much any healthcare system that divides care based on their ability to pay is not a country you want to emulate.

heres a list of some of the countries that have no "financial" system for healthcare (which would mean free market):

View attachment 403894
from wikipedia.

fwiw, US in this chart was listed as mixed.

the "out of pocket" systems are listed as N/A.

there are 4 countries with private health insurance - Leichtenstein, Israel, Netherlands, Switzerland (which all have universal healthcare - for example Switzerland, the patient subscribes for healthcare, but if the patient cant afford, the government gives cash subsidy)

and you want the US to join one of these select groups .... huh.
Give us some real data instead of something off Wikipedia
 
not comprehend the meaning of the post?

if the US were to go to a entirely free market economy, its healthcare would most likely devolve to those of Nepal, Guinea, Tajikstan, Seirra Leone, Angola, etc.
I don't think we are at the point where we can eliminate all government healthcare safety net programs. My argument has always been to SEPARATE the government healthcare safety net from a free market system, not to eliminate the safety net. For example, instead of using quasi government committees to set universal prices for healthcare services rendered by private enterprise, have strictly contained systems like VA and government funded HMOs while separately nurturing a robust free market system for those who can afford it. The critical factor is that government money should remain controlled and nonprofit.

Having said that, completely ELIMINATING the government safety net, and restoring and relying on charity in our country as a safety net would probably usher in a new age of enlightenment in our country.

We would not revert to 3rd world country status like Angola JFC lol.
 
not comprehend the meaning of the post?

if the US were to go to a entirely free market economy, its healthcare would most likely devolve to those of Nepal, Guinea, Tajikstan, Seirra Leone, Angola, etc.

I don’t think 3rd world countries have poor healthcare systems due to it being a free market. More likely is related to the whole being a 3rd world country thing.
 
Unfortunately Jake Tapper was complicit in the cover up of Joe's entirely lacking mental capacity to lead the country, and released this book only AFTER the entire country realized Biden wasn't fit to lead. Tapper, like most of his colleagues from leftist legacy media, had plenty of chances to be a real journalist, but he has chosen instead to be a shill and propagandist for the Democrat party.

This book is a virtue signal to the millions of legacy media's audience flocking to real news sources after realizing Tapper, and others like him, engaged in an >8 year blatantly misleading propaganda campaign.

1748105945099.png
1748105957159.png
 
I don’t think 3rd world countries have poor healthcare systems due to it being a free market. More likely is related to the whole being a 3rd world country thing.
so name me a first world country that has a free market healthcare system (and no, not israel, netherlands or switzerland).

ill be waiting.
 
"UAE nationals receive free or low-cost care, while expats are required to have health insurance. "
"The UAE has a relatively robust public healthcare system, which include the ministry of health and prevention"
 
"UAE nationals receive free or low-cost care, while expats are required to have health insurance. "
"The UAE has a relatively robust public healthcare system, which include the ministry of health and prevention"
Do you understand that having a public healthcare system doesn't preclude having a free market system as well?

That was my whole point - to have both separate systems.
 
Do you understand that having a public healthcare system doesn't preclude having a free market system as well?

That was my whole point - to have both separate systems.
do YOU understand that you didnt answer the question raised by ducctape?

you consistently dodge and reframe to fit your narrative.
 
Do you understand that having a public healthcare system doesn't preclude having a free market system as well?

That was my whole point - to have both separate systems.
if you want a free market system, you not use a universal healthcare system as the foundation of such a system and still say you have a free market system. this is not a thing.


Singapore has a dual healthcare system. there is a government funded universal healthcare system with a separate private healthcare section. all employed patients are required to pay in to the system.

you want a true free market heatlhcare system. Singapore is not it.


The CPF is a mandatory social security savings scheme funded by contributions from employers and employees.

The CPF is a key pillar of Singapore’s social security system, and serves to meet our retirement, housing and healthcare needs.

The government also helps to supplement the CPF savings of lower wage workers through schemes such as Workfare and top-ups to MediSave for senior citizens.
 
if you want a free market system, you not use a universal healthcare system as the foundation of such a system and still say you have a free market system. this is not a thing.


Singapore has a dual healthcare system. there is a government funded universal healthcare system with a separate private healthcare section. all employed patients are required to pay in to the system.

you want a true free market heatlhcare system. Singapore is not it.

Edit: I see where the confusion is.

As I said, I don't think we are ready for a completely free market system without a government safety net and a successful model of such a country doesn't exist to my knowledge.

What I'm advocating for is to separate the safety net - public system from the free market system, like UAE, Singapore, and others.

We don't have a robust free market system currently, and they do.
 
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Edit: I see where the confusion is.

As I said, I don't think we are ready for a completely free market system without a government safety net and a successful model of such a country doesn't exist to my knowledge.

What I'm advocating for is to separate the safety net - public system from the free market system, like UAE, Singapore, and others.

We don't have a robust free market system currently, and they do.
i do accept that many other countries have a more robust free market system. there is the gvt insurance, and there is the private insurance that the wealthy can buy. this exists in a bunch of european countries, israel, etc.

but, what you are missing, is that it is pretty sh$tty to be a doctor in those countries. they get paid pennies on the dollar to what we get paid.

also, that system only works if the gvt funded system is REALLY crappy, and people need to buy the supplement to be able to get care in a realistic time frame.

im not sure why we should be striving to get to those other countries. from a public health standpoint, they are better. from a doctor standpoint, they are worse.

it seems to me that, as docs, we reap the benefits of the gvt pouring medicare money into the system.
 
i do accept that many other countries have a more robust free market system. there is the gvt insurance, and there is the private insurance that the wealthy can buy. this exists in a bunch of european countries, israel, etc.

but, what you are missing, is that it is pretty sh$tty to be a doctor in those countries. they get paid pennies on the dollar to what we get paid.

also, that system only works if the gvt funded system is REALLY crappy, and people need to buy the supplement to be able to get care in a realistic time frame.

im not sure why we should be striving to get to those other countries. from a public health standpoint, they are better. from a doctor standpoint, they are worse.

it seems to me that, as docs, we reap the benefits of the gvt pouring medicare money into the system.
I think when people see it's shtty for docs in those countries, they're talking about the public doctors, not the private docs.

I think our country is unique in it's wealth, American expectations, and ability to sustain a free market.

My proposal only gives states the option to try out their own systems. I would like to see how things work out.
 
I think when people see it's shtty for docs in those countries, they're talking about the public doctors, not the private docs.

I think our country is unique in it's wealth, American expectations, and ability to sustain a free market.

My proposal only gives states the option to try out their own systems. I would like to see how things work out.
no. its the german docs at conferences who complain about their pay. or the brits who have trouble getting the right supplies and flouro time. of the spaniards who marvel that there is a flouroscope at every office in town

"american exceptionism" eh? eff that. we dont know how lucky we are
 
no. its the german docs at conferences who complain about their pay. or the brits who have trouble getting the right supplies and flouro time. of the spaniards who marvel that there is a flouroscope at every office in town

"american exceptionism" eh? eff that. we dont know how lucky we are
These don't sound like private practice complaints to me.

We are extremely lucky in America, docs and patients, rich and poor. We're blessed with resources, our Constitution, and lots of other things.

I don't know what you mean by "exceptionalism" but no one should feel entitled to anything.
 
These don't sound like private practice complaints to me.

We are extremely lucky in America, docs and patients, rich and poor. We're blessed with resources, our Constitution, and lots of other things.

I don't know what you mean by "exceptionalism" but no one should feel entitled to anything.
what you are describing is american expetionalism

americans think that just b/c we live in america things are inherently better. or that WE are inherently better. i dont subscribe to this philosophy.

from de Tocqueville

 
At the end of the day, I have always said we need to separate socialized, population healthcare from a robust free market system. Instead what we have is a socialized system that suppresses and piggy-backs off an anemic quasi market system.

If we had a robust free market system, people would be getting MRIs and/or U/S at yearly screenings for reasonable cost and with intelligent guidelines to address findings.
if you want a true free market system, a completely free market system. not one that rests on top of a subsidized public healthcare system.


the ones that come closest all have universal healthcare. and those dont have a market that predicates competition will determine market price.
 
So
what you are describing is american expetionalism

americans think that just b/c we live in america things are inherently better. or that WE are inherently better. i dont subscribe to this philosophy.

from de Tocqueville

so where in the world is better than America? And more importantly, why don’t you live there?
 
So

so where in the world is better than America? And more importantly, why don’t you live there?
Nowhere. But it is not god given that America is best. It doesn’t happen by default. We aren’t born better individually
 
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