And he’s giving us even more reason to punch him!

Infamous “Pharma Bro” Martin Shkreli announced his newest venture yesterday, and it’s about as awful as you’d expect. In a Substack post and on Twitter, he unveiled DrGupta.ai, a “virtual healthcare assistant” that (predictably) Shkreli believes will disrupt medicine—in spite of some very real and worrying legal and ethical gray areas.

“My central thesis is: Healthcare is more expensive than we’d like mostly because of the artificially constrained supply of healthcare professionals,” he wrote on Substack. “I envision a future where our children ask what physicians were like and why society ever needed them.”

“Dr. Gupta” is just Shkreli’s latest health venture since being released from prison last May. Last year, he founded Druglike, a drug discovery software platform being investigated by the Federal Trade Commission. The FTC is looking into whether Shkreli is violating a court-ordered lifetime ban on working in the pharmaceutical industry by running Druglike.

Madness. If you replace all the healthcare professionals who generate the data that is leeched off by a glorified chatbot with said chatbot, where is the information that they parrot going to come from? All you’re going to have left is a feedback loop that is disconnected from any reality checks, it’s going to get progressively worse, and we’re not going to get any new medical knowledge.

It’s quite rich that he’s blaming the high expenses of medical care on scarce skilled medical labor and knowledge, when he’s the guy who artificially elevated the cost of life-saving drugs. Blame the greedy pharmaceutical executives instead.

Hey, people like Shkreli are the ones who could be replaced by a mindless software program!

A few weeks ago, I had what is called a transient ischemic attack — don’t worry, it was brief, hasn’t returned, and the doctors examined me inside & out with embarrassing thoroughness, and have given me a clean bill of health — but it was terrifying. For a whole ten minutes, I couldn’t focus on a simple and familiar task on the computer. I knew what I had to do, if I was thinking normally, and I couldn’t figure out how to find basic, abstract functions on the screen in front of me. When it passed, then click-click-click it was a second’s work, and I couldn’t understand what had happened.

Today I read Ed Yong’s latest, and dear god, it is chilling.

On March 25, 2020, Hannah Davis was texting with two friends when she realized that she couldn’t understand one of their messages. In hindsight, that was the first sign that she had COVID-19. It was also her first experience with the phenomenon known as “brain fog,” and the moment when her old life contracted into her current one. She once worked in artificial intelligence and analyzed complex systems without hesitation, but now “runs into a mental wall” when faced with tasks as simple as filling out forms. Her memory, once vivid, feels frayed and fleeting. Former mundanities—buying food, making meals, cleaning up—can be agonizingly difficult. Her inner world—what she calls “the extras of thinking, like daydreaming, making plans, imagining”—is gone. The fog “is so encompassing,” she told me, “it affects every area of my life.” For more than 900 days, while other long-COVID symptoms have waxed and waned, her brain fog has never really lifted.

Of long COVID’s many possible symptoms, brain fog “is by far one of the most disabling and destructive,” Emma Ladds, a primary-care specialist from the University of Oxford, told me. It’s also among the most misunderstood. It wasn’t even included in the list of possible COVID symptoms when the coronavirus pandemic first began. But 20 to 30 percent of patients report brain fog three months after their initial infection, as do 65 to 85 percent of the long-haulers who stay sick for much longer. It can afflict people who were never ill enough to need a ventilator—or any hospital care. And it can affect young people in the prime of their mental lives.

AAAAAAAAAAAAIIEEE! That’s what I experienced…for ten minutes. But that’s one of the possible symptoms of long-COVID, and people go through it for months? I can’t imagine it. I wouldn’t want to go through that.

For example, Robertson’s brain often loses focus mid-sentence, leading to what she jokingly calls “so-yeah syndrome”: “I forget what I’m saying, tail off, and go, ‘So, yeah …’” she said. Brain fog stopped Kristen Tjaden from driving, because she’d forget her destination en route. For more than a year, she couldn’t read, either, because making sense of a series of words had become too difficult. Angela Meriquez Vázquez told me it once took her two hours to schedule a meeting over email: She’d check her calendar, but the information would slip in the second it took to bring up her inbox. At her worst, she couldn’t unload a dishwasher, because identifying an object, remembering where it should go, and putting it there was too complicated.

That’s exactly what I was trying to do! I was trying to put a presentation I had to give on my calendar/email, and somehow I couldn’t figure out where anything was or what steps I had to take. Even my brief experience with that was intolerably frustrating. It was so awful that immediately after I recovered my ability to act again, I checked into a hospital, despite feeling totally fine once it passed.

Thanks, Ed Yong. Now in addition to worrying about respiratory failure and death, I can dread losing my brain. I’ve managed to avoid getting COVID at all so far, and now I’m motivated to be even more scrupulous in my preventive efforts. It’s too bad my employers, a fucking university, has so little concern about the minds of their faculty and students.

A man in Maryland has received a pig heart transplant. What an interesting idea! People have been talking about xenotransplants of this magnitude for decades, and now someone actually gets to try it. It’s also a terrifying idea.

• My first thought was of Baby Fae, the infant in 1984 who received a baboon heart. It was a disaster. The surgeon didn’t believe in evolution and dismissed concerns about the degree of relatedness, and the donor was blood type AB and Fae was type O. They also didn’t have any means of genetically modifying the baboon. Would you believe there are ethical concerns and responsibilities in this sort of thing?
• The Washington post article is all about the ethics of the surgery, which is good. It takes a really cock-eyed perspective, though: the recipient was a bad guy who stabbed and paralyzed someone, failed to pay court-ordered compensation to his victim, and also has a history of being sloppy and undisciplined about his medications. Should he have been given this gift?
  YES.
  Jesus, it’s not even in question. Doctors should deliver health care based on need, not passing judgment on the worth (in all senses of the word) of their patient. What next? Will doctors decide on my treatment based on my credit score? Yeah, you don’t have to tell me that here in the good ol’ USA that is the de facto situation. It’s not good.
• For the retribution crowd, relax. He is being punished. He’s an experimental guinea pig for a treatment that’s going to buy him a little time. The pig was extensively manipulated with 10 genes modified to reduce, but not totally eliminate, the chance of rejection. He’s going to be trapped in a hospital bed for a good long while, with nurses waking him up every few hours through the night to do blood tests, and he’s going to be taking so many pills. I’ve been in that place for relatively trivial surgeries, it’s a necessary hell. Have a little pity.
• He’s probably going to die in a few months, anyway — I’ll be surprised if his new heart isn’t shredded by rejection in short order. I’ll be pleasantly surprised if he gets a significant survival time, though, since that means this could be a very promising treatment for everyone.
• Except the pigs. You do realize that this implies the existence of pig farms for animals whose fate is to be chopped up as needed for organs, right? It’s a tiny drop in the slaughterhouse bucket, since humans butcher 1.5 billion pigs per year to make pulled pork sandwiches and bacon, so it’s not the numbers that are daunting, it’s the fact that right now there are cloned pigs being modified and raised in artisanal farms in the hopes that genetic refinement will make them incredibly valuable to corporations. These are long term investments!
• No one is talking about how much these expendable pigs cost. We aren’t talking about the ethics from the pig’s perspective, and we’re suspiciously mum about what the bill is going to be. This lucky (?) fellow in Maryland is benefitting from a bit of scientific curiosity — hey, we’ve been raising all these special pigs for a decade or so, how about if we splice one heart into a test subject and see what happens — but if it works and becomes a relatively routine intervention, who’s going to be able to afford it?
• While I’m on the pig’s side, what do these gene modifications do to the health of the pig stock? Does this compromise their immune systems? Are these going to be bubble-pigs that need to be raised in a sterile environment?
• I got to wondering about the scientific methodology behind making pigs with all these genetic modifications. Here’s an article on practical approaches for knock-out gene editing in pigs. It’s a multi-step, multi-generational process to produce pigs with specific mutations. Scientists have been working for years to make these pigs.
  

  Schematic workflow of the different steps needed to generate a gene edited pig. (A) Efficiency analysis of mutations induced by CRISPR-Cas9 system. (B) Different strategies to generate one-cell stage porcine edited embryos. (C) Gene editing analysis of the founder pigs (F0) and offspring produced by crossbreeding F0 pigs (F1).

• The above article describes the mechanics, but not the research that goes into discovering candidate genes to reduce the immune response. Everyone is fumbling forward in the dark, finding likely genes that are affecting rejection, but they have to put that pig donor tissue in a human host to see if they actually got ’em all. This man in Maryland is very much a wildly experimental test subject, a scientific experiment in progress. The most likely result is they’ll find that “oops, we missed an important gene” and they’ll go back to the pig farm with a new CRISPR/Cas target and raise another generation with 11 modified genes for the next attempt. Meanwhile, this host is dead. But he will have contributed to Science with his demise!

Anyway, my brain is currently split between a Frankensteinian fascination with this bold experiment, and a humane dismay at the cost in suffering for humans and pigs.

Good morning, everybody! It’s colonoscopy prep day, and I am so excited!

For you young’uns out there, this is a rite of passage you get to enjoy once you turn 50, or maybe earlier if you have risk factors. This is a process where a doctor invasively scrutinizes every inch of your colon to screen for cancer, and you get to do it every 5 years (or in my case, every 3 years because last time they found a few harmless polyps). So today is the day I get ready for an outpatient trip to the local hospital.

Everyone will tell you the prep is worse than the procedure, and it is. You have to completely empty your bowels so the doctor’s view isn’t impeded by, umm, shall we call them Deplorables? Today I’m purging the Deplorables.

First thing, I’m fasting. No solid foods at all today. I made some pineapple jello yesterday, and I get to have clear broth, but otherwise, it’s all drinking down fluids and nothing else. I do get to drink all the coffee I want, so I will.

I have to take 4 Dulcolax pills this morning, a stool softener.

At 3pm this afternoon, I get to fill up this jug with four liters of water, and start drinking it. I’m supposed to finish all four liters by 6pm. Chug, chug, chug!

It says “lemon flavor”. This is only sort of true, if your lemonade tastes more like watery mucus. I will cope. This is really the worst part of the worst day. Well, maybe the worst part — I do get to spend the rest of the evening expelling Deplorables.

Then, as of midnight, I go dry. No water, nothing, shall pass these lips, and prep day will have passed.

Tomorrow I go into the hospital at 8:15. I get to strip naked and put on one of those chic hospital gowns that opens at the back, and the nurse will stick a needle in my arm, and Dr Sam will walk in and tell me to lie on my side and bring my knees up to my chest, and then deliver the magic drugs and a veil of darkness will fall over the unspeakable events that ensue. He’s going to stick a tube up my butt with a small flashlight and a camera at the end, and also little snippy scissors so he can chop out anything he wants to take a closer look at.

By 10am I’ll be groggily putting my clothes back on and my wife will drive me home, where I’m told I’m supposed to be lazy all day. I can do that! I might also be hungry.

Why am I doing all this? Consider the payoff matrix. It’s the only rational thing to do.

	I get a colonoscopy	I don’t get a colonoscopy
I have cancer	I catch it early! I have to get cancer treatments, but I have a better chance of not dying, and the treatments won’t be as debilitating as if I let the cancer grow.	I have cancer, but I don’t know it. It grows until the unpleasant symptoms become noticeable and require more serious intervention. Or I die.
I don’t have cancer	Yay! And I know it! Relax, resume my decadent lifestyle until the next colonoscopy.	I’m OK! But do I know for sure? I do not. I might have to hold some reservations, rather than plunging into my life of careless hedonism.

As you can easily see, all the possible outcomes from the decision to get a colonoscopy are positive, while all the outcomes from shirking my responsibilities range from negligible concerns to dire, horrible consequences.

We even have graphic examples right here on Freethoughtblogs!

Caine’s Journey.

Caine died of this terrible disease in 2018, after a long struggle.

Iris discovers a serious problem.

Fortunately, Iris is surviving, but read her account of her travails: no one wants to go through that. I don’t want to experience that.

So, yeah, get your butt checked regularly. It inconveniently wrecks a day, but that’s better than wrecking your life.

It’s driving me nuts. We are in a serious pandemic, and authorities everywhere are acting as if the best strategy is to pretend we’re already back to normal, full speed ahead, don’t deviate from the pretense that everything is just dandy. Yet…

The delta variant of the coronavirus appears to cause more severe illness than earlier variants and spreads as easily as chickenpox, according to an internal federal health document that argues officials must “acknowledge the war has changed.”

Public schools are opening in a few weeks, as is my university. No one is acknowledging that the war has changed. Instead, we’re all planning to march right into the maw of the pandemic.

My prediction: they’re all going to be frantically backpedaling by October. I fully expect my school to shut down in-person classes by the middle of the semester.

I could be wrong, and I would be very happy if I were — we could have a gentle, delightful Fall with brightly colored leaves and soft snows and a world that embraces love and peace, and all the homeless would be given homes, and all the sick cared for, the QAnoners could all wake and look at each other and say “What are we doing?” and go home to their families, and peace could reign across all the lands. Sure. It could happen. But only if we struggle to make it all happen. And that’s what I’m not seeing, a will to change and do what needs to be done.

The CDC isn’t helping, either. They keep dithering. Recommendations change at the first breeze of new data, and change back a few weeks later. There is a difference between being responsive to new information, and being too quick to accept new suggestions in the face of uncertainty; it’s also important to build the public trust with consistent messages.

The document strikes an urgent note, revealing the agency knows it must revamp its public messaging to emphasize vaccination as the best defense against a variant so contagious that it acts almost like a different novel virus, leaping from target to target more swiftly than Ebola or the common cold.

It cites a combination of recently obtained, still-unpublished data from outbreak investigations and outside studies showing that vaccinated individuals infected with delta may be able to transmit the virus as easily as those who are unvaccinated. Vaccinated people infected with delta have measurable viral loads similar to those who are unvaccinated and infected with the variant.

Right. So the appropriate message from the very beginning should have been conservative, assuming the worst and establishing a consistent policy. I want to hear the words, “It wasn’t as bad as we feared, now that we’ve got solid evidence from three months of hard science we can think about easing some restrictions,” rather than “Oh, I guess we shouldn’t have told everyone to have orgies, you’ve all got three months to live.”

Be decisive for a change. I wrote to my university president urging her to take a stronger stand, but I’ll make another bold prediction: she’ll dither. It’s all the rage.

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Important qualifier to the CDC’s “ebola” comment:

Saying that the Delta variant is more contagious than Ebola is like saying your car is faster than a '76 Ford Pinto.

Of course it's faster. Everything is. The Pinto isn't famous for being quick, it's famous because it'll kill you.

Likewise Ebola. pic.twitter.com/PPBVRxoU9S

— Carl T. Bergstrom (@CT_Bergstrom) July 30, 2021

You know, it’s becoming really obvious that the CDC is very bad at science communication, at a time when we need the science communicated effectively.