Couldn't Care Less
Doctors
Any non-wealthy person who’s had to interact with America’s labyrinthine health care system in recent years may have witnessed a decline in quality of care. We’ve previously discussed the looming doctor shortage our country faces, and touched on the various ways financialization impacts the care patients receive at medical facilities. It’s not a good time to be a health professional, but why?
For a long time, doctors were seen as an elevated professional class - highly educated, well paid, enjoying the autonomy afforded to someone who’s spent a third of their lives training to do a complicated, difficult job. How did we go from there to an epidemic of doctors killing themselves?
[Physician] deaths were distressingly common, she discovered. The suicide rate among doctors appeared to be even higher than the rate among active military members…
In 2018, a study conducted by medical researchers found many physicians were suffering from a condition called ‘moral injury’, coined to describe emotional trauma sustained by soldiers witnessing acts that went against their core values. Here were hundreds of doctors, a vaunted profession in the world’s richest country, complaining they had to regularly violate their moral and ethical codes to simply do their jobs. What gives?
The answer is the job of doctoring has changed, as owners of hospitals and medical practices commodified the profession:
A 2013 study by Robert McNamara, the chairman of the emergency-medicine department at Temple University in Philadelphia, found that 62 percent of emergency physicians in the United States could be fired without due process. Nearly 20 percent of the 389 E.R. doctors surveyed said they had been threatened for raising quality-of-care concerns, and pressured to make decisions based on financial considerations that could be detrimental to the people in their care, like being pushed to discharge Medicare and Medicaid patients or being encouraged to order more testing than necessary.
A ten-year old study should have been a dire warning about what was happening in medicine, but it’s only gotten worse since then. Industry consolidation means doctors are subjected to working conditions that would have been unthinkable decades ago - time tracking software, consultant-derived acronyms like R.V.U.s (Relative Value Units) placing emphasis on running expensive tests and procedures and spending as little time as possible at a patient’s bedside.
Patients reasonably blame their doctors for the lack of bedside manner and the confusing maze of tests and medications they’re expected to take because their physician isn’t afforded the time to properly diagnose a condition. Doctors are fighting on two fronts - against their corporate bosses who meticulously track their every minute on the floor, and upset patients who feel they aren’t being listened to.
Then there are the bills:
One patient came to her in tears after being billed $7,000 for an IV infusion, for which the patient held her responsible. “They have to blame someone, and we are the interface of the system,” she said. “They think we are the greedy ones.” Fed up, Girnita eventually left the practice.
Medical school sells the promise of a moral world - students are drilled on the need for patient care above all, only to discover they’re treated more like an auto mechanic than a healer - an endless line of confused customers wondering why everything is so expensive and doesn’t fix the problem.
How did the system become so hostile to doctors? The AMA was directly responsible:
To the contrary, the American Medical Association consistently opposed efforts to broaden access to health care after World War II, undertaking aggressive lobbying campaigns against proposals for a single-payer public system, which it saw as a threat to physicians’ autonomy.
Ah, the irony. Once, doctors were removed from the pressures of markets. Yet here we are, in whatever-stage capitalism, and it’s never been more frustrating (and expensive) to receive adequate care:
Throughout the medical system, the insistence on revenue and profits has accelerated. This can be seen in the shuttering of pediatric units at many hospitals and regional medical centers, in part because treating children is less lucrative than treating adults, who order more elective surgeries and are less likely to be on Medicaid.
What must it be like as a pediatrician when the medical industry decides your job is obsolete because it’s not financially advantageous to treat kids? Or an ER doctor at a private equity-owned hospital intent on shuffling poor patients out the door? Moral injury indeed.
What happens now? Can health professionals take matters into their own hands? Maybe! The answer is - as it usually is - unionization:
Last May, the medical residents at Stanford voted to form a union by a tally of 835 to 214, a campaign [Phillip] Sossenheimer enthusiastically supported.
Doctors are beginning to look to nurses - many of whom are unionized - as an example. Unions may be the only way to force improvements in care and working conditions for the time being, so here’s hoping more doctors hop aboard the train. In the mean time, Americans have to suffer substandard, expensive care because the people running the system have become so bold they’ve turned doctors into just another set of employees to grind into dust in the pursuit of profits.
Clouds
After nearly four years writing this newsletter, it has come time for me to yell at some clouds.
You may have read stories about how the ocean off the coast of Florida has turned into a jacuzzi and sure, it’s easy to point and laugh at giant coastal settlements full of people who don’t believe in science and can’t get flood insurance. But! Warming oceans are very bad for all of us - the fish we eat live there, and oceans actually capture a huge amount of CO2 from our deteriorating atmosphere. Warm oceans also mean more hurricanes, which cause damage places that aren’t Florida.
What I did not expect to read was that we’re responsible for warming the oceans because we made ships pollute less?
Disappearing clouds are to blame for the “crazy” rise in ocean temperatures, scientists have warned.
A policy introduced in 2020 to cut the amount of sulphur emitted by ships resulted in an 80 per cent reduction of the element in the Earth’s atmosphere.
[…]
The policy resulted in fewer build-ups of the element in clouds and less cloud coverage overall.
But this has increased the warming effect of carbon emissions by 50 per cent, partly because the sun heats the seas more effectively when the skies are clearer.
What?! Come on! By passing rules that boats had to use cleaner fuel, we might be cooking the fucking planet? I just can’t. Apparently this isn’t the first time it’s been talked about, according to this article from earlier in the year:
That progress on the health front, however, means the cooling effect that aerosols have provided since the dawn of the industrial era is disappearing — a setback in climate terms. As a result, even a fall in carbon emissions may be insufficient to halt the heating of the planet.
Sulfur and nitrogen emissions were targeted by scientists because they put nasty stuff into the atmosphere that could produce acid rain and other forms of pollution. But, thanks to (successful!) efforts to reduce those aerosols, we may be eliminating the helpful cloud cover that prevents the sun from boiling the damn oceans.
One thing we could do is install a bunch of particle sprayers on ships, which seems…kind of cool?
One strategy called “marine cloud brightening”, which would see ships inject particles back into the air to make clouds more reflective, could be used to slow global warming.
Mr Diamond even suggested additional particles could be introduced to the clouds to boost cloud density and in turn its reflective properties which would help reverse the current trend.
He claimed his study’s findings suggest humanity could cool the planet significantly by brightening clouds.
I mean, I freakin’ hope we’ve got some sort of plan. It feels a little too easy that the solution to global warming could be putting a bunch of giant sprayers on Carnival Cruise boats, but if they can help stave off a global climate catastrophe I will temporarily swallow my many criticisms of the shipping and cruise industries.
Freedom Holding
Our friends at Hindenburg Research are at it again, this time targeting a Kazakh financial services company somewhat inexplicably trading on the NASDAQ to the tune of billions. They claim, among other things, the firm is evading US sanctions and providing services to Russian clients, as well as inflating earnings and potentially comingling customer funds - the kind of thing that FTX also got up to.
If you find Hindenburg’s lengthy reports a bit inscrutable (it’s fine if you do) here’s a write-up in Forbes that highlights a few other…concerning details about how the company is run:
The company’s previous auditors, a small Utah-based firm called WSRP LLC, was sanctioned last December by the Public Company Accounting Oversight Board for failing to “inquire about the business purpose of…related party transactions.” Freedom also had to restate its 2022 earnings and three different quarterly reports (the fourth quarter of 2021, as well as Q2 and Q3 of last year). Nasdaq has been threatening to delist the company since June 15 this year.
I mean, good on Freedom eschewing the big four auditors for a smaller boutique shop committed to lack of oversight. The owner of Freedom is a Russian-born millenial ‘fond of wearing black turtlenecks’ and ‘speaking to US press’ which is the literal template for charismatic fraudsters mid arc between the billionaires’ list and federal prison.
It’s also generally not a good sign when your employees are willing to speak openly about your love of financial crimes:
“They came in like cowboys, wild cowboys,” a former Freedom executive working in Dubai told Forbes a few weeks ago. “They were primarily looking for black funds, dark funds, unreported funds, to siphon them off into stock markets like they’d previously done very successfully in Russia” added the individual, who asked to remain anonymous in order to speak openly. “Once you go into unreported funds, that could be anything, especially in a market like Dubai. It could be terrorist money, it could be criminal syndicate money. It’s all kind of mixed up.”
Not great! The story of Freedom’s founding reads like a word-for-word remake of FTX, ten years prior:
Turlov got his start in finance nearly two decades ago. In 2003, at age 16, he applied to a Moscow trading firm as a part-time junior trader, before moving to another bank two years later with the goal of investing in U.S. markets, he told Forbes in 2021. When the great recession hit and Turlov lost his job, he and about a half dozen of his fellow traders started a new company that would become Freedom, Turlov told Forbes.
The company has a Belize-based brokerage firm, which it claims grants its customers access to ‘hot IPO stocks’ through unspecified backroom deals with hedge funds. Which is the sort of thing you’d say when you owned a sham brokerage run out of Kazakhstan with offices in Cyrpus and Dubai, handling money for large networks of sanctioned Russians and international criminals.
Remember, this company is listed on the NASDAQ (for now) and allegedly worth billions of dollars, with a turtlenecked Russian thirty-something sitting on seventy percent of its shares. All completely normal and legal stuff that auditors and regulators and investors would have no reason to question.
Rudy Giuliani
We talked last week about co-conspirators putting their crimes in writing, and boy do we have a stunning example of that again, this week. One of Trump’s Finally Indicted Co-Conspirators in the Georgia election case is Rudy Giuliani, who manages to rack up nearly as many charges as Trump himself, an impressive feat.
Rudy is no stranger to providing evidence of his misbehavior unprompted - he’s notorious for butt-dialing reporters and senators while grousing with his disreputable pals about one scheme or another. It appears his antics have finally caught up with him in a criminal case - not to be confused with the messy divorce lawsuit that almost landed him in jail.
Americans of all stripes can rejoice that Rudy might finally get some comeuppance for his years of awful behavior. Liberals, true patriots, et cetera can all nod along together and think yeah, that guy sucks. Even mafia wiseguys are in on the action:
"You can quote me to say, 'They're f------ thrilled,'" [mob lawyer Murray] Richman said Wednesday.
"I don’t want to say the language, but they really ripped Rudy a new a------."
Richman noted that "half of these guys love Trump. They freaking love Trump."
"But all of them are almost unified in their position of hating f------ Rudy," he said.
What a world we live in. Trump is, unsurprisingly, very popular among the organized crime set, but even Rudy’s heel turn from prosecutor to prosecutee elicits no sympathy from these goombas. Honor, thieves, etc. I think I speak for everyone across the political and criminal spectrum when I wish Rudy luck with his forthcoming legal bills.
Short Cons
Jezebel - “The federal judge who tried to ban the abortion pill will decide the fate of an absurd lawsuit against Planned Parenthood that could end up with the organization having to pay billions, bankrupting its Texas affiliates and possibly the entire organization.”
The Markup - “AI detectors tend to be programmed to flag writing as AI-generated when the word choice is predictable and the sentences are more simple. As it turns out, writing by non-native English speakers often fits this pattern, and therein lies the problem.”
NPR - “For extremism researchers, the shooting death this week of a Utah man who was alleged to have made violent threats against President Biden and other public officials highlights a concerning trend. For years, they have watched a steady escalation in violent political rhetoric that appears to be fueling acts of real-life violence.”
The Atlantic - “In most cases, compostable plastic is compostable only under very specific conditions. “It’s not like what you would do in your yard if you tried to compost a banana peel,” Sarah-Jeanne Royer, an oceanographer at Hawaii Pacific University, told me. “You need to have access to a composting facility.””
Bloomberg - “Toxic chemicals were found in Indian-produced medicine that led to the deaths of dozens of children. It revealed how poorly the country’s pharmaceutical industry is policed.”
Bloomberg - “Bitcoin miner Riot Platforms Inc. made millions of dollars by selling power rather than producing the tokens in the second quarter as the crypto-mining industry continued to grapple with the impact of low digital asset prices.”
Have a friend thinking about a career in medicine? First, tell them to unionize, then send them this newsletter!