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AAPS News June 2024 – Disparity

 Volume 80, no. 6 June 2024

In the 1960 Webster’s New World Dictionary of the American Language, “disparity” is defined as (1) inequality or difference, as in rank, amount, degree, excellence, etc.; (2) unlikeness; incongruity. One might think of the disparity between Harvard’s motto “Veritas” (truth) and its current curriculum.

Internet dictionaries now emphasize inequalities that are considered somehow unfair. The American Medical Association (AMA) promotes “equity” through reducing “disparities.” Apparently, equity means that desirable things (salary, promotions, representation in various specialties) and undesirable things (ill health, postpartum hemorrhage, arrests, and prosecutions) should be distributed proportionately by population group.

Racial/ethnic groups are defined by the U.S. Census Bureau as Hispanic or non-Hispanic; the latter include White alone, Black alone, American Indian or Alaska Native alone, Asian alone, Pacific Islander alone, some other race alone, or multiracial. Hispanic can be any race (https://tinyurl.com/5c8fjw5z). Asian includes Indian, Chinese, Korean, Japanese, or others even if these groups consider themselves distinct.

How pure must one be to be “White alone,” or how much is too much or too little to qualify as an oppressor or a victim, “privileged” or “marginalized”? Grandparents were previously determinative. The 1935 Nuremberg racial laws defined a Jew as a person with at least three Jewish grandparents. Mischlinge had one or two. Under the Law of Return, anyone with one Jewish grandparent can be granted Israeli citizenship. Miscegenation laws in the U.S. forbade white persons to marry anyone with one-eighth or more of Negro or “Mongolian” blood. But with genomics, far lesser contributions can be detected. Elizabeth Warren’s DNA shows that she had a Native American ancestor six to ten generations back. This does not qualify her for tribal membership, but her self-identification qualified her for listing as a presumably disadvantaged minority in a law-school directory.

So what criteria should be used in defining “diversity” compliance or eliminating disparities?

The question becomes far more complex with expanding identity politics to gender. According to an AMA Ed Hub presentation, “extensive evidence documents health disparities for lesbian, gay, and bisexual (LGB) women, including worse physical, mental, and behavioral health than heterosexual women” (https://tinyurl.com/5xb69apf). LGB women had much earlier mortality, and this was worse for those also belonging to a “minoritized” racial or ethnic group. “These disparities are due to chronic and cumulative exposure to stressors (including interpersonal and structural stigma)” (JAMA, 5/21/24, https://tinyurl.com/5n97esm4)—evidently not to an unhealthy lifestyle.

“Biases in care based on sexual orientation occur at every point….” And “many clinicians do not receive mandatory, culturally informed training on caring for LGB patients” (ibid.).

Implicit bias, which is supposedly responsible for disparities, is said to be pervasive and hidden. “Education on implicit bias and ways to manage its harms should be part of health system-wide efforts to standardize knowledge in this domain and recognize and manage bias” (NEJM 7/9/22, https://tinyurl.com/56p7knrh).

A new law in California requires that “all [CME] courses shall contain curriculum that includes the understanding of implicit bias,” if taught in California. 2 Cal. Bus & Prof. Code §2190.1(d)(1). It is being challenged in the 9th Circuit. In Virginia, the governor vetoed a bill that would have directed the Board of Medicine to require training on so-called “unconscious bias” for license renewals. Michigan mandates implicit bias training for all medical professionals except veterinarians. One hour per year on average is required forever (https://tinyurl.com/56pz9scp).

UCLA medical school has made great strides in diversity, although race-based admissions are officially illegal. It also happens that half of the students fail tests on basic medical knowledge, a ten-fold increase since 2020 (tinyurl.com/4v9fs23a).

Victimhood: the Root of Marxism

The seminal text of political economy, the handbook for bad economics and the woke movement alike, the 1888 Communist Manifesto, opens with the simplistic declaration: “The history of all hitherto existing society is the history of class struggles.”

Everyone was held to be either a tyrant or a victim, by historical accident. Thus, private property and all existing social conditions must be forcibly overthrown.

Since 1945, half of humanity has lived under a Marxist dictatorship, yet despite the miserable, toxic results, the odious doctrine remains popular. Why? Ross McKitrick suggests that Marxist doctrine spreads because the “oppressed” gain instant status and power without need of personal virtues or accomplishments. “Exempt from criticism, the oppressed come to believe they’re entitled to take everything the so-called oppressors have, by force if necessary, or to burn the whole system down for revenge.”

“The only remedy for this cult-like mindset, what Elon Musk called the ‘woke mind virus,’ is to teach people a healthy and proper loathing of victim status” (tinyurl.com/ubpxxjd8).

The whole calculus of disparity is an advanced stage of this fatal virus. The “scholarly” discussions might appear to be, as the late Rush Limbaugh said, “illustrating absurdity by being absurd.” But how can Frédéric Bastiat’s favorite method, the reductio ad absurdum, work, if the absurd becomes undisputable orthodoxy?


Critical Race Theory (CRT) and Anti-Semitism

         Pro-Hamas demonstrations on college campuses have exposed an unusual rift in the generally solid front of the woke Left—and a startling level of anti-Semitism (tinyurl.com/2vyvwff8).

         Jews have been victims of the oldest and deadliest forms of discrimination. But instead of being included in the minorities who unite against a common enemy, Jews are located among the oppressors. Anti-Semitism is the linchpin of intersectionality, which is closely aligned with CRT, writes Edward Halper.

CRT attempts to explain why there is still a black underclass. But the success of Jews in overcoming discrimination suggests that there may be internal, cultural factors explaining why others have not—rather than “systemic racism.” Anti-Semitism forestalls any real consideration of reforms within the black community.

On campus riots, Halper concludes that “the only things shared by Hamas and progressives are anti-Americanism and anti-Semitism” (tinyurl.com/33me5mxd).

 Over the Fiscal Brink

The Congressional Budget Office’s 10-year outlook predicts another $20 trillion in red ink through FY 2034—with the budget gap steadily worsening to $2.6 trillion by 2034. Outlays are expected to consume 25% of GDP while current tax policy generates barely 17% of GDP in revenue. After nearly doubling from $345 billion in 2020 to $659 billion in 2023, interest costs will double again to $1.3 trillion by 2031. They will exceed the cost of defense and Medicare this year. CBO ignores the coming bankruptcy of trust funds. Social Security will be insolvent by 2033, when all beneficiaries will face an immediate 25% cut. This is the “Rosy Scenario” (https://tinyurl.com/bdeudmp2).

The Socialism/Capitalism False Dichotomy

Hedge-fund manager Alex Krainer, born in Yugoslavia, rejected Marxist ideology as a teenager, because the system wasn’t delivering as advertised. At the age of 17, he moved to the “capitalist” U.S., which appeared to be based on a much superior system. But he became convinced that the same seed of doom that made “socialism” unsustainable was also baked into the foundation of the “capitalist” system: Both had a fiat currency with fractional reserve lending. This “reliably corrodes the democratic framework of society, suffocates free market economy, kills entrepreneurship and innovation, and guarantees that government sector of the economy will gradually displace more and more private enterprise.”

The U.S., for more than a century, has had periodic reruns of the “debt ceiling” Kabuki theater. The ceiling always gets raised.

“If we want to fix what’s wrong in the world today it is essential that our analysis goes past the handy but misleading labels of ‘socialism’ vs. ‘capitalism,’ or left vs. right, and that we deconstruct our challenges down to their essential building blocks.

The labels merely maintain an entrenched ideological divide, enabling each side to disqualify the other without ever having to…actually think things through” (tinyurl.com/mr39ezsu).

 X X X

The most powerful force in the universe is…compound interest.

Albert Einstein, apocryphal

What If Police Officers Were Hired by IQ?

In 1939, New York City attracted almost 30,000 men to a written and physical examination for 300 openings in the city’s police force. The written test was similar to the intelligence test then being given by the federal civil service. Positions were offered top down for a composite score on the mental and physical tests, with the mental test more heavily weighted. It was the first class of police officers that had a large number of Jews. The group had far fewer than usual disciplinary infractions and had extraordinarily successful careers, both in and out of policing. One went to medical school and returned as the department’s psychiatrist (https://tinyurl.com/p2vnrz94).

‘Pre-bunking’ Misinformation

Ursula von der Leyen, president of the European Commission, states that the EU will start “pre-bunking” false information. “As technology evolves, we need to build up societal immunity around information manipulation. Because research has shown that pre-bunking is much more successful than debunking…. In short, prevention is preferable to cure…. If you think of information manipulation as a virus, instead of treating an infection once it has taken hold (that is debunking), it is much better to vaccinate so that the body is inoculated. Pre-bunking is the same approach. Because disinformation relies on people passing it on to others, it is essential for people to know what malign information’s influence is and what the techniques are that are behind it. And as the knowledge goes up, our chances of being influenced goes down and that builds up the societal resilience that we will need (https://tinyurl.com/445zdfd3).

COVID Data

·  Vaccine Effectiveness Zero: Based on a study of 2.2 million individual health records, a Czech study (https://tinyurl.com/y3t7vtku) concluded that the healthy vaccinee effect bias caused vaccine effectiveness to be overestimated. Mathew Crawford  adds the effect of miscategorizing the vaccination status of the recently vaccinated. “Every piece of evidence can be explained by a statistical bias filter to reach consistency with the zero vaccine effectiveness hypothesis” (https://tinyurl.com/esk5y7zx).

·  Non-science of WHO Reports: For its Weekly Epidemiological Update (WEU), WHO could not obtain data from each country directly, but likely used the Johns Hopkins University dashboard—which was primarily generated by computer simulations  (https://tinyurl.com/4p4c8cbf).

AAPS Calendar

June 12. Pennsylvania chapter webinar with Do No Harm.

July 13. Missouri chapter meeting, Lake Ozark, MO.

Sep 18-21. 81st Annual Meeting, San Antonio, TX.


Hospital Sued over Failure to Report to VAERS

         Physician’s assistant Deborah Conrad is suing a New York Hospital System under the False Claims Act for failure to complete mandatory reporting of injuries associated with COVID-19 vaccines to the Vaccine Adverse Event Reporting System (VAERS). Conrad was fired from her job at United Memorial Hospital System, part of Rochester Regional Health, because she did file reports. The complaint alleges that hospital blocked Conrad from submitting approximately 170 reports of serious adverse events between May 27 and Oct 6, 2021, and that the hospital system failed to report more than 12,000 adverse events. The government declined to intervene, so the case is moving forward with Conrad as the relator. For each failure, the mandatory penalty is at least $20,000. Attorney Warner Mendenhall stated that of roughly 2,800 systems in the country he knew of none that had met their obligations under the vaccination program participation agreement that they all signed (https://tinyurl.com/3a826kdf).

Disparate Impact, the Law, and Criminal Justice

The legal profession, which came up with the disparate impact concept in the first place, is seeing its own standards plummet, writes Heather  Mac Donald. In 2020, California lowered the pass score on its bar exam because only 5% of black applicants passed on their first try, compared to 52% of white law school graduates. The lack of proportional representation among California’s attorneys was held to be proof of a discriminatory credentialing system. Whole categories of crime, such as shoplifting, cannot be prosecuted because a disproportionate number of perpetrators are black. No one says the names of murdered black children—if they are killed by other blacks (tinyurl.com/yxmvhszm).

APHA Applauds Biden Rule

The American Public Heath Association, in a letter to Office  for Civil Rights Director Melanie Fontes Rainer, writes that the Medicare Part B exemption from  civil-rights  rules was “a historical anomaly meant to preserve a time when, in many states, separate ‘Whites Only’ signs and separate entries dotted countless medical practices across the health care landscape.” Since “federal funding plays such a foundational role in both public and private insurance financing,” and “coverage and care have become so intertwined,” APHA finds it “essential to clarify the applicability of nondiscrimination duties to the entire continuum of modern hybrid systems of coverage, care, and payment.” Transgender status must be covered, including the withholding of certain health services (https://tinyurl.com/kjrtktbj).

Tip of the Month: Transgender lawfare consists of lawsuits for profit and to advance the ideology. This has been unleashed by new Biden Administration rules that impose, on everyone who accepts Medicare or Medicaid for any patient, anti-discrimination requirements as to transgender patients. Perceived discrimination is far broader than actual discrimination, and many judges are ruling for transgender plaintiffs every time. Group practices have already been looted by this. An office procedure for how to deal with transgender patients is worth developing. Opted-out physicians are not subject to Biden’s new rules.

Conflict of Interest on COVID Vaccine

A COVID vaccination incentive program was offered to Kentucky primary care providers who had a panel of 25 or more members of Anthem Blue Cross and Blue Shield Medicaid. If 30% of members were newly vaccinated between Sep 1 and Dec 31, 2021, the provider could receive a bonus of $100 per new vaccinee. The bonus increased to $250 per new vaccinee if 75% of Anthem members were vaccinated.

Transgender Lawfare

Could this be as big a threat to Americans as Soviet Communism once was? The trans agenda is linked to lawfare, whereby every institution and employer can be bankrupted by lawsuits over “misgendering” and “discrimination.” One viral video shows a supposed transgender trying to entrap an airline employee into “misgendering” him, presumably for the basis of suing. There’s a new court ruling favoring the transgender side almost daily. The U.S. Supreme Court has dodged, ducked, or denied every petition for review that has reached its docket. Some examples:

·  On Apr 29, 2024, an 8-6 en banc ruling by the Fourth Circuit required States (in this case, West Virginia) to fund transgender surgeries at taxpayer expense through Medicaid.

·  On May 8, 2024, it was reported that the California Coastal Commission required a surfing competition to allow participation by a transgender biological man, over the objection of the event organizers.

·  On May 10, 2024, an effort by Nassau County to ban transgender women from competing in women’s sports was struck down by a State Supreme Court judge.

·    A 2015 decision being cited as precedent, Rumble v. Fairview Health Services, found that Section 1557 of ACA extends to claims of gender discrimination based on gender identity, and that “it is plausible that Fairview staff treated Plaintiff in the manner that they did because of his protected class status.” Rumble was an 18-year-old F-to-M transgender man, who presented to the  emergency department complaining of extreme pain in “his” [female] reproductive organs. “His” wristband identified the patient as “F,” and a sign on the patient’s door identified the consulting physician  as an ob/gyn, effectively identifying “him” to staff and visitors as having female organs (https://tinyurl.com/89ckjw46).

Diversity Is Our Death

Everyone who is anyone has assured us that the “Great Replacement,” a plan to replace white Europeans with minority ethnic groups, is a far-right conspiracy theory, states Mark Steyn. But as Patrick Buchanan wrote in 2002: “In 1960, only sixteen million Americans did not trace their ancestors to Europe. Today, the number is eighty million. No nation has ever undergone so rapid and radical a transformation” (tinyurl.com/ycxfpu9e). Despite our “Founding Myth of Equality,” it is ridiculous to believe that all people are, in direct and hostile opposition to all observation in all time, really the same, writes William Briggs (tinyurl.com/ye23y4rc). “Equality is like the worm that bored through RFK Jr’s brain. It has been eating away at our minds since the badly misnamed Enlightenment…. It is now…extraordinarily difficult to get past equalitarian thought-blocks formed by the worm’s tunnels.”

ACTION OF THE MONTH

Scholarships are available to help medical students and residents attend the AAPS 81st Annual Meeting, Sept 18-21, 2024, in San Antonio. Details at https://aapsonline.org/2024am.


Correspondence

NPs Entitled to Due Process. A recent court ruling held that the Health Care Quality Improvement Act (HCQIA) applies to nurse practitioners, who are entitled to due process before revocation of privileges. A clinic was required to void a report to the National Practitioner Data Bank (NPDB). What a reporting entity may do is like holding a committee meeting in secret, determining that an accused person is guilty of murder without even obtaining the accused’s side of the story, marching the victim to the gallows and hanging him—then claiming that an NPDB report is truthful and accurate because it accurately describes the execution procedure. (This is the standard used in NPDB evaluation of “accuracy,” including Secretarial review.)

Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY

Nothing New Here. For years now medical school admission standards, exam pass rates, and licensure pass rates for blacks and Hispanics have been abysmal; now they just changed the standards and grading to hide the deficits. UCLA is one of the majority of medical schools and professional societies that are all in on DEI and CRT and the Marxist agenda.

The medical profession actually is late to the Marxist conquer-America party. Lawyers had already eaten all the hors d’oeuvres and were into their second cocktail, having established the agenda to bring on the administrative state. Just look at today’s lawyers and judiciary—rare to find a trace of law or ethics.

John Dale Dunn, M.D., J.D., Brownwood, TX

‘White Privilege’ in Communist Romania. My “privilege” growing up was to live poorly, starve, and stand in interminable lines daily for basic needs. Nobody gave us generous welfare. We had to be responsible for our own survival, and it had nothing to do with skin color. No one is interested in this, but Americans are heading there as they sleep and go about their lives.

Ileana Johnson, Ed.D., https://tinyurl.com/yyxnxh2s

School-to-Clinic Pipeline. When I was a kid, I couldn’t get an aspirin or Tylenol from the nurse. But now kids in Seattle public schools can get their “gender-affirming” hormones right at school. Neighborcare Health runs 14 school-based clinics. This is not currently listed under services offered on its public website, but an email obtained by Parents Defending Education through a public records request reads: “Our program will begin offering comprehensive, evidence-based, gender-affirming care services to our students and families who need them.”

Douglas Farrago, M.D., https://tinyurl.com/yc4u6kza

Hospitals Enabled the Crisis. As Kip Sullivan explains in the  Star Tribune (tinyurl.com/55b5f42v), Minnesota hospitals didn’t start the HMO craze that led to the stress they are experiencing, but instead of contesting the groupthink that induced policymakers to promote HMOs, they competed with each other to curry favor with them, and succumbed to merger mania. Demand inflation itself, from 1965 federally subsidized “free” insurance, was never understood. The political response was the error of empowering HMOs to ration care for “cost control” through giving them the perverse power to control the benefits they insured; something not allowed indemnity companies. The result has been the panaceas of costly massive corporate bureaucracies that profit from rationing care—at the expense of patients and the hospitals and physicians that care for them.

Robert Geist, M.D., North Oaks, MN

Why Hospitals Became Managed Care Corporate Wolves. The key squeeze play was to require all hospitals doing Medicare/Medicaid—basically all hospitals—to take DRG (diagnosis-related group) government price fixing for all their inpatient services. That killed many hospitals quickly and caused the loss of quality patient-centered hospital services. It was the death knell for a premier multidisciplinary psychiatric treatment program at Metropolitan Medical Center in the 1980s and presaged the demise of the hospital in 1991.

Lee Beecher, M.D., Maple Grove, MN

More ACA Destruction. Doctors, hospitals, pharmacies, and equipment suppliers lost about $1 billion/day when Change Healthcare, a subsidiary of the UnitedHealth Group was unable to process claims because of a ransomware attack. The Affordable Care Act enabled vast vertical integration. [Change Healthcare handles one in three patient records, and processes 15 billion transactions worth $1.5 trillion per year. UnitedHealth Care, based on market cap and revenue, is even bigger than JPMorgan Chase, the nation’s largest bank (tinyurl.com/pdr4hn64)].

Grace-Marie Turner, AmericanHealthcare Choices

On Memorial Day. Ours is not a war fought with cannons and musket balls. Our generation’s war is a mental, emotional, and cultural war, a war waged in secret and in lies, a war with needles and mysterious snake oil payloads, a mendacious war waged against truth, thoughts and feelings. Keep fighting, until we have achieved a new birth of freedom in America. We are all joyful warriors and loyal stewards of the great blessing of freedom bestowed upon our Great Nation by the Creator of the Universe.

Jeff Childers,  https://tinyurl.com/5btkynh2

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