Thursday, July 18, 2024

What JD Vance Isn't Telling You About Eastern Kentucky ...


** PS added.


I haven't read or watched "Hillbilly Elegy," because knowing that JD Vance is a Republican, I already knew that he would be prone to blaming people for their own poverty and addiction, despite the fact that these are chronically economically deprived communities, we're talking about, with little to no jobs (with their leadership making no attempts to attract more business, I'll get to that below) and were targeted by certain pharma companies for the opioid crisis.

I have read excerpts, however, and I think he's oversimplifying solutions to complex problems (like Republicans often do), as well as not telling you everything you need to know about these areas. 


For example, communities that are chronically economically deprived are also drug-addled, violent (gun and otherwise) and full of crime, whether it's inner-city or Appalachia.

(Republicans like to ignore that Appalachian America is just as gun-violent and drug-addled as inner cities, because it doesn't support their narrative that only Democrat-led "chocolate" cities are drug-addled and violent.)


And despite JD Vance insinuating the culture is chosen and creates the economy, IMO - with some statistics to back it up - it's actually the other way around - the economy creates the culture. 


When there are few jobs and few resources, especially for decades, people will resort to fighting each other over them and do whatever they need to do to survive, as if there's an apocalypse - and it's not pretty.


But to step back a minute,  the first and most important thing you need to know that JD fails to mention is that these Eastern Kentucky counties have exclusively Republican leadership a, as their populations are 80% or more Republican - and have been for the last 60+ years.


Ironically, yes - many of them are on food stamps public assistance,  and still vote Republican - but when there are no jobs, what else have they?

(The only part of that I can't figure out is how they can still vote Republican though on public assistance.)

And yes, many do sell opioids for extra cash, guns, prostitution, whatever they can do to make extra cash. 

Like I said, with few jobs and few resources -  people will do whatever they need to do to survive.


You see, my Dad was born and raised in Harlan County, also in Eastern Kentucky (about 30 minutes from Vance's Breathitt County) - yes, THAT Harlan County, AKA as "Bloody Harlan," dramatized in the popular FX TV show "Justified."


Harlan County, Kentucky, is one of the most drug-addled, violent communities in America (thus the TV Show).

Harlan County is also 94.4% white of European heritage, 85% Republican.

And though the official religious census data gives Christian faith a 51% in Harlan County in 2020, it only tracked church membership/regular attendance, and since only 1 person in the total population of 23K in Harlan identified as "other" (Baha'i faith) - with no Jewish, Muslim, Buddhist, agnostic/atheists at all being reported - it is likely the true Christian demographic in Harlan County is just shy of 100%

JD Vance's nearby Breathitt County has almost identical demographics, but with a slightly larger Democrat population.

Thus, the second thing JD Vance isn't telling you is that these Eastern Kentucky, drug-addled, gun-violent communities are almost exclusively white, Christian Republicans.


Well, at least he mentions them, he just conveniently ignores the demographics - because as I said, it doesn't fit the Republican false-narrative that only Democratic-led, black, inner cities are addled with drugs and violence!


One thing JD does get right, from what I understand, is that the culture begets itself - but is that their own fault?

Some may carry some choice responsibility, but they don't have many choices - and just as much argument against that regarding their leadership's choices - so perhaps it's actually a combination of both. 

People fear change and the people in charge know that and want to keep it that way, because it benefits them, using their their fear of change and outsiders to glean votes.


My grandfather was once a deputy sheriff in Harlan, leaving Harlan as "a crooked puzzle that will never be solved" for Louisville.

He said it's not the fault of the everyday, poor Harlan person - it's the fault of the leadership and people that DO have money, benefitting from (and exploiting) the culture - and again, the leadership in all of those counties is Republican and has been for a century.

(My grandfather was also Republican, but considered the Republicans in Harlan as corrupt lackeys for the coal companies.)


Just like the coal companies that came in years earlier who exploited them, causing the "Harlan County Wars," to where the federal government had to come in and stop the violence and rescue them from exploitation - and yet coal miners and other labor unions in American continue to support Republican economic policies, despite it being the same political side as the coal corporations, cutting their own throats financially and benefitting those that already have money.


Why?

Because their fear/distrust of outsiders "invading them" is greater.

Fear of people of color, immigrants, Northerners, newcomers in town, non-Christians, and nowadays, non-Republicans stealing their stuff or taking control of them is what motivates them to vote more than economic policies - and don't Republican politicians know it!

Another facet of this then is a matter of the devil you know is better than the one you don't and fear of change  - and just about everyone they know is Republican, for better or worse. At least they know what to expect.


Thus, their fear is based on the unknown, and it would border on irrational, if it wasn't helped by the coal companies being based in the Northeast, and what they did do them  - pushed them off their land using law enforcement, when they wouldn't sell for pennies by burning houses down and killing family members.

I guess it never dawns on them that the same people that did that to them were also white Republicans - or that it was the federal government and it was liberals from the Northeast  that came in and rescued them?

To them, however, the main problem was that they didn't know the people that did those things to them, they came from somewhere else. 

Actually, this distrust for outsiders/new people is somewhat pervasive throughout Kentucky in general, but nowhere is this mentality more prevalent than than Eastern Kentucky/Appalachia,

It's amazing to me that this borderline-irrational rural fear, particularly with how violent and drug-addled Eastern Kentucky tends to be, has essentially taken control of America.

As for what Kentuckians think of JD Vance, Breathitt County is one of the few Eastern Kentucky counties that has a larger Democratic population than other Eastern Kentucky counties, but still a strong Republican, Trump-supporting votership - and the LHL reported today that many consider him a "sellout."  

Also, someone who shall remain nameless that we know from Breathitt County  - who has a master's degree himself - said this today (paraphrasing):


 "We're real proud of him for getting out of that and what he's made of himself and all, but he's part of the problem.  My family from Breathitt wanted to strangle him for making them all look like lazy hillbillies who enjoy living that way, in his book."

"He acts like he's got it all figured out, it's so easy, that he's just smarter, harder working and better than everybody else in Breathitt, but there aren't enough jobs there, which is why his grandparents left - which, by the way, most people can't even afford to do, even if they have family.  They don't have two cents to rub together between them to be able to afford to move away." 

"He also acts like he's the only person to ever get out, when the rest of us got GI bills, just like him, or got scholarships or put ourselves in debt for years with student loans."

"Also, he was previously a "Never Trumper," calling Trump the "cultural heroin" of the nation and possibly the "American Hitler" - but now he's all about Trump?!?" 

"That's why people are calling him a sellout, Democrats and Republicans alike, because he never explained that 180, so it just looks like he's about himself and whatever it takes to get power. " 


That's true, about not being the only person to get out, and not because he worked harder than everybody else - coal miners are some of the hardest working people in America, doing the jobs no one else wants to do, for little pay.


After both shoveling coal for at least some time, both my father and my grandfather were able to get out of Harlan alive, too, despite that song ("You'll Never Leave Harlan Alive") - to Louisville and Cincinnati respectively, but not by worker harder than anybody else, and they didn't do it alone.

My father got a public-university rural scholarship to EKU and earned a double-degree in physics and chemistry, and my grandfather used his GI bill, just like JD Vance, to buy a house in Louisville, at the same time, pulling favors with state politicians he had met during his time as a deputy, after passing the civil service exam for engineering (with the highest score ever in Kentucky, at that time), requesting a job from them, which they granted him. 

Sure, they were smarter than the average bear - but that in and of itself doesn't get you there.

No one is truly self-made, whether it's private or public assistance, or somebody simply took a chance on you enough to help you.

Instead of crediting yourself for your hard work, you should be thanking them!


And here's something interesting.

Except for politics, my straight-arrow grandfather rejected the violent culture and extreme "haves/have-not" culture of Harlan completely, in favor of a straight-laced, non-violent, non-dramatic life. He was by no means wealthy, in the end, but lived a comfortable, peaceful life.

In my Dad's case, he instead admired the flashy, gaudy lifestyle that his dishonest insurance salesman father-in-law had, gleaned from cheating his neighbors to get wealthy, as did violence, to get what he wanted.

(In fact, my great grandmother's first husband, my great-grandfather's predecessor, was shot and killed in a shoe store over a pair of shoes - not by him, but just to show you how limited resources are there and how prevalent gun violence is.)

Thus, that double-degree in physics and chemistry didn't even matter, in the end, because even though he started out working for Fisher Scientific, due to his "get rick quick" mentality from his youth, my father ended up becoming a violent criminal, in the end.

In a way, you can understand that "get rich quick" mentality after being so poor, but what you have to do to get that comes at a cost.

So in some cases, you can take the boy out of Harlan, but you can't take Harlan out of the boy - in other cases you can - it depends on each personality and what they value.


Yes, the culture does perpetuate itself - but what JD Vance isn't telling you is that the leadership all of these counties is exclusively Republican and does nothing for the people but line their own pockets by exploiting them and doing the bidding for the coal companies, getting their votes through fearmongering. 


So I'd call JD Vance worse than a "sellout" - he's a political prostitute of the highest order.

Because he's exploiting these people for money with his book,  then fearmongering them for their votes, while at the same time, blaming them for their own poverty, despite his party being in charge where they live and knowing there aren't any jobs and no efforts to attract any to these regions.


_______________________


PS 

Hehehe - I just looked at a British Trump-supporting conservative's blog, who often likes to "mirror" what I say politically, just to be an ass, and he didn't disappoint.  

He hadn't mentioned Trump's VP pick of JD Vance before, except that he was picked (and I checked before I wrote this post, as a sort of experiment), but since I wrote this post, last night, he has - especially laughable because it's being presented by a person who doesn't even live in this country πŸ˜‚

I didn't comment, haven't in literally years, because that's what he wants, is to provoke, so I'll say this here, since I know he's reading: 


Dude, I gotta tell you - though America in general does not care what you think, Eastern Kentucky especially does not care what you think.

They don't even care that you're a white-male conservative who supports Trump.

All they care about is that they don't know you, you're not from there, you have no family ties there, and you have a funny accent - and that you haven't done a thing for them.

If you actually showed up at somebody's house in Harlan, with that British accent, the shotguns would likely come out, same as anybody else, just because you're an outsider, but especially because you're not American - and waving your Trump flag around would not save you. πŸ˜‚


In fact, the only thing that saves my husband with his Detroit accent, when we visit that area, isn't even his time as an Army ranger - it's his marriage to me, who does have family in that area.

He knows that if anyone ever gives him shit, the first thing out of his mouth is "My wife's people are from Harlan County the X and Y families of Harlan County" and then just start rattling off family names from there, starting with my dad, my grandfather, uncles, aunts, cousins. πŸ˜‚

Not because we were so prominent there, but because you have to prove kin there.

Nothing else you could possibly ever say would matter in the least, but having family there would at least give them pause to check first.
(I also have to interpret what they're saying to him and vice versa πŸ˜‚ I've never actually taken him into Harlan, because that would be pushing fate, but the surrounding areas)

Harlan is especially that way, they don't like strangers, as I said, due to the coal wars years ago.

But if you have ties to the region, they'll welcome you in with hugs, like they know you. They just have to "know your daddy."

Your daddy could be a serial killer, for all they careπŸ˜‚, they just have to know your people and that they lived their same struggle, at one time.

Point being, you have no idea what it's like to live in America, you've never even stepped foot here, and you know even less about what Eastern Kentucky is like, even most Americans don't.

You haven't done shit for Americans but criticize our culture and our politics, you can't even vote here, and nobody even knows who you are - so why would any American care what you have to say again?
In fact, you haven't even done anything to truly help anyone in your own country but yourself!
You just sit around, writing multiple posts all day,  apparently having nothing better to do than write about than what's wrong with everybody else -  not just the general world, but people in general, including other bloggers - as IF you know them personally and have no flaws yourself!
Written as if you are a qualified, experienced expert on anything at all, really, when you were an English teacher decades ago, that became a bicycle salesman, and you never go out among people and find out for yourself what people are like!
All comfy, from behind your computer, you post the latest reactionary "news," which is actually just what someone you don't even know said on X/Twitter, accepting it as gospel truth, though it could be a Russian bot, for all you know (or care)!

You don't actually care about people's experiences, you just  want to use them so you can be right, validate yourself, and have things your way -  and hopefully get a book deal out of it (never gonna happen, largely because you've never once been right about any of your prognostications).
If you want to keep criticizing American culture and politics anyway, as if you're an expert, without ever having even stepped foot in this country, it's your folly - but do realize that's all it is - your own ignorance and folly.





Monday, July 15, 2024

Shannen Doherty and Triple-Negative Breast Cancer

*Editing in progress 





So as I mentioned yesterday, while I was writing my post, the news alert came in that Shannen Doherty of Beverly Hills 90210 and Charmed had passed from breast cancer.  

This was very sad news, not just because she was a famous actress, but because she had been so brave and public, fighting her cancer, for over a decade, including being put on the latest and newest protocols, as well as often the harshest on the body,  for her particular type of difficult-to-treat breast cancer.  

So often, we hear of celebrity cancer deaths due to not doing the proper screening, waiting too long, but not so with Shannen - she did everything right and was right on the mark, being treated by the best, but unfortunately, she had the most difficult-to-treat breast cancer diagnosis that exists. 


So essentially, whatever else her flaws/prior feuds with other actresses were, what Shannen did was bravely sign up to be a very public guinea pig for any new treatment that came down the pike for the type of breast cancer with the poorest prognosis, with the harshest, most grueling treatments  - triple-negative breast cancer. 


Because at present - even with the new immunologics -  much like pancreatic cancer, if it recurs - and it likely will - if triple-negative breast cancer doesn't get you the first time, it will the second or third time. 

She had hoped to be the face of surviving it, with all of the new advances in cancer treatments, and though doing so did prolong her life by a few years, eventually she, too, succumbed to it.😒


So what is triple-negative breast cancer?

I get to that below, but before that ... 

So for Contract 1, I type the test-marketing interviews between pharma, insurance companies, and expert clinicians for new drugs before launch, often for cancer, and for Contract 2, I type predominantly for a respected cancer clinic.

So nearly every day, with one contract or the other, I hear encouraging stories about cancer survival, which I wouldn't have heard 15 years ago, before the new immunologics knows as "mabs" or "monoclonal antibodies" were launched.


Immunologics aren't typically used as a first-line treatment for cancer at present, because they were originally designed and studied in later-stage cancers.

In other words, they were designed such that if chemo, surgery, and radiation don't work, and your cancer progresses, then immunologics are tried - the rationale being to save the "big guns" for last as a sort of "Plan B."

The result was that they have had life-saving effects with certain types of later-stage cancers that were previously a death sentence,  including melanoma, breast cancer, lung cancer, multiple myeloma,  prostate cancer and many others, including even certain non-solid tumor cancers of the lymph and blood. 


Now, they either have been or are currently being studied in earlier stages, in either a first-line "neoadjuvant" or "just before"/presurgical setting or as first-line "adjuvant" or "along with" surgery setting, with some success, depending on the type of cancer, so that they can be used first-line with more aggressive types of cancers or cancers that have some response, but not enough response, in later stages.


Immunologics work differently than chemo, in that they target only cancer cells, as opposed to chemo, which is cytotoxic to all biological cells. 

They do come with side effects, but we've learned how to manage them, and they are often less grueling than those with regular chemo (but not always), and sometimes they are given in conjunction with chemo.


Thus, oversimplified, unlike chemo, which is cytotoxic and kills all biological cells, immunologics instead work with the body's immune system to target and recognize only the cancer cells and help attack them, like the body should, rather than bypass cancer as being a natural part of the body.

That is because up until the immunologics, our immune systems could not fully recognize cancer as a foreign body that should be attacked, because often cancer shares some of the DNA of whatever organ it grows from (except in blood cancer).


In breast cancer (and also prostate cancer), this process is helped along by hormone treatments, if the cancer is found to have hormone receptors present.


(As an aside, this is why the birth control you use or the hormone-replacement therapy after menopause is so important.  While these things can protect you from other reproductive types of cancer, with breast cancer, you can have too much of a good thing with hormones, if not in the right balance, and thus you have agreater risk of overreception or even overexpression of one hormone and not enough of the other  - which is what puts you at a 2% higher risk for breast cancer.  Some suspect an even a greater risk, but point being, there is a slight risk to keep in mind in selecting hormones to use and lab tests to check your hormone levels can help. )


Those hormone receptors are ER (estrogen receptors), PR (progesterone receptors), and the third measures gene expression of HER2/neu, a growth factor hormone-related protein related to tissue growth, found to be present in excess in certain types of breast, prostate, ovarian, esophageal, and pancreatic cancers, among others.


Thus, when your cancer is described as "triple-negative," don't let the word "negative" fool you - it means your type of cancer has tested negative for all 3 markers we currently have that are known to respond well to current treatments


In Shannen's case, she tested negative for all three or "Triple Negative" - meaning her cancer would not respond to hormone-mediated and/or genetic-expression treatments and only minimally to surgery, regular chemo and radiation.

Additionally, even the immunologics would not be able save her, just extend her life by a few years.

Also, it is important to note that men are also tested for these same genetic markers, as well hormone receptivity for their types of reproductive cancers.

Men produce smaller amounts of estrogen and progesterone, just as women produce smaller amounts of testosterone, but they are particularly tested for HER2/neu overexpression in prostate and testicular cancer, because again, HER2/neu is a tissue growth factor hormone protein.

Now, how the staging is determined ...




As most know, cancer is given initial basic overall staging from I through IV, which is based on the size of the tumor, the degree to which it has invaded the surrounding tissue, the degree to which it has invaded into the surrounding lymph nodes, and the degree to which it has already metastacized, or already been carried by the lymph and blood past the margins and into other parts of the body, typically the liver, lungs, brain and bone..

Then after overall staging based on imaging, a tissue sample is obtained, either through biopsy or surgery, and the substaging happens for greater specificity. 

This way, we can then further characterize the invasiveness into  a "T N M" format - with the "T" meaning tumor size, "N" meaning the degree to which it's invaded into the surrounding lymph nodes, and "M" meaning whether or not it has metastacized past the margins and been carried by the lymph/blood, into other parts of the body, with lots of subclass numbers regarding the degree of each of those.


We also now do genetic testing on the tissue to determine initial genetic components, as well as any mutations that have or are occurring, so we can know which protocol pathway will result in the best outcome - surgery or not,  radiation, chemo or not, immunologics or not, and whether the latter should be given neoadjuvant (before surgery or radiation) or adjuvant (along with surgery or radiation) and whether chemo/immunologics should be given concurrently or in a specific order. 


You've likely heard of BRCA carriers, which are the basics, but also whether or not your cancer is PD-L1 positive can make a difference in treatment, as well as genetic mutation testing for BRAF, KRAS, EGFR, ALK, and ROS1 mutations and many others, which can also make a difference in your treatment, what your cancer will respond to and what it won't.


As a result, although late stage breast, prostate, and lung cancers used to be an automatic death sentence, the immunologics and genetic testing has altered that, so not necessarily anymore (but mutations still happen).


HOWEVER - with all of the advances we've made with genetic testing and immunologics and hormone therapies, they all appear to still have little to no effect on certain specific types of cancer - specifically pancreatic, ovarian, certain types of breast, prostate, and renal cancers, certain brain cancers and other more uncommon forms of cancer. 


In Shannen's case, based solely on what I've read in the press, she had recurrent, Stage IV, metastatic "triple-negative" breast cancer.


This means she beat it the first time, but it came back aggressively, quickly metastacized to the brain, and her cancer did not contain the 3 known hormone receptors and growth factors that we can typically can use to treat breast cancer  - so negative for ER, negative for PR, and negative for HER2/neu.

Again, this means her cancer would not respond to hormone treatments, or much of any treatment, for that matter, and although  monoclonal antibodies/immunologics such as Kysqali can extend your life by a few years, it cannot cure you.  

Chemo is still the most effective with triple-negative breast cancer, but again, it kills all cells, not just cancer cells, and it's not a course or two, it's constant chemo, so it's rough.  

Radiation is used to control the size of the metastases to the brain, lungs, and bone for comfort, but it can't stop it, either.


(Just as an FYI, HER2/neu-positive-only cancer isn't the type of breast cancer you'd want, either, as it's also in this same boat regarding regular hormones and difficult to treat, but there is an immunologic specifically for them called "Enhertu," which has some effect for some patients, but not effective enough, and it's also dependent on the genetic mutations you might have.)


Shannen was the face of all of the new treatments for triple-negative breast cancer and tried all the new treatments, and was able to successfully live years longer than expected, but ultimately succumbed to her cancer.  😒

Super sad, but her willingness to be a very public guinea pig for any new trials and protocols was admirable, and hopefully as a result, one day we will be able to cure this type of breast cancer, too.



Sunday, July 14, 2024

Saving "Evil"







No -  this post is NOT about the assassination attempt on Trump.

I decided to write about this on Thursday, after watching the most recent episode of the show "Evil," originally on CBS, now on Paramount. I had already decided this would be the title of the post, knowing that  the series will likely be its final, pending cancelation.  

However, I can't deny that in writing this title today, the double-entendre didn't cross my mind.


It's no secret that I have nothing positive to say about Trump - but I also do not wish pain, suffering or death for him, or for anyone, for that matter.


Also, those of us who work in healthcare are committed to doing what we can to help either treat and end suffering and save lives, or assist others who end suffering and save lives  -  despite what we think of the person and their character. 

Because it is not the healthcare professionals' job to decide life and death, nor who is most deserving of life and death, only to save it -  no matter who you are or what you've done - Trump, Biden, soldiers, terrorists - they are all lives. 


Speaking of which, that is also the job of the FBI, who is now stepping in with an investigation - an agency which Trump has insinuated needs to go - but is now in charge of investigating his assassination attempt, because that is what they do.


And if anything good can come from this assassination attempt and crowd shooting yesterday, I hope it's that gun laws change and that Trump might rethink some of his rhetoric - because it's one thing to  advocate for for insurrections and violence, but quite another when you, yourself, are the victim of it.

Thus, I'm praying for changes of the heart, amen?

Not holding my breath for that, but sometimes it takes your life flashing before you eyes to make positive changes.


Unfortunately, my husband - the former Army Ranger - does not feel the same way, and half-jokingly said "Damn, they missed ... hehehe"- to which I said "Markkkk - he doesn't deserve to die."

He said "I'm just joking.  Sort of.  It sure would've solved a lot of problems, though, and we can get back to normal here in the U.S."


In other news, it's been quite a week for famous deaths - "The Shining's Shelley Duval, Dr. Ruth, Richard Simmons and just moments ago, we heard that Shannen Doherty of Beverly Hills 90210 fame died from metastatic breast cancer. 


Thus, with so much bad news, we often turn to escaping into TV and movies for a little fantasy, with such events.

Or is it? 

Paramount's "Evil" - which I've written about before - is nearing the close of its final season - unless there's a chance it can be saved? 

Though it's no Ozark - and it has gained a following since I wrote that post - it was still not able to cross that threshold to being that show that everyone was talking about.

Recognizing it's no masterpiece like Ozark, I personally am glued to my seat almost as much, and certainly laughing a lot more, but apparently others aren't.

Why is that?

Granted, there are a few loopholes not closed, a few writing troubles at times, but it's still fairly brilliant, both drama and comedy.

Mark and I were discussing why that was, and I think the subject matter can be questionable, if you're the sort of person who is either staunch atheist or staunchly religious.


The show is meant to be like an X-files, only for spiritual happenings - and much funnier.

So a Catholic priest , an agnostic forensic psychologist, and a lapsed Muslim IT expert walk into a bar ...

Just kidding, no - well, sometimes?


No, the premise is, a Catholic priest (David), an agnostic forensic psychologist (Kristen), and a lapsed Muslim atheist and  IT expert (Ben) are all recruited by the Catholic Diocese in NYC to investigate claims of possession and other dark happenings, to rule them out for exorcism.


The show was written by married writing team, Robert and Michelle King, with Robert being a practicing Catholic, and Michelle being a culturally Jewish atheist, so it gives interesting perspectives on these issues, allowing for some space in between.



Because 98% of of the time on the show, no matter how it looks at first, the phenomenon are ruled out and pronounced either a mental or physical illness or tech trickery, with another 2% being pronounced by Kristen and Ben as "unexplained," which the church then addresses -  much to the dismay of Kristen and Ben, who say that just because they can't solve it, doesn't necessarily mean it's spiritual, just that we don't know the answer yet.


The show centers most around Kristen, a forensic psychologist and agnostic, who's job is to evaluate and assess criminals for motive and mental status, particularly when a defendant tries to use an insanity plea.  



She is also the married mother of 4 girls, holding down the fort of their modest NYC home mostly alone, while her husband sporadically works as a mountain-climbing guide, often gone for months at a time. 

Kristen acknowledges that evil exists, but believes that there's nothing spiritual about it - it's a uniquely human trait.

Also, that most people are a mix of good and bad, and what is "good" and "evil" can also be culturally subjective.

Thus, in our culture, she believes that most "evil" can be attributed to mental illness in some way, but that it's actually rare for a person to be pronounced "evil" overall.

However, with the serial killer, she does pronounce him evil, as she cannot find enough organic/biologic mental illness or psychological trauma damage to explain his behavior away. 

(She also doesn't believe in ghosts, stating that most "hauntings" or "possessions," if not psychotic mental illness, are extended guilt or grief reactions "possessing" or "haunting" a person.)


Not helping matters is that Leland - the forensic psychologist for the defense - happily believes that he is possessed by a demon, himself, after inviting it in for power, and believes that he is serving Satan, as part of a group of businessmen who believe the same.

Kristen quickly learns about this and their businesses (which include social media propaganda), but finds this, too, as ridiculous religious belief, and although she believes Leland is also evil, there's nothing spiritual about it - "the devil" is just an excuse for humans like Leland and his friends to do the evil they want to do anyway.


Nevertheless, as (Father) David would say "They still believe they're serving Satan regardless, and can be a contagious mindset and negative energy, regardless of the motivation."


David - the new priest - he has also assessed the serial killer on behalf of the church (as the killer was initially Catholic) and does believe him to be demon-possessed.

He disagrees with Kristen, but is impressed with her assessment abilities, and thus tries to recruit her after witnessing her assessment in court (as well as her handling of Leland), to assist him and the church in investigating these cases.  





She refuses, having left the church and becoming agnostic many years ago, wanting nothing to do with religion - but David argues that he needs her input to help disprove the phenomena as spiritual.

Kristen still refuses, until Leland somehow wins the case, the serial killer walks free, and Leland takes over most of her case load.

Thus, to pay the bills, she relents, plus the Catholic Diocese of NYC has now formally requested her, along with Ben for his IT investigation debunking skills. 


David, though a priest, is also a highly educated man, so he does not necessarily believe himself that everything is spiritual, but also says just because science can explain it, it doesn't mean science isn't used for evil - both can be true. 

Kristen will concede that "evil" behavior can be contagious, as copycat murder, mass hysteria and paranoia, or peer pressure, but that this is again psychological, not spiritual.


Complicating matters further, Kristen's own mother, Sheryl - played by one of my favorite actresses, Christine Lahti - joins the organization fully aware, literally seduced in by Leland. 




But don't mistake Sheryl for a sucker - she's a bad-ass and knows full well what she's doing, but is herself drawn to power, and convinces herself that going along will bring protection and power for her family, particularly her granddaughters.


As for Leland - brilliantly played by Michael Emerson - isn't your typical maniacal-laughing, room-commanding, cat-stroking evil genius -  he instead looks and speaks like your average, meek, mild-mannered psychologist, but is also incredibly manipulative and essentially has no empathy, soul, or conscience.




And as if all of that wasn't bad enough, Kristen had previously frozen her eggs to preserve them for later use in her youth, discovers that the company that owns the fertility clinic that stores her eggs (of which she has used one for her 4th daughter) is owned by the organization Leland works for, and has a dastardly plan regarding them, and actually learns that she may not have legal rights to them.

As mentioned, Kristen believes that Leland is evil, as is the organization he works for, but believes that their belief in Satanism is simply an excuse to do evil they want to do anyway.

David, on the other hand, believes it is both. 




David has been spiritually sensitive all of his life, initially resorting to addictions to push it away, but during one particular acid-dropping episode, believes he saw God and Jesus, who told him his life had a bigger purpose and to accept his spiritual sense as a gift from God and he doesn't need hallucinogens to access it, and in fact, they may obfuscate it.

Thus, believing he was saved by divine intervention and grace, he becomes a priest.

Initially, in the first season, he will sometimes still drop acid in order to try to see/speak to God again and induce/enhance his gift so that he can see spiritual things clearly, but he never sees God again.


But after talking with Sister Andrea - a nun with the same gift,  but more advanced - hilariously play by comedic actress, Andrea Martin - he discovers he doesn't need it.

In fact, Sister Andrea tells him hallucinogens are a crutch, a lack of belief in a gift - and the reason he can't see God again is because the vision was a one-and-done scenario, because God himself, directly communicating with any human, is extraordinarily rare.

Thus, he can either accept what God said in his one-time visit, as well accept God's gift without crutches that may confuse the visions, or he can keep trying to push it away - but perhaps it is the key to finding his true purpose and peace.




Thus, he begins to experience visions without the hallucinogens  - which are remarkable CGI work, I've gotta say.

Of course, Kristen pronounces them as "hallucinogen flashbacks" - only wait, hold up - darned if they aren't also premonitory!

And of course, the church takes notice of them, too - and a special secretive group from the Vatican also recruits David to participate in church CIA-like missions.

However, David is often directed to these missions, despite feeling his visions are directing his attention elsewhere, which begins to conflict with what the secret-society "church CIA" wants him to do - - and he is beginning to question whether this secret organization is truly directed by God or their own power and politics - and that is where we currently are with David.


Speaking of Sister Andrea, she is absolutely my favorite character on the show - although everyone can be funny (with this season being the funniest), she is the funniest - not easy to do with the subject matter.  She is played by SCTV Alumni comedic actress, Andrea Martin (most  known for playing Aunt Voula in My Big Fat Greek Wedding).




Sister Andrea believes in science and mental illness and that most times, these are exactly the explanations behind these phenomenon and nothing more - but she also has the "gift of discernment," meaning she can see when demons are also afoot in a situation and when they are not. 

She is a nun at the NYC diocese and often spends her days doing the laundry and cleaning the church,  sometimes counseling others, but can also be found chasing demons out with holy objects and prayer.

(FYI, in the Catholic church, "demons" have to answer nuns, but nuns are not allowed to perform exorcisms - so Sister Andrea is left to her own devices).


She doesn't do this in a frantic manner, just a quiet walkthrough like shovel that's been doused in holy water, and a calm "And who are you and what do you want?" 

To the sarcastic and snarky demon, whom she handles with equal snarkiness, but never with fear.

She calmly addresses whatever it is and gets rid of it, unbeknownst to the priests, who believe she's a little crazy (because they cannot see them, except for increasingly David), but harmless, well-meaning, and devoted. 

However, most often, she simply outsmarts them/tricks the demons out of the church. 

For example, when Leland comes to the church to falsely claim he wants an exorcism, Andrea can see right away that he's demonic, and when he comes to have a private chat with her to pick at her about her  faith and her powerlessness in the church versus men, she not only says that his organization is no different versus men, and neither concerns her - God knows her worth and her true purpose versus the purposes placed upon her by men.

She threatens to douse Leland in holy water to leave her alone and get out, to which Leland laughs, saying that he is much too powerful for that now.

She throws the holy water, which actually does burn him and he leaves - EXCEPT - we only later learn that it wasn't holy water at all, it was a mix of house-cleaning chemicals she'd mixed up πŸ˜‚


In fact, Sister Andrea appears to be the only thing that Leland is afraid of.

Not only because she's as uncompromising about God as he is about Satan and himself, and his manipulation/temptation has no effect on her, but because Leland knows she can see the demon in him whereas others can't, including priests, initially states: "How come I've never heard of you?"

To which Sister Andrea replies "Because I'm a nun."

And after she tricks Leland away, says to himself "Wow.  The Catholic church really needs to respect their nuns more."

The demons themselves, however, have heard of Sister Andrea - and are sore afraid. 


In fact, it is because of Sister Andrea that of Kristen's daughters, Lynn, is considering becoming a nun, but tries to keep this a secret from her mother, who will have none of it, until Ben says "Let me get this straight - you're upset because your daughter is sneaking out of the house to talk to a nun instead of pregnant?"

Thus, Kristen visits Sister Andrea and discovers that her daughter has forged the permission slip to talk with Sister Andrea, and relents to her daughter speaking to Sister Andrea, only with her present. 

Thus, in this most recent episode - which became a little more "Touched by an Angel-ish" than I care for, regarding David's "visions" - Kristen asks Sister Andrea to come and speak to her daughter in her presence, plus David believes her house is now a hotbed for demons because Leland and her mother's activities - so David asks if he can bless the house and have Sister Andrea also take a look around.

The girls, too, believe there is something going on, because of strange events in the home, especially when Kristen is not there. 

Sister Andrea does indeed find a demon named "Lou" living in a hole in the wall in their basement and decides to wait him out of the hole, he has to come out eventually, and though she can cleanse somewhat, it is the presence of Father David that can actually rid and bless the home after she's done so.


In the meantime, Kristen and Sister Andrea have a one-on-one talk about Sister's Andrea's beliefs, and Kristen expresses her fears that despite her intelligence, Lynn will instead spend her life sweeping floors and doing men's laundry, tucked away from the world.

Sister Andrea replies something like "I do not try to sway her to the vocation, I simply answer her questions. And doing men's laundry isn't my true purpose, it's just what the church says I do, when I'm not serving in the true purpose and service of God and others.  Some, including the priests themselves, might THINK that's my purpose, but it isn't.  Regardless, some people's purpose is to serve others and we enjoy serving others."

Kristen smiles and seems very happy with this answer, willing to let her daughter decide what gives her joy.


Then Sister Andrea successfully draws Lou out, David finishes the job, and the demons are gone - at least from inside of the house - but they're still there, right outside the home, waiting to get back in.


As for Ben - sweet, hypersmart Ben - he is usually the answer-giver with most of the phenomenon.  If he doesn't know, he'll research and find out and then test it.





That is, until one of their investigations is to a particle-acceleration plant, where someone has anonymously posted a video of people worshipping Satan, with someone being "sacrificed" to it.

The company says the video was an internal fake, created as an internal joke regarding all the rumors about "God-particle" accelerators, but the team is nevertheless called to investigate it. 

The team's investigation do find that the actress "being sacrificed" is indeed an actress, who refuses to be contacted, citing that although the video was fake, something is definitely wrong at the plant.

But other that safety concerns, they find nothing else - with the exception of David, who does see something sinister in a hole created by an explosion from a nearby tank, that the others can't see.

HOWEVER, Ben is blasted by a radiation beam from the particle accelerator that has run amuck, but his radiation levels come down and no brain damage is found - and yet now, he has a Djinn that shows up in his apartment, every day, wreaking havoc.

He believes he's gone crazy, but Kristen - and his scientist sister - believe the hallucinations are just a side effect of such a blast of radiation, with the exception of his sister, who despite being a scientist, is still a practicing Muslim and believes that it can be both.

Ben throws out her theory, going with the idea that this is just a hallucinatory side effect of the particle-accelerator blast to his brain and begins to perform experiments on himself to help him understand it and its limitations so that he can function, but struggles when he discovers that calls and even videos of himself were sent out to ex-girlfriends asking them to visit him, despite no record of these being made on his phone and him having no memory of them.

That is Ben's current dilemma, driving him literally crazy, when he is the one that usually figures everything out scientifically. 


Needless to say, lots of gray-area issues to unpack, here, so I can see if you are a hard-core atheist or hard-core Catholic/otherwise religious (Christian, Muslim or Jewish), you might have a problem with it.

However, if you're open to the idea of exploring and pushing the boundaries of what we currently  want to believe, whether from a scientific or faith perspective, then it's right up your alley.

It poses some interesting questions, that's for sure - the thinking person's approach to as-of-yet unexplained phenomena.

However, sadly, this is the show's final season due to never fully having the audience the show deserves - so give it a try and help them out?

The first 2 seasons are now on Netflix, but they really find their footing by Season 3, and Season 4 can get a bit hokey, but the climax of the coming antichrist and what is being done to prevent it is worth a watch. 

Another feature which becomes almost its own character in the show - which I think is a brilliant filmmaking move - are the lighting and the long-lens/wide-angle "upshots" taken ...





You will notice that rarely are there "flipped" close-ups during conversations, they're often done as an "upshot" - from underneath for effect - above them, on with a wide-angle or long-lens for effect - with the lighting itself being an almost central character. 



In the above photo, the lightning itself gives a halo effect, over their heads - signifying God is with them in their pursuit to do good, and that they have been chosen, even if they don't believe in him.

Last but not least, the theme song is fantastic - which dramatically starts slowly and builds faster and faster, along with black and white contrasting images, and animated scene openers/interscene "book" popouts are among the best parts of the show.

One of the best theme songs since Yellowstone, IMO, I give you the theme song of "Evil" ....

(The objects seen in the opening theme song often change, but they have meaning regarding what's currently going on. )








Saturday, July 13, 2024

A Weakened Biden Vs. Trump or Someone Else?

 Biden has dug in his heels, claiming this next election is to important and his experience is required, which is admirable in its own way - I guess.  

Or is it that thing that happens with older people when they just aren't ready to hand you the keys to their car, fearing loss of their own independence, without thinking of the consequences to others?

It's true that this next election is important and his experience is important - but he could be a top advisor to the next candidate?

One thing I do want to draw everyone's attention to is this - look at how we Democrats handle our candidates when all is not as it should be.

We don't pretend behavior is normal when it's not, we don't act like he's an infallible God who never makes mistakes, and we think about what's best for this country - unlike like Trumpers do.

That is because contrary to Trump-Republican Kool-Aid belief, we don't have a cult-like mentality - definitively proving that once again, Trump-Republican accusations that we're the brainwashed ones is total projection.


We're worried for him, for his well-being, as well as the well-being of this country, with him beginning to totter like this.

As sharp and fit as my grandfather was at 82, there were some things that started to worsen, and I'd not want him to do it for his own health (not that he would've wanted to do it, anyway.)

Trump's defense of him was predicted, both because of age and because his team knows how to undermine him with falsehoods via social media; anyone else, they've have to start again πŸ˜‚

But will Trump's semi-defense of Biden undermine his own strategy of attacking him with falsehoods?

Because one of his attacks on him was calling him "Sleepy Joe," which curiously stopped after he fell asleep in court himself on several occasions πŸ˜‚ 

(Oh, wait, no - he was just "resting his eyes" πŸ˜‰πŸ˜‰πŸ˜‰)


I guess only Trump can throw shade at him, no one else? 

Biden pretending nothing's wrong?

And we're all supposed to play along, like it's one big hug dysfunctional family  πŸ˜‚

Well, when it comes to American politics, that might actually be the case!


No thanks, I lived that life way too long already, it's not healthy to "pretend" so much, either for the person, the "family," or the self.

Truth is always the healthiest in the long run, even when it's uncomfortable - inconvenient.


Thus, though it makes me immensely sad, because I do admire Biden, and his wanting to fight to the end, I do have to say - a weakened Biden is no match for Trump, and I don't think it's good for his health, and perhaps the health of our country - so I think he should step aside and be an advisor for the next candidate 😒


Regardless, I don't know who we would get, this late in the game. I'd be fine with Kamala, even better, IMO, but not sure about the rest of the country. 


HOWEVER - if Biden is our candidate, then I will vote for him - because literally just about anyone is better than Trump - Republican, Democrat, Independent, I don't care.

Trump is too authoritarian, too crooked, too emotionally immature, too hot-tempered, too greedy, and too selfish.

Worse, he's been too divisive for this country, and not because he necessarily believes all the stuff he's peddling -  but for his own glory.

Because he knows that peddling uneducated ignorance and lack of religious free will unite the fringe conspiracists, the religious-fanatics who negative God-given freewill,  untreated  (or not properly treated) addicts/alcoholics and the mentally ill, who don't think clearly, greedy, unethical businessmen who care about nothing but money and themselves/their own families, racists, misogynists, and bigots together to back him - and unfortunately, there are a LOT of these people in our country.

Hillary pegged it right when she called half of them a "basket of deplorables." 


We shall see ... 





Sunday, July 7, 2024

Nationwide Insurance, Drops 100K Policies, Pulling Out of Pet Insurance


Speaking of the rising cost of healthcare (particularly pharmaceuticals) in America in my previous post today, veterinary costs have also skyrocketed, and I'm super sick of the "COVID" excuse for inflation.  


If you're a small business, I get it if you're still struggling, but corporations?

No - they got major subsidies for COVID and loans with a lower interest rate, plus continued tax shelters lingering under Trump, still in effect by March 2020 and continued throughout the pandemic.


When it comes to healthcare, that includes corporations that make pharmaceuticals, imaging equipment, lab tests and equipment, even medical office supplies - thousands to millions more than any of us got with our stimulus checks.  

Also, their labor has been back for years now - so that excuse needs to die, at this point - they're just being greedy.


Also, some corporations - particularly gas and car companies - do not like it when there's a Democrat elected, because they're afraid that will mean less tax shelters, more labor laws, and more consumer protection.

Even if these things won't happen or don't happen, they will raise and lower their prices at whim just after an election in anticipation, based on who is in office, which makes it appear to be some sort of "reward" or "punishment" of the voters for voting the way they like, rather than a true financial crisis yet  πŸ˜‚


Don't believe me? 

Watch how fast gas prices drop, usually within 2 days, after a Republican gets elected, particularly by state - but only for a month or so, then it creeps back up.

(For which, of course, they'll now blame something else, like storms in the Gulf, before they even hit, or conflict in the Middle East even though it's been quiet, or Democrat-sponsored labor or consumer protection laws on the table that haven't even passed yet and likely won't be, blocked by Republicans. ).

However, watch gas prices skyrocket within 2 days after a Democrat is elected and stay that way, going even higher.  πŸ˜‚



Now, you know dang well, nothing happened to their profit margin, their taxes, labor or consumer protection laws, nor even significant decreases to their stock margins, just 2 days after an election - so methinks it's less about financial anticipation and more about just being shitty over politics.

Because such an immediate price response to elections - which always goes back up, after a couple of months, even if a Republican - is proof that they can raise or lower their prices at whim without true justification.

Regardless, whoever was actually elected has zero control over that, other than the gas company's stamp of approval on them as a candidate or not.


Also, not only do presidents have nothing to do with prices themselves, but there's nothing they can do about them, either.

So if you're blaming or crediting Biden - or any president - for prices, you're an idiot - and you really need to reread the Constitution regarding the roles and rules of the Executive, Legislative, and Judicial branches of government. 


Only Congress has the power to regulate prices, by passing laws - but they haven't and they won't regulate the price of annnnytttthinnng, even healthcare, due to irrational "Socialism" fears.

This is despite the fact that not regulating even just pharmaceutical costs alone is now bankrupting both public and private insurance companies, but boosting the profit margins of not just U.S. corporations with less taxes than we pay, but corporations in other countries that do have socialized healthcare, thereby boosting the  overall economy of entire countries in doing so (see below post regarding Ozempic and Denmark's GDP rise)!


Yes, the president can author a bill, but Congress still has to vote on approval.

Thus, the only string the government has to pull is the Federal Reserve to just keep raising interest rates, which does very little. In fact, companies just use the high interest rates they're paying for business loans as an excuse to charge you more!

But I digress, to my actual point πŸ˜‚


So 6 years ago, Mark's employer began offering pet insurance, and we jumped on it.  The company was Nationwide, one of the first insurance companies providing pet insurance, and they paid for everything - exams, shots, wellness visits, even allergy testing.  In fact, they are still the only company out there that pays for as much as they do - until now?


We paid $15 out of every paycheck, his company matched it.  The deductible was $250, then Nationwide would reimburse you 80% of whatever costs were accrued over that.  It was GREAT!

Other companies have come along, but no one offered full coverage at a great price, so we stuck with it. 


Fast forward to this past year - suddenly, our premiums increased without warning to $60 a paycheck a month ago.  

Also, we had Ziggy neutered April 29th and they have yet to reimburse us for that, though we met our deductible earlier in the year. 

Then last weekend, when we took Ziggy to the urgent vet for an allergic reaction, the vet informed us of THIS - Nationwide is pulling out of pet insurance because they're bleeding money due to costs - and they just dropped 100,000 members without warning, spurring a class-action lawsuit.


Thus, I wonder if we ever will get reimbursed?


Last week, Mark contacted his work benefits and they're checking into it, to make sure we haven't been dropped, too, but with the July 4th holiday, we don't know.  


However, on calling another company for a quote - the name as yet TBA -  they told us that we are unlikely to be among the 100,000  dropped, because Kentucky makes it difficult for you to stop doing insurance business at whim; however, we WILL be dropped in the next couple of years because Nationwide is getting out of the pet insurance business.


(Wow, I finally found the one good thing about living in Kentucky πŸ˜‚)


This person was very honest and advised us to stay with Nationwide for now, because if we switch now, we will never get reimbursed, and to call Nationwide every day and bug them to pay, especially since they raised our premiums without warning.

He also said although his company is great, Nationwide was previously the best, they covered more than any other company, including allergy testing, which is what Ziggy will need next.


I said, "Okay, but if we aren't getting reimbursed for things they said they would cover anyway, we have to pay out of pocket anyway, so what's the difference if we're never reimbursed?"


He said, "I get it, but if you switch now, you can be certain you'll never get paid for your open claims. Get those claims paid, then give me a call."


I was super grateful for his honesty and definitely will!


Now, my current vet is also awesome - in fact, he left his former practice and went into business himself, because he felt they were overcharging and he wants to keep prices reasonable - but there are certain things he still has to send out for or outsource for, like labs or testing or imaging, for which he has no control over the price. 


What kills me is all of the American people complaining about inflation, but still cutting their own throats financially by supporting politicians who have provided large corporations with the largest tax shelters in history and are anti-consumer protection laws, labor /pay laws, and healthcare/pharmaceutical-control laws - it defies logic, right?

(Mostly because these same Republican politicians also do so much fearmongering about immigrants, gender issues, race issues, and abortion issues, as distraction tactics, and they take the bait!)


Okay, I'm done for today, bitching about the cost of American healthcare without justification,  though we could fix this very easily, with consumer protection laws and pharmaceutical price regulation -  but noooo, Republicans would scream "socialism," instead of realizing that healthcare - especially for humans -  should NEVER be treated like a regular business, it should be about providing for the general welfare for our citizens. 

*Hop* off my soapbox now! πŸ˜‚



Things to Consider Before Using Ozempic


Though I'm prediabetic, I only weigh 128 pounds (making my BMI 22) and have been thin most of my life, so Ozempic wouldn't be an option for me, even if I went into type 2 diabetes, unless my BMI was greater - so this post is for anyone who does qualify and is considering Ozempic (or even if you don't and just want to use it for weight loss and pay out of pocket, as many do). 

And though I'd like to lose 10 pounds still, I'm not about to use Ozempic for it, because temporary use isn't what it's designed for and there is a proven boomerang effect in doing so - you will gain all of your weight back (and then some, if you don't also diet and exercise), with a couple of months. 


But before I get to the specifics of Ozempic, a little background ...


So most people know what I do for a living, and that Contract #1 is transcribing the price-test marketing interviews before new drugs launch, between Big Pharma and insurance companies, both public and private, as well as key-opinion-leading clinicians. 

Unfortunately, the interviews have dwindled since the Inflation Reduction Act, which goes into full effect in 2025, and isn't targeting inflation as a whole, nor is it regulating prices (I wish).


The IRA only targets Medicare copays - meaning that as of 2025, Medicare members will never pay more than a $50 copay for any pharmaceutical drug, regardless of the price.  

Also, Medicare will drop a list of 10 medications every September which Medicare will offer to renegotiate lower prices on, and if pharma won't negotiate, they will no longer be covered - and private insurance will reflect those prices (though will pay slightly more). 


Thus, though passed two years ago, it doesn't officially go into effect until 2025, and they've also dropped the first list of target drugs last September as a warning shot - which has left insurance companies and pharma scrambling to figure out how to accomplish this (without actually dropping the price, of course, though some did for insulin before the last list was dropped last year because they knew they'd be on it). πŸ˜‚

The government doesn't care HOW pharma and insurance companies accomplish this, just that they get it done, so that no Medicare patient ever pays more than $50 for a prescription. 


What this means for me and Contract 1 is, I guess there's no sense in doing price-testing if you know you're going to overcharge and may end up on Medicare's shit list, with the Medicare consumer now paying no more out of pocket for any drug than a $50 copay anyway, right? πŸ˜‚


Thus, the work has dwindled over the past year with Contract 1 and so I picked up Contract 2, going back to regular medical transcription.  It takes me 1-1/2 days at Contract 2 to make what I could make in a 3 hours with Contract 1, but c'est la vie; this is the going rate for medical transcription, now, after competing with electronic medical records and outsourcing to India still, when we used to make $50K with benefits. 

(At least this newer, smaller company is fair with QA, not cutthroat over few resources, and verbally abusive and bullying because you're not face-to-face, like other companies, and that's worth a million to me!)


ANYWAY -  to the point of this post, finally ...

The work that I have received is regarding "me-too" Ozempic-like drugs coming out soon, and I just learned that the the Novo Nordisk type 2 diabetes/weight loss injected drug, semaglutide - the active ingredient their drugs Ozempic, Wegovy and Rybelsus (oral formulation) - has boosted the national GDP of Denmark by 1.7% in 2023, and is expected to rise to 2% in 2024.

So essentially, because the U.S. pays the most for pharmaceuticals out of any country in the world, we have paid for the boost in Denmark's economy - so Denmark is a wealthier country because of semaglutide, mostly because of us!

You're welcome, Denmark!  πŸ˜‚

I say that because America, paying the outrageous prices that we do for drugs compared to the rest of the world, is largely responsible for that boost. 


So what is semaglutide and how does it work?


Semaglutide is an injectable incretin mimetic of GLP-1.  In layman's terms, this means it's a "mimic" or synthetic version of the GLP-1 hormone,  which is the body's natural incretin hormone that is responsible for not only stimulating the pancreas to produce more insulin (which regulates blood sugar), but triggers the satiation mechanism in the brain into thinking you're full (though this mechanism is still not well understood). 

Additionally, it thus can create nausea/vomiting/and even diarrhea or constipation if you eat past the brain's satiation-point hormone release.

Thus, all of this combined will result in weight loss - on average, at least 20 pounds, but up to 75 pounds has been recorded IF you also diet and exercise, too (and the effects are sustained longer, and more weight is lost,  if you also diet and exercise).

Additionally, we already knew that semaglutide showed a reduction in cardiovascular events in people with type 2 diabetes due to the original 2016 SUSTAIN clinical trial, but in November 2023, the SELECT clinical trial just proved that even people without type 2 diabetes showed a reduction in cardiovascular events. (New England Journal of Medicine.)

Then just this past May, a European study showed that semaglutide also reduced the risk of kidney failure in people with type 2 diabetes (not yet published in the NEJM or can't find yet).


Though this study hasn't been done in non-type 2 diabetics yet, we can extrapolate, to a certain degree, that the same would happen in non-diabetics, just like the cardiovascular reduction.


Sounds like a wonder drug, right?

Somewhat, but not so fast - there are some things to consider -  especially if American.


THE COST


The official FDA label states that semaglutide (as the injectible product Ozempic) is only indicated for blood sugar control for type 2 diabetics with a BMI over 27% - NOT weight loss. 

If you're not diabetic and you want to use injectable semaglutide for weight loss only, you have to buy the exact same semaglutide from the exact same company, only called Wegovy. 

(FYI, Novo Nordisk also makes Rybelsus, which is an oral formulation of semaglutide for needle-phobics, but it's less effective and only costs $50 less than the more-effective injection, so most people opt for the injectable.)


Why does the same product, by the same company, have two different product names and lines?


Because Novo Nordisk knew that insurance companies do not cover weight loss drugs.  So if they put both blood sugar control AND weight loss indications on the same label for the same product, insurance companies would never cover it, and thus, the product would never be used, for either blood sugar control OR weight loss.

Thus, the solution was to then put the same drug out as 2 separate products, with 2 separate indications. 

Smart move, right? 


And it worked - your insurance WILL cover Ozempic *IF* you're a type 2 diabetic using it for blood sugar control (after you've tried 1 or 2, even 3 other products first, because of the price).

However, if you're NOT a type 2 diabetic and using it instead for weight loss only, then you MUST use Wegovy and your insurance will NOT cover it - UNLESS - your employer has specifically "carved out" a weight-loss rider on your employer's health plan, but this is rare. 


And the cost? 


Even though though it's the same drug, Ozempic is $1,000 a month without insurance, and Wegovy is $1,300 a month without insurance. . 

If you DO have insurance -  and you have type 2 diabetes and your BMI is greater is 27% or greater -  you will pay around $780 a month until you hit your deductible (and considering most health care plans now have high deductibles, that would likely take you anywhere from 3 to 6 months).  

After meeting your deductible, and if on typical 80/20 copay plans, you will pay $200 a month.

For Wegovy, since insurance coverage is rare, you're going to continue pay $1,300 per month. 


Subsidized/partially subsidized or socialized health care?

Yes, please - at least and especially with pharmaceuticals.


Now - lots of little clinics and docs are popping up and prescribing Ozempic, either suddenly finding a lot more people with type 2 diabetes, these days, or finding ways around it, but either way, you're likely going to pay more out of pocket for it. 

In fact, LA has gotten the reputation for finding ways not only to get it, but to overpay to get it - to the degree that legitimate type 2 diabetics couldn't get it, for a while, as they bought them out! 

Regardless, even if you truly meet the criteria and have insurance, you're going to pay a minimum of $2,400 a year , but since most don't, are you ready to pay $12,000 to $16,000 a year for it?

That's like buying a car every year for the rest of your life!


Also consider this ...

If you go on it before you develop type 2 diabetes, you likely won't develop it - so yeah, you're going to pay $16K a year for Wegovy, for the rest of your life - even higher with inflation.


With regards to the IRA and Medicare's new "shit list" of overpriced drugs to renegotiate, many are speculating Ozempic will be on it, this September, but we shall see.  

Last year, they targeted expensive drugs of equal efficacy that have never reduced their price in 20 years, despite the market being flooded with competitors, including generic -   i.e, insulin and the novel anticoagulants of Eliquis, Xarelto, Brilinta and Pradaxa. 

(For why the pharma market doesn't play by the same market rules as every other product, keep reading below.)

However, semaglutide has no direct competitors of equal efficacy yet and no generics, so the government might just wait for pipeline competitors to launch to see if the prices drop then or not (likely not - again, see why below).





THE NECESSITY FOR CHRONIC USE

Speaking of that cost, we'll start with the financial "side effects" before the clinical ones. 

Though many people use semaglutide for a temporary event like a wedding, etc., it doesn't actually work that way - if you stop semaglutide, you will gain the weight back, the majority of people do, especially if you don't also diet and exercise.

Which means, you - and your insurance company - will be paying the above amounts for the rest of your life (unless you move to Europe).

The good news is, lately I have done a couple of test-marketing interviews for some "me-too" drugs in the pipeline with the same mechanism of action from other countries.

The bad news is, in America, flooding the market with more of a product, even if generic, doesn't bring the price of pharmaceuticals down much, if at all.

This is partly due to still increased demand, but mostly due to the way that PBMs operate. 


PBMs or Pharmacy Benefit Managers are the often third-party companies that manage the pharmacy benefits for your health insurance plan, although a few insurance companies have bought their own PBM, over the last couple of years, due to the below issues I'm about to tell you about.

PBMs rely almost solely on "rebates" on certain drugs for their profit.  The bigger the rebate off the price, the more profit they make, 

Worse, unlike insurance companies, PBMs are not yet legally required to disclose the total rebate percentage received back and where that money goes, to either their insurance-company clients nor its members. 

They have to guarantee insurance companies a rebate percent back , sure - but they don't have to disclose to them the entire rebate percentage they're getting back from the pharmaceutical company, nor where it goes - back into other programs within the company or in their pockets..



So for example - and I'm just making up these percentages, but they are reflective of the types of deals made -  let's say PBM  #1 negotiates a deal for Ozempic where it they get an upfront discount of 10% off the WAC (wholesale acquisition price) PLUS a rebate of 30% on every vial sold.

However, here's the catch  - the PBM, and their client, have to both promise that:

1.  A certain amount of volume of Ozempic will be bought over a year's time.   
2.  Ozempic is their preferred drug over Trulicity (another GLP-1 with somewhat less efficacy)or even excludes Trulicity altogether off  their formulary. 
3.  There will be no prior-authorization requirements other than what's on the label - the doctor attests they have type 2 diabetes without lab-test documentation, 27% or higher BMI - period. 
4.  There will be no more than one step through another drug first, such as metformin, before you can to get to their drug.

PBM #1 takes the deal, excludes Trulicity so that Ozempic is either the only option for patients, or is offered at a lesser copay.

The PBM gets to keep half of the 10% upfront discount plus 20%  of the 30% rebate at purchase of the agreed volume. 

Thus, in the end, the PBM gets a total of a 35% discount, but their client, the insurance company, only gets a 15% discount to put towards lower premiums - and the insurance company doesn't even know, because PBMs do not have to disclose the total rebate percentage!


Now, PBM #2 doesn't take  the same deal.

Maybe because they also own their own PBM rather than use a third-party and thus don't depend on rebates as their income. Maybe they fear that the rebates will not offset the total increased cost for the sheer volume of Ozempic.  Or maybe even some think the the physicians should be primarily responsible for making the choices as to what's best for the patient rather than an entirely financial decision. 

Thus, the insurance company sends PBM 2 a a counter contract in front of Novo Nordisk, and also reminds them that if Ozempic prices get too high, then they can always prefer Trulicity over Ozempic. 

So let's say  PBM 2's counteroffer contract says they will: 

1.   Put Ozempic on the formulary - BUT -  at parity price to Trulicity, with no volume-utilization guarantee, and they'll just let the prescribers and the market decide what's best to use for the patient.
2.  Need at least a 2-year price-freeze.  
3. Require patients to get a prior authorization before approval, such as producing lab tests to prove type 2 diabetes rather than just physician attestation, that your BMI must be 35% rather than 27%, and that an endocrinologist has to prescribe it rather than your PCP.  
4.  Require that patients must have tried metformin and an SGLT first.  
5.  Require that patients also have to subscribe to a third-party digital health and wellness program for diet and exercise, to ensure optimum outcomes, with proof of usage and results before they'll reauthorize it, next year.   

Novo Nordisk then says: "Um, okay -  but if you do, we'll only offer you the basic 1% pay-to-play discount with no rebates at all ..." 

"However ...  if you can convince your insurance client to loosen up  some of those restrictions, we'll give you a 5% rebate or even higher, depending on how many you convince them loosen.  But still, because we're at parity to Trulicity, the rebates will never go higher than 10%, of which you'll get 8%, they'll get 2%."

So the PBM will go back try to convince the insurance company to loosen some restrictions, because they'll get rebates and a profit, that way, and the lion's share of the rebates. 

See how that works, now?


Thus, because the rebate amounts and contracting differ so dramatically, rather than letting the market decide, the profit and losses for the pharma company vary' thus, the price never goes down substantially. 

Because of this, the pharmaceutical industry in America is one of the few market players that does not follow normal market rules and trends.

So just because you have other players now, even generics or biosimilars, doesn't mean the price will go down as with other consumer products. 




Now, the second concern regarding chronicity is clinical rather than financial.


Because although we're also seeing positive outcomes with cardiovascular and kidney results, we really don't know yet what the long-term effects of semaglutide are.  

It has been out 8 years, and we haven't seen any yet, but there is no drug out there without them, and we need more time.

Because remember, you're messing with your pancreas and insulin production.

And keep in mind, pancreatic cancer is the deadliest - I'm not saying semaglutide CAUSES pancreatic cancer, there's no evidence whatsoever to support that (at least not yet) - I'm just saying we don't know and you're messing with your pancreas. 

Though we have made huge leaps in cancer treatment over the past decade with immunotherapy, they seem to have no effect whatsoever on pancreatic cancer, we cannot seem to make a dent.  If caught early enough, it can go into remission, but since the early stages are symptomless, most people aren't. 

Also, if caught in later stages and you are lucky enough to put it in remission, the recurrence rate is astronomical, so if it doesn't get you the first time, it will likely in the second or third time.

And even if it's not pancreatic, all of our systems are more connected than we ever knew, after so much immunologic research, even on things like psoriasis, where we now know that other organ systems are damaged than the skin, like GI and arthritic problems related 

The body can be like a set of dominos in a "cascade" effect - you mess with/fix one chink in the immunologic chain, but trigger a chain of events further down in the immunologic cascade.

Just something to think about - we don't know. 

Lastly, "Ozempic face" has become treated as if it's  "side effect."

It's actually not a side effect of Ozempic, it's a side effects of rapid weight loss - if you lose weight faster than your skin can keep up, it will sag.

In fact, the same happens with bariatric surgery - which, by the way, only costs $20,000 and it's a one time deal versus $12K to $16 K a year for the rest of your life


Now, as I said, for me personally, although I'm prediabetic and would like to lose a few pounds, I only weigh 128 pounds, so even if I do transition to type 2 diabetes, I would never be able to take semaglutide as long as my BMI isn't 27% or greater anyway, so it isn't a concern for me, and I wouldn't want to use it even temporarily because the swing in blood sugar might in and of itself trigger diabetes, because your pancreas is confused!


Now, I know that some people will read this and still go "Sign me up!" but just some things to think about before jumping on that bandwagon, right?