On Christmas Day at the WaTiki indoor water park, Hans Wirt was getting winded from following his son up the stairs to the waterslides.
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Wirt’s breathing became more labored once they returned to the nearby hotel where they and Wirt’s girlfriend were staying while visiting family in Rapid City, South Dakota.

Then he grew nauseated and went pale. Wirt thought the cause might have been the altitude change between his home in Deltona, Florida — 33 feet above sea level — and Rapid City, at the edge of the Black Hills. But his 12-year-old son was worried and called for an ambulance.

“I could tell by the look in his eyes that there was something a little more to this,” Wirt said. “So I can kind of thank my son for saving my life.”

It turned out the 62-year-old was having a heart attack. A “lousy Christmas present,” Wirt said.

Medics stabilized Wirt before taking him to Monument Health — the only hospital in Rapid City with an emergency room — where he was treated over two days.

Then the bill came.

The Medical Procedure

Paramedics used a defibrillator to restore a normal heart rhythm. Doctors at the hospital gave Wirt various medications, used an electrocardiograph and other diagnostic and monitoring devices, and inserted stents into his arteries to improve blood flow to his heart.

The Final Bill

$95,523.73, including $32,998.90 for medical supplies, mostly related to the stents, and $28,879 for treatment in a cardiac catheterization lab. After unspecified hospital adjustments to the bill, Wirt owed $77,574.44.

. . .

The Billing Problem: Medicaid Across State Lines

Wirt is covered by Florida’s Medicaid program through Sunshine Health, a managed-care plan. But the South Dakota hospital refused to submit the bill to his out-of-state Medicaid plan, instead sending it to Wirt and eventually threatening to send the debt to a collection agency.

. . .

Somers and DeBriere said Medicaid recipients who receive bills they don’t think they owe should file a complaint with their state’s Medicaid program and, if they have one, their managed-care plan. They can also ask whether there is a Medicaid or managed-care caseworker who can advocate on their behalf.

The attorneys said patients should also contact a legal aid clinic or a consumer protection firm that specializes in medical debt. DeBriere said those organizations can help file complaints and communicate with the hospital.

DeBriere said that, had she assisted Wirt, she would have immediately sent a letter to Monument Health ordering it to stop billing him and to either register with Florida Medicaid to submit his bill or offer him charity care.

. . .

I realize that it’s been four weeks since I posted here, posting about the soft eugenics of MAHA. I’ve been meaning to get back into it, but, for whatever reason, whenever I’ve tried to do so something got in the way; that is, until now. Perhaps it’s because there are few things that I enjoy writing about more than a good crank fight, and few cranks are as cranky as disgraced Dr. William Makis, Makis, as you might recall, is the disgraced nuclear medicine radiologist who lost his medical license in Alberta and, while probably not the originator of the antivax concept that COVID-19 vaccines cause not just cancer, but turbo cancer, has arguably been the most vocal antivax quack promoting the idea. In Makis’ telling, COVID-19 vaccines are so full of mutating evil humors that they cause cancers that are not just run-of-the-mill cancers that anyone can get as they get older, but rather cancers so fast-growing and malignant that the are called “turbo cancers,” cancers. Never mind that he can’t define what the heck a “turbo cancer” is compared to regular cancers or provide any good evidence that cancer, much less “turbo cancers,” are associated with COVID-19 vaccination. None of that stopped him from becoming a total cancer quack, promoting all manner of quackery. On the opposing side of this crank fight is Dilbert cartoonist Scott Adams, who actually comes off closer to the side of reason, not to mention being the more sympathetic character due to his having been diagnosed with stage 4 prostate cancer that he tried to treat with Makis’ “protocol,” which involves:

As you will see, Makis is a big fan of ivermectin, that anthelminthic drug that is very effective against diseases caused by parasitic roundworms and was seized upon as a miracle cure for COVID-19 not long after hydroxychloroquine was being promoted as a miracle cure. He’s also a fan of other anthelminthic drugs mebendazole and fenbendazole, drugs that had shown mild antitumor effects in preclinical models (but not in humans), drugs that he recommends, as is the case with many cancer quacks, in a “protocol” or cocktail with ivermectin, vitamins, and supplements rather like the one touted above. I’ve discussed how mebendazole and fenbendazole show mild promise in the lab but have never been validated in clinical trials in humans, making them at best unproven and at worst quackery now (barring new evidence); indeed, I referred to the claims about fenbendazole as reminding me of those of cancer quack Stanislaw Burzynski about his antineoplastons therapy. I’m not going to go into that more here, as you can read my previous posted linked to in this paragraph. Rather, I’m interested in what happened after Adams posted this on X, the hellsite formerly known as Twitter:

I haven’t written much about Scott Adams before, other than to note that over time he has increasingly embraced COVID-19 minimization, antivax narratives (even saying that “antivaxxers were right“), and conspiracy theories, although there were signs as long ago as 2007 that he was slowly heading down the rabbit hole of unreason. (These days, he’s become fairly Trumpy, and President Trump apparently even called him after his announcement to check on how he was doing.) Adam’s history aside, a little more than a week ago he announced that he had been diagnosed with metastatic stage 4 prostate cancer; within a day or two of that came the post/Tweet cited above.

It’s unclear when Adams was initially diagnosed with prostate cancer, but he was fairly calculating about when he chose to announce his diagnosis. In fact, he quite frankly says that he decided to do so after former President Joe Biden had announced that he had been diagnosed with stage 4 prostate cancer:

It was not clear when Mr. Adams was diagnosed, but he said that he decided to share the news after learning that Mr. Biden had the same disease, in part because he hoped that Mr. Biden’s announcement would draw attention away from his own. He had kept quiet about it to prolong a sense of normalcy, he said: “Once you go public, you’re just the dying cancer guy.”

Mr. Adams said he was also wary of sharing his diagnosis because he wanted to avoid the kind of negative online attention that Mr. Biden has received since his office announced the news on Sunday.

“One of the things I’ve been watching is how terrible the public is,” he said, adding that people had been “cruel.”

“There’s no sympathy for Joe Biden for a lot of people,” Mr. Adams said. “It’s hard to watch.”

. . .

WASHINGTON (AP) — Get ready for several years of even more record-breaking heat that pushes Earth to more deadly, fiery and uncomfortable extremes, two of the world’s top weather agencies forecast.

There’s an 80% chance the world will break another annual temperature record in the next five years, and it’s even more probable that the world will again exceed the international temperature threshold set 10 years ago, according to a five-year forecast released Wednesday by the World Meteorological Organization and the U.K. Meteorological Office.

“Higher global mean temperatures may sound abstract, but it translates in real life to a higher chance of extreme weather: stronger hurricanes, stronger precipitation, droughts,” said Cornell University climate scientist Natalie Mahowald, who wasn’t part of the calculations but said they made sense. “So higher global mean temperatures translates to more lives lost.”

With every tenth of a degree the world warms from human-caused climate change “we will experience higher frequency and more extreme events (particularly heat waves but also droughts, floods, fires and human-reinforced hurricanes/typhoons),” emailed Johan Rockstrom, director of the Potsdam Institute for Climate Impact Research in Germany. He was not part of the research.

. . .

nside Manu Prakash (opens a new tab) are two scientists. A bioengineer at Stanford University, he spends half his time studying urgent health issues with global impact and the rest pursuing questions “of no use to anyone,” he said. To him, though, there is no conflict between these pursuits. Together, they represent something of a philosophy for life.
(opens a new tab)
Prakash is widely recognized for his pioneering low-cost scientific tools. In 2014, he invented the world’s cheapest microscope (costing less than $1), known as the Foldscope (opens a new tab), built primarily from a piece of paper; he has since distributed the device to amateur biologists all over the world.* He also dreamed up the paperfuge (opens a new tab), a hand-powered centrifuge that can separate blood components for medical diagnostics, and Inkwell (opens a new tab), a portable device for making blood smears to diagnose infectious diseases.

Those practical pursuits are worthwhile, he said, but Prakash is happiest on a boat, pulling up samples of seawater to investigate weird microscopic organisms for their own, glorious sake. He then figures out the physics and math that govern the often extraordinary behaviors of these single-celled critters.

Not many researchers pursue both applied and theoretical sciences with equal fervor, but Prakash argues that we cannot have one without the other. He has christened a new field at their intersection: recreational biology. Like recreational math, which pursues puzzles and games for the fun of it, Prakash’s recreational biology freely observes and asks questions about life as a form of play.

“We are humans, and curiosity defines us,” Prakash said. “Awe and wonder are wired in our brains,” and they are the foundation of all human discovery, he added.


"
A close-up of Manu Prakash’s face: brown black hair with some gray strays, and a voluminous black beard.

“Half the time, I don’t care whether a piece of knowledge is useful,” Prakash said. “But the other half, it’s about studying the most urgent problem that nobody’s working on.”

. . .

Numbers have a funny way about them. Young math students are taught various strategies to make problem-solving easier. Comparing fractions? Find a common denominator or convert to decimals. The strategies get more complex when doing the kind of math used to describe the activities of DNA, RNA, or protein sequences.

In science, when you make a model, its parameters determine its predictions. But what do you do when different sets of parameters result in the same predictions? Call one half 2/4 or 3/6—either way, the result's the same. In physics, such parameter sets are called gauge freedoms.

They play a key role in how we understand electromagnetism and quantum mechanics. Surprisingly, gauge freedoms also arise in computational biology when trying to model how different mutations interact.

Now, Cold Spring Harbor Laboratory (CSHL) quantitative biologists have developed a unified theory for gauge freedoms in models of biological sequences. Their solution could have countless applications, from plant breeding to drug development.

The paper is published in the journal PLOS Computational Biology.

. . .

Drew Pavlou’s Iceberg Journal considered back in April how Chairman Mao’s crackpot war on “the humble Eurasian tree sparrow” resulted in a famine that “killed at least 40 million people in a disaster of world-historic proportions.”

Donald Trump’s cult is a kind of MAGA Maoism, Pavlou suggests:

Like Chairman Mao, President Donald Trump subscribes to a wide range of bizarre crackpot theories about economics, politics and world affairs. And like the Great Helmsman, he too has managed to concentrate an extraordinary amount of power in his hands, building up an immense personality cult so as to terrify other figures in his party into submission.

Pavlou argues:

Honestly, the right way to think about MAGA is through the lens of Maoism and other Third Worldist political movements and personality cults. It uniquely draws upon the dumbest, shittiest and most repulsive parts of each: Peron’s economic illiteracy; Mao’s ideological wars on reality; Juche’s exaltation of economic pain and hardship in service of national self-reliance; Idi Amin’s ethnic expulsions of minority groups.

I believe that the central motivating force behind the movement is a rejection of the Enlightenment and liberal modernity. In place of reason it exalts superstition, magical thinking and primitive suspicion of anything beyond direct experience. It is the ideology of the medieval peasant, the goat herder, the cab driver who blames all world problems on the Jews. Its motivating essence is simple: ‘‘Burn anything I can’t understand.’’

His conclusion:

These people have nothing in common with the civilisation they claim to speak for. They demand America abolish its 250 year old Constitution, abolish its liberal democratic heritage, so that the government can run Latin American tin pot dictatorship style paramilitary death squads.

This is MAGA Maoism. They hate everything good about Western civilisation: freedom of thought, freedom of expression, rule of law, presumption of innocence, trial by peers. They want death squads and struggle sessions against political enemies because they want to make America a Third World country.

They are going to fail, but my God they will inflict an insane and psychotic amount of destruction and suffering in the process.

Yes, but that’s mostly the plebs. The rich elite backing Trump want a kind of neofeudalism. I wrote over a year ago that Democrats want an American economy that serves you. Republicans want an America in which you serve the economy.

. . .

“How are you doing?”

These days, what used to be a casual greeting can seem like an existential question -- something more like: “So, how are you personally handling the extraordinary cognitive dissonance of the moment?”

Because on the one hand, Donald Trump is doing catastrophic damage to our country and our democracy and the world every single day. It’s awful.

But on the other hand, life goes on -- for most of us, pretty much the same as usual. The job still needs to get done. The errands still need to get run.

I was quite taken by an essay in the Guardian the other day, by writer Adrienne Matei, in which she uses the word “hypernormalization” to describe “the weird, dire atmosphere of the US in 2025.” She explains:

First articulated in 2005 by scholar Alexei Yurchak to describe the civilian experience in Soviet Russia, hypernormalization describes life in a society where two main things are happening.

The first is people seeing that governing systems and institutions are broken. And the second is that, for reasons including a lack of effective leadership and an inability to imagine how to disrupt the status quo, people carry on with their lives as normal despite systemic dysfunction – give or take a heavy load of fear, dread, denial and dissociation.

One possible response is to just shut down:

Confronting systemic collapse can be so disorienting, overwhelming and even humiliating, that many tune it out or find themselves in a state of freeze.

But here’s the little bit of good news:

Experts say action can break the spell. “Being active politically, in whatever way, I think helps reduce apocalyptic gloom,” says Betsy Hartmann, an activist, scholar and author of The America Syndrome, which explores the importance of resisting apocalyptic thinking.

And just doing it online doesn’t count, apparently:

“It’s easy to feel like: ‘Oh, I’m in community because I’m on TikTok,’” she says. But genuine community is about “getting outside and talking to your neighbor and knowing that there’s someone out there that can help you if something really bad goes down,” she says.

“You’re actually out there talking to people, working with people and realizing there are so many good people in the world, too, and maybe feeling less isolated than before,” says Hartmann.

. . .

The Colorado River basin has lost 27.8m acre-feet of groundwater in the past 20 years, an amount of water nearly equivalent to the full capacity of Lake Mead, the largest reservoir in the United States, a new study has found.

The research findings, based on Nasa satellite imagery from across the south-west, highlight the scale of the ongoing water crisis in the region, as both groundwater and surface water are being severely depleted.

“Groundwater is disappearing 2.4 times faster than the surface water,” said Jay Famiglietti, a hydrologist at Arizona State University and the study’s senior author.

“Everyone in the US should be worried about it, because we grow a lot of food in the Colorado River basin, and that’s food that’s used all over the entire country,” he added. “These days, we’re also supporting a number of data centers and computer chip manufacturers, and these are essential to our economy.”

The Colorado River basin provides water to approximately 40 million people across seven US states, as well as to millions of acres of farmland. Most of the groundwater losses since 2003 occurred in the Lower Colorado River basin, including Arizona, Nevada and California, the study found.

The decreasing availability of surface water is easy to visualize across the west. There are the stark photographs of the dropping levels of water in Lake Powell and Lake Mead, and images of the Colorado River, whose flow has decreased approximately 20% in the past century.

But groundwater is different, Famiglietti said: “It’s invisible. It’s mysterious. The average citizen doesn’t really understand it.”

. . .

In this absolutely fabulous article by Even Osnos in the New Yorker about Trump’s corruption we finally see the best modern example of Trump style oligarchy. I can’t believe I didn’t see this myself:

The nascent United States had its own share of oligarchs, as voting was reserved for white men who held property. But it was a “civil” oligarchy, in which the wealthiest citizens supported the state, because it protected their interests and because they profited more under the rule of law. If the rule of law collapses, though, a civil oligarchy can become a “sultanistic” oligarchy, in which the ultra-wealthy consent to be ruled by one of their own—an “oligarch-in-chief,” in Winters’s phrase.

A prime example of a sultanistic oligarch is Ferdinand Marcos, the President of the Philippines from 1965 to 1986. Marcos was a dogged kleptocrat, estimated to have stolen as much as ten billion dollars during his tenure. On an official salary of $13,500, he secured for his family at least four skyscrapers in Manhattan and a set of Old Master paintings. His wife, Imelda, was known for amassing thousands of pairs of shoes—a habit so distinctive that few people recall she also tried to buy Tiffany & Co.

As Winters notes, oligarchs of this category govern through “fear and rewards.” Marcos subdued the business community by strategically deploying permits and broadcast licenses. He made a special example of Eugenio Lopez, the country’s richest man and the owner of the Manila Chronicle, by breaking up an empire estimated at four hundred million dollars. After a few years, there was little boundary between the President’s financial assets and the nation’s. Marcos gave the sugar industry to one of his former fraternity brothers, and turned over the banana business to another friend. As Marcos’s pals mismanaged their holdings, the country sank into its worst recession since the Second World War.

Oligarchs-in-chief don’t like to retire, because civilian life leaves them vulnerable to retribution from those they ejected from their club. But in 1986, after three years of public protests, the Marcoses fled into exile, with a planeload of jewels, cash, and gold bars. In time, their allies rewrote enough history that, after Ferdinand died, Imelda was able to return home and eventually got elected to Congress. In 2022, after a relentless disinformation campaign that cast the Marcos years as a “golden age,” their son became President. Their perfidy is memorialized in the English language, though. Alfred McCoy, a historian at the University of Wisconsin-Madison, told me, “Marcos’s corruption led to the creation of the term ‘crony capitalism.’ It’s a useful term to describe the Trump era.”

Needless to say, the consequences for the world of having Ferdinand Trump running things are far more dangerous. The Philippines is a great country but it wasn’t the world’s only superpower when it succumbed to this kleptocratic chaos. But Trump sure seems like a modern Marcos, down to the cheap and gaudy ersatz palace.

If you have the chance to read the whole thing do it. It’s the best, and most entertainingly written, piece on this subject that I’ve read.

I have had these thoughts recently but dismissed them because I was afraid of sounding too hysterical. But Adam Serwer (who was ironically, one of the people who made me a little paranoid about that...) has a compelling case to make that this era is more than just Trump’s crazy and a bunch of cowards, it’s an attack on knowledge itself. Gift link here.



It’s a seriously great piece and you should read the whole thing.

The truth is that this project has been a long time coming. We have chronicled the return to superstition, the assault on science, the conspiracy theories and more for a long time. The primitive tribalism has been on full display. But the arrival of Trump and his clear agenda to sack the U.S. Government and all the institutions that undergird our 21st century society is next level. We will no longer be a world leader in anything but arms sales and shitty entertainment.