reureu

Also, this isn't strictly a Christian concept, but similar ideas exist in

Judaism: https://www.chabad.org/library/article_cdo/aid/256321/jewish...

Buddhism: https://www.learnreligions.com/perfection-of-giving-449724

Islam: https://www.quranexplorer.com/blog/Education-In-The-Light-Of...

Hinduism: https://www.hindupedia.com/en/Ideals_and_Values/Charity_and_...?

First, there's value in decreasing the viral load of ALL patients regardless of risk, as viral load is likely proportionate to risk of onward transmission. If it decreases onward transmission, then the math would likely favor its use in all cases, since exponential spread gets costly fast.

Second, we continue to focus on hospitalizations and deaths with increasingly poor data and with no focus on disability. Treatment may decrease risk of long covid in non-"high risk" patients, which itself may be beneficial.

Third, while we should expect paxlovid-resistant variants to pop up, the fact that we prescribe it about 4x the rate of molnupiravir and don't see nearly that level mutation should be somewhat comforting. It seems equally plausible that a new "long branch" lineage would pop up with resistance irrespective of evolutionary pressure from paxlovid prescriptions. If that's the case, it'd be a shame to ration its use to only have it go bad anyway (this is basically what we saw happen with all of our monoclonal antibodies).

Fourth, this entire conversation should be less focused on who we deem worthy of one of our last remaining treatments, and more focused on how we're allowing a very quickly mutating virus to spread virtually unchecked and with basically no investment in any further treatment or prevention. None of us need to be prisoners here if we were continuing to invest in new treatments, better vaccines, improved air filtration and ventilation, and paid sick leave.

If you're going to construct a new strawman argument, don't make up quotes that I never wrote. I also have a lot of thoughts about how controlled substance laws create problems and harm patients. But I'll stick to the main point of this thread: paxlovid drug interactions are easily checked and managed for the majority of patients, and should not be a reason for providers to reflexively deny prescription requests for it.

> but it's not like the doctor is in any way responsible for verifying that information.

Yeah, that's the exact point. Everybody does things that the doctor says they shouldn't, but that doesn't mean we withhold care as a result.

People stop antibiotics before the scripts are done. People smoke and drink too much, some even drink and drive. People don't take their blood pressure or cholesterol or even HIV meds as prescribed. Some people take half a pill because the pill they were prescribed is "too big" -- people are weird and do all kinds of things.

Paxlovid is no different. The provider can be checking drug interactions, making adjustments as needed and counseling the patient. That's their job. They can't babysit the patient all of the time. If it's clear the patient doesn't understand and can't care for themselves, then there are larger conversations to be had.

My point is that deciding not to prescribe a medication to a qualifying patient because it generally has too many drug interactions and patients can't be trusted with their health is not ok. Patients don't need to understand that ritonavir is a protease inhibitor that was incidentally found to inhibit cytochrome P450-3A4, which subsequently boosts the levels of many other medications. They just need to know to stop taking their cholesterol pill for the next week. That's all. Some, like your elderly relative, may not be able to follow that direction. But there are millions of high risk people who are able to do that, and shouldn't be denied care based on the assumption they're incompetent.

Managing drug interactions for paxlovid isn't much more complicated than inputting meds into a web form and looking at the color of the box that pops up after. I think most providers can handle that if they know these tools exist and get past the reflex of "paxlovid has drug interactions, you don't want to take it."

Managing drug interactions is part of ordering medications, and if it's really taking that much time (i.e., the EHR isn't just doing all the work for you), then it'd result in a higher E&M code when it's billed out. Medication management, in some cases, can also be billed and reimbursed by the pharmacist.

So, totally agree that the US medical system is optimized for billing. I don't think those of us in the US should be ok with that, and I don't think it's an excuse in this case to not prescribe paxlovid to patients who want it and would qualify for it.

According to the CDC, risk factors that make you at "high risk" include being over 50, having a mood disorder (including anxiety and depression), being obese or overweight, being physically inactive, being a current or former smoker, or having asthma: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/...

Most Americans would check one of those boxes, even the healthy and young among us. And some of those (e.g., "physically inactive") are pretty ill-defined that you could argue even more fit in that category. Just saying you're anxious about covid outcomes should qualify you for paxlovid because anxiety is a risk factor.

Many of the infectious disease doctors I work with think that paxlovid should be offered to virtually everybody because it seems to decrease your viral load (this could decrease the chance of onward transmission), there may be a decrease in risk of long covid, it may shorten your symptom duration, and there aren't many other treatment options if you get sicker. So, short of being on one of the medications that's absolutely contraindicated, their opinion is generally if you want paxlovid you should get it.

So if your doctor is saying you don't need it or don't qualify, and you want to take it, I would find a different doctor or use a telemedicine provider.

One's ability to "trust" a patient isn't a factor here, and is, frankly, pretty condescending. The patient and provider have aligned interests, it's just a matter of ensuring the provider is making sure the patient understands what's going on. The provider should be doing that in all of their encounters, so that's nothing specific to paxlovid.

And then I've heard from too many patients their doctor doesn't think they need it because they're not that sick, so it's not worth managing the drug interactions. Unfortunately, paxlovid needs to be started within five days of symptom onset, but most patients aren't going to be hospitalized within those first five days.

Given the lack of monoclonal antibodies, the potential mutagenic effect of molupiravir, and the less-than-steller impact of remdesivir... if I or someone I loved got covid, I'd be jumping on paxlovid since there aren't many other options right now.

To anyone who has tried CBT and felt like it wasn't working for you, know that there are other types of therapy that might be more appropriate for your situation. Personally, I went through multiple CBT therapists before happening across someone who does internal family systems (IFS) work, and have found that to be immensely more helpful for my situation.

In the process of going through therapists, I got to progressively darker places, because each bad experience with a therapist would make me feel that much more broken and unfixable. So, I really want to emphasize to anybody that's been through this, that there are dozens of different approaches to therapy and every therapist applies a particular type of therapy differently.

So, if you're struggling and have had bad therapists in the past, look up your past therapists to see what their approach was, read about different approaches to therapy, and intentionally look for someone orthogonal to what you've been through before. You might find a different approach clicks better with your situation.

And stay away from talkspace and betterhelp.

My mom, driving me home from the hospital where I had just finished a stay for a large abscess, started telling me how my problem was I was "too anxious" and really should try prozac. Huh? No, my problem is there's an avocado-sized sac of pus in my insides that could have exploded and killed me. That seemed to be the pretty consistent consensus from the doctors who just spent a week treating me with antibiotics and the surgeons who poked me every day to make sure I didn't need emergency surgery and the interventional radiologist who inserted a drain into my belly.

There was another point where I physically couldn't walk a single block, I couldn't eat anything (on doctors orders) other than popsicles and pudding and ensure, was losing a pound per day, and had to sleep for 2-3 hours for every hour that I was awake. And one of my close friend's response was "your problem is you're eating crappy food, what if you just had a nice big salad?" It was infuriating for its tone deafness: the problem was not the crappy food I was eating, it was the hole in my colon that had caused sepsis; the doctors were clear that eating any fiber could make everything worse and I needed to stay on a super low fiber diet until the perforation and fistula resolved.

Anyway, the whole thing was a wake-up call in multiple senses. I need to take better are care of myself. I need to do things that I love while I'm able to do them, because that little glimpse at living with illness was pretty terrifying. When I have issues, I need to be judicious with what and to whom I disclose (including updating my emergency contact information to not be my mom).

My favorite quote that I heard during that ordeal was "health is a crown only the sick can see." I feel really lucky that my situation largely resolved, and that having been very sick has left me with the ability to recognize the privilege of health.

It's definitely changed how I think about people living with chronic illness-- not that I thought they were "just anxious" or "just need to eat a big salad" before, but recognizing that their struggle is so multifaceted. It's feeling physically unwell in ways you can't imagine (not just feeling sleepy, but it's like your body giving you a 5 minute warning that we're going down for a nap whether you like it or not). It's struggling with a broken healthcare system that's not designed to help you and requires you to be your own advocate (when admitted for sepsis, they forgot to order antibiotics for me after my first round in the ER, so I became septic again on the floor, and had to ask multiple times when my next round of antibiotics were; the hospital maintains that was appropriate care). It's navigating your own relationships where people dispense unsolicited and demeaning advice while also sometimes distancing themselves from you. It's horrible.

So, stay healthy and avoid getting sick as best you can, identify and build a support network, and be kind and gentle and inclusive with your friends that are sick-- someday that will be you.

There are multiple productions on YouTube, such as: https://www.youtube.com/watch?v=vuL7EbjFBBw

Description on wikipedia: https://en.wikipedia.org/wiki/Mr._Burns,_a_Post-Electric_Pla...

Many of the comments/responses to me seem to be missing the original context. Yes, all friendships come and go. Yes, interaction isn't family and family isn't interaction. Yes, you can carry on friendships with people after you quit.

Everyone is saying true things. But as someone who has moved cross country to work at a startup, treated the startup as my social life, and then left that job... I was devastated by the number of people who I thought were close friends who basically didn't talk to me after I left the company. I learned that lesson in a really rough way at 26.

Now, I take my own advice, and when I meet people through work that I get along well with, I try to move that friendship outside of work so hopefully it has a chance to outlast the job and be an ongoing social connection. That also opens my network up to their friend network. It also gives me social support beyond someone to gripe about work with.

That's all I'm saying. When you have no friends or support, having daily interactions is good/necessary, but try to use that to solve the main problem: having no friends or support.

If OP is feeling better because they can go to bowling night with their team, and feel connected and bonded... then that's not sufficient long term. If they meet one or two people who they seem to jive with and suggest meeting up outside of work for bowling... then that's a good way to start a social network that'll outlast their job and potentially not land them in the misery they were in originally.

Startups, especially in the Bay Area, will often promote the former to make people feel engaged in their work and to scratch that itch for connection. But in some ways that works against your own longer-term social needs.

Then my manager quit. Or a power-hungry executive starts targeting your area, creating chaos. Or the company doesn't raise the funding it needs.

So, you quit, or get laid off, or fired. That family culture, and friends you saw every day and bonded with are either no where to be seen or the dynamic shifts so dramatically it becomes practically unbearable.

Each job I seem to stay in touch with 1 or 2 coworkers regularly, and am on good terms with a few dozen more. But in terms meeting your social needs, it ends up hurting a lot more when you realize you were all alone the entire time and your coworkers were just paid to talk to you.

This is part of why you see a lot more people in their 20s attending company functions or working in startup "family" cultures, and fewer in their 30s, 40s, or 50.

It's good that you're finding something to help address your loneliness. I would encourage you to try to find a few work friendships that you can take offline and outside of work to start building a social network that's divorced from where you're working. And if you have a difficult time doing that, then that's particularly a skill you should work on developing -- because as someone in my mid-30s, it's only going to get harder to make and maintain friendships from here on out.

I don't think this paper can be taken as sufficient evidence to rule out nutritional deficiencies that could contribute to mental health issues (e.g., decreased B vitamins, iron, vitamin D, tryptophan, etc). I know that when I diligently take these kinds of supplements, I do have more energy and sleep better. However, the "humans are destroying the world" sad feelings that drove me to stop eating meat persist, making me wonder if this is quite confounded relationship.

If you're interested in this topic, there's a couple of really good documentaries about the early HIV epidemic and how gay men adapted: "how to survive a plague" and "we were here" are two of my favorites.

Alright, do One Medical next.

Of course, if you were already pulling 200/200 from a big company, you might have already banked enough of a nest egg to feel comfortable with the risk of startups.