Healthcare

August, 2019 – Deciding to try IVF

We did a lot of research before starting the IVF process. The difficulty of adoption in the US in this era is comparable to or worse than IVF, and it’s almost as expensive, so we didn’t go that route — and besides, no one in my family is carrying on the family name, so we’d prefer to have my ancestor’s genetic threads continue.

We searched online for an egg donor. This is still an unregulated business, with some effort made to provide a code of conduct from a nonprofit organization of donation agents, but couples looking for Only The Best eggs clamor for Ivy League, Asian, accomplished concert pianist donors; which means a donor with those desirable characteristics can charge far more for her donation. Some agencies advertise “$50-100 thousand dollars for your eggs,” which is well beyond the guidelines.

We found a great donor but at one of the more mercenary agencies; she’s a graduate of a great but not Ivy League science-oriented college, she has a high IQ, and she was not that expensive as a first-time donor. “Proven” donors (after at least one successful donation) can charge more, but this was her first time. We had the agency’s help and did Skype calls to see if we liked her and vice-versa. Contracts had to be drawn up (there are lawyers for both sides at every stage of the process!) and signed.

Recognize that this isn’t easy for donors — they have to put up with medical, psychological, and genetic screening, making many visits to clinics, taking precisely-timed drugs to mature their egg follicles in abnormal numbers for a carefully-timed harvest. Our donor had to fly cross-country twice. The harvesting procedure can be painful and the wrenching-around of body chemistry can result in bad reactions. Fortunately, none of that happened and she was very successful. (And we had to have her back for a second donation when only one embryo came of the first, for reasons that I’ll describe in a later post.)

Our IVF doctor is semi-famous: “IVF doctor to the Stars,” kinda, with past clients like [redacted] and numerous Hollywood types. His office is in West LA on Wilshire, almost to the Santa Monica border, so we visited several times.

Genetic screening is a big part of the matching process. Both egg donor and sperm donor are screened for genetic abnormalities; many people harbor genes that can produce syndromes or diseases that would cause miscarriage if combined with similar genes from the other parent.

My Counsyl gene tests showed three more-or-less damaging flaws; fortunately, none of these overlapped with similar flaws in the egg donor, so we were cleared. I had two recessive conditions, plus a third which apparently is held back from the report for laypeople because it’s too diffuse a danger (sufferers live long enough to reproduce but are extra-susceptible to emphysema and liver failure.) I carry one copy of the good gene and one half-good gene (S) which means it would be wise to avoid hooking up with another carrier (and even wiser to splice it out for good, but we don’t do that yet.) https://ghr.nlm.nih.gov/…/alpha-1-antitrypsin…

Then I got my first sperm count of zero! That will be the subject of a later post — male factor infertility and remedies.

Driving to IVF clinic

Downtown LA as seen from highway

Thanksgiving Note: Out of Action, Health Scare

US Thanksgiving Day is being celebrated. The turkey’s in the oven, it’s cold and raining, the game is on, and we have much to be thankful for.

If you’re a regular reader, you’ve noticed I’ve posted rarely in the past six months. Lots of projects away from writing, family issues, distractions.

On Nov. 1st, we were in Austria a few days into a lengthy itinerary which was to include a Danube cruise, a Nile cruise, and visits to Petra in Jordan, then Jerusalem. On a bus tour to Salzburg, Austria, we stopped at a rest stop and on returning from the bathroom, I had a grand mal seizure in the parking lot. I woke up in the ambulance to the regional hospital, the Salzkammergut Klinikum Vöcklabruck. I was seen in the ER and had a workup before having another seizure an hour after the first. I woke up the next day in the stroke intensive care unit, not because I had a stroke (no evidence of anything at all unusual in MRIs or EEG) but because monitoring and care was continuous so if there had been any further activity they’d know immediately and be able to do scans and tests as it was happening.

Nothing more happened, but because it was now an Austrian holiday coming into a weekend, I had to stay three more days so the MRIs could be done when staff returned. Our holiday terminated there and we spent a few days in Vienna waiting for clearance to travel. Our travel insurance company, Allianz, was incredibly helpful and booked flights back on Air France (which I couldn’t recommend, but it was the first available flight.) The river tour company, Tauck, also went above and beyond, and this week refunded the entire cruise fee. I highly commend them for Americans touring overseas.

Having a grand mal seizure is similar to ECT (Electro-Convulsive Therapy, aka “shock treatment.”) Both hemispheres are involved in a storm of neural activity, wiping all memory of the event and time around it. I was mentally fuzzy afterwards and nothing was quite where it had been in my head. I did notice in Vienna that colors were more vivid and experiences less filtered; it could well be that the scrambling of normal neural activity is in some ways good for you, as when it relieves an obsessive depression by simply hammering the negative thought loops and memories that reinforce them.

It happens that we are also deep into the IVF process, aiming for two children, and today we heard that at least three embryos have matured on Day 5, with two more developing still. That’s something to be thankful for. The IVF effort and the new house we’re building in a more appropriate neighborhood for children has taken up most of my time for many months. So I have been less available to update here and supervise the Jeb Kinnison Forum, which luckily is mostly self-policing. Some of the participants there are at least as good as I am in handing out advice on attachment issues, though of course there is a lot of personal experience chit-chat and people with chips on their shoulders from their relationship breakups.

So Happy Thanksgiving for those who are celebrating it today!

Nessun Dorma: Insomnia and Sleep Aids

Sleep deprivation side effects -- Wikimedia

Sleep deprivation side effects — Wikimedia

Most people experience less than satisfying sleep at least occasionally, but some sufferers go for years without relief. Not being able to fall asleep at the normal hour in a reasonable length of time is known as “sleep onset insomnia.” Older people especially may suffer from waking too soon or not getting enough deep sleep. Sleep is a complex neurochemical phenomenon, and a wide variety of different causes for poor sleep make it hard to diagnose and relieve.

What’s often called sleep hygiene is a collection of good practices and habits that tend to lead to better sleep. Harvard Medical School’s Division of Sleep Medicine has a good list.

If you’re getting exercise and avoiding caffeine or alcohol late in the evening, you might still have problems. Chemical sleep inducers in the form of drugs and supplements can help get you to sleep or keep you asleep, but prescription medications like Ambien and Lunesta can have side-effects, cost a lot, and can be addictive. Many people have been hooked on them (and the drugs of past eras like tranquilizers and sedatives) for years, unable to stop without going through far worse withdrawal symptoms.

If your problem is getting to sleep, your body and mind may be revved up and out of synch with your natural sleep hours. Not engaging in eating, drinking, or stimulating activities for a few hours before normal bedtime can help. Some natural supplements — chemicals already found in your body or food that promote sleep — work for many people. A list:

Melatonin, one of the body’s primary sleep signalling chemicals, is continuously produced by the pineal gland, but destroyed by light hitting the eyes, so it is a driver of the sleep-wake cycle that lags exposure to light; it’s partly because exposure to light synchronizes your sleep cycle that staying up late with bright lighting can disturb it. Taking natural melatonin a few hours before normal bedtime reinforces the natural cycle somewhat, although there’s little evidence of it crossing the blood-brain barrier after absorption by the digestive system. Try sprinkling a bit of melatonin in powdered form under your tongue, perhaps by opening a commercial capsule like these. Melatonin, like some other drugs and vitamins, can be absorbed somewhat by the blood-vessel-rich skin under the tongue — this is called sublingual administration. Melatonin successfully reduces time-to-sleep and insomnia for most people, though it is less effective at keeping you asleep. If you’re already getting up to go to the bathroom at 3 AM, though, you can do another sublingual dose of melatonin and sleep a few more hours successfully.

5-HTP or its precursor L-Tryptophan. Tryptophan is an amino acid component of the proteins in many meats, eggs, and dairy products, and is commonly believed to create the sleepiness after a big Thanksgiving turkey dinner — though turkey meat has no more L-Tryptophan than most other meats. It is also usually credited for the “glass of milk at bedtime” method for assisting sleep. After a Japanese manufacturer of L-Tryptophan produced contaminated batches in 1989, injuring thousands and killing as many as 37 people, L-Tryptophan was banned by the FDA in the US. These restrictions were loosened and finally lifted completely in 2005. As a result of that incident, though, more people still take 5-HTP, which is a metabolite of L-Tryptophan and his similar effects. A few hundred mg of either does tend to produce faster and deeper sleep in most people, and like melatonin thet are both safe and not habit-forming.

Valerian Root is somewhat less harmless. An old herbal standby, this herb in capsule form is used by millions as a sleep aid. While it does work, it can’t be recommended for any but the shortest-term use because it is a mild liver poison — long-term use damages liver function. Other herbal teas like chamomile also have some sedative effects without any obvious toxicities.

GABA is another amino acid and neurotransmitter which doesn’t seem to cross the blood-brain barrier, yet has some obvious effects, producing calm and deeper sleep and perhaps aiding production of growth hormone in older body builders who take it. I take a gram every night before bed and it seems to deepen sleep. It also has some side-effects reminiscent of the niacin flush for some, so be careful and experiment with small doses before trying more. A reliable low-cost provider of GABA powder which can be mixed into any drink is here. Capsules tend to provide less effective dosages.

Doxylamine succinate is an old standby which works fairly well and is cheap and safe as a sleep aid: as an antihistamine, it is obsolete because its side-effect of drowsiness is intolerable during the day. But while it’s unwise to take any drug regularly unless you really need to, it’s at least not addictive and is easy to buy OTC: as this Kirkland-label product from Costco, for example.

Everyone’s sleep problem is different, and with age staying asleep becomes the most common problem. Natural substances can help but good sleep hygiene should be tried first.


More reading on other topics:

Regulation Strangling Innovation: Planes, Trains, and Hyperloop
Public Schools in Poor Districts: For Control Not Education
Real-Life “Hunger Games”: Soft Oppression Destroys the Poor
The Social Decay of Black Neighborhoods (And Yours!)
Child Welfare Ideas: Every Child Gets a Government Guardian!
“Income Inequality” Propaganda is Just Disguised Materialism

The greatest hits from SubstrateWars.com (Science Fiction topics):

Fear is the Mindkiller
Mirror Neurons and Irene Gallo
YA Dystopias vs Heinlein et al: Social Justice Warriors Strike Again
Selective Outrage
Sons of Liberty vs. National Front
“Tomorrowland”: Tragic Misfire

Accountability, Equality, and Partial Fairness

Seal of the Handicapper General - Harrison Bergeron

Seal of the Handicapper General – Harrison Bergeron

One of the bigger problems with the ACA or any health insurance system which outlaws medical rating is its removal of the financial consequences of bad health habits. Progressives believe heavy taxes on cigarettes will reduce smoking and thereby reduce lung cancer and early death; a financial penalty on a self-destructive habit justified by the social welfare state’s future payment of medical expenses. (One issue is whether this is even true — it turns out most actuarial calculations show those who die early as a result of lung cancer have less spent on their medical care in old age and forego social security payments, so they save the welfare state money.)

But if you equalize the cost of medical insurance regardless of health habits, you are reducing the consequences of unhealthy habits and thus encouraging them. Accountability — having to be responsible for one’s actions — suffers under equalizing systems. Drivers with many accidents and drunk-driving convictions on their record will pay much more for (and find it difficult to even obtain) car insurance, and that’s normally considered a Good Thing because we want there to be financial penalties for habits that endanger others, like driving recklessly or under the influence.

The reasonable objection to charging for health insurance based on health record is that health status is only partly controlled by previous habits and behavior; a big chunk is genetics and chance. So it seems unfair to those who are sick because of bad luck in the genetic lottery — or even by accident, as cancers, for example, are thought in some cases to be created by accidental mutations, and only some cancers are caused by avoidable environmental exposures like smoking.

And many children begin life behind the eight-ball, having inherited problematic genes that make them more likely to suffer from conditions that cost a great deal to treat. Should insurance companies be able to use the results of genetic tests to offer low-cost policies to some, and much higher-cost policies to the unlucky?

In a laissez-faire world, insurance is an adversarial game with customers trying to hide any damaging information from the insurer as the policy is being sought, and the insurer doing their best to deny claims afterward. As a result, governments set up insurance commissions and regulators since it was impractical to adjudicate disputes over every consumer’s insurance policy in an expensive court of law. Arbitration and insurance commissions have done a fairly good job in the past of managing this conflict of interest, with some states being more pro-consumer than others.

One partial workaround for the medical rating problems is the idea of “continuous coverage.” The initial risk pool is assumed equal, and anyone who keeps paying for coverage continuously is allowed to stay in that average-risk category because some small part of their earlier premiums is true insurance — covering the risk that a health issue will turn up which makes them a bad risk in the future. Insurance contracts typically cover one year, and so if there is no requirement to continue coverage beyond that contract, rates could adjust upward or renewal could be denied based on negative events that happened during that year. Requiring renewal at the same rate as the rest of the risk pool makes the contract insurance against the long-term costs of treating any illness acquired during the period, not just that year’s costs.

What happens to people who allow their insurance coverage to lapse because they can’t afford the premiums or simply forget to pay? Most states had a high-risk pool with required must-issue, but rates were very high (of course — since the people seeking insurance under it were far more likely to need expensive care in the short term.) Some hybrids, like exclusions for pre-existing conditions for six months or a year, helped get people coverage at in-between prices.

The PPACA (“Obamacare”) tried to eliminate the problem with must-issue (no one could be refused insurance) combined with narrow time windows for seeking coverage and penalties for going uninsured. These were intended to force everyone to get insurance and to keep them paying for their insurance even if they were being charged much more than they were likely to receive in benefits. Younger, healthy people were expected to pay more to cover the costs of older, sicker people. In practice this did not work — even the subsidized rates were too high to get healthy young people to join up, and the penalties of going without insurance were small compared to the inflated new prices for insurance. So individual insurance coverage pools shrank and were dominated by new customers needing a lot of expensive, deferred care, and rates rose further as doctor networks were narrowed and more healthy people stopped paying.

The Supreme Court’s ruling deeming the ACA constitutional was only partial — the attempt to force states to increase Medicaid enrollments was deemed unconstitutional, so many states did not expand Medicaid. This left a bizarre hole in coverage in those states where a person could make too much to get Medicaid coverage, but too little to get private insurance subsidized through the exchanges. And the expansion greatly increased Medicaid enrollments in those states that participated, accounting for nearly all of the decrease in the uninsured in the US, but Medicaid itself has never been shown to improve medical outcomes or decrease mortality, and many people complained that they were forced to join Medicaid when they would have preferred to buy private insurance.

Also, the Supreme Court’s swing voter on the case, Chief Justice John Roberts, specifically warned that the fine for not having approved insurance was only constitutional if it was viewed as a tax, and an increase to the fine to an amount sufficient to force compliance would make it unconstitutional. This cuts off the ACA proponents’ attempt to raise fines to try to force more enrollment.

Which brings us to the subject of this essay — how do we decide what is fair when consequences of simple bad luck and genetics are mixed with the downside of behavior under a person’s control? Suppose a well-off person (let’s say the son from a wealthy family who left him a trust fund) drinks, smokes, and plays video games all day throughout his life. In his 40s now, he’s obese and unhealthy, with emphysema and cardiac problems imminent. Should his expensive future healthcare be subsidized by middle-class families who have worked hard, exercised, and been careful to avoid bad habits? That is the way ACA policies are now set up. Even unsubsidized, policies for wealthy people in poor health are much cheaper under the ACA than they would be in a free market, and those who have restrained their appetites and sacrificed to maintain their health pay more than they otherwise would to make up for those costs.

But there’s no easy way to separate those “bad unhealthy” people whose illness is due to their own choices from those “deserving unhealthy” people who are ill because of chance or genetic inheritance.

The ACA plan tried to compel more equality of premiums regardless of actual risk or likely use of medical services, which removed some of the incentive for healthier behavior and burdened those who made the effort and sacrifice to keep themselves healthy. This tried to protect those who were simply unlucky, but many of those people are worse off than they were under previous high risk pool plans provided by the states, and have had their care disrupted or cut off by the high prices and narrow networks.

Every complex system is adaptive, and human systems especially so, with people quite capable of understanding the rules and seeking out every loophole to their advantage. The ACA has failed because people aren’t easily herded by programs designed by committees, and by finding the loopholes (paying for one month and using it for three, staying off until actually ill then signing up under the many loopholes in enrollment windows to get expensive care then dropping out again), the ornery people have ensured the ACA cannot be sustained in its current form.

The ACA, which was promoted as saving everyone money, has ended up being much more costly for most than the old system. It has helped a few, but cost far more tax and premium dollars to help those few than a direct subsidy to the existing high-risk pools would have. The redistributionists have again discovered that unintended consequences will make nonsense of their social engineering schemes.

Philosopher John Rawls is usually cited by progressives intent on redistribution; his thought experiment suggested we view a system as just if we would choose it willingly, not knowing in advance what advantages or disadvantages we would be born with. You can argue that much behavior is also dictated by fate — our example of the obese videogamer may well have been doomed by being born into his particular family with parents who could not guide him toward a better way of living. But under that view, no one is responsible for anything, and we know that people can change to overcome even the worst background and genetic inheritance. Removing rewards for modifying one’s behavior toward the socially-valuable means a society which is less civilized and poorer in every way.

The classic Vonnegut story “Harrison Bergeron” takes equality to the extreme. The government has decreed that all must have equal abilities and outcomes, and so those who are more intelligent or talented are handicapped to bring them down to average. Of course, this becomes a nightmare with tragic outcomes as society grinds to a totalitarian halt.

But suppose we already have a little bit of this deadening effect introduced by the government’s emphasis on hiring by ethnicity or sex rather than ability. Would we even realize that the but-for world where only merit is considered would be wealthier, happier, and more fulfilling for most if not all people? If one has never seen a ballet performed to perfection by the most talented dancers on Earth, would we notice that the dancers are being dragged down by lead weights they have been forced to carry — or selected for political reasons rather than talent — making their performance less satisfying?

Socialists and redistributionists tend to think diversity and choice and product improvement are not as important as providing the poorest an equal quantity of goods, and the central planners of the USSR counted quantities of production, not quality; the stories of great quantities of useless, poor-quality, ugly products available from state stores while people schemed and bribed to get better-quality goods from abroad show how central planners failed to understand what mattered to the people. Even Bernie Sanders, who should know better, suggested there was too much choice in deodorant and shoes, and restricting choice would somehow allow more poor people to be fed, clearly missing a lesson or two of the socialist past.

So if you had never seen a perfect ballet or operatic performance, you might not notice how the ones you have seen have been compromised for the sake of political goals. Similarly, if you’ve never seen a world of free enterprise without identitarian politics or Party corruption, you will never realize how much freer and more productive your society might have been. The US overcame a history of race and sex discrimination to more closely approach the standard of merit alone — then has been backsliding incrementally as race- and sex-conscious employment policies took hold. While it appears the US is now limiting progressive overreach by not electing Hillary Clinton president, there has been a lot of damage already, with government agencies especially dysfunctional. It will take a lot of work battling entrenched special interests to reverse the educational system’s failure to teach children civics, history, and economics.


For more reading goodness:

Materialism vs Purposeful Life: Trump, Bannon, and Teilhard de Chardin
Sekrit Reform Agenda: Untangling Government: Medical Deregulation
No More Elections or Campaigns: Liquid Democracy
“Death by HR” – High Tech Threatened by Social Justice Activists

Seal of the Handicapper General - Harrison Bergeron

Seal of the Handicapper General – Harrison Bergeron