I was looking for someone to mention Ghost in the Shell and Cowboy Bebop.

What are your thoughts on Fullmetal Alchemist? I personally adore FMA: Brotherhood and I think it meets these criteria.

From the emergency medicine perspective on that last bit…we don’t care if you have a DNR somewhere on file. If you show up in cardiac arrest and someone isn’t shoving an official POLST into our hands, we’re running the code. We’d rather someone try (and fail) to sue for malpractice for saving them than accidentally let someone die that didn’t want to.

These companies investing in nuclear is the only good thing about it. Nuclear power is our best, cleanest option to supplement renewables like solar and wind, and it has the ability to pick up the slack when the variable power generation doesn’t meet the variable demand. If we can trick those mega-companies into lobbying the government to allow nuclear fuel recycling, we’ll be all set to ditch fossil fuels fairly quickly. (provided they also lobby to streamline the permitting process and reverse the DOGE gutting of the government agency that provides all of the startup loans used for nuclear power plants.)

For a lot of doctors, the incentive to not do risky procedures is the fact that you have to live with the guilt of your patient’s death, even if you did everything perfectly. Or, you do everything perfectly, but they still have a poor outcome because they weren’t healthy enough to go through the procedure and the recovery, and you get sued for millions of dollars because you didn’t spend 4 hours going through the informed consent with the patient to ensure that every single possible complication was adequately discussed.

I’ve worked in emergency medicine and I’ve had patients die in my care that we had absolutely no way of saving. The screams of their families still haunt me and I will carry those cries of anguish and loss to my grave. I would not perform a procedure that was not 1000000% necessary if the risks are too high because I have enough blood on my hands already, and I haven’t even finished medical school.

Sometimes. It depends why the first surgeon would be unable to do the procedure. If the problem is that the patient might not wake up from anesthesia because of problems with heart disease, lung problems, or other metabolic issues, then it doesn’t really matter what the surgeon has to say about actually doing the procedure because the anesthesiologist is the one saying “no”. If it’s an issue of too much adipose, sometimes it would mean that the surgery would take longer than it’s safe for the patient to be under anesthesia.

Another possibility is that the first surgeon operates at a facility that doesn’t have access to more advanced technologies or other medical specialists in the event that something goes wrong. And there are some surgeons that are just more willing to accept the risk of a bad outcome, and I would argue that that’s rarely in the patient’s best interest. There are alternative options that the surgeon should discuss with the patient as part of the informed consent process, and sometimes, the alternatives to surgery are just safer than the risk of the surgery itself, even if they aren’t as effective or are a long term treatment (ongoing) as opposed to a definitive treatment (cure). If the patient has a high risk of serious complications, up to and including death, then attempting the curative procedure might be more risk than it’s worth compared to a long term medication that mitigates the disease.

You’ll see this with pregnant patients too. For elective procedures that have safer alternatives or temporizing measures (a holdover treatment until surgery is safe), those are generally preferred to putting a pregnant patient under anesthesia because of all the cardiovascular, immunologic, and other physiologic changes that happen during pregnancy alongside potential risks to the fetus.

There’s a reason you have to get a pre-op physical exam for any non-emergent surgery. Figuring out if you’ll wake up from the anesthesia at all is part of the calculus that determines whether the benefits of the procedure outweigh the risks.

I’m in my 30’s and my Dad still refers to me as “kiddo” sometimes.

And I’m pretty sure she’s from the UK…

One of the biggest problems with the GLP-1’s (Ozempic, etc) is the fact that people lose weight by just not eating as much, and the things they do eat aren’t likely to be very nutritious. Protein malnutrition and muscle wasting are very common sources of weight loss on Ozempic. That’s why it’s standard of care to get your patient to a licensed dietician before starting them on one of those drugs if at all possible.

The BMI number that is calculated just from weight and height is really just a number that tells us we need to go look at some other numbers. The other numbers are things like body fat percentage, cholesterol levels, blood pressure, blood sugar, etc. It is entirely possible for someone to have a “normal” BMI and still be very fat and unhealthy, and those people are pretty easy to identify visually, just as someone with a “high” BMI who is a powerlifter or something is very easy to visually identify.

I’m a medical student and I have some direct experience with this. Sometimes, the difference between the surgeon who will do the procedure versus the surgeon that won’t do the procedure is the availability of specialized facilities and equipment that they have access to. An elective surgery (i.e. not an emergency surgery) can go from routine to very high risk depending on the amount of adipose tissue the patient has.

And it’s not just a matter of the fat tissue overlying the surgical site. Morbidly obese patients are much more likely to have things like sleep apnea which can make anesthesia more risky and might require more specialized equipment than a particular surgeon/hospital/anesthesiologist might have access to. The “morbid” part of “morbid obesity” also refers to the fact that people above a certain threshold of weight are much more likely to have other health conditions like heart disease that make anesthesia more risky.

This looks like a great recommendation, thank you!

I have to know all of the medications for my board exams, but knowing what bullshit the pharma companies are advertising would be useful. There’s a lot of people who will ask for Ozempic and then be horrified when they learn about the side effects (or the price of the medication). I worry a lot about the “compounding pharmacies” that will mail people knock-off Ozempic with minimal medical oversight. It’s just a matter of time before someone gets killed by the pancreatitis or something.

One account in the milieu isn’t going to make that much of a difference.

That will actually be helpful towards the weird stuff that men get into in addition to wholly unnecessary “hormone replacement therapy” (aka juicing on steroids)

That’s actually super helpful. I’ll need a few “content creators” to seed the dummy account with.

That will be a good downtime activity, but I also want to know what the algorithms are shoveling.

Signing up for emailing lists is probably a good place to start. I also accidentally subscribed to an RFK apologist Substack when it was recommending health-related writers to me.

Dr. Oz and Oprah are featured in Behind The Bastards for a reason. Oprah actually got a 7-episode mini-series.

I’ll be looking into free versions of Chat GPT and the like. And I like the idea of AI summaries of Joe Rogan because I don’t think I could actually listen to him without having an actual aneurysm.