State of Restat - Time Toxicity, The UK Post Office, and New Appliances for a New Year.
Week in Review - 1/19/2024
Rest At Elevation This Week
We survived our annual Cold Week in Denver, where we actually have to sit through the kind of cold temperatures everyone else thinks of when they think of Denver.
My proofreader started a new job, so it’s completely their fault if this contains any social faux pas or grammar mistakes.
I read it so you don’t have to…but you totally should anyway: A discussion of time toxicity in serious illnesses, the UK’s communal reckoning with the single biggest technical failure I can remember, and reproductive justice win in Ohio.
Big Opinions about Small Things: New Year, New Self, The Inevitable New Appliances
It’s About the People: Reader mail! And an astonishing lack of reader mail.
I read it so you don’t have to, but you totally should anyway
Informal (but rigorous) Time Toxicity Study, courtesy of Out of Pocket: Those of us who have never been seriously ill are aware, in the abstract, of the extent to which dealing with the health system - in ways planned, unplanned, clinical and financial- is a big emotional drain. What I was unaware of is end stage clinical trials measure their outcomes in terms of additional days of life. What this adds up to is that patients need a metric by which to consider whether an experimental or home-based treatment is worth any additional health-care focused days. There’s a need to add this as an axis to the benefits of clinical studies. One patient took this a step farther and charted the health care days and hours involved in treating her ultimately very treatable “normal” cancer.
“Essentially, when you have cancer and are going through treatment, it’s almost impossible to separate yourself from it. It’s emotionally everpresent, and it’s practically there too. Cancer becomes a part-time job, a chore, a regular, frequent unpleasant thing you have to do. Its presence is always felt, and the amount of time spent only amplifies this.”
Turns out, it’s a LOT, and a not-inconsiderable amount of that new part time job is spent dealing with hospital billing. The article is worth a read, as is the balance of what’s going on at Out of Pocket → https://www.outofpocket.health/p/time-toxicitiy-a-real-world-exampleFujitsu and the UK Post Office Scandal: This one has taken me a fair of time to unknot, and it’s a doozy. Essentially, in the early 1990’s, the UK government struck a deal with Fujitsu to automate their benefits services and put details on a magnetized card. It failed horribly, and in attempt to claw back any value whatsoever, it was repurposed to run the finances for the UK post office. Laden with known bugs, one of the main side effects of it’s implementation was that it consistently misreported earnings for individual postmasters general - and in the UK that’s a serious issue because those positions are privately contracted. Upwards of 1000 sub postmasters-general were charged with siphoning money from the post office. 39 were convicted, and all were thrown out of work. Rather than accept that, perhaps, there was a systemic issue, the government allowed the injustice to languish for almost two decades before this month, when an ITV series detailing the drama [Mr. Bates Vs. The Post Office, not yet available in the US] re-enraged everyone on their behalf. Fujitsu’s stock has taken a hit since it aired, as have calls for pardons and reparations on the part of the government. The bugs and issues were known from the time of implementation.
Patient / Payer Nightmare of the Month: Follow up time! A few issues ago we went over the dreadful report from Pro Publica about Michigan insurance companies playing semantic pickleball about whether a cancer drug and a cancer treatment were the same thing. Apparently, the state insurance regulators of Michigan read Pro Publica and the loophole is now closed. I’m sure we will never hear of anyone ever doing anything like this ever again. Lolz —> https://www.propublica.org/article/michigan-insurance-must-cover-proven-cancer-treatments-priority-health
New CMS regulations are intended to slip-stream prior authorizations: New Medicaid / Medicare standards are insurers have 72 hours to provide a decision for an urgent request and a week for a standard one. I’m sure this is well intentioned, but my experience is that they’re already awfully efficient at saying no. —> https://www.healthcarefinancenews.com/news/cms-releases-interoperability-and-prior-authorization-final-rule
This is what counts as a win: An Ohio grand jury declined to indict a woman who was ratted on by a healthcare worker/ wanna-be-a-cop after a miscarriage. TW: the circumstances on this one are rough. Also, in case you’re wondering whether these bans will specifically criminalize women of color…Yep.—> https://homewiththearmadillo.blog/2024/01/16/another-huge-win-in-ohio-no-charges-for-brittany-watts-who-vows-to-continue-to-fight/
Big Opinions about Small Things
It is now officially halfway through January. If your new year’s resolutions are going to stick, they’re probably at the point where you can invest in some merchandising to make them easier. I actually don’t make resolutions so much as use the new year as a hash mark to start things I need to do…which now that I think about it is probably a resolution. Is it different because I generally don’t tell anyone?
Anyway, at the flip of the year I started with three new programs.
1) Try to raise my good cholesterol by secreting dark colored veggies into smoothies.
2) Try to create a predicable sleep cycle.
3) Year one of a Hobonichi 5-year journal.
Each one, naturally, required purchases. I’m now two weeks into each of these are ready to tell you whether they’ll help you with anything similar you might have going on.
1) Hiding veggies in smoothies: This required a new blender. I have done my time replacing and repairing various parts of my Costco ninja bundle. I’ve replaced the base, and I attempted in good faith to replace the hockey puck smoothie blade. When the new one showed up, was wrong, and hermetically sealed to the smoothie cup I was done.
The coin of the realm in smoothie world is horsepower. The second coin of the realm is whether it’s going to look hideous and take up a bunch of counter space. I traded the second for the first and went with the Costco bundled Beast—> https://www.costco.com/beast-blender-deluxe.product.4000151795.html
[Costco mail-order has the best price on this, coming in at $99. Costco in person comes in at $110. Amazon was, last I looked, holding strong at $164.]
It promised a quieter smoother smoothie experience and that the internal ribs in the smoothie cups would help break up frozen fruit more efficiently. It also has a one -minute timed setting so you, theoretically, can walk away from it while it’s blending to let the dogs out and come back to a finished smoothie. It does, and you do, with one massive caveat, which is making sure you put enough liquid in. I failed at this the first few times and had to do the patented unseal and shake thing. Problem was, I had taken the lid off when I shook the canister and soon found myself wearing a significant portion of my smoothie. What’s worse, with my hair, my face, and my pajamas soaked I realized I’d done this stupid thing in front of my teenager. What can you do but own it?
Me: Oh my god my smoothie went all over me.
Her: *cool silence*
Me: How stupid!
Her: *mentally slides evidence.txt into the Moms_Poor_Impulse_Control folder on her chromebook*
So should you get this blender? Yes, if you need a blender. Will it create a new sense of balance in your life? Maybe. It does look nice on the counter. It takes up very little space. It is not, however, any quieter and might cause you to lose face with your kids.
2) Create an actual sleep cycle: For this one I recruited members of my family to buy me the Hutch Restore 2.0 for Christmas. --> https://shorturl.at/fhkAF
For lack of a better description it’s an alarm clock, but it’s really a lot more than that. It allows you to program your wind-down time before you go to sleep, the noise and light show that you have on while you sleep, a progressive wake up cycle, and then a traditional alarm and inspirational content before you get up.
It takes some experimentation before you really feel like you have this where you want it. What I now do is have a musical outro set up for 10:30pm. At that point, assuming I’m obeying my own rules, I’m putting down anything that generates blue light and transitioning to the wind down content. Hatch itself provides this content, and it took about four tries before I had it right. We have a comedian who now reads, in a subdued tone, the front page of a different small town English newspaper. Then, we have someone who basically reads us 15 minutes of her scrolling through her own phone, literally narrating scrolling so you don’t have to. And then we have the final sleep setting, which is brown noise and no light.
Wake up is a 30 minute gradual sunrise, followed by ocean sounds that get the cats all agitated because it includes birds. The next step is being ironed out because one of us likes to mock the vocal fry of the inspirational wake-up content. But figure there’s about five minutes of that before my real alarm and my google news briefing.
So, this is one new year’s appliance I’m really recommending. It takes a few weeks to get it customized to your preferences but I will say it is helping me go to sleep at a regular hour rather than whatever time I can no longer keep my eyes open in front of my kindle.
3) Start year one of a Hobonichi 5 year: This one is special. Since I no longer keep a paper planner, I missed being able to flip through my year and look at what happened when. The other thing is that there was really never any attraction to me of keeping a daily journal. Enter this thing, which is a five year book. You have 1/5th of one page per year, meaning your normal entry takes less than five minutes, but you have an entire facing page in case you have a life event or something else you want to write down for posterity.
I’ve been digging this so far and each page has an entry. A couple of times I’ve doubled back the next day because the sleep machine was too effective or I forgot. This book, if I keep up with it, will take me through when my daughter leaves for college! Terrifying but also, you accomplish such a look-back each year just by flipping to the right page.
Last thing, you’ll notice the inspirational quotes are in Japanese. I’ve solved this problem using google lens, so it is possible for an English speaker to take advantage of them.
There are still a few at Jet Pens if you want to get going with one. —> https://www.1101.com/store/techo/en/5year/
It’s about the People
Reader Mail:
“In all my 85 years I have never seasoned a frozen pizza!” - I don’t feel like this is the own it was intended to be, but flip side I know for a fact he hasn’t eaten a frozen pizza since the Carter administration.
Lack of reader response! No one had the answer, or at least no one sent me the answer, to the reference in last time’s Big Opinions on Small Things. I’m kind of shocked. Offer still stands, though.
Coming Next Time:
Not sure. It’ll come to me though :)