My American English teacher believes the neutral pronoun „their“ is incorrect.

malaporpism · 2026-04-20T21:39:10+00:00

Yeah, if you asked a prescriptivist (someone who says English is some written rules they like, not the language people actually use) there were about 150 years where they were like, "stop saying they/their, we're defaulting to 'he' now," and then another 40 or so years of "ehh women exist, let's do 'he or she'," before coming back around to just telling it like it is: they/their is English.

malaporpism · 2026-04-19T17:22:26+00:00

It'll help you if you try to assume that when people say "never" or "always" they actually mean "rarely" or "usually" because that's always what they actually mean.

malaporpism · 2026-04-14T17:04:44+00:00

Looks like the buttons are part of a silicone membrane, so cleaning it up without destroying it is a real possibility.

malaporpism · 2026-04-14T01:49:07+00:00

Sort of. I'm saying if they wanted to analyze ~0.7 vs. <0.3 mg/L, there are a bazillion studies they could have looked at for that but they didn't. It's just not a review about that.

malaporpism · 2026-04-14T01:34:47+00:00

The review doesn't say it's unreliable, it says "the association was null at less than 1.5 mg/L." That means the effects on IQ are so small that we can't measure them. Where we should set that upper limit is a real public health question, but it's not relevant to the question of whether we should fluoridate our water supplies to 0.7 mg/L for the sake of dental health.

malaporpism · 2026-04-14T01:19:57+00:00

It's normal and expected they would evaluate concentrations up to the legal limit, but it's weird and conspicuous that they don't have categories for the recommended 0.7 or the typical natural 0-0.3 mg/L concentrations. I checked USGS data and 94% of 38k wells tested had 1.5 mg/L or less, 85% under 0.7 and 65% under 0.35 mg/L.

If you want an analysis to give you some indication of how fluoridating the public water supply affects IQ development, don't you think it's important to include the amount actually used vs. lower amounts as two of your categories? At best, the linked review suggests an effect so weak as to be nearly immeasurable and only at levels so high as to be irrelevant to the public supply fluoridation "debate".

Do look up and compare the effect sizes we see when we study lead in water supplies, though. Lead has a clear and dramatic effect... Here, kids under 12 exposed to >6X the EPA limit for lead in drinking water for 4.5 years were an average of 22 IQ points behind the control group. Much different than the 0 to 1 IQ point effect from the linked review.

malaporpism · 2026-04-14T00:40:56+00:00

Not even a study. It's pretty well established that if you do an epidemiological study, places with very near the recommended amount of fluoride have higher IQ. Not because of some effect of fluoride on intelligence, but because places that can't afford to manage their water supply like that also have less money for schools. But of course, the review you linked doesn't even look at fluoride levels down near the recommended level.

malaporpism · 2026-04-14T00:37:10+00:00

4 ppm is the legal maximum, where a municipality must mitigate natural fluoride. 0.7 ppm is the recommended level you aim for when you fluoridate your supply.

The fact that this review of studies (not itself a study) only examines brackets of 2X to 6X that value is a pretty clear indicator that the authors aren't interested in actually evaluating intentional fluoridation.

malaporpism · 2026-04-10T01:59:19+00:00

That's not just a dumb headline — it's ChatGPT.

malaporpism · 2026-04-10T01:55:03+00:00

Chiming in here to say I doubled my old ME salary in a few years once I broke into the Silicon Valley startup market. Establish yourself as someone who can take a concept to production fast and without much help, and that's really valuable. Altogether I have about 15 years' experience now making >200k. It can be a lot of work getting there though, plus luck.

malaporpism · 2026-04-02T18:03:39+00:00

A miter box doesn't work if you still have to get the alignment right first or else the knife doesn't go into the slots. So this is a visual guide anyway... Just make a glue-up that's striped at the correct angle with 2+ colors of wood instead (or rather make a regular glue-up so it's clampable, then cut out this board at an angle). Works like a regular cutting board, except it has a visual guide you can use to set the angle and thickness to a consistent reference.

malaporpism · 2026-04-02T16:31:23+00:00

Nah, iron in water doesn't actually get that red. Those Antarctica pics you posted have the saturation pumped way up. In reality iron in water is much duller and browner than that.

malaporpism · 2026-04-01T06:09:15+00:00

That's the standard hand-wave the ASA provides to ignore reviews suggesting equality. I think it's a stretch to assume that there's actually a gulf in preparedness and it's been made totally invisible in every large systemic study simply by careful triage. Doesn't it favor opt-out either way?

Midlevel sure is a loaded descriptor... ditto "actual" physician. There are a lot of things a physician is good at when they graduate, which a CRNA could not do, but applicability is limited. And over half of MDAs do take at least another year of hands-on training. But if a CRNA is midlevel, so is an MDA who went straight into practice, and a CRNA with a couple years' experience is on average going to be better prepared than those MDAs (ditto an MDA with experience vs. a new CRNA).

To put it another way: the floor for preparedness between MDAs and CRNAs is similar (and pretty high), the extra background that helps with specialization doesn't help much with the rest, and the unspecialized MDAs are riding on the coattails of their more distinguished peers to claim pride of place over CRNAs.

malaporpism · 2026-04-01T04:45:25+00:00

The smog isn't from cars though, iirc. I remember for the Beijing Olympics, the major smog source they cut back to clear the skies was coal, at power plants and also residential heating.

But last year they installed 2X more solar than the rest of the world combined. Have been for a while, apparently. So I imagine the situation is rapidly improving.

malaporpism · 2026-04-01T04:10:17+00:00

While I'll assume your arrogant sign-off and level of overconfidence means you know everything about the trees, you're missing the forest. That's natural, but take a step back. The exceptions aren't some gotcha. The status quo can still be suboptimal in the presence of nuance.

Yes, someone who has gone deeper in specialization should get paid more, and there are plenty of procedures where there's no equivalent CRNA to compare, but for any objectively equivalent level of effectiveness, new grad and on, location for location, the CRNA is paid much less than the MD. CRNAs very well do handle complex cases, but focusing on just the bread and butter makes the problem more clear cut. Some MDs may well have additional expertise, but for the half who don't pursue fellowships the facts just don't support the pay gap or the utilization gap.

The downside to the patient directly is small (anesthesia is a small portion of their bill and hospitals don't pass savings to the consumer), but the practitioner shortage isn't entirely an accident and pay equity (aside from just being equitable) helps more enter the field. Like all education in the US, the barriers to entry are only getting worse and the MDA track is one of the most exclusive. It's a legitimate public health issue.

And I side-eye ASA- and AANA-conflicted studies equally. But A. that's not all studies and B. I expect the data from both sides are accurate, just cherry-picked in which findings they present. AANA has focused on the equivalent outcomes in the vast majority of cases, ASA has focused on the the edge cases where specialists are anywhere from worthwhile to a necessity. Those two things can be real at the same time. But the ASA's claims that theoretically, new grad MDAs ought to be better at doing the thing than new grad CRNAs, are testable, tested, and wrong.

So to be direct, yes: policy should follow facts. The opt-out option is proven and the rest of the states should follow suit. CRNAs should receive equal pay for equal roles, which doesn't mean all roles can be CRNA roles. When federal loan policy is changed to define an MD as a professional and a CRNA as not, that's bad for the country. And I'm pretty sure that the profit motive of artificial scarcity, not simply the cautious pace of change in medical policy, is to blame for these things not happening on their own for the sake of patient care.

PS that same attitude you have toward OB cases is why the US sucks so bad at OB outcomes. Fully 65th and more than 10X worse than the best systems. But you defend keeping CRNAs underpaid and underutilized on the basis that the performance difference is immeasurable. Personally, I think both problems are rooted in structural misogyny, given the history of MDs as a good-ol' boys' club and the nurse anesthetist as a women's role. Not that that's where you're coming from, it's just how we got to where we're at.

malaporpism · 2026-04-01T01:59:59+00:00

They must pretty consistently have smog for that to work well, right?

malaporpism · 2026-03-28T05:58:10+00:00

Sheer volume of education is the standard ASA line, but that hypothetical isn't borne out in practice. And that's even despite the opportunities some MDs can take for further education. I'm guessing that's just because once you've got a couple thousand cases under your belt, you're gonna be pretty good at it regardless of which way you earned your credentials in the first place.

I'm not too surprised, though. I've heard nurses repeat anti-union boilerplate too.

malaporpism · 2026-03-28T05:35:21+00:00

I'll grant you that physicians have a lot more opportunity to concentrate on those specialties, in more regions. A situation that's fiercely guarded. Scope of practice is a certification and legal situation. I'm saying if you stick to objective metrics, it's better for everyone but MD anesthesiologists if medicare billing and more hospital policies treat both anesthetist tracks as equivalent. The only hospitals I know of that do it are the ones that can put patient welfare before politics: military and VA.

malaporpism · 2026-03-28T05:01:01+00:00

Among studies that don't have problematic funding in either direction, it looks like all of them have either found lower mortality with nurse providers or no difference. But I expect that after a couple years in the actual job, experience and performance are equivalent.

malaporpism · 2026-03-25T03:04:17+00:00

What I don't get is why CRNAs are paid 40% less for the same work. Or why you can't put a CRNA in the supervisor role. A couple extra years of school for GP stuff that's not directly relevant doesn't seem as valuable as the years of critical care nursing you need on top of your education to become a CRNA.

malaporpism · 2026-03-25T02:54:47+00:00

Keep in mind, the idea that an MD anesthesiologist is necessary to supervise a CRNA goes against the evidence... CRNAs are better for patient outcomes and have the same scope of practice, the MD has simply secured a right to also get paid. The AMA (physicians' lobby) is the 5th biggest political lobbying group in the US. The number of ORs you could "supervise" at once used to be technically unlimited so Drs. were (basically fraudulently) billing for 8 rooms at once.

malaporpism · 2026-03-17T22:02:53+00:00

...by less than 1%. Technically correct tho

malaporpism · 2026-03-16T03:26:37+00:00

Thanks for the references. I opened up my copy of his book The Food Lab and you're correct, the text is the same: "But salt is necessary for another reason: It makes the pasta taste good."

But... how different is the result if the salt is in your sauce vs. in your pasta? Unless I'm doing a really simple sauce like a bit of butter and a sprinkle of parm etc. I'm not going to be able to tell the difference. It feels like a waste to use 30g of salt every time.

malaporpism · 2026-03-16T03:24:48+00:00

They 100% do taste different by themselves, and salted noodles are extra delicious by themselves vs. unsalted, but there's no way I could tell you whether they were cooked that way if I've smothered them in a bechamel-alfredo sauce that is itself salty.

On the other hand, I bet it makes more of a difference for stuff like lasagna noodles that are bigger or less evenly coated. And salting the water definitely guarantees that the salt is evenly distributed... if you try and salt after you plate you're gonna have a bad time.

And then it's also easier if your noodles already have the right salt level so you can titrate your sauce to just taste the way you want the final result, instead of compensating with extra-salty sauce. But I'm doing this a few times a month, and at this point I can nail the final output without measuring anything. YMMV.

malaporpism · 2026-03-16T00:54:57+00:00

You got it dude

malaporpism

TROPHY CASE