Welcome to my blog. Approaching the end of my eighth decade on the planet with a collection of old guy ailments, my aim here is to share my travails working through the medical morass. I also spew opinions on the current state of healthcare, which we all agree is in a sad state, at least in the good old US of A.
This week’s issue of Peptide Purgatory casts a cynical eye toward a JAMA initiative to protect us from our guns, or so they think. Later on, if you need some more bullshit, our even more cynical weekly Bullshit Corner makes light of Big Pharma wanting to monetize every aspect of our lives by classifying everything in the human experience as a treatable disease. It’s not a stretch to consider treating natural aging and death similarly. Aging as a chronic, relapsing disease? Who knew? (Well, I’m scratching my head over the “relapsing” part, but still…)
My Mounjaro Weekly Update discusses some new research into chronic kidney disease, a frequent companion of diabetes. We look at two lab methods for measuring kidney function and the implications of disparities between the two. Anyone who has been diagnosed with CKD Stage 3 or higher should familiarize themselves with the testing methodology.
Let us now turn to our establishment doctor friends, who believe it is their responsibility to re-engineer society. For years, I’ve read in publications like JAMA and Healio how doctors should pry into gun ownership by their patients. They tell docs how to bring up the sensitive subject and “counsel” their patients. What we’ll look at below is the healthcare industry’s more comprehensive plan (in the central planning sense) to address the subject of gun violence.
How the healers of humanity keep trying to rewrite the Constitution in the name of “safety.”
The New Hippocratic Hypocrisy
I spent a bored half-hour reading JAMA’s latest special communication, “Toward a Safer World 2040.” It opens like scripture and closes like a five-year plan. The same profession that cheerfully prescribes weight-loss peptides, antidepressants, and statins by the bucket now declares it must also regulate our relationship with metal objects that go bang. When your prescription pad becomes a policy platform, you’re no longer practicing medicine — you’re practicing behavioral economics. Somehow, the AMA has taken it upon itself to re-engineer society, because doctors are omniscient, unassailable, and not to be questioned.
If I didn’t make this the feature article this week, it would fully qualify for inclusion in Bullshit Corner.
The Gospel According to Public Health
Modern “public-health language” has acquired its own liturgy: sin, compliance, and redemption through regulation. The JAMA authors promise to “change the narrative” and “re-engineer social norms.” Translation: we’ll fix society the way we fix cholesterol.
They describe “primordial prevention,” which apparently means fixing everything before it starts — housing, jobs, emotions, perhaps the cosmic alignment of the moon — so nobody ever has a bad thought that could lead to violence. It’s social work by decree, a wellness plan for the human condition.
Big Pharma’s Glass House
You’d think, before lecturing us on “commercial determinants of health,” medicine might look in its own mirrored medicine cabinet. Every night, prime-time TV hums with pharma ads promising liberation from everything from heartburn to despair — just ask your doctor about side effects including blindness, renal failure, and spontaneous bankruptcy. Yet these same white coats now clutch their pearls over an industry that sells firearms to willing adults. If hypocrisy were billable, the health-care sector could pay off the national debt.
Coming Soon: Thorazine for All — and for Gun Ownership, a Diagnosis
Public-health utopians never let a new initiative go to waste; it’s a marketing opportunity with peer-reviewed footnotes. Expect Big Pharma’s creative wing to pivot immediately:
Ask your doctor if Thorazine Preventive™ is right for you — because anyone could become agitated at any time.
They’ll sell it like a cholesterol pill for the conscience: take one daily to keep your darker impulses within CDC limits.
Gun ownership itself will get a new entry in the diagnostic manual — Chronic Relapsing Ballistic Disorder (CRBD) — treatable with a lifetime subscription to the latest mood-modulating injectable. The military, naturally, will be exempt; can’t have the Marines dozing through boot camp. But for the rest of us, a mandatory micro-dose might “flatten the emotional curve.” Think of it as herd sedation.
Soon there’ll be friendly reminder ads:
“If you see something, medicate something.”
And some enterprising venture fund will roll out TheraSafe™ kiosks at the pharmacy, where your insurance card unlocks both your blood-pressure cuff and your moral-restraint meter.
The Smart Gun and the Smarter Bureaucrat
The summit swooned over “biometrically authorized firearms,” “AI-driven weapon detection,” and “non-lethal home-defense robots.”
I can hardly wait for my pistol to sync with my smartwatch and refuse to fire because my heart rate is above CDC guidelines. Maybe Alexa will phone 911 if I look angry over a dumbass play in the football game I’m watching.
Techno-utopianism always sounds noble until you realize it comes with firmware updates, auto-renewals, and government terms of service. “Your freedom license has expired; please renew to continue defending yourself. You want to cancel? Helen Waite is our Customer Service manager in the Maldives. To cancel, go to Helen Waite!”
The Pathologizing of Freedom
Somewhere along the line, the medical mind stopped at “risk reduction” and kept driving until it hit “risk elimination.” Everything risky — drinking, driving, eating butter, owning tools — is now a health condition. Freedom itself, viewed through this lens, becomes a chronic disorder requiring managed care. I remember when “risk factors” meant cholesterol, not ideology. These days, owning a lawn mower and a spine of your own can get you diagnosed with Non-Compliant Personality Syndrome.
The Mental Health Mirage
Buried deep in the report is a line or two about “behavioral supports.” Translation: more seminars, fewer psychiatrists. They’ll light up vacant lots and hold community workshops while the genuinely unstable wander untreated through the system. Why build mental-health infrastructure when you can install LED streetlights and call it “primordial prevention”?
Reading Between the Lines of ‘Conclusions and Relevance’
A safer world will require investing in the discovery, implementation, and scaling of solutions that reduce firearm harms and center on the people and communities most affected.
Lovely prose. But tucked between those commas is an entire bureaucracy.
“Investing” means tax-funded research centers staffed by the already-converted.
“Implementation” means new regulations.
“Scaling” means permanent funding lines.
And “centering communities” means forming advisory panels that look diverse, think uniform, and never invite anyone who actually enjoys target shooting.
It’s the mission statement of every well-meaning technocracy: spend money, expand authority, and declare victory over human nature.
The 2040 Utopia — Terms and Conditions Apply
Picture their promised land:
Smart guns that check your mood, drones that sniff for “unauthorized powder residue,” and AI counselors that text you affirmations when your KFRE risk score looks agitated.
Every home will be “violence-informed.”
Every citizen will be “empowered to feel safe.”
Every dissenting opinion will be politely referred for counseling.
Safety, we are told, is priceless — until you get the bill in autonomy.
A Little Perspective from the Waiting Room
I’m not blind to real tragedy. Violence, suicide, and despair are heartbreakingly real. But the cure isn’t to deputize medicine as moral guardian of the republic. Doctors already have a full docket: obesity, addiction, Alzheimer’s, COVID after-effects, billing software and CPT codes. How about we fix the mental-health pipeline before redesigning the social contract?
Prescription for Sanity
So here’s my counter-treatment plan:
- Less sermon, more science. Spare us the manifestos; show us data that survive contact with reality.
- Treat people, not probabilities. Heal minds instead of modeling behaviors.
- Respect informed risk. Freedom carries side effects — call it the natural price of adulthood.
Aging isn’t a disease, owning property isn’t pathology, and exercising rights isn’t a “modifiable determinant of health.”
Doctor, heal thy gun—or better yet, heal thy hubris.
My Week on Mounjaro
Boring week, so I shaved my head. This is a look that I’ve been wanting to play with for a while. I believe it was two birthdays ago when my wife bought me a head shaver, but until last weekend, I left it in the box while I buzzed my hair shorter and shorter, sneaking up on baldness gradually. I finally bit the bullet, and I now sport a shiny, new (dubiously) chrome dome. (see photo)
The numbers this week were pretty stable, so I won’t bore you with them. Instead, I’ll give you a little insight into my geriatric kidneys, always a source of amusement in a mixed crowd. Our doctor friends at JAMA published a paper recently that caught my eye, about disparities in the two current means of measuring kidney function and their implications about kidney patients’ longevity.
While you might have gotten the idea from our lead article that JAMA has aspirations to rival The New Republic, that vaunted journal actually still does publish legitimate medical research between the social engineering bullshit and progressive opinions. But I digress.
I’ll use my labs as example — fortunately, the conclusion in my case is that something else might kill me before my kidneys do.
When the Numbers Don’t Agree, Believe the Smarter One
On October 1, my labs staged me as G2–G3/A1: creatinine 1.22 mg/dL, eGFR 61.
The same day, my cystatin C came back 1.19 mg/L—mathematically equivalent to about 66 mL/min/1.73 m².
According to the new JAMA meta-analysis by Estrella et al., that tiny five-point bump puts me on the “lower-risk” side of the curve. They found that roughly one in ten outpatients had a cystatin C number at least 30 percent worse than their creatinine value—and those folks aged faster and died younger. My slightly better reading means I’m not one of them.
In other words, my kidneys might not be auditioning for a transplant list anytime soon. They’re just 79 years old and a little tired of the paperwork.
The real lesson? Creatinine alone is like judging horsepower by tailpipe smoke. Cystatin C measures what’s actually coming off the assembly line. If you’re north of 70 and the doc only runs creatinine, ask for the smarter test—it can tell whether you’re losing kidney function or just muscle tone.
Reconciling the Two: eGFRcr-cys
When you plug both numbers into the 2021 CKD-EPI combined equation, the values average out around 63–64 mL/min/1.73 m²—a statistical peace treaty between creatinine’s pessimism and cystatin C’s optimism.
That’s the figure clinicians increasingly prefer, because it smooths out the extremes: if muscle mass drags creatinine up or inflammation drags cystatin C down, the combo keeps your staging honest. In practice, my GFR looks exactly where it should for an active late-septuagenarian who deadlifts and hikes instead of shuffling to bingo.
The Estrella paper’s takeaway fits me to a tee: if your cystatin C-based eGFR is similar to or better than your creatinine-based one, you’re probably doing fine—especially if you’re busy defying your birth certificate.
And now, for a little closing bullshit, we enter the Bullshit Corner. Today’s subject is natural aging as a treatable disease, or so the marketing fiends of Big Pharma might think.
There was a time when aging was simply called “getting older.” Now it’s being recast as a chronic, relapsing disease—one that, conveniently, can only be “managed” with perpetual prescriptions and quarterly labs. Welcome to the next frontier of medical marketing: the war on mortality itself.
From metabolism to monetization
Big Pharma’s campaign to redefine obesity as a “chronic metabolic disease” was just the pilot episode. It worked spectacularly: GLP-1 drugs like Mounjaro became the Netflix of modern medicine—subscribe forever, lose a few pounds, and pray the side effects don’t outlast the co-pay. With that proof of concept, the marketing people have now turned their sights on a more universal affliction: being alive long enough to get old.
The pathology of existence
The new narrative goes something like this: aging is “a systemic, progressive disorder of cellular senescence and mitochondrial dysfunction.” Translation: it’s a normal biological process in need of a billing code. Once you call it a disease, you can measure it, treat it, and—best of all—bill for it. Expect forthcoming miracles like “AgeStat RX,” “Senolyze Plus,” and “YouthReboot Pro,” each promising to slow the ticking clock by about half a headline per quarter.
Consensus by committee (and underwriter)
White papers will follow. “Consensus panels” funded by “unrestricted educational grants” will declare that an 80-year-old with an eGFR of 61, blood pressure of 116/67, and a pulse should be considered “Stage 1 Age-Related Functional Decline.” KDIGO and the AHA will update the guidelines to ensure you can’t die without a prior authorization.
The perpetual patient economy
It’s a business model only entropy could love: convert the inevitable into the treatable. If every person is a patient, there are no healthy people—just undiagnosed opportunities. The stock analysts will call it “total addressable lifespan.”
But here’s the catch
They can regulate, legislate, and medicate, but they can’t repeal thermodynamics. No matter how many “cellular rejuvenators” they hawk, we’re all marching toward the same actuarial conclusion. Aging isn’t a disease—it’s the invoice for staying alive this long. The rest is marketing copy with a co-pay.
So when the next glossy ad tells you to “fight the signs of chronic aging,” smile, lift your glass, and toast to the only cure Big Pharma will never patent: acceptance. Death and taxes remain undefeated—but at least the IRS doesn’t claim to prevent mortality for $799 a month.
Peptide Purgatory chronicles one man’s ongoing experiment with Mounjaro, metabolism, and medical modernity. Side effects may include sarcasm, elevated skepticism, and mild tachycardia while reading policy papers.
