And with only a passing familiarity with actual women.

The woman in the picture looks like a contender for Escher Girls or the Hawkeye Initiative. Her posture and anatomy make very little sense.

Ancient Egypt as we think of it had archeologists that studied the original smaller kingdoms that unified to become Egypt. Cleopatra is closer to our time than she was to the building of the Great Pyramids.

And if some dumbass wants to make some kind of argument about the US being a super special first Christian country, they should know that Ethiopia was the first country to declare itself as a Christian nation in the 300’s CE…and has been a contiguous sovereign state since then.

I didn’t say they paid no taxes at all, but I was explaining how the bottom 50% of earners in the country pay very little, if anything. The 19.3% is the bottom 19.3% of earners in the country, not a percentage of the bottom half.

I would argue that if you get everything (or most of your withheld taxes) back on your return…that means that you effectively didn’t pay federal income taxes or paid very little. If you get most of your withholding back every year, you could look at how you filed your exemptions on your I-9 and increase the number to the maximum allowable. I know some people that put the maximum allowances so that no federal tax is withheld from their paycheck and they just pay the balance at the end of the year when they file their taxes instead of getting a return.

They just try to slide it under the radar by not showing the taxes on your payslip because you’re more likely to look closer at that than your receipt from the grocery store.

And that’s not even getting into state income taxes, Medicare taxes, and Social Security taxes. Those all have different brackets and some states are more regressive than others. There are states like Texas that don’t have income taxes, but they make up for it by taxing everything else through things like sales and property taxes.

Of note: sales tax is always the most regressive taxation model, and tariffs are basically sales taxes on steroids.

The bottom 50% of Americans make less than $40k a year. They do pay some federal taxes, but with the standard deduction, the 19.3% of working Americans that make less than $15k a year don’t pay any federal taxes. The standard deduction goes up to $22.5k for a head of household (i.e. a single working parent). Given that the federal minimum wage still works out to $15,080 a year, that means a full-time minimum wage worker doesn’t make enough to get hit with income taxes.

Edit: Here’s a wikipedia article with the numbers I pulled and the tax bracket info is on the IRS website: https://en.wikipedia.org/wiki/Personal_income_in_the_United_States

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.

Another option for diabetes are the SGLT-2 inhibitors like Jardiance. They work by making you pee out all the excess sugar. You won’t have the diarrhea issues, but you will be peeing a lot. (It’s basically a special diuretic, so it’s also really good for blood pressure.) Bonus: they’ve also gained approval for slowing the progression of diabetic nephropathy (kidney disease), so if that’s something you have any trouble with, it can help get it covered.

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.

As an ED tech, I had to clean up C diff and chemo diarrhea off patients, beds, floors, and commodes multiple times. ED boarding meant that patients that should have been admitted to hospital rooms that had a bathroom attached were stuck in the ED for hours or even days.

I worked as an assistant in a plastic surgery office for a while as well, and I had to clean lipoaspirate out of the suction tube/syringe and the erlenmyer flask it was emptied into. That was still preferable to the time it got splattered on my scrubs because the surgeon emptied it into a kidney basin the first time. (The flask was my idea to prevent getting splattered again.)

As a former ER tech that had to hold up a belly that size for 30 minutes for a doctor to put in femoral central lines…I feel your pain. (literally)