This morning, I gave up on the medical-industrial complex and centralized Western medicine

[SwampNut]

It's 2025, medical care should (and can be) de-centralized.  Despite the pharma industry's insistence that you need their version of deeply controlled health care, they have lost control, if you so choose.

 

Background:

I had an appointment with my PCP, who I've used for about 15 years.  Unfortunately, ACA/Obamacare's complexity and extremely high costs drove him to close his neighborhood family practice and go to the Cigna conglomerate.  This was probably one of the drivers behind ACA; concentrate the power over health into highly centralized major corporations.  I moved along with him to using Cigna specifically for him.  Later on, my insurance plan got a divorce from Cigna and I could not reliably count on what was covered with him or what the costs would be.  It became a game/fiasco to deal with the billing, despite the claims (lies) of the ACA.

 

Some of the problems:

My appointment this week was a "forced" one, not because I need to see him on my own accord.  In order to get a prescription renewal for Montelukast, a common, non-dangerous allergy med, I had to have a "checkup" with him.

 

Stop and think about this.  Take a moment.

 

My allergy med, that has no potential for abuse, and basically zero risk, is being gate-kept behind a $146.98-$365 forced appointment.  Is this not completely fucked?  Is this not the evidence we need that the system is just a massive centralized power and money grab fueled by government complicity?  Aside from the cost itself is the time and stress of dealing with totally unpredictable billing.  Over the years with him being off-network, I have had to pay anywhere from $0 to $365.  Nobody can fix this, and despite all assurances at their office, it's just random.  I may get the insured discount price of $146.98 for those who do have insurance, but a high deductible.  I sometimes get an "all paid up" bill and have no idea why.  And sometimes it's the ultra-high $365 uninsured/cash price.  WTF!

 

What are the alternatives?

Meanwhile though, while he's been a fantastic doctor, the resources available to us mere mortals and consumers have grown astronomically.  It's far less important to talk to a medical professional now, compared to 15 years ago.  You can do so much on your own.  In particular, my changing needs have mostly been solved by ME, not him.  And he fully agrees with this.  While he gave me a prescription for a very important drug that's part of my core needs, I had to go outside of the $1100/mo pharma game to make it affordable.  Since then, again according to HIM, I've become more knowledgeable on that one specific topic than most PCPs who have only broad but flat knowledge.  I developed vertical knowledge in what my specific needs are.  And in solving the problem of big pharma cost, I also solved the prescription problem because I simply buy it on the gray market without one.  It's also recently become very easy and pretty affordable to have your own testing, or buyer's group testing, done on the gray market options that cost literally less than 1/20th of the US pharma price.  So it's not only cheap and easy, but safe.

 

Risks and opportunities:

Of course, I'm not medically trained.  There is alleged risk in not having routine checkups, but there's also strong evidence that they don't really increase longevity.  (Citation:  https://pmc.ncbi.nlm.nih.gov/articles/PMC6353639 Systematic offers of general health checks for adults do not reduce illness or death rates and are unlikely to provide significant benefit, but may lead to unnecessary tests and treatments.)  Still however, it means I need to maintain a conscious awareness and expend effort.  Which I already do.  I think it's foolish to think that you can meet your health needs with 15-minute increments of doctor time, and absolutely nobody cares more or has more invested in your health than...you.  There's risk in the gray market, but then, there's always been risk with pharma too.  I can mitigate risks with testing.

 

I think this is even more true for chronic challenges, like diabetes for me.  That's because it's something you can concentrate on over time, and continually read, which is what I've done for years.  This builds person-specific, disease-specific knowledge that likely exceeds a PCP's more horizontal knowledgebase.  I'm able to measure, adjust, experiment, measure, adjust...  Over and over again, until I get the results I need.  For example I've managed my A1C, myself, from dangerous to BELOW the "norm" for most Americans eating the standard junk American diet.  This is because I learned about how both nutrition and peptides affect me specifically, as well as the general population.

 

The decision flow:

So anyway, I originally had a "forced" appointment today, which I rescheduled yesterday, for Friday.  Because I wasn't prepped for it.  I wasn't sure what data I needed to have ready for the one health mystery I have ongoing.  This morning when I woke up and was having coffee with Moriah outside, thinking of how to collate the data for this discussion, it hit me.  I can do it with AI tools, and de-centralized medicine where I simply pay an Indian/Pakistani doctor or NP by the hour to consult with me.  For far less than the 15 minutes with my PCP.  Maybe offer to engage my PCP on a video appointment AFTER I have more knowledge, and see where that goes.  I've done this for minor things in the past rather than try to engage my PCP's massive corporate bullshit, and it has gone well.

 

So I said to Moriah, "I think I'm done with Western industrialize medicine."  She fully and instantly agreed.

 

I'm going to blow off the Montelukast and see how that goes.  Do I still even need it?  If so, I'll gray market it from India like I do with Metformin.

 

[SwampNut]

I used AI to help me edit this, but not directly.  I find that letting AI edit ruins the personality and flow of what I write.  I think my style of clearly saying "THIS IS FUCKED" is important here, rather than the watery version AI wanted.  "This may not be an ideal circumstance for your health."

 

Yeah no, IT'S FUCKING FUCKED.

 

I reference George Carlin:  

 

 

Here is the AI conversation in whole if you're interested:  https://www.perplexity.ai/search/read-this-and-critique-it-pOjpAKXlTxOqOcRkSjFlQw#4

[SwampNut]

Someone highly recommended this podcast episode relative to what I just posted:

 

Here are links for the "Plain English" podcast episode "America in the Age of Diagnosis" that work on all major platforms:

• Apple Podcasts (iPhone/iPad):
  America in the Age of Diagnosis on Apple Podcasts

• Spotify (iPhone, Android, Web):
  Plain English on Spotify (find the episode by date/title)

• Player FM (Android, iPhone, Web):
  America in the Age of Diagnosis on Player FM

• Overcast (iPhone/iPad):
  Plain English – America in the Age of Diagnosis on Overcast
  (If the link does not load directly, search for "Plain English" and the episode title in the Overcast app.)

• Universal Link Generator (all platforms):
  Plain English podcast episode links (Plink)

Use these links for whichever app you prefer!

[02XXCA]

I went in for my annual visit on Monday and got my Cholesterol and Vitamin D checked, since it's free as preventative care with no copay.   I would assume most plans have preventative covered for little to no out of pocket, so that getting a renewed prescription would be a no brainer.   I still pay a hefty medical insurance amount per year to control catastrophic costs if I was to be in an accident or have severe illness, part of life.

 

I'm suprised you hadn't already sourced your ownn allergy drugs, you are resourceful that way.

Edited September 24 by 02XXCA

[SwampNut]

26 minutes ago, 02XXCA said:

I'm suprised you hadn't already sourced your ownn allergy drugs, you are resourceful that way.

 

I had no reason to.

 

[Zero Knievel]

On 9/23/2025 at 1:19 PM, SwampNut said:

My appointment this week was a "forced" one, not because I need to see him on my own accord.  In order to get a prescription renewal for Montelukast, a common, non-dangerous allergy med, I had to have a "checkup" with him.

 

This, in essence, is your problem.  WHY does your PCP need to see you to renew an existing prescription?  Do you not get an annual physical?  My doctor would only need a visit to do a new prescription...not to renew an existing one I've been using for several months.

[SwampNut]

4 hours ago, Zero Knievel said:

Do you not get an annual physical? 

 

No.  Do you?  If so, why?

 

If I had that visit, we wouldn't talk about the specific allergy med anyway, as I've been on it for almost a decade.

 

[satchmo]

1 hour ago, SwampNut said:

 

No.  Do you?  If so, why?

 

 

I get an annual "physical"...well, annually.

 

Not usually because I feel unwell or whatever. Rather, I meet with my physician to bullshit about work...and to renew the social currency that allows me to call his office and state that I need a prescription for XYZ sent to my pharmacy or the lab or imaging...and, he doesn't need to see me before prescribing it. 

 

Plus, as my insurance actually pays for this annual "physical," I am out nothing but some time. Time which I recover later by not going to the doctor's office when I need a script later in the year. 

 

Anyhoozals, that's how I look at this situation. YMMV, of course. 

 

[Zero Knievel]

6 hours ago, satchmo said:

I get an annual "physical"...well, annually.

 

Not usually because I feel unwell or whatever. Rather, I meet with my physician to bullshit about work...and to renew the social currency that allows me to call his office and state that I need a prescription for XYZ sent to my pharmacy or the lab or imaging...and, he doesn't need to see me before prescribing it. 

 

Plus, as my insurance actually pays for this annual "physical," I am out nothing but some time. Time which I recover later by not going to the doctor's office when I need a script later in the year. 

Ditto.

 

I’m diagnosed with low testosterone and hypothyroidism.  For this alone, I need annual blood tests to see if my numbers are where they need to be.  Insurance pays for the visit and bloodwork.

 

With Carlos’ health issues and age, getting an annual physical and bloodwork is highly recommended.

[Zero Knievel]

8 hours ago, SwampNut said:

No.  Do you?  If so, why?

 

If I had that visit, we wouldn't talk about the specific allergy med anyway, as I've been on it for almost a decade.

If you need an Rx for it, you would talk about it…even if to only note that it’s doing its job or if you aren't happy with its performance.

[blackhawkxx]

7 hours ago, satchmo said:

I get an annual "physical"...well, annually.

My insurance company pays me $30 per year to get one and $60 for an at home FIT test with nothing out of pocket. 

[SwampNut]

6 hours ago, Zero Knievel said:

an annual physical

 

What does the doctor measure that I can't do at home?

 

6 hours ago, Zero Knievel said:

and bloodwork

 

I do that more than annually.  In my state, no doctor is needed for this.  You can walk in and do it.

 

5 hours ago, blackhawkxx said:

My insurance company pays me $30 per year to get one and $60 for an at home FIT test with nothing out of pocket. 

 

It would be $0 for me if I go with an in-network doctor.  Maybe I should.  But the black liar in chief said that if I like my doctor, I can keep my doctor.

 

Personally I think insurance should be half the price and pay for nothing unless it's a huge expense.  It should be like car insurance.  I don't want to nickel and dime them for oil changes.

 

13 hours ago, satchmo said:

and to renew the social currency that allows me to call his office and state that I need a prescription for XYZ sent to my pharmacy or the lab or imaging

 

Yeah, it used to be that I could skip years and get that anyway.  But Cigna corporate (his words) has decreed otherwise as of about two years ago.

 

Third day with no Montelukast, no change yet.  Because of my radical dietary changes, I may have stopped the constant sub-clinical allergy/inflammatory state most Americans are in.

[SwampNut]

6 hours ago, Zero Knievel said:

If you need an Rx for it, you would talk about it…even if to only note that it’s doing its job or if you aren't happy with its performance.

 

We discussed it once in ten years.

 

Also you do need to see a doc for your chronic ailments if you prefer not to handle them on your own.  My PCP has openly admitted that I have more knowledge in the deep vertical space of my own diabetic care and especially the peptides.  His recommendation was that I go see an endocrinologist, which is sure to add more fuckery.  When I'm faced with either handling things on my own or starting down the unknown path of random docs, I see this...

 

 

 

When I needed a brain MRI, I didn't do that at home.  But it led to nothing, other than a shitload of appointments and zero *actionable* answers.  So I continue to choose the DIY path.

 

[Zero Knievel]

You and doctors is like me and Starlink.

[SwampNut]

I love my doctor and my Starlink, but find that I don't need either of them.

 

[SwampNut]

As is often the case, I was simply slightly early to the Next Big Thing in medical care.

 

https://www.wsj.com/health/healthcare/patient-self-medical-treatment-tools-85b43eaa

 

Patients Are Diagnosing Themselves With Home Tests, Devices and Chatbots

People increasingly turn to do-it-yourself healthcare amid long waits for medical appointments and a rise in self-care options

[CALCXX]

On 9/25/2025 at 1:40 AM, Zero Knievel said:

 

I’m diagnosed with low testosterone and hypothyroidism.

 

No, actually, you have phenal mycosis.

 

Phenal Mycosis is a microscopic organism that enters the body by way of the rectal passage.

It migrates its way up the spine thru the brain and lodges itself behind the optic nerve thus giving you --

A shitty outlook on life.

[OMG]

[Zero Knievel]

7 hours ago, CALCXX said:

No, actually, you have phenal mycosis.

 

Phenal Mycosis is a microscopic organism that enters the body by way of the rectal passage.

It migrates its way up the spine thru the brain and lodges itself behind the optic nerve thus giving you --

A shitty outlook on life.

Nice build up and punch line. 

[Zero Knievel]

17 hours ago, SwampNut said:

As is often the case, I was simply slightly early to the Next Big Thing in medical care.

Not saying it can’t be helpful, but we really don’t have AI…just LLMs.  How accurate they are depends on who designed them and what data from which they draw.  A poorly designed one will basically tell the patient what they want to hear…furthering hypochondria…like doom scrolling WebMD and convincing yourself you have a dozen new health conditions.  Part of a doctor’s job is to subjectively scrutinize the patient to see if they are telling the truth of their condition or trying to steer the doctor towards a desired conclusion.

 

Military sick calls involve a minimally medically trained person following a flowchart.  If they aren’t invested in getting the patient the best care, they will blindly follow the flowchart and overlook key details that would otherwise require referral to the doctor on shift.  AI medical diagnosis isn’t much better than a clerk with a flowchart.  Handy perhaps for getting an idea of what MIGHT be wrong but incapable of accurately determining what is wrong.

[SwampNut]

7 hours ago, Zero Knievel said:

but we really don’t have AI…just LLMs.

 

Bullshit.  Again.

 

[superhawk996]

On 10/3/2025 at 5:41 PM, CALCXX said:

 

No, actually, you have phenal mycosis.

 

Phenal Mycosis is a microscopic organism that enters the body by way of the rectal passage.

It migrates its way up the spine thru the brain and lodges itself behind the optic nerve thus giving you --

A shitty outlook on life.

It might be related to rectal myopia.  I was self-diagnosed with this condition when I was at my last job.  When I called in during my first flare-up I had to explain it to my boss- I can't see my ass coming to work today.  Luckily he was receptive to it and the flareups never lasted more than a day so I always came in to work the next day when it had subsided.  Several months after they fired him I was self-diagnosed with chronic rectal myopia and haven't been able to work ever since.  I should have gone to a lawyer, could have gotten disability pay.

[SwampNut]

More in democratizing, decentralizing, and reducing the cost of common medical needs...

 

https://www.cnbc.com/2025/10/08/amazon-debuts-prescription-kiosks-at-los-angeles-one-medical-clinics.html?utm_source=tldrnewsletter

 

Amazon is launching prescription drug kiosks at some One Medical offices in Los Angeles, the company announced Wednesday, in a move that could disrupt brick-and-mortar pharmacy businesses.

The kiosks are operated by Amazon Pharmacy and work similar to a vending machine, disbursing prescriptions for patients “within minutes” of their doctor visit, the company said.

 

Each machine can stock hundreds of prescriptions, such as antibiotics, inhalers and blood pressure treatments, with inventory that’s tailored to specific locations.