It’s really hard to pin down because of inconsistencies between manufacturers. I’ve had patients that got pellets and had no effects whatsoever, and some that got way too much because it dissolved too quickly. It also kind of matters who is implanting them and if they know what they’re doing. (Pro tip, chiropractors and naturopaths do not know what the fuck they are doing.)

The problem with pellets is that they can release the hormones at uneven rates as they dissolve because they aren’t perfectly homogeneous. There’s also a chance that your body rejects it and forms a fibrous capsule around it that prevents it from releasing the hormones at all.

That is indeed the gun going off. It looks like there’s a flash suppressor on there, but higher-resolution versions of the clip show the gas blow back from the bullet firing.

No, that was a negligent discharge. They are actually walking around with their fingers on the trigger and the safety off.

Yeah, I have him on Patreon, but I want to see the whole thing when it’s done. He had a couple side videos on Patreon about Oreos that nearly amounted to a cookie crash out that were very amusing last year.

Look, the man is making feature-length films about rabbit holes he never expected to find. The “Roblox OOF!” video was supposed to be about 10-20 minutes, but then he found the Tommy Tallarico absurdity and just couldn’t leave that part out.

IRL? H. Bomberguy

In fiction? Deadpool.

Honestly, a lot of bisexual and pansexual men and masculine characters are pretty well adjusted in part due to the fact that they are comfortable with who they are as a person and know what kinds of things make men attractive. Way too many men these days have a completely warped idea of what other people find attractive in men and toxic masculinity is built on a framework of those misconceptions.

No, it’d be the Orange Cube.

It was so zoomed in and cropped that I thought this was one of those weird corner scenes in a Bosch tryptic.

But occasional use for moderate pain is quite reasonable and people should not be afraid to take medications at the doses and frequency listed in the instructions. For those with liver or kidney problems, listen to your doctor about what medications to avoid and what to use in their place, but don’t suffer unnecessarily.

Taking these meds once in a while is perfectly safe if you don’t have preexisting organ damage or dysfunction.

Copied from another posting of this article:

The headline (and the article for that matter) are very sensationalist and I don’t think they’ve presented this in a balanced way. They are discussing how sorbitol behaves in zebrafish with limited data presented on human biochemistry, and they discuss it in a vacuum without quantifying the amount of sorbitol it takes to cause a problem. Yes, any substance in excess can be harmful, but the amount of sorbitol in food compared to the amount of high fructose corn syrup makes it the substantially lesser evil. The artificial sweeteners are vastly more potent than actual sugar, so you don’t need very much of it to get the same amount of sweetness. High fructose corn syrup is used in massive amounts in food and is much worse for you on the scale that either substance would be consumed.

They once tried to prove that DNPs (Doctorate of Nurse Practitioner) was just as good as an MD or DO education. They did this by taking the top DNP grads from the best programs and gave them a dumbed down version of the easiest part of the medical license exam, and only 40% passed it.

For context, to get a medical license, a physician has to have passed Steps 1-3 of the USMLE (US Medical License Exam) or Levels 1-3 of COMLEX (Comprehensive Osteopathic Medical Licensing Exam) to be eligible to apply for a medical license. Step/Level 2 is usually considered the hardest one of the three, and Step/Level 3 is the longest exam (2 full days), but generally considered to be the easiest. This DNP exam took the easiest 20% of questions from Step 3 and made a half-length version of the exam…and 60% of the DNPs still failed it.

The NP/DNP education is almost entirely algorithm-based and doesn’t meaningfully get into the anatomy, physiology, pathophysiology, and pharmacology that the first 2 years of medical school are devoted to. I have seen NPs miss life-threatening diagnoses because they were rare diseases that don’t come up outside of those first 2 years of drinking from a firehose of textbooks in medical school. Their education just isn’t long enough or in-depth enough to actually be equivalent to an MD or DO degree.

Also, MDs and DOs have almost 4000 hours of supervised medical practice where a physician is checking their work and directly observing or guiding their clinical experience before finishing medical school. Residency is, at minimum, another 8000 to 10000 hours of supervised practice in the specialties that only require 3 years of residency (it ranges from 3 to 9 years based on specialty).

NPs don’t have any standardized requirements for supervised practice to get their licenses and most programs only require 1000 hours or less of shadowing where they are just observing a licensed NP practice and not actually doing anything hands-on themselves… And they try to argue that this education is sufficient for them to be equal to physicians. There are some NPs who are amazing providers, but they’re usually the ones that were bedside nurses for 10+ years before going back to school for their NP license. The newer NPs that are going straight through from their BSN without any actual experience are the really dangerous ones.

TO BE CLEAR: I love the nurses I work with and I value their work and their input immensely. I was an EMT/ER tech before med school and it’s really sad when nurses are so confused when I help them clean up patients or reposition or whatever as a med student because most physicians and medical students don’t stop to help the nurses clean up poop. You can always tell which physicians have never had to clean up poop before, and I try very hard not to be like them.

Actually, the problem is the number of residencies. Once you graduate from medical school, you MUST complete an accredited residency program to be able to practice independently. The number of residency programs is controlled by Congress because residencies are funded through Medicare, and the last substantial increase in the number of residencies was when they added 1000 more in the Covid Omnibus bill.

It’s actually a growing crisis because more medical schools are opening and existing ones are increasing their class sizes, but the number of residencies isn’t keeping pace. This means that more and more people are going to be medical graduates with no way of obtaining a medical license without a residency and therefore no way to pay off their student loans. There’s a couple stories every year about medical graduates that couldn’t get into residency or couldn’t complete residency that end up dying by suicide, but it gets pretty effectively swept under the rug.

That “clinical experience” can usually be fulfilled by shadowing and supervised practice like medical students and medical residents have to do isn’t actually required for NPs. Also, in most places, those 4 years of clinical practice can be as an MA or CNA, not necessarily an RN. The education and certification requirements for NPs are wildly inconsistent which I think is actually more dangerous than a standardized lower level of education.

A huge piece of a physician’s medical training is knowing what questions to ask (as well as how and when to ask) to uncover the sneaky things that aren’t apparent on the surface. For example, as a 4th year medical student, I had a patient in the ER that came in with shortness of breath, fatigue, and chest discomfort. There were a couple hints of red flags, so I asked more questions that didn’t seem like they were related at all. Was he having unintended weight changes, night sweats, or changes to his bowel movements? The answer to all three was “yes”, but he had no idea why I was asking about that when he was there for breathing problems. I had a suspicion that he was having complications from metastatic cancer, and I was right. The resident I was working with hadn’t even thought to dig into those other niggling suspicions and was more focused on cardiac and pulmonary causes of chest pain and breathing problems.

I can almost guarantee that a nurse practitioner wouldn’t have asked those questions either. I keyed into some very subtle signs on his exam which prompted me to dig deeper, but NP’s aren’t even really trained on how to get a deeper history, let alone when to do so.

As a patient, you do have the right to refuse to be treated by anyone. You may have to wait for a physician to be available, but no one can treat you without your consent and you can always ask for a provider’s title and licensure.

The AI alleviates the process of critical thinking though. I make my own review notebooks for my boards and for clinical rotations by taking the time to figure out what’s important and what I don’t know to put those things in my notebooks. I write these out by hand on paper, so I have to be judicious about what is going to actually be important, and just the process of making those priorities helps me to have a better understanding of my own deficiencies.

Making a good study guide requires critical thinking skills, and if that gets outsourced to AI, that means the critical thinking isn’t being done by the human that needs to learn that skill.

Nope. They can (and these days often do) go straight from their nursing degree to an NP program with no real work experience.

The problem is that most people don’t double check or they check a couple things then think “good enough”, and turn off the critical thinking part of their brain. That’s how lawyers ended up submitting a case brief with fake case citations. The “citations” look real enough, but to verify it, you have to go read the source yourself.

This goes for people citing studies without reading them first. There are a lot of studies that squidge the numbers around to make things look better and you have to look for things like how they parsed the data for the results and conclusions. I’ve personally made pharma reps very uncomfortable by digging into things like how they did or did not parse complications by sex (ie one complication was parsed by sex, but the other was combined)

Part of my concern is that APPs like nurse practitioners that have no supervised practice as part of their training are going to become even more poorly educated. Their curriculum is already algorithm-based, and because of the Nursing lobby pushing for more and more independence for NP’s, they have dwindling physician oversight requirements (in some places a physician only needs to audit 10% of their notes and never actually lay eyes on the patient themselves.)