A big problem is that people receiving psychiatric care often can't get justice in court. Who is the jury, or judge, more likely to believe, someone who needed psychiatric care, or a credentialed doctor?
I know someone who was threatened with having their children taken away, and prison if they tried to leave the hospital, or stopped taking medication that was making them feel worse.
But since it was just the doctor's word against theirs, they were told there was very little chance of winning in court.
If this happening as frequently as the article suggests, and if Arcadia operates over 50 hospitals, you’d think there would be at least 1 law firm dedicated solely to prosecuting this specific hospital.
Skip the class action BS, and run those “mesothelioma” type commercials. Then have a boilerplate structure for a lawsuit that you can repeat successfully, hire your own doctors as expert witnesses to refute the hospital, etc.
If they are imprisoning people illegally, I imagine the settlements would be quite high per patient.
> But since it was just the doctor's word against theirs
When something is widespread and perpetrated by the same people, you have to establish a pattern of behavior to discredit the witness.
The narrative could be pretty straight forward: the doctor was lying to the insurance company, and they’re lying to the jury, too.
Seems they already settled a couple suits, which could potentially be used to discredit the hospital as well.
But again, you really need a specialized firm willing to take them down by taking on a bunch of similar cases to make it worthwhile to do all of the background/evidence/research to make a case.
This is also the type of case that could get heavy PR / public support which the right law firms can leverage in their favor.
…or we embrace better regulation and trust the government to fix this. But the government also has a terrible track record when it comes to caring for the mentally ill.
> If they are imprisoning people illegally, I imagine the settlements would be quite high per patient.
That depends on whether or not anyone cares about the patient.
Many, many psych patients have basically been disowned by their families, they have no friends, and don't have the ability to live on their own in society. Maybe the lawyers would care enough about them, if they could win a suit, but I'd not bet on that.
I'd suspect that a huge number of homeless folks were ones that would have been "lifers" in mental hospitals. The enormous homeless problem in the US is actually relatively new. I remember when it was much, much less of a problem (We have always had them, but nowhere near the scale we have them, now).
We live in a nation, where it is easier for mentally ill people to get weapons, than help[0].
That said, in MD, where I lived for a while, we had The Patuxent Institution[1]. It may still be around. Charming place. It inspired this movie[2].
> Many, many psych patients have basically been disowned by their families, they have no friends, and don't have the ability to live on their own in society. Maybe the lawyers would care enough about them, if they could win a suit, but I'd not bet on that.
What after winning the suit? I mean, if they dont have the ability to live on their own, what happens with them?
The article isn’t 100% clear, but it sounds like these are people with private insurance. So if they’re not directly employed, they are likely married to someone who is. This doesn’t sound like they’re targeting indigents.
You don't think they do the same thing to people on medicaid to get money from the government? Or people who have private insurance, but don't have the resources to pursue legal recourse?
I’d rather see tons of homeless on the street, free from government tyranny, rather than live in the one flew over the cuckoo nest hell scape that conservatives want to fling us back into.
Thank god for Ken Kasey and thank god for desinsitutionalization and the anti-psychiatry movement.
Most of those homeless folks are institutionalized in a very real, albeit virtual way. They're being held in chemical restraints and they're being continually monitored by clinicians when they do mandatory check-ins and doctor visits. The clinicians are also alerted, and swoop in, upon word of legal trouble or health crises.
The effects of medications will encourage patients to act out, decompensate, commit acts of self-harm and violence upon others. The strategy is to get them jailed or cause serious bodily harm/death, because... Well let's just say that the incentives are perverse.
Whereas lunatics of old wore visible chains and straitjackets, and were mercifully housed, fed, and clothed, now they are largely on their own, sink or swim; hope some other human family member cares enough to pick up the pieces.
The mesothelioma commercials only really became prevalent after suits were won and the firms knew they could get money just by adding more people to the class (or really getting them to collect).
The individual meso cases? Lol no. At least some of the defendants nearly always settle but they’re not remotely slam dunks for the plaintiffs if they make it to trial.
> Who is the jury, or judge, more likely to believe, someone who needed psychiatric care, or a credentialed doctor?
> or stopped taking medication that was making them feel worse.
This kind of thing used to scare me - once you're booked into the system, they can literally stab you with an injection to make you behave in whatever way they want to portray you in court. And that's just if they're outright malicious.
Worse, they might instead be entirely earnest in their belief that you need to take that particular pill, that makes your misdiagnosed condition worse.
It gets more fundamental than this. These laws for involuntary commitment are civil laws and lack the protections of criminal court. The hearings can be ex parte, you don't have a right to an attorney, and proof is only what is more likely than not and not beyond a reasonable doubt. If you had a lawyer at the hearing and the proof required overcoming reasonable doubt, then there would be fewer abuses (one would hope anyways).
These types of abuses happen with all the "institutional" civil laws - involuntary commitment, civil asset forfeiture, guardianship, red flag, and especially protection from abuse orders (weaponized in divorces fairly commonly). It will continue to increase as we, as a society, continue to favor quick and easy "fixes" to overcome the protections found on the criminal side.
I think they’ve made a good effort on the laws in CA, 5150 and 5160 ensure each patient has a social worker advocate to look out for them and it needs recurring sign offs from a judge.
They helped more than 1 friend of mine when they when they needed the help.
The real issue is the 100k+ bill they got at the end, but politics so I digress.
This story is an incredible illustration of incentives gone wrong.
The affordable care act mandated that insurance companies cover mental health. Psychiatric hospitals can charge insurers $2,200/day for holding patients who "pose an imminent threat to themselves or others".
So now you get this:
> Once Acadia gets patients in the door, it often tries to hold them until their insurance runs out.
> Acadia goes to great lengths to convince insurers that the patients should stay as long as possible, often around five days.
> To do that, Acadia needs to show that patients are unstable and require ongoing intensive care. Former Acadia executives and staff in 10 states said employees were coached to use certain buzzwords, like “combative,” in patients’ charts to make that case.
Health insurance companies aren't incentivised to fight this kind of thing.
Clearly falls into mandatory coverage (if claims are accurate), so all companies are going to have to pay it. Raises costs. Insurance gets to have overhead (profit) based on claims paid.
There's more incentive to deny marginal claims, because some insurance companies won't and then you may attract more customers with a lower price and maybe you get more money that way.
Patients are unlikely to complain to insurance to tell them the treatment/confinement was unjustified... because the patient will then need to pay the bill.
> Patients are unlikely to complain to insurance to tell them the treatment/confinement was unjustified... because the patient will then need to pay the bill.
Honestly, you buried the lede here. This is the horrifying and broken part. Under no circumstances should someone have to be afraid of paying for their involuntary commitment.
Like is Acadia really going to sue so they can have the insurance company and the patient testify under oath that Acadia management is guilty of kidnapping at scale, and in this particular case?
As someone who went through this with a child and Acadia’s competitor UHS, yes. Yes, they do. The number of parents in our support group who fought in court to get their kids or relatives out of one of these hospitals only to be presented with a back-breaking bill for their commitment is genuinely nauseating.
This is one of the prime examples of the utter failure of the US for-profit healthcare model.
I wholeheartedly attest to this.
I had to stay in an Acadia facility due to a bipolar flare-up.
The bill was so bad... I think if I hadn't been in a better place, the bill would have sent me right back in!
The last time I checked, you can simply dispute a bill to get it off your credit report.
If they actually kidnapped you (as is apparently common practice there), I doubt they’d be dumb enough to sue you.
If they were, you can countersue in California, and the civil damages they owe you for kidnapping you will be deducted from whatever court judgement they win (probably making it negative).
Patient was treated. If insurance refuses to cover, the hospital bill the patient. If the patient refuses to pay, they'll end up in collections or bankruptcy, depending.
Insurance company profits are capped as a percentage of expenses, so saving money means they make less money. There are bad incentives all over the place in healthcare regulations.
If you're referring to the minimum medical loss ratio provisions in the ACA, most insurance companies are above the minimum, which means any marginal fraud reduction is pure profit for them.
Insurance executives' pay is limited by a pool of money that is calculated as a % of total expenses. If expenses are higher due to this sort of fraud, have an incentive to ignore it to keep that pool of money available for compensation as large as possible.
For health plan executives the financial incentives run both ways. Most medical "insurance" companies no longer provide much insurance and primarily act as third-party administrators for self-insured employers. In the short term, health plans can make more profit by approving more claims. But in the long term they have to compete for the business of those group buyers and so they try to block waste/fraud/abuse that drives up customer costs.
Sure, it didn't start with the ACA, but this story implies that the ACA lead to a growth in this kind of bad behaviour:
> Acadia was founded in 2005 by Reeve B. Waud, a financier, and grew slowly at first. But in 2011, the company went public and embarked on a major expansion.
> The timing was ideal. Over the next several years, Acadia got a lift from Obamacare, which required insurers to cover mental health. Today Acadia has 54 inpatient psychiatric hospitals with a total of 5,900 beds.
I'm not trying to imply that the ACA is bad here - just that the incentive provided by the requirement for insurance companies to cover this form of treatment inadvertently incentivized the kind of fraud described in the article.
This is why legislation needs to be iterated on - to correct for unexpected consequences like this. Ideally the abuse described in this article would be prevented by further legislation - though there's always a chance that could open up further loopholes.
Yes; if a patient didn't [couldn't] take good care of their body to begin with, then they're punished for complaining and/or being sick.
The more they lean on the PCP or psychiatrist, the more opportunities to find "treatable" disorders.
It's a test of obedience and willingness to cooperate. You dutifully believe the screening tests, you fill the scrips, you take the pills, and now you're on a treadmill that is profitable for all parties except you, and you may notice that you're not healing but actually becoming sicker.
No, we're left to suffer so we can keep coming back and handing them more profit. At least I can't think of a better reason for so many of the decisions our health "care" system makes.
I'm not anti-psychiatry per se, but I always keep in mind that every industry has perverse incentives to not lose their customers. Every once in a while, a professor or journalist checks themselves into a psychiatric hospital with some temporary fake symptoms, then behaves perfectly healthy, but are unable to escape without a lot of outside intervention. E.g. https://en.wikipedia.org/wiki/Ten_Days_in_a_Mad-House (1887), https://en.wikipedia.org/wiki/Rosenhan_experiment (1973) .
A friend of mine was on screwed in the other direction here in California.
When stable, they signed over the right to commit them to me, their doctor, their spouse and their parents.
We all attempted to get care for the person during a psychotic break (including talking about plans to shoot up a religious gathering - the police wouldn’t do anything even after that).
As a result, they lost their job, marriage, apartment, possessions, life savings, and ended up $100K in debt.
The insurance company didn’t pay a dime when they finally got help, since coverage had already lapsed.
I can’t believe how broken healthcare is in the US.
Do the patients ever use the phones from these facilities to call the local police departments about being held against their will without cause? At this scale seems like that should happen.
Phone access is typically restricted to a supervised call using the phone on the staff administrator's desk who can simply cut you off and glare at you with silent promises of retaliation if you don't say what they want you to say and what they agreed to let you say before they hand you the phone, all with their finger resting on the disconnect button the whole time.
Unless you are not making them money, then they get you out of there asap and make calls on your behalf all day to other places to shuffle you around to.
I'm not a psychiatrist, but it might be hard to tell them from the psychotics who can model the standard view of the world well enough, for long enough, to lie to the police about their condition.
More practically, I doubt they get unsupervised phone calls.
The only thing that should matter is if they are medically claiming the patient "poses an imminent threat to themselves or others", either they did the paperwork or they didn't.
And these aren't one of occurrences, these are systematic abuses in the same communities that would come up over and over again - which is presumably why police raided their facility in Georgia.
> More practically, I doubt they get unsupervised phone calls.
Most facilities have communal phones that are available throughout the day for short periods of time.
Most doctors agree that people in the throes of a psychological crisis must sometimes be detained against their will to stabilize them and prevent harm. These can be tough calls, balancing patients’ safety with their civil rights.
IMHO it's acceptable sometimes to balance others' safety with a patients' civil rights. But it's not acceptable to trump someone's civil rights with concerns about their own safety. That balance can certainly result in tragedy when people make horrible choices. But it preserves the concept of civil rights against the incompatible alternative of overruling them in the name of safety. We can't get the benefits of freedom by only allowing "good" choices, because those benefits flow largely from learning from the bad ones. We are very capable of collectively making bad choices (from slavery to lobotomies) and defining them as good. Civil rights are a way to counterbalance those.
I’m guessing you’ve never had to deal with a loved one in the throws of addiction or severe mental illness. We are not perfectly rational beings and sometimes we make very bad choices, especially when we suffer from a mental illness like addiction. If I had the choice between seeing a loved one temporarily institutionalized versus having them die of an overdose, I would take the former. It isn’t ideal, but sometimes you have to choose the least awful thing.
What does “temporary institutionalization” look like in that choice? One of the highest risk periods for overdose is after leaving jail or rehab.
Do you support proposals to reduce the risk of overdoses that don’t rely on complete abstinence, such as drug test kits, safe injection rooms or even legal supply?
I generally agree with you, but how far should we take this? Like if a loved one has been diagnosed with hyperlipidemia and makes the very bad choice of refusing to take their prescribed statins, should they be forcibly institutionalized? They are likely to die early, although it isn't an "imminent" threat.
> That balance can certainly result in tragedy when people make horrible choices.
The thing is, someone may not be rational enough to make that choice. I’ve been suicidal in the past. Reasoning goes out the window and you can easily make a decision you never wanted to make. You simply can’t choose to stay alive any longer.
I’ve lost a friend because they couldn’t hold out long enough for things to get better. They killed themselves because of a temporary situation they could have easily recovered from.
I’ve saved a friend by preventing him from going down that route. It took over a year for him to be healthy. He doesn’t want to die now.
I’m always going to side with stopping people from suicide until they’ve had a chance to be mentally sound enough to make an informed decision.
There have been people I’ve known who did make that decision and did so rationally. All of them had medical conditions they could never recover from without divine intervention. In their case, they wanted to spare themselves and others from a long, painful death. They should be able to make that choice.
> I’m always going to side with stopping people from suicide until they’ve had a chance to be mentally sound enough to make an informed decision.
The problem is that “mentally sound” is partially defined as not wanting to die. It doesn't matter how stable and coherent you are, as long as you keep saying “on net, I don't feel like my life has been worth living and I would prefer to end it painlessly if I could”, they will not let you out. Getting out is a process of learning the lies you need to tell the doctors and nurses.
My understanding is that for many (not all) suicidal people, the time period of actually wanting to die can be remarkably short. Like on the order of 20 minutes, and then thought passes (at least for a little while)
If you mean at extreme risk of carrying through with a plan, that seems fairly accurate in my experience. I had a number of safety plans I’d use to remove myself from the means I’d use until I could get back to passively suicidal instead of actively suicidal.
The fact the current process isn’t perfect doesn’t change how I think things should work. Determining another person’s mental state is difficult and you’ll always run into problems.
On a whole, more people ultimately wish to live afterwards than those who want to die. So any system is going to err on the side of caution.
As I mentioned, there are situations in which a rational decision is easy to understand and verify. Our current system in the US does not allow for these cases.
Helping clinically depressed people act on their most-awful impulses - this doesn't seem likely to yield whatever positive outcomes you're thinking of.
I'm as big a libertarian as anyone, and I see the logic and morality of this argument.
Still, I can't be against violating people's rights by stopping them from suicide, and keeping them locked up for a while afterward. A close friend is alive because this.
It's sad that this information is behind a paywall. Not as a fault of the New York Times, they deserve money for this work.
It's sad that the default freely available information spread around is that the chain of hospitals is a professional institution that's endorsed by the board of medicine. And knowing the truth costs money. Just as bringing these folks to justice costs money.
To be fair, the journalism was not historically free service. There was brief period where they tried to live by ads and use free articles to make people buy paper, but it did not worked.
The idea that we don’t do things which are at least as bad as lobotomies in 2024 is asinine.
Male genitalia mutilation AKA circumcising is something that most doctors in America think is okay but will get you jailed in many European countries. A societies understanding of what qualifies as being mentally unwell is extremely subjective and often leads to extreme cruelty. Americans declaw their cats, dock their dogs tails, crop their ears, and lock them in crates for inhumane amounts of time. Americans love to beat their children, and many schools in the south legally can paddle children (and this happens to usually black kids)
That movie is spot on the mark and is not a day out of date.
Take note that all these victims were either employed or had insurance coverage. It's telling that they're not targeting the local homeless individual for 'care.' Which makes this more disgusting.
>Take note that all these victims were either employed or had insurance coverage. It's telling that they're not targeting the local homeless individual for 'care.' Which makes this more disgusting.
Apparently, "Medicaid is the single largest payer for mental health services in the United States"[0]
That said, one will likely have to dig through quite a bit of data to determine, on a state-by-state basis, what the reimbursement rates are for inpatient psychiatric services. And they don't make it easy, either.
For example, reimbursement rates for Texas[1], California[2] and New York[3] (chosen because they're large states which, together, make up a significant chunk of the US population) are available, but need to be parsed to figure out which specific code corresponds to daily reimbursement rates for psychiatric care.
Edit: In case my point isn't obvious, I'm wondering aloud whether or not Medicaid (the US medical insurance program for those under 65 who can't afford to pay for insurance) reimbursement rates make it a target for similar shenanigans. While Medicaid is significantly funded by the US Federal government (via block grants[4]), it's administered (in vastly different ways) by each state, which set their own eligibility and reimbursement rates
Medicaid is the largest payer because the state is who determined that an individual needs 24/7 hospitalization. There's nothing even remotely remarkable about this. If you drink heavily your entire adult life, your brain is swiss cheese before retirement age. You can no longer "function" in society. The courts cannot do anything until you present a problem for society at large. State run hospitals are very nearly entirely comprised of people who will be in the hospital until they die, with a marginal few matriculating into a group home or another facility (for instance, end-of-life facility).
I don't remember offhand what the facilities "charge per day" but i imagine it wouldn't be too difficult to ask someone in billing the next time i have a chance.
Unlike Medicare, which won’t pay for poor performance, Medicaid pays for services rendered, period. If you’re a shitty provider, there’s a calculus for when to bill Medicaid for a lower, guaranteed payment vs Medicare.
There’s a wide variety of shenanigans at the provider, managed care and state/county level. A big part of the performative shipping of migrants and poor people to northern states is all about shifting Medicaid expenses.
This happens often to mental patients, who often find themselves released from a police station or hospital, at a bus station with a ticket to NYC.
>Unlike Medicare, which won’t pay for poor performance, Medicaid pays for services rendered, period.
I don't believe that's true. Do you have any evidence for this?
I have never heard of anyone challenging a Medicare reimbursement for "poor performance." In fact, billing codes often don't make a whole lot of sense, yet are approved without question just because the billing code exists.
What's more, Medicare and Medicaid fraud are often perpetrated[0] by the same folks without and done in exactly the same way.
The most common way they do this is with hospital re-admissions. The hospital eats the cost, which is often because of poor hygiene and nursing practices.
Prisons and psychiatric care provide compelling examples of the boundaries of for-profit models and why they might not always be the best solutions in an area. You can always argue — reasonably I think — that these cases represent anomalous bad apples but I think as long as that incentive structure is there it will pull for this kind of thing at some level, even it's not quite as extreme as this example. I think that profit incentives and lack of competition tend to distort healthcare across all sorts of specialties in much more subtle ways than what was going on at this hospital chain. When threats to personal autonomy start to become the consequence it seems to clarify some of the problems involved, but the same processes are at work in all sorts of areas.
Well, yeah. Nobody actually wants a true free market system, no matter how much libertarians and anarchocapitalists may scream that that’s exactly what they want. If they got their way, the whole planet would become a dystopian nightmare, with no safety for anyone but the top handful richest people, and every single tragedy of the commons possible occurring, polluting the earth to the point of unusability. The only reason they claim to want it, is because of either greed, complete lack of empathy, or willful ignorance.
The only possible way to have a society is to have regulations.
Free market healthcare means it gets cheaper. Go pay cash at a doctor or a surgeon — it’s dramatically less expensive. The idea of comprehensive health insurance has ruined healthcare. Insurance should be to protect against financial risk from an unforeseen loss — a car crash should be insured, changing the oil should not. If car insurance covered tires and oil changes, car insurance would cost dramatically more.
That's great if all you ever need to do is see a doctor, full stop. Getting, for example, an MRI is around $2k out of pocket. Just for one imaging! Most Americans can't come up with $500 for an unexpected expense. Comprehensive health insurance protects people from instantly going broke from everything in health care that isn't just seeing a primary care doctor.
edit: Not defending insurers or our system at all, btw. Quite clear to me as ex-healthtech that a single payer system would solve many of our problems.
Can confirm, as a libertarian I don’t want a free market, it’s more like I think the rights of people should be above the rights of companies, corporations and so on. Governments exist to protect the rights of the people and in this age, in developed countries, there is no greater infringement on those rights than by large businesses.
I think i understand why this was flagged, so i will give a small bit of insight that maybe people on HN do not know.
There's a growing list of research publications that implicate the gut biome in ... well most disorders. It's hard to see the forest for the trees because of the implications - but there is a growing body of evidence that "metabolics" or in layman's terms your "gut health" is one of the easiest ways to effect psychological changes.
Also, everyone who can afford $50 should get their serum vitamin D levels tested, just for fun. The recommendation is 30 ng/ml - but this is to prevent rickets or whatever - not for optimal body and brain function - that number is, well, it's 100ng/ml. There's marginal risk to going over 100ng/ml, but this can be mitigated by additional supplements of vitamin K and Calcium*. As far as i know, vitamin D works either outside of or in tandem with the gut flora and fauna, but does fit in to "metabolic", right?
I'm sorry your friend has had such issues.
* reputable vitamin manufacturers know this and will produce high-potency vitamin D supplements with all three, or at least D and K as a single pill.
That person had 600ng/ml of vitamin D in their blood.
Pay real close attention to what i said, i said "you want about 100ng/ml, and if more, you want vitamin K" - if that person's doctors had suspected vitamin D at any point and had them start taking K in the interim, they may have not been hospitalized so many times.
My information about vitamin D is from two decades of reading papers about it and watching experts discuss it via video and interview notes. The 100ng/ml portions are state of the art in discussions about vitamin D deficiency, as of, well, Q1 2024.
I wouldn't exceed 50 ng/ml because it will risk excessive calcium deposits where they don't belong, such as in the blood vessels. Moreover, 99% of the potential benefits would already have been realized at 50 ng/ml. This is also the level that was found to work for preventing severe Covid.
the calcium issue only occurs over 100ng/ml (as i said) - i could cite, but apparently this sort of information isn't relevant on this forum. But, regardless of people's feelings on this (and your old data; 50ng/ml isn't enough) - the calcium issues are mitigated completely by, as i said, vitamin K. and, as i said, this is why the higher dosage vitamin D supplements contain K, as well.
per your covid reference, there's a reason that 50,000IU or more, dosed 2-4 times (over 2-4 days!) was recommended for certain people with covid.
You'd have to show me scientific evidence of >50 ng/ml being more beneficial than 50 ng/ml. This is for a long-term lifelong consideration. I am not convinced that any such evidence exists.
i spent exactly 5 seconds searching merely to disprove your 50ng/ml.
>Although it is not known what the safe upper value for 25(OH)D is for avoiding hypercalcemia, most studies in children and adults have suggested that the blood levels need to be *above 150 ng/ml* before there is any concern. Therefore, an UL of 100 ng/ml provides a safety margin in reducing risk of hypercalcemia [0].
well, that reinforces what i said. weird, that. also:
>But in 2011, the respected Endocrine Society issued a report urging a much, much higher minimum blood level of vitamin D. At that time, their experts concluded: "Based on all the evidence, at a minimum, we recommend vitamin D levels of 30 ng/mL, and because of the vagaries of some of the assays, to guarantee sufficiency, we recommend between 40 and 60 ng/mL for both children and adults."
so your information is at least 13 years out of date (and science marches on, as i mentioned, my ~100ng/ml is from Q1 of this year.) Technically, the research i heard and read hedged saying 80-100ng/ml "is probably the best range" - specifically to avoid hypercalcemia which occurs as noted above when the concentration is over 150ng/ml. Basically, if you tell people *only* that vitamin D is good and they should dose themselves, you get people taking 50,000IU/day for months, without Vitamin K and/or proper monitoring.
There's a reason that the "general" recommendation is 600-800IU/day for children and adults, it's because "vitamin D is good so more vitamin D is better" and while technically true there's that hypercalcemia risk "gotcha."
Anyhow, it's not my duty or job to convince you of anything.
No, your job is not to disprove me. Your job is to show evidence via studies that 100 ng/ml is better than 50 ng/ml, and you haven't yet shown any studies to do it. In contrast, I can in principle show evidence that 50 ng/ml is better than 30 because Covid studies say so. Until you do, you don't have a basis to ask people to get their level higher than 50.
This is not about convincing me. It is about converting me. If you can convert me, I will convert many others, but you don't have the evidence to do it. If you are going to ask someone to gamble on a higher level, at least they deserve to know exactly why.
No risk of hypercalcemia in patients taking extremely large doses of vitamin D - D blood levels of 118ng/ml and calcium levels at 9.6 (8.5 - 10.6 is normal) not sure of the units and don't care since it's in the same range.
oh and it was (mentioned in the DOI hotlink above) used to treat tuberculosis, rheumatoid arthritis, asthma - blood levels over 100ng/ml. I am unsure of what sort of evidence you need for ~100ng/ml being optimal. Preventing or curing covid? Preventing cancers? aiding treatment of cancer? Psychological and neurological health?
In fact, that paper explains why the limit was set to 50ng/ml, so maybe that will nudge you a bit ;-)
also here's two doctors discussing the reasoning and how to achieve 100ng/ml
https://youtu.be/2hO7fniCbmw?t=139 you can rewind, but the timestamp is where that discussion starts.
If you don't have time; partially an IU of D is the amount a 10 gram mouse needs, daily. So a 60kg human needs 6000IU, daily. Overweight people need more, underweight people need less. This was discovered ages ago (several decades).
Tiny tip of the iceberg. And all of those only got to prison for crimes against their investors, not for crimes done on behalf of their investors. Your examples actually support grandparent's point.
I'm not sure those are instances of executives being held to account for harm to the public as much as they're instances of people being punished for stealing money from the wealthy.
>much as they're instances of people being punished for stealing money from the wealthy.
Don't most instances of corporate malfeasance result in "stealing money from the wealthy"? If you do a bad, try to cover it up, and then try to raise money from investors, that's basically stealing money from them.
My point is that it seems that the only circumstances that lead to corporate decision makers being held to account for wrongdoing is if someone can link their wrongdoing to a financial fraud.
The Wells Fargo scandal is a good illustration of the problem with this kind of thing. The people who actually opened the fake accounts were low level sales staff and their direct managers, who public opinion saw as victims of unrealistic expectations. So prosecuting any of the actual perpetrators wasn't politically feasible. The only other person they could find to prosecute was an executive who didn't support the fake accounts, and routinely had her team fire people who opened them, but knew about them and didn't disclose them when she should have. Which is a crime, don't get me wrong, but it's not a very serious one.
If I remember correctly, both Bernie Madoff and SBF had a vast number of victims of all economic classes. I think this is more related to the ability to build a criminal case.
