Losing Chagos would end the claim that the sun never sets on the British Empire. From Bermuda to Pitcairn, the UK's remaining territories form an unrivalled network worth keeping, argues James Alexander.

The post The Bermuda Quadrangle? Why the UK Should Hold On to the Empire on Which the Sun Never Sets appeared first on The Daily Sceptic.

• I've been a doctor for more than a decade and have a family of four.
• I've traded traditional health insurance for direct primary care and a medical cost-sharing group.
• For the first time, I feel like I'm truly in control of our healthcare.

I've spent more than a decade navigating the labyrinth of American healthcare. I've worn the white coat, spent sleepless nights on call, signed the charts, and cared for thousands of patients.

A few years ago, I realized I couldn't keep participating in a system that felt like it was designed to fail the very people it was meant to serve.

Today, my family and I are uninsured in the traditional sense — and I'm confident that it's the best financial and medical decision I've ever made.

I hit my breaking point

For years, I worked in a traditional, insurance-based primary care practice. My days were a blur of 15-minute appointments, dictated not by medical necessity, but by billing codes and insurance reimbursements. I felt completely beholden to the behemoth of corporate medicine. Patients were waiting months to see me and were almost always shortchanged on the time I was able to spend with them.

I felt like the insurance companies were the invisible third party in every exam room, deciding which tests I could order and which medications my patients deserved. I wasn't just a doctor anymore; I was a data-entry clerk for multibillion-dollar payers. The result was a total, soul-crushing burnout that followed me home every night.

On the other side of it, some of my patients were forgoing necessary care because the costs presented to them were simply too high. Did it make sense to spend $300 to check a thyroid test to ensure the $10 per month medication I prescribed was working as it was supposed to? Many patients, rightfully so, decided to spend their money elsewhere.

I knew I had to get out — not just for my own sanity, but to actually provide the type of care I believed in.

Direct primary care offered something different

I eventually traded the treadmill for Direct Primary Care (DPC). In this model, my patients (or their employers or an insurance company) pay a flat monthly membership fee directly to me (around $100 per month). This type of care is affordable— my current patient panel includes attorneys, electricians, teachers, and retirees. There are no co-pays, no deductibles, and most importantly, no insurance companies breathing down my neck.

The difference was night and day. Without the administrative bloat of insurance billing, I finally became the doctor I trained to be:

• Time: I went from seeing 20 patients a day to seeing six or eight.
• Access: My patients can text me directly. We have hour-long conversations instead of 10-minute sprints.
• Cost: By cutting out the intermediary, I'm able to offer wholesale pricing on labs and imaging that are often 90% cheaper than hospital rates. That $300 thyroid test from my previous job? I now offer that for $8.

I took my own family off the grid

Once I saw how much better medicine functioned without traditional insurance interference, I took the ultimate leap. I took my wife and children, now 9 and 6, off our health insurance plan.

Instead, we joined a medical cost-sharing community. It isn't insurance; it's a community of members who share each other's large, unexpected medical expenses. When I combined a DPC membership for our routine care with a health share for the big stuff, I realized I had found a better way to protect my family — and was paying far, far less for it.

The math backs up my decision

To understand why we left, look at the cost of childbirth. When our first child was born under a supposedly high-end traditional insurance plan, we still walked away owing about $10,000 after paying our insurance premiums. We were paying twice: once for the premium and again for the actual care.

My wife spent hours of her precious maternity leave arguing with insurance companies about the services we received in the hospital. When our infant son was hospitalized a few months later, she was back on the phone again, having to advocate for his coverage during the time of a family crisis. We spent years paying off the cost of the birth and his illness.

With our second child, we looked at the numbers through the lens of a cost-share program. On a plan like ours, the Initial Unshareable Amount (IUA) — the part we pay before the community kicks in — was only $1,500.

Beyond that $1,500, the community shared the rest. We didn't have to spend my wife's recovery time fighting with a claims adjuster or waiting for pre-authorizations. We knew exactly what our responsibility was, and more importantly, we knew our family was covered by a community, not a corporation.

I feel like I took back control

As a physician, I've seen the insurance trap from both sides. We've been conditioned to believe that without a blue or green plastic card in our wallets, we are unsafe.

The reality is that for some, traditional insurance has become a barrier to care rather than a bridge. By opting out and pairing Direct Primary Care with a health share, I've reclaimed my time as a doctor and my peace of mind as a father. I'm no longer waiting for an insurance company to tell me how to care for my kids or my patients. As a doctor and as a father, for the first time in my career, I feel truly secure.

After Bryce Ramsey was diagnosed with stage 3 colon cancer at 33, she learned another piece of shocking news: She had a genetically high chance of developing it from the very beginning.

Ramsey tested positive for Lynch syndrome, a silent, inherited condition that heightened her lifetime risk of being diagnosed with colorectal cancer by up to 56% for her variant. It also put her at greater risk of developing ovarian, uterine, stomach, pancreatic, and other forms of cancer.

Before she learned she had Lynch, Ramsey urged her relatives to also get screened for colon cancer. Since then, her father, brother, and aunt have all been diagnosed with various stages of colon cancer. Like Ramsey, her aunt also tested positive for Lynch.

"I was the whistleblower," Ramsey, 40, based in Mississippi, told Business Insider. Ramsey now wants her two young sons to test for Lynch once they're in their early 20s, the recommended starting age for her specific Lynch mutation.

Like most genetic testing, Lynch syndrome testing is relatively quick, cheap, and non-invasive. It involves a saliva test, a cheek swab, or a blood test, with the latter having the least room for error.

Still, it hasn't caught on: About 1 in 279 Americans (1.2 million people) are estimated to have Lynch syndrome, including between 3 to 5% colon cancer patients. Yet an estimated 95% of Americans with Lynch syndrome have no idea they have it.

All the while, cases of colon, breast, uterine, and pancreatic cancers are rising in young people, with colon cancer the deadliest cancer for adults under 50. "If you don't know, then you can't get help," Ramsey said, including earlier screenings or preventive measures such as hysterectomies.

"Ignorance is not always bliss."

The 'lowest hanging fruit' for cutting down cancer risk

Some experts view broader Lynch syndrome testing as a way to get more people screened for cancer before symptoms arise — and a way to potentially help entire families better understand their cancer risks.

Like Ramsey, the majority of people diagnosed with Lynch syndrome only get screened after they have cancer. In the US, the CDC's general guidelines recommend that colon and uterine cancer patients have tumors biopsied for Lynch, followed by Lynch syndrome screening for the patient if there are abnormal findings.

Some experts believe the lack of early genetic testing is a huge missed opportunity for reducing cancer risk. One 2021 study found that about 16.4% of 713 early-onset colorectal cancer cases could have been prevented if patients knew either their family history or had been genetically screened, and would have subsequently started getting colonoscopies sooner.

Lynch syndrome testing "has got so much potential, but it's not being utilized," Heather Hampel, a professor at City of Hope in California who specializes in clinical cancer genomics and Lynch syndrome, and a co-author of the study, told Business Insider.

While Lynch syndrome remains unknown to most Americans, some health systems are trying to expand testing to the broader population. Helix, a genetic screening company that first started out as a consumer DNA marketplace, started partnering with 17 health systems in 2021 as part of its "Population Genomics Initiative." The goal has been to introduce broader population-scale genomic programs that include testing for Lynch syndrome.

Dr. Cassie Hajek, the medical director of Helix, told Business Insider that most patients diagnosed with one of these hereditary conditions by Helix were completely taken aback by the news. "They're kind of operating on the assumption that their risk is just as it is in the general population, but in fact, it's significantly elevated," she said. "The whole goal is to identify these patients hiding in plain sight."

By knowing their genetic predispositions for cancer, they can both more easily start earlier cancer screenings and also inform their family members of their potential genetic risks.

Hampel noted that lowering overall cancer rates is complicated. We still don't know why colon cancer cases are rising so rapidly among young people, and lifestyle factors like sedentary routines and diets high in ultra-processed foods are far more difficult to control for.

"If the lowest-hanging fruit is family history and gene testing, and we can't even prevent those," Hampel said, "how are we ever going to prevent things where we need people to make lifestyle or behavioral changes?"

The ripple effects for families

Michelle York was 33 when she first heard of Lynch syndrome.

Up until that point, all she'd known was that her mom's side of the family had a long cancer history. Her great-grandmother died from colon cancer. Her grandfather had stomach and brain cancer. Her great-aunts died from liver, ovarian, and breast cancer, respectively. Her mother's cousin died from pancreatic cancer.

York's mother, a nurse at the time, had come across the term through her work. She tested positive for Lynch, along with York, her two siblings, aunt, uncle, and cousin.

At first, the news caused some anxiety. "Does this mean I'm going to get cancer at a young age?" York, 43 and based in Los Angeles, told Business Insider. "Does this mean every time I don't feel well, I'm going to immediately think I have cancer?"

However, once York and her family started getting routine cancer screenings, including annual colonoscopies, they felt more reassured than afraid, because they knew they could catch cancer early. York's mother had multiple precancerous polyps removed.

"None of us have had cancer yet, but we've had lots of scares," York said. She also wants her kids, ages 17 and 14, to test once they're older.

York's mother triggered something called "cascade testing," in which other family members test for Lynch and can take preventive measures to reduce their cancer risk.

Dr. Sapna Syngal, the director of research at the division of cancer genetics and prevention at the Dana-Farber Cancer Institute in Boston and the founder of its Lynch Syndrome Center, sees cascade testing for Lynch as a "real opportunity" to lower cancer risk, she told Business Insider.

Particularly for young people, if they test positive for Lynch in their 20s and start getting cancer screenings, "there's a really, really good chance that you could prevent that cancer by taking out polyps earlier on," she said.

There are also financial benefits to knowing you have a genetic predisposition to cancer. While insurance coverage for Lynch-related cancer screenings can vary, Hajek said her patients typically have a more "straightforward" experience in getting otherwise expensive screenings like colonoscopies covered. York, for example, said her insurance covered her cancer screenings once she got her Lynch syndrome diagnosis.

Ultimately, Hajek said Lynch syndrome testing can help patients get more precise care than simply knowing they have a family history of cancer. Just as testing positive for Lynch can prompt someone to start cancer screenings sooner, testing negative can also relieve a person of anxiety about being at high risk of early-onset cancer and potentially call for less frequent cancer screenings than if they had Lynch.

York said she's ultimately grateful for finding out and knowing she can catch any early signs of cancer by starting annual screenings such as colonoscopies in her 30s — over a decade before the average-risk recommended screening age of 45. Both Ramsey and York also had hysterectomies and oophorectomies unrelated to cancer, which brought extra relief in also reducing their uterine and ovarian cancer risks to essentially zero.

"I think knowledge is power," York said. "Now, it almost feels comforting because I know that I started doing this young."

Lynch needs its Angelina Jolie

In 2013, Angelina Jolie revealed in a New York Times op-ed that she had tested positive for BRCA1, a gene that increases the risks of breast and ovarian cancer.

Her revelation — and subsequent operations to remove her breasts and ovaries — sparked an international drive to get tested for BRCA1/BRCA2. Years later, a study found that 15 business days after Jolie's op-ed went live, BRCA testing rose 64% in the US.

Over a decade later, researchers and patients are working to make Lynch syndrome screening similarly universal.

Getting every person screened comes with its own obstacles.

Lynch could be added to the list of genetic conditions screened for in newborn heel tests. However, critics of the idea believe it can create years of stress when the person with Lynch isn't recommended to start getting colonoscopies until they're in their early 20s.

Other routes, such as including Lynch syndrome testing when people join the military or go to college, would miss broad swaths of the population.

There's also the question of funding. Helix, for example, doesn't bill patients and instead relies on the participating health systems for financial support. Few hospital systems can afford to prioritize testing for a gene condition that impacts a small portion of the population.

Syngal said one immediate option for getting more people screened for Lynch is to follow York's route: consider getting tested if you have a family history of colon or other relevant cancers.

Since their diagnoses, Ramsey and York have tried to spread the word about Lynch syndrome testing. Ramsey is an official advocate for the non-profit Lynch Syndrome Awareness, while York, a full-time content creator, has shared her story on social media.

"It's scary when you first find out that you have a genetic mutation that predisposes you to cancer," York said. "But at the end of the day, knowing that and taking those precautions could ultimately save your life."

• For decades, Accutane has been a drug of last resort for persistent acne.
• A founder who designed a new platform to streamline regulatory red tape is changing access.
• People are microdosing Accutane and reporting fewer side effects. Dermatologists have mixed views.

In the dermatology world, Accutane has a reputation as the nuclear option for bad acne.

It's the only drug that can shrink oil glands, potentially clearing pimples for good. But it comes with serious risks — primarily: a high rate of birth defects if you take it and become pregnant. Other side effects include sun sensitivity, high cholesterol, mood changes, and joint pain.

Parents are scared to put their teens on it. Dermatologists often reserve it for stubborn acne, after other creams, cleansers, antibiotics, and pills have been exhausted. And strict pregnancy-prevention rules mean monthly check-ins, tests, and blood work.

But in recent years, some of the stigma around the retinoid drug, generically called isotretinoin, has started to fade, as people have gravitated to a smaller, more strategic "Hollywood dose" of Accutane. By taking small amounts of the drug, maybe just a few days per week, many patients find they can maintain a dewy, glass-like complexion on camera while avoiding painful side effects like ultra dry skin, and the initial acne breakout purge that comes with heftier prescriptions.

"I love the Accutane glow-up," Honeydew dermatology founder David Futoran, 29, said. For him, it includes hair that's less oily, and baby-soft cheeks.

Futoran is partly responsible for turning Accutane from a maligned prescription of last resort into a buzzy internet sensation. He's found new ways to streamline and digitize paperwork, turning most of the required monthly doctor's office visits and testing for the drug into something people can do at home. Honeydew is now growing 3x year over year, Futoran said, and interest in low-dose prescriptions is increasing.

Dermatologists are divided on the trend of microdosed Accutane. Yes, it is a very effective drug, and it can clear up most breakouts. But there are tradeoffs to taking an intermittent or low-dose approach, and some doctors say why bother dancing around side effects when you could get on and off the potent drug in months, and have clear skin for life?

Founder mode for skin

Futoran founded Honeydew in 2022 after spending years on various antibiotics and multi-step cleansing and cream routines, with his acne constantly coming back.

His vision was to make prescription acne care faster and more accessible. He partnered with his longtime dermatologist, Dr. Joel Spitz, to build a telemedicine platform connecting patients with providers and treatments for acne, rosacea, eczema, and psoriasis.

Yet Futoran was still hesitant to take Accutane himself, partly because of the logistical headaches.

One morning, he said, he woke up with a large, painful cyst in the middle of his forehead. That was it, he said — he decided he was finally going on the low-dose form of Accutane his company had been prescribing.

"I should have done that from the start," he said. "My skin is way less irritated than it ever was on any of the topicals, and I just have peace because I know it works."

Accutane works because it shrinks oil glands by turning down sebum production. It triggers the death of some stem cells, which is great for clearing up overactive oil-producing glands, but very bad for developing fetuses.

In addition to making regulatory compliance digital, Honeydew offers specially formulated lip balms, cleansers, antihistamines and supplements like Omega-3 designed to replace lost oil.

Bringing a celebrity skin trick to the masses

Celebrities including Chris Pine, Pete Davidson, Emma Stone, and Kendall Jenner have all been open about using this powerful oral retinoid to help clear up persistent acne. The shadow business of microdosing Accutane, though, using it as a glow up drug even for minor, isolated breakouts, happens more through a whisper system between doctors and patients.

26-year-old marketing manager and social media influencer Kennedy Faris started microdosing Accutane with Honeydew in the spring. About a decade ago, she watched her little brother suffer some of the rarer mental health side effects of Accutane, and she was worried about the possibility the drug could lead to depression.

"My brother's a very happy person, so it was really scary," Faris told Business Insider. "I was really hesitant about starting."

After struggling to get a prescription from an in-person dermatologist, Faris heard about Honeydew from a follower and partnered with the brand. She started on a low dose of 10 milligrams, working her way up to a standard 40 mg dose over the course of a few months.

After years of trying different skincare products, antibiotics, and medications, she feels like she's finally found a more permanent solution to cystic acne. There are drawbacks to being on the drug, she said, including sensitivity to alcohol, sunlight, and some nightmares. But the real benefit has been her renewed confidence, optimism, and joy, with friends noticing she's "more bubbly and happy," she said. "I was like, 'wow, I was kind of depressed.'"

Because the drug shrinks pores, Faris has also noticed her face and nose appear slimmer.

"Everyone talks about the fake nose job," she said.

Some patients recovering from real nose jobs even use the drug to lower surgery-related inflammation and shrink pores on the nose while their face heals. As testosterone therapy booms, more men are taking Accutane to deal with oilier skin. And increasingly, patients are lining up for low-dose Accutane for minor breakouts, just to be in the clear. People are gravitating to skin treatments that will give them the edge at work and on screen, Spitz said.

"Everyone's on Zoom or Google Meets or they're on TikTok or they're on Insta, and they want to look good," he added.

The potential drawbacks of microdosing

Some doctors worry that microdosing Accutane could lead to more health complications if people stay on the medication for years at a time.

"In my practice, I just basically put people on the standard dose and then they're done at five months, and then they feel much better, Dr. Ariel Ostad, a dermatologist in Manhattan who is not affiliated with Honeydew, said. "Patients, once they go on it, their skin clears up really quickly, and they're happy, and they realize it's not as bad as they thought."

A shorter treatment course means less time worrying about drug interactions, liver or heart health, pregnancy, sun sensitivity, or bone issues.

Futoran said traditional dosing can be "absolutely the right answer for some patients," and roughly 40% of Honeydew prescriptions are at standard dosages. Still, he cites studies showing patient satisfaction is higher with low-dose Accutane, and said Honeydew patients on smaller dosages have "materially better retention."

"The best clinical outcome is when patients complete their course, but faster is not always better," he said.

De casas de sonho a histórias caóticas, The Sims transformou a vida quotidiana num fenómeno mundial. No Geração Gamer, Cristiana Reis recebe Mariana Bossy e Sara Mercury para recordar a série que deu aos jogadores liberdade para criarem os seus próprios mundos

It’s been a month since the story of the Cornell Seven case became national news. Ruby Cramer documents what she describes as “an ever-expanding blast radius of online abuse, threats, and vigilantism which has touched virtually every person connected to the case, along with people who have no immediate connection to it at all.” Among those closest to the center is the accuser herself:

Jane Doe explained to the police that her phone number and address had been leaked on the internet, and that she’d been receiving harassing phone calls, including that evening. She had recorded one such call. In the recording, the man says, “I’m probably just gonna, like, pull up to your house and shoot. . . .” The caller speaks in a deep, throaty voice that at times sounds almost garbled. In response, Jane Doe says nothing. The man says, “I can hear you breathing.”

While officers were still at the family’s house, dispatch reported that the initial caller was back on the line, saying that he had an AR-15 assault rifle and was going to kill everyone at the house, then himself. About an hour later, police reported another call, this one saying that the house was on fire. In yet another phone call, a man stated that he had explosives and that the family would die—“either now, midnight, or tomorrow.” Jane Doe was receiving additional threats via text message and D.M. Her phone had hundreds of unread messages on it, but some of them she opened. “Typical white btich whore crying ‘rape,’ ” one of the messages read. “Hopefully someone does the world a favor and 🔫🔫🔫 you, nothing of value would be lost.” Officers advised her to keep her phone turned off. The next day, according to her attorney, she started taping pieces of paper over the windows at the house.

VTM

O comandante dos Bombeiros Voluntários de Mondim de Basto, Carlos Magalhães, explicou à VTM que o acidente “ocorreu quando o trator agrícola capotou e despencou por uma vereda com cerca de 60 metros de extensão”.

Acrescentou que os Bombeiros Voluntários de Mondim de Basto mobilizaram para o local uma ambulância de socorro com dois operacionais. “Dada a gravidade do cenário e a complexidade do socorro, as equipas contaram com o apoio diferenciado do Instituto Nacional de Emergência Médica (INEM), através da ambulância de Suporte Imediato de Vida (SIV) de Amarante e da Viatura Médica de Emergência e Reanimação (VMER) de Vila Real”.

A vítima recebeu assistência médica no local pelas equipas especializadas do INEM e foi estabilizada antes do transporte para o Hospital de Vila Real, acompanhada pela equipa da VMER.

O alerta foi dado às 07h14 e o acidente ocorreu na área florestal do Toumilo.

A Guarda Nacional Republicana de Mondim de Basto esteve também no local e tomou conta da ocorrência.

The post Um ferido grave em acidente com trator appeared first on A Voz de Trás-os-Montes.

VTM

A perda de memória é uma característica natural do envelhecimento, mas quando começa a perturbar a vida quotidiana da pessoa, já não estamos a falar de algo natural, mas sim daquilo que poderá ser um sintoma de demência.

A VTM foi tentar compreender melhor esta doença, que é, cada vez mais, frequente em todo o mundo.

Ana João Marques, neurologista na Unidade Local de Saúde de Trás-os-Montes e Alto Douro (ULSTMAD), revela que a Alzheimer é uma doença que não tem cura, mas, hoje em dia, pode ser gerida. “Se até há 20 anos era uma doença com uma sentença quase de uma debilidade muito precoce e de uma mortalidade muito elevada, hoje em dia é possível viver-se com Alzheimer até mais tarde e com mais qualidade”.

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VTM

Com um veículo de intervenção pré-hospitalar devidamente equipado, as equipas, que são compostas por um médico e um enfermeiro, vão diretamente ao local onde se encontra o utente para prestar socorro, em situações de emergência.

Numa área de atuação muito dispersa e abrangente, Sandra Tavares, coordenadora da VMER de Chaves desde 2015, revela que a VMER “é extremamente importante” para a região. “É a primeira linha de auxílio às pessoas, numa área que deve ser das mais extensas da Unidade Local de Saúde de Trás-os-Montes e Alto Douro, com más acessibilidades e uma população muito envelhecida”.

A área de atuação abrange os concelhos de Chaves, Valpaços, Montalegre, Boticas, Vila Pouca de Aguiar e Ribeira de Pena, mas também alguns concelhos do distrito de Bragança, se for necessário.

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The post Equipas da VMER percorrem quilómetros para salvar vidas appeared first on A Voz de Trás-os-Montes.