The 3,000 reported cases are hiding many times as many that are unreported or will never be reported because who has the money to see a doctor these days? Once people realize they can't die from this parasite, they'll forgo a diagnostic visit that will likely cost hundreds of dollars they don't have.
Appreciated the youtube, even though it feels as though, one by one, many of the small pleasures in life are becoming a little frightening. Now including produce. Sigh. But hey, there's always beef - IF one can afford it, and IF one doesn't develop tick-borne allergy to it. More sigh.
Dr Jetelina ia an excellent communicator, but her background is in injury epidemiology, not infectious disease. The CDC surveillance systems depend on state and local reporting with the underlying goal of tracking overall trends as well as managing outbreaks. FoodNet was intended to focus surveillance efforts on the most common sources of foodborne outbreaks and utilize a more streamlined reporting system to identify outbreaks more quickly. Given that this outbreak seems focused in Michigan, FoodNet may or may not have helped because Michigan wasn't one of the FoodNet states. With challenges facing us from climate change and increased human-wildlife interaction this is the wrong time to cut public health. When public health works the general public doesn't always know because you can't track something that didn't happen. It's when things go wrong and we have an outbreak or worse that people realize that it's important. Our success makes idiots like RFK think that we don't need public health.
I disagree with the skepticism expressed here about the Food Net cuts being a major reason why this outbreak is so bad. Food Net doesn't only track long term "background" trends "over time." It does do that, but It also collects reported data in real time from mutliple sources to help with efforts to stop outbreaks from spreading, or at least it did before the cuts. Here is an article from August of last year that details how the number of pathogens was cut form 8 to 2, how one of those 6 cut was Cyclospora, and how reporting was made voluntary instead of mandatory. These kinds of illnesses need to be stopped quickly in their tracks. This particular pathogen is known to exist as a source specific pathogen that can be eliminated by tracing it to the source. When outbreaks are small and quickly tracked, that task is made so much easier, because the source variables are much less. Let it spread and good luck. Food Net played a huge role in helping with that effort though a centralized and quickly populated tracking apparatus. It was literally just completely halted for Cyclospora one year ago. In addition, RFKJR, for all his reputation as an activist who lobbied against "industry capture," has proven to be completely and totally rolled over by its captains as HHS Secretary. My guess is that part of this effort to defund and decentralize and destroy our monitoring systems has been to benefit them. For instance, if the parasite came from Taco Bell, this lack of knowledge and supposed unknown origin benefits them. Think of Chi-Chi's or Chipotle from food poisonings past. I would not be surprised if shareholders of these companies bribed Secretary Numbnuts to de-regulate this threat.
I guess I'll pass on all this important information on explosive diarrhea to the other folks at the senior center. We are really looking forward to the additional health challenge.
But, actually, the reason I am inserting this comment is off the topic of today, but on the topic of recent prior Jonathan Cohn posts -- all of the going backwards with the ACA and expanded Medicare and all the propaganda and all that widespread fraud and the "phantoms" (which, incidentally, are now "ghosts" and you really may want to update everything.)
Thus, since your last post on the topic, things have happened. There are two new editorials from Jeff at the Washington Post. One just today 7/15/26, the other 7/10/26. They are both vacuous but effective as propaganda in the way vacuous things can be effective as propaganda.
There are other new things as well. The "Let Them Eat Pancakes" initiative. Other stuff. Let me lay them out.
1) THE 7/15/26 WASHINGTON POST EDITORIAL
entitled
“Medicaid Fraud Control Units aren’t doing enough to control fraud Indictments and convictions are down, despite a surge in funding.”
The editorial continues in the logically vacuous style of the prior one, apparently attempting to have people just see “ACA—FRAUD—BAD—STUPID DEMOCRATS WHO LET EVERYONE CHEAT”, which a certain class of minds take as equivalent to airtight reasoning.
So, that approach seems to be most evident at the very end, with, in the last paragraph:
“Targeting waste and abuse is necessary but not sufficient to save Medicaid, whose costs have ballooned in unsustainable ways because of the Affordable Care Act.”
This may need an explainer—as to why Medicaid costs have gone up—”ballooned in unsustainable ways” is, of course, wording chosen for the benefit of those who get mixed up between words and actual content):
Medicaid costs have gone up quite a bit with the Affordable Care Act, because a new part of Medicaid was added, expanded Medicaid.
Expanded Medicaid is part of the ACA, and covers about 20 million people now. It is the way people without other health coverage, such as from an employer, who are below 138% of the Federal Poverty Level (FPL), get coverage. (There is no asset test—people below 138% of FPL get it regardless of assets—done to make the system airtight and leave no one out.) So, they get expanded Medicaid. (Without the expanded Medicaid, they would not have coverage unless they dropped down to being dirt poor in BOTH income and assets to qualify for traditional, pre-ACA Medicaid, which still exists.) The expanded Medicaid people cannot get subsidized on-exchange coverage, as the ACA structure prohibits them from doing that. This provision of the ACA was done as a cost-saving measure, to keep the lower-income group getting services paid for by the government at the lower Medicaid reimbursement rates.)
Beyond the “fraud” and “ballooned in unsustainable ways” wording to manipulate the less-analytically-discerning, which is the apparent purpose of the editorial,
NOTE THESE:
BIG ONE, in the quoted text: “but not sufficient”!!!
More fully: “Targeting waste and abuse is necessary but not sufficient”.
Do you see that? Thinking caps, the logically capable. Those cuts from OBBB. (Not in effect yet. They go into effect right after the midterms. Coming. Sure to bring chaos and uninsurance to many.)
Begging the question here on “not sufficient” (in the old fashioned logic meaning—not the newer “raises the question” sense.)
Also:
We don’t see much in dollar amounts of the fraud. Keeping dollar amounts out of perspective is a repeated technique of these guys. A millions, a billion, a trillion—what’s the difference—they all rhyme, after all?
and I don’t have a dollar number on tax loopholes, which would be separate. And I wonder how much the administration is doing about that. (It would be Scott Bessant, not Dr. Oz.)
2) The 7/10/26 Washington Post Editorial, which I find so problematic I have a full POST on it. It has a $5.898 number from the "Paragon Health Institute" in it which I am proud to say I was able to trace the origin of quickly owing to my work on a graph (which I'm pretty sure is wildly off or intentionally deceptive) from same Paragon entity, used to justify the non-extension of the ACA expanded subsidies 8 months ago.
My post on that 7/10/26 editorial, where I found a problem or two, and a vacuousness, here
you can get back to the Paragon graph of 8 months ago-- which was on the exact same data--if you are interested in that.)
3) The “phantoms” from a few Cohn posts ago, they had to switch to “ghosts” because they may have figured too many of those targeted didn’t know what the word “phantom” means, explored here:
I have a monitoring question. Covid has been and is being tracked via wastewater streams. Specific virus extraction and RNA testing. Cyclospora can also be detected in wastewater streams and relative outbreaks in communities detected. "Researchers use molecular techniques, such as qPCR (quantitative polymerase chain reaction), to amplify and detect the genetic material of the Cyclospora cayetanensis parasite in sewage samples." Is this being used to monitor the outbreaks along with coordination and data gathering from the CDC? Somehow I already know the answer. "If you do not measure it, you do not need to worry about it?"
No, my local was water uses PCR to monitor for a variety of virus (norovirus, Hep A, Measles, seasonal viruses), and I was hoping they monitor of Cyclospora but they have not started.
I hear some doctors are ordering PCR testing on stool samples, I don't have access to even order the testing through Quest diagnostics in my outpatient clinic. And I think the test is niche enough that I can't imagine scaling it without significant government willpower. Without PCR, the best way to identify it is to centrifuge stool samples to try to concentrate the sample as much as possible, use a specialized stain to look for it, and (this is the tricky part) having someone who knows what their looking for it under the microscope.
https://www.wastewaterscan.org is the website that does open access waste water data, I reference my local results constantly in the clinic, and try to encourage other clinicians to do the same.
Edit: For broader clarity, PCR is better than detecting things than it is at clarifying the scope of the problems. It's good for testing in individual (you have a disease or you don't) or for monitoring for a disease that might pop up. It's less great for saying "wow, this is the degree to which our community is affected".
The needless undermining of public health initiatives seems to be primarily about eugenics: authoritarians who genuinely want to believe in their own physical/mental superiority and are happy to put it to the test, thinking that they'll be immune because of "superior genes" or "better life choices," or that others will be hurt more than they were. The dark irony of this is that horrible diseases don't often play by those rules (the Spanish Flu was the most lethal to healthy young people), and avoiding getting sick in yesteryear was often simply a matter of either not being exposed or being exposed in a situation where the circumstances wouldn't take someone's life in the process. That and the only reason why authoritarians can delude themselves is because of public health initiatives (mass vaccinations, public sanitation, etc.) minimized and/or eliminated those diseases in the first place.
Best of luck, health wellness influencers and MAGA bros. Try not to squirt all over the toilet and bathroom floor.
No more fresh vegetables, we are on the Trump diet now. Our skies are turning Trump orange. Our orange leader orders his troops to continue stopping and shooting innocent people. We are now striking coins and creating statues in his image. And the band plays YMCA as the ship of state slides beneath the surface.
JVL. I got the title. (it made a brief return on a bob's burger, [i *think*- "when you're sliding down the gutter with a piece of bread and butter.." -- Parady Thereof, by Linda Belcher.) AS WELL AS got a great Homage in PARENTHOOD! (1989... i was off by 4 yrs).... (little kid, in car, steve martin is driving....)
The 3,000 reported cases are hiding many times as many that are unreported or will never be reported because who has the money to see a doctor these days? Once people realize they can't die from this parasite, they'll forgo a diagnostic visit that will likely cost hundreds of dollars they don't have.
Appreciated the youtube, even though it feels as though, one by one, many of the small pleasures in life are becoming a little frightening. Now including produce. Sigh. But hey, there's always beef - IF one can afford it, and IF one doesn't develop tick-borne allergy to it. More sigh.
Also -- a great headline indeed!!
Dr Jetelina ia an excellent communicator, but her background is in injury epidemiology, not infectious disease. The CDC surveillance systems depend on state and local reporting with the underlying goal of tracking overall trends as well as managing outbreaks. FoodNet was intended to focus surveillance efforts on the most common sources of foodborne outbreaks and utilize a more streamlined reporting system to identify outbreaks more quickly. Given that this outbreak seems focused in Michigan, FoodNet may or may not have helped because Michigan wasn't one of the FoodNet states. With challenges facing us from climate change and increased human-wildlife interaction this is the wrong time to cut public health. When public health works the general public doesn't always know because you can't track something that didn't happen. It's when things go wrong and we have an outbreak or worse that people realize that it's important. Our success makes idiots like RFK think that we don't need public health.
Just in case the Trump Era didn't seem monarchic/feudal enough, we now have Americans dying of dysentery. Divine.
I disagree with the skepticism expressed here about the Food Net cuts being a major reason why this outbreak is so bad. Food Net doesn't only track long term "background" trends "over time." It does do that, but It also collects reported data in real time from mutliple sources to help with efforts to stop outbreaks from spreading, or at least it did before the cuts. Here is an article from August of last year that details how the number of pathogens was cut form 8 to 2, how one of those 6 cut was Cyclospora, and how reporting was made voluntary instead of mandatory. These kinds of illnesses need to be stopped quickly in their tracks. This particular pathogen is known to exist as a source specific pathogen that can be eliminated by tracing it to the source. When outbreaks are small and quickly tracked, that task is made so much easier, because the source variables are much less. Let it spread and good luck. Food Net played a huge role in helping with that effort though a centralized and quickly populated tracking apparatus. It was literally just completely halted for Cyclospora one year ago. In addition, RFKJR, for all his reputation as an activist who lobbied against "industry capture," has proven to be completely and totally rolled over by its captains as HHS Secretary. My guess is that part of this effort to defund and decentralize and destroy our monitoring systems has been to benefit them. For instance, if the parasite came from Taco Bell, this lack of knowledge and supposed unknown origin benefits them. Think of Chi-Chi's or Chipotle from food poisonings past. I would not be surprised if shareholders of these companies bribed Secretary Numbnuts to de-regulate this threat.
https://apnews.com/article/cdc-foodnet-surveillance-a6a8270540de89797e3b50b3eb2a4f11
Thank you, Mr. Cohn. A very informative and honest interview.
I guess I'll pass on all this important information on explosive diarrhea to the other folks at the senior center. We are really looking forward to the additional health challenge.
But, actually, the reason I am inserting this comment is off the topic of today, but on the topic of recent prior Jonathan Cohn posts -- all of the going backwards with the ACA and expanded Medicare and all the propaganda and all that widespread fraud and the "phantoms" (which, incidentally, are now "ghosts" and you really may want to update everything.)
Thus, since your last post on the topic, things have happened. There are two new editorials from Jeff at the Washington Post. One just today 7/15/26, the other 7/10/26. They are both vacuous but effective as propaganda in the way vacuous things can be effective as propaganda.
There are other new things as well. The "Let Them Eat Pancakes" initiative. Other stuff. Let me lay them out.
1) THE 7/15/26 WASHINGTON POST EDITORIAL
entitled
“Medicaid Fraud Control Units aren’t doing enough to control fraud Indictments and convictions are down, despite a surge in funding.”
The editorial continues in the logically vacuous style of the prior one, apparently attempting to have people just see “ACA—FRAUD—BAD—STUPID DEMOCRATS WHO LET EVERYONE CHEAT”, which a certain class of minds take as equivalent to airtight reasoning.
So, that approach seems to be most evident at the very end, with, in the last paragraph:
“Targeting waste and abuse is necessary but not sufficient to save Medicaid, whose costs have ballooned in unsustainable ways because of the Affordable Care Act.”
This may need an explainer—as to why Medicaid costs have gone up—”ballooned in unsustainable ways” is, of course, wording chosen for the benefit of those who get mixed up between words and actual content):
Medicaid costs have gone up quite a bit with the Affordable Care Act, because a new part of Medicaid was added, expanded Medicaid.
Expanded Medicaid is part of the ACA, and covers about 20 million people now. It is the way people without other health coverage, such as from an employer, who are below 138% of the Federal Poverty Level (FPL), get coverage. (There is no asset test—people below 138% of FPL get it regardless of assets—done to make the system airtight and leave no one out.) So, they get expanded Medicaid. (Without the expanded Medicaid, they would not have coverage unless they dropped down to being dirt poor in BOTH income and assets to qualify for traditional, pre-ACA Medicaid, which still exists.) The expanded Medicaid people cannot get subsidized on-exchange coverage, as the ACA structure prohibits them from doing that. This provision of the ACA was done as a cost-saving measure, to keep the lower-income group getting services paid for by the government at the lower Medicaid reimbursement rates.)
Beyond the “fraud” and “ballooned in unsustainable ways” wording to manipulate the less-analytically-discerning, which is the apparent purpose of the editorial,
NOTE THESE:
BIG ONE, in the quoted text: “but not sufficient”!!!
More fully: “Targeting waste and abuse is necessary but not sufficient”.
Do you see that? Thinking caps, the logically capable. Those cuts from OBBB. (Not in effect yet. They go into effect right after the midterms. Coming. Sure to bring chaos and uninsurance to many.)
Begging the question here on “not sufficient” (in the old fashioned logic meaning—not the newer “raises the question” sense.)
Also:
We don’t see much in dollar amounts of the fraud. Keeping dollar amounts out of perspective is a repeated technique of these guys. A millions, a billion, a trillion—what’s the difference—they all rhyme, after all?
So, note total federal spending on health care is about $1.9 trillion a year. That would be 1,900 billion. (From https://www.kff.org/medicaid/what-does-the-federal-government-spend-on-health-care/ )
Meanwhile, I don’t see any dollar amounts in this thing: https://thefga.org/research/americas-medicaid-fraud-control-units-are-failing-their-mission/ that the Wa Po editorial refrenced from this “Foundation for Government Accountability” think tank that they reference.
They also seem to have left off a comparator, that tax evasion in the U.S. is about $700 billion a year https://siepr.stanford.edu/news/mapping-maze-where-irs-could-find-billions-unpaid-taxes
and I don’t have a dollar number on tax loopholes, which would be separate. And I wonder how much the administration is doing about that. (It would be Scott Bessant, not Dr. Oz.)
2) The 7/10/26 Washington Post Editorial, which I find so problematic I have a full POST on it. It has a $5.898 number from the "Paragon Health Institute" in it which I am proud to say I was able to trace the origin of quickly owing to my work on a graph (which I'm pretty sure is wildly off or intentionally deceptive) from same Paragon entity, used to justify the non-extension of the ACA expanded subsidies 8 months ago.
My post on that 7/10/26 editorial, where I found a problem or two, and a vacuousness, here
https://normspier828307.substack.com/p/washington-post-editorial-71026-i , and, from there,
you can get back to the Paragon graph of 8 months ago-- which was on the exact same data--if you are interested in that.)
3) The “phantoms” from a few Cohn posts ago, they had to switch to “ghosts” because they may have figured too many of those targeted didn’t know what the word “phantom” means, explored here:
https://substack.com/@normspier828307/note/c-288953391
4) Then you’ve got Dr. Oz, with his four wild deceptions, on the National Mall, as part of the new “Let Them Eat Pancakes” campaign:
https://substack.com/@normspier828307/note/c-289373653
5) Then you’ve got the huge and increasing coverage number drops are supposed to all be from stopping the fraud. (Baloney:
https://normspier828307.substack.com/p/the-administrations-claim-in-the
based on the same CMS report as the Cohn post as the one that included the Trump Death Panels:
https://www.thebulwark.com/p/donald-trump-is-bringing-back-death-panels
6) Then you’ve got the earlier leak from CMS that the false due-to-fraud explanation was coming
https://normspier828307.substack.com/p/loss-of-aca-coverage-after-republicans
kind of similar in content to the Cohn Post on phantoms:
https://www.thebulwark.com/p/obamacare-phantom-menace-aca-fraud-trump-oz-insurance-coverage
--
That's all I have today.
Why couldn’t the epicenter of this event be in DC where it belongs. Miller’s office, specifically.
I agree! Let’s serve bagged lettuce to all the Republicans in Congress and hope they all get the disease at the same time!
Trump really needs to be infected! Give those depends a real workout!
Nothing will change until it affects them!
Best headline of the year lol!
I have a monitoring question. Covid has been and is being tracked via wastewater streams. Specific virus extraction and RNA testing. Cyclospora can also be detected in wastewater streams and relative outbreaks in communities detected. "Researchers use molecular techniques, such as qPCR (quantitative polymerase chain reaction), to amplify and detect the genetic material of the Cyclospora cayetanensis parasite in sewage samples." Is this being used to monitor the outbreaks along with coordination and data gathering from the CDC? Somehow I already know the answer. "If you do not measure it, you do not need to worry about it?"
No, my local was water uses PCR to monitor for a variety of virus (norovirus, Hep A, Measles, seasonal viruses), and I was hoping they monitor of Cyclospora but they have not started.
I hear some doctors are ordering PCR testing on stool samples, I don't have access to even order the testing through Quest diagnostics in my outpatient clinic. And I think the test is niche enough that I can't imagine scaling it without significant government willpower. Without PCR, the best way to identify it is to centrifuge stool samples to try to concentrate the sample as much as possible, use a specialized stain to look for it, and (this is the tricky part) having someone who knows what their looking for it under the microscope.
https://www.wastewaterscan.org is the website that does open access waste water data, I reference my local results constantly in the clinic, and try to encourage other clinicians to do the same.
Edit: For broader clarity, PCR is better than detecting things than it is at clarifying the scope of the problems. It's good for testing in individual (you have a disease or you don't) or for monitoring for a disease that might pop up. It's less great for saying "wow, this is the degree to which our community is affected".
For more depressing news about the state of our "health" agencies, Reuters has an article about the extremes Kennedy wanted, and still wants, to go to to make sure we all die of preventable diseases: https://www.reuters.com/world/americas/inside-rfk-jrs-push-dismantle-decades-us-vaccine-policy-2026-07-14/
I'm shocked, shocked, to read that poor field sanitation may be a cause. Not enough porta-potties for field workers.
The needless undermining of public health initiatives seems to be primarily about eugenics: authoritarians who genuinely want to believe in their own physical/mental superiority and are happy to put it to the test, thinking that they'll be immune because of "superior genes" or "better life choices," or that others will be hurt more than they were. The dark irony of this is that horrible diseases don't often play by those rules (the Spanish Flu was the most lethal to healthy young people), and avoiding getting sick in yesteryear was often simply a matter of either not being exposed or being exposed in a situation where the circumstances wouldn't take someone's life in the process. That and the only reason why authoritarians can delude themselves is because of public health initiatives (mass vaccinations, public sanitation, etc.) minimized and/or eliminated those diseases in the first place.
Best of luck, health wellness influencers and MAGA bros. Try not to squirt all over the toilet and bathroom floor.
“I don’t know why we don’t know the source. I wish we had more answers, but we don’t.”
I’ve got a guess!
No more fresh vegetables, we are on the Trump diet now. Our skies are turning Trump orange. Our orange leader orders his troops to continue stopping and shooting innocent people. We are now striking coins and creating statues in his image. And the band plays YMCA as the ship of state slides beneath the surface.
JVL. I got the title. (it made a brief return on a bob's burger, [i *think*- "when you're sliding down the gutter with a piece of bread and butter.." -- Parady Thereof, by Linda Belcher.) AS WELL AS got a great Homage in PARENTHOOD! (1989... i was off by 4 yrs).... (little kid, in car, steve martin is driving....)