It's just the two of us this week, which means we bounce between Star Wars, ageism in medicine, Mark Cuban's healthcare policy ideas, and the spleen. Kristin sent me a video about the Bajau people of Southeast Asia, a group of divers from Indonesia and the Philippines who have genetically evolved spleens that are 50% larger than average, which they use as an oxygen reservoir to dive 70 meters and hold their breath for up to 13 minutes, and look, I'm not saying I was wrong about the spleen, but I'm being forced to acknowledge it might have one useful function. We also talk about the 72-year-old medical school graduate who is now heading into a family medicine residency and the baffling ageist backlash she received from people who apparently think someone "stole a spot", in family medicine, where programs regularly can't fill their positions. She earned it, full stop.

We get into Mark Cuban's argument that free medical school tied to service requirements could help fix the primary care shortage, I think he's closer to right than I initially gave him credit for, but the downstream problems are thornier than they look, and the direct primary care model, which makes a lot of happy doctors but probably has a selection bias problem. We also go deep on spleen physiology because Kristin is my heckler and this is the bit now: splenic lacerations, splenules, Howell-Jolly bodies in the blood post-splenectomy, and why losing your spleen means you really, genuinely need to be vaccinated against pneumococcus, meningococcus, and Haemophilus influenzae type b. Also, I had mono in college, did not follow the no-contact-sports instructions, and I only survived because Kristin wasn't around yet to enforce anything. She has since made up for lost time.

Takeaways:

The Bajau people of Southeast Asia have genetically evolved larger spleens.

A 72-year-old woman earning her medical degree and entering family medicine isn't taking anyone's spot

Free medical school tied to service requirements is a more interesting idea than pure loan forgiveness

Losing your spleen significantly raises your infection risk from encapsulated bacteria

Direct primary care attracts genuinely enthusiastic physicians, but that may partly reflect selection bias

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