The American Medical Association Specialty Society Relative Value Scale Update Committee (nicknamed RUC, because AMASSRVSUC is an abominable Elder God summoned to our plane by successfully pronouncing his unwieldy name) consists of a mere 31 physicians, each representing one of the different medical specialties, but all tasked with deciding what literally everything they do should cost. You might have heard of this practice before, but using different words -- in basically any other industry, it's known as "price fixing," the culprits are called "cartels," and the whole thing is incredibly illegal. In the case of American medicine, it's standard government-approved practice.

Here's how it works (or rather, "works"): The committee assigns every medical procedure a number of relative value units (RVU), which account for the amount of work a doctor performs, the costs to the practice, and malpractice liability.

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The ARM (arbitrary random markup) is built into each value automatically.

And though the RUC technically only makes "suggestions," the Centers for Medicare and Medicaid Services (CMS) accept the committee's recommendations 90 percent of the time. Private insurance companies in turn base their negotiations on whatever CMS pays through Medicare. In a healthcare system dominated by fee-for-service payment models, physicians' pay is based on how many RVUs they produce. Three types of specialist -- orthopedic surgeons, neurosurgeons, and general surgeons -- are members of the "Two Million Club," meaning each type of physician makes, on average, more than $2 million a year for their hospital, based on their RVUs.

Interestingly, assigning RVUs is a zero sum game; if the RUC wants to increase RVUs for one procedure, they need to decrease it for others. Needless to say, the arguments can get pretty heated, since the members know they are essentially negotiating their salaries. Specialists absolutely dominate the RUC. As a result, the committee is partly responsible for the gap in pay between specialists and primary care physicians. This has led to a shortage of primary care physicians in the U.S., and an emphasis on complex procedures at the expense of preventive health measures. RVU assignments may also explain why 15 minutes became the standard amount of time for each doctor appointment. Typical wellness visits are not given very high RVUs, so doctors are pressured to crank through patients like Pringles.

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A child's smile, though, is priceless!
(It is worth nothing.)

Michelin's unlikely influence in the world of high-class cuisine began in 1900, when hardly anyone owned a car. They started publishing the Michelin Restaurant Guide as a free brochure that mapped the best restaurants in France (their home country), using a three-star rating system. The rather flimsy subtext was "You could visit any of these places right now if you had a car. A car with tires. Specifically, our tires." It was a cheap, desperate gimmick, and it didn't really matter.

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It was like that time a beer company put out a trivia book, and everyone responded reasonably.

But over the next hundred years, Michelin continued to publish its annual guide, and its standards began to evolve. Today, earning a single Michelin star is the restaurant equivalent of winning an Oscar. Having two means you're one of the top dining establishments in the entire world. Three Michelin stars means you're the kind of place Bill Gates has to budget for, and you're serving meals that Caligula would call "a little over the top."

So who decides the rating of all these restaurants? Well ... nobody knows. Their reviewers are anonymous. Even the company executives don't know their names or what they look like. Very rarely will a Michelin reviewer grant an interview, and it's always given with strict instructions to obscure all personal information. Severe penalties are given to any establishment that tries to fish for some. Nobody knows how many reviewers even exist, or what their training is. And since they're completely unaccountable, there's no way of knowing whether they even ate at any damn place or just hand out stars to their chef buddies.

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All we know is they're presumably really good at changing tires.

Nevertheless, the Michelin Guide is such a huge deal that losing a Michelin star can easily bankrupt a restaurant. In fact, at least two world-renowned chefs have committed suicide after discovering that their rating had been downgraded. That's quite a lot of power for a few connoisseurs to have, considering that, technically speaking, they work for a damn tire company.

Though President Trump has made every effort to define "fake news" as anything he doesn't like, from The New York Times to a particularly difficult word jumble (some of the words go diagonally, Donny!), fake news is a real problem. In the run-up to the 2016 election, social media was swamped with false viral news stories, and when the real media tried to trace them to their sources, they discovered that most of them were, weirdly enough, coming from the small Macedonian town of Veles, which has a population of around 50,000.

The teenagers and young adults of Veles have become rich off an entire cottage industry of fake news, having set up around 100 websites dedicated to making up stories about American politicians and sharing them on Facebook for ad revenue. And when we say rich, we mean these kids are making upwards of $100,000 a year from Google Ads -- all in a town where the average annual wage is around $4,800.

via Wiki Commons
Its next-biggest industries are turnip farming and begging.

According to the young men in question, they don't have any ideological reason for focusing on pro-Trump articles -- those are simply the ones that succeed. During the election campaign, they also tried making up pro-Hillary and pro-Sanders bullshit, but people weren't sharing it. In Veles, new nightclubs have opened this year just for local youths to spend their money on. The impoverished streets are now lined with brand-new BMWs, all purchased with ad revenue from viral articles they wrote about Hillary Clinton being diagnosed with Ebola and Trump having a secret Iron Man suit.

The poppy seed trade in Afghanistan is so massive that it accounts for around 15 percent of the country's GDP, and although poppy seeds are also a non-mind-altering culinary ingredient, the bulk of this annual harvest doesn't wind up sprinkled on a disappointing muffin. Afghanistan has the biggest drug economy in the world, leaving even South America's cocaine industry in the dust and making Pablo Escobar's empire look like a Kickstarter project.

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We hope this doesn't lead to Afghanistan becoming a dangerous place sometime in the future.

The 2001 American invasion of Afghanistan only made this issue worse. The ruling Taliban had a lot of really, really shitty ideas, but one of their better ones was "zero tolerance on opium production." When the regime fell, poppy production and exports skyrocketed, despite a multi-billion-dollar effort by the U.S. to curtail it. Technically, the practice is still illegal in Afghanistan, but the government knows how much money it rakes in for the country and how well poppy farmers, uh, "tip" the authorities.

Battle was feared like a dictator for the decade that he worked as the TTB's chief beer dude. Since there are no clearly defined regulations on what can or cannot appear on a beer label, Battle was handed the power to approve or veto the designs of one of America's biggest industries based on little more than his intuition ... and how much he likes puns. Because beer brewers seem to love them.

Battle was renowned for being irritatingly pedantic. Among those beers he vetoed, one was called "Liquid Wisdom" (rejected because "the name contains a medical claim" -- a medical claim to ... wisdom?), one featured a King of Hearts playing card (any image of a heart apparently implies a health benefit), one had a picture of a hamburger (supposedly misled customers into "thinking the beer includes a meat product" -- how ripped off would you feel if you bought it and it wasn't Baconator-flavored?), and one had a picture of Santa Claus, but according to Battle, Santa looked drunk. And Santa doesn't get drunk. That's an official government opinion.

Scott Olson/Getty Images
Other labels should have been banned for implying the beverage contains alcohol.

Brewers knew that his word was law, and in all his time in office, there was only one known example of someone winning a battle against Battle. A California brewer wanted to market a beer called Weed Ale, which Battle vetoed because of the marijuana implication. But the beer was brewed in the town of Weed, CA, named after Civil War hero Abner Weed. It took an intervention from the ACLU, a senator, and goddamn Congress before Battle agreed to back down. Turns out his name wasn't just bravado -- the dude would fistfight God himself if the Almighty dared to put a Whopper on a Pilsner label.

Adam Koski took a big step toward secretly running the world when he wrote half of a fantasy book. Nathan Kamal lives in Oregon and writes there. He co-founded Asymmetry Fiction for all your fiction needs. Ryan is currently a medical student at the University of Pennsylvania. He is the host of the Penn Health-X Podcast, which focuses on healthcare management, entrepreneurship, and technology. Check out https://soundcloud.com/pennhealthxpodcast for more info!

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