COVID Divides a Divided Country

For millions of Americans, the pandemic has been disastrous.  We have lost an uncountable number of Americans. We cannot even grasp the magnitude of the loss.  Have you ever stood at the Vietnam Veterans Memorial on the mall in Washington, DC and scanned through the uncountable number of names etched into the Wall?   We have lost well over ten times this number of Americans in the pandemic.  And it’s not over yet.  Beyond those who have died, we have to contemplate family members and friends who have been left behind.  And those who have become seriously ill or even hospitalized or even spent time in an ICU have been changed forever.   And many who escaped the virus were scared that they might become the next victim, particularly before the release of the vaccines.  And now Omicron has swept onto our shores reminding us that the pandemic still lives.  Will we go through the entire Greek alphabet?

Similarly, we cannot even calculate the economic devastation and disruption that the pandemic has wrought. And, we have all witnessed the Great Resignation, a phenomenon that we still do not entirely understand.  It appears that many Americans simply do not want to return to the grinding jobs that they had become accustomed to.  Many have resisted the lure of substantial wage increases and astronomical signing bonuses.  At first, many speculated that folks were staying home as they were enjoying government subsidies.  These payments have largely ended but there has been no migration back to the work force. Clearly, something deeper is occurring here. 

COVID-19 - Uniter or Divider?

I shudder when I contemplate the consequences of having kept our kids home for a year.  Some are still ‘learning’ virtually.  The damage has extended far beyond the educational realm and reaches into mental health, economic, nutritional and social spheres.  Did we really have sufficient scientific evidence to justify such a draconian measure?  I wonder.

And sadly, a plague that in an earlier time would have bound us together has only further divided a separating nation.  Everything seems to be a fight.  Test yourself on my thesis.  Consider half a dozen or so issues of the day and if they are uniting or fracturing the nation.  Now, test yourself again.  Can you identify a issue that is bringing us together?

Any reader who is inclined to leave an uplifting comment is strongly urged to do so.

Whistleblower Holiday Cheer 2021!

     

‘Twas the night before Christmas

And all through the House,

Progressives were screaming,

‘Are you a man or a mouse?’

 

They wanted it all.

No matter the cost.

They wanted it now.

So much would be lost.

 

The voted for Biden,

Who now is their tool,

And dream of ‘reforming’

The filibuster rule.

 

Pelosi’s been smacked,

And Schumer’s been bruised.

Does Biden realize

That he’s being used?

 

And while Biden is napping

In the White House mansion,

The man of the moment,

Is Senator Joe Manchin.

 

And while mainstream Dems

Fight with the ‘Squad’,

The real threat they face?

A circular firing squad!

GOP are no better.

They have no spines.

Trump is their leader.

He is divine!

 

Liz Cheney is out

For telling the truth.

While others are praised

For being uncouth.

 

How do Republicans

The few decent legislators,

Run in a primary

When they’ll be called ‘Traitors!’?

 

Kevin McCarthy

Unhinged and unraveled,

Dreams every night

Of the Speaker’s gavel. 

 

On January 6^th,

As criminals crashed,

Now called Patriots

By the GOP unabashed.

 

Health is now politics.

What a crazy scene!

When folks can oppose

An amazing vaccine.

 

Who would have thought

That folks would believe,

That Anthony Fauci

Should be relieved.

 

So who will emerge

Who’s got the roar

To whack away Trump

In 2024?

 

Tom Cotton? DeSantis?

Who else might lose?

Marjorie or Nikki?

How ‘bout Ted Cruz?

 

One thing I know,

One thing for sure

We all know what ails us,

But what is the cure?

 

 

 

 

 

 

 

 

 

 

 

 

Is the Physical Examination Still Useful?

Medical students, please read no further.

I am going to challenge one of the bedrock beliefs in medical training – the value of the physical examination.  Indeed, I was taught of the primacy of the physical exam as a young pup during my 4 years of medical education in New York City.  I believed it and did my best to acquire these skills from master diagnosticians.  Indeed, this was one of the thrills of being a medical student – learning what those clicks and clacks meant when we listened to hearts with our stethoscopes, seeing changes of diabetes and other diseases when we peered into your eyes with an ophthalmoscope or palpating a pulsating aneurysm that was lurking in your abdomen.

An Ophthalmoscope and Otoscope

The Eyes and Ears of Medicine

I was in awe of these seasoned physicians who could make a diagnosis just by watching a patient walk across the room.

While I still think the physical examination is useful, I have found over the years that it is less valuable than I was originally taught.  Years ago, such a statement would be considered heresy and might risk excommunication from the profession.  But yesterday’s heresy has become today’s dogma.

In general, physicians consider data from 3 separate tranches when evaluating patients:

• The Medical History – the patient’s narrative
• The Physical Examination
• Objective Date including Laboratory and Radiology Reports

Medical students have been taught for generations to rely upon this triad and to regard them as coequal branches of medicine.  But they are not.  If physicians were asked which of the 3 is least helpful, I surmise that most would choose to forego the physical examination.  I would be among them.  Indeed, it is my view that the patient’s history is paramount.  In most cases, I can assemble accurate diagnostic considerations after hearing only the patient’s story.  Of course, the history must be detailed, and the patient given sufficient time to relate it.  Interrupting a patient in mid-sentence or not following the narrative path that a patient creates will not yield a full and useful history.   While less important, I do find that the Objective Data can be useful in narrowing the list of diagnostic possibilities or suggesting other considerations.   For example, abnormal blood test results might point to pancreatitis, a condition I might not have suspected as a cause of a patient’s abdominal pain. 

The reason the physical examination is the shortest leg of the 3-legged stool is because it is either normal or has abnormalities that are not relevant to the current issue.  For example, the vast majority of patients I see in my office with abdominal pain have normal abdominal physical examinations.

I am not counseling that we abandon the physical examination. And there are certainly cases when the exam is a game changer.  But these instances are less common than you might think.

Should There Be A COVID-19 Vaccine Mandate?

It is easy to opine on issues that don’t personally affect us.  We’ve all seen folks on television or in our own lives who righteously stake out positions when they are far beyond the reach of their effects.  Conversely, we’ve seen the irony and the hypocrisy of individuals who ‘evolve’ almost instantly when a controversial issue becomes relevant to their personal circumstances.  Senator Rob Portman of my state of Ohio, for example, was against same sex marriage until he wasn’t.  Readers are encouraged to look up what led to a reversal in Senator Portman’s view.

Charles Darwin didn't realize that politicians can evolve.

The pandemic has also exposed much public (and private) pontification from individuals, businesses, organizations, government agencies – all of whom may have agendas that extend beyond any actual public health concerns.  One issue that has created raw fissures among us is the concept of mandating vaccines.  There are spirited arguments on various sides of this issue.  There’s the public health angle.  There’s the personal freedom argument.  There are business concerns regarding worker retention.  It’s now a legal issue.  It permeates commerce, education, travel, politics and nearly every sphere of our lives.

As of this writing, it has yet to be determined if the Occupational Safety and Health Administration’s (OSHA) Emergency Temporary Standard (ETS) requiring vaccinations of businesses who employ more than 100 workers is lawful.  The ETS has been stayed by the courts.

But here’s my point.  Assume that every business of any size must have all employees fully vaccinated. I have no doubt that tens of millions of Americans would support this from a public health standpoint.  This mandate would protect employees as well as customers.  In addition, the more of us who are vaccinated the closer we are to overpowering the pandemic before new variants emerge.  Can you say, 'Omicron'?

So, how does one oppose a measure that seems to have no legitimate counter-argument?

Think of it from a small business’s point of view.  Say you run a small retail shop, perhaps in a rural area or a part of the country where there is vaccine reluctance.  You have 7 employees and 5 of them have decided against the vaccine and would sooner quit than submit to the mandate.  The prospect for hiring new employees is non-existent, even though you have raised wages substantially and have offered a hiring bonus.  

What would a vaccine mandate do to this business and millions of similar businesses?  While the employer might favor a vaccine mandate in principle, do we expect that he or she would support a measure that would incinerate his livelihood?   And, are the folks who are arguing for a broad vaccine mandate at risk of losing their livelihoods if they prevail?

It’s quite different to argue a position when you’re not in the line of fire.

 

Thanksgiving 2022

 

This has been a tough year for America and the world.  For many folks and families, it may be challenging to find reasons to feel thankful.  But we must try.  When you’re in a dark room, you might not see a way to let the light in.  Try to find a window that you can crack open.  Or, one of us will do our best to open it from the outside.

Wishing blessings, contentment and peace to all.

Hoping for a lot more light in the year to come.

Calling Your Doctor's Office - Frustration #1

There are joys and satisfactions in the practice of medicine.  Indeed, they have sustained me for the past few decades.  I enjoy the work and I continue to be honored that my long-term patients as well as new ones place their trust in me.  Despite my best efforts to deliver perfect advice to every patient every time, I confess that I am a member of the imperfect human species.  I have reminded patients that while I try to offer sound medical advice, I am neither omniscient nor clairvoyant.   If I knew, for example, that the medicine I am prescribing wouldn’t work, or would cause you an unpleasant side effect, then I would not have prescribed it. If you become a ill a week after you have been discharged from the hospital, it does not mean that you were thrown out prematurely.   Excellent medical judgement doesn’t guarantee an excellent outcome.  Conversely, a favorable medical result may occur after mediocre medical care. 

There are also frustrations in the everyday medical world.  Assuming that you can even decode your medical bills, try rectifying an error with your insurance company.  If you didn’t have high blood pressure when you called them to inquire, you will surely have it before the end of the conversation, that is if you actually reach a living and breathing human.  When your doctor’s prescription is denied by your insurance company, does this restore your faith that the insurance company cares deeply about your health?   Have you had the experience of trying to make an appointment to see your doctor to be told he or she is booked out for months?  

I think that the most frustrating experience for patients and us in the medical universe is the labyrinthine telephonic chamber of horrors.  This dwarfs every other frustration and seems to defy any solution.  This can test the mettle of a battle-hardened Marine.  It can bring an athlete to her knees.  It can make a stoic Philistine weep.  After 30 years of medical practice, my staff and I have been unable to crack the code on this. 

Alexander Graham Bell Trying to Reach His Doctor

In each of the 3 jobs I have had as a gastroenterologist, the telephone Theater of the Absurd was there. Of course, this vexes patients who can get through several chapters of War and Peace as they are left hanging on the line.  The lucky ones will ultimately reach a helpful human.  The rest may end up being cut off or simply left dangling on hold for a few months or so.  I suspect that many patients, who hit the jackpot and reach a live human after an interminable wait, have forgotten the reason for the call – yet another frustration!

Trust me, dear patients, that this issue is just as frustrating for us.  Our phones ring constantly which forces our staff to put most of you on hold as they juggle this onslaught.  And, try managing this while they are supposed to be checking in patients, arranging diagnostic tests and responding to impatient physicians who are waving their arms at them.  Sound like fun?

The reality, at least for smaller practices, is they cannot afford to hire a team of dedicated phone answerers.  And, even if they could, would these folks have enough training to handle the calls, or would they simply route the call to another staff member?

So, now you understand better the need for the obnoxious phone menu that greets you.

‘Please listen carefully as our options have changed.’   This is a lie.  The options haven’t changed and I doubt they will. 

Why I Oppose Medical Marijuana

I don't really oppose medical marijuana, only the process that has brought it to market.

In general, I hew to the philosophy of  ‘leaving it to the professionals’.   Yes, I support all of us engaging in some measure of due diligence, but I try to select advisors and professionals whom I trust. If they have knowledge and experience that I lack, shouldn't their views carry more weight than mine?

In my own life, and probably yours, there are many areas in which I simply am not capable of any due diligence. If a car mechanic, for example, recommends that an expensive part needs to be replaced, I can only hope that this is truly necessary.  If the folks we deal with are honest and experienced, then things will tend to fall into place as they should.  Obviously, for this to work out well, several assumptions need to be true.

Many people today soundly reject the ‘leave it to the professionals’ philosophy.  For most of my life, the curricula in our public schools was dictated by education professionals.  When I was a student in grade school through high school, I don’t recall any protests or objections to our courses of study.  Yes, I’m sure that if our assignments, book reports, reading materials and classroom discussions were viewed through today’s prisms, that there would be many legitimate issues to criticize.  But, the zeitgeist today seems to be to criticize and protest everything.  Dialogue is neither encouraged nor practiced.

Indeed, there’s a benefit today to reject professionals' advice.  Candidates today are buoyed by championing the rights of parents to have a real voice in what their kids are being taught in public schools.  Police departments are being monitored by citizens who do not have formal training or experience in law enforcement.   I’m not weighing in on these issues, only pointing out how the situation has flipped. 

Medical Marijuana Approved by Legislators!

(What Have They Been Smoking?)

                                                                 

Here in Ohio, a bill has recently been sponsored that would add various medical indications for medical marijuana use including autism, muscle spasms, headaches, arthritis and other conditions.  In my view this is ridiculous.  I’ve written before and continue to be believe that elected legislators should not be making medical decisions.  Not only do they have no requisite training and experience, but their mere involvement politicizes the process.  It’s axiomatic that politicians support stuff in order to get folks to vote for them.  How is such a process defensible with regard to medical care?  (Hint, it isn’t.)  And to those who defend it, why not then have lawmakers decide on drugs or treatments for heart disease, Alzheimer’s disease or cancer?  Do you think that lobbyists or corporate donors might be able to influence legislators on adding a disease or two to the medical marijuana list?  (Hint, answer 'yes' here.)

Sure, there are medical studies out there that show medical benefits of marijuana.  But, this is not sufficient.  Medical marijuana, like any proposed medical treatment, must be subjected to rigorous and impartial scientific inquiry with final approval or rejection falling to the FDA, where this authority resides.  

There are spheres of society where professionals must remain in charge, even though others voices should be heard.  If you want medical advice, then ask a doctor.  If there’s a rattle in your car, then don’t ask me.

 

How to Treat Your Upset Stomach

There is a general fascination with the medical profession.  Consider how many television shows over past decades have had a medical motif.  And today’s patients are so über-informed and empowered, that at times they dabble with the practice of medicine themselves as an avocation.  When a patient, for example queries me about Barrett’s esophagus and dysplasia or if I intend to test them for H. pylori, a germ that resides in the stomach, then I know by their use of medical terminology that the office visit will be a  "peer to peer” experience.

So, I’ll ask my erudite reader-practitioners to respond to the following medical inquiry. 

A patient is suffering from a chronic upset stomach (called dyspepsia) nearly every day.  The cause of the condition cannot be ascertained, and the treatment options are wanting.  Assume that the medical professional has undertaken an appropriate evaluation and that no cause has been discovered.  Assume as well that there is no established treatment for the condition. Nevertheless, it is commonplace for doctors to offer various prescriptions to these patients.

The stomach often hurts for mysterious reasons.

If you were the doctor, which of the following would you advise?

Tell the patient that there is no effective treatment for his condition and that he will need to continue to live with it as best he can.

Tell the patient that, while there is no proven remedy, that there are various medicines to consider that the he has prescribed to others.  You recommend one of them.

My guess is that most readers and patients would prefer option #2 for reasons that need not be explained.  Most doctors and patients would rather do something than nothing.

As medical professionals know, and often lament, there are too many drugs being prescribed.  We know this and yet we physicians are the perpetrators.  And, the public has an outsized appetite for pharmaceuticals.  This has proved to be an unshakable cycle to break. 

What could be wrong about offering a prescription to a patient with unexplained dyspepsia? 

• Physicians and patients should be guided by science and truth.
• It is not fair to expend resources on ineffective medicines
• It is not ethical to expose patients to risks of adverse reactions without any reasonable promise of benefit.
• Physicians should not serve as willing accomplices in the over-medication of our society.
• The medical profession and the public should come to terms that not every medical symptom has a pharmaceutical remedy.

So, what could be done for these patients?  There is a rising role for integrative medicine and other alternative medical practices for patients with unexplained and unexplainable medical symptoms.  And, if a conventional doctor like me starts carping that those alternative folks operate without data or proof, then point out that  we medical doctors have been doing this forever.

 

 

 

Was the Alec Baldwin Shooting Accidental?

Even casual followers of the news are aware that actor Alec Baldwin killed one associate and wounded another during a film rehearsal.  It was a horrible tragedy that captured the nation’s attention.  How could such a thing happen? This is the same question we ask when we learn that a surgeon has removed the wrong kidney.  

I’ll leave aside how much attention this tragedy has received in comparison to the intentional killings that occur daily in cities throughout the country.  While all lives are equal, it does not seem that every life receives the same attention.

Based on what is now known, it does not seem to me that this shooting was a mere accident that occurred from pure happenstance.  Of course, the shooting was not intentional, but it appears that there was a reckless disregard of established firearm safety protocols.  Investigators will surely discover how a live bullet ended up in Alec Baldwin’s gun.  More facts are emerging daily that indicate a laxity of gun safety and multiple deviations from industry standards.  I suspect that the ongoing investigation will only further highlight the negligent behaviors that culminated in a tragic homicide that should never have occurred.  Criminal charges are possible.

If my tire is punctured while driving and my car hits a tree, this is an accident.

If I notice that my front tire is deflated, and I take it for a drive anyway, is it still an accident if the tire blows and I hit a tree?

Live Rounds on the Set?

I’ll admit that I don’t know much about filmmaking, and I know even less about firearms.  But, I know quite a bit about safety processes and protocols to minimize the risk of adverse events.  We are all aware that airline pilots methodically run through a checklist before every flight to verify that everything is in proper order.  We would likely feel less secure if pilots simply took a quick scan of the cockpit and then flashed us a thumbs up.  This checklist is the result of intense research and experience and is designed to catch any item that is out of line.  The key is that this process must be faithfully executed every time without exception. 

Physicians understand this process well.  Before every surgery or medical procedure, the team participates in a ‘time out’, when the patient’s identify is confirmed as well as the intended procedure and any potentially complicating factors.  Does the x-ray with the broken hip hanging in the operating room correspond to the patient about to be put under?  Complacency and indifference can lead to tragic outcomes. We have all heard about patients who had the wrong organ removed or received medication intended for another patient.  The checklist procedure minimizes the risks of these outcomes.

I surmise that the results of the Alec Baldwin investigation will show serial deviations of process that involved multiple individuals all of which led to a horrible outcome.  Does this sound like an accident to you?

 

Jeopardy Host Sidelined but Still Kept His Job?

When improper actions are followed by proportionate and predictable consequences, it serves as an incentive for us to behave better.  Let’s face it.  We are not hardwired to do the right thing. If we were, then there would be no need for thousands of laws, rules and regulations to guide our behavior.  We need laws against theft, insider trading and assault because we have accepted that our natural human inclinations often lead us astray.

And, if we were moral creatures by design, parents, teachers and religious leaders would not have to devote so much effort to teaching us to do the right thing.

When a consequence is hollow it threatens our confidence in the integrity of the system.  When a professional athlete has committed assault, the investigations and punishments have seemed to be a very different process than we would expect if an ordinary person, like me, were the accused.  We have all witnessed examples of this over the years.

Some time ago, Mike Richards, who was anointed as the designated new host of the Jeopardy game show, was pulled from his position based on prior offensive social media postings.  Yet, he continued to serve as the show's executive producer.  How does this make sense?  If the company believes that his violation of social norms rendered him unqualified to host the show, how does he still serve as a corporate leader?  Was Sony, who produces the game show, trying to calibrate the minimum level of punishment that would satisfy critics and yet still permit his employment?  Don’t companies realize that these tortured attempts to thread the needle nearly always come back to prick them?

Sony's Corporate Policy

It took a full 10 days for Sony to do what it should have done at the outset.  Richards was removed from the executive producer position.  Sony, however,  was not held to account for this clumsy bungling.

We can’t legislate or incentivize every behavior.  Many acts are wrong and yet escape accountability. Try this hypothetical.  An individual refuses the COVID-19 vaccine and has no medical or religious exception.  His mask, when he does don one, is dangling underneath his nostrils.  Consider some potential outcomes

He infects several people one of whom requires a ventilator.

He spreads the virus at work causing a work shutdown.

He does not reveal to his dating partners that he is unvaccinated.  Two of them become ill.

He infects his grandchild who contracts COVID-19.  His classmates must now return home for remote learning for a period of time.

Should there accountability for this behavior?

 

Will We Be Wearing Face Masks Forever?

I don’t foresee them disappearing from the public landscape anytime soon.

I think there will be a segment of the population that will continue to wear masks even after the pandemic has subsided.  Indeed, there are parts of the world where donning a face mask is routine.

And as we have all seen, there is a vocal segment of the population that will refuse mask wearing regardless of the circumstances.  For example, sitting governors, with a keen eye for politics, have ordered that no mask mandates can be instituted in their states.  Score 1 for Politics and 0 for Science.

Just as our country has not experienced its last hurricane or wildfire, there are other pandemics lurking over the horizon.  So, over time, mask wearing will rise periodically when nature’s germ warfare strikes us again.

'The Mask Stays!'

I also suspect that many health care institutions will require their staffs to wear masks long after the public will have been advised that masking is no longer advised.  These hospitals and medical facilities may truly believe that ongoing mask wearing will offer protection with no downside.  And, it may serve as a branding function to reassure the public regarding the institution’s culture of safety.  Many medical images – a stethoscope, the nurse’s cap of yore, the white coat, the doctor’s black bag and a surgical mask – are viewed favorably by the public. 

Have you ever noticed how often physicians being interviewed on television are wearing a white coat when there isn’t a patient in site?  Image matters.

I don’t envision that a face mask will become a permanent wardrobe accessory for me.  But I expect to see others masked up on ground and air transportation, in theaters and at sporting or entertainment events.  Perhaps, our marketing gurus, who spend their professional lives convincing us to buy products that we don’t need, will convince us that masks are cool.  Imagine a 30-second ad spot during the Super Bowl depicting a biker on a Harley cruising up a dirt road, sunlight gleaming off the motorcycle, mask in place... 

 

 

 

 

 

Doctors Spreading COVID-19 Vaccine Misinformation

(As published recently in cleveland.com)

Should a physician who spreads misinformation on coronavirus vaccines lose his medical license?  Would this violate the doctor’s right to free speech?  Shouldn’t physicians be able to offer their patients counsel and advice that differs from mainstream medical thought? 

Every profession has ethical and legal requirements to maintain the integrity of the profession as well as the public trust.

·      If an attorney lies to a judge, then this lawyer can expect to be severely sanctioned. 

·      If a public-school teacher instructs science students that the world was created exactly as recorded in the Book of Genesis, then professional repercussions are expected.

·      If a police officer is discovered to have planted evidence to justify an arrest, then the officer will likely face criminal penalties.

In the medical profession, there are also professional and ethical boundaries that practitioners must respect.  Consider these flagrant violations.

·      A doctor falsifies a medical record to buttress his legal defense in a medical malpractice case.

·      A physician accepts a kickback for sending referrals to a colleague.

·      A physician performs unnecessary procedures to make money.

·      A doctor submits false documentation when applying for hospital privileges.

Such breaches may very well jeopardize the doctor’s professional standing and even his personal liberty. 

This past July, the Federation of State Medical Boards (FSMB) stated that doctors who spread misinformation on Covid-19 vaccines risk disciplinary action which could include revocation of their medical licenses.  The FSMB instructs that physicians are obligated to share medical advice that accords with sound science and medical judgment.

The State Medical Board of Ohio requires every licensed physician to report misconduct which includes, among other behaviors, a colleague practicing below minimal standards.  Indeed, a physician who fails to report suspected misconduct to the Board may face disciplinary actions.

                         

Hippocrates, remember him?

One would expect that physicians who promote false information regarding Covid-19 vaccines would be ripe for sanction.  Remember the Ohio physician who testified before a House Health Committee hearing this past June that coronavirus vaccines magnetize recipients?  In the doctor’s own words, “… they can put a key on their forehead. It sticks.  They can put spoons and forks all over them and they can stick...”  The Plain Dealer recently reported that her medical license was just renewed by the State Medical Board of Ohio for 2 years, an automated process that does not mean she is not also under a confidential disciplinary investigation.  Let’s hope that the Board does the right thing.

Her testimony might make for a compelling Twilight Zone script, but it has no place in the medical landscape.  This is not a free speech issue. It’s a competency issue.  

Governing bodies of professions have rules and standards that must be enforced if they are to mean anything. 

Scientific support for coronavirus vaccines is overwhelming - much more solid than for many other standard medical treatments that physicians prescribe every day.  I wish that my own advice to patients was in the range of >90% effective with almost zero risk of serious complications. 

Millions of Americans have become ill and hundreds of thousands have died from this virus.  And there will be more to come.  If a medical practitioner is advising against coronavirus vaccines on medical grounds, or recommends ivermectin as a treatment or promotes misinformation that risks the health of patients and the community, then please sell your snake oil elsewhere.  You took an oath upon becoming a doctor.  And if you willfully violate it, as well as the medical profession’s clear standards, then you should be called to account.  We physicians must denounce anyone who purveys deception and misinformation that threatens everyone’s health, even if it is one of our own.  

 

 

I won’t take the COVID-19 vaccine!

 Recently, I faced 3 patients who had chosen not to receive a COVID-19 vaccine.  Interestingly, each had a different reason underlying their hesitancy. 

The first patient gave an adamant refusal that there is no way he would ever submit to the vaccine.  He didn’t trust the government.  The second patient offered the canard that the approval process was rushed.  The third patient had simply procrastinated.  Her family members had all been vaccinated and she has received many other vaccinations.  She was simply perched on the fence and hadn’t moved.

I offered counsel to Patients #2 and #3 as I felt there was a chance I might have impact with them.  I hope that I did.

Stop Vaccine Tyranny!

The walls are closing in on the unvaccinated.  With the recent formal Food and Drug Administration (FDA) approval of the Pfizer vaccine, and the increasing number of businesses, organizations and venues that will only admit the vaccinated, the vast space that the unvaccinated have inhabited is fast shrinking.  Will the unvaccinated be able to function if they cannot attend a concert, visit a museum, dine at a restaurant, take ground or air transportation, attend theater or even their place of employment?

Some will submit to the vaccine because rising inconveniences would be unbearable.  Others may belatedly decide on the merits that the vaccines make sense.  And yes, there will be some diehards who will continue to reject reason and science.   For them, rolling up their sleeves or donning a mask is to surrender.  We saw during Hurricane Ida, as we do in all prior deadly storms, when some folks reject all of the repeated dire warnings to evacuate and hunker down instead.

 It’s hard to understand how some folks place themselves in avoidable danger just to prove a point. I have a different understanding of what they are actually proving to the rest of us. 

TSA Fails to Protect Passengers from COVID-19

We are taught from a young age to finish the entire job.  I confess that I still need reminding on this virtue.

I suspect that all of us must plead guilty to partial task completion from time to time.  Have you ever washed some of the dishes remaining in the sink?  How about cleaning out part of the garage and rationalizing that this is enough work for one day.  How many of us have projects around the house that are waiting patiently for our attention as they sit frozen in time?

There are more stark examples  when stopping short if the finish line is downright absurd.

Consider some examples extracted from my imagination.

• An artist paints only on one side of the canvas, and I don’t mean for artistic reasons.
• A car wash cleans only the rear section of automobiles.
• A publisher distributes books that are 100 pages short of their true length.

Silly, right?

It’s easy to conjure up similar examples regarding the medical universe.

• A surgeon washes only one hand prior to surgery.
• A doctor prescribes antibiotics for only half of the standard number of days.
• A hospital housekeeper cleans half of a patient’s room after discharge.
• A gastroenterologist begins a colonoscopy and decides to end the procedure at the halfway mark.

In these examples, the medical interventions are all pointing in the right direction, but they are simply insufficient. 

Half measures are called that for a reason.

We're Half Safe on Airplanes Today

Recently, the Transportation Security Administration (TSA) extended its mask requirement for travelers using air and ground transportation from September 13^th to January 18,2022.

This is the Mother of All Half Measures.  Yes, we know that masks have impact and I have been wearing one more often since the Delta variant has taken off.  But the better response – which every responsible public health expert (or even novice) endorses - is vaccination.  If COVID-19 vaccine has incredible safety and efficacy data, far superior to masking, then why doesn’t the TSA require this?  Technically, it wouldn’t be a vaccine mandate since the individual is still free to forego travel. But I suspect it would make vaccination more attractive for those that wish to use public transportation and air travel. 

In addition, masked travelers are permitted to demask when taking food or drink, which markedly decreases the masks’ effectiveness. 

If we are wheeled into the surgical suite to hear the scrub nurse in the operating room announce that half the instruments have been sterilized, wouldn’t we be sprinting out of there like a race horse?

Why then are we satisfied traveling if we are only half protected?

 

 

Religious Exemptions to the COVID-19 Vaccine

We have all been counseled to avoid discussing religion and politics in order to reduce the risk of a hostile encounter.  I recall being reminded of this maxim when dining with a new acquaintance many years ago.  My response?  ‘That’s all I like to talk about!’

I am writing this at 9:30 a.m. on a Saturday and I’ve already had multiple conversations – both directly and electronically – with people in my life on both of these radioactive subjects.  As far as I know, all of the friendships remain whole.  Indeed, these debates and exchanges serve to fortify our friendships rather than to threaten them.

I recognized that discussing religion can be fraught for many individuals and might be best avoided for them.  Same with politics.  Many a thanksgiving dinner has been sullied by someone who decides to serve as the family turkey 

Look at the national response when a Colorado baker refused to bake a wedding cake for gay couple in 2012.  The cake shop owner claimed this violated his religious beliefs at a time that the state did not recognize same-sex marriage.

Praying for Wisdom

The COVID-19 pandemic has provided fuel for some to argue that the vaccine encroaches on their religious freedom.  Indeed, federal law provides for a vaccine exemption for a sincerely held religious belief.  (Individuals can also claim a medical disability exemption under the Americans with Disability Act.)  If the exemption claims are legitimate, then the employee is entitled to receive a reasonable accommodation at the workplace so long as this would not pose undue hardship on the employer.

While defining a medical disability can be somewhat objective, how does one define a religion?  This is murky terrain.  Try to do this yourself before reading further and you’ll see what I mean.

Here’s a summary statement on the definition of religion taken from the Equal Employment Opportunity Commission (EEOC).

The presence of a deity or deities is not necessary for a religion to receive protection under Title VII.  Religious beliefs can include unique beliefs held by a few or even one individual; however, mere personal preferences are not religious beliefs.  Individuals who do not practice any religion are also protected from discrimination on the basis of religion or lack thereof.  

Seems rather a broad definition to me.  The courts will be charged with defining religion and they will need Solomonic wisdom to achieve this.  Might veganism or vegetarianism be religions?  Satanism?  Atheism? One man’s religion is another man’s cult.  All of this will be good news for discrimination lawyers whose prayers for prosperity have been answered.  

 

The Meaning of Labor Day 2021

Labor Day, which honors American workers, was established well over a century ago in 1894. The holiday emerged from a cauldron of worker unrest protesting against harsh, unfair and unsafe working conditions.  Indeed, there were strikes and even violence in the early years of the fight for workers’ rights.  Over the ensuing decades, organized labor gained membership and power as increasing numbers of workers sought out union protections.   Those numbers have declined over time for several reasons.  Currently, about 11% of workers belong to unions.

While I have not always supported organized labor’s positions and actions, I certainly agree that every employee -union or non-union - is entitled to a fair wage and safe working conditions.

It’s been a very tough year for labor and for the rest of us.  When a company or a business is forced to close by an enemy that we can’t see or touch, toxic ripples spread out far and wide.   When a restaurant shuts down, for example, imagine how many people are impacted directly and indirectly.

Many important holidays seem to have lost their meaning.  Labor Day for many has become a day to purchase sale items or to throw burgers on the grill.  Memorial Day’s significance has similarly dimmed.

Let's honor all those who have built this country, fought for fairness and are still laboring to lead us forward.

Politics and the Pandemic - Progress Denied

Over the course of this pandemic, we have learned a lot about the country, our leaders and ourselves – and not all of it has been good.  One thing we have learned is that anything can be politicized.  Will anyone be shocked, for example, if a protest movement develops demanding that that Mother’s Day either be abolished or renamed?  

Overall, Governor Mike DeWine has provided sober guidance and directives here in Ohio.  I think that his performance during the pandemic will be an important reason why he will be reelected in 2022.  Interestingly, although he is a bonafide conservative, he will face primary threats from the right in a state that Trump handily won in the past 2 presidential elections.  As we all have learned in November 2016, anything can happen.

But, DeWine, like every other political leader considered the political impact of public health decisions.

Governor DeWine Understands the Pandemic and Politics.

In April 2020, he issued a mask mandate for customers and employees in newly opened retail establishments and businesses.  The slogan was ‘no mask, no work, no service, no exception.’  The governor issued this recommendation after consulting with public health experts.  Although I have only rudimentary public health knowledge, this measure seemed very rationale to me. 

What a difference a day makes.  Within 24 hours, the governor did a political back flip and reversed the requirement that customers must be masked.  This abrupt U-turn resulted after howls of protest from mask opponents.  The public health facts certainly didn’t change, but the politics did. 

We have seen repeatedly our political leaders caving to serve political concerns. I am not suggesting that public health experts are the only ones wearing white hats.  Because their mission is to protect the entire population, I think some of them have been overzealous to protect the public at the expense of our economic health, the education of our kids and mental health consequences of mitigation strategies.  It’s easier to recommend that someone else lose his job to serve the greater good.  It’s easier to support extending the eviction moratorium if you are not a landlord.   It’s easier for teachers to support cancelling classroom learning for ‘safety’s sake, than it is for parents who must quit their jobs so that they can become homeschool teachers. 

I don’t claim to know where to establish the balance between public health protection and society’s other needs.  Of course, this is not a mathematical query that has a single correct solution.  Experts will disagree as they face a moving target with insufficient data.  But, had politics been stripped from the process, then we would be a lot farther along than we are now. 

 

  

Biden Botches Afghanistan - Where Does the Buck Stop?

 We have all witnessed the debacle from our clumsy and precipitous withdrawal of our military from Afghanistan.  The humanitarian and moral disaster was as astonishing as it was avoidable.  Not only do our allies and our adversaries correctly point out our incompetence, but so do members of the the president’s own political party and administration.  Perhaps, this is an issue that might unite the Democrats and the GOP. 

Indeed, the record contradicts President Biden’s claim that no military experts warned him that his plan risked chaos and catastrophe.  All of us certainly heard the president reassure us only weeks ago that the Taliban were unlikely to prevail in the short term and there would certainly not be a ‘Saigon moment’, recalling an iconic and humiliating scene from 1975.

The president also claimed that he was handcuffed to withdraw troops as he needed to honor the prior agreement between the Taliban and the former administration.  This is malarkey!  First of all, President Biden already broke the prior deal by extending the withdrawal deadline from May 1^st to August 31^st.  And Biden’s fidelity to Trump’s Taliban agreement seems inconsistent as he readily and enthusiastically reversed many other Trump actions with regard to the Paris Climate Agreement, the World Health Organization and the Iran nuclear deal. 

Of course, the president and his minions tried to deflect by arguing that we needed to extricate ourselves from this ‘forever war’, a point that most of us agreed with but was not the actual point. The withdrawal was botched even if the strategy to disengage was sound.

We also heard the president argue that he didn’t want a 5^th president to inherit this war as if the next presidential election were only days away. 

'Joe, take a lesson from Harry.'

But, here’s the point of this post.  I find Biden’s reaction and explanation to this colossal failure to be deeply disappointing and contrary to his repeated pledge to be straight with us.  In his initial explanation to the nation on 8/16/2021, he stated that ‘the buck stops with me’, while his remarks were largely devoted to blaming everyone else (except the Taliban) for what transpired.  And during subsequent remarks and interviews, he continued to deny any personal responsibility.  We didn’t even hear the typical passive voice construction that ‘mistakes were made’. 

While it may have been painful and difficult, the president should have admitted to what we all saw with our own eyes.  And in the same speech, he would promise to do all he could to make the situation right.  Isn't this what we try to teach to our kids?

Not only would such a course be the right thing to do, but it would also serve the president’s interest.  It would reinforce to all of us that his promise to give it to us straight is still true.

 

 

How Much Do You Know About Covid? Test Your Knowledge!

 There isn’t a person, a pet or a plant in this country who is not aware of COVID-19.  With regret, but not surprisingly, the pandemic has struck back as it successfully targets the unvaccinated community.  We have to hope that this outbreak will be the last gasp of the pandemic and not that of many ailing Americans.

The nation has been deluged with information, misinformation and disinformation.  We confront facts and alternative facts.  Even legitimate public health experts are not consistently singing from the same hymnal.

So, I thought this was an apt opportunity to test your knowledge on the novel coronavirus with ten True or False questions – no multiple choice or essay.  What could be easier?  And there is no penalty for guessing.  Answers appear at the foot of this post. 

Good luck.  Let the games begin.

How Much Do You Know?

 

The Delta variant is so named since this strain was brought in from overseas by a Delta airline pilot.

CNN, a leading cable news station, stands for Coronavirus News Network.

Masks offer superior protection than vaccines since they directly block virus from entering the respiratory passages. 

Employees cannot be legally required to get vaccinated against COVID-19.

An employer who asks if an employee has been vaccinated against COVID-19 has violated HIPAA rules and risks government sanctions.

The two-shot Moderna and Pfizer vaccines are twice as effective as the one-shot Johnson and Johnson vaccine.

‘Long Covid’ is caused by a long sausage shaped virus rather than the typical spherical viral particle.

The N-95 mask gets its name from Lab 95 at the National Institutes of Health where the mask was designed. 

A newly described Baldo variant has no spikes on the viral surface and can therefore slide more easily into the lungs. 

Vigorous handwashing with designated soap and very warm water kills the COVID-19 virus. 

I hope that you found this quiz to be enlightening and amusing.  Feel free to share the post with family and friends who might enjoy this diversionary challenge. 

The answer key?  The correct answer to every question is False!

 

How Do We Reach Herd Immunity Against COVID-19?

Last week I conjectured that the Center for Disease Control and Prevention (CDC) obfuscated when they recently recommended that vaccinated individuals resume indoor masking under certain circumstances.  My speculation was that the policy was justified but that the CDC was not forthcoming in explaining the rationale for the policy revision.

The revised re-masking recommendation, as with every other aspect in this pandemic, has only further polarized a nation that seems to be trying very hard not to heal itself literally and politically.  I predict that our collective political affliction will long outlast the coronavirus plague. 

I routinely ask patients if they have received the COVID-19 vaccine.  Recently, a patient replied that has not received one.  I asked what his concerns were and he firmly responded that he would never get vaccinated against the coronavirus.  Not much space for dialogue here.

The CDC and public health experts admit that masks are not the antidote.  The shortest and surest pathway to the other side is for the unvaccinated to vax up. The government hasn’t yet figured out a strategy of how to get this done.

Trying to Crack the Herd Immunity Code

Here are 3 options.

Educate the public so they will voluntarily accept the vaccine to protect themselves and rest of us. Highlight the rather incredible safety and efficacy statistics.  Begging, pleading and downright bribing may be incorporated into this policy.   This has been our current policy which thus far has failed rather spectacularly.

Mandate vaccinations for every eligible person, either immediately or when official Food and Drug Administration (FDA) approval for the vaccines is granted, which is anticipated in the near term.  While you might be tempted to choose this option with zeal and enthusiasm, you may wish to consider what may follow the vaccination edict.  One of the pandemic’s lessons is that Americans, unlike many other countries, are individualists who are not swayed by serving the greater good.  A mandate would fuel protests and refusals to succumb to governmental tyranny.  Politicians and candidates would pander to this aggrieved group which might serve to elect and re-elect anti-vaxxer officials.  The nation might end up being further divided and not much closer to herd immunity. 

Discomfit the unvaccinated sufficiently such that the voluntarily accept the vaccine.  If concert venues, airlines, restaurants, public transportation, hotels, employers and retail establishments increasing required proof of vaccination for entry, it might serve to induce vaccination compliance.

What have I left out here?  What would you suggest?  Give it a shot. 

 

CDC Reverses Indoor Mask Policy - Are We Getting the Whole Truth?

Depending upon your politics, the Center for Disease Control and Prevention (CDC) has either shamelessly reversed course or simply issued a new guideline in response to new medical evidence. Indeed, many are hostile to the agency’s recent 'new & improved' recommendation that those who have been vaccinated against COVID-19 mask up when indoors in regions where the Delta variant is highly prevalent. The dissenters point out that this directly contradicts very recent CDC and public health expert advice that clearly stated that those vaccinated could be safely liberated from their face masks.  In fact, this demasking was offered as a direct incentive to those who remained hesitant to roll up their sleeves.  The CDC and its supporters maintain that their new policy on masking the vaccinated is based on a sound review of recent data, which they tarried in releasing. 

I am a rationalist who practices gastroenterology guided by medical evidence.  Despite some missteps, I have largely supported the CDC and have heeded and disseminated their advice.  But, in this instance, I don’t think they are being straight with us.

Making a comeback!

Here are some facts. The vaccines are performing very well including protecting against the Delta variant.  The overwhelming majority of COVID-19 cases, hospitalizations and deaths are occurring in those who have not been vaccinated.  It is within this population – not among the vaccinated – where the pandemic now lives.

We also know that ‘breakthrough infections’ in vaccinated individual is extremely rare, a fact that the CDC admits.  For example, breakthrough rate is estimated to be 0.098% for symptomatic infections, in other words, very close to zero.  The CDC now argues for vaccinated folks to mask up to prevent them from transmitting the virus if they become infected, although this seems like overkill considering that the breakthrough rate is about zero.  What is the quality of evidence that suggests that the few infected vaccinated individuals can transmit the infection?  What does make sense, of course, is for unvaccinated folks to don a mask since this is how the disease is being perpetuated. 

Since there is no way to enforce the more rational strategy that unvaccinated people wear a mask indoors, the CDC is asking all of us to do so in order to capture the unvaccinated within the new policy.  Otherwise, how could a retail store, for example, know that some unmasked customers were vaccinated or not?  They couldn’t.  In my view, the CDC has unnecessarily rolled the vaccinated into the new mask group to eliminate this conundrum.  If all of us are masked, then we know that the unvaccinated are also masked.  If I am correct about the CDC’s motives and strategy, shouldn’t they have told us the truth rather than exaggerate and mislead us about how dangerous vaccinated individuals might be?  It’s the CDC’s explanation that needs to be unmasked.

And masks won’t end the pandemic anyway.  This is a half measure at best.  The right approach is to increase vaccination rates and I anticipate that the government, employers, schools and others will be leaning hard in this direction in the near term.