Sunday, January 31, 2021

Variant COVID-19 Strains Coming to America

 This past week, I received my 2nd Moderna vaccine uneventfully.  Leaving science aside for a moment, I marveled that a small amount of clear liquid thrust into my upper arm could shield me from a contagious and invisible invader.  Indeed, with the many public health failures we have suffered this past year, the development of safe and effective vaccines in record time has been a monumental scientific triumph.  Obviously, these successes were the result of decades of medical research and development that created a ladder that today’s scientists could ascend.  This is how medical science works.  While it is true that medical breakthroughs can occur ex nihilo – out of nothing – more typically new scientific achievement builds on prior successes and failures. 

We've added a few more rungs this past year.

Even with the advent of vaccines, this remains an uneasy time.  Yes, there will be additional vaccines added to the armamentarium.  Johnson & Johnson’s single-dose vaccine is expected to be granted emergency use authorization by the Food and Drug Administration in the near term.  But, new potential disease threats have appeared and others are surely lurking in the shadows.   We are aware of variant strains of the novel coronavirus in the United Kingdom, South Africa and Brazil.  Do we not think that these and yet undetected mutant strains are already present in other corners of the world?  While many of these variants may contain innocuous mutations, others may confer advantages to the virus with respect to transmissibility and virulence.  At some point, we may need to call for Operation Warp Speed 2.0 to create new vaccines and therapeutics to combat new viral threats.

I feel that we are engaged in global cat and mouse conflict.  It seems unfair that the goal posts are shifting.  But disease and illness are unfair.  They strike and afflict the innocent.  But, we are not defenseless.   We have robust protective techniques available as public health experts have admonished us for months.

The scientific community and the public have learned so much this past year.  And without doubt, these lessons will save many lives when the next pandemic strikes.  We’ve created a few more rungs in the ladder that scientists and researchers will climb in the future.

Sunday, January 24, 2021

Donald Trump and the Butterfly Effect

We are all familiar with the ‘butterfly effect’, describing a phenomenon when a seemingly trivial action – a whisper, a smile, a compliment or the fluttering of a butterfly’s wing – causes a soft ripple that can reach a distant continent.  You simply cannot calculate the power and reach of a simple act of kindness. Here’s how it works. 

You are in line waiting to buy your first coffee of the day and you discover that the stranger ahead of you has paid for your order.  You are moved by this this simple act of generosity.  Your mood elevates.  You wonder why such an idea never occurred to you.  You ruminate over this on your drive to work.  You greet your secretary who has been under stress and very distracted over her spouse who is recovering at home after surgery.  You think about what that must be like for her and her family.  It’s Thursday morning and you send her home for the rest of the work week so she can help her spouse get well.  The secretary is overcome with gratitude.  After her return to work, she feels that she wants to emulate the kindness that you showed her.  See receives yet another e-mail from her local food bank, only this time she feels the urge to participate and she does so.  Three families she will never meet will now receive food.  A child from one of these families ends up becoming very wealthy and makes it her mission to give back.  And, with a hope and a prayer, the chain keeps extending one link at a time.

The flutter of a wing can change the world.

Of course, the butterfly effect can also create a chain that leads to darkness.  The impact of an unkind remark a scowl, idle gossip  or a vengeful act can reach far beyond the original action.  Since the ultimate negative effects appear unconnected to the first action, the creator of the first link in this dark chain is unaware that he bears some responsibility for the damage that he seeded.

What might the cumulative effects be of leaders who failed to step up for truth, dismissed and excused dishonesty, supported those who trafficked in baseless conspiracy fantasies, rejected mask wearing and other public health measures during a pandemic, challenged the results of a repeatedly verified presidential election, told an alt-rite group with a history of violence to 'stand back and stand by', fired government officials whose transgression was to tell the truth, whipped up tens of millions of supporters to ‘take back our county’ and voted to reject a state’s electoral vote count?

You don’t think that all of this could lead to a violent insurrection, do you?

As of a few days ago, there's a new butterfly in town. 

What Medicine Can Learn from the Airline Industry - Nothing

I have at times detoured from my typical medical commentaries to rail about the airline industry.  If I may borrow some phrasing from a legendary British Prime Minister, the flying experience is a hassle wrapped in a frustration inside a delay.  We arrive at the airport 2 hours early, drag ourselves through the TSA process, ambulate to the gate, pray the flight is on time, hope that they will not deem my luggage as unfit to carry on, march like snails onto the aircraft, test my lumbar disc strength as I hoist my bag into the overhead bin and then finally relax as I sink into a commodious and plush chair that could comfortably seat a gerbil. 

Do I have to sit in the middle seat?

And, if the flight is delayed, the inconvenienced passengers can expect no compensation.
If my medical practice had adopted airline culture, we would have had no patients. Think of all the reading I could have accomplished!  If we made every office visit with us an unpleasant hassle, we would not have been able to pay the electric bill.  And, I don’t think our patients would have been placated if we tossed them a tiny bag of pretzels when we ran late.

I think the airline industry has been more solicitous of the comfort animals being permitted on board than they are of the human passengers.  Such guests have included

If I am dissatisfied with a restaurant, a tradesman, an attorney or a retail store, then I am free to find an alternative.  This is how most of the world works and is an incentive for all of us to perform well.  If, however, you feel that the air travel experience is wanting and less than you deserve, what recourse is available to you?

It’s one of the few industries that can thrive despite providing mediocre and erratic customer service.  And, for the truly brave travel warriors, just try calling the customer service phone numbers.  If customer service were truly an industry priority, would we be kept on hold longer than the duration of some flights?  Is our call ‘really important to them’?  Let me answer my own question.  No, it isn’t. 

Sunday, January 17, 2021

What the COVID-19 Vaccine Meant to Me

 Although I am not a front-line worker, I do interface with several dozen patients each week.  The COVID-19 metrics in Ohio are all coursing in the wrong direction.  Over the past few months, several staff at work and personal friends have contracted the disease.  I’ve had a few close calls with patients whom I learned after an office visit with me were infected.  Thus far, I’ve managed to dodge the virus.   What weapon have I used to repel the invader?  See photo below. 

Two weeks ago, I received my initial injection of the Moderna COVID-19 vaccine at my workplace.  I arrived at the appointed hour expecting to bare my upper arm for a quick puncture.  Not quite.  After entering the building, I was directed to the end of a long line which was trailing outside in the parking lot.  So, I took my place during the pleasant winter climate that all of us in Cleveland adore.

Once I advanced into the building proper, I discovered that the experience reminded me of Disneyworld.   I am not referring to costumed interpreters interacting with the crowd, or hearing ‘It’s a Small World’ piped in or a gift shop where I could purchase a Mickey Mouse doll with a facemask who blurts out ‘keep your distance’ if you cross the 6 feet barrier.  I am referring to the hidden winding lines that awaited all of us who were waiting.  As soon as we would turn a corner, another queue bank came into view.  Very clever.

Ultimately, I was face to face with a retired registered nurse who had come back into service to help the nation resist the virus.  After the inoculation of messenger RNA, I waited the required 15 minutes and then headed back to my car.

I’ve had dozens of vaccines throughout my life, but I will never forget this one.  It was an emotional experience as much as it was an immunological event.  There was a dreaminess about all of it.  There we were, there I was, participating in something so much bigger than ourselves.  The nation had been praying for a successful vaccine and scientists throughout the world broke all records and expectations and delivered.  And we represented the first steps back to normal life for everyone   

While vaccine distribution has been woefully inadequate, I hope that every arm who wants a vaccine, will receive one ahead of schedule.  The incoming Biden administration properly regards this as Priority 1.

So far, in the contest of COVID-19 vs Humanity, we are losing badly.  We will prevail.  Ultimately, the vaccine will vanquish the virus.  Until then, we must do everything to minimize our casualties.

As I reflect on 2020, our annus horribilis, the COVID-19 vaccines were the green shoots of renewal. We need to turn them into forests.







Sunday, January 10, 2021

Telemedicine is Here to Stay

Most of us recognize that Operation Warp Speed was the name given to COVID-19 vaccine development, which succeeded brilliantly and in record time.   Early on, no one predicted that by the end of 2020, two safe and highly effective vaccines would gain emergency use FDA approval. 

There were other developments that also rolled out at warp speed.  Telemedicine is now omnipresent.  Prior to the pandemic, telemedicine existed in pockets throughout the country, but most physicians and patients had never participated in it.  The plan was for it to gain a much larger footprint in the medical landscape in the years to come.  Instead, the transformation occurred in weeks.  Physicians and patients who previously would have rejected the notion of a distant and impersonal virtual visit were now enthusiastic participants.  Patients and caregivers of all ages became quite conversant with Zoom and other similar platforms.   

'The Doctor Will See You Now'

The urgency for warp speed adoption of telemedicine was to mitigate the pandemic.  By seeing patients virtually, we could protect medical personnel and the public by limiting close exposure with potentially infected individuals.  The more we limit close contact with others beyond our household, the more likely we will remain uninfected.

It soon became evident that telemedicine offered many advantages beyond viral mitigation. 

Indeed, telemedicine is not only here to stay, but its continued growth is assured.  Patients will have routine access to medical care from physicians who practice in other states or even in other countries.  Technology will continue to be developed to make the virtual visit more similar to a full office visit exam including a physical examination.   While this sounds heretical and fantastical, patients may undergo actual physical exams without a physician laying a hand or a stethoscope on the patient. Stay tuned.

Like with other technological advances, there will be a cost.  Intimacy and humanity will be sacrificed on the techno-altar of progress.  To those who want to hang onto the personal visit, with real eye contact. body language, palpation of your abdomen and interacting with medical staff you know and trust, I hope there will be a place for you.   But there is a transformation underway in how medical care will be delivered.  And telemedicine right now is the profession’s north star.   The old fashioned office visit will likely end up like the old fashioned hardware store – not exactly extinct but harder and harder to find.

Today, we buy (or download) books from our couches.  Yes, it is very efficient and those who do so routinely would never contemplate hauling out to a brick & mortar store.  But, what of the joy and pleasure of wandering through a bookstore’s aisles, checking out various titles and then leaving with a book or two that was not on your intended list?  Are you all about the destination or the journey?



Sunday, January 3, 2021

Happy New Year! -A Look Back & A Look Ahead

                                                                             Division                                                                                                                                                                                                                                                                                                                                                Heartache




                                                                                                                       Lies                                                                                                                                                                                                                                    Racism                                                                                                                                                                                                        Revenge

                                                                                             Tearing down







                                                                                                                 Alliances                                                                                                                                                                               Forgiveness

                                                                    Repairing the world