MD Whistleblower

We all have taken lessons from the pandemic. There were many things we got right, particularly the development and administration of safe and effective vaccines.  There was also much we got wrong including inaccurate and contradictory information from government agencies and keeping kids out of school long after the data supported a return to in person learning.  And while I am not a public health expert, I still wonder about the wisdom of having imposed restrictions and mitigating measures on all of us rather than focus more narrowly on at risk folks.  I realize that this is a controversial issue as there was the fear that low-risk individuals could transmit the virus to a vulnerable recipient.  The mortality and morbidity in elderly infected people were quite different from that of younger and sturdier individuals.  Public health experts argued that we needed a broad brush to protect more people. Coronavirus Caused Illness, Death, Anger and Division Protecting public health should

I presume that most of us are hostile to hate speech, misinformation and disinformation.  Politicians and others want social media to be scrubbed of all nefarious postings.  Twitter is most recently in the crosshairs on this issue after Elon Musk assumed ownership of the company.  They still haven’t settled on a moderation policy.  Social media and other information sources have been accused of radicalizing Americans, fostering hate, undermining our elections, providing a forum for bullies and predators, promoting division and coarsening our national discourse.  One man’s cleansing of disinformation is another man’s censorship. There is some speech that all reasonable people would agree should be banned, such as incitement to violence or prurient matter that children can access.   I challenge those who advocate against publishing hate speech, misinformation or disinformation to offer precise definitions of these categories.   Trust me, this is no easy endeavor.     And if you are

During the pandemic, which has not yet ended, we’ve all heard lots of chatter about freedom.  Folks are figuratively burning their masks as a statement of their personal freedom.  We have seen patrons packed into bars and other venues, against the advice of medical professionals, claiming they have the freedom to congregate.  Political leaders in some states have banned mask mandates in schools arguing that parents have the freedom to make their own decisions regarding their kids. And the fundamental reason given by so many anti-vaxers and government skeptics is that they have the freedom to accept or reject any medical intervention.  These arguments are framed as pro-freedom positions in an effort to make it difficult for opponents to challenge them.   Who wants to be seen protesting against freedom?   Not surprisingly, and as I have posted previously on this blog, these issues are more complex.   Freedom is not absolute.   That’s why we have laws, regulations and societal mores t

I’m long on the record that we need to recalibrate the balance between individual freedom and society’s rights.  Personal freedom is often at the direct expense of society’s rights and expectations.   For example, an individual may argue that he has a right to air travel without having to proffer a government authorized ID or to submit to a search of his luggage. On this example, I think most of us would argue that society’s rights would prevail. And there needs to be personal responsibility and accountability when one exercises particular personal freedoms.   If you want to ride a motorcycle, for example, then your insurance risks should be priced accordingly.  And if you don’t want to wear a helmet while riding, then you and other helmetless riders need to share in this risk so the rest of us don’t have to pay when an unwelcome event occurs on your ride.   As in everything else in life, this terrain can become murky.   If a patient declines surgery that her medical team unanimous

Thus far, to the best of my knowledge, I have dodged infection with the coronavirus.  I am up-to-date on the recommended vaccinations and have comported myself with caution.  However, I am not in a state of personal lockdown and I still enter area retail establishments to make personal purchases, although I am always masked.  Currently, I am sipping a sugar-free peppermint mocha in a very sparsely populated coffee shop.  I accept that public health experts might challenge my definition of cautious.  Indeed, I’m sure many of them wouldn’t step foot, let alone a toe, into a supermarket these days. But the risks of catching the corona on my personal forays in the community pale next to the risks I face each week at work when I am in direct contact with several dozens of patients and staff.   The omicron variant spiked into the stratosphere here in Northeast Ohio, but thankfully it appears to be in a steady descent now. It does not seem that the vaccines and boosters protect us against o

2022 is here!   2021 has been an annus horribilis for America and the world.   We have simply not been able to vaccinate and boost ourselves free of the suffocating tentacles of an evolving coronavirus. Here in Ohio and elsewhere COVID-19 tests are endangered species.  Folks spend hours trolling around town hoping that a local pharmacy or a public library will receive a supply at the very moment he or she walks in.  My own inquiries have all yielded the same result – no tests available and no idea if and when they may arrive. Did you watch the ball drop on New Year's Eve? The pandemic, which in any earlier time in our history would likely have drawn us together, is cleaving the nation.   The day before writing this, I saw 2 patients who had elected to shun the vaccine.   I’ll spare readers their explanations which originated in the huge ‘science-free zone’ that tens of millions of Americans inhabit.   And earlier in the week, a medical professional who had been vaccinated express

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 pan

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 i

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 advi

( 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 violatio

 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

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 surge

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 religi

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 empl

 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 sta

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.  

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 la

 I think we’re headed in that direction.  There are various angles and positions to consider.  But, as in so many disputes, it’s not a matter of right and wrong but an issue of which side has the better argument. When a judge rules for one party in a dispute, this does not mean that the other side had no legitimate position.  If means that the judge concluded that an analysis of the facts and the law tilted toward one side. We must acknowledge that an individual has a right not to be forced to accept a vaccine or any medical treatment.   The doctrines of informed consent and patient autonomy are bedrock pillars in American medical care.   If, for example, I recommend a colonoscopy to a patient with symptoms highly suggestive of a serious colon condition, the patient is free to decline my advice.   While I may feel strongly that this decision – referred to as informed refusal – is unwise, no medical practitioner or ethicist would argue that I should be able to compel compliance with m

 I am not a public health expert.  But I have learned this past year that one need not have any public health knowledge in order issue advice and opinions.  How ‘bout some hydroxychloroquine with a bleach chaser? I trust our public health experts and have largely hewed to their advice, although I’m not sure that they have hit the bullseye every time.    As expected, they have modified their advice over time in response to new knowledge.   This is not a flip-flop – this is how science works. And millions of folks have completely rejected their advice for all kinds of reasons.   We’ve all seen photos of patrons who were piled into bars or kids on spring break who were recklessly partying on.   Masks optional. Others, in contrast, were pushing back on the Center for Disease Control and Prevention (CDC) arguing that the rules were not strict enough.   We’ve seen the teachers’ unions refuse to return to classrooms despite CDC guidance assuring that it was safe to do so, as long as pro

 While most of us prefer order and routine, life can turn course unexpectedly and randomly.  Of course, we all know this.  For many of us, our occupation, our choice of mates or where we live are the result of some chance occurrence, not the product of diligent planning.   Indeed, this reality adds some excitement and wonder into our existences.  Would we really want to live according to a prescribed routine like a train schedule?   For me, I am most satisfied when my days include my daily routine pleasures seasoned with some spontaneity.  I suspect that this is true for most of us.  However, we differ in the ratio of random/routine that we prefer.   Some of us plan a trip, for example, with each day carefully planned while others prefer to simply land in their destination and explore untethered to a guidebook or a rigid schedule. And no force can set order aside more forcefully than nature.   Here is the scene from our window earlier this week.   Does this look like a typical spring