MD Whistleblower

 There’s been lots of talk about lockdowns lately.  This issue, like masks, has become politically contaminated.  It’s been one of the fascinating lessons of the Pandemic of 2020 – the recognition that issues that would seem to be ‘immune’ to political interference became instead potent partisan weapons. Consider two rather distinct reactions to the recommendation to don a mask when frolicking about in public. Citizen #1:   Of course, I will mask up.   This will keep me and others safer.   In a small way, I feel I’m doing my part on the journey to the other side. Citizen #2:   Mask?  Hell no!  Just more encroachment by the government to rule our lives.   Similarly, locking down the economy, both here and abroad, has provoked bitter reactions from all sides. 'No mask for this patriot!' As I have written, I feel awful about the hundreds of thousands of businesses who have closed or are barely hanging on.   I also feel that their plight has not been given the attention

Millions of Americans are working remotely during the pandemic.  Many of them would have never believed that they could perform their jobs away from the office.  I’m one of them.  But we all now acknowledge that the basic structure and function of the workplace has been forever altered. This transformation was inevitable, but the pandemic was a potent catalyst to bring it about at, shall I say, ‘warp speed’? Did we really believe that in a world with remote robotic surgery, driverless cars, personalized genetic medicine, exploration of Mars, Alexa and the explosion of artificial intelligence, that we would continue to commute to brick-and-mortar offices each day?   It was only a matter of time before the physical workplace would be recalibrated.   The disruption has been monumental and to a great extent irrevocable.   While I do believe that there will be some backward adjustment after the pandemic has largely resolved, I do not expect a return to the status quo ante.   Do you think

I read recently that Kroger, who runs a grocery store chain, has joined with other retailers in paying employees who receive a COVID-19 vaccination.  The $100 payment should serve as an incentive for employees to roll up their sleeves. There is an ongoing debate whether employers can or should mandate COVID-19 vaccinations for their employees.   The state of play now is that employers are encouraging, but not requiring vaccines, as mandating vaccines creates legal exposure for employers.   For example, if you require that an employee is vaccinated against the worker’s wishes, and a complication occurs, is the employer responsible?   Can an employee be disciplined or terminated for failure to vaccinate if there are no vaccines available within a reasonable distance?   And mandating vaccinations may be complicated when workers are unionized. The right to refuse treatment is a bedrock medical ethical principle that I support.   For example, if I advise an individual with acute appendi

 This past week, I received my 2 nd 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

 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

One of the most challenging symptoms that physicians and patients grapple with is fatigue.  It is exceedingly common and elusive.   In general, medical studies do not identify a cause and the symptom remains unexplained.  And, failure to identify an explanation only compounds the frustration. I have been frustrated recently over a new iteration of fatigue, a malady that has crept onto the national scene over the past few months.   This illness, spawned by the COVID-19 plague, is called Pandemic Fatigue (PF) and it is spreading aggressively. As of yet there is no vaccine to prevent it or any proven therapeutic agent to combat it.   Scientists thus far do not even understand how one contracts the illness.   Judging by the rampant community spread, one would suspect that it is highly contagious, but no infectious agent has been identified. The disease seems to follow several weeks of adhering to public health guidelines to mitigate the spread of coronavirus.    At some point, either

Many of us have sought distractions from the rising fears and frustrations of the pandemic. Why do you think it’s nearly impossible to buy a jigsaw puzzle now?  They are all on back order as the supply cannot meet the demand.  Board games are also more popular than ever.  Even I've competed in a few rounds of Boggle.  And binge-watching various television series has become a welcome oasis from the surrounding chaos. Jigsaw Puzzles - Endangered Species As a medical professional and an ordinary person, I am well aware of the health and economic horrors that the virus has wrought.   Yes, the upcoming vaccines represent a monumental scientific triumph, but there will be many dark months before they are widely available. In this posting, permit me to offer readers a lighter look at COVID-19 to provide a few minutes of deserved distraction. Here’s a COVID-19 quiz to test how current and accurate your knowledge is.   True or False Anthony Fauci, MD is obsessed with masks.   He

This is not really a fair fight.  In one corner of the ring sits the novel coronavirus.  It's invisible and can attack without warning.  Moreover, when it lands a punch, the victim may not even feel its impact for several days.  It can fell even a highly trained athletic competitor.  And it has proven expertise in psychological warfare.  It's opponents - us - are scared that we might become tomorrow's victims.  The virus clearly understands and exploits the power of fear.   And with deepening pandemic fatigue, the virus gains a strategic advantage as we tire of practicing recommended public health mitigation efforts.   And in the opposite corner sits us, with a mask dangling loosely below our nostrils.  We thought that heading into the mall or to a friend's party would relax us before the competition.   After all, how much risk could there to be to have a quick drink at a coworker's house?   Or flying to another city to join with family at a Thanksgiving reunion?   

Presently, your humble scrivener is situated in Atlanta, Georgia, the destination of a long road trip from Cleveland, Ohio.   Tucked safely inside our car, we were insulated from the novel coronavirus as well as the storm surge of seething of the nation.   As of yet, there is no vaccine or truly effective therapeutic agent available for either of these afflictions.   My sense is that the virus will be sooner and more easily vanquished than will be the malignant divisions that are threatening our society.    Am I being serious here?   Do I actually argue that a scourge from an invisible warrior that has wounded millions will be more easily defeated than our vile and vindictive politics?   Is reaching across the aisle or across the street or across the table such in insurmountable task? Here’s why the virus, as wily and destructive as it is, will at some point be the first to be defeated. Our politics, in contrast, will be more like arthritis and diabetes, long term and progressive d

 In one’s profession and in life, we strive to improve our performance.  There are so many pathways available to progress on this journey.  One of the best ways is to emulate others.  Athletes, artists, musicians, writers, parents, tradesmen, educators, clergy, law enforcement personnel and even physicians can better their performance by imitating others.  And while it might seem axiomatic that our best role model is one who is more proficient than we, this is not necessarily the case .  The team captain can learn much from a rookie.  The Jewish Talmud expresses the truth more eloquently.                                                 Who is wise?  One who learns from every man. Over my career, I have tried to improve my practice of medicine from watching other physicians and nurses in action.   As an example, I have heard medical professionals having difficult conversations with patients which taught me how to do this better. So, when President Trump’s doctor recently led several

Perhaps, October 31 st will be an inflection point in the pandemic since more folks will be wearing masks on Halloween. I assume that the annual ritual of trick or treating will be suspended this year, as have so many of our performances, celebrations, concerts and athletic event spectating.    It has been my observation in Ohio that more folks are masking up, although there are exceptions everywhere.   Our governor has directed concern for some rising case numbers toward college youth, who astonishingly haven’t followed the rules.   Just because one is a college student doesn’t guarantee that his decisions will be graced with wisdom.   And, if there is to be any chance that college kids who are drawn toward campus parties like iron filings are attracted to a strong magnet, there will need to be sure and certain enforcement.   What if a college made students aware that violating public health rules would result in expulsion with no refund of monies spent?    Yes, I know this sounds

 Yesterday, I entered a convenience store for a small item with my mask securely in place. I also do my best to maintain adequate distance from others, but it seem that others have a much more relaxed view on this.  I approached the check out line and stood behind two maskless men.   Why?  Is it possible that they are not aware that every state and national health expert recommends mask wearing? Yes, there was some confusion on this initially, but all of the experts are singing from the same hymnal now.  It’s an act of ignorance and selfishness.  How do they justify putting themselves, other customers like me and store employees at risk of contracting COVID-19?  Is this the example they choose to set for their children, friends and coworkers?  Or, are these just folks who don’t like to be told what to do? If the nation had not become a cauldron of anger, I might have approached these men to engage them in a conversation.   But, not these days.   Yesterday’s Road Rag e has morphed int

We are all hopeful that effective treatments against COVID-19 will emerge in the next 1-2 years.   The first round of medicines will be replaced with superior alternatives.   This is called progress.   But as of now, we have no effective therapy.   I have already expressed my skepticism over chloroquine and hydroxychloroquine, whose popularity and usage had skyrocketed despite the absence of credible and persuasive medical evidence of efficacy, but the initial sugar-high has dampened.     Clinical trials are in progress on various agents and will bring some clarity to the issue.   Scientists throughout the world are working doggedly to create an effective vaccine.   This won’t be easy.   The forecasts of an effective vaccine in 12-18 months may prove to be wildly optimistic.   Consider that the common cold which tortures tens of millions of us every year is also caused by a coronavirus.   No protective vaccine against cold viruses has been created and scientists have had decade

In general, I’ve been wearing a mask when I’m out and about.   I continue to believe that maintaining adequate distance between me and the next guy is more important than masking up.   I’ve seen many folks who must not agree with me as they have no qualms about breaking the recommended 6 feet barrier while donning a mask.   One of my criticisms of masking up is my suspicion that folks would feel more protected than they are and would reduce their social distancing range from 6 feet to 6 inches. And, does the public truly understand that the mask is to protect others?  And, it may also be possible that the mask wearer may also enjoy some personal protection. Of course, the messaging on masking has been atrocious.  On February 29th the Surgeon General implored us in ALL CAPS on a tweet to STOP BUYING MASKS!  His advice has since 'evolved' and is now in line with the consensus of all responsible public health leaders to mask up. And yet, we have a segment of folks who re

Life is so much easier when we can rely upon a playbook to guide us over and around obstacles.   Indeed, many professions are devoted to creating policies and procedures to help businesses, individuals and organizations navigate through rough currents.   In general, these prepared plans are created to address challenges that are either known from prior outbreaks or can reasonably be assumed to be potential adverse events.   For example, regions of the country that have suffered from natural disasters would be expected to have contingency plans in place to prepare for the next arrival of Mother Nature.   Navigating Through Rough Currents How comfortable it is when facing a dilemma to be able to pull a binder off the shelf for advice. Of course, as anyone alive knows, we don’t have a binder, an advisor, a parent or a GOOGLE site that can reliably land us safely when confronted with adversity.   So many issues require us to rely upon our experience and judgement and to lea

The first case of COVID-19 in the United States was reported on January 20 th .    Of course, this is akin to finding one termite in your garage and thinking that there are no others.   Of course, by January 20 th there were an unknown number of infected Americans who were silently and efficiently transmitting the virus to others.   It’s easy to say now what we all should have done then.   The rapidity of the explosion of worldwide infections has been staggering and humbling.   Compare the known infections and mortality in America today with the state of affairs on January 20 th , only 3 months ago.   Just prior to posting this, the known number of U.S. fatalities to COVID-19 is 150,000. For some perspective, our country lost over 58,000 individuals in the Vietnam War, but this horrible tragedy was the result of 8 bloody years, not just several months.   The current diabolical enemy is a merciless adversary.   Like a terrorist, it scares those who have not been infe

“I have my rights!” “Don’t tell me what to do!” “This is a freedom issue!” All of us have rights.   Often, one person’s right to do or say something may collide with some else’s right.   One of our courts’ primary roles is to decide in these disputes whose has the better argument. These issues are not scored 100-0 in favor of the winner.   The decisions are nuanced as often both sides have a reasonable claim to argue. That's why the issue ended up in court.    And, as we know, the same set of facts might have led to a different result if a different judge or a different court had heard the case. I have heard and read about individuals who have refused to wear a mask because they argue it encroaches on their personal freedom.   They have a right to determine their own dress code and the government has no right to impose its will on individual citizens. We’ve heard similar arguments offered by businesses who wish to open up faster than the government or public health o

Early on, when the first coronavirus infections starting springing up in the U.S, I wondered if these infections and the threat they posed were truly qualitatively different from seasonal influenza.   As I became more informed, I recognized that the health experts were correct; this is not the flu. I was not persuaded, however, by the high mortality rates which were initially quoted.   Even today, we will hear and read that mortality rate for COVID-19 may be 10 times higher than that of seasonal flu, which is in the range of 0.1%.  We simply cannot make such an assertion authoritatively. The truth is that may be grossly overestimating COVID-19 mortality for a simple mathematical reason – we simply don’t know the extent of infected Americans who have mild disease or remain asymptomatic.  With widespread testing, we will likely verify that the percentage of COVID-19 fatalities is much lower than originally thought.  In simple terms, the larger the population segment there is with m

Several decades ago, Thomas ‘Tip’ O’Neill, who was Speaker of the House is associated with the adage, all politics is local .   In other words, caring for the needs of one’s constituents is the best strategy to preserve one’s political viability.   Of course, those were also the days when Democrats and Republicans – despite their philosophical differences – could argue and thrash out a deal.   Indeed, it has become political lore how Speaker O’Neill and President Ronald Reagan could capitalize on their personal chemistry to make progress for the nation. Those were the days. There is a different type of chemistry today that exists between Speaker Pelosi and President Donald Trump.   When they are mixed together, they form an unstable compound that is highly volatile and may explode. Instead of all politics is local , we now have all things are politics , a sad bastardization of O’Neill’s principle.   Now, as we are all so painfully aware, anything can be politicized, whic

Not long ago, Telemedicine was something that I read about.   Now, it’s something I do.   Over the past weeks I have been evaluating patients over the phone from home.   It has been an adjustment, but it has been smoother than expected.   First, I have always thought that the physical examination is overrated.   Yes, I recognize that such a declaration constitutes medical blasphemy, but I stand by it.   Don’t extrapolate beyond my actual meaning.   I am not suggesting that the physical exam is superfluous.   Indeed, there are many circumstances when the exam is absolutely critical.   However, for a good bulk of the routine gastroenterology patients I see, particularly for those who are returning to my office for a follow up visit, the exam contributes little value. Here is a sampling of patient visits where the history alone is largely sufficient. A patient with years of chronic constipation returns to see me for a 6 month follow up visit. A new patient sees me to evaluate f