IM Doc pt 33 v. 2
Jan. 19th, 2022 12:53 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
temporaryrealityFirst, a full post - note that copy/paste was misbehaving this time around and the usually-available embedded media isn't showing up.:
Likewise, I'm being smacked with some weird formatting that's creating a table-like effect, which I don't want and which didn't show up when I first prepared this post. This may be something I have to keep playing with, so there may be modifications in the next few days.
Omicron: Fog of Information and Definitions
It’s a bit disconcerting to find we are a day further into a fast moving crisis yet I don’t have the sense anything both new and meaningful has emerged. But it still seems useful to try to clarify some of the claims floating about as well as a few new Omicron factoids that that have emerged but seem a lot less dispositive than the press enthusiasm would have you believe.
As usual we are very grateful for the help of our Covid Brain Trust and I am quoting more liberally from them than I did our also very valuable Brexit Brain Trust. The reason for hewing to our sources’ words more closely is I don’t want my interpretation to distort meaning.
And What Pray Tell Do You Mean By Severe?
Alarms appear to have gone off at WHO and the CDC after a spell of “initial signs are that Omicron isn’t that bad:
https://t.co/Xsr5nVgQRP
Oddly we have to go to Daily Mail rather than Twitter for a pointed recap of our CDC’s more downbeat outlook:
And remember, even if Omicron is actually is less nasty on average, it’s so highly transmissive that hospitals will be overwhelmed:
And there is an offset that Thomas Peacock, the scientist first to post on B.1.1.529 before it was called even that, noticed immediately: that it probably evades monoclonal antibodies. Our GM was quite certain that would be the case, and our IM Doc now has pretty some pretty sick patients who are not responding at all to Regeneron, which has an EUA for use as a Covid treatment and is generally seen as effective. German researchers confirmed yesterday that Regeneron’s and Eli Lilly’s Covid treatments are not effective against Omicron. GlaxoSmithKline’s cocktail Xevudy still appears to work in vitro, but that may not translate as well in vivo.
The loss of some, perhaps all, monoclonal antibodies as Omicron remedies means that some patients that could otherwise have been treated outside a hospital will wind up being admitted. This is an offset to any average reduction in severity.
So it should not come as any surprise that, so far, deaths in Gauteng are tracking previous Covid waves:
Yet as our GM was correct to warn, the “mild” meme, as the hot take meant to preserve Christmas festivities and shopping, has become anchored. The press is pumping out even more articles to try to normalize Covid, such as the Atlantic’s Don’t Be Surprised When You Get Omicron. Gee, how about instead running a public service piece like “What You Need to Do to Not Get Omicron.”
GM reacted, quoting the article and then commenting:
One by one, the symptoms I knew so well on paper made their real-life debut: cough, fever, fatigue, and a loss of smell so severe, I couldn’t detect my dog’s habitually fishy breath.
Mild brain damage.
Once you know you’re infected, hang tight, limit your encounters with other people, and just take care of yourself.
As discussed earlier today, all the effective treatments need to be started early on. So what exactly is the advice to “just take care of yourself” on your own going to achieve?
And what are they going to do with the monoclonals and Omicron? There is only sotrovimab [GlaxoSmithKline] that actually still works and that is presumably in very short supply. But do they still refuse to give to the vaccinated (which are no longer actually vaccinated)?
IM Doc was even more disturbed:
This article is a sterling example of the vaccine only mantra.
“Stay home and take care of yourself.”
This is the terminal lunacy of VAX VAX VAX.
The problem is that many of these people are being told to stay home while they are turning blue and coughing up their lungs. And this week in my area 85% of the COVID outpatients are fully vaccinated with 30% of those boostered. It is as if the entire medical industrial complex has learned not a fucking thing in 2 years.
I cannot tell you how ashamed I am of where my profession is today.
The fact that our media is still putting out this kind of tripe to mislead the masses is yet another sign of the mass delusion.
IM Doc pointed out how the “mild” meme was doublespeak:
I think Americans think of “mild” as a head cold. I think the medical establishment thinks of “mild” as not being admitted. The non-admitted, however, can be violently ill, trust me.
GM wanted to understand exactly what “violently ill” meant. IM Doc again:
That is a medical intern phrase – it means very very sick – but not quite hospital level. And it is also very age dependent – younger people can handle this much better than older people.
I have 7 patients with COVID right now that my office and I are calling twice daily. They would all fall into this category.
By definition, they all have someone to watch them at home.
Some of the symptoms we are dealing with today – temps up to 103, severe shaking racking chills, sweating enough to soak the sheets 1-2 times daily, severe coughing, vomiting their guts up, severe myalgias.
These people are sicker than just a flu. However, not quite admission. Mind you, the criteria for admission has been higher lately, we have just not had the bed space – and people really do not want to be in the hospital.
This is most definitely not the average course of influenza….
We do not really have people deteriorating where they cannot get them to the hospital on time. WE KEEP A VERY TIGHT LEASH ON THEM. Unfortunately I do not think many Americans have a primary care practice that does this.
They also have very strict parameters to call us instantly.
And I call them twice a day. Most of the time there are 5-7 people. Some days upwards of 15. The highest has been 22 – but that is absolutely not the norm. It really gets quite crazy.
This is the large reason why I and my staff are so exhausted. To keep them out of the hospital and safe at home is just enormous amounts of work.
Unfortunately, I think myself and my practice are the extreme exception. I do not get the idea this level of care is being done by most practices. I just feel obligated to keep them at home as best we can.
IM Doc also underscored yesterday that even though he might have some Omicron cases (due to failure to respond to Regeneron) it was still too early in the course of a normal Covid case for any to be admitted.
Delta-Omicron Recombination Unlikely
Some readers were concerned by news reports of Moderna’s chief medical officer telling MPs that Delta and Omicron might recombine. GM was perplexed. His reaction was even if that happened, it would not appear to give the new variant any real advantage. But Delta and Omicron circulating at the same time (as opposed to Omicron pretty quickly becoming dominant) could still be very nasty. GM:
There isn’t much that Omicron can obviously gain from Delta and vice versa. Omicron has the immune escape, it has FCS enhancement, it has the N protein packaging improvement, it has the Nsp6 deletion, so what exactly is there in Delta that will make it fitter by recombination? And vice versa — Delta has those transmission enhancing features too. Some of the AYs have accumulated further ORF and Nsp mutations, so there might be some room for improvement there, but it will be marginal.
The bigger problem will be that you will have sick people in the same rooms in hospitals and they might become cross-infected, which should worsen the outcomes.
The Lack of Interest in Treatments
Biomedical professor KLG had said from the get-go that he expected the approach to Covid to come to depend heavily on treatments, as it has with HIV. The fact that we have instead gone all in with limited efficacy, comparatively short-lived vaccines is a big departure.
PlutoniumKun of our Brexit brain trust had found some hints in the Japanese press that Japanese doctors were prescribing Ivermectin and added:
From what I understand of the Japanese medical system, it wouldn’t surprise me at all if they are giving it to patients without telling them….Those who have lived in Japan will confirm I think that getting a straight answer from a Japanese doctor on any medical topic is nearly impossible.
Epidemiologist Ignacio noted:
One of the problems with Ivermectin, IMO, is the hospital-centric view that dominates medicine. It is well known that some approaches with medicines might work in early stages of infection (very early so as to be considered nearly preemptive) and only or mostly work if administered timely. This is, or can be the case of Ivermectin. When you go an do clinical trials the result is “It has no effect” and that might be the case if the design of the trial results in too late delivery to notice an effect. But in real life practice it might be the case that words have circulated among Japanese doctors in the sense that it indeed does something.
IM Doc described how the CDC has hung doctors out to dry:
When you have been doing this as long as I have, you have a memory of what happened before and with that comes certain expectations about what should be happening now. I think that is what separates the older than 55 crowd from the under 40 crowd.
We do not even have to go back to AIDS. I am thinking of the last 2 events in my career where there was exceptional involvement from the CDC. In 2018, we had the vaping crisis. In 2012 or thereabouts, we had the West Nile issue. Although that virus had been with us since 2001 here in the USA, it really exploded in the summer of 2012 in the Deep South in the USA. I will not include the 2014 Ebola problem. The CDC was very involved there but that never really had to be taken nationally, these other 2 examples did.
In both cases, there was frequent, at times weekly updating from the CDC about treatment options and guidelines. There was intense discussion of what seemed to be working and what did not. In both cases, these treatment options were obviously non-approved for these purposes by the FDA. There was a crisis, and this is what we have available, and this is how you should be using them. This is what works. This is what does not work. And this is our evidence why we feel the way we do. This was constant from the CDC in both cases.
That has simply not happened at all in COVID. Here we are 2 years into this. There is not a single shred of treatment advice from the CDC outside of the inpatient setting. Let’s face it – most antiviral efforts have to be done immediately. That would mean where I work in an outpatient setting is the golden hour. If we wait till the patients are in the hospital they are going to have much worse outcomes. The agencies are saying nothing about outpatient therapy and have put forth nothing. We have worldwide studies on fluvoxamine, ivermectin, HCQ, steroids, VIT D, VIT C, Zinc, and I am sure there are many others. We now have monoclonal AB. A question – have you ever heard Dr. Fauci discuss monoclonal AB in a positive way? If you have please show it to me.
There has been no guidance at all about any of these therapy options. There has been lots of censoring, hectoring, belittling, and confusion. It is unusual to find a physician willing to engage any of these therapies, despite some of them having overwhelming positive signals in early outpatient therapy.
There is not ONE single bullet. By now, 2 years into this we should be throwing all kinds of things at these patients – anti-virals, anti-clotting agents, anti-inflammatory agents. But we are doing nothing.
Again, our CDC has done nothing to help with this at all. NOTHING. Not only the CDC. In previous events, there was treatment advice flowing from medical schools around the country. CRICKETS.
We have gone all in on the vaccine approach and have done so from the beginning.
Now, the bill is due. My office is literally flooding with vaxxed and boosted patients that are very ill. We are in a precarious situation with the hospitals of America. They are in much worse shape employee-wise than many Americans would dare dream.
I feel all alone. I feel it is my sworn job to keep as many of these people safe and out of the hospital as possible. But there is literally no help from the CDC at all VAX VAX VAX. Here is the problem – about 85% of these patients in my practice that are now positive and getting sicker by the day are already VAXED Many of them boostered. We are in the middle of a crisis with the hospitals – and we simply cannot fill them up the way we have.
Hyping of Way Too Preliminary Report of Omicron Bronchial Replication
This finding is being hyped in the mainstream media, such as Reuters, as if Omicron won’t take hold in the lungs and will nicely and courteously stay up in your bronchial passages:
Help me. It typically takes five to seven days from symptom onset for Covid to produce viral pneumonia, in cases where it advances that far. The NHS indicates that the most rapid onset of garden variety pneumonia is 24 to 48 hours, with several days more common, strongly implying that 24 hours is bleeding edge.
Thus concluding anything about possible disease evolution at 24 hours for pathogen that normally takes well over a week after exposure to get really ugly (recall symptom onset averages 5 days after exposure) is quite a stretch.
GM was also skeptical and pointed out that Delta was hard to make behave in vitro and that may be true of Omicron, further complicating reaching early conclusions:
They found greatly increased replication in bronchus cells but reduced replication in lower lung tissue.
And now the narrative is that it is becoming an URT [upper respiratory tract] infection.
But this makes no sense — in the same plot they have Delta showing the same pattern, and Delta was more severe than WT [wild type], not less, and this is what every study finds, so it’s not even controversial.
And they tested this only up to 48 hours, but that is not how this works in actual human bodies — it starts as an URT infection then moves further down. So if you have 70 times more virus in the middle lung, you should be seeding a lot more of it in the lower lung, even if it replicates a bit less there, and the net effect is negative…
Everyone is in a mad rush to put out results as quickly as possible and as a result they are not even thinking how damaging putting out incomplete data with premature conclusions can be…
But there is more to this story.
Another factoid, from Vineet Menachery:
https://twitter.com/TheMenacheryLab/status/1471258680511369217
“A bit inside virology, but #omicron grows very poorly and causes very little CPE. This makes interpretation of replication data difficult since most measures are dependent on CPE based measures. Doesn’t mean that data is wrong, but magnitudes maybe a bit fuzzy.”
Menachery is someone who studied coronaviruses before the pandemic, i.e. one of the few OG coronavirus scientists and someone who knows this stuff inside out
But apparently Delta is not that easy to grow either. Yet both are hypertransmissible. So there is some major poorly understood difference between in vivo and in vitro…
Then this preprint came out too:
https://www.biorxiv.org/content/10..1101/2021.12.12.472252v1
Which is mostly yet another neutralization study, but the supplement is interesting:
https://www.biorxiv.org/content/biorxiv/early/2021/12/13/2021.12.12.472252/DC1/embed/media-1.pdf
Figure S2.
Here, they grew it up to 96 hours in VeroE6 cells.
And you see a curious thing — Delta shoots up real fast, but even WT [wild type] grows much better than Omicron, which initially goes down at from 0 to 48 and only then ramps up.
Yet it is hypertransmissible like nothing seen before…
I have no explanation nor can I square any of this (or any putative reduced virulence) with the mutations in the virus.
It’s a wait and see for the fog to disperse…
Yves Smith
Ancient Greek drug could cut COVID-19 deaths – Israeli scientist Jerusalem Post. IM Doc:
Yes – that may really work – colchicine has been an amazing all around anti-inflammatory drug for centuries. It is being used more and more for all kinds of stuff.
When I was fresh out in practice, literally a 2 liter bottle of pills could be had for pennies.
Then a few years ago – colchicine got SHKRELI’d – and it is now hundreds of dollars for 5 days.
Notice though how in Israel it is described as cheap medication –
Well – it is everywhere else in the world – but not in the USA. It was 30 years ago – but not anymore.
And about Pharma patents. Since this drug was used heavily by Henry VIIII for his gout – seriously doubt it is a patent. No – it was our own stupidity and greed that allowed the fleecing to occur. They are now slowly doing the same exact thing to insulin.
Interestingly coded language in the title of this article (not using the words vaccine, Pfizer, or BioNTech - but it's about those things)
Cumulative Analysis of Post-Authorization Adverse Event Reports of PF-07302048 (BNT162B2) Received Through 28-Feb-2021 Scribd. IM Doc’s hot take:
I really need to look this over.
This is very early in the vaccine drive ending on 2-28.
Just at a glance there were over 1200 deaths and over 2000 anaphylactic reactions…..
Amazing just how bad they have been lying.
This is devastating and is an indication of how low this could possibly go.
More than 11000 not recovered as of the date 2-28 from whatever se [side effects] they had.
I assure you no IRB [Institutional Review Board] on earth would let this see the light of day with these numbers.
I would need to get the dates, but March 1 was I am certain still in the time frame when minimal vaccines were available and were being rationed by age, etc. This makes that all the more concerning.
Re: a post about an in-hospital experience with medical personnel not using PPE appropriately,
IM Doc confirmed that this attitude is not uncommon:
I was taken aside a few weeks ago and told that my PPE was over the top and scaring patients.
I was told I was vaccinated and could not spread the virus and was protected. Just two weeks ago. I told them to go fuck themselves and the side eye continues to this day.
Administration’s Obvious Covid Flail: Officially Abdicates as Case Count Hits Record; Scientists and Press Misrepresent Data to Put Happy Face on Omicron
Forgive me for doing a cursory job on such an important and sorry set of Covid developments. But I had really intended this to be a holiday week and instead I’m up to my eyeballs in family duties. But the raw facts are so bad that to a fair degree, they speak for themselves.
It’s become painfully evident that the “follow the science” and Biden Administration campaign promise to act as the adults in the room are a sick joke. Policy all politics. Public health long ago left the barn and is now in the next county. Biden threw in the towel on Monday after having promised on the campaign trail to shut down the virus:
While constitutionally, public health is indeed a state and local responsibility, the Feds have the say over interstate commerce, and they also have many other powerful levers they can pull though their bully pulpit, data collection and dissemination, and their ability to fund nationwide programs. We’ve instead had inconsistent, often inaccurate, and actively damaging messaging (“if you are vaccinated, you are protected”; “the vaccinated can stop masking”) but also making things worse by not understanding how poor the CDC’s data is (something the agency has abjectly failed to address) made worse by officials apparently believing their own spin.
The latest is the CDC making horrendous decisions based on its own crap information. The agency admitted that its December 18 estimate, that Omicron represented 73% of all cases, was too high and the point estimate should have been 22.5%.
This CDC bad call, just like its 2020 fail on test kits, has real world implications. IM Doc had been complaining that his hospital could no longer get Regeneron when his patients were clamoring for it. He learned from his mafia that the CDC had believed its 73% Omicron estimate and based on monoclonal antibodies not being effective against Omicron, it wasn’t cost justified. IM Doc is sure some of his patients have Delta and he now can’t treat them properly.
Yet alarmingly, we are also seeing Saint Fauci and Rochelle Walenksy, despite their repeated abject failures, act as they are in running Covid policy, in defiance of Biden and the states. Fauci tried to assert authority over the airline industry during his Sunday talk show rounds by pumping for a vaccine mandate for domestic air travel. This was extremely presumptuous in light of:
The industry lobbying Congress during formal testimony for an end to masking, based on the claim that planes have super duper filtered air (yes, but what about the guy near you coughing or talking and his Covid cooties getting to you before a filter?)
Delta [the airline] petitioning for reducing vaccine quarantines to five days for the fully vaccinated…despite evidence that for Delta [the variant], and even more so for Omicron, the vaccines do little if anything to reduce spread
Many employers retreating from the >100 employee Federal vaccine mandate while it is in legal play, demonstrating they are not on board
The real possibility that the Supreme Court will overturn or restrict the employer mandate, and that could have implications for other Federal vaccine schemes
On Monday, the Administration capitulated to Delta’s request and reduced the recommended quarantine to five days, and Fauci reversed himself on a vaccine mandate for flights.
Even former Administration backers were gobsmacked. From the Financial Times:
Eric Topol, director of the Scripps Research Translational Institute in California, said: “It seems pretty chaotic. You have an announcement yesterday on isolation guidance with no data, no evidence, nothing. And this is from an administration that says it wants to stick to the science.
“Then today, we have the drastic changes to their genomic estimates. The last 24 hours show that the credibility of the agency is lower than it has been at any point during this administration.”
Topol has even more unkind words in The very bad day at the CDC, which I strongly urge you to read in full. He makes clearer than the press does the degree of the CDC’s data failure.
Scientist GM’s take on the quarantine reduction:
So now if you work in, for example, retail or fast food, your boss can force you to come back to work on Day 6, where you will proceed to infect all customers you interact with.
Also, people will die on the job because of this. How is that going to play out in practice?
You test positive, then you go through the flu-like phase of COVID. A lot of people will not at all be in any shape to come back to work on day 6, many are still really sick at that time.
But bigger problem comes later — you have come back to work, you start your shift, then the day-10 rapid deterioration kicks in, at which point you need to be in the hospital ASAP. But you just started your shift and will be fired if you leave so you try to carry on.
One hypothesis about why we no longer see people randomly dropping on the street as was the case early on on in China, Iran, Italy, etc. is that everyone is aware of COVID now and has tested positive before it gets to that point and is thus either in hospital or isolating at tome. While those people randomly dropping dead were the rapid deterioration or heart attack/stroke cases that thought they had the flu at the time nobody was aware of COVID and were thus were freely walking around.
We are about to test that hypothesis now…
P.S. This is straight up premeditated mass murder at this point
He added:
It includes HCWs [health care workers], but this is definitely not about them.
They could have been handled with a specific provision.
And that provision could have been temporary.
And it could have been to the effect of “if you test positive, you are assigned to the COVID ward, but you must absolutely not step foot in the oncology department next to the chemo patients”.
This is nothing of the sort — this is a permanent irreversible policy shift for everyone.
So from now on wherever you go to buy anything you have to be aware that the people working there might be on their Day 6…
IM Doc confirmed the management response:
The ERs and urgent cares in the affected areas are being cremated as we speak. The hospital units not so much – at least yet. You should hear some of the horror stories I am hearing from colleagues.
It has indeed now risen to the level of a public health menace.
After years of nurse mis-treatment, on top of COVID burnout, firing tons of staff over vaccine mandates – and now seeing whole units being quarantined – they see the writing on the wall.
The only one of those issues that is readily fixable is changing the quarantine time. Calling in the National Guard is simply not going to do much at all – as they are finding out the hard way right now.
So much for the whole argument that the vaccine people have had – I DO NOT WANT TO GET CARE FROM AN UNVACCINATED HCW – Well now you are going to get care from a HCW who may very well still be contagious.
This is a clusterfuck of obscene proportions. I can scarcely believe what I am seeing.
And if we are to hold Biden to his word – why would anyone listen to the CDC anymore – this is not a federal problem as of his speech today. Why is the CDC even making proclamations like this.
And he confirmed shortly that his hospital’s personnel department had sent out a “celebratory e-mail,” for those coming off the new shortened quarantine to contact their supervisor pronto since there were many open shifts.
Other news tidbits are similarly damming if you have a modicum of the backstory. The Financial Times tells us Biden’s promised 500 million home test kits are yet to materialize:
Last week, the US president announced that the federal government would respond by distributing 500m at-home tests. Speaking to reporters on Wednesday, Biden said his administration had “a bit of progress” on distributing the test kits.
In fact, the normally Democrat-friendly Vanity Fair broke the story that the Administration had nixed an October proposal of a mass home test program by Christmas. On top of that, Biden hadn’t even signed a contract when he announced his scheme; a Johns Hopkins expert said it would likely be a year before the kits were distributed.
Walensky, like Fauci, is also operating well beyond her authority. She not only fell in line with Fauci on giving in to the airlines on the length of recommended quarantines, but she also appointed herself as arbiter of broad social policies:
Neither Fauci nor Walensky were subject to any democratic approval process. Decisions about non-health impacts are none of her business and should be left to those who are supposed to be in charge. Unfortunately, there appears to be a gaping power vacuum and she’s all too willing to seize ground.
A final issue, which will get only brief treatment, is putative experts and the press are pushing every bit of Omicron hopium they can find, to the degree that they are baldly misrepresenting research….which even if the spin were accurate, should be treated with caution. We still don’t know enough about Omicron to be certain of much save its very high level of transmission and resistance to vaccines and monoclonal antibodies. As Lambert put it:
If you believe in the precautionary principle, then you don’t amplify “emerging data” where the policy implication is to do nothing.
One reader with a medical background sent a link to the hopium in question, a very small South African study where the title of the preprint, Omicron infection enhances neutralizing immunity against the Delta, flat out misrepresents what the data actually says. As GM said:
The PR spin is profoundly misleading and the opposite of what the data says, but unfortunately in this case the scientists themselves are to blame as they are pushing that narrative too.
The data shows little actual cross immunity.
I would not be surprised if Omicron burns through the whole world and then in mid-2022 it all starts again in some part of the world with a new strain….
Here is the first Delta/Omicron cross-neutralization data:
There is some cross-neutralization, but if you look at the unvaccinated subjects, half of them were below the limit of detection at the follow up. Which was two weeks after the initial presentation.
So they were infected with Omicron but are not showing appreciable neutralization against Delta.
Overall, including the vaccinated, titers went up 14.4x against Omicron, but 4.4x against Delta.
Which is touted as great protection against Delta, but it really is not, as titers are going down from there.
This might be enough to push Delta down in the short term, though it will not be a fast displacement into oblivion.
But it will do nothing against future variants a year from now.
And yet what does the abstract of the paper say?
The increase in Delta variant neutralization in individuals 39 infected with Omicron may result in decreased ability of Delta to re-infect those individuals. Along with emerging data indicating that Omicron, at this time in the pandemic, is less pathogenic than Delta, such an outcome may have positive implications in terms of decreasing the Covid-19 burden 42 of severe disease
Which fits well with a very disturbing trend over the last few weeks — most of the top scientists in South Africa have come out in support of the governmental policy of abdicating completely from infection control and have given statements in the spirit of “Omicron is mild and will end the pandemic”.
I have no information of why that is being done, but the suspicions are obvious and natural — this has all the hallmarks of political pressure from on top.
Because those people do/should know better scientifically.
And even if the “mild” narrative were true (the UK’s Imperial College is not on board, and the UK, between having an actual national public health service plus regular surveys of 100,000 people, has some of the best Covid data in the world), that is not necessarily good news. It appears if anything that more are getting symptomatic Omicron than Delta. In particular, note the relatively high level of symptomatic Omicron in children and young adults who have robust immune systems and showed a much lower level of symptomatic cases under Delta…and this with much more of the population, even young adults and teens, vaccinated than before.
The reason for concern is that a new, reasonable size study (n>500) found that 67% of those who had mild to moderate Covid developed long Covid. There’s no reason to think Omicron will be more forgiving.
Yet the CDC keeps digging its hole even deeper:
The Administration can barely keep up its pretense of being in the business of protecting the public. Every man is now on his own, at least in the US.
First of all – what are we doing allowing a surgery center to be owned by a personal injury attorney?
That is almost as bad an ethical lapse as Dr. Fauci’s own wife being the head of Ethics at the NIH. Unfortunately, that is true.
There was a time and day not that long ago when medical ethics meant something. Neither one of the above scenarios would have even gotten close to being implemented.
The other thing I would say is how frequent it is in my professional life for spine surgeons to be cesspools of unethical behavior. There is all kinds of unethical things going on in medicine these days – but when something is really bad, there is a higher chance it is a spine surgeon.
This kind of stuff pains me.