temporaryreality

Grandmother's "Rum Pot"

2023-06-04T17:51:21Z

Ever so long ago, I promised @sdi that I'd translate and post a recipe I obtained while living in Germany. There must be an equivalent term in English for "Rumtopf" but since I'm not much of an imbiber of alcohol, I don't know what it is - maybe a liqueur?

Without further ado (and with my comments in parentheses),

Großmutters Rumtopf

Ingredients: rum, fruit, sugar

The recipe collects fruit from spring through fall, with the additional ingredients, in a stoneware crock with a lid.

The following fruits are not suitable: apples, black currants, blueberries, blackberries (no reason given in the original).

Use only unblemished ripe fruit. One batch (original says “layer” – I’m not sure what’s intended, so went with “batch”. 10/30/23 comment: actually, I think layer is correct as you do add fruit layer by layer, apparently about 6 weeks apart) needs about six weeks to mature. Before refilling, stir with a clean spoon (this suggests that you can add fruit as you go along).

To prepare:

Rumtopf begins with the first summer fruit: strawberries.

Wash, drain (original says “dry”) and weigh strawberries and place in a bowl. Add half their weight in sugar. Let it sit for an hour and then add it to the stoneware crock (called “the rumpot”). Add enough rum (descriptions says it should be “54%” which I guess refers to the proof) so that the strawberries are covered to a fingerwidth. (Here begins the mixing metric and imperial measurements, which is amusing) So, you’ll need about .7 liters for every pound of fruit and half pound of sugar.

Close the crock and set in a cool place. Check periodically to confirm there is still enough liquid (always a fingerwidth above the fruit).

As soon as the next seasonal fruit is ripe, proceed as with the strawberries, but adding only about .2 liters of rum per pound of fruit.

Rumtopf calendar (obviously for the Northern Hemisphere)

May/June: .5 kg strawberries + .25 kg sugar + .75 liter rum

June/July: 1 kg unpitted sour cherries (pie cherries) + .5 kg sugar + .4 liter rum

July/Aug: .5 kg each of apricots and peaches + .5 kg sugar + .4 liter rum.

Aug/Sep: .5 kg plums (particularly Mirabelle – a yellow variety)+ .5 kg raspberries + .5 kg sugar + .4 liter rum

Sep/Oct: .5 kg pear (peeled, cored, and sliced) + .25 kg sugar + .2 liter rum

Oct/Nov: at the latest, four weeks after the last fruit has been added, add half a bottle of rum (no quantity given. How big is a bottle?)

Let the Rumtopf sit for a few days.

Nov/Dec: Now you can enjoy the Rumtopf!

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IM doc pt 36

2022-04-25T19:09:37Z

IM Doc posts/comments for March 2022.

Naked Capitalism ran this post on March 3rd. Here, IM Doc is quoted and he comments in the section below.: https://www.nakedcapitalism.com/2022/03/pfizer-february-2021-post-marketing-vaccine-side-effects-tally-raises-alarms.html. Although it's long, I'm just going to copy the whole thing here.

The topic is the Pfizer document with the extremely long list of adverse events they were prompted to look for during the course of the study. There seemed to be a fair amount of debate on the ecosophia site over whether this list was actual adverse events or a list of things frequently associated with vaccines in general that should be monitored in this case.

IM Doc seems to feel that this is not just a generic list but actually a list of reactions and results that for some reason were on the radar for this particular Pfizer cocktail.

I thought it was useful to include the entirety of the comments section to get a sense of the conversation.

Pfizer February 2021 “Post Marketing” Vaccine Side Effects Tally Raises Alarms

Posted on March 3, 2022 by Yves Smith

We are late to turn to a critical document obtained by FOIA by the Public Health and Medical Professionals for Transparency Documents. Called 5.3.6 Cumulative analysis of post-authorization adverse event reports of pf-07302048 (bnt162b2) received through 28-feb-2021. The publication of what ought to be regarded as an explosive revelation of the range and frequency of its Covid vaccine side effects has gotten barely any notice, even on Twitter. We’ve posted the document in full at the end of this post for your inspection.

Unfortunately, it’s impossible to reach any definitive conclusions about this information because it isn’t a Phase IV clinical trial, where participants trials are tracked to capture any adverse effects that occur over an intermediate period of time. Instead, this report is based on a hodge-podge of voluntary reports into various systems across 63 countries, with the overwhelming majority coming from the US and UK, from December 1, 2020 through February 28, 2021. I find putting the start as of December 1 misleading, since the first shots in the US were administered starting December 14, 2020. So you wouldn’t even start to see what happens after a full two-shot regime until end of December, which means this is effectively two, not three, months of data

Aside from side effect information not being gathered systematically and to a consistent standard, an even bigger problem is the lack of data about the denominator, the number and mix of vaccinated subjects. The lack of information about the underlying population means it’s impossible to determine the rate of these side effects. Recall that the initial rollout gave priority to the elderly, to at risk groups, and to medical workers. One of the things you’ll notice right away is that the side effects are far more common among women:

The fact that the reports don’t even capture the gender of 7% of the respondents tells you how casual and haphazard an exercise this was. Even so, at least 71% of the total is female. Is this because the underlying population was heavily female due to overrepresenting the aged (women live longer than men) and medical workers (nursing and housekeeping staff are typically women and outnumber doctors, who skew male)? Or because one of the common side effects is the triggering or intensification of autoimmune diseases, and women are more prone to them? Or both?

However, some who took an early look at the document discredited themselves by not bothering to understand its huge limits, and naively or disingenuously making claims about supposedly horribly high levels of bad outcomes among pregnant women, when there was no information whatsoever about how many pregnant women were vaccinated. Without that number, you can’t determine if those results were any worse than for a control of unvaccinated pregnant women.

Due to this document being released pursuant to the Emergency Use Authorization, as opposed to a typical drug approval process, I’m not sure what if any standards governed its production. Readers who know the ins and outs of FDA regulations are very much encouraged to pipe up. The commentary from Reuters at the end of January wasn’t terribly enlightening:

The document was submitted by Pfizer-BioNTech as part of its Biological License Application (BLA) to the U.S. Federal Drug Administration (FDA), Alison Hunt, an FDA Press Officer told Reuters via email.
The BLA is a request for permission to introduce or distribute a new biologic product across states ( here ). The FDA reviews the information in the BLA “to make sure the vaccine is safe and effective and meets the FDA’s standards for approval.” ( here )

This large number of reports comes despite the fact that, as Pfizer blandly warns using boilerplate language, the number of side effects is almost certainly understated:

Reports are submitted voluntarily, and the magnitude of underreporting is unknown…
Among adverse event reports received into the Pfizer safety database during the cumulative period, only those having a complete workflow cycle in the safety database (meaning they progressed to Distribution or Closed workflow status) are included in the monthly SMSR. This approach prevents the inclusion of cases that are not fully processed hence not accurately reflecting final information. Due to the large numbers of spontaneous adverse event reports received for the product, the MAH has prioritised the processing of serious cases, in order to meet expedited regulatory reporting timelines and ensure these reports are available for signal detection and evaluation activity. The increased volume of reports has not impacted case processing for serious reports, and compliance metrics continue to be monitored weekly with prompt action taken as needed to maintain compliance with expedited reporting obligations.

Pfizer also points out that the reporting of an adverse event does not establish causality, as in that the jab was necessarily responsible.

Nevertheless, as IM Doc said:

This is a post marketing document.
in normal times, this would be in the Phase IV period. I have no idea how this is done for an EUA.
These are apparently side effects reported after the vaccines were rolled out.
No wonder they wanted to bury this.
OMG even my cynical self is whomperjawed. I have quite frankly never seen anything like this in all my years of IRB [Institutional Review Board] work. This is absolutely unprecedented.
Please look at starting at page 30. The list is overwhelming. Something about this tells me someone should be going to jail.
It is vindication for all the months I have been questioning my sanity. Having these happening to patients all the while the media and colleagues screaming about 100% safety. This is not the vindication I wanted though. This is just plain sad.

To provide further evidence that the adverse events are undercounted, menstrual period irregularities and post menopausal bleeding are not listed. The only female reproductive plumbing issue listed is “premature menopause”. Doctors tend to downplay menstrual cycle issues, since they can be affected by stress, weight loss, and intense exercise. But a subset of women is hyper regular and changes tell them something is amiss. Other I know first or second hand report extreme change, such as going from four to five days of flow to only one and remaining there.

Even though female non-fertility is treated less seriously that female fertility, period/bleeding among menopausal women is particularly troubling, since it can be a sign of cancer. I’ve had that side effect, three times, along with PMS bloating worse than I ever had in my youth. My sonogram at the top lists the bleeding as triggered by the vaccine, which means is it considered uncontroversial in NYC to link the vaccines to the resumption of periods. My doctor was sufficiently alarmed that she wanted me scraped out pronto. So I am having to have a medical procedure due to having gotten a jab. Yet if I understand Pfizer’s categorization correctly, they would deem a case like mine to be “non-serious”.

It’s bad enough to see a significant category of side effects omitted. But on top of that, no one is tracking whether cases Covid-vaccine-induced post-menopausal bleeding have a higher incidence of cancer than typical instances of post-menopausal bleeding bleeding.

emergent systems and oscillations toward equilibrium(s)

2022-02-26T18:18:46Z

"The things that affect a living organism's functioning, and the responses it makes, cover a very broad range....Physicist Friedeman Kaiser notes, 'The type of the external stimulus is irrelevant...It is the information contained in the signal that is significant.'

Thus it is the information, the meaning encoded, within the perturbation, that is important, not the form in which it is delivered. The form is merely one possible language of communication out of myriad possibilities. In the end it is the meaning inside the behavior that is significant, not the behavior itself. It is not the chemical released, nor the movement of the body, nor the electromagnetic field that is important, but the information, the meaning, that it carries.

And for too long scientists have assumed there is no meaning in Nature. As a result, they have spent their time studying static, dead forms, when the communications of meaning themselves are the essential thing."

--Stephen Harrod Buhner, The Secret Teachings of Plants: The Intelligence of the Heart in the Direct Perception of Nature, pp. 43-44.

I've been commenting here and there about my recent experience with Covid - and how I could tell there was some meaning involved, being expressed between the virus and my body. On a conscious level I've made a few guesses, but honestly I have no idea what the meaning is - I can only sense that it's there.

So, I'd like to keep in the front of my mind the fact that my mind is not necessarily always an important player in the meaning-making. There's much going on on cellular and chemical and energetic levels (and more).* When this is looked at from a Big Timeline perspective (not exactly deep time, but the timeframe of Earth's livingness and on a planetary scale), the meaning will be expressing itself over centuries and across populations. I am but a singular biological cell in a larger living pattern. I shall keep from being surprised that I don't know the meaning of this particular perturbation.

____
* Here's a theory - as @sdi pointed out in a private message, there's been observation of a state of acedia accompanying covid infection. Perhaps the meaningness that'll be played out will be a species-wide decrease in busy-body-ness, and in the kind of viral-mindset we call productivity. I admit that in a lot of ways this culture already looks listless, diffused, and wasted, but what if the viral changes modify our equally-present social compunction to manipulate the world and tally marks on spreadsheets as evidence of "doing something"? In the long run, natural systems might breathe a little sigh of relief if we can't "be bothered" to reignite the drive toward economic growth (not to mention the difficulty of doing that post resource draw-down). Anyway, this is pure speculation, don't trust it too far - it just points to some of the ways this two-plus-year experiment in viral spread and social upheaval might play out.

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This passes for political humor?

2022-02-05T05:44:41Z

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the "lower level" of society

2022-01-13T22:02:10Z

I'm editing a text on Chinese government and policy relative to rural needs. This paragraph stood out to me and raised some questions and stirred some ponderings on what we value and how it plays out in the US (text contains my emphasis, with the thought-stirring phrases numbered for ease of making a brief commentary). Nothing particularly profound, just the sheer obviousness of how head-on-backward we are:

On the one hand, from a long-term and comprehensive perspective, [1] peasants, as lower strata of society, will benefit less and less from modernization, becoming more discontent on a psychological level. It is unlikely that their income will increase significantly in the near future, that ordinary villages will urbanize, or that the overwhelming majority of peasants will become urbanites. Under conditions where it is difficult for the peasant economy to modernize, it is an empirical fact that [2] the standard of living for Chinese peasants will freeze at a level of mere subsistence. In other words, [3] the common condition throughout contemporary rural China, where people “have enough food to eat but are not yet moderately prosperous,” will continue for years into the future. However, [4] current high-consumption lifestyles have come to dominate the whole society’s values, stimulating peasants’ desire to consume, while the “poverty-generating” socioeconomic structure lacks the conditions of domestic demand necessary to satisfy this desire, creating a very contradictory tension.

[1] - what if, instead of considering them "lower," we considered "primary producers" as foundational? Here I mean not just "peasants," which are hard to come by in North America, but agriculturalists, animal-husbandry-folk, makers of food and fiber, and building materials and tools, etc.... all the actual literal producers. Not that we see these people and their roles the same way they're viewed in China, but we certainly don't accord them the important social place they and their contribution deserve. Imagine if these activities, for which we all owe our lives and comfort, were promoted/celebrated/supported (and if we were educated to join in actual production rather than the simulated productivity that's promoted in its stead).

If the producers benefit "less and less from modernization," then don't we all ultimately benefit less and less? Modernity, it seems cannot support life if this is the case.

That said, [2] the standard of living "freezing" for the producers of real goods and services is evidence of the absolute backwardness of the way we do things.

Consider this in terms of the general US populace (because ultimately I am critiquing the US way of doing things) - the common (and becoming more common) condition for many to not have enough food while many do have food and prosperity; we're living in a time of both abundance and deficiency. This is mostly because of [3] high consumption lifestyles that "dominate the whole society's values," stimulate the desire to consume, and the "need" for higher income, etc.

So, what's wrong with living on a subsistence level (with some bit of resilience worked in, so you're not one step away from starvation). Remind me why we are marketing ourselves into a consumption frenzy (other than to enrich some at the expense of others). To fill some sort of deep need that ultimately can't be filled by acquisition but that can most probably be filled by activities of foundational production and the meaning such activity generates - were we to actually accord it honor.

(edited to take care of typeface confusion, and to clarify a few sentences)

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finding a way through

2022-01-05T21:46:29Z

(cross-posted on JMG's open Covid post)

In post #6 (https://ecosophia.dreamwidth.org/165100.html?thread=23918572#cmt23918572), erika talks about the decades of training individual members of our society/ies have been subjected to that have restructured not only our brains, our responses, and our ability to manage complexity, but also our subtle bodies as well as our collective reality. Leading to (and being continued by) what's going on now.

She mentions the numerical thinking, the quantification of juicy biological and spiritual/mental/astral/etheric life.

I assume that ultimately none of this comes as news to anyone here but I thought I'd still think out loud on and invite a continuation of erika's topic because of its relation to the ways we think, the ways we respond, and the ways we think we can respond to this digital mass hysteria clickbait age.

Here's this thread where it's also discussed: https://ecosophia.dreamwidth.org/165100.html?thread=23945196#cmt23945196

How do we find our "forest passage" when we've inherited a world we're told has no such passages? One in which the literal forests are themselves damaged and inaccessible to us?

This year I'm learning more German and in a moment of weakness the other day, I downloaded duolingo and watched how I interacted with it. The "placement test" was fun - I answered question after question, and was pleased at having retained some semblance of language proficiency after a few years of not really working on it... and then I got scored and plopped somewhere in the "learning track." At that point things went downhill and I was able to observe how.

But first a digression or two. Late in December I could feel my tension and frustration with all of this mess just rising - commensurate with reading these threads, clicking on their various links, watching the insurmountability of changing the groundswell toward unwholesome/unholy things. You know, just the ick, and the cloyingness of the ick, and how it FEELS, in spite of THIS SPACE being what it is.

And then, I found myself thinking once more (because I do think about this periodically) about my mindless-moments' scrolling through craft patterns online, or looking at pinterest images or whatnot.

And of course there's all sorts of info out there about how the online world triggers chemical reactions and dopamine rushes in our brains. Click...ahhh....click....ahhh - the rollercoaster of false gratification on some neurological unconscious level.

Yesterday I went to study German at my allotted time but instead of turning (as had been my wont in the month or two previous) to my books, and the text I'm learning by heart, I popped onto duolingo and found myself revisiting "Ja" and "Nein" and "Hallo" so that I could earn some sort of weird gem-reward and accompanying mocking praise from code dressed as animated characters who DO NOT CARE; and I jumped up the "leaderboard" for having learned nothing but only clicked and typed things I already know.

And I kept going. The room grew dark and I lulled myself into thinking "I'm doing my German."

I'm not even much of a TV or movie watcher (I'll sit down with my daughter to watch shows now and then, but more as a way to sit WITH her and share and discuss the thing). And I'm not really a social-media user (excepting one fake fb account with which I can stay apprised of mimeograph groups and users' projects). But the machine-world has infiltrated so much.

Yesterday, too, my daughter mentioned a conversation she'd had with a friend about children watching TV. She later went online to look up one that was mentioned and she found reports of toddlers becoming functionally addicted to one show in particular. Here are some quotes from the thread she found:

The most epic meltdown we had was while shutting off the show to get her ready for her bath, it was on another level. I said right there and then that the show is banned in the house. I wasn’t fully subscribed to what some of the other posters had said about the show before that but I got it after that.

My 16 month old quit [name of show] cold turkey 2 weeks ago, and has only had a few severe cravings since then.

We noticed she stopped playing and would just stare at the back tv screen waiting for [it] to come on.

Now she only watches [name of show]. Half the time she'll go play while the tv is on, or sit with me and play/try to eat a board book while watching.

I had to do this with my little guy too and I swear he had withdrawals like someone on crack. He would stare at the black screen and cry. He cried for probably 2 weeks straight before it got better. My pediatrician said he was delayed in speech and that’s when I cut out screen time. I knew that was it.

I was floored to read posts from so many parents commenting that [name of show] was addictive and terrible but then they let their tiny kid watch [name of other show] that is somehow better. These kids are plugged in and programmed.

We're all plugged in and programmed and we're continuing to do it on a society-wide level across all ages.

Here, today, I've been working (on the computer) and drafting up this post (on the computer). Of course later I'll get offline and do Real Things, but will it be enough? I don't know.

Every moment requires navigation through forest and machine-lined passages.

We have to create more forest (literal and otherwise).

I don't have a prescription or a list of options (still trying to figure out how to unchain my ways of thinking of what's possible) other than (for myself) to continue to cultivate awareness of machine-life within me, of the ways I fall back into it, of the small seeds and tiny germinating presences I'd like to carry forward instead. Of the soft duff of the path I prefer rather than the rhythmic tramp through paved-worlds in unison with all the other trained target-audience members.

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Have courage in the face of these trials

2021-12-26T23:11:57Z

What I wrote to DenG when he bemoaned the paltry number of colleagues who resisted injection:

Do not be discouraged. At every moment each incarnated soul is diving and surfacing, diving and surfacing. Each breath at the surface gives vitality to commit to the difficult travel beneath, and each dive stirs the deeps and brings us in contact with forces beyond our puny human conceptualizations. How frightening for most.

There is no knowing the effect of your ripples, as you dove deep and found something to hold to of virtue and value and integrity; but that you don't SEE those ripples in obvious form doesn't mean they aren't there.

This is a long game - way longer than just 2020-2022, or this decade, or century. Each act of virtue and valor is important, is creative and sacred. Each act is necessary and not easy to pull off, all things considered and knowing humanity.

Thank you for taking a stand for good when it was not the easy way. May we all be guided so.

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IM Doc pt 29

2021-12-19T19:32:21Z

I'm putting all of October in one post because the first half of the month had fewer comments than in other two-week periods.

Cuibono

October 2, 2021 at 9:50 pm

where did IM Doc disappear to? Miss his commentary

Yves SmithOctober 3, 2021 at 8:14 pm
He’s overwhelmed with cases. Fewer than the earlier peak but tons of staff have quit.

Vaccination by region:

Coercion works? As exhortation, Biden’s speech had no impact at all.

IM DocOctober 6, 2021 at 2:24 pm

A quick question about the vaccination graph above?

Does that graph represent total doses given or is it actually reflective of the hesitant unvaccinated being vaccinated?

The way I am reading it – it appears that it is total doses given.

Accordingly, I would not be betting so hard that the mandates/coercion are working to a great degree – the spikes may represent nothing more than large numbers of people getting their boosters. I wish there was a way to tell the difference.

In my neck of the woods – we have had large crowds showing up at the recently opened booster stations – and also large numbers of younger people walking off their jobs mandating vaccines and immediately being hired at places where they are not being mandated. In my community – we are now watching many of these companies mandating vaccinations begin to flail badly. It appears to me that outlets of the multi-national corporations are really having staffing problems in a big way – while the local small businesses with no mandates are having a much better time with their staff. Multiple fast food places are now open only 3-4 days a week for instance. I have no problem with this – it is has been the exact opposite for most of the last year. My family and I avoid multinational corporation retail and restaurants like the plague anyway.

Again – I am not sure what the vaccination graph is actually telling us — boosters or deplorables?

Lambert StretherOctober 6, 2021 at 2:40 pm
> Accordingly, I would not be betting so hard that the mandates/coercion are working to a great degree – the spikes may represent nothing more than large numbers of people getting their boosters. I wish there was a way to tell the difference.
It is total doses. I’m not sure we have the data to distinguish deplorables from boosters, so good point. I will say there hasn’t been a whole lot of messaging on boosters, and on the company mandates we have a lot of anecdotes.
Adding, I did put a question mark after “coercion works”. And you can be sure that’s how the powers that be will spin it, as in the FT’s editorial on “enlightened docility” yesterday.

“Covid-19 booster shots have outpaced the US rate of new vaccinations. And the millions still unvaccinated could trigger ‘future waves,’ expert warns” [CNN]. “[W]ith the number of Americans getting booster shots surpassing those who are initiating vaccination, experts warn more is needed to continue the progress…. An average of 384,963 booster vaccine doses are being given daily, while roughly 281,303 people are getting their first dose every day and about 292,927 people are becoming fully vaccinated each day, according to Wednesday’s CDC data.” • So IM Doc was, unsurprisingly, correct to draw attention to how mixed this data is. I looked at the CDC page with this data, and there’s no time element which is what I want. Perhaps I can use this tool, which allows different visualizations to be created. I wish there were a FRED for Covid data…

56.1% of the US is fully vaccinated (mediocre by world standards, being just below Czech Republic, and just above Saudi Arabia). We are back to the stately 0.1% rise per day. I would bet that the stately rise = word of mouth from actual cases. However, as readers point out, every day those vaccinated become less protected, especially the earliest. So we are trying to outrun the virus… (I have also not said, because it’s too obvious, that if by Bubba we mean The South, then Bubba has done pretty well.)

White House on vaccine requirements generally:

Vaccination requirements work. They drive up vaccination rates, which makes our communities and schools safer, along with strengthening our economic recovery. Vaccine requirements are widely supported, proven successful, and quickly becoming the standard across the country. pic.twitter.com/qo1swxjbYg
— The White House (@WhiteHouse) October 7, 2021

RE: Patient, Donor Denied Kidney Transplant Surgery Over Being Unvaccinated CBS. Good precedent. I assume this is but the first item on a developing checklist of what other conditions people can be denied care for, thereby strengthening the reach of Rule #2. Say, gout? Perforated septum?

IM DocOctober 8, 2021 at 1:43 pm

I will add a couple of things –

I am horrified by this decision. It is not surprising however. The entire transplant realm in medicine is manned by some of the worst of the narcissist jerks. In brief, it is not that they do not know how to use a moral compass, they do not even have one.

As a medical ethics professor for decades and one who has taken care of countless recipients of kidney transplants, the moral reasoning is just simply hogwash. Their main line of reasoning in this case is that she is going to be on immunocompromising meds, which are dangerous, and obviously she does not have the ability to “follow directions” in something simple like a vaccine. Furthermore, the meds may put her at risk for COVID ( although there are plenty of folks I know who are quite certain that the dreaded COVID storm may be mitigated by many of these transplant meds).

The entire framework of their whole argument will fall to the ground with a simple trip to a renal transplant ward in any academic center. I would say more than 2/3 of the patients are morbidly obese diabetics whose years of self-abuse have led to the transplant in the first place. It has also been my experience that the abuse continues on after the transplant with even more Cheetos and Ding Dongs. What I am trying to say is these transplant patients for the most part, have destroyed their own bodies BY THEIR OWN DECISIONS IN LIFE. And they have no regard going forward that they are destroying their new kidneys. But yet somehow things are different for a patient balking on a COVID vaccine? And the decisions made by these diabetics are not just as pertient?

This whole framework is unsustainable. I get headaches trying to follow the pretzel-reasoning these people are putting my profession through. Again – as I have said many times before – this is not going to end well for medicine.

antidlcOctober 8, 2021 at 2:14 pm

I would say more than 2/3 of the patients are morbidly obese diabetics whose years of self-abuse have led to the transplant in the first place. It has also been my experience that the abuse continues on after the transplant with even more Cheetos and Ding Dongs. What I am trying to say is these transplant patients for the most part, have destroyed their own bodies BY THEIR OWN DECISIONS IN LIFE. And they have no regard going forward that they are destroying their new kidneys.

How many of them eat unhealthy foods because they are depressed?

IM DocOctober 8, 2021 at 3:14 pm
I admit that came out much harsher than I had intended.
After reflection – I would add – that not only are these diabetic patients suffering from their own decisions – they are also suffering from the bad decisions of years of Big Ag that have destroyed these people with high fructose corn syrup and the like – while medicine and public health have turned their cheeks the other way.

Raymond SimOctober 8, 2021 at 4:38 pm

“I admit that came out much harsher than I had intended.”

Lol, I hear that happens to people sometimes.

But it was informative for me. My first thought was “Omg, don’t let the neolibs know, they’ll cut everybody off.” But of course that would depend on who profits. Is treating renal failure lucrative for big healthcare?

IM DocOctober 8, 2021 at 5:47 pm
The top 2 “profit centers” in medicine are cardiology and oncology.
Renal disease/dialysis is #3 closely followed by GI at $4 (those colonoscopies are not cheap after all).
Most people do not realize that by federal law the instant someone is on chronic maintenance dialysis they are covered by Medicare. The insurance companies have nothing to do with chronic dialysis. At about 1500 dollars a pop multiplied by tens or hundreds of thousands across the country daily – and you get the picture really quick.

RE one of these links (I'm not sure which):

Employment Situation: “United States Non Farm Payrolls” [Trading Economics]. “The US economy added a meager 194K jobs in September, of 2021, the lowest so far this year and well below forecasts of 500K. Job gains occurred in leisure and hospitality (74K), professional and business services (60K), retail trade (56K), and transportation and warehousing (47K). Meanwhile, employment declined sharply in public education (-161K) and in health care (-18K).” • Interesting that “essential workers” in health care and education would leave the workforce. I wonder why? Some angst over this one:’

oof
— Felix Salmon (@felixsalmon) October 8, 2021

Weisenthal comments:

The number is out and it’s another big miss. Just 194,000 jobs created in the month, less than the 500,000 consensus estimate.
However, the unemployment rate fell to 4.8%. Combined, these two numbers tell a story of slow hiring and seemingly tight labor markets at the same time.
Despite persistent frustration among employers that the labor market is “tight” (from their perspective), we’re still millions of jobs in the hole relative to where we likely would have been at this point in the absence of the pandemic.

Employment Situation: “United States Unemployment Rate” [Trading Economics]. “The US unemployment rate dropped to 4.8 percent in September 2021, from 5.2 percent in the previous month and below market expectations of 5.1 percent. It was the lowest rate since March 2020, as many people left the labor force and the negative effects of Hurricane Ida and the Delta variant’s summer spike started to fade. Still, the jobless rate remained well above the pre-crisis level of about 3.5 percent due to ongoing labor shortages but is seen declining further in the coming months as companies fill widespread vacancies and as more workers are expected to go back into the labor force.” • “Are expected” lacks agency…

IM DocOctober 8, 2021 at 2:36 pm

About the labor statistics numbers and the big miss from today.

I am a physician – I am not an accountant nor am I an economist – so I have no special expertise in sussing out these numbers.

However, I feel that I have enough background to comment on my own little world of health care.

I wonder how much the ongoing retirement of the boomers is playing a role here?

The first big picture – if you go back through all these numbers since JAN of 2020 when the pandemic was in utero – this country’s loss of jobs in the health care sector for that whole time is now approaching half a million. Those of us who work in the hospitals and clinics are very acutely aware of this situation, believe me. Let me get this straight, DURING A WORLD WIDE PANDEMIC WHICH HAS NOW KILLED 700K AMERICANS, OUR HEALTH CARE SECTOR HAS LET GO OF HALF A MILLION JOBS? And if one looks at the more granular data – the vast majority of these jobs have been front line nurses, CNAs, and nursing home workers and the like – NOT THE ADMINISTRATORS……

Is there something I am missing here? I just find that whole situation appalling. And now when the screws are really tight we have just no more capacity to lose more. And that is the time our dear leaders have decided to play the mandate card.

Which brings me to the apparent 18000 health care jobs that were lost in SEP 2021 alone. Again – looking at the details – these are front line health care workers for the most part. And I know from personal experience and the scuttlebutt from many others that this is absolutely related to the pending vaccine mandates. This is only going to get worse. Many of our facilities across the country are already in dire straits. And this number was actually quite shocking today.

And yet – you have Nicole Wallace and others during the Biden speech coverage yesterday stating that the mandates are working spectacularly – that all is perfect and going according to plan. Americans are showing the courage not to leave their jobs and keep supporting the family.

Hmmmmm.

I feel obligated to put forth a PSA. In my area, there is a large nursing home run by the hospital and led by MDs and RNs. There is another closeby run by a multi-national corporation and run by MBAs. The MBA nursing home got the edict from HQ that all employees must be vaccinated by OCT 1 – and promptly lost 18 front line staff in one week. The hospital nursing home run by MDs told their employees not to worry right now – no one would be fired until this had all played out in the courts. All these fired CNAs et al easily found jobs in the community. They are not suffering. Who is suffering? The little old people in that nursing home and their families – it has quickly turned into a complete disaster.

LISTEN WELL – IF YOU HAVE FAMILY MEMBERS IN A NURSING HOME SITUATION or PLANNING TO PUT THEM THERE RIGHT NOW – YOU NEED TO BE VERY CAREFUL ABOUT HOW THE PLACE IS STAFFED. I CANNOT STRESS THIS ENOUGH. MANY OF THESE PLACES WHICH WERE ALREADY VERY DYSFUNCTIONAL ARE TURNING INTO DISASTER AREAS ALL OVER THE COUNTRY. I DO NOT CARE WHAT NICOLE WALLACE HAS TO SAY ABOUT IT – IT IS A PATIENT SAFETY ISSUE AT THIS POINT. YOU NEED TO BE KEEPING AN EAGLE EYE ON YOUR LOVED ONES.

I am not sure I have ever seen such a bigger own-goal by national politicians as what this one is turning out to be. And that is just the health care aspect of it. All the crap talk by the talking heads exhorting the wondrous decision is not going to change the actual events on the ground. Nursing homes and lots of hospitals are headed for big trouble.

IM DocOctober 15, 2021 at 11:41 am
I always like to point out that the very phrase –
AFFORDABLE HEALTH CARE –
Is an absolute slap in the face to anyone with 2 firing neurons and a moral compass. Not even Orwellian. And the neoliberal corporatists like Pelosi and Romney throw that name around as if it is a good and moral thing.

IM DocOctober 16, 2021 at 9:42 am

About the National Guard being called into various states to man the rehab and nursing homes, urgent care centers and hospitals…..This is even happening right now in my own area.

This is having to be done for 2 main reasons. The employees in the medical realm are just simply exhausted and depressed and are leaving for that reason. And also in many places, those who are left are being fired as part of a vaccine mandate.

FUN FACT – Did you know that a good number if not most of the National Guard troops being called out to fill these positions are actually UNVACCINATED? Oh yes – it is true. I thought it was just my area – but after a few phone calls to colleagues, this is happening elsewhere.

So we are firing people for being unvaccinated – and then turning right around and replacing them with the unvaccinated……to try to alleviate the emergency caused by the initial firing?

Makes sense? right?

Can someone explain to me how this has a God damned thing to do with public health?

Lambert StretherOctober 16, 2021 at 12:48 pm

To be fair, the military is one of the few institutions that continues to function (granted, not in a war-winning way, but at least they can still do logistics). Function in some other way than extracting rents from the helpless or deceived, that is.

Another one of these few institutions is the intelligence community (granted, not insofar as collecting intelligence against foreign enemies is concerned, but in terms of domestic politics, I’d say it’s doing pretty well.

Leading me to suggest that when we need to take the National Guard off nursing home duty, we could send in the spooks.

IM DocOctober 16, 2021 at 1:05 pm
The problem with this situation we are facing now is the National Guard is trained to take care of guarding the nation. The spooks are trained to be spooks. Neither skill set is going to translate into a nursing home of 90 year old demented patients.
Hilariously, one of them has had to take frequent breaks to vomit. Nursing homes have a certain odor especially in the rooms. It can at times be overwhelming. During my intern year there was a quote told to all the interns – “Breathe deep the aroma of life – let life’s beautiful smells inhabit every cell in your nostrils. But when you are at the VA – just breathe through your mouth”. Believe it or not – even that simple thing is a learned skill.
The new employees have absolutely no idea for the most part how to correctly take care of patients – especially nursing home patients. The medics among them have some clue – but watching “weekend warrior” used care salesman transporting patients safely much less changing diapers, taking care of catheters correctly or even turning people in bed correctly has been harrowing to say the least. The safety in many of these tasks is certainly not intuitive.
Again – this is not about public health. We have replaced unvaccinated employees who knew what they were doing and had been trained with unvaccinated “volunteers” who for the most part have not a clue what they are doing. My educated estimation is this is not going to go well for public or patient safety.

IM DocOctober 17, 2021 at 12:41 pm

Some of my fondest memories as a child were to sit with my father and watch the original series of Star Trek.

After viewing the new Star Trek offerings in the past few years, regrettably, I would never dream for a second of having a child sitting and watching anything having to do with Star Trek at this point. Mr. Roddenberry, who I heard speak at conventions multiple times, repeatedly stated that he was so proud of what his show had meant to America’s Children. Indeed, he must be rolling in his grave right now. I recently read that immediately before his death, he was begging on his knees for the producers to never make Deep Space Nine. Amazing, DS9 is like Captain Kangaroo to some of the fare being offered today – full of F-bombs, gore, extreme violence and angst. What I think would offend him the most is the very very dark overall atmosphere. They even managed to ruin the character of Picard for me forever. There have been episodes where unlike the optimism of Mr. Roddenberry – I just wanted to go blow my head off. At least we still have the DVDs of the old stuff which I am happily watching with my kids right now.

I would also add the the character of Dr. McCoy is one of the big reasons I am a physician.

I was at a conference recently of young physicians about COVID. One of the presentations was actually about Star Trek – and how the philosophy of that show would make it mandatory for any fans to applaud the current “science” and laud any and all efforts that Dr. Fauci was doing for viral research and how so many folks in the Pharma industry were big Star Trek fans. What a wonderful thing that Mr. Roddenberry had invented to instill a love for “science” in so many people. “Science” of course being defined in its current iteration under Pope Fauci.

It fell to me to inform this young man that he had not a clue what he was talking about. During Mr. Roddenberry’s production of the show, there were countless examples of “science” gone wrong at the hands of those who would warp it.

Indeed, just within the first 10 shows of the first season, I can find 5 examples of this extreme concern for what “science” is capable of in the wrong hands.

The most apropos for today – Season 1 Episode 8 – Miri – where the Enterprise crew finds a planet where the scientists had been doing what we would call “gain of function” research and released a virus into the populace that destroyed that world, leaving only the kids behind. It is stuffed with quotes from Dr. McCoy that I would just love to hurl at the Dr Faucis and Dr Wens of our world today.

TV shows like Star Trek-TOS and The Twilight Zone and The Outer Limits and much of the written science fiction of that era are both very dated AND simultaneously more profoundly relevant than ever. A dead giveaway that someone is hitting the nail on the head.

IM DocOctober 17, 2021 at 6:38 pm
Kirk – You will need to isolate that virus – we need to develop a vaccine.
McCoy – Is that all Captain? We do have 5 days.
________________________
McCoy – “It did not work out quite as they had planned.”
A general comment on the whole viral project on this planet – they were trying to genetically engineer an immortality virus.
__________________________
Kirk putting pressure on McCoy to develop a vaccine.
Kirk – Work faster doctor….
McCoy throws the papers on the desk – “Maybe you would like to take a crack at it…”
_______________________________
I think the most important of all is the increasing fear and panic experienced by the members of the crew as the disease got worse and worse. The landing party became infected the instant they beamed onto the planet. The increasing signs of infection were highlighted as the episode evolves – and the fear and panic are masterfully played by the actors.
_____________________
Spock and McCoy discussing the vaccine ——
McCoy – The question is what is the correct dose?
Spock – That is a very good question……It could be a beaker full of death….
____________________
Spock – The vaccine may be fatal
McCoy – The disease most certainly is…How long do you want to wait?….
And then McCoy picks up the syringe and plunges it into himself – valiantly making himself the guinea pig……
______________________
It is amazing how well they did with the social mechanics of pandemics and what happens to the collective psyche – and all in just a 50 minute show. I showed this episode and the one that immediately followed – “Dagger of the Mind” – in the Medical Ethics and History Class. Miri was informative about how people react in the setting of a rapidly progressing epidemic – and “Dagger” was a very thorough piece about involuntary commitment in the psych setting and mad doctor experimentation with unproven technology.

The Rev KevOctober 20, 2021 at 7:55 am

“Aspirin lowers risk of COVID: New findings support preliminary Israeli trial”

CNN Newsflash – ‘An unsubstantiated and unreliable Israeli study recommends people take medicine given to dogs to cure Covid. Scientists from the Centers for Disease Control and Prevention have criticized this unproven approach and have stated that this is a dangerous practice made worse by the fact that typically people ingested this animal product with dihydrogen monoxide when taking it.’

HelenaOctober 20, 2021 at 8:20 am
Am I being overly paranoid to wonder why it is suddenly dangerous for people to take low-dose aspirin? After it was found to help with COVID?
I take aspirin daily, it’s the only remedy I can tolerate for my spasticity and arthritis, and works very well. I have been doing this for years. without any problems. It seems like a bonus to find out it has COVID benefits. We are living in dubious times, IMO.
1. Yves SmithOctober 20, 2021 at 8:36 am
  IM Doc and his colleagues were super duper pissed about these stories. Hoisted from e-mail:
  This is very confusing – and really inappropriate to be putting this in a national newspaper.
  There are so many heart patients out there and their daily ASA is what is keeping their arteries open.
  There are indeed patients who should not be taking ASA – mainly those who have very malignant hypertension. In that setting it can precipitate brain bleeding. But their internist should be paying close attention to these details. ASA is no more likely to cause GI bleeding than any other NSAID – and has a much lower incidence of renal disease.
  I was informed today that our cardiologist office has been bombed with phone calls about this article – and the accompanying piece on CNN.
  This is yet another example of very very dangerous behavior on the part of the news media. They should not be breathlessly reporting these kinds of singleton research findings and they never ever discuss anything in context.

IM DocOctober 21, 2021 at 2:46 pm

About inflation……..

I was raised in a very large extended family on an ancestral family farm.

As a kid, I listened to my grandparents and uncles tell stories of what it was like in the Great Depression. As I got older, my grandfather would pound into my head multiple things that happened to him as a young man that were harbingers of the bad times to come. That was deflation. As a child myself, my family lived through the oil shock and the stagflation of the 1970s. I think all of us over 50 have living experience with this type of thing.

I will tell everyone here – my red alert signals planted by my elders deep in my brain have been going off full blast this entire year.

I am unable to procure a windshield for my late model van. At any price. There are just none available.

My neighbor’s Ford truck has been disabled since August and unusable because a small part is needed to fix it and is unavailable.

There are multiple buildings all around in various stages of building that have just been abandoned for want of supplies or supplies that are now all of a sudden prohibitively expensive. Some have clearly been left to rot.

We have kids in my kids’ school whose parents were already marginal financially whose children now just have no lunches to eat at these prices in the grocery store. And the school lunches have turned into a horrifying joke. My wife and multiple other parents are making extra for these kids every day.

We have in our part of the country seen the cost of basic staples explode in price just in the past month – sometimes at a very scary rate.

We are seeing large swaths of the local stores empty of many things. Large empty rows of things like canned vegetables, frozen vegetables, and just forget about large groups of various pre-processed foods ( our family does not eat this type of thing anyway). The sections with sodas ( yet another thing we do not use) are just empty most of the time except for the Coca Cola products which it seems everyone around my place are boycotting.

And many essentials are non-existent, for example Kerr and Ball canning products.

And like no time in my career, we in the office are having to juggle all kinds of medications and prescriptions. Many pharmaceuticals are just simply not available. Especially all the various types of long-acting insulin (Tresiba and Tuojeo are the worst), rheumatology drugs (Enbrel and Humira), asthma inhalers and many types of antibiotics.

I am somewhat comforted that my wife and I saw the writing on the wall several years ago and moved to the vast expanse of rural America. We have just procured half a cow from our neighbor for example and have on our property chickens galore and abundant eggs every day. Just like my grandparents taught me to do – we have been canning and preparing all summer. Large containers of flour and sugar are stored and ready. We are about as prepared as anyone in our family.

Yet – I never dreamed I would hear an American administration just so glibly blow off the entire situation – Psaki – “Everything is great – people are just buying a lot of stuff” and “Get over it, maybe no treadmill this year”. I just cannot believe what I am hearing. I know from talking to my patients that there are already lots of people already suffering – and this tripe is what is coming out of Washington? First we were blessed with the visage of an American president smiling with glee announcing that many millions of Americans were about to be fired – and now this? I truly no longer recognize my country. I have serious reservations that any of our leaders in either party have a clue or the will to do anything about this impeding situation.

The Rev KevOctober 24, 2021 at 9:22 am

“In Major Shift, NIH Admits Funding Risky Virus Research in Wuhan”

The National Institutes of Health & Fauci are like one of those rocks that you pry up and all sort of creepy crawlies start to scuttle their way out of the daylight. This knowledge of the NIH funding risky research in a foreign country like China is already know. But today I read about another project conducted by the NIH that was investigated by the same people that revealed the Wuhan connection and House members were shocked to discover this other research funded by them.

In this case, “Our investigators show that Fauci’s NIH division shipped part of a $375,800 grant to a lab in Tunisia to drug beagles and lock their heads in mesh cages filled with hungry sand flies so that the insects could eat them alive.” It gets better. “Some of the dogs had their vocal cords removed so scientists could work without incessant barking.” So an experiment that probably could not be conducted in the US without bringing down the wrath of all sorts of rights groups was outsourced to another country so that it would be out of sight and the NIH & Fauci would get to keep their hands clean. Link below with picture of experiment. Sometimes profanity is not enough-

https://thehill.com/changing-america/well-being/medical-advances/578086-bipartisan-legislators-demand-answers-from-fauci

ScrewballOctober 24, 2021 at 1:56 pm
Funny, nothing of this story on the CNN website when I looked a little bit ago. Curious if it made the Sunday morning shows as well since I won’t watch them, maybe someone did. I expect this to get the same treatment that so many other stories get they don’t want to talk about – nothing to see here, move along.
chrisOctober 24, 2021 at 2:54 pm
That’s atrocious. I have no idea why an IRB or ethics review would have allowed that kind of thing even if it was proposed to be done in another jurisdiction.
And yeah, I expect that kind of story to continually be in the news for middle America and absent on the coasts. If you really want to take Biden down, hamstring him by pointing out he’s surrounded by horrible people, and then force voters and viewers to see him handle stuff by himself. With someone like Fauci, he really doesn’t have an option to distance his administration from him. So making Fauci look bad is an easy way to attack the president.
1. IM DocOctober 24, 2021 at 4:15 pm
  From an IRB chairman for more than a decade –
  In general – IRB ( institutional review boards ) are only applicable to research involving HUMAN subjects. In any research, there are usually multiple animal trials early on that are not under the guidance of the IRB. Once the research makes it to patients and humans, the animal research is certainly applicable and ALL OF IT is made known to the IRB in every detail they demand.
  This type of gain-of-function research to my knowledge was never intended to be used for patient care. This was being done for viral research in a broad population manner – as in to see what we can create to kill the most humans – or what can we create that our side can vaccinate quickly, or let’s see what the enemies are doing, or let’s prepare for pandemics with this XYZ virus. Gain of function research on viruses in general is not really applicable to health or alleviating disease. I suppose a case could be made for mutating viruses for cancer therapy or somesuch but that does not appear to be what they seem to be mainly doing. As you can see, this type of thing is clearly not in the purview of a local IRB. It is also fraught with moral problems as evidenced by the actions of recent Congresses and the Obama Administration.
  It absolutely SHOULD be under the purview of the Ethics Committee at the NIH or the NIAID or whatever government agency funded the research. Obviously, it would be somewhat difficult to take to the NIH Ethics Board that which has been explicitly forbidden by Presidents and Congress alike. Of course, one has only to look at who exactly is the head of the Ethics Department at the NIH to realize that we have an enormous conflict of interest. One that I have yet to hear a peep this entire 2 years from ANY mainstream media source.
  Whether or not COVID-19 came from a lab or not, there is now available such overwhelming and incontrivertible documentation that Fauci, et al, seemed to be involved in things that were directly opposed to guidance provided from both the Executive and Legislative branches of our government that a full investigation is warranted and must be done. In Congress. In front of everyone. Look at what this virus has done. Given the toll that any novel virus could promulgate on our planet, especially one genetically altered to maximize damage, to not investigate this at this point would be a crime against humanity. Put COVID aside. It is still unclear whether COVID was a lab leak or not. But just imagine the menagerie of beasties that could be out there somewhere ready to escape.
  It is my considered opinion that we will get nowhere as a country with this pandemic until we have medical leadership that can be trusted by all Americans. With all of this going on with EcoHealth and the NIH, it is very clear to me that whatever happened, Dr. Fauci needs to be fired right now. And then a full investigation into this mess needs to be immediately convened in the US Congress.

RE: Business groups ask Biden to delay vaccine mandate until after the holidays Becker’s Hospital Review, a longer thread that I didn't want to take the time to sort out (sorry, skip whatever you feel inclined to skip) :D :

IM DocOctober 26, 2021 at 9:26 am

One has only to read the article above in the links regarding big business trying to postpone the mandates until after Christmas to realize this has nothing to do with the truth.

All the happy horse shit talk about how well the vaccine mandates are going is just that – happy horse shit. Where I am, we are seeing local outlets of the big corporations dying on the vine. It has everything to do with the mandates – I talk to these people daily. There are some local owners telling their national corporations to rot in hell.

We are firing Americans but allowing all kinds of illegals in without even testing them.

Why has the administration not had a formal filing of these mandates? Because the instant they do file, there will be lawsuits flying and the administration knows it does not have a chance.

This has nothing to do with truth, science, or public health. I simply cannot understand their purpose.

CarolinianOctober 26, 2021 at 10:38 am
What you said.
And I think the purpose is to try to “solve” Covid so that business as usual can resume. But Biden is surrounded by people who have drunk the Kool Aid on the vaccines and he himself, judging from a townhall, doesn’t even seem to know that the vaxxed can both get the disease and transmit it. To me the whole notion that this wouldn’t be a political disaster, at least, is baffling. It has to be because he and his advisers are in a bubble.
1. Katniss EverdeenOctober 26, 2021 at 12:14 pm
  I suspect covid will not be “solved” until 12/31/21 when the cdc
  ….. withdraw[s] the request to the U.S. Food and Drug Administration (FDA) for Emergency Use Authorization (EUA) [!!!] of the CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel, the assay first introduced in February 2020 for detection of SARS-CoV-2 only.
  The bad news is that the flu will be making a comeback.
  “CDC encourages laboratories to consider adoption of a multiplexed method that can facilitate detection and differentiation of SARS-CoV-2 and influenza viruses. Such assays can facilitate continued testing for both influenza and SARS-CoV-2 and can save both time and resources as we head into influenza season….
  I am being only marginally sarcastic.
  https://www.cdc.gov/csels/dls/locs/2021/07-21-2021-lab-alert-Changes_CDC_RT-PCR_SARS-CoV-2_Testing_1.html
2. MikelOctober 26, 2021 at 1:57 pm
  I’m beginning ti wonder how much of it is a mindset aling the lines of “just following orders.”
  It’s like they developed a plan with half-baked research and data that pointed them to a return to “the normal” and it’s imagined previous glory and, despite any evidence to the contrary, they will now just gaslight the public with authoritarian wishful thinking.
3. Lambert StretherOctober 27, 2021 at 12:44 am
  > It has to be because he and his advisers are in a bubble.
  To be fair to Biden, where exactly would he go for good information? We had CDC and WHO refusing to accept the correct theory of transmission for (it feels like, anyhow) a solid year. And they still resist it bureaucratically. The infection control community in hospitals resists aerosol transmission ferociously.
  Bubbles tend to be pretty thick-walled and they pop only when the class of people inside them are deposed. Think of LBJ and Vietnam…. The Romanovs…
Regulus regulusOctober 26, 2021 at 10:49 am
Where does one “file” Executive Orders? The order was executed and published on Sept 9, extending EO 13991. The order gives authority to the Agencies to provide guidance on how best to comply with EO 13991.
The foreign services have required certain vaccines for a long time. One is not free to die of malaria on Congress’s dime. The Court is not likely to injunct other Federal Employees from getting the vaccine. Public safety and communicable disease control is the least controversial power the States share with Federal Agencies.
1. CarolinianOctober 26, 2021 at 11:51 am
  I believe he means the OSHA vax rule which has not yet been published.
  And comparing the still experimental Covid vax (still applies to leftover vials as FDA approved the named commercial Pfizer version*) to sterilizing childhood vaccines or other vaccines with decades of successful use is a false analogy. But since it will come down to courts to decide then surely the mandate should be on hold until they do. Biden isn’t a king who gets to make drastic social rules with the wave of a hand.
  *Apparently this being claimed by some of the legal challenges already filed.
  1. Lambert StretherOctober 26, 2021 at 2:19 pm
    > I believe he means the OSHA vax rule which has not yet been published.
    Or leaked.
    1. CarolinianOctober 26, 2021 at 3:00 pm
      A relevant Turley column.
      https://jonathanturley.org/2021/10/25/bidens-come-on-man-defense-will-not-fly-on-religious-freedom/
2. IM DocOctober 26, 2021 at 12:21 pm
  Can you please show me where OSHA has actually made any kind of ruling in this matter? If not, why not? – this has now been going on for weeks. The entity for whom I personally work has vociferously stated that no action on the mandates will be taken until OSHA has spoken. And then, trust me, the tsunami of lawsuits wiil begin. There are all kinds of companies across this country telegraphing a similar message. There are consequences for leaders when they make orders like this and put them on the backs of agencies that have no business whatsoever involved in the situation.
  Additionally – we are not talking about malaria – nor are we talking about the foreign service. We are talking about millions of Americans whose president just announced before a CNN audience that he would happily have them fired – all to a rousing applause. Again – I am not speaking to a whole lot of patients or friends who find this type of thing even remotely appropriate. I for instance am a life long liberal. I will be voting a straight Republican ticket from now on until the enema that the Dems need has occurred. Looking at polls, it is quite clear I am not alone. I would rather live with the knowns of what the GOP has to offer rather than these duplicitous fools. I can show you all kinds of videos from politicos – from Biden to Pelosi to Fauci to Schumer just in the fall of last year stating that vaccine mandates have no way to work and no way to be enforced. They were very correct then. They are liars now.
  FYI – public health is not something that was just invented. It has been through centuries of trials and testing. One of its cardinal rules is that COERCION never works – and we are about to relearn that lesson right now in a big way.
  Talking about vaccinating the military and the foreign service is NOT THE GENERAL PUBLIC – nor does it have a thing to do with PUBLIC health.
  I deal with the vaccine hesitant daily. The simple underlying issue that is going on with most of them – is they have zero trust in our federal health officials. ZERO. Just look at the NIH statement about gain of function research put out this week – and compare that to the Fauci testimony of May and July. If he is lying about that – what else is he lying about?
  1. pjayOctober 26, 2021 at 1:17 pm
    Lambert has linked to this article by Peter Sandman two days in a row, though he has not highlighted it by name. It is very relevant to this issue, and its effects on public trust. Well worth reading.
    https://www.psandman.com/col/dishonesty.htm
    1. Lambert StretherOctober 26, 2021 at 2:17 pm
      Yes, it is. I linked to it several weeks ago, and it got no traction at all. But vile though Fauci’s Noble Lie was, it’s important to depersonalize the issue, and to see that his lies are an issue with the so-called public health establishment generally.

IM DocOctober 27, 2021 at 2:33 pm

I feel like I need to give an update from my world. Many things are happening all at the same time.

In brief, I feel that the “troubles” have started in earnest now in medicine in ways I did not see coming just weeks ago. What we in medicine are simply not going to be able to abide right now is a surge like we saw last winter.

First of all, as a PCP, I have always had the ability to zap small non-invasive skin cancers. We do that with liquid nitrogen. We have been out of this for a week or so now. Sourcing a new supply is now virtually impossible. And the amounts being asked for what is left are so astronomically high that we simply cannot afford it. Medicare reimbursement (which is most of these patients) will not even come close to recovering the cost. I understand from the supplier that the same issues are occurring to some degree with dry ice and more ominously liquid oxygen (used in hospitals of patient oxygen). I heard from 2 different suppliers the reason why this seems to be happening – but the reason is so “tin foil” that I am not going to repeat it here until I can confirm this more reliably.

I know there are lots of biomedical folks here in labs that are frequent commenters….Are any of you having the same problems?

If this becomes a pattern, I would recommend to all to get your derm visit scheduled ASAP – my understanding is this will not be temporary.

Our hospital staff is so diminished that my clinic employees are constantly being pulled to cover issues there. Outpatient clinical medicine is no longer organized here – it has become a frantic triage. Right now, I would urge all Americans to not take their anger and temper out on medical office employees. They and their physicians are absolutely overwhelmed.

That problem however is minor. The hospital system pre-COVID was a disaster area – it is now officially a shit show. The discharge process is now turned into a complete cludge. The problem in brief is that the companies that do home health and home oxygen and nursing home care have had their staffs now vanish to unworkable levels. Much of this has to do with exhaustion. But it is also the vaccine mandates. These are all national corporations – so they instituted mandates weeks ago. And promptly lost large segments of their staff. Enough time has now passed for the remaining employees to experience complete exhaustion. You can only do so many 80 hour work weeks after all. So now – there is nowhere for these discharging patients to go that is safe. They are having to stay in the hospital – but that is simply not going to be workable for long. The hospital too has had its staff decimated.

I have sat through a whole 4 months or so of patients condescendingly tell me they would never allow an unvaccinated HCW to touch them. Over and over. My constant refrain was to be very careful about that feeling – you may have NO health care workers to touch you if you keep that up. And we are slowly but surely arriving at that destination. At least two of these patients stuck in the hospital are two who could not bash the intransigent HCWs enough. They have now received their wish. Payment in full.

My niece just graduated from nursing school in June. Immediately hired on a COVID unit in a major hospital in one of our big cities. She has been there three months as dozens and dozens of nurses, MAs and RTs have left. My mind was completely and totally blown when she called to ask my advice last night – THEY HAD JUST OFFERED HER THE JOB OF FLOOR CHARGE NURSE in her hospital – a 3 month nurse – a job that in other times was given to grizzled veterans.

I am not sure we are going to have to wait for judicial input into these vaccine mandates. The slow motion implosion has already begun at least in medicine. I am hearing the same stories if not worse from colleagues everywhere.

I am not trying to alarm or scare. I am presenting my world as it is. I do not believe most Americans understand how dire this situation really is.

IM DocOctober 29, 2021 at 2:52 pm

When I get angry or alarmed, I come here to write it all out – it makes me feel better to just know that I have some kind of outlet. I appreciate that greatly about this site. I think this is important today.

I have a feeling we are in for far more serious “troubles” in the medical realm than just nurses in the hospital quitting. Pharma issues are happening – and may reach out and touch any one of you or your family. To be warned is to be prepared.

A very pernicious problem with pharma shortages has begun to set in. For the most part, they seem to be temporary – but they are absolutely devastating to patients financially – and I want all to understand what is going on.

This mainly seems to be happening in insulin products, immunologic agents ( as in Enbrel and Humira) and chemotherapy ( of which I personally deal very infrequently).

I am now up to 11 patients where this has happened just this week alone. All of whom are under 30, diabetic and on insulin or with lupus and on immunomodulating drugs. All are taking their health very seriously.

Most modern pharmaceuticals are distributed with the use of PBMs. big gigantic companies that are middlemen between pharma and consumers. They all have contracts with each product where they get a very good price on 1 particular agent in each class. For example – XYZ PBM has a great price on Lantus Insulin – so they will only distribute Lantus to their patients. If you must have the others – well – you get to pay the 700 dollars a month out of pocket – uncovered by your insurance. It is really quite a racket if some poor soul cannot tolerate the selected drug.

We are now experiencing fairly severe shortages on insulin products and immunoproducts. Again – they seem to be temporary – but 10 days is life or death to a Type I DM. So when their refill comes up – and their particular PBM contracted insulin type is unavailable – they get to pay full freight on another in the class – often 500-700 dollars a month. The PBMs are absolutely heartless – will not budge an inch – knowing in full that the shortage is beyond the patient’s control – and also that they are completely dependent. So the patients pay the 500 dollars for an alternative – only to find out that 7 days later – their “covered” insulin is available again. But it may not be when it comes time for a refill. And because their “great” insurance (It’s a big f@#ckin’ deal! – remember that?) that Obamacare delivered to the land has often 10 or 15 thousand dollar deductibles – they get to pay the full amount.

I have no idea why these shortages are happening. It is however constant. Again – not just insulin – the arthritis drugs are a real problem as well. My office staff is spending large chunks of time on this. Nothing like this has happened before in my career. This is new territory.

500-700 dollars is a lot of cash for these young people – and they are struggling under the load. I have not experienced young fathers crying in my office like I have this week. Again, the “troubles” have just begun.

We have here a pharmacy from a national corporation and also a local owned and operated pharmacy. The national chain basically tells the kids to pound sand. The local owned outfit, whose owner is in multiple civic organizations is giving them their alternative at his cost – and indeed I think he is giving it to them at his own expense as well. This fact is not going unnoticed in the community at large – and who do you think the goodwill is being bestowed upon? And who is getting the evil eye? I do not find it strange that we are suddenly seeing many prescription requests transferred to the local guy.

Furthermore, these young under 30s, black white and Hispanic – historically in the Dems back pocket – are now repeatedly discussing their politics with me. Unsolicited. I hear “FJB” all day long now. I am very sad to report that the coddling of Big Pharma, the year of one lie after another from our medical leadership, the disaster that Obamacare actually is on the ground, the promise to “follow the science” and then clearly act more political than anything before, and the raping that our populace is getting from these PBMs is absolutely causing a sea change in where I have normally seen young people politically. Again many minorities as well. They are very angry. Right or wrong, they perceive the Dems and people like Biden and Pelosi as directly responsible. And I live in a mostly blue area. And I do not blame them for a minute. One man explained to me very kindly that he had to be discharged from his federal job because of the vaccine mandate – and reported to me with great contempt that Biden had him fired – but was going to hand out half a million dollars to all kinds of illegal immigrants. “I voted for Obama twice, Clinton and Biden – but they can suck it if they think I am voting for them again.” I simply do not engage politics in my office. If they bring it up, I listen. Clearly, the kids are indeed beginning to realize what is at stake in their future. As a life-long Dem, I am very concerned that we may be seeing another Whig implosion. The thing that bothers me is I do not see any evidence whatsoever that anyone in the Dem leadership even cares. They have anchored themselves to some very troubling things that really affect people in their daily lives – and the bill is coming due. Again – I am seeing enough tragic things being ignored and lied about that for the first time in my life, I will be voting a straight GOP ticket until the bad apples are rooted out. I do not think in my life I have ever seen a group of politicians that need some time in the wilderness more urgently.

petalOctober 29, 2021 at 6:49 pm

IM Doc, my friends with the core facility that has multiple freezers heard from the hospital’s procurement folks who had tracked down the airgas manager. “He said there is no shortage of product(LN2) but a shortage of drivers for bulk tank deliveries.”
The procurement folks thanked my friends for bringing it to their attention and said they will keep an eye on the situation. I hope I don’t look too much like an idiot/boy that cried wolf.

IM DocOctober 29, 2021 at 7:15 pm
We still have not received any – and there is no date when it can be delivered. The “tin foil” issue that I brought up was indeed about trucking – apparently, there are very specific training guidelines for these types of products and very specific trucks and there are just no drivers available. There was more “colorful” commentary but again I cannot confirm at this time.
I am in a remote area – that is certainly part of the problem. But the fact we are having these troubles with vital supplies even here should be an early warning indicator that we have issues as a society. The system has thrown a rod – and what used to be reliable no longer is. Fascinating times.
Our supplier is trying very hard to get the now very elevated cost of the transport of these gases passed onto the final user – and there is just no way that is economically feasible in our area. And then another wrinkle at least here is the actual company that puts it in the cans is having trouble getting the equipment and other needs transported to their facility. “We have not had the ability in about a month”. So they do not even have product to send. So we have supply chain problems – and we have delivery chain problems. It seems like everything has a screw loose right now. I do also have multiple patients who are now on emergency oxygen compressors – because the cans of oxygen are no longer available reliably in our area – and I have just not had the time to figure out why that is suddenly happening. The compressor approach is much more expensive and I have no idea how long the insurance companies are going to be willing to pay.
As far as the skin lesions and the liqiud nitrogen, looks like it is back to the old clip them off and put in a stitch. So much more time consuming that it is hardly done anymore.
I am seriously not understanding what happened – it is like all the truck drivers just POOF disappeared.

IM Doc on Medication/Medical Supply Shortages and Political Backlash

Posted on October 30, 2021 by Yves Smith

IM Doc weighed in twice this week in Water Cooler on the dire scarcity of some critical medical products in his area, a rich pocket in flyover. While some of them may be significantly the result of being at a remove from big cities, others seemed to reflect wide-spread outages.

We’ve seen less scary versions of this movie before. A few years ago, the US was suffering widespread shortages of the bags used to deliver IV fluids because the factory in Puerto Rico that was close to the sole producer was knocked out in a hurricane.

IM Doc does not have a clear answer as to why these shortages are so numerous. Domestic trucker shortages may be part of the problem. But the US is extremely dependent on China and India for drugs. 80% of the active pharmaceutical ingredients and and 90% of generics are believed to come from them (no one knows for sure because the US does not believe in having the government know anything). So the famed coastal port traffic jams may be contributing to the problem. The Wall Street Journal pointed out in August 2020 that disruptions in product from China had generated shortages in acetaminophen, antibiotics and high blood pressure medications.

IM Doc weighed in on Wednesday and again yesterday and I though it was worth hoisting them to encourage further discussion as well as circulation to friends and colleagues. I’ve edited both comments to focus on the supply issues; he also discussed staffing shortages at his and other hospitals. As his second comment makes clear, at least in the people he treats, there’s a great deal of anger at the Administration, as in the Democrats, for not even acknowledging these potentially life-threatening and also budget-destroying shortages, even among groups like the young and minorities who would otherwise generally be assumed to favor or at least consider Democrats.

I’m amazed that there hasn’t been a backlash against the Tories for their deliberate destruction of the NHS, which has become more catastrophic thanks to Brexit and Covid. But Labour is so enfeebled that it seems unable to find any way to profit from Tory disasters, plus the Brits are a very stoic bunch.

Even though the first discussion, of difficulties in getting liquid nitrogen, is revealing, the meat comes in IM Doc’s second topic, shortages in multiple categories of critically important medications.

From IM Doc on October 27:

I feel that the “troubles” have started in earnest now in medicine in ways I did not see coming just weeks ago. What we in medicine are simply not going to be able to abide right now is a surge like we saw last winter.
First of all, as a PCP, I have always had the ability to zap small non-invasive skin cancers. We do that with liquid nitrogen. We have been out of this for a week or so now. Sourcing a new supply is now virtually impossible. And the amounts being asked for what is left are so astronomically high that we simply cannot afford it. Medicare reimbursement (which is most of these patients) will not even come close to recovering the cost. I understand from the supplier that the same issues are occurring to some degree with dry ice and more ominously liquid oxygen (used in hospitals of patient oxygen). I heard from 2 different suppliers the reason why this seems to be happening – but the reason is so “tin foil” that I am not going to repeat it here until I can confirm this more reliably.

On October 27 from petal:

I run a research lab at a well-known med school. We have a -140 freezer. It was alarming, which is unusual. We had been given 1 regular tank and 1 half tank instead of the usual 2 regular tanks-1 attached and 1 for backup. Both tanks we had were empty, including the attached half tank even though it was showing half full (or half empty, whichever kind of person you are…). Our Airgas guy comes once a week anywhere from Tuesday-Thursday. I emailed the manager, got an out of office reply(great!). Called the #, got a live guy. He said he’d ring the delivery guy and see if he could swing by with a partial tank because it’s an emergency. He said there’s a nationwide shortage of LN2, and they “are having trouble getting it.” Luckily the guy dropped off the partial. I let my friends in a core facility (they have 2 huge -140s) know about the LN2 shortage and they’re freaking out (as was I). We cannot lose what’s in these, and cells can’t be stored at -80 for long before losing viability.
I did a net search, and a bunch of space industry articles came up(this stuff is needed for rockets). They said due to the spike in covid patients being put on vents, there’s a spike in the need for liquid oxygen for the vents, and that trucks that used to carry LN2 are being converted to carry liquid oxygen because the premium is higher than if they deliver a load of LN2. That’s all I found. So if there’s also a shortage of liquid oxygen, I don’t have any ideas, unless it’s the whole trucker shortage thing. Not a clue.

petal later added:

My friends with the core facility that has multiple freezers heard from the hospital’s procurement folks who had tracked down the Airgas manager. “He said there is no shortage of product(LN2) but a shortage of drivers for bulk tank deliveries.”

IM Doc’s reply:

I am in a remote area – that is certainly part of the problem. But the fact we are having these troubles with vital supplies even here should be an early warning indicator that we have issues as a society. The system has thrown a rod – and what used to be reliable no longer is. Fascinating times.
Our supplier is trying very hard to get the now very elevated cost of the transport of these gases passed onto the final user – and there is just no way that is economically feasible in our area. And then another wrinkle at least here is the actual company that puts it in the cans is having trouble getting the equipment and other needs transported to their facility. “We have not had the ability in about a month”. So they do not even have product to send. So we have supply chain problems – and we have delivery chain problems. It seems like everything has a screw loose right now. I do also have multiple patients who are now on emergency oxygen compressors – because the cans of oxygen are no longer available reliably in our area – and I have just not had the time to figure out why that is suddenly happening. The compressor approach is much more expensive and I have no idea how long the insurance companies are going to be willing to pay.
As far as the skin lesions and the liqiud nitrogen, looks like it is back to the old clip them off and put in a stitch. So much more time consuming that it is hardly done anymore.
I am seriously not understanding what happened – it is like all the truck drivers just POOF

From IM Doc on October 29:

I have a feeling we are in for far more serious “troubles” in the medical realm than just nurses in the hospital quitting. Pharma issues are happening – and may reach out and touch any one of you or your family. To be warned is to be prepared.
A very pernicious problem with pharma shortages has begun to set in. For the most part, they seem to be temporary – but they are absolutely devastating to patients financially – and I want all to understand what is going on.
This mainly seems to be happening in insulin products, immunologic agents ( as in Enbrel and Humira) and chemotherapy ( of which I personally deal very infrequently).
I am now up to 11 patients where this has happened just this week alone. All of whom are under 30, diabetic and on insulin or with lupus and on immunomodulating drugs. All are taking their health very seriously.
Most modern pharmaceuticals are distributed with the use of PBMs. big gigantic companies that are middlemen between pharma and consumers. They all have contracts with each product where they get a very good price on 1 particular agent in each class. For example – XYZ PBM has a great price on Lantus Insulin – so they will only distribute Lantus to their patients. If you must have the others – well – you get to pay the 700 dollars a month out of pocket – uncovered by your insurance. It is really quite a racket if some poor soul cannot tolerate the selected drug.
We are now experiencing fairly severe shortages on insulin products and immunoproducts. Again – they seem to be temporary – but 10 days is life or death to a Type I DM. So when their refill comes up – and their particular PBM contracted insulin type is unavailable – they get to pay full freight on another in the class – often 500-700 dollars a month. The PBMs are absolutely heartless – will not budge an inch – knowing in full that the shortage is beyond the patient’s control – and also that they are completely dependent. So the patients pay the 500 dollars for an alternative – only to find out that 7 days later – their “covered” insulin is available again. But it may not be when it comes time for a refill. And because their “great” insurance (It’s a big f@#ckin’ deal! – remember that?) that Obamacare delivered to the land has often 10 or 15 thousand dollar deductibles – they get to pay the full amount.
I have no idea why these shortages are happening. It is however constant. Again – not just insulin – the arthritis drugs are a real problem as well. My office staff is spending large chunks of time on this. Nothing like this has happened before in my career. This is new territory.
500-700 dollars is a lot of cash for these young people – and they are struggling under the load. I have not experienced young fathers crying in my office like I have this week. Again, the “troubles” have just begun.
We have here a pharmacy from a national corporation and also a local owned and operated pharmacy. The national chain basically tells the kids to pound sand. The local owned outfit, whose owner is in multiple civic organizations is giving them their alternative at his cost – and indeed I think he is giving it to them at his own expense as well. This fact is not going unnoticed in the community at large – and who do you think the goodwill is being bestowed upon? And who is getting the evil eye? I do not find it strange that we are suddenly seeing many prescription requests transferred to the local guy.
Furthermore, these young under 30s, black white and Hispanic – historically in the Dems back pocket – are now repeatedly discussing their politics with me. Unsolicited. I hear “FJB” all day long now.
I am very sad to report that the coddling of Big Pharma, the year of one lie after another from our medical leadership, the disaster that Obamacare actually is on the ground, the promise to “follow the science” and then clearly act more political than anything before, and the raping that our populace is getting from these PBMs is absolutely causing a sea change in where I have normally seen young people politically. Again many minorities as well. They are very angry. Right or wrong, they perceive the Dems and people like Biden and Pelosi as directly responsible. And I live in a mostly blue area.
And I do not blame them for a minute. One man explained to me very kindly that he had to be discharged from his federal job because of the vaccine mandate – and reported to me with great contempt that Biden had him fired – but was going to hand out half a million dollars to all kinds of illegal immigrants. “I voted for Obama twice, Clinton and Biden – but they can suck it if they think I am voting for them again.” I simply do not engage politics in my office. If they bring it up, I listen. Clearly, the kids are indeed beginning to realize what is at stake in their future.
As a life-long Dem, I am very concerned that we may be seeing another Whig implosion. The thing that bothers me is I do not see any evidence whatsoever that anyone in the Dem leadership even cares. They have anchored themselves to some very troubling things that really affect people in their daily lives – and the bill is coming due. Again – I am seeing enough tragic things being ignored and lied about that for the first time in my life, I will be voting a straight GOP ticket until the bad apples are rooted out. I do not think in my life I have ever seen a group of politicians that need some time in the wilderness more urgently.

Needless to say, the fact that problems of this seriousness are happening and aren’t even being acknowledged means that the situation can and likely will get much worse.

IM DocOctober 30, 2021 at 7:51 am

I have not even had time to process the outrage I have for the next problem – but I thought this was about as good a place to share it – I am just dumbfounded by what I am seeing going on.

I have now had 2 different patients in the past week with the same problem. They are both young fathers. They are both Roman Catholic. They are both profoundly healthy as are their wives and young kids. They both are employed by 2 different multi-national corporations who have imposed vaccine mandates on ALL their employees. These 2 young men both work from home in front of a computer all day. They never encounter anyone outside of their family and grocery stores, etc.

Because both have very traditional Catholic views, both have declined the COVID vaccines because of the fetal tissue problems. I have always been under the impression that religious freedom was a bedrock of our Republic.

Both corporate HR departments have now sent both of these patients emails demanding further “clarification” of their religious views.

Interestingly, both emails from 2 different companies with HQ thousands of miles from one another, contain a very interesting statement. It is slightly different between the 2 – but I will paraphrase it – “Since you are claiming a religious exemption based on your objection to fetal tissue being used in the vaccine development, please discuss how you also plan to deal with your objection when using common drugs like aspirin, tums, ibuprofen, and tylenol…….

Both emails had the SAME 4 DRUGS listed – but the question was written in different language in both.

That is when I knew that games were being played. It is very clear to me that some entity has been pushing this out for all the corporations to send out. And whoever sent this out is literally as dumb as bricks.

Fetal tissue being used in the development of these drugs? Are you fucking serious?

Tums is basically chalk – as in chalkboard. A simple chemical compound.

Aspirin was developed before the Civil War. Tylenol or its forebears date back to the late 1800s and ibuprofen came of its own in the 1960s.

ALL FOUR OF THESE HAVE NOTHING WHATSOEVER TO DO WITH HUMAN FETAL CELL LINES. They are all old drugs. Fetal cell lines were really not a thing until after Roe v Wade in the 1970s once the procurement procedure became legal.

After consulting with their priest, I have sent the HR people in both companies the following letter –

Dear XXX,

Patient XYZ has been under my care for X years. I have gotten to know him very well. As a practicing Roman Catholic, who espouses the traditional aspects of his religion, he is opposed in every way to the practice of abortion and certainly to the use of the fruits of what he considers an immoral act.
Because of the tone and flippancy of your letter to him, I have to conclude that you are not serious in addressing his concerns. Since we are indeed discussing the livelihood of a young man and his wife and young kids, I feel that everything we do in this matter should be done with good faith.
I am therefore asking of you a simple request. I need you to back up your assertions in the email you sent him that aspirin, tylenol, ibuprofen and tums were engineered with the use of human fetal cell lines. I have been a physician for decades and have never heard any such thing about these drugs. I am however open to learning new things. Please provide me with those sources so I can discuss your concerns and ramifications with my patient.
Until such time that proof of your assertions has been provided, I will assume you are not acting in good faith – and I will be sharing my concerns with any attorneys that happen to get involved.

Warm Regards,
IM DOC

I want everyone to understand. When I learned Public Health principles 30 years ago, when my father learned them 60 years ago, there was a bedrock statement – COERCION IN PUBLIC HEALTH NEVER WORKS – IT WILL INSTEAD OFTEN BACKFIRE. It is clear to me that Biden, Pelosi, and Fauci were all keenly aware of this simple fact last fall and winter when they were emphatically stating that mandates did not work and were not going to happen. Unfortunately, that wisdom was not continued – and I fear we are all going to learn that time-honored public health wisdom is not something to be ignored or played with. God help us.

Yves SmithOctober 30, 2021 at 8:12 am
I looked at the laws on a cursory basis early on, in terms of religious and Americans With Disabilities exemptions (let’s just assume clear cut ones, like being allergic to the vaccine constituents; even the CDC says “Don’t take it!” in that case). I was surprised. The requirement for private sector employers to provide an accommodation is pretty weak. This is more evenhanded than some write-ups I have seen:
https://www.venable.com/insights/publications/2021/06/employers-guide-to-the-religious-exemption
Nevertheless, the officialdom has succeeded in promulgating the myth (or at best exaggeration) that not being vaccinated = health risk to others, as opposed to self. It’s back to the Big Lie that the vaccines are sterilizing. But the CDC and various officials have made enough statements to that effect that employers can treat that as true.
And the Feds moving to strong-form mandates (vax only) means an employer can be bullheaded and not offer frequent testing as an accommodation (we’ve said everyone should be tested, this treating the vaccinated as if they can’t transmit has led high vax countries into a world of hurt, see high vaccine rates in Ireland, Iceland, and Israel accompanied by surges, as well as the big study that showed zero correlation between vax rates and contagion rates).
As for the religious part, the next level of attack by an employer that wants to play hardball is questioning the bona fides of the “religious” belief. The first is demanding proof of their observance. The second is to point out that the Catholic Church has said being vaxxed is “an act of love.” Who are they to question the Pope? The third is to try to argue that the use of fetal cell lines is only super tenuous for Pfizer and Moderna, as in their objection could not be bona fide if they had good information (see here: https://www.icsi.org/covid-19-vaccine-faq/are-the-mrna-vaccines-made-with-fetal-cells/)
1. IM DocOctober 30, 2021 at 8:50 am
  Of course, we must consider that is the same Catholic hierarchy who has been covering up boy raping for decades.
  I guess that is an “act of love” as well.
  I am not Catholic. However, it became immediately apparent when talking to this particular priest that this fetal cell line issue may not be equal between the boy raping hierarchy and the great masses in the hinterlands.
  I am not sure how that all plays out in court.

Objective AceOctober 30, 2021 at 1:34 pm

450,000 per child or familly seperated at the border is a far cry from “every illegal immigrant” which is what Timbers started this chain off saying

timbersOctober 30, 2021 at 1:42 pm
Except that’s not what I wrote nor is it I who started the chain. iMdoc or his patient did.
1. Objective AceOctober 30, 2021 at 3:34 pm
  Direct copied quote “AND…headlines that Senator Biden is considering giving $450,000 to each illegal immigrant”
  ImDoc clearly quoted a patient. Most people wouldn’t take that as a fact like we would a Wallstreet journal report
  1. timbersOctober 30, 2021 at 4:55 pm
    Thank you for correcting you misstatement, which as you note, I did not say “every” as you originally said I did. I said “each.”
    But yes, I stand corrected on a point of grammar/sloppy wording.
    But, it seems you might be missing the point, which IM Doc made more clearly than I, below.
    $450,000 to non US citizens who broke the law when US citizens get far less if anything.
  2. timbersOctober 30, 2021 at 5:51 pm
    And patient quote:
    “Biden… was going to hand out half a million dollars to all kinds of illegal immigrants.”
    I did not say it was a fact. Others did, and I didn’t say “every” YOU said “every” and I didn’t start the chain.
    In other words, every thing you said I said, I didn’t say.
IM DocOctober 30, 2021 at 2:38 pm
It is also a far cry from what was offered to my aunt after losing her husband in Vietnam and who spent the rest of her life as a single mother raising their kids. It was a fraction of 450,000 in today’s money. Fortunately, she had lots of help from her family members. It was a hard life for them – but fortunately those kids are all adults now and citizens in good standing today.
What is being proposed is a complete slap in the face to every family or spouse who has had to face such a situation.
I absolutely understand why these people are pissed off.
I must face my own feelings and realize I am in concordance with how my patient feels. I will never vote for anyone whose administration has the balls to put anything like this forward – I just simply cannot believe it.
If there was not some truth to this preposterous story, I would think the White House would be all over the place with the denial cannons. I have seen no such effort.. If any of you have please point me to it.

The Rev KevOctober 30, 2021 at 9:05 am

Got no real answer except for a question here. Liquid nitrogen may be important for treating skin cancers, etc. but liquid oxygen is critical from what I have seen to treat Coronavirus victims. Last year they were running short of oxygen tanks in India and patients in hospitals died by the numbers when the oxygen ran out. So would it be worthwhile contacting other industries (sporting actually) where they use oxygen so that you can grab your hospital some bottles? Here I am thinking of suppliers for mountain climbers and deep sea divers. I understand that the stuff, with proper insulation, lasts almost indefinitely but I would not be surprised to see a shortage down the track of oxygen bottles.

IM DocOctober 30, 2021 at 9:28 am
Modern hospitals do not use bottles except during transport of patients from different areas while they are mobile or for brief periods of time in the ER or radiology.
Every room in the hospital has an oxygen port that is ultimately connected to gigantic tanks of liquid or gas oxygen in the parking lots. They are often stories tall and in the USA are often painted at least partially green.
The temporary bottles are filled from this source as well.
In essence, modern hospitals are absolutely dependent on a constant flow of oxygen into those gigantic storage tanks. I have often marveled at how vulnerable this is to an attack. Unfortunately, these tanks are also highly explosive if ignited although I am told that would be very difficult to pull off.
We often refer to this incident in Oklahoma as to what can happen if these things do ignite. Basically very fast projectile fire bombs.
https://www.oklahoman.com/article/1942053/tulsa-gas-business-explodes-br-nearby-homes-burned-but-no-injuries-reported
There are videos – I just cannot find them at the moment. It happened right next to what appeared to be an interstate.
Basically, if for whatever reason those big tanks in the hospital parking lots quit being filled, Lord have mercy. They do not even have enough bottles on standby inside to even begin to cover the needs.
1. BobOctober 30, 2021 at 11:00 am
  No, oxygen is NOT EXPLOSIVE.
  Oxygen can and does vigorously accelerate combustion sometimes to the point of an explosion – see Sprengel explosives.
  This is why the pads upon which the LOX tanks sit are concrete rather than asphalt. Asphalt being a combustible petroleum product.
  And it curious that there is a shortage liquid of Nitrogen.
  Although my understanding maybe dated, the classic method of generating liquid oxygen, liquid nitrogen, and other sundry gases (argon, neon, Xeon) is to compress ambient air (the air we breathe), liquify the compressed air, and then fractionally distill it. Since ambient air is some 60% to 70% nitrogen it would be expected that an air plant would produce many times as much nitrogen as oxygen.
  1. IM DocOctober 30, 2021 at 11:13 am
    I get the impression from talking to these distributors that there is no issue in compressing gas. It is mainly a matter of the fact that the containers going back and forth have reached a standstill because of a lack of trucking. They have limited supplies of stuff to put the new product. They are apparently working on this issue very diligently and hopefully this will all work out.
    So many of our issues right now seem to be related to a sudden lack of trained truckers. I have not heard a good explanation for this yet.
    FYI I have had more than one patient in my life smoking while on a cannula of oxygen. Maybe explosive is not the best word but I guarantee you it is flammable. And those cans in Oklahoma did not just launch on their own.

CHOctober 30, 2021 at 9:30 am

Companies have been forcing working-class Americans to pee in a cup (i.e. randomized drug testing) for decades. The only recourse was the same as it is for anti-vaxxers today: if you don’t like it, don’t take the job or quit.

Now…NOW…the right-wingers are all concerned about “individual freedoms” at work. Give me a f—ing break! Political grandstanding of the highest order.

As for the Catholics, the Pope himself has been vaccinated, so it seems that would have been a much more rational line of argument: https://www.bbc.com/news/world-europe-58573892

IM DocOctober 30, 2021 at 1:19 pm
With all due respect, being injected with any pharmaceutical and peeing in a cup are two entirely different issues.
Peeing in a cup does not typically require informed consent and signing a document stating that the process has not been approved and the risks are as yet unknown – which was going on all over America by the millions for months earlier this year.
For the first time in my life, the risks and benefits counseling of people’s own physicians, familiar with their own medical issues, was replaced by TV doctors with who knows what agenda and conducted in parking lots or stadiums. And all this with an agent which at the time and still even now had not gone through all the usual rigors of trials.
It is interesting you should bring up that topic of peeing in a cup. While these vaccine mandates are now all the rage, every other want-ad in my local paper is screaming that no drug testing is required.
We do indeed live in a very interesting time.

MarieOctober 30, 2021 at 2:20 pm
I’ll add in my observations about what has been happening in my neck of the woods.
I’m an ER Doctor in a community hospital in Canada.
In the past month we’ve had shortages or outright disappearances of the following equipment:
Crutches
Knee Braces
Plaster Slabs
The paper sheets we line beds with for hygienic reasons (completely disappeared on my last shift)
We are also hemorrhaging nurses. I used to know all the faces in my department, and most of the names, and could accommodate and get to know a new face. Now when I walk into work I don’t recognize half the nurses I’m working with – the new folks are a mix of agency (temp) nurses and new grads. This has lead to more medical errors, as it’s difficult for our department to integrate THIS many new folks at once. Also even with their help (and don’t get me wrong, I’m VERY grateful they are here), we are still routinely short 5-6 nurses per shift. The attrition seems to be due to a mix of early retirements, burnout and transfer to other departments, and firings due to the vaccine mandate.
We are also getting slammed due to increased patient volumes – a percentage of family doctors in the community are still not seeing their patients in person, and not all patients are okay with totally virtual care or they are being sent in by their MDs who think the patient needs a physical exam but won’t do it themselves.
My question is – what is truly worse: having a nurse who *may* be at increased risk of transmitting Covid because they are unvaccinated, or having no nurse at all?
1. IM DocOctober 30, 2021 at 10:45 pm
  Myself and my partner make no bones about seeing any patient that comes in the door. I do virtual visits only if the patient requests it.
  There are a couple docs in my community who just will not see people in person. You cannot even imagine the number of transfers that my partner and I have had.
  The problem though is that eventually the brick wall is hit – you just simply cannot keep it up.
  There is a massive shortage of PCPs in this country. And I suppose in Canada too. There is this big huge push to get nurse practitioners to fill the void. Hysterically, the NPs too avoid primary care like the plague and most of them end up in oncology, ortho, GI or cardiology or general surgery.
  The PCP crisis we have been working on for decades that this pandemic has brought to the forefront has just now started to seriously implode.
  And do not get me started on ER docs. God bless em. Just months ago – the venture capitalist firms in the USA that own the group ER practices were laying off the docs right and left. Everyone in America should remember this fact when they go to an ER and take in the just unbelievable chaos. I hope your lot in life in Canada is much better.

TomOctober 30, 2021 at 9:30 am

https://www.youtube.com/watch?v=80OvNaEgmmw

Michael Mina is an immunologist, epidemiologist, and physician at Harvard. This guy makes so much sense. His position: rapid tests should be widely available and used all the time and everywhere. Not as sensitive as PCR tests, but very accurate if a person is carrying a high enough viral load to be infectious.

We’re doing it all wrong.

You can also find the interview wherever you get your podcasts.

IM DocOctober 30, 2021 at 9:50 am
I could not agree with this doctor more.
100%.
And we have the technology and the capability. Since we are arguing about trillions of dollars here and trillions there – we surely have the finances.
Accurate? Reliable 100%? – until the vaccines are 100% reliable at stopping spread – why are we even having this debate. If the tests are even 70-80% effective – that is good enough to make a huge dent in the spread.
And certainly, this approach of mass testing would have years of public health behind it. And if presented correctly to the public, I feel strongly would be accepted in no time. Unlike the vaccine mandates which have no basis in previous public health and may lead to serious social problems.
But we no longer do anything in this country based on common sense. That is a different timeline to which none of us are a part.

VerifyfirstOctober 30, 2021 at 11:49 am

Vaccine mandates have no basis in previous public health? Kids have to have lots of vaccines in order to be allowed into school don’t they?

MiltonOctober 30, 2021 at 12:44 pm
Vaccines yes, therapeutic shots no.
IM DocOctober 30, 2021 at 2:06 pm
Yes – you are correct.
However – you are talking about vaccines that have gone through all the appropriate trials and the risks and benefits are known – and the benefits of preventing epidemics of very lethal infections are overwhelming. And because the safety is known there is widespread trust.
As I have repeatedly stated, I have ordered tens of thousands of vaccines in my lifetime.
We have not had near the time or ability to completely assess this situation with the COVID vaccines. And certainly with what we know about the COVID vaccines now, there is really no big benefits for “public health” in general. There is enormous benefit for individual patients that are at high risk and I have spent inordinate amount of my time trying to convince these people to go for it.
In the vaccinated, it appears the contagion can be spread and caught likely just as easily as in the unvaccinated. Therefore, the risks and benefits are all on the individual side and not on the community side. This is completely different than in most of the childhood vaccines which lead us to sterilization and decreased spread to zero. Our COVID vaccines currently will be able to do no such thing. We can greatly impact high-risk individual lives with these vaccines and we should all be trying to do that – but impacting the course of spread in a vast population is much different with these COVID vaccines than say with measles. It is unfortunately simply not going to work that way until/if we get better vaccines.
If the COVID vaccines worked like the measles vaccine, we would not be having all the discussion about “protecting the vaccinated” would we? If they worked like they were early on promised, the vaccinated would not have to worry for a second about the unvaccinated. The consequences and problems would theoretically all be on the unvaccinated. We can behave that way with certainty with the measles and mumps vaccines with just microscopic levels of breakthrough. But the COVID vaccines offer no such protection. I applaud anyone who gets vaccinated – especially those in higher risk situations. I spend large amounts of my day every day doing just that. But given the way these were sold, and given what has occurred, I blame no one for being hesitant. It is my job to convince those high-risk to overcome their doubts. But demonizing anyone who has concerns and having them fired is just completely inappropriate.
I really do wish Rachel Maddow and Tucker Carlson and Chris Cuomo and even Dr. Wen and Dr. Fauci could spend just one day with me – and see what all the confusion and chaos has wrought in the minds and souls of my patients. I really do.
Public health has no business mandating these for individuals in this situation. Heart disease and strokes have killed more people than COVID this year – but you do not hear the public health authorities mandating that every adult take LIPITOR. Why not?
It is because coercion simply does not work in these situations. Coercion often severely coalesces resistance. Look around you. Much research has been done on this in the past. Just look at Dr. Fauci’s take on coercion and vaccine mandates from just last autumn before the vaccines arrived. What he said then and what he is saying now cannot both be true. (Of course when looking for that link, I was able to find 3 different contradictory things he has said about vaccines in the past year). There has been no sudden sea change in decades of public health research. And what he said last autumn had years of public health research and wisdom behind it. He appropriately exempted from his statement last year Health Care workers (and I would add the military) – which are not at all “the public” in public health.

comments

IM Doc pt 27

2021-12-16T01:23:36Z

Yves Smith

September 1, 2021 at 8:01 am

Garbage in, garbage out study. Deaths almost certainly not being evaluated.

IM Doc has had proportionately vastly more cases in his rural county. Sent him this link:

Heart inflammation link to Pfizer and Moderna jabs

https://www.bbc.com/news/health-57781637

With this comment: “Either the patients in his county are having extremely bad luck or these #s are understated.”

His reply:

We have had 1 case for sure – a few others unclear – mainly young people dropping dead – and I have another that will be being biopsied/cardiac MRI in the next week in a distant academic center.
None of the drop dead patients were ever fully evaluated – The coroner here is actually a family practice doctor – and is loathe to crack the chest…
And as I heard this week from a cardiologist – who in big cities are seeing this way more often than I – it is actually very much concentrated in the younger and the more fit. The patients who get out and work out vigorously and frequently. Often folks on some kind of athletic teams. In his opinion – and I would tend to agree – there could be one of two things we are seeing. 1) Patients who have very fit myocardial cells are for some reason more at risk for this – that reason as yet unexplained ( there is precedent for this – AFIB is increased in chances in the 60 and up crowd if when they were younger they were into extreme aerobic sports like marathons and triathlons —- OR 2) Much more concerning when you think about it – the ones who are mainly coming to clinical attention are the very athletic ones because even with a fraction of decreased reserve they are aware instantly that something is wrong. There could be a literal army of overweight out of shape x-boxers whose hearts have been dinged but they would not really be aware of it because their main physical activity is a joystick maneuver. Unfortunately, if this is the case – there will be an army of heart failure patients becoming clinically apparent over the next few decades. We will not be seeing it anytime soon. There are some alarming surveillance numbers that indicate this might be happening – but nothing is concrete. This too has precedent in medicine – see the current J&J talc fiasco, or the DES problem in the mid 20th century – not really picked up on until the 1980s and after because the unfortunate cancer it caused – was in the female offspring of the original patients. I could go on and on.

floraSeptember 2, 2021 at 7:50 am

From Reuters, via Yahoo:

UPDATE 1-Pfizer, Merck launch new trials of oral COVID-19 drugs

“Sept 1 (Reuters) – Pfizer Inc and Merck & Co Inc announced on Wednesday new trials of their experimental oral antiviral drugs for COVID-19 as the race to develop an easy-to-administer treatment for the potentially fatal illness heats up.”

https://finance.yahoo.com/news/1-pfizer-merck-launch-trials-180240611.html

smashscSeptember 2, 2021 at 8:16 am
Hmm,
Merck’s Ivermectin cost shows as low as $30 for 20 tablets on GoodRx
The Feds recently paid $1.2B for 1.7 Million 5-day courses of Merck’s molnupiravir – $705. per course.
It shouldn’t be surprising to this site’s readers which treatment Merck is focusing on
1. Pookah HarveySeptember 2, 2021 at 12:02 pm
  I have heard the argument that Merck as developer of Ivermectin would greatly profit from an antiCovid usage therefore their statement:
  “We do not believe that the data available support the safety and efficacy of ivermectin beyond the doses and populations indicated in the regulatory agency-approved prescribing information.”
  is proof that Ivemectin is not viable for antiCovid treatment or prevention.
  The problem is that Merck let the patent drop in 1996 and it is now a generic with several manufacturers. Merck could never jack up the price. I guess I shouldn’t say never. They can always use the tried and true method of paying off other manufacturers to stop production. Of course they then may have PR problems if the MSM decided to do their job.
  1. IM DocSeptember 2, 2021 at 1:42 pm
    Yes – please do not assume that ivermectin will always be forever cheap. They could play all kinds of games.
    A few examples.
    Colchicine – a drug for gout and other inflammatory conditions, in some form has been around since the time of Henry VIII. When I was a young doctor in the 1990s, a 2 L bottle of pills could be had for a few dollars. Then the drug companies and FDA did their magic – and now it is no longer available in the previous format – and the new and only available stuff – COLCRYS – costs 400-1000 dollars for a few days.
    The same exact game has been played with multiple asthma inhalers, insulin, BP meds, and multiple forms of chemotherapy. All used to be dirt cheap and very effective as generics – now are literally “break the bank” expensive. And there is no end in sight. Insulin in particular is so morally galling because those who discovered it in the 1920s, Banting & Best, basically gave it to the world for a pittance – not the blockbuster amounts Big Pharma gets today. Multiple actual dewormers and parasite drugs are on the list to have this same thing done and there are multiple old antibiotics that I understand are under the gun. The most famous parasite medicine incident and the hideous jack-up in price involved shenanigans by one Martin Shkreli.
    I can see them easily doing this same game with something like Ivermectin. Just FYI – sources have told me that at least some of the antiviral COVID drugs under investigation by Big Pharma have exactly the same theorized activity on the virus as does ivermectin. They are not exact analogs but they do exactly the same thing. It really is a total joke – and is so emblematic of the total regulatory capture of our once proud CDC FDA and NIH. As I have stated repeatedly, once this whole thing blows over, my profession is going to have a big deep hole to dig itself out of.

Hana MSeptember 2, 2021 at 10:46 am

These reports of breakthrough infections/hospitalizations (as in the WV story) are deeply unhelpful. All such reports should also provide data stratified by age and co-morbidities. What I’m hearing locally is that almost all vaccinated patients hospitalized with Covid are also basically very sick with underlying problems such as obesity and diabetes.

hunkerdownSeptember 2, 2021 at 10:57 am
Unhelpful to whom, and why should I not deny them their interests for prioritizing themselves over people like me, to whom such posts are in fact helpful? Personal Pfizer holdings are not a public interest. But if you nationalize the company, we can talk about a jab.
IM DocSeptember 2, 2021 at 11:01 am
The vaccinated patients in the hospital with co-morbitities and age is largely true – at least where I am – However – that too is slowly changing. Admitting more and more vaccinated patients who are baseline healthy – and just really sick. And in the outpatient side of my practice – where people do not need to be admitted, it is now unusual that I see any unvaccinated patients – just being inundated with vaccinated patients. Many but not most of these people are quite ill – a lesser number nearing hospitalization status. We are still seeing large numbers of vaccinated patients infected all at once at superspreader events. Luncheons, church services, parties, etc. These events almost always require vaccination as a ticket to admission – and you can see how well that helps. That whole concept of vaccination proof, etc – is just such a joke it is not even funny anymore. So many people getting sick at these events where they feel they are safe because everyone is “vaccinated”. It makes politicians like deBlasio, et al look like total morons in my eyes. There are also lots of health care and personal service workers – like waiters and bartenders. It is really overwhelming the ability of my staff to deal with them all. And the majority of these patients have no co-morbidities and are not necessarily old.
I have learned to just not focus on the numbers that the various dashboards and news outlets are providing – I have to deal day by day with what is going on in front of me. I no longer even have time to think about numbers that are not consistent with my reality going on here on the ground.

RE: “More Hospitals Sued Over Right to Try Ivermectin” [MedPage Today]. “As hospitals continue to admit COVID-19 patients, some are contending with demands from family members to attempt to treat their loved ones with ivermectin. Just last week, the CDC warned healthcare professionals to steer patients away from the drug. But that hasn’t stopped the pressure on hospitals, and the outcomes of new legal cases to force hospitals to provide the drug to struggling, ventilated patients have been mixed…. The CDC reiterated in its warning to healthcare professionals last week that ivermectin is not authorized or approved by the FDA for the prevention or treatment of COVID. The agency added that the NIH has also determined there are currently insufficient data to recommend ivermectin for the treatment of COVID. The CDC did say that there are ongoing clinical trials that might provide more information about these ‘hypothesized uses.'”

Good question:

Why is basically the entire media lying about what Ivermectin is and calling it a horse drug?
— Zaid Jilani (@ZaidJilani) September 2, 2021

IM DocSeptember 2, 2021 at 2:50 pm

About the above Medpage Ivermectin article –

This sentence –

The agency added that the NIH has also determined there are currently insufficient data to recommend ivermectin for the treatment of COVID.

Not actually correct – the NIH current status on ivermectin is there is not enough data to recommend OR to discourage its use. The NIH changed this recommendation in December of 2020 as previously the NIH status on ivermectin usage was to discourage its use. Usually the status in which ivermectin is now placed would be accompanied with all kinds of funds to study the true efficacy of the drug, to see if it is successful. That of course is not being done at this time.

Interestingly, 2 of our other COVID modalities have exactly the same recommend/discourage status. That would be remdesevir and outpatient monoclonal antibodies. EXACTLY the same status on both of these as ivermectin currently. The NIH states there is not enough evidence to recommend or to discourage the use of either of these.

And yet we continue right on with both the others without a blink of an eye.

A little math –

Ivermectin course for COVID is less than twenty dollars.

A course of REMDESEVIR is currently right at 8800 dollars.

An outpatient treatment with monoclonal antibodies is right at 23000 – 25000 dollars with all the infusion costs added.

Remdesevir is loaded with all kinds of safety problems that I have seen with my own eyes. And it has the extra benefit of obviously not working – it literally does not do a god damned thing. Multiple studies have hinted at this.

The monoclonal antibodies are reasonably safe, unless you are one of the unlucky 1-3 out of 200 who have a very significant allergic reaction. Sometimes quite bad. They do seem to help to some degree.
But it is my immunologist and virologist friends who are having seizures about their use like this in massive 100-200 daily infusion centers, and the very high likelihood of producing all kinds of mutant variants with this therapy.

Your bankrupt government that is in hawk already for tens of trillions of dollars is currently “paying” for the last 2 choices – but not sure how long that will last.

Facebook feeds are now filled with all kinds of memes and stories with horse paste and horse pictures. But not a word about the other 2 or how expensive they are. I have seen all kinds of pics lately of my fully vaccinated friends and family in a monoclonal infusion center. They seem to have no clue they are bankrupting their kids future for a medication with the same NIH recommendation as ivermectin – which they are just laughing out of the room. They go right on blaming the unvaccinated for the pandemic in their feeds, all the while the antibodies they have just been given may be leading to the next mutation that will come up snake-eyes. And to boot, that one dose of meds they are getting is more than a lot of people in this country make in a year.

Yet, I continue to use ivermectin and budesonide with statistically obvious effects to keep patients out of the hospital compared to my peers who are not using it.

I have never dreamed in my life that I would live to see the American people bamboozled this easily. But here we are. I just keep working – very hard lately – it keeps my mind in much better places.

I spoke with one of my old students who is now a medical missionary in Africa this week. How this is being handled in the West has been an eye-opener for all to see where he lives. At least they have perspective in Africa. We have lost 600K people in the USA to COVID. The world loses upwards of 1 to million a year from diarrhea. The only difference between the two is that the diarrhea deaths are almost completely avoidable with appropriate care that is freely available in the West but not so much in Africa. And that is just diarrhea. They see the immense COVID freak out in the West and just shake their heads. My poor student just stated that he has to pray every day for strength not to despise what his culture has become.

My mind has been reliving the story of Lot and Sodom & Gomorrah a lot lately. But also to the Book of Daniel and Balthazzar’s feast. MENE MENE TEKEL UPHARSHIM. Written by a hand on the wall to leader of the most powerful country on earth at the time. NUMBERED NUMBERED WEIGHED AND DIVIDED. “Alas O Babylon, the Lord God Jehovah has weighed you in the balance and has found you wanting. Thy last day is upon you.”

Lord have mercy.

LeeSeptember 4, 2021 at 11:04 am

“Israel fighting record breaking surge in Covid-19 cases despite high levels of vaccination News.com.au (Kevin W). So much for Pfizer….”

To be fair, according to the linked article and other sources, while the vaccine does not prevent infection or transmission of Covid-19, it does decrease incidents of serious illness and death….for now.

We know that the asymptomatic infected can develop long Covid. To what extent vaccinations reduce the chances of developing long Covid is unclear for lack of tracking testing for and tracking of asymptomatic cases.

“While breakthrough cases of Covid-19 in vaccinated individuals remain rare, early research shows that a small number of those cases lead to “long Covid,” in which Covid-19 symptoms persist for weeks or months.

Why data on breakthrough infections and long Covid is so limited?

Research suggests that between 10% and 30% of adults who test positive for the coronavirus will go on to develop long Covid. The condition can arise even in those who develop only mild Covid-19 or are asymptomatic, the New York Times reports.

However, most research relates to Covid-19 in unvaccinated individuals. So far, there’s little research on how often breakthrough infections lead to long Covid.

Zijian Chen, medical director at the Center for Post-Covid Care at Mount Sinai Health System, said, “It’s too early to tell. The population of people getting sick post vaccination isn’t that high right now, and there’s no good tracking mechanism for these patients.”

According to the Times, one reason for the lack of data is CDC’s decision to track only breakthrough infections that result in hospitalization or death.

“It’s very frustrating not to have data at this point in the pandemic to know what happens to breakthrough cases,” Akiko Iwasaki, an immunologist at Yale School of Medicine, said. “If mild breakthrough infection is turning into long Covid, we don’t have a grasp of that number.” Advisory Board Daily Briefing, 8/19/21

IM DocSeptember 4, 2021 at 11:59 am
For what it is worth –
This is considered to be a total joke diagnosis by many Americans. You just have to trust me – it is most definitely not. Both the NEJM and the ANNALS of INTERNAL MEDICINE have just in the past few weeks had large preliminary articles about patients suffering from this problem. We do not have a handle on how common it is or how long it will last. Things are just too new.
I am seeing LONG COVID symptoms in vaccinated breakthroughs at what seems to be the same level as the unvaccinated cases although I do not believe enough time with Delta has passed to be really sure. But I am definitely seeing this in vaccinated patients.
LONG COVID symptoms are mainly 2 big groups.
1) There are the neuro issues that are the vast majority of these cases – headaches, chronic nausea, chronic malaise, severe and disabling fatigue, brain fog, memory/recall issues, and a very difficult symptom to pin down – “feeling that something is wrong.” Severe depression and to a lesser degree suicidal ideation in folks who have never had that before is also present.
2) Also happening in many vaccinated breakthroughs are the lung issues. This is usually but not always reserved for those who are really ill and have X-ray changes of ground glass while they are in the hospital or very ill at home. This often leads to a long lasting but not necessarily permanent pulmonary function decrease. In many of the unvaccinated patients from last year, this has largely resolved but certainly not for everybody. I will be interested to see how this plays out over time for the vaccinated as well. They are certainly getting it just as bad as the unvaccinated patients did last year. And please note, these types of problems do not just happen with COVID. This kind of thing happens with so many other infectious disease that leads to ARDS. This will hopefully end up being like our experience in the past with non-COVID infections where with time and exercise this does seem to get much better over time.
#2 is very concerning – because it is happening at a large incidence in many many breakthrough cases as well. They may not feel sick enough to be in the hospital, but they are hypoxic and clearly having lung issues even at home while acutely ill with COVID. And they very often have these crippled lung issues for weeks/months after their infection. This is happening to healthy patients but is way more common in patients who are not active, who are smokers (including marijuana) or have medical problems like asthma.
There are other issues that happen with acute COVID, mainly blood clotting events but many others, that are also happening with breakthrough vaccinated patients. These almost always resolve after a time and seem to cause no long term issues. But we have in no way had enough time to really fully evaluate what the long term issues may be. The big concern with these issues is what happens acutely – as in strokes, pulmonary emboli, or sudden cardiac death. I have also seen with acute COVID big blood clot problems in very unusual places, such as splenic vein thrombosis. Once you get through the acute setting, these issues tend to be very manageable.
1. LeeSeptember 4, 2021 at 1:07 pm
  Having developed symptoms of ME/CFS 15 years ago, and currently under treatment at Stanford Medical CFS clinic, I know well that long term post-viral illness is no joke. It was probably triggered by a severe respiratory illness I had in the first quarter of 2006.
2. MikelSeptember 4, 2021 at 1:20 pm
  “There are the neuro issues that are the vast majority of these cases – headaches, chronic nausea, chronic malaise, severe and disabling fatigue, brain fog, memory/recall issues, and a very difficult symptom to pin down – “feeling that something is wrong.” Severe depression and to a lesser degree suicidal ideation in folks who have never had that before is also present…”
  Maybe not only the long term effects of the disease should be considered, but also the long term effects of the psychological trauma and/or disorientation of the entire pandemic, from the way it’s been politicized to the way identies are being formed around what is believed about it…and the way grief is processed.
3. lordkoosSeptember 4, 2021 at 1:43 pm
  I would think that some of these symptoms such as depression, fatigue, malaise etc could be hard to separate from the feelings many people are experiencing from the general stress of living with the pandemic.
  1. IM DocSeptember 4, 2021 at 3:17 pm
    I have been doing a great deal of research about a past pandemic which I have never spent much time investigating – the Great Russian Flu of the 1890s. This has always been thought to be an actual influenza – but recent genetic and virologic studies are showing us that this was very likely the introduction of Coronavirus OC43 to the world.
    Many many physicians at the time were chronicling that the symptoms of this “flu” were different than any other influenza had ever been. Even Sir William Osler, in written statements in his textbooks of Internal Medicine, was of the notion that the symptoms exhibited by patients during that pandemic of the 1890s were really not like the normal flu. His books were written in the decades immediately leading up to the “real” influenza pandemic of 1918. And the one symptom that over and over described by numerous physicians that were writing at the time, including Sir Arthur Conan Doyle, was depression. This just does not happen to any degree in true INFLUENZA and many remarked on the difference.
    It must be noted that the word “depression” is a rather modern word and a modern construct. This construct is from our very reductionist, form-filling out, check the boxes modern medicine. “Depression” today is a drop bucket of multiple different diagnoses of the past. FYI, there are many things like this in medicine, not just depression.
    Conan Doyle and Osler would have used more prominently the diagnosis “melancholia” to describe what we commonly use as “depression” today. But interestingly enough, contemporaneous medical writers of the 1890s often used a completely different word with a completely different diagnostic meaning to describe what they were seeing in patients of that pandemic. That word is ACEDIA. I have seen it used repeatedly in my research of the pandemic of the 1890s.
    The difference is completely lost on us today – but it is actually a very important distinction. ACEDIA is an old medieval concept which is very difficult to describe. Basically it means a depression of the soul. A SPIRITUAL depression. While melancholia was more of a behavioral depression. Mainly having to do with living with consequences of behavior or reaction to events in a patient’s life.
    Interestingly, when I am really talking to these POST COVID patients today – it is indeed more consistent with the spiritual and soul exhaustion of ACEDIA – and not behavioral or reactive like most depressions are. I have occasionally seen this ACEDIA type of depression before, but it is now just one patient after the other. I am also seeing ACEDIA like depression repeatedly in patients who have never had COVID. It is a sign of the times. In the days of Osler and Conan Doyle, they had no way to test patients for the presence of the virus and just assumed everyone had been infected by the miasma. I think today I am seeing this in POST COVID patients and non-infected as well.
    The writers of that era in the 1890s were unequivocal in what they were seeing in their coronavirus pandemic – an epidemic of ACEDIA in those who had had the illness. I find it profoundly fascinating that the exact same type of thing is happening in our coronavirus patients and our COVID world today.

Ian PerkinsSeptember 4, 2021 at 10:01 pm

What you say about Coronavirus OC43 arriving in the 1890s could be good news in the long run, though not directly for old fogies like myself! Some NC commenters will probably want to jump down my throat for mentioning it, but it has been suggested that natural infection, rather than – or after – vaccination, offers the best immunity to COVID, and the young seem to be at much lower risk of illness than adults. (Yes, I’m well aware they’re not 100% immune, and there are delta and MIS-C and the possible complications of long COVID to consider, but in terms of COVID itself, they don’t seem anywhere near as vulnerable as the elderly – on average.)

My point being, if this has happened before, with a coronavirus sweeping the world as a deadly pandemic before settling down to become a common cold, perhaps because we all get exposed as children and develop immunity, might it happen again? But like I say, that’s a long term view, with probably little bearing on what we do now, today – and some will no doubt continue to insist eradication is possible, which it may yet be.

HotFlashSeptember 4, 2021 at 11:03 pm
Herd immunity requires some culls. What was the death rate from the 1890 Flu? 50 to 60% infection rate, 3-4% death rate, so I read. So that’s alright, then. Bangs head on desk.
1. IM DocSeptember 4, 2021 at 11:49 pm
  If indeed it was OC43 the infection rate is now 100%.
  It sweeps over the earth and we all get it every other year or so.
  That is what the concept of endemic status is.
  Endemicity isn’t necessarily a good thing. Many endemic infections still kill millions yearly malaria and AIDS being the ones that come to my mind instantly. There are many others.
  We should obviously try as hard as we can to limit casualities. But at some point, we as humans will need to come to grips with the fact that these pandemic introductions are one of the costs of the privilege of living here. It is part of life.
  There is possibly nothing we can do about it. We have repeatedly tried in both human and animal outbreaks and have never been successful even once. I have my doubts we will succeed this time. It will however eventually calm down and behave like its cousins like OC43.
  Unlike the mantra of modern neoliberalism, we as humans are not in charge.
  When you read contemporaneous writing from politicians and medical people both in the 1890s and 1918 flu you instantly realize that they were doing their best to make citizens understand this simple concept. The hubris approach of modern times that we are in charge would have been unthinkable then. We will see how it all plays out. I have my opinion that they were much more wise during those earlier pandemics.

Basil PestoSeptember 5, 2021 at 12:58 am

I’ve always found it interesting to read literature that pre-dates modern medicine and psychiatry in particular. You see signs of depression in ‘The Sorrows of Young Werther’. I’m seeing it in snatches in Emma as I reread ‘Madame Bovary’ (which is very funny on what might you might want to call “bourgeois science” – Flaubert’s father was a surgeon, and his museum in Rouen is a joint literary/medical museum).

There’s also the ongoing debate about whether King Lear suffered from dementia. I sort of reject the framing of the debate – dementia didn’t exist then, because it had not been classified. King Lear’s mental state was wholly invented by Shakespeare, albeit doubtless informed by some kind of real world experience, some kind of knowledge, pertaining to a certain kind or kinds of senescence. It’s an interesting case study, medically, but do we gain anything classifying an illness that only truly exists in the mind of its readers and writers. Should authors now be discouraged from inventing new diseases given that we assume that we have a thorough grasp of modern medicine (and I don’t mean inventing a disease that is in itself purely functional as a plot conceit, like in dystopian/disaster fiction). I’ve mentioned once before in comments that I had a case of akathisia. I never would have imagined until then that such unbearable suffering could even be possible. Perhaps there are lots more anguishes yet to be imagined, or discovered.

Would you say those with acedia experience a ‘sense of doom’ as a symptom? or is it a bit less urgent or acute than that?

SkunkSeptember 5, 2021 at 2:31 am
There are many references to “sweating sickness” in Medieval accounts. No one knows what it was, but it seems to have been prevalent.
IM DocSeptember 5, 2021 at 9:43 am
There is absolutely a sense of doom in many of them. But that is a common symptom in all kinds of depression.
Being grounded in medical history has been a lifesaver for me all through my career.
And yes there are so many things that are very clearly described in the past, that we have absolutely no idea exactly what they were.
Look up St Vitas’ Dance – one of the most amazing medical outbreaks in the history of mankind – and to this day we have not a clue what exactly happened.

LawnDartSeptember 5, 2021 at 1:07 pm

Covid: is it OK for medical staff to not treat the unvaccinated?

https://www.rt.com/op-ed/533903-medical-treatment-denial-unvaccinated-covid/

Well, a fat old guy like myself who’s been known to scarf down a bacon cheeseburger for breakfast really isn’t putting medical staff at any additional risk for this particular unhealthy behaviour: I got a couple of jabs of Moderna a few months ago, which means that I am less likely to end up in the hospital with the highly-infectious covid as the cause of my ails.

Yes, medical personel (and others) should not be forced to expose their own selves to harm from those whose actions helped create such risk of harm. In my case, should I collapse to the floor from chest-pains, none should attempt to load me onto a gurney until a small crane is available in order to lessen the risks of hernias or back injuries.

Swim across crocodile-infested waters on a dare? Could one really expect others to jump in to try to rescue them if toothy beasts start swimming in their direction midstream?

Objective AceSeptember 5, 2021 at 2:56 pm
>Yes, medical personel (and others) should not be forced to expose their own selves to harm from those whose actions helped create such risk of harm
So no treating vaccinated individuals who left their house to socialize either, right? Just confirming consistency
1. LawnDartSeptember 5, 2021 at 7:01 pm
  How about “reasonable care” or taking reasonable precautions to avoid infection? And what is “reasonable”? Maybe we can get some lawyers and linguists to take this chum of a comment as a reason enough to square-off in bloodsport.
  I get that people with autoimmune disorders, persons with a history of bad reactions to vaccines, or women of childbearing years, don’t want to roll the dice on RNA witches brew, and that to me is a perfectly good reason not to get jabbed– conditions beyond their control. And kids… we were used as pawns back when I was a kid– it’s only gotten worse. And thus, it would be wrong to refuse to provide care should they catch a dose of CV.
  But fear of microchips or anti-science/anti-vax “justa-flu” “only affects old people (f-em)” refusals? I ain’t jumping in the crocodile-infested river to save your nutjob arse (although I might root for you if I got $5 on the square marked 0:12 seconds– how long you might out-swim and fight off the hungry reptiles).
  I disagree with Doc: you’re free to jump into that croc-filled river on your own free will in order to save those who have taken extreme risks/behaved with utter irresponsibility, but others do not have the right to compel you to do so.
  To those in the field of medicine, past and present, who have put themselves at risk of injury for the sake of others, thank you for your service.
  1. Objective AceSeptember 5, 2021 at 9:57 pm
    Lumping people into 2 groups — those you consider to have valid reasons to not get vaccinated and those whose reasons you disagree with — does make ones view of the world pretty straightforward.
    I’d ask if you think everyone else shares (or should share) the exact same set of acceptable reasons as you? I’m also curious where you would put people who do not really fit in either of your stated groups: the 16-19 year olds no longer considered children; those concerned or with a history of blood clotting; or those with heart issues who are susceptible to myocarditis; etc
  2. Basil PestoSeptember 6, 2021 at 4:41 am
    like, “women of a childbearing age” is a *lot* of people. I’d understand your point to some extent if the vaccines were better than they are, but do you hold such strident views about, say, people who aren’t vaccinated with the annual flu vaccine? If not, why not? (acknowledging, of course, that Covid is far more serious than the flu)
IM DocSeptember 5, 2021 at 3:18 pm
Here is the problem. The very fact that there is an article like this is profoundly disturbing to me.
I guess you could call me old school.
I did my residency and internship when a previous pandemic – AIDS – was raging. Panic and fear was palpable. We were doing all kinds of procedures as novices where one false move could have infected us for life. Multi drug resistant TB was everywhere in hospital rooms.
I was taught by some of the brightest and best internists of the 20th Century. The very first thing that came out of our Chairman’s mouth on the first day – “You are now a doctor. That means something. We do not run from pandemics. We run into them. Never forget that.” And I have not.
I can only imagine what these bright stars of Internal Medicine would think about these constant statements of denigration toward the unvaccinated – and the refusal to treat them. If I would have dared say a word like that around or about an AIDS patient I would have been smacked in the head and fired within hours.
I can guarantee all that there are some serious RPMs going on these doctors’ graves now.
I can scarcely believe what is happening to my profession. It is breathtaking. There are many days that I fear that myself and the old guys like me clearly do not belong. What keeps me going though is the knowledge that just like so many aspects of AIDS, this is going to all detonate very soon – and my profession is going to need old folks like us to pick up the pieces.
And I love taking care of and being around my patients. There is no more noble profession. I have way too many people depending on me to cut and run. And those worried about people being fired or de-licensed. There is simply not nearly enough of us in primary care to even begin contemplating doing anything like that except for the most egregious unethical behavior. And that has always been and will be in the immediate future not related to COVID. It is also a complete non-starter in every red state in this country. The torrential flow of physicians and NPs and RNs leaving the blue states this past year has also been something I would never have seen coming.

Josef KSeptember 6, 2021 at 2:15 pm

Cases per 100k population, SC is #1 in the USA at 105.7, followed by:

TN 99.8
KY 97.8
WY 92.3
MS 92.3
LA 91.8
FL 85.9
GA 83.9
WV 83.4

And so on. Anyone see a pattern? I see a pattern.

IM DocSeptember 6, 2021 at 2:50 pm
Yes
I see a very similar pattern as last summer.
It is after all the same virus but different variant this time.
The southern states got lambasted first in the summer/fall wave. Next came Arizona followed a few weeks later by the northern Rockies one of which is already in this list the others like Idaho are already deeply in trouble.
If things play out like last year it will very soon spread to the northern plains followed closely by California and the upper Midwest. And then finally New England. By that time in October/November last year the whole country was bad but the northern states and west coast were really bad.
A big outlier in this years pattern is Oregon which is way more affected than it was last year at a similar time during the wave.
I am assuming that is the pattern you are seeing as well.

Josef KSeptember 6, 2021 at 4:48 pm
IM Doc:
I was thinking of a different pattern, a political one: the highest-rate states tend towards lower rates of mask-wearing and vaccination, with the former being the major factor in the increases.
The pattern you point is interested, no doubt valid, but there’s no causality stated; would you agree it’s the reasons (predominantly at least) I put forth, or others (in place of them or in addition to them)?

bassmuleSeptember 7, 2021 at 7:50 am

David Leonhardt in today’s NY Times. Critiques of his math, etc., encouraged.

“But at least one part of the American anxiety does seem to have become disconnected from the facts in recent weeks: the effectiveness of the vaccines. In a new ABC News/Washington Post poll, nearly half of adults judged their “risk of getting sick from the coronavirus” as either moderate or high — even though 75 percent of adults have received at least one shot.

In reality, the risks of getting any version of the virus remain small for the vaccinated, and the risks of getting badly sick remain minuscule.”

One in 5,000: The real chances of a breakthrough infection.

The Rev KevSeptember 7, 2021 at 9:06 am
Are you prepared to risk your health and possibly your life on something printed in the New York Times? A newspaper with a proven track record for lying when it suited their purposes? Not having a go at you but with this evolving virus a precautionary approach would probably be wise.
IM DocSeptember 7, 2021 at 9:26 am
There are less than 25000 in the total area where I live. By their calculus, that would mean that all the physicians in our area would have seen about 5 breakthroughs in total since Delta arrived.
Well I worked this whole weekend.
11 on sat
9 on Sunday
12 yesterday
I had 54 total for the week last week. Things may be slowing down because I had 61 the week before. There are days with more than 10 repeatedly. And as time has progressed, these breakthroughs are not just head colds – yet another lie. Serious lung changes and other covid issues are becoming increasingly common among them.
And the thing is everyone knows it. This has been in the newspaper here repeatedly. These pundits and the doctors supporting them are doing absolutely grave damage to the credibility of the media and medicine. This may be generational in its impact.
I just cannot believe what I am seeing happen.
Hey NYT WSJ and all others – is the Pfizer and big Pharma advertising cash really worth your credibility? You are looking more like prostitutes every day. Average people are increasingly noticing it and tuning you out. Just look at the cratering numbers for CNN and MSNBC. This country desperately needs an independent media but instead we have you.
1. EustachedesaintpierreSeptember 7, 2021 at 10:04 am
  You 5 last words – thank goodness for that & people like you.
  ” Even in a time of elephantine vanity and greed, one never has to look far to see the campfires of gentle people ” – Garrison Keillor.
2. vladeSeptember 7, 2021 at 10:40 am
  Not to question your numbers, but if you have a 25k vaccinated in your area, but are seeing on average say 9 breakthrough cases/day, for a couple of months, that means about 500-600 cases (for say two 10 weeks or so of Delta, no idea what the period you’re seeing this is for).
  Which out of those 25k vaccinated means 0.5% (at least) are sufficiently sick to seek medical help.
  Which seems quite a bit to me. Israel (that has pretty good data) says that in vaccinated, severe cases (can’t find what they call “severe” though) is less than 50 in 100k (as of early August, can’t find any recent numbers), so less than 0.05%, ten times less than what your numbers would indicate.
  I’m just trying to make sense of numbers.
  1. IM DocSeptember 7, 2021 at 10:55 am
    I am reporting what I am seeing.
    Please note as well that even now reporting of non critical vaccinated breakthroughs is not happening. At least where I am and I assume a lot of the country.
    That is why I have said multiple times the dashboards are only a part of the picture in many areas.

GlossolaliaSeptember 7, 2021 at 9:53 am

My state of Maryland is now publishing data on breakthrough cases:

About 3,369,018 Maryland residents have been fully vaccinated as of August 15, 2021.
There have been 11,454 COVID-19 cases among fully vaccinated Maryland residents.
Of those cases, there were:
883 cases hospitalized, representing 6.5% of all COVID-19 cases hospitalized
82 deaths, representing 5.3% of lab-confirmed COVID-19 deaths in Maryland
Approximately 7.8% of all confirmed COVID-19 cases in Maryland since January 2021 have been among fully vaccinated individuals.

IM DocSeptember 7, 2021 at 1:08 pm
That has become a very common tactic to underwhelm the citizenry with the vaccinated positive percentage. To run the numbers all the way back to JAN.
I would be very interested to see what the numbers are since the advent of Delta. I would guess it would likely be different. Comparing things now to back pre-June is really comparing apples to oranges.

The Rev KevSeptember 7, 2021 at 9:01 am
“Doctors should be allowed to give priority to vaccinated patients when resources are scarce”
These people have literally no idea that they are playing with sweaty dynamite here. So forget Wapo writer Ruth Marcus and give me Dr. Marcus Welby instead. At least he followed his Hippocratic Oath. She says that this idea of hers to deny people medical treatment conflicts radically with accepted medical ethics but she is prepared to ditch those ethics not on medical grounds but moral grounds – her morals. This time she wants to do it for vaccine refusal without recognizing that there might be several reasons why people hesitate to take these first generation vaccines. But once you have dumped medical ethics you open yourself up to other ideas which I have seen over the years. You can then deny medical treatment because they are smokers, they are drinkers, they are too fat, they don’t go to the gym to keep themselves fit, they are too poor, etc. But here I will cede the ground to link to an article where a doctor weighs in on this whole idea-
https://www.rt.com/op-ed/533903-medical-treatment-denial-unvaccinated-covid/
1. IM DocSeptember 7, 2021 at 9:36 am
  The principles of medical ethics have often been a response to the darkest of human times. Think Dr. Mengele.
  I have spent my life telling students that the ethics are there not just for the patients protection but also for theirs and their society.
  They serve us all during good times but more importantly can lead the way out of bad times.
  The very fact that such prominent people are allowed to spew like this about the sacred is beginning to make me question every assumption I have had about the very concept of America.
  On a more practical matter, what these knuckleheads seem to not be able to process is that I and every other HCW are in just as much danger from the sick vaccinated as the unvaccinated.
  The imbecile is just overwhelming.
  Lord have mercy.

RE: AAPS Letter to AMA Re: Ivermectin and COVID Association of American Physicians and Surgeons

IM DocSeptember 8, 2021 at 7:50 am

I think it important for a little context in the above linked letter from the AAPS (American Association of Physicians & Surgeons ) to the AMA.

First off, I am not yet a member of AAPS but have been trending in that direction and now after this letter and other recent statements will likely become one.

Furthermore, here we are in a national medical crisis. AAPS has been on the ball with repeated statements like this and all kinds of takes on COVID issues. By contrast, in the middle of a crisis which has taken the lives of 600k Americans, the AMA from what I can tell has spent much of its time this past year on “birthing people” nomenclature and other such inanities.

The AMA is what everyone think is America’s physicians lobbying and political arm. Nothing could be further from the truth. In the past 40 years, AMA has become a corrupt horrific influence on medicine. They are more interested in the interests of the power elite – hospitals, insurance companies, and Pharma. They certainly do not give a rats ass about patient care. They own the ICD coding system. So every time you are billed, their proprietary system gets a little cut. They rake in millions of dollars to fund their corruption every year this way.

AAPS is actually an ever growing physician group whose purpose is to represent the physicians, patients and the actual health of Americans. It was a fringe group of outliers. But rapidly gaining on the AMA in physician member numbers. Physicians are leaving the AMA in droves.

I am not surprised by this stand. The questions in the letter are important and the ossified AMA and other agencies cannot answer them without revealing their rank corruption.

This group is the group representing patients and physicians that most people think the AMA is. This letter shows that just like I have been telling you, there is a very large contingent of physicians across America who are just not eating the dog food anymore. Slowly but surely, the battle is being joined.

mistah charley, ph.d.September 8, 2021 at 8:04 am
Doctor, the Wikipedia article about the AAPS states:
AAPS is generally recognized as politically conservative or ultra-conservative, and its positions are fringe and commonly contradict with existing federal health policy. It is opposed to the Affordable Care Act and other forms of universal health insurance.
The Washington Post summarized their beliefs in February 2017 as “doctors should be autonomous in treating their patients — with far fewer government rules, medical quality standards, insurance coverage limits and legal penalties when they make mistakes”. The organization requires its members to sign a “declaration of independence” pledging that they will not work with Medicare, Medicaid, or private insurance companies.
Are these assertions about AAPS accurate? And would you personally pledge not to work with Medicare, Medicaid, or private insurance companies?
1. IM DocSeptember 8, 2021 at 9:34 am
  As I stated above, it has been in the past a largely fringe group. As the ama has become more and more corrupt, physicians have been joining that are not in that fringe.
  That is indeed why I have not signed up in the past.
  However, as more and more are seeing the absolute disaster that our organized medicine has become, these groups are becoming the only choice for true patient and doctor centered health care. The AMA and all the various boards and governing bodies could absolutely care less about patients. It really is unfortunately true.
  The group has attracted a lot of concierge docs in the past – that is no longer the case.
  I am not at all sure about the Medicare stance since every PCP I know that is in the group have practices larded with Medicare patients.
  If they are for reforming our Medicare system, I am all for that. Especially the crime against humanity known as Medicare advantage plans. Furthermore, this group was 100 percent against Obamacare. I was actually an ardent supporter. Enough time has passed to make me realize that was likely one of the worst things to happen to patients in history. They were right, I was wrong. Having huge chunks of your practice paying astronomical premiums all the while with 10000 dedictibles leads to people not with health care but people with NO care. This group of “right wingers” as you point out they are referred to by wiki ( I never go there anymore for very good reason – the latest of which was the whole Philip Cross fun of last month on this very site and much of their entries on medical issues are just flat out wrong) predicted that was exactly what would happen with Obamacare and here we are. I am daily confronted with people with “insurance” as outlined by Obamacare who have desperate medical issues but have no way to pay their 10000 deductible. Amazingly cruel and yet every.single.day. Yesterday’s entry was a young man with seizures out of nowhere who cannot afford the 2100 for an mri. He has a 10000 deductible but he is “fully insured”. It is a true disaster every day but you will never hear that from the AMA but you will hear it from the right wingers as you call them.
  I have learned as I am older that dealing with dogma and those who criticize others often have their own agenda which may even be worse. That is the sense I get when I hear wiki entries like the above.
  Until we realize our health care system is a complete disaster for almost everyone, I refuse any longer to criticize or belittle anyone with ideas because of their politics. Our system is that bad.
  The physicians across the country I have interacted with that have joined are not rabid right wingers. I have noted in the recent past that anyone who does not agree with the narrative is immediately branded a right winger. And pages like wiki are often the cudgel used to do so. Since I have been commenting on this site about Covid, that has been said about me personally in comments quite a few times. Anyone who knows me would find that statement LOL hilarious.

BondsOfSteelSeptember 8, 2021 at 11:56 am

Being a member of this group would greatly hurt your reputation and credibility:

https://en.wikipedia.org/wiki/Association_of_American_Physicians_and_Surgeons#Journal_of_American_Physicians_and_Surgeons

They don’t just support a political agenda… they’re pushing quackery.

IM DocSeptember 8, 2021 at 12:24 pm
I will do some more research into this today –
However – I believe absolutely nothing that wikipedia has to say about any organization – left or right. When they can make up things out of whole-cloth on multiple medical history entires in the past I have encountered – I can not trust a thing they say. Anyone can make a mistake – but when a Medical History professor like myself can repeatedly email them and try to correct their severe misrepresentations – and get nothing but a laugh or scorn back or just complete blow off – I have no use for them. After those experiences – I trust literally nothing on their website to be accurate in any way.
1. Parker DooleySeptember 8, 2021 at 1:47 pm
  Suggest you check out Physicians for a National Health Program. They are more about benefitting patients and not just encouraging docs to go all concierge.
2. lordkoosSeptember 8, 2021 at 3:18 pm
  Wikipedia is a terrible source if you expect to get a balanced view of anything having to do with health care. Their editors seem like an extension of the AMA (and perhaps they are). Wikipedia is virulently against any type of alternative medical practice, even ones that have been proven to be beneficial such as acupuncture, which is covered by most insurance policies as a health treatment.
  Wikipedia on acupuncture: “Acupuncture is a pseudoscience, the theories and practices of TCM are not based on scientific knowledge, and it has been characterized as quackery.”
  I had a similar experience to IM Doc when I attempted to edit a wiki page to defend an alternative practice that Wikipedia referred to as “quackery”. I had taken a 4 year training in this particular practice and had found great benefit in my own life from it. It was obvious to me that the person in charge of editing the page (a Dr David Gorski from Michigan, he’s on twitter) had zero direct experience with the practice in question, and no interest in finding what was true or looking at studies etc. At this point I have little trust in Wikipedia in general, and none at all when it comes to health care issues.
  1. lordkoosSeptember 8, 2021 at 3:24 pm
    The founder of wikipedia himself now says he regards the site as “propaganda”:
    https://nypost.com/2021/07/16/wikipedia-co-founder-says-site-is-now-propaganda-for-left-leaning-establishment/

IM DocSeptember 8, 2021 at 12:00 pm
I have just now looked at their membership application – correct me if I am wrong – but I see absolutely nothing on there about signing a pledge not to work with Medicare, Medicaid or private insurance companies.
What I do see on the top of the page is a Latin motto – which translated means – Everything for the patient. There is also a call to oppose government-run medicine. After the debacle that Medcare Advantage plans and Obamacare have become – I join them in their concern there. I would also add to that – the corporate run medicine we have – but this group is not really the corporate type. Mostly private practitioners running their own businesses.
Some of the things on their website I disagree with – but I can say the same if not more so about the AMA.
https://aaps.wufoo.com/forms/join-aaps-physician-member/
It appears you can fill out that application online and submit your fees – and you are a member – no pledge signing required.
I will ask my colleagues who have joined if they were asked to sign such a pledge. I have looked through the website at length – and noted no such verbiage anywhere. What I do see talked about quite a bit is their opposition to MOC (Maintenance of Certification). That is a very large issue in medicine these days – and is way beyond what I have time to discuss here. Let me just say – this physician who has seen the MOC system abused for decades for the financial benefits and corruption of the various Boards and the detriment to patient care – has nothing but praise for anyone standing up to expose the fraud that it is.
As you quoted the Washington Post above – long gone are the days of their glory with things like Watergate. I hold them, the NYT, and the WSJ about to the same expectations of journalistic excellence these days as the National Enquirer, Rachel Maddow or Tucker Carlson. The fact checkers constantly employed by the Washington Post have recently been producing one howler after the other. Our entire media landscape is slowly becoming a tragedy.
Just checked – 2 of the 5 friends I emailed this AM got back to me and have absolutely no idea what the Washington Post is talking about – they have never been asked to sign any kind of pledge like that. One of them has attended the national convention recently – and absolutely nothing like that was even mentioned.
And both of them have lots of Medicare and private insurance patients. If the other 3 have anything different to add – I will update. I am unable to have the time to find your reference to the Washington Post in 2017 – but according to my friends, they appear to be inaccurate in their reporting.
1. Ian PerkinsSeptember 8, 2021 at 12:23 pm
  This appears to be the 2017 Washington Post piece in question. I’ve skimmed through it, and noticed no mention of any pledge, though it does imply the AAPS membership generally held some ‘right-wing’ views. But as you say, that was then, and now may be different.
  https://www.washingtonpost.com/news/powerpost/wp/2017/02/09/through-views-and-alliances-hhs-nominee-has-long-opposed-government-role-in-health-care/

haywoodSeptember 8, 2021 at 10:24 am

IM Doc, your contributions here have been invaluable to me as this pandemic has progresses and the public health response regresses.

With that said, I can tell you from first hand experience that the AAPS is a group of hard-right cranks who prioritize profits over people’s health, overtly.

I worked on the political side of the ACA fight many years ago and I remember this outfit well. They were on every Tea Party bus slamming the ACA, an already conservative bill that aimed to further subsidize the insurance industry, as some sort of death-panel care rationing grandma-killing nightmare.

They’re real pieces of shit, even if they might have made some good points about the overreaches and failures of the American public health system during this crisis.

IM DocSeptember 8, 2021 at 12:33 pm
As I stated above – I was an ardent supporter of Obamacare. ARDENT.
It has proven to be a disaster in almost every way. These “cranks” were right – and I get to live the tragedy of it all with my patients on a daily basis.
At the same time as the advent of Obamacare – came the advent of all the GoFundMe pages, bake sales, carnivals, etc for communities to support “insured” patients who cannot afford their cancer and other care. If that is success – I hate to see what failure is.
The Tea Partiers absolutely were “pieces of shit” – I hate people who turn our discourses into this kind of stuff. BUT they happened to absolutely correct in their predictions of how bad this is turning out for so many people.
As for it being a “conservative” bill – I am always very interested in having people who proclaim that explain something to me –
That bill was made law with Barack “Mr. Progressive” Obama as President, the House under absolutely dominating Dem control – and the Senate with a filibuster proof majority. How did that confluence of absolute Dem control pass a “conservative” law? – It is like the Dems now see what a disaster it is – and like to call it conservative – but that is not the way it went down. Please tell me – I am all ears – how did that happen?
Had they done something that was really for the people – I would have been elated – M4All – etc – but that is not what was done with that complete Dem lock on the government – instead we have this nightmare.
This “working class” Dem for one will never forgive them for it.
1. Fiery HuntSeptember 8, 2021 at 1:21 pm
  I hear ya, Doc. Don’t let ’em get ya down,,,
  I don’t care what political strip people are…on any specific issue, I’m with whomever is looking out for the working/middle class. For example…with Dems re:abortion rights and with Republicans re: ACA.
  Anyone who still supports ACA and private insurance is absolutely NOT on the side of working/middle class people/patients.

IM DocSeptember 8, 2021 at 2:52 pm

About the deSantis article above – and his stance on the current COVID vaccines –

‘It’s about your health and whether you want that protection or not. It really doesn’t impact me or anyone else.’”

I am not sure that there could be a more fitting epitaph for this entire fiasco.

And it is the same false reasoning on both sides.

This is the exact way that most people think about vaccines – even today I am having this discussion over and over again with patients. I am vaccinated. Therefore, I will not have the virus, I cannot get sick – and I cannot spread the contagion.

And the reason this is in their minds this way is because this is true of most every other vaccine there is. But this is most definitely not true with non-sterilizing vaccines.

We have placed into our world a non-sterilizing vaccine which is completely different than what people are accustomed to. For public health and safety, Plan B must be initiated – yet no such plans are even on the horizon. Plan A of total freedom from infection and spread is not only unworkable – it is actually quite dangerous.

We have one third of our our society who feel that they are vaccinated and protected and who cares if others are not.

While the other third is cudgeling everyone else with vaccine mandates and passports with zero evidence that any such thing will work in an environment created by a non-sterilizing vaccine. But what does work are all the bang-on effects of social and economic meltdown. No benefit provided, but all the ongoing damage is happening and encouraged.

And then all the “deplorable” unvaccinated who threw up their hands long ago – most of him have very legitimate concerns about the vaccines – and absolutely no one addressing them. Instead, a constant barrage of belittling, health-care shaming, moral superiority condescending and now outright lying directed their way.

All the while, no one is pressing hard on Plan B consisting of masks, ventilation, vigorous testing, vigorous quarantine and so many other measures that are sorely needed right now. No one is having any kind of serious discussion with the people about life style changes and risk factor modification. No one.

And the PCPs of America are stuck in the big middle of this morass, patients getting madder by the day, with no guidance whatsoever. The big topic of the past 2 weeks has been boosters – coming up almost every visit. Not an official peep out of our health authorities for guidance. Just a mishmash of contradictions and off the wall talk.

I never dreamed such a hellscape would ever happen in this country. It is truly incredible.

lordkoosSeptember 8, 2021 at 4:44 pm

I’m playing a gig this Saturday for a Seattle dance club, it will be the first I’ve done where all of the musicians (including the singers!) as well as the audience will be required to wear a mask. It’s a large space & hopefully it will be well ventilated. Although I have a few more bookings this year, it will probably end up being my last gig of 2021 the way things are trending.

IM DocSeptember 8, 2021 at 5:06 pm
Please be careful –
About 10 days ago – I had to admit 2 members of a swing dancing band to the hospital. It was part of a larger superspreader event. Everyone in attendance had to show proof of vaccination – I understand about 80 were there – and yet we had 14 vaccinated breakthroughs from that event – with 2 of them – the band members – having to be admitted. So far everyone is OK. But those 2 and 2 of the others got really really sick.
It was in a large ballroom. Lots of singing, drinking, instrument playing, and dancing. Masks were not required because they were all vaccinated. They all thought they were good because there was a vaccine mandate for entrance. They thought wrong.
Please be careful and take care of yourself.

IM DocSeptember 9, 2021 at 12:41 pm

Three big differences. And remember the smallpox vaccine in 1905 was still in the Wild Wild West of pharmaceuticals – long before the FDA and CDC were even thought of. Read HG Wells TONO BUNGAY – or Sinclair Lewis ARROWSMITH.

1) The vaccine for smallpox had been around for decades. The side effects and complications were well known – by all providers and health authorities and the safety concerns were easily handled because of the familiarity. This is not the case with the COVID vaccines even now. I have just had yet another patient develop a DVT and seek treatment on TUE of this week after having his 2nd Moderna last week. Related? Who knows? – we have no idea what the exact safety issues are with these vaccines. We have educated guesses – but my personal experience so far with the CDC and VAERS and FDA have been they are trying to do all they can to minimize problems. I have very little faith in the validity of our current safety knowledge.

2) Smallpox is absolutely orders of magnitude more lethal than COVID. Smallpox outbreaks were just horrific in their death and morbidity counts back in the day. Despite all the panic porn, COVID remains a much different level of threat by orders of magnitude.

3) The vaccinations for smallpox were absolutely sterilizing – it ended with the person that minute. That is most definitely not the case with COVID vaccines – there is individual benefit ( how long that will last – who knows?) – but the public health “herd” benefit with these vaccines is very nebulous right now – and they may actually cause much more harm than benefit as we go along. We will see. There is also increasing evidence that at least some of the mutation pressure is happening in the vaccinated. This was NOT the case in smallpox vaccines and never was.

The difference between the two is overwhelming. It is easy to see for anyone with a background in vaccinology or infectious disease. We are however not listening to these experts – instead we are listening to Big Pharma and media and political shills with their own agendas that have nothing whatsoever to do with public health.

EustachedesaintpierreSeptember 9, 2021 at 2:08 pm
Just a thought – but isn’t it the case that boosters will always be a reactive measure, as the tweeking unless we get a steady state Covid, will always depend on the particular evolution of a new variant. If that is indeed the case we will I suppose be for at least the foreseeable future condemned to playing catch up, with perhaps the added risk of vaccine breakthroughs.
I am I guess just wondering what force is actually running this shitshow – feel free to enlighten me.
1. IM DocSeptember 9, 2021 at 8:40 pm
  Look how long it has taken us to get 50% of the country vaccinated – 8 months or so. Viruses move much quicker – especially one with this kind of turnover.
  We would be 3 steps behind at all times.
  I have never yet had a decent explanation of a very simple question I have – How is a booster toward the wild original virus spike protein going to do anything at this point – that virus is now extinct in the wild? If this was a vaccine that had the entire virus – that is a different story – but these vaccines are just to one small part….the part that changes all the time.
  I have never had anyone in any way shape or form in any academic center ever be able to answer that question. They turn into Elmer Fudd.

IM DocSeptember 9, 2021 at 1:02 pm
When we moved from the big city and now live in the fruited plain – I took the skills from my childhood and planted an orchard, built greenhouses, and started working with chickens again. Bees and honey. Mushroom racks. The whole enchilada. Dozens of fruit trees in the orchards. 4 large greenhouses now.
We get all of our other protein from fishing and hunting – and we buy a fourth of a grass finished cow from our neighbor rancher at a much reduced price of ZERO dollars every 9 months or so. His family constantly helps us consume our eggs and other vegetables and fruit in return.
Harvest time is here. Wife and I have been working hard with the kids – and we are now over 1000 cans of jams, salsa, marinara, pickles, mushrooms and other vegetables. We have filled 2 freezers with frozen fruit and we have not even started the apples yet. When done – we will be good for the year.
About the only thing we buy from the grocery store is sugar and flour and some non-seasonal fruits like melons. We get all butter and milk from the farmer down the road.
I have never felt so free – and we do not worry too much about the prices in the grocery store. There is however a price – a lot of work. But I am OK with that – I have not been as fit as I am since my 20s. It has been the best thing for me mentally too. And I am bound and determined to make sure my kids have these skills handed down to me from my family.They used them to survive the Great Depression and WW2. It will be up to the kids if they use them or not – but by God – they will know how. It does wonders for the soul to see them climbing trees and picking fruit – and tending to the chicken coops.

lyman alpha blobSeptember 9, 2021 at 2:51 pm
I was poking around in a dusty old used bookstore recently and found an essay from Voltaire on smallpox inoculation. After today’s earlier discussion of the rona vaccine mandates and early 20th century smallpox vaccination mandates in links, I thought this might be of historical interest – Letter on Inoculation with Smallpox.
Not a medical historian so maybe IM Doc can correct me if this is mistaken, but based on Voltaire’s take, the practice didn’t develop in the West by scientists, but as a form of folk medicine through empirical trials. Lots of snobbery about it at the time – evidently for some Europeans, inoculation was the “horse paste” of the 18th century. I’m sure Dr. “The Science” Fauci would have disapproved had he been alive.
Also interesting is the supposed rationale – without inoculation smallpox could kill or disfigure young women whose parents were planning on selling them into harems. I wonder if some of the women would have rather had smallpox…
1. jrSeptember 9, 2021 at 3:21 pm
  Years ago in school I learned that it was slaves who introduced the practice to the West but this article indicates it was in use in the Near East as well. According to Wiki, the Chinese were doing it a long time too:
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407399/
  “ I had from a servant of my own an account of its being practised in Africa. Enquiring of my Negro man, Onesimus, who is a pretty intelligent fellow” -Cotton Mather
2. GarethSeptember 9, 2021 at 3:41 pm
  Several years ago, I was browsing a digital archive of newspapers from the 1770s to the 1790s and came across a few classified ads related to smallpox inoculation. One was for a doctor who was setting up shop after receiving training for it in Europe. The other two were for the same doctor. In the first, he was notifying residents that he was moving to another town, but that he would stop by periodically to offer inoculation. In the second, he apologized for considering leaving and stated that the residents had convinced him to stay. America had at least 125 years of experience with smallpox inoculation and vaccination before the court’s decision in 1905.
  1. GarethSeptember 9, 2021 at 3:56 pm
    I checked to see if I could link to those, but it is subscription only. Thankfully, LOC has a page from the Gazette of the United States in New York from 1789. In the middle column, there is a brief mention of a British doctor successfully applying the same techniques used to inoculate against smallpox to horses for one of their illnesses.
  2. begobSeptember 10, 2021 at 6:03 am
    Good review of the anti-vaccination case around 1800 – “The Creator stamped on man the divine image, but Jenner placed on him the mark of the beast”: https://publicdomainreview.org/essay/the-mark-of-the-beast-georgian-britains-anti-vaxxer-movement
    The same debate applied to the earlier practice of variolation, which is what Voltaire discusses – infection with a mild form of actual smallpox, rather than cowpox. Cotton Mather and the Puritans were in favour, relying on an unusually enlightened take on providence.
    Vaccination with cowpox was actually first practised by Benjamin Jesty, a farmer and citizen scientist, whose observations seemed to confirm folk wisdom about the immunity of milk maids:
    Some years before this [1805-7] he had lived at a farm in the neighbourhood of Cerne, in this County, (Dorset), and there he first practised vaccination on his own children. Fever ran high with his patients, and he called in Mr. Trowbridge the medical man at Cerne, (whom I full well remember in later years when he lived near that place,) and told him what he had done. Trowbridge said, “you have done a bold thing, but I will get you through it if I can” — treated it as fever and was successful. I should have said that old Jesty not being equipped with a lancet, performed the operation with a stocking needle!!
3. IM DocSeptember 9, 2021 at 11:11 pm
  I would really need to dig deep into this article but the smallpox immunization has been around for centuries. Jenner was the first to do it with vaccination. The process before this was called variolation and my guess is that what is being referred to here.
  I will just say it took practice and apprenticeship to do the procedure correctly. One false move and well you could actually start an outbreak.
  They had gotten pretty good at it by the mid to late 1700s and this was ordered to be done on the troops by Washington in some battles.

Ian PerkinsSeptember 10, 2021 at 2:42 pm

a vaccine I only need to take once (possibly with a booster), like polio or measles, is sterilizing

Yes, but that’s the trouble when technical terms get into the mainstream. Polio, measles and smallpox vaccines certainly work, but vaccines or previous infections aren’t necessarily so good at preventing subsequent infections, only illnesses! From ‘Individuals cannot rely on COVID-19 herd immunity: Durable immunity to viral disease is limited to viruses with obligate viremic spread‘, linked to in the Atlantic article,
“Poliovirus vaccination provides insight into the nature of protective antiviral immunity. Intramuscular immunization with inactivated virus prevents paralytic disease but not GI infection, with repeat vaccination necessary to reduce shedding of infectious virus. Similarly, even natural respiratory infections with measles or variola (smallpox) viruses, famous for inducing life-long immunity to disease, do not prevent respiratory reinfection, which though asymptomatic and nontransmissible, can be detected by increased antiviral antibody titers [7,8].”

IM DocSeptember 10, 2021 at 3:52 pm
While these issues are true – I think it must be stated about SMALLPOX – it has been eradicated from the planet in the wild – may still be alive in freezers somewhere. And the others are so extremely rare that they are miniscule in their occurrence –
I would also like to ask the writer of that article – after the statement above about the polio vaccines – What do you think the ORAL sugar cube form is for? Why is it that we give BOTH to patients?

RE: “We’re Asking the Impossible of Vaccines” [The Atlantic]. “Eventually, all discussions about sterilizing immunity become nerdy quibbles over semantics.” • Holy moley, if there were an Oscars for goal-post moving, this would be a top candidate. To my simple, layperson’s mind, a vaccine I only need to take once (possibly with a booster), like polio or measles, is sterilizing. A vaccine I have to keep taking, like a flu vaccine, is not. I wonder if of our experts would care to comment on this article, which, however motivated, seems designed to normalize the rapidly waning effiicacy of today’s Covid vaccines.

IM DocSeptember 10, 2021 at 3:32 pm

With regard to The Atlantic article about vaccination –

There is a highlighted sentence directly under the title of the article ( I am not a journalist – I am sure this sentence in the layout has a name – do not know what it is, though).

Complete protection against infection has long been hailed as the holy grail of vaccination. It might simply be unachievable.

The very instant I read that sentence – as a medical doctor and a medical historian – I know instantly that this person has no idea what they are talking about – and has not bothered to do the most basic of research in the topic.

One word –

SMALLPOX

It has been achieved – it is not unachievable. But it took a STERILIZING vaccine. And ON TOP OF THE VACCINE, all kinds of other efforts which were completely different based on the part of the world. The top priority – Truth being told to the population at all times. A concerted effort with non-compromised leaders and spokespeople. And to have the entire health system on board in an organized manner. Also, not a small amount of PR was required then, because the vaccinations left permanent scars on the skin. The authorities got out ahead in front of this issue – and did not wait until it detonated when people started noticing it and sharing it with friends. Furthermore, smallpox vaccination rates were nowhere near 100% – but when you have a sterilizing vaccine, it does not need to be so. Political and health leaders did absolutely no kind of shaming or belittling. The messaging was almost all positive and congratulatory. It is also important to realize that this eradication occurred in an era of mass media but long before we had the Internet and especially social media. I do not think we can even begin to overestimate the absolutely horrific effect social media has had on our response this time. Most patients I see every day literally want to throw their hands in the air – they have completely given up.

There is ZERO wild smallpox on the face of this planet today. ZERO. The only place it is left intact is purportedly in the freezers of viral labs at the CDC and in Russia. I am not even certain about that.

Polio is a very similar story, but is not completely eradicated from the planet – just a sliver is left. And one could argue the same about measles, mumps, and others that have been made so uncommon that young doctors would not recognize the symptoms if seen in the ER.

Coronaviruses are a completely and totally unique virus family in almost every way conceivable. The pox viruses are much more amenable to vaccination efforts. But that in no way means that science will never find a way to eradicate a coronavirus aided by vaccinatinon.

But ERADICATION via vaccination would require a STERILIZING vaccine. And that is not where we are today. The sooner our health agencies and media begin to level with the people and not put out this kind of article the better we will all be. I was gravely concerned when the messaging earlier this year was so misleading that it was giving people the idea that the vaccines were causing eradication. The mainstream narrative today saying this was never the case just 4 months ago is totally deluding itself just like with so many other issues. “Why we never said that – everyone always knew it was never going to prevent you from getting it” – all over the news today – is belied by the statement on my vaccination consent form right in front of me – THIS VACCINATION WAS GIVEN AN EUA for PREVENTION of COVID-19. Right there on the form. It was a classic case of miscontruing concepts without actually lying that misled the vast majority of my patients. Big Pharma is very very good at that.

I am of the firm belief, that after the Biden performance last night, unless an intense leveling is done with the American people about appropriate expectations and soon – there will be enormous political consequences for his administration. More than half the country thinks that forced vaccination of these NON-STERILIZING vaccines is going to end this pandemic. That is not the case at all. And I can see a future of a lot of disappointment and anger.

There is precedent for where we are today – the FLU shots. Also non-sterilizing. But nobody discusses the flu vaccination in terms of eradication – because it is simply impossible with non-sterilizing vaccines. Level with the people. They clearly understand the flu shot. They clearly get it – the flu shot will not eradicate the virus from earth – it will however make you less likely to get really sick – WHEN YOU GET THE FLU. And we have learned to live with the flu with the tens/hundreds of thousands of casualties every year. Until something much better comes for COVID, it is going to be a similar story.

Until we begin to treat the citizens of the world as adults, and not kids – and quit bamboozling – we are never going to have buy in from every group as has happened in the past.

My two cents.

jimmy ccSeptember 10, 2021 at 3:42 pm
there will be enormous political consequences for his administration
one can always hope….
Ian PerkinsSeptember 10, 2021 at 3:49 pm
Do smallpox vaccines completely prevent infections, or just transmissible infections? Polio vaccines prevent the latter, but don’t achieve the former entirely – which is somewhat academic, as they both work, but if we’re quibbling the use of words, “Complete protection against infection has long been hailed as the holy grail of vaccination. It might simply be unachievable” might be accurate.
See my comment above – https://www.nakedcapitalism.com/2021/09/200pm-water-cooler-9-10-2021.html#comment-3604595
1. IM DocSeptember 10, 2021 at 3:57 pm
  I would suggest – that making statements such as that sentence are really misleading to everyone but those who have been schooled in virology and vaccinology. Those words mean something completely different to me than my patients. The difference between an “infection” and a “transmissible infection” is debating angels on a pinhead for most people.
  I get the feeling that they are realizing that the whole COVID vaccination story is getting shot through with holes – and they are pulling at straws.
  I just had my front desk person read this article. A college graduate in English. She did not understand it the way it is being presented. Again – this is common BIG PHARMA dissembling.
2. IM DocSeptember 10, 2021 at 4:02 pm
  It seems to me the argument here that most people get that the writer is trying to convey – is OH well – the COVID vaccine is not working out as well as we would hoped – but no big deal – neither did any other, when you really think about it and use arcane terms.
  Nothing could be further from the truth –
  When is the last time I saw a polio infection or a transmissable polio infection? NEVER
  When is the last time I saw a smallpox infection or a transmissable smallpox infection? NEVER
  I can go on with measles mumps, etc.
  When is the last time I saw a COVID infection or a transmissable COVID infection – well I have seen 8 this AM – all in vaccinated patients.
  And most people get that – and look sideways at articles like this trying to explain this away via word games.

timSeptember 11, 2021 at 7:26 am

Covis19#

I would like to ask GM why Denmark with 76% overall vaccination rate and i think 86-87% for 12-110 year old people aren’t experiencing these dramatic increases.

It is like we are on a different planet. All restrictions have been lifted, people go to music festivals with +15.000 spectators and still the number of new cases pr. day is stable at a very low rate yesterday it was 458 cases if I remember correctly

Basil PestoSeptember 11, 2021 at 7:35 am
yeah, a friend of mine lives in CPH. He agrees with a lot of what I say about Covid but at the same time, he’s pretty bullish about how Denmark is doing right now. I haven’t had a close look myself, but I also don’t know when their vaccination campaign started. I gather they’ve been doing some other things throughout the pandemic pretty well too.
IM DocSeptember 11, 2021 at 8:58 am
I have found this very interesting as well.
I was reading a Twitter feed last night about this very issue ( unfortunately I cannot currently find it – will keep looking ). The tweets were written by a US epidemiologist lamenting the fact that all the non-vaccine measure that have been done in Denmark have been overwhelmingly positive. They were organized. They were truthful and transparent from Day 1. They have apparently early on actually fired a few Health Officials who were scaremongering and inappropriate. They made their vaccination approach very team oriented and apparently very positive. Those were the things I recall. There were others. And basically the point was made that they took their playbook directly from the USA approach to both polio and smallpox. Another sentiment expressed was they had no intention of emulating the current USA approach to COVID.
I am not sure any of those things could be done successfully here in the USA in our current environment. Denmark is not the USA.
Please note that forced vaccine mandates were not part of the Denmark plan at all. Calling others unclean, unmasked, etc. was not part of the plan. And had they done vaccine mandates – nothing like this link would ever have been allowed – https://twitter.com/Newsweek/status/1436357805041242125
That one link right there tells me all I need to know. The USA is a completely un-serious country. I just cannot believe our leaders – it is like they are purposely sabotaging their credibility and our health efforts on purpose in all possible ways they can.

LilDSeptember 12, 2021 at 1:14 pm

Sweetgreens went too far, but the link between nutrition and health is very strong. It’s not just BMI, it’s junk vs nutrients…

For evidence based examples
https://nutritionfacts.org/book/how-not-to-die/

I don’t think it’s too strong to say that if most of the world adopted a whole food plant based diet, health outcomes would be much better. And, less pressure on the environment by reducing the industrial food complex.

IM DocSeptember 12, 2021 at 1:41 pm
More than a year ago, I wanted to get my nurses and office staff on some kind of project in the office that would actually be constructive and positive in their work on the pandemic. You have no idea, but the amount of screaming and yelling directed at doctors and their staffs is at an all time high. And much worse now with all the breakthroughs.
We all decided to double down on diabetes because that is the biggest single risk factor for covid severity in everyone other than age. And you cannot really fix that.
And they did with gusto. Diet education. Exercise. Diabetic education. Fine tuning meds. Praising patients without ceasing. A marked increase in follow up calls.
Our average a1c reading in August 2020 was 8.1.
August 2021 that average a1c was 6.9.
I could not be more proud of my staff and their intense efforts to do something anything positive for covid. It is important for all hard workers to have positive success and the feeling of contributing.
I have always felt with health issues that carrots work much better than sticks. It is also beyond me that the CDC has not been all over this issue on a national basis since it was known in the very beginning. I have no words.

VandemonianSeptember 12, 2021 at 2:57 pm
IM Doc, I suspect that CDC’s reluctance to promote your approach is related to the absence of a market based impact. Looks like you and your team forgot to put medications front and centre of your campaign – where’s the benefit in that? In fact, your patients may have reduced their medication use overall. Did you track that?
1. newcattySeptember 12, 2021 at 6:12 pm
  Another note of appreciation for IM Doc’s contributions to all that is knowledgeable, fair, kind and honorable in his profession. Not only are your patients fortunate to have you as their Doc, but your staff is fortunate to have you as their “boss”.
  1. juno masSeptember 12, 2021 at 8:05 pm
    Most Doc’s don’t Boss, they lead.
2. IM DocSeptember 12, 2021 at 9:58 pm
  That is the one aspect of this whole operation totally in my purview – I do not have exact numbers – but the med use, especially insulin, is down as well. Most people do not realize actually how toxic insulin is. It is so much better for the body to diet and exercise and lose weight than to pump it full of insulin.
  By the way, there are all kinds of videos of Dr. Fauci himself lauding this “eat well, sleep well and exercise” approach to infectious disease avoidance and overall general health. Something happened to him at the beginning of COVID – and I have not heard him mention it once. He literally talked about it all the time preCOVID. I have heard him talk in person multiple times – and he used to just dwell on this. Eat well, exercise, etc.
  I am certain there are many others – but this is just one example from MAY 2019.
  Go to about the 16:50 mark – and it lasts about a minute. He was asked if he would wear a mask when ill – and you can hear his answer…….
  https://www.bloomberg.com/news/videos/2019-05-22/david-rubenstein-show-anthony-fauci-video

Louis FyneSeptember 13, 2021 at 7:11 pm

now if anyone in the Commentariat wants a gold star, compare/contrast with the polio vaccine rollout…..particularly if one has first-hand anecdotes

IM DocSeptember 13, 2021 at 7:26 pm
Right off the bat – the first hand anecdote I do not want to have repeated is this right here –
https://www.nytimes.com/1955/05/05/archives/bulbar-polio-kills-doctors-grandson.html
That is the best link I could find to the story right now. But it is very important nonetheless. Dr. Alton Oschner was the closest thing to someone in stature in the 1950s as Dr. Koop was in the 1980s. He thought it best to vaccinate his 2 grandchildren on TV in New Orleans for all to see how safe it was. The debacle that was about to unfurl in the country was known as the Cutter Event. That particular vaccine ended up being very problematic and killed thousands of kids all over America – maiming many more. There were those in the federal health apparatus that were deeply concerned beforehand – but were ignored. It is a blemish on public health for all time.
Unfortunately, one of the children was dead within weeks, the other was maimed with polio the rest of her life.
I do not believe in any way shape or form that enough safety data is known for the COVID vaccination of our children in what for them is a very low risk disease process. There are studies now coming down, especially in boys, that COVID vaccine risk may be higher than COVID risk. Let me put it this way, with conviction, my sons will not be vaccinated whatsoever until much further safety and efficacy data is known. As in absolutely not. With the oncoming mandates, I am concerned it will be no time before this is mandated for the kids and I see, just like with the vaccines for adults this past winter, legions of physicians vaccinating their kids on Facebook. It is called stupid human tricks. I simply cannot comprehend this whole impulse. It has the potential to backfire “bigly”.
1. GMSeptember 13, 2021 at 8:04 pm
  There are studies now coming down, especially in boys, that COVID vaccine risk may be higher than COVID risk
  The COVID risk is hidden.
  The immune system damage incurred is not visible in kids because they are kids, but is still very real. T-cells are a limited resource (we don’t really have a thymus past a certain age), and this virus is triggering massive overstimulation, dysregulation, exhaustion, accelerated aging.
  Problem is that this will be conclusively proven only when 60 years from now it turns out their life expectancy is 70 instead of 80 (and that assumes this infection will be their first and last, while under current policies it will be the first of many, and they will definitely not live to 70).
  Of course that does not mean that the vaccine should have been rushed the way it has been, but it has to be kept in mind.
  1. IM DocSeptember 13, 2021 at 8:30 pm
    I have learned the hard way to never trust Big Pharma with anything. The fact that this vaccine program was handed over to them and not some other agency ( which we really do not have ) without all the baggage is the problem for me. I will NOT trust Big Pharma or anything they say with the lives of my kids. Anything that gets put into my kids in any way has to have years of use outside in the real world. They are fully vaccinated with everything else with a few exceptions because I trust the experience garnered over the years. I have too many scars from multitudes of patients over the years that have learned this lesson the hard way.
    It is one thing to have a drug reaction that is unexpected. It is another thing entirely to have drug reactions and problems that were known by Big Pharma and covered up or hidden during the research phase. And they have made a habit of this repeatedly. How many drugs have been taken off the market very rapidly – only to find out they knew there was a problem?
    I do not think I am alone in this assessment – not by a long shot. Among medical people or the public. The behavior and events this year have done nothing but fuel the concerns. I hear about it every day.

dcraneSeptember 13, 2021 at 7:36 pm

Over at (Steve) Bannons War Room on Rumble the allegation is made that we’re facing a pandemic of the censored, not one the unvaccinated. Dr. Robert Malone and a couple of other doctors are interviewed about the systemic forces being applied to stop doctors from treating covid early and aggressively with a wide range of repurposed drugs and other measures, and to stop the actual transmission of information on the success of such measures via the scientific literature as well as the internet. Note that Malone (who is himself vaccinated) emphasizes that these early treatments are not intended to compete with or replace vaccination, but should be applied alongside vaccination. These doctors claim that many thousands of people have died needlessly because the system would not treat them until they were well advanced in their illnesses.

I see little from Biden’s speech annotated above to suggest he cares about this.

https://rumble.com/vmgj15-episode-1257-from-rome-doctors-against-madness.html

(Yes, you have to ignore the overboard theme song about the CCP that goes with all episodes…)

GMSeptember 13, 2021 at 8:12 pm
Dr. Robert Malone and a couple of other doctors are interviewed about the systemic forces being applied to stop doctors from treating covid early and aggressively with a wide range of repurposed drugs and other measures, and to stop the actual transmission of information on the success of such measures via the scientific literature as well as the internet.
COVID is treated with repurposed drugs right now — dexamethasone and other steroids used to suppress the overstimulated immune system are exactly that.
1. IM DocSeptember 13, 2021 at 8:36 pm
  And they shamed doctors for months for using dexamethasone for COVID. During the big problems in MAR/APR of 2020. In my hospital, we were absolutely forbidden to do so. It is ridiculous – because that is the exact same drug class used in all kinds of sepsis syndromes. But NOPE – did not happen. Until pulmonary/critical care physicians all over the country just started doing it anyway. The success made them back down. A lesson that these overlords are determined not to repeat with any others.
  1. GMSeptember 13, 2021 at 11:04 pm
    My understanding is that there was a good reason at least for that — people got damaged from being pumped with too much steroids during the SARS-1 epidemic back in 2003 (the post-SARS syndrome is primarily due to the virus, but some aspects of it were because of the steroids too). Thus the reluctance to use them initially.
    Unfortunately, the death toll in the first wave would have been 40% of what it was had they just applied them from the start…
    P.S. This is actually bad news for a different reason — even I myself have on numerous occasions noted that the SARS-1 CFR might be lower today with modern treatment, say, 5%, not 10%. But more recently I realized that we lowered the SARS-2 CFR by going back to the SARS-1 treatment, i.e. SARS-1 was indeed that bad. Which is not good news for the future, if SARS-2 keeps evolving towards higher virulence — there is plenty of room for that in the evolutionary space…

Re: Biden's mandate (and patience wearing thin, etc.)

IM DocSeptember 13, 2021 at 7:44 pm

A primary care office can at times be a gauge for the nation.

Based on what has already been yelled at me on Friday and now today, this has already failed. This has made many Dems in my practice absolutely furious. I cannot remember a political speech that has garnered as much discussion in my office – but pretty much everyone was talking about it – and not in a good way.

I really get the idea that the only groups where this is finding favor are the very small Twitter mob, some of the more vocal millenial liberal groups, and the news media. My older than 40 crowd, liberal or conservative, have recoiled in disdain. Especially those alive during the polio and smallpox vaccine efforts.

An elderly Dem asked me today – paraphrased – “Can you point to any time when Eisenhower, Kennedy, or LBJ threatened every worker in America with being fired during polio/smallpox? No you cannot – because they did not. They kept it positive. They made it popular. They turned it into a civic duty. They criticized no one. And the undermining of governors in the way he did – just forget about it……He is really not the paragon of virtue to do this anyway.” And that man is a big Dem donor and a former Dem officeholder.

My initial impression is that this is not going well with a huge chunk of the American people – especially older ones – and uniquely very unpopular with Blacks and Latinos.

The Rev KevSeptember 14, 2021 at 8:17 am

Working link for “Massachusetts National Guard Activated To Help Deal With School Bus Driver Shortage” article at-

https://boston.cbslocal.com/2021/09/13/massachusetts-national-guard-activated-school-bus-driver-shortage/

I bet that we see more and more of these types of stories going forward.

KevinSeptember 14, 2021 at 8:33 am
Indeed, fighting fires, helping hospitals, traveling to Poland..
IM DocSeptember 14, 2021 at 9:28 am
This was about 2 weeks ago – https://gov.idaho.gov/pressrelease/gov-little-activates-national-guard-again-directs-hundreds-of-new-medical-personnel-to-help-idaho-hospitals-overwhelmed-with-unvaccinated-covid-19-patients/
I would like to make sure everyone knows – COVID itself is a huge part of this problem. But so is the fact that nurses and hospital staff have been walking off the job all over America. And this was before the vaccine mandates.
The hospital I work in is literally crippled at this moment.
The entire vaccine mandate executive order from Biden is being done through OSHA. I have begun to pray daily that someone in OSHA has the sense to make this not so bad and include both natural immunity or weekly testing as an alternative to forced vaccines. That would actually make it doable. Furthermore, I would have little if any problems medically or morally with such a plan. I know for sure many of my HCW patients who are unvaccinated would stay in those cases. And it has the benefit of making sense medically.
The only thing that would hold this back at this point is those political actors determined to stick it to the unvaccinated. And given what I am seeing, they may very well prevail. Tragedy will ensue – not just in our hospitals, but also schools and businesses. I have many many business owners as patients now quaking in their boots because they know they will not only have no staff – they will have no customers. People getting fired tend to hold on to every dollar.
We all should be praying for such wisdom right now – or our hospitals and nursing homes are going to crater.

LeeSeptember 14, 2021 at 11:24 am

“… include both natural immunity or weekly testing as an alternative to forced vaccines.”

Please correct me if I’m wrong.

It is my understanding that antibodies from vaccination and infections wane and become undetectable after a few months and that if there is long term protection then it resides elsewhere in the immune system but is not measurable.

Also, assuming high prevalence of infection, since the vaccinated and unvaccinated can both test positive for the virus and are contagious, I would imagine a considerable portion of the population at any given time will be, regardless of their immune status, subject to quarantine.

On the upside, vaccines reducing hospitalizations in understaffed facilities is fortuitous. Ever the optimist, me.

IM DocSeptember 14, 2021 at 11:33 am
Vaccination immunity and infection immunity are likely going to wane over time. It appears that natural immunity is going to wane much more slowly. Although we are way too early in this to make any firm conclusions.
You have no idea what will happen to our nursing homes and many hospitals if the vaccine mandate goes through. Even losing 5% of the staff that is still there will be a disaster. At that point, it will be very difficult to deliver adequate care to anyone.
So far the vaccines have been reducing hospitalizations, however, I have already admitted 3 vaccinated patients to the hospital this week, and it is only Tuesday. I have admitted 5 unvaccinated patients. My gut feeling is this is slowly but surely offering less and less protection as well. I am only counting the actual COVID patients. There are others in the hospital with something else that turn out to have positive COVID tests. It is rare to see any of these people get really sick.
I think we are going to have to compromise here on these mandates – I firmly believe it is the only way that we are going to not have a disaster in our health care system. Vaccination, natural immunity, or frequent testing – makes sense and will not cause the walk outs.

1. 1. Brian BeijerSeptember 14, 2021 at 12:53 pm
    Vaccination, natural immunity, or frequent testing – makes sense and will not cause the walk outs.
    I don’t quite understand. Shouldn’t this read “Vaccination, natural immunity AND frequent testing – makes sense and will not cause the walk outs”? I mean, we’ve already well established that the vaccinated are almost as likey to transmit the Corona virus as the unvaccinated. If we’re insisting that everyone return to work and not taking other precautionary measures; shouldn’t everyone be tested weekly?
    1. IM DocSeptember 14, 2021 at 8:34 pm
      You have a very good point.
SawdustSeptember 14, 2021 at 11:45 am
Is there a way to demonstrate natural immunity on its own? As I understand it, you (hopefully) only get a positive test result if you are currently infected with Covid. What if there’s a pretty good chance that you’ve already had it but never got tested?
1. IM DocSeptember 14, 2021 at 11:59 am
  You can be checked for IgG antibodies to SARS Cov2 – and this has been very highly correlative with patients I have in my practice with known POS PCR testing in the past. If the IgG are positive, you have already been infected. If negative, things are a bit less clear.
  Both Qwest and LabCorp offer a test known at Tcell COVID or somesuch. Most employers are demanding this as well to demonstrate natural immunity. This is all new just in the past few weeks at least in my area. To be honest, I have not looked into the efficacy of these tests. They may be much better at determining natural immunity than IgG tests are. I just do not know – I have not had a lot of time lately for research.
  That is on my list of things to do this week – do a deep dive into the science and numbers on these tests being offered. I have a feeling this is going to become a very important issue very quickly.

IM DocSeptember 14, 2021 at 2:34 pm

I would dare anyone to follow in my steps every day and try to explain all of this contradictory information to patients. Yesterday, it was this paper where no one needs a booster. Friday before, it was only booster the Pfizer. Thursday, it was everyone needs a booster right now this minute.

I have many patients who are very bright, who know how to read scientific studies, and who have very appropriate and often very piercing questions. Many of them have the papers in hand with yellow highlighted statistics.

And they have every right to ask questions. I just have no way of telling them what the correct answers are.

As a veteran of other pandemics like AIDS, I can assure you this level of national attention was never focused on all the conflicting data and papers that were coming out daily in that era. Never in a million years. All of this was debated vehemently behind closed doors in medicine and public health. It was only when consensus about validity was reached that things made it out to the public. Often, many studies with very dramatic conclusions were found to be deeply flawed when we were able to hash them out with one another first outside of the public eye. They never made it to primetime news.

Somehow, I think that was a much better system. The effects of social media and instant distribution of medical papers to the entire world has really caused much much confusion and angst. I view it as one of the main contributors to the confidence problem we have today. I see tweets and web posts daily from this or that expert – making very scary statements about this or that table of numbers – with really no evidence or statistical power for their assertions. It literally scares people to death.

I can tell you without hesitation that the past two weeks, confusion and chaos has reigned supreme about these boosters with my patients. They often show me the same MD on their Twitter feed saying two different contradictory things within 24 hours of one another. I see no one in charge at the federal level steering the ship. I see a hundred minions with a hundred agendas all over the place spinning things their way. The longer this ineffectual leadership is allowed – the more confusion it generates. That is why I comment here – trying to do my efforts to tell the truth the way I see it – hoping I can decrease the angst – but I have often thought that maybe I am adding to the chaos as well.

Never thought I would ever see this in my country.

GMSeptember 14, 2021 at 5:40 pm

As a veteran of other pandemics like AIDS, I can assure you this level of national attention was never focused on all the conflicting data and papers that were coming out daily in that era. Never in a million years. All of this was debated vehemently behind closed doors in medicine and public health. It was only when consensus about validity was reached that things made it out to the public. Often, many studies with very dramatic conclusions were found to be deeply flawed when we were able to hash them out with one another first outside of the public eye. They never made it to primetime news.

I’m not so sure about this in this case.

AIDS was a relatively slow moving pandemic. It still demanded quick action, but on the scale of months and years.

With COVID we are talking hours and days because if things are left to their own, it will infect nearly everyone within a few months (it has done that already in a few places with very young populations that allow the damage to be tolerated for long enough to get to that point).

If it was left to the “scientific community” to hammer it out between themselves, everyone would have indeed gotten infected long ago.

That is what the current “consensus” is anyway, in case people have not noticed. The big shot senior-level scientists are going along with the program, for completely non-scientific reasons, and are giving interviews about how we have to “learn to live with the virus” and how everyone will get infected multiple times. Some are even going as far as saying that this was always known from the beginning.

If anything, it is the availability of things like Twitter that has allowed people to find the correct relevant information in real time. Which would not have been the case if there was the filter of the “scientific community”.

Remember that WHO “Fact check: COVID is NOT airborne” tweet? Well, it has been that sort of thing from the beginning.

How did regular people know that the pandemic is starting and it will be very serious? From social media, already in late 2019 and in early January 2020. The other key source of near-real-time information has been preprints. Not from official channels.

When and where did every relevant development after the beginning of the pandemic become apparent? Long before it was noticed by the “scientific community” as a whole and mostly on Twitter — people in the affected areas noticed things and shared them, and those who followed the right sources of information took notice. Reinfections in Iran, second wave in Manaus, second wave in South Africa, B.1.1.7/Alpha appearing in England, the appearance of Delta (the start of the second wave was pointed by a few independent Indian researchers on Twitter in mid-February, that Delta is a beast first became apparent by statistical analysis from a scientist in Belgium posted on Twitter already in April, etc.), and many others. B.1.621/Mu was first noticed in a preprint. Etc.

The “scientific community” has been soundly asleep on all such occasions, only awakening to record the damage long after it’s too late to stop it.

People know COVID is airborne only because of social media, if it was left to the authorities, they would be herded into unsafe classrooms and workplaces without that knowledge. They still have been herded that way but at least the information is available out there.

So yes, we do have the problem of social media drowning people in misinformation. But at least with social media there is also correct relevant info to be found within the general stream of noise. Without it and with the usual gatekeepers, we would not even have that…

IM DocSeptember 14, 2021 at 8:11 pm
I would add argue that in the AIDS pandemic, we had a much more functional CDC and a completely different FDA. There were all kinds of hiccups – but nothing like what we are witnessing today.
There are a lot of good Twitter feeds out there today. They are literally drowned out by the minions of those whose main goal is clearly either panic porn or complete dismissal of the problem. People who do not really understand medical statistics and epidemiology are having a field day scaring people to death.
I am now witnessing on Twitter the literal flaying alive of a doctor named John Mandrola. A cardiologist – who has dared to put his name on a paper concerning the incidence of vaccine-induced myocarditis in kids. Minions of Twitter folks are threatening him with his license, calling him all kinds of names and doing all possible to destroy his reputation. Interestingly, the paper he is on has found the incidence to be in exactly the same ball park as all the other papers. That is his sin. The fact that it is right on target with other papers does not matter to the Twitter mob – he has an Internet following, he has spoken against the narrative, he must be destroyed. Non-medical people reading this stuff are just overwhelmed with dissonance and all kinds of misinformation presented in very inappropriately emotional ways. This is not even the tenth time this year I have seen similar things occur. It is my absolute belief that because of this type of thing, Twitter and Facebook have been far more damaging than anything good that has come of them.
As far as cable news, we did not have a death count ticker on the chryons for months on end during the AIDS epidemic either. Right in front of Rachel Maddow and Tucker Carlson with gleams in their eyes. That ghoulishness has set the emotional stage for so much of what has happened.
And as far as the papers coming out daily – I long ago have tried to tune it all out. But last week, I saw a paper from the ID dept at a major US univ discussing the fact that the COVID virus has run out of places to mutate. All is well. This is almost over – SARS COV2 is out of its bag of tricks.
Followed the next day by a paper from an equally excellent place stating these mutations could go on for eternity. As an MD after looking at both, it is easy to tell they are both garbage. But they were online and on Twitter and being hotly debated by people all over this country. They are papers – THEY ARE SCIENCE – THEY ARE GOSPEL TRUTH – when nothing could be further from the truth – when you have some experience with garbage papers all your life. The average Twitter user has no clue what to even look for. I have found most of the time they are arguing over headlines.
During the AIDS pandemic, there was no Internet. We discussed the important papers of the day and had imminent visitors, and our own faculty helping us duke it out. It was a slower pandemic as you say – but I wonder how much of that “slower” has to do with the reporting of it as well. It was certainly not slower in the rate of death certificates for me personally.
I will always contend that the AIDS media and public health environment in the 80s and 90s had its problems – but was much more sane – and did not cause near the problems among citizens as this morass is today. I deal with it every day of my life.
IM DocSeptember 14, 2021 at 8:30 pm
I forgot to add one more thing. And ask the other commenters if they have a different experience….
Anyone old enough to be alive in the AIDS epidemic – Did you ever hear Johnny Carson mocking AIDS patients or laughing about AIDS deaths? I sure did not. That would have been considered a career killer back then.
But look what happened this week. I sure do not watch this show – and I just happened to find out about this today because it was being replayed.
Correct me if I am incorrect – but he is talking about Florida COVID deaths – and lamenting the fact that there will be 50000 orphaned ferrets. Funny. Real funny. On national TV – ABC.
I cannot remember anyone on national TV making fun of all the death going on in NYC in MAR and APR of last year. Maybe I did not see it – but it would have surely made the zeitgeist if present. Why is it OK to make jokes about COVID victims now? Or is it just funny because he is “owning” Southern rubes? Who cares?
I cannot even believe this man still has a job after that kind of thing. But that is yet another example of how mass media and social media memes are completely debasing our feelings and our response to this entire situation. And explicitly giving large swaths of our population permission to actively denigrate the unclean and unwashed. I find the whole thing deeply alarming.
1. Tom StoneSeptember 14, 2021 at 9:08 pm
  IM Doc, there were people who called AIDS God’s Judgement on homosexuals and there was shunning of AIDS caretakers in the workplace, but there was nothing like what is going on now.
  This is horrifying to anyone with an ounce of decency and it is being encouraged by truly evil people.
  1. IM DocSeptember 14, 2021 at 10:47 pm
    Yes indeed Mr. Stone.
    I spent many nights as an intern watching people die who had been tormented by those you describe. And karma was right there watching with me.
    Interestingly, as she often does, karma paid a visit to many of those tormenters. Sometimes very immediately as in Jimmy Swaggart. Sometimes, karma takes her time. Look at Jerry Falwell – and how just recently karma revealed that he raised one of the most horrible human beings in modern pop culture exposing him for all the world to see.
    Karma is whimsical. But I cannot help but think she is waiting in the wings thinking of next moves that she will one day spring on people like Mr. Kimmel.
    She never misses.
    I have learned as I have become older to just sit back and watch karma do her work. It takes so much anguish off my mind and soul.

IM DocSeptember 14, 2021 at 3:22 pm

Never thought it would be a blue state where this happened first – but I feel we should be getting used to this.

That is a temporary restraining order against the State of New York. They are at this time not allowed to follow through with the state vaccine mandate for health care workers apparently until further notice.

I think there are lots of responsible people out there in health care who realize just what a complete disaster this mandate plan would be for staffing. It is not a guess, I know that many of these legislators and judges are hearing some back channel warnings – maybe even from their own primary care docs.

Look right here. This is the official press release from the American Hospital Association from Friday Morning – the day after Biden released his plan. Interesting to read through this – they admit in the first half that they are all for the mandates, but spend the last half describing what a disaster they would be and that they need to work together to come up with some other workable way. Firing people is not going to be too helpful right now.

We live in fascinating times.

voteforno6September 14, 2021 at 6:22 pm

We live in a society where everything is politicized, and with something as big as a pandemic, it’s no surprise that this is, too. I’m sure a lot of people can remember having to get vaccinated before being allowed to attend school, or join the military. Talk to people about the polio vaccinations, and they’ll tell you there wasn’t nearly this much pushback. For religious people to complain about these mandates, well, it comes off as being rather hypocritical on their part, to be complaining about someone else forcing their beliefs on them. So, there may very well be some staffing issues because of these mandates, but the other side of that is there is a lot of support for them as well. Besides, how much can we trust a health care provider who won’t undergo certain medical treatments themselves, due to religious beliefs? Are these same beliefs affecting the treatment that they provide to others?

rowlfSeptember 14, 2021 at 6:53 pm
Has any other vaccine been fast tracked like the Covid 19 vaccines? Has the FDA a history of approving products that had to be removed from use later on?
Come to think of it, what are the Covid 19 vaccination rates at the CDC and the FDA? 99%? Are they leading from the front?
IM DocSeptember 14, 2021 at 7:42 pm
I cannot recall a single patient saying a word about aborted fetuses as being the cause of their hesitancy.
I have however – had large numbers of 20-30 year old female CNAs and other staff in my office very worried about losing fertility. Their being fired would be the proximate cause of hospital failure – this is THE group of concern. This is not a religious issue – this is a natural human impulse – to have kids.
I have no idea if this is a real concern or not – what I do know for certain is this has been being discussed on social media from the beginning. This has been all over the Internet for months. When the health officials have made it a habit of lying, manipulating, and dissembling about so much else, I cannot blame these people in the least for their concerns.
The federal health officials have completely ignored this problem from day one. They have acted like it does not exist. I have been at a conference back in April with FDA officials where a physician went out of their way to warn them this was happening…..their response – “We do not have the time to deal with conspiracy theories.” And here we are. Complete and total incompetence. I did not find it ironic at all that during the very same week that the mandate program was announced, suddenly in the national media were stories about trials starting to investigate fertility. Too little too late. AND MORE IMPORTANTLY – announcing those trials has the side effect of making all these young women feel “You know – there may be something to this after all.” I have never seen such complete incompetence in my life. Such complete ignorance of primal human desires to have kids.
Since you brought up past pandemics – it is important to note the smallpox campaign. Very early on, it was brought to political leaders’ attention that the vaccine would cause a scar on every patient and that may cause hesitancy. Did they try to hide it? Did they mock Americans for being conspiracy theorists? Did they call people stupid? Did they ban people from the media? HELL NO. That instant, they got on the media and told every single American this would happen – and it would be a “badge of honor”. And we all know the end of this story.
So many lessons have been learned by our public health folks in the past. And this current generation has decided that the best course of action is to flush all those lessons right down the stool – or worse, they have shat all over them.
I find it incredible how many people are BLAMING the great unwashed and dirty throng of unvaccinated. That is morally incorrect in many cases given the abysmal nature of how this has all been handled. The real blame belongs with the total incompetence of our politicians, the media, and our health officials.

comments

IM Doc pt 26

2021-12-12T01:55:50Z

Eric Topol Discusses Covid Vaccines Not Meeting Expectations, Breakthrough Cases Sicker

Posted on August 9, 2021 by Yves Smith

It looks as if conventional wisdom on the Covid vaccines has run head first into some ugly realities. Eric Topol, formerly a “Get vaccinated, problem solved” cheerleader, grapples out loud with troubling data about Covid deaths and breakthrough cases with a serious journalist, David Wallace-Wells of New York Magazine. The short version is that both measures are much worse than expected and the trajectory bodes ill.

We’ll go through many of the bad trends Topol and Wallace-Wells identify, including one we hadn’t wanted to believe when IM Doc started telling us of it privately via e-mail weeks ago, and presented in comments yesterday: that his breakthrough cases have been typically sicker than those among the unvaccinated. Topol is seeing the same thing and his population isn’t from IM Doc’s part of the world.

Topol may have fallen for orthodox thinking, but sits on the Scripps Research board as the founder of the Scripps Research Translational Institute , he has tremendous clout and can’t be dismissed, both by virtue of his reputation and because the data he and Wallace-Wells discuss speaks for itself. But the officialdom has bet so heavily on magical vaccines being the solution for Covid that the denialism is likely to remain strong and get even uglier.

As we say often here, it would be better if we were wrong, but it appears we haven’t been. And I don’t like sounding triumhpalist; I felt nauseous during September 2008 when just about everything we said about the credit, mortgage and derivative markets in 2007 and 2008 was proven correct, and then some.

However, Topol and Wallace-Wells substantiate what we and our experts, IM Doc, GM, KLG and Iganacio have been saying from early on: the vaccines were overhyped. For starters, there was no basis for believing a vaccine for a coronavirus would produce immunity that lasted more than months to at most a year. While the vaccines were under development, data from Imperial College indicated that the rate of decline in neutralizing antibodies from contracting Covid provided immunity on the order of six to eight months. A vaccine might produce more durable immunity, but not vastly so. Plus no expert expected a vaccine for a respiratory virus to confer sterilizing immunity.

Yet not only did our putative leaders tell outrageous howlers, with both the CDC’s Rochelle Walensky and Biden repeatedly and falsely stating that if you got vaccinated, you would not get Covid (“If you’re vaccinated, you’re protected”), they also committed the cardinal sin of betting on their own PR. They treated vaccines as the one-stop answer to the Covid problem.

And not only did they actively discourage the use of non-pharmaceutical interventions like masking and social distancing (can’t harsh the mellow of convention sponsors and holiday makers) but they also crippled an already slipshod Covid data gathering system by telling public health officials not to collect data on breakthrough cases among the vaccinated. So now we have to rely on figures from less incompetent countries like Israel, and Topol is forced to make back-of-the-envelope computations.

Some of the grim news from Too Many People Are Dying Right Now:

Lower reduction in mortality than expected. Wallace-Wells starts with the expected Covid vaccine death reduction of 90% or at least, per another expert, 75%. That means Covid fatalities should be 25% or lower relative to last year…which is not where we are. Instead, from Wallace-Wells:

But at the national level, at least for the moment, the reduction of mortality risk seems to be considerably smaller. In the worst of the winter surge, the country was registering 250,000 new cases per day; at its peak, that surge was killing roughly 3,000 Americans each day (often a bit above, but with a few dips below). Today, we have a bit more than 100,000 new cases each day, though the numbers are still rising as part of the Delta wave. If we had reduced mortality risk by 75 percent, that would mean about 300 daily deaths. If we had reduced it by 90 percent, it would mean 120. Instead, in our seven-day average, we just passed 500.
Things may be even worse than that, though. In general, epidemiologists expect a lag of a week or two, perhaps more, between case peaks and death peaks… comparing case data from even one week ago with today’s death data reveals an even grimmer picture: about 75,000 cases per day then yielding the current average of 500 deaths, suggesting the mortality rate had fallen by less than half since winter. If you work from two-week-old data, it suggests that the mortality rate had hardly fallen at all. Applying the winter ratio to the case load from July 24 would predict an average of 600 daily deaths. On Friday, there were 763.

And Topol:

Just looking at the U.K. and Israel, which had been our guideposts, I thought we would keep the hospitalizations pretty darn low — maybe a fourth of where we’d been in prior waves. And deaths 10 percent of prior waves. But we’re not doing that at all. If you look at the log charts of the U.S. and the U.K, you’re starting to see some real separation for death. It’s certainly going in the wrong direction, and it had been tracking incredibly closely, until recently.

Weaker effectiveness of vaccines. The bold is Wallace-Wells, per the original, and Topol, in regular type, in response:

What I just can’t understand is why all three things are all moving up together so rapidly. Given everything we’ve seen in other countries and everything we think we know about the vaccines, even if cases rose dramatically, we’d expect much lower rates of hospitalization and death. But we’re not.
It’s like we didn’t have vaccines. Or worse. I was just putting this talk together and I made the same observation. I’m looking at the four waves, and, as you know, in the monster wave, we got to 250,000 cases per day. And at that time we had 120,000 plus hospitalizations [per day]. About half. What’s amazing is, we’re at about 120,000 cases now, and we’re over 60,000 hospitalizations.
It’s the same ratio.
Yeah. So when I look at that, I say, what happened to the vaccines?

Topol also pointed out these results were all that much attributable to low vaccination rates in certain states. Florida, for instance, is the standout mortality state yet is has an average, not low, vaccination rate. Los Angeles County, an early and continuing high infection/death area, has a higher vaccination rate than the US overall. He returns to that issue later:

I mean, one of the worst signals that I’ve seen is San Francisco. San Francisco is like Vermont, they’re even a little higher than Vermont for fully vaccinated — it’s 70 percent of the population of San Francisco county and it’s going through a very substantial hospitalization spike, unlike Vermont.

We flagged this indicator of apparent limited vaccine impact last month (hat tip GM). Admittedly only one week of data, but it showed infection rates were proportional to vaccination rates, implying that the vaccinations weren’t reducing the case count.

Data from Israel pic.twitter.com/Qmu4ZDtN7a
— Irene Tosetti (@itosettiMD_MBA) July 10, 2021

Severity of breakthrough cases From Topol:

What I’m hearing — and I’ve been helping with a bunch of patients — is that people who are breaking through are getting very sick. They’re getting Regeneron antibodies.
There may be something to this waning immunity story. It’s fuzzy, but the people who are getting hit are more apt to be people who were vaccinated very early. I had a patient in recent days, who’s in her 70s. She got vaccinated in January. And, I mean, she almost died. I mean, it’s just terrible. I think — I hope — the monoclonals are going to save her life. But she was a healthy 70-year-old lady, and just following her case was illuminating — she thought she was protected, but she also wore masks everywhere. She was on guard and still got infected and desperately ill.

It is crazy-making to see Topol act as if he hadn’t considered that the vaccine-induced immunity might wear off in six months or so, particularly when much worse that expected immunity data coming out of Israel (which got pretty much everyone jabbed who was going to be jabbed in Jan-Feb), with efficacy down to 64% in June and 39% in August and Delta being markedly different than wild-type Covid.

And that’s before you get to an elephant in the room that oddly no one appears to have mentioned: immune responses in the elderly are weaker. That is why the good old fashioned flu vaccine has a more potent (and more expensive) version for those over 65. But these vaccines had very thin representation in their clinical trials of the over 65, and effectively none for over 80. So it isn’t hard to think that the vaccine-conferred immunity would be weaker and/or shorter lived in the elderly.

Other researchers were already sounding the alarm:

That is plainly wrong – people die on re infection with variants different to the original infecting virus. Immunity from natural infection decays within 6 months and often earlier
— Gupta Lab, Cambridge (@GuptaR_lab) July 11, 2021

The boosters might not work. OMG, Topol dares to say it!

This booster thing is yet another issue, because we don’t even know if they’re going to protect against a Delta. I mean, everybody’s assuming it, but there’s no data. You know, there’s some neutralizing antibodies from the Pfizer report in 23 people and there’s an Israeli pre-print, it says there’s waning immunity without any neutralizing antibodies. So we’ll see. But these are just classic spike-protein boosters. There’s nothing special about them to handle Delta. So I don’t know. I mean, I suspect they’re going to provide some protection, but I’m not sure I’m so confident it’s going to be great.

Oddly, Topol appears to have missed the Moderna data, which as GM had pointed out to us, showed that a third booster shot generated only 40% the level of neutralizing antibodies of the first vaccinations. Again, that translates into some combination of less robust immune responses and shorter immunity.1

* * *We’ve detected rising anger among our readers about Covid and the lack of good information, and they report if anything being met with even more ire when they try to tell vaccine true believers that things aren’t working out as promised.

The credibility of the public health establishment and the establishment generally is on track to take a big hit. We’ve published this observation from GM before, and we believe it bears repeating:

That part about the patients taking it out on their doctors will sadly become an even more common occurrence. In retrospect that was predictable, but you can’t really blame the patients — the medical establishment has been telling them lies for many months, and they see the doctors in front of them as part of one monolithic such entity. In reality it is no such thing — there are the honest doctors directly taking care of patients and then there is the corrupt lying actual high-level establishment, but that is not how the regular people perceive it.
The part about the willing self-deception of the elites is also very important. I too have come to the conclusion that either there is some absurdly nefarious grand conspiracy behind this (not really likely) or it is just stupidity and shortsightedness all around. COVID has shown, again and again and again, that you can ignore it for some time, but eventually you will pay for it. Wuhan CCP officials, Trump, the Tanzanian president, and many others learned that lesson the hard way. And it’s been 18 months of that. And it’s not like it was not known there is antigenic drift with these viruses, or that they have all sorts of tricks up their sleeve yet to be played, or that the vaccine was not going to last (was talked about from the start), or that we were never going to vaccinate enough people to reach herd immunity, etc.. So why would you possibly spend half a year blatantly lying when it was crystal clear from the start that it will backfire eventually? Unless you are indeed that deluded and unable to think rationally about the long term…

Unfortunately, this is rule by MBA, or pathological big organizational behavior, writ large. Too many bosses want to hear only good news from subordinates, which means they engage in cover ups or delays, hoping things will either blow over or they can find someone else to scapegoat. And now we run our country based on short-term careerist calculations.

While we can hope for well deserved days of reckoning to come eventually, too many people will suffer in the meantime due to their negligence and cowardice.

I am looking forward to is the well-deserved pillorying of Rochelle Walensky. We called her as likely to perform poorly as the newly-elevated head of the CDC, but our assessment turns out to have been far too generous. The CDC is a above all a data shop. Topol laments in passing about our inability to do rapid Covid testing, as if this is just some sort of regrettable outcome. It’s not. It’s Walensky’s fault. Getting testing right, and pushing Biden to use the Defense Procurement Act to requisition materials if they were in short supply, should have been a top priority in her first two weeks. Instead it doesn’t even appear to be on her list.

And how about getting more accurate and timely reports out of the various states? Has Walensky gone out into the field to meet a single official to offer CDC help and quietly threaten public embarrassment if they didn’t shape up? I could go on, but she seems to have the same conception of her job as Marcie Frost at CalPERS: being a pretty face for the organization, making PR her priority, and leaving the dirty work to minions.

____

.1 From GM via e-mail in July:

When Moderna put out their preprint on the B.1.351 booster (now obsolete with the rise of B.1.617.2):
https://www.medrxiv.org/content/10.1101/2021.05.05.21256716v1
There were two concerning observations there:
1. No neutralization activity left against P.1 and B.1.351 after 6-8 months
2. The booster worked, but only increased the neutralizing titers to ~40% of what they were originally against the Wuhan variant and what they are against it when boosted.
Based on the fact that the booster “worked”, OAS was dismissed by most, but this would in fact consistent with an “original antigenic sin” effect — nAbs only got boosted to less than half of the previous level.
But then the AZ booster preprint came out:
https://www.biorxiv.org/content/10.1101/2021.06.08.447308v1
They saw the same <50% boosting against B.1.351, and they also analyzed neutralization against B.1.617.2 and saw that it was even worse against it (B.1.617.2 is antigenically more different from B.1.351 than it is from the wild type).
But they also did several more important experiments:
1. They immunized naive mice with a WT and with a B.1.351 vaccine, single dose
2. They immunized naive mice with a mixture of the two
And the neutralization against B.1.351 was still half of what it is against the WT
So one has to conclude that it is the virus itself that is the difference, not an OAS effect.
Hopefully we get such analyses for B.1.617.2 soon, as B.1.351 is probably not going to be relevant moving forward.

GM also noted that the Pfizer vaccine has been functionally equivalent to Moderna and in an e-mail last week, that Moderna’s latest investor update essentially repeats earlier date, with nothing new on Delta

The comments are of interest, perhaps, though IM Doc doesn't make an appearance there. Click on the article header to be taken to its page, including comments.

The following comment was the one that started my endeavor to copy IM Doc's posts here, so it's a repeat. Still worth rereading, though:

IM DocAugust 10, 2021 at 8:42 am

Good Morning.

I have endeavored to share all I could about what is going on on the ground in my world. I have had a very emotional past 10 days – and sometimes on the ground reporting as a physician is going to have to include very emotional things. This current situation has really taken a turn for the worse. The patients who are getting to the stage of critically ill are very very ill indeed. It seems they are not responding to things that were useful in previous waves. I am not sure what that means at this point. And although, we have not seen any kids here that are critically ill, I know this is happening to some degree across the USA. Furthermore, I have now seen with my own eyes cases of other viruses that should be confined to winter now making people very sick right now. I fear that our COVID friend may be learning some new tricks.

We now have multiple doctors and nurses on quarantine because although fully vaccinated they too have fallen ill, just as I did a few weeks ago. So I am going to be very busy and this will be the last report for a long while.

I have two brand new students with me starting this past Monday. As I always do, I start their rotation off with a very simple statement – THIS IS STILL A NOBLE PROFESSION. I endeavor always to make sure they know that through their entire time with me.

I have a lot in common with them as they enter their careers in this COVIDtide. When I was 25 and a brand new doctor, AIDS was raging. Death and dying hung in the air. But what kept me grounded back then was the other aspect of being an intern in that era – taking care of the WWII generation as they hit their 70s and 80s. As I always tell my students, go through your life learning more from your patients than they ever learned from you – and those WWII folks could not have been a better font for a young man.

One of the mystical things about being a PCP is the opening up that happens much of the time right as people know they are about to leave this realm. It happens all the time. I was 24 back then. I do not need to watch Saving Private Ryan to know what life was like for a 24 year old on D Day. I saw it repeatedly in haunted eyes and words as these men were dying generations later. I did not need to watch Judgement at Nuremberg to know what it was like to see the Nazis being executed one by one – I lived it out through memories of a 24 year old who was there – spilling his soul years later to his 24 year old doctor as he lay dying. I could go on and on with kamikazes, Iwo Jima, the USS Missouri, and Pearl Harbor.

I have also realized that patients will tell me in all kinds of ways that they are ready to go. And I best not stand in the way. And the thing that has become so important to me – this process can be just as mystical as watching a baby being born.

And as I have learned so many times in the past, life lessons are often given to me as their physician as they are dying – it is one of the greatest gifts of my life.

This happened this past weekend. A very elderly woman, fully vaccinated, told me in her own way that she was ready to go. This has been a very difficult struggle for her, but she took it with all the grace and dignity that I know she has. Her family has been here in this area for generations and she is as tough as nails. She gave it everything she had. But it was her time to go.

That morning, when I walked in the room, she looked up at me – “Doctor, there are angels in this very room – Do you see them? – They are all around me. They are getting ready to take me home. I am not afraid. They are standing right behind you and have their hands on your shoulders. Take their strength. They are trying to lift you up. Let them.”

One lesson I have learned is to not get in the way. When people are talking like that, they are indeed ready to go home.

And I walked out of her room, and promptly fell to the floor and I started weeping like a baby. I am no longer 24, and this gets harder and harder every year. I also think there is just an overall exhaustion at play. This whole thing is really taking its toll on all of us in the hospitals. There is also some PTSD at play with me personally. Abandoning people to face this moment alone was common in the AIDS era. It was horrible then. I thought I would never see it again – but it is happening all over again now. People dying all alone.

But her family and her church family were just not going to let that happen. A few minutes later, as I was doing her note, a chorus started to ring out from the windows in the room – an old American hymn – There were about 50 people outside her room letting her know they were right there.

O COME ANGEL BAND
COME AND AROUND ME STAND
BEAR ME AWAY ON YOUR SNOW WHITE WINGS
TO MY IMMORTAL HOME

And they kept right on going with another African American hymn —

MOSES LED GOD’S CHILDREN, 40 YEARS HE LED THEM
THROUGH THE COLD AND THROUGH THE NIGHT

THOUGH THEY SAID LET’S TURN BACK
MOSES SAID KEEP GOING
CANAANLAND IS JUST IN SIGHT

THOUGH WE WALK THROUGH VALLEYS, THOUGH WE CLIMB HIGH MOUNTAINS
WE MUST NOT GIVE UP THE FIGHT
WE MUST BE LIKE MOSES, WE’VE GOT TO KEEP ON TRYING
CANAANLAND IS JUST IN SIGHT

THERE WILL BE NO SORROW
THERE IN THAT TOMORROW
WE WILL ALL BE THERE BYE AND BYE
MILK AND HONEY FLOWING – THAT IS WHERE I’M GOING
CANAANLAND IS JUST IN SIGHT.

It was a joyous occasion. And as has always been the case – I learned many many lessons.
But the reason I bring this story up – I think we can all learn lessons.

That last song is from an ancient story sacred to Jews, Christians and Muslims. It has a message that should be visible to even agnostics and atheists.

I will sum it up for you like this –
Americans – time is running out. We need to begin to realize we are all on the same team here. If we fail to do so, it will likely lead to 40 more years in the wilderness. If we find it in ourselves to start working together, the milk and honey will be flowing. We are going to do this together or not at all.

If you are high risk, get vaccinated NOW. All of us should be eating well, exercising, out in the sun, losing weight and getting the stress off. We should all be looking for moments in our lives that are transcendent like I described above. It is very important for all of us to know that there is a higher purpose and we must get there together.

Live not by Lies
Live not in fear.

*******

IM DocAugust 14, 2021 at 11:35 am

The Great Russian Flu of the 1890s almost assuredly was a coronavirus and is the most applicable historical model to what we face now.

It came in 5-7 waves over 12-15 years.

What is happening right now is Wave #2 of this one.

“Are vaccines becoming less effective at preventing Covid infection?”

Posted on August 20, 2021 by Yves Smith

Forgive me if I take a small victory lap on behalf of our Covid brain trust and Lambert for yet again delivering on the NC aspiration of being early and accurate. The headline above is from a Financial Times story, based on a spate of recent research showing waning efficacy of the Covid 19 vaccines, particularly Pfizer, from a variety of sources: data from Israel, which injected most of its population early, in January and February, with the Pfizer vaccine; a Mayo study, which showed falling efficacy for all vaccines, particularly Pfizer, which it found at 42% (Moderna holds by contrast at 76% over the same time period), a new Oxford report, and a study from Qatar.

The MSM finally starting to acknowledge that the vaccines are not all that they were cracked up to be came about largely due to foreign sources (doing a better job of tracking Covid cases than the US, a very low bar to beat) and one large US institution beyond reproach posting what has largely been missing from the CDC: actual pretty to very reliable findings. The fault isn’t simply that of the fragmented US public health care system. The CDC has not gone on the road to try to help/prod state public health officials. It hasn’t staffed up to fix VAERS. And the CDC has gone to some lengths to corrupt fact-gathering, most notably by saying it would not track breakthrough cases among the vaccinated as part of its May “Mission accomplished” chest thumping. And the CDC has engaged in dishonest PR by telling Americans that the vaccines would prevent Covid infection.

Mind you, in polarized, attention-deficit-disorder afflicted America, not being all in with vaccine cheerleading is a dangerous editorial position. Merely pointing out that the vaccines were overhyped was seen as being against them. So we’ve had to be more careful than we’d like in providing what we thought were early and important indicators that things were not well in vaccine-land. One was the number of breakthrough cases that IM Doc and his MD professional network (large by virtue of their participation in regular Grand Rounds and other sessions) when conventional wisdom was that that was impossible. And as time went on, IM Doc was seeing the breakthrough cases presenting as sicker and was also seeing and getting reports of breakthrough cases winding up in the hospital. From a mid-July e-mail:

To put it mildly, they are seeing a huge increase in hospitalizations in the Dallas area this week….A nurse XXX Hospital – deep in the heart of Dallas’ African American community – reported to me today that the hospital was full – certainly not with just Covid but there were many many COVID patients – starting to show up in just the past week or so – and she would guess 40-50% are vaccinated. She works on the COVID unit. She also reported to me that multiple nurses (as in critical numbers for staffing levels) have just up and quit this week – confirming my worst fears of the potential with our entire system. I fear that the front line nurses can see the approaching flood more clearly than anyone. They are paying her to work extra shifts up to 120 dollars an hour….
There are now press reports in Dallas stating that every admitted patient is unvaccinated. Who am I going to believe – my trusted colleagues who have just stated to me otherwise tonight? Or the media which has lied again and again and again? It really is a bad feeling as an American to be living under Pravda.

The next day, in a different hospital, when confronted with showing confirmed Covid cases in the area running nearly 57% vaccinated, one doctor went into meltdown, saying something pretty close to:

It is completely obvious to anyone with a brain that these people are liars – these supposedly “vaccinated” people never got vaccinated- it is that simple – they are lying – THE NUMBERS IN THE RESEARCH ARE JUST TOO OVERWHELMINGLY POSITIVE. We are surrounded by liars.

Within a month, he and 6 family members, all fully vaccinated, came down with Covid.

Along with IM Doc’s on the ground sightings, GM was relentlessly watching data. He had predicted in April, which was confirmed by Moderna data in May, “So basically protection against those two variants {P.1 and B.1.351] is gone after 6-8 months if you have been vaccinated against the original strain.”. And they have proven to be more vaccine-tractable than Delta.

Recall that GM was also alarmed at the rapid rise in cases in the Seychelles, which opened up after it hit a 63% vaccination level and immediately saw a spike in cases. GM also caught this snippet in early July:

Data from Israel pic.twitter.com/Qmu4ZDtN7a
— Irene Tosetti (@itosettiMD_MBA) July 10, 2021

The latest Israel reports show vaccine efficacy against severe Covid for the >65 year olds vaccinated first to be down to 54%:

The Financial Times article also discusses another topic we’ve dared to broach: that the vaccines have not proven to be terribly effective in preventing the spread of the highly contagious Delta. Ys the officialdom is doubling down on at best marginally effective vaccinations rather than promoting cheap tests and quarantines.

For convenience, we’ll repeat an extract from Charles Ferguson’s newsletter that we showcased in Links yesterday:

Case growth in high vaccination areas. Most national media coverage and government statements have portrayed the Delta surge in both cases and hospitalizations as primarily driven by states with low vaccination rates and/or anti-masking laws, implying that states with higher vaccination rates and/or stronger regulation are being spared. This is flatly false. Over the last month, the state with the highest growth rate in new covid cases in the entire U.S. is Vermont, which also has the highest vaccination rate of any U.S. state. Covid cases in Vermont grew nearly a factor of ten in the last month (from a seven day average of 10 cases on July 12 to a seven day average of 95 on August 12 – and 126 new cases on August 12 alone). Over just the last two weeks ending August 12, high vaccination states with higher covid case growth rates than Texas and Florida include not only Vermont (263% growth in the last two weeks) but also Hawaii (176% growth over the last two weeks), Oregon (144%), Washington state (146%), New York (108%), and Washington DC (158%), versus Texas with 72% growth in covid cases over the two weeks ending August 12, and Florida with only 50% growth. California is slightly behind Florida with 48% growth.
Furthermore, high-vaccination states are also experiencing high growth in hospitalizations. The seven day average for hospitalizations over the two weeks have increased 425% in Vermont, 140% in Hawaii, 70% in Washington state, and 128% in Oregon. This is not to say that vaccination rates and masking policy are unimportant. Without question, the policies of Florida, Texas, and other “resistant” states have worsened their problems…

The Financial Times article is very much worth reading in full.1 Key sections:

A rise in vaccinated people becoming infected with coronavirus has cast doubt over the lasting efficacy of Covid-19 vaccines, according to new studies, including one that found protection gained from the BioNTech/Pfizer shot declined more rapidly than that from the AstraZeneca jab.
An Oxford university study published on Thursday found that the efficacy of the Pfizer vaccine against symptomatic infection almost halved after four months, and that vaccinated people infected with the more infectious Delta variant had as high viral loads as the unvaccinated.
Two research papers from the US and Qatar have also fuelled debate over the need for top-up booster shots as they found higher numbers of “breakthrough infections” than anticipated, even though protection against serious cases of the virus appears to hold.
A preprint based on evidence collected at the Mayo Clinic hospital chain in the US state of Minnesota showed protection against infection fell from 91 per cent to 76 per cent between February and July for the vaccine made by Moderna, and from 89 per cent to 42 per cent for the Pfizer jab….2
A separate Qatar study focusing on the Delta variant found that two doses of Pfizer were 60 per cent effective at stopping infection, whether symptomatic or not, while Moderna was 86 per cent effective.

Interestingly, the Financial Times acted as if a third shot might not be the way to go since UK health officials are still weighing the issue:

Pfizer has said for some time that a third shot would be necessary, probably about eight to 10 months after the second dose. It has applied to several regulators for approval for a booster shot.
Adam Finn, a member of the UK’s joint committee on vaccination and immunisation, said there was “no clear evidence” of the need for a booster and urged caution, especially when some companies had a “strong financial incentive to propose boosting”.

Perhaps they’ve looked at Moderna data on a third shot, which GM reviewed months ago. His bottom like (supported by earlier tech-speak): “The booster only upped the neutralization activity against the variant to half of what the levels were against the original strain.” And again, these were against easier-to-thwart variants that Delta.3

For the bioscience-literate among you, Igancio added:

It [the article[ points out most of the uncertainties on vaccine efficacy due to the timing and speed of Ab waning, the different behavior of the Delta variant and differences in vulnerabilities between age cohorts. It also mentions, though only by passing, the possible differences in the complexity of the immune response with different vaccines which in my opinion, and I have said this repeatedly, is now the most important feature of the vaccines with the dominating Delta strain. When you have a virus that replicates much faster than previous variants the importance of NAb levels might be lower, with viruses outnumbering NAbs by much. Then, non-neutralizing Abs that trigger NK activity and others might have a more important role in protection as well as nursing better Memory B cells.
A hugh research effort is needed to do detailed immunological profiles of infected people (and uninfected vaccinated) at various times after shots, compare profiles with disease outcomes and identify the factors that provide better protection. This would provide orientation for decisions on 3rd shots and might save the life of many.

As you can imagine, no such research effort will occur in the US. If we are very very lucky, the UK might take a stab and we will piggy back on it.

So the US gearing up for a third shot of the current mRNA vaccines against Delta looks an awful lot like “If the only tool you have is a hammer, every problem looks like a nail.” And the really sorry part is our health establishment has other tools that for the most part, they are refusing to use.

___

1 It appears to have a misconstruction, which is not the reporter’s fault. A source claimed that the Moderna vaccine had “three times the mRNA” as Pfizer. That sounded simplistic enough to be wrong. From GM:

It’s not exactly the same thing though, so it is hard to compare 30 ug of one vs. 100 ug of the other

And Ignacio:

The immune response profile, not only NAb levels, is slightly different between Moderna and Pfizer, but there hasn’t been a direct and thorough comparison between them, and it is a pity. (And not only those, what about ChadOx or Novavax). Not everything has to do with NAbs, neither with reactogenicity. How the cellular response is balanced between Thelper 1 or 2 cells and the levels of non neutralizing antibodies might be of outmost importance, specially for delta variant.reactions.
But if NAb levels go higher with Moderna (something I have also read in a systematic review and meta-analysis paper) one can expect longer times for NAb waning and more durable protection.

2 From later in the article:

One complication is that the Pfizer jabs were given first and Moderna’s rollout has been more recent, but the researchers tried to compensate for this by only comparing groups vaccinated in the same month.

3 It’s weird to see the campaign of silence against J&J in the US. As GM pointed out:

In reality J&J is just half of a course of AZ, perhaps a bit more potent. But remember how people were talking about how the first dose gives you most of the protection? Well, it was indeed true, but it no longer is after the appearance of B.1.617.2

IM Doc didn't appear in the comment section of this particular post.

MikelAugust 23, 2021 at 2:25 pm

“Opinion: As an aerosol scientist, I know schools need masks, HEPA filters and outdoor lunches:” [The Denver Post].

Good. Somebody moved the bus that aerosol scientists must have been thrown under for over a year and a half.

Lambert StretherAugust 23, 2021 at 3:22 pm
This is the Denver Post, and the University of Colorado has been very strong on aerosols. What we needed on school ventilation was continuous messaging from Walensky, Fauci, and sometimes Biden, starting when the school summer began, because that’s when schools can work on their physical plant. What we got instead was Walensky and Biden’s moronic “Mission Accomplished” moment, plus about two weeks of intense “hot vax summmer” from our moronic press before the reality of Delta set in. And the Biden Administration, having discredited or abandoned Non-Pharmaceutical Intervention, is now betting the farm on vaccination. It would have been better to hedge, but here we are.
IM DocAugust 23, 2021 at 4:06 pm
It must be noted to readers that the University of Colorado and one of its affiliate hospitals, Denver Jewish, is the pre-eminent academic center in this entire country for pulmonary disease. Hands down.
They know a thing or two about aerosolization there.

IM DocAugust 25, 2021 at 4:36 pm

Rachel Maddow was the big instigator of the “fish tank cleaner” Arizona death last year in the very early part of the pandemic.

This was of course regarding the use of Plaquenil ( hydroxychloroquine) for the use of COVID. Yet another repurposed drug like ivermectin or fluvoxamine. The initial study about this drug and its use in COVID had all kinds of scandal associated with it – all of which came out some months later. But the damage had already been done – and the media had already done the dirty work. Multiple other non-USA studies have shown it does have some benefit. I have used this drug safely for decades. I currently have multiple dozens of little old ladies on it without problems for their rheumatoid arthritis. But to hear Rachel and her fellow travelers talk – it was as if the person was using cyanide. Like so many things, the dosing and use of the drug should be monitored by a physician – it is what I have done for 30 years. I have never, not once, had a complication with this drug.

But if you remember, the Trump supporter had ingested fish tank cleaner thinking it was full of hydroxychloroquine – and his subsequent death was all Trump’s fault for pushing it. That is when this previous liberal started to really question anything coming out of that lying Rachel mouth.

It did turn out later ( and I have not looked for months at any resolution to the story ) that the guy’s wife actually poisoned him with the fish tank cleaner in a murder attempt. But did Rachel say a word about her gross error – of course not. It is all fun and games to these people. And will be – until the pitchforks with their names on them start to arrive. The level of anger and bitterness I am seeing in my patients, both Dem and GOP, toward these clowns is rising every day and the boiling point will soon be here. I am trying to give a warning – just do not know that anyone is listening.

IM DocAugust 26, 2021 at 10:04 am

From one clinician in one practice so this is not dispositive.

Since the advent of Delta in mid May when we saw the first repeated vaccine breakthroughs I have now in my own practice had 179 vaccine breakthroughs including myself.

In that same time frame, I have had 14 patients who were previously infected become sick and positive again. Interestingly, in my group all 14 of these were related to having been vaccinated or boostered (on their own by lying to the pharmacy) the week or so before.

I am therefore not certain how to classify those 14. Partially vaccinated or partially boostered?

As to patients with previous positive covid illnesses, many of whom with documented IgG antibody tests as positive, and unvaccinated, I have had a grand total of zero become ill so far, even with delta.

I am evermore relying on my own observations about advice I am giving rather than this constant mishmash of research and public health statements. I am doing this for my own sanity and the sanity of my patients who are quite confused and angrier by the hour.

Raymond SimAugust 26, 2021 at 1:59 pm

“As to patients with previous positive covid illnesses, many of whom with documented IgG antibody tests as positive, and unvaccinated, I have had a grand total of zero become ill so far, even with delta.”

I’m not wanting to pick nits, but your writings here are attended to very closely, so I think it’s important that readers understand that ‘previously infected, as verified by IgG tests’ and ‘previously infected’ are not identical categories. If there were more overlap we might not be in this mess at all.

IM DocAugust 26, 2021 at 5:11 pm
Yes
I have very bad timing some times when I sit down to write something – an alarm goes off – or a patient crumps – and I lose all my train of thought. I really should be careful about not going ahead and submitting during those times.
There are all kinds of patients who have had an illness and were COVID positive – but who later do not have any kind of antibodies. I have honestly not seen any of these patients get sick either.
There are others who check their antibody status like a hawk every few months or so – I am not so sure that this is too helpful either.
I just saw a report on TV just now from Israel – that a new study of the data show that about 0.2-0.3% of the previously infected are getting COVID in the past few weeks. That too is consistent with what I am seeing. It does not appear to be too common at all.
As you can only imagine – trying to be rational in this environment with people who are scared to death has become next to impossible.
I am not comfortable assuming that someone will never have COVID again once they have had the real disease – that is just not the way corona viruses work. I do think it is very likely that future infections in an already infected person will likely become more muted on each subsequent turn. THAT IS how all other corona viruses work. We have 4 circulating corona viruses in humans right now – and we all pass them around to each other year after year – with various symptoms of URI or congestion, cough, or flu-like illness.
What I am trying to convey in what I wrote earlier – is that what I am seeing on the ground in my own practice is consistent with the conclusions of the above paper – patients with a history of COVID positive illness and certainly with IgG antibodies just are not showing up in my office with COVID right now. The only ones who are have almost always been vaccinated in the preceding weeks – and that is something I have noticed all the way back to December. It really puzzles me. The same cannot be said for vaccinated patients – by a long shot – they continue to show up in droves. Another 6 just this AM. I absolutely see unvaccinated patients who have never had COVID before all the time. Just not in the numbers of the breakthroughs. But I feel there are so many more factors at work there – a doctor’s office is not the place to find those patients. The unvaccinated have sub-cohorts that do not seek medical care, many are young and are barely if at all symptomatic – but the most concerning is the large number of them who cannot afford to be sick – and certainly not be in quarantine – without losing their job – so they do not seek care. I lament the fact that our health authorities have been so negligent in their record-keeping – we are quite literally totally blind in these matters.
I will also say that the worm is clearly turning in many of my colleagues. I think we are all starting to realize that we are going to have to learn to live with this. That was the central theme of a Grand Rounds I attended this week on Zoom. The vaccines are certainly not the silver bullet. We are going to have to work very hard on any repurposed or new antivirals. We are going to have to take masking and distancing much more seriously until this thing has calmed down to a dull roar (may be months – may be years – who knows at this point?) and we are going to have to work hard to protect the vulnerable – and we are going to have to put down the swords and really begin to work hard together. There are many of us in medicine who are working hard with our colleagues about not being so rigid about vaccine primacy. For example, after the presentation today, I do not think there was a single person who could forcefully support vaccine mandates for those with IgG antibodies – especially younger patients. I am seeing hardened minds changing – very slowly – but changing nonetheless. That is why I write here – non-medical people would never see what I am seeing behind the scenes.

NC staff write:

IM Doc vis e-mail:

In August and September of last year – Texas Florida and the rest of the south were getting killed – and then it kind of let up by October.
And just like last year – the action moved to the Northern Tier – Montana, Idaho, Wyoming, Dakotas, and Nebraska and the surge started right around Labor Day – and crescendoed through NOV and DEC – just like it is right now. In OCT and NOV last year – it began the surge into the upper Midwest and New England – and the West Coast – and then eventually into the South again –
We are starting just like we did last year –
And Texas and Florida are slowly receding just like last year.
And we are on a definite upswing here – almost literally the same week it started last year.
It is so far exactly like last year as far as the timing and geography. Thankfully – the case numbers and deaths are not as high so far.

curlydanAugust 28, 2021 at 12:07 pm
I’d say you’re doing OK, but a bit worse than national averages.
13.8% of Miller County has tested positive. 0.26% have died.
For the U.S., 11.7% have tested positive, 0.19% have died.
One thing about Lake of the Ozarks, though, is that it’s possible that people may contact the virus while there on the weekends then head back to “home” and test positive in their home counties.
Also, your ICU situation doesn’t look that great. The hospital map in this link below shows 3 local hospitals with % of ICU beds filled at 76%, 78%, and 100%. That looks like thin margins to me.
https://www.nytimes.com/interactive/2021/us/miller-missouri-covid-cases.html
1. IM DocAugust 28, 2021 at 1:48 pm
  I would be very careful making any firm conclusions about anything using that website.
  When I look at my county – it in no way reflects the current situation on the ground which is actually much worse than reported there.
  It looks to me that the website is about 2-3 weeks behind based on my county.
  I am not sure what data they are using to make these judgments but it is often very incorrect.

IM DocAugust 28, 2021 at 12:06 pm

For years, my mother was the cook in our local elementary school. This was in the days before Marriott or whatever corporation was hired to bring in frozen pizza and ketchup. This was real food and required real work.

As a consequence, she was put in charge of dozens of these kids that were tasked with working to “pay” for their food. She found the whole concept abhorrent. But what she did become was a fierce protector of these kids. Throughout my young life, there were often 5-10 of these kids at our house for holidays, etc. They would never have had any if not for my mother.

What I will never forget as long as I live, was at my mother’s funeral, dozens of these kids showed up, now fully grown up, At the receiving line, my sisters and I were treated to one story after the other about how she had changed the course of their lives.

My mother always taught us all that we should take every opportunity we have to be positive. And do good for others. No matter the situation. And she lived it.

JBird4049August 28, 2021 at 6:57 pm

Anytime before the first two decades of the 20th century, the Western world, including the United States was just full of infectious, often deadly, frequently crippling diseases. Here is a partial list and these diseases were endemic in the United States including malaria.

Chicken pox
Cholera
Dysentery/diarrhea
Diphtheria
Malaria
Meningitis
Measles
Mumps
Polio
Syphilis
Tetanus
Tuberculosis
Plague
Pneumonia
Rubella
Scarlet Fever
Smallpox
Typhoid Fever
Typhus
Whooping Cough

They were all dealt with one by one during about century of effort. Aside from smallpox, all of them are still around with only constant work keeping them away, but this has and is still being done, which is why I know that Covid is solvable.
It might take much time, effort, money, a lack of corruption, but our ancestors with much less knowledge and resources did succeed with these far greater threats. Alll levels of government, municipal, state, and federal for more than a century did the work. Somehow, today, the mighty CDC, the agency responsible for much, though not all, of this is a joke.

All this death also explains the gloom, despair, and general sadness I often see when reading the history (and poetry) of the time of all classes regardless of wealth. Reading any accurate biographies of Abraham Lincoln just plops you into that gloom, doom, and despair, which is easily explain by the deaths both Mr and Mrs Lincoln had to endure. Everybody lost children, sometimes the majority. People often had so many children, not because they wanted to, but because it was often the only way to have any survivors.

IM DocAugust 28, 2021 at 9:57 pm
I would add Yellow Fever to this list as well. Big problem especially in the Pennsylvania area during the Revolutionary Era.
A physician named Benjamin Rush was a lynchpin in its eradication. And he is well remembered as a hero for this among many other things.
Somehow, a few centuries from now, I do not believe the name Anthony Fauci will be held in the same regard.

jo6pacAugust 29, 2021 at 8:18 am

Some news on the virus. paywall

https://www.bloomberg.com/news/articles/2021-08-28/antibodies-waning-the-immune-system-has-a-backup-plan-for-that?srnd=premium

antidlcAugust 29, 2021 at 11:12 am
From the article:
Antibodies against the coronavirus wane over time, but the immune system has a backup plan that doesn’t rely on boosters, according to a study by scientists at the University of Pennsylvania, where technology for mRNA vaccines was developed.
Researchers at the university’s Perelman School of Medicine tracked 61 people for six months after immunization with mRNA vaccines. The team noted that antibodies gradually ebbed, but that the shots generated durable immune memory to SARS-CoV-2 in the form of B and T cells that increased over time to help ward off serious illness.
They’re finding this out NOW? Why wasn’t this studied before the EUA, before the FDA approval?
Seems to me this should have been known a long time ago…but what do I know.
1. Yves SmithAugust 29, 2021 at 3:54 pm
  Lordie, this is like an economist’s theory paper.
  Memory B and T cells are a secondary line of defense. They are activated after an pathogen has gotten going. They are very helpful in slow-moving infections but the Covid cytokine storm happens quickly and aggressively, and faster with Delta than wild type Covid.
  1. Raymond SimAugust 29, 2021 at 6:02 pm
    And (I know I’m a broken record.) the virus’s structure, its behavior in cell culture, postmortem evidence and public health statistics from around the world all strongly, in fact overwhelmingly indicate it can beat immune memory. This was always to be anticipated, but with Delta there shouldn’t be any question in anybody’s mind.
    1. SkunkAugust 30, 2021 at 5:47 am
      Yes. This is why ultimately vaccination with the types of vaccines we currently use will not be enough. Vaccination is helpful, but will not solve the problem.
2. IM DocAugust 29, 2021 at 4:54 pm
  The problem with this kind of paper is answered by a simple question—-
  DOES THIS COMPORT WITH WHAT WE ARE SEEING IN REAL LIFE ON THE GROUND?
  I believe the answer unfortunately has to be a big NO.
  Way too many breakthrough infections, way too many of them getting fairly ill and even dying. This is not what one would expect if the conclusions in that research were correct…..
  I have not had time to look at the paper – but just right off the bat something appears to be wrong with the conclusions.
  
  IM DocAugust 29, 2021 at 10:39 am
  I find it hard to fathom an article talking about the lack of honesty when in the article is the statement that no vaccinated patients have died of COVID. I think the author may be referring just to the Provincetown outbreak, but the wording is such that it could be easily misconstrued. However, the sentiment remains.
  We have already had 2 vaccinated COVID deaths, multiple dozens of vaccinated hospital admissions, and literally hundreds of breakthrough cases, many quite ill, in my small community. Maybe we are being punished by the gods and this is the only place in the world this is happening. I do somewhat doubt that however.
  DO THESE PEOPLE EVER EVEN BOTHER TO LISTEN TO THE LIES THEY ARE TELLING THEMSELVES?

IM DocAugust 29, 2021 at 11:31 am

As a Professor of Medicine – most specifically Internal Medicine and Medical History, this is the time of the year that I am preparing for a new group of students, 2 of whom will be starting with me next week. Because I have left the big city, I am no longer in front of lecture halls, but I am responsible for teaching these young kids what it is like to be a physician on the front lines.

Always looking for new material, I found a most amazing book. I would like to share it with you all.

Published in 2019, right before COVID, it is called THE PANDEMIC CENTURY and was written by Mark Honigsbaum. It is a detailed look at 9 different major infectious disease crises of the 20th century. I would quibble about calling some of them pandemics – for example The Parrot Fever Scare of 1930 – but the common threads to all of these events are hauntingly familiar to what we are seeing now. One of the great comforts of reading history is the famous throwaway line – “This has all happened before, and will all happen again.” And we survived each and every time.

There are things described in almost every one of these events that we are dealing with at this very minute –

1). The complete inability of the medical profession to realize something new was going on, to change course, and to admit mistakes – In the Parrot Fever event of 1930, medical science had thought it had already determined the cause of psittacosis and despite all evidence to the contrary that they were wrong in every way, continued to act on wrong foundations until finally the medical scientists themselves started dying because they were allowing themselves to be infected out of ignorance. In the 1918 Spanish flu it took TWO WHOLE YEARS before medical science admitted it was completely wrong and that the cause of the flu was not a bacteria known as Bacillus.

2). Bungling and misdirection at the beginning in almost every case led to critical months being wasted. This was largely the fault of the public health authorities and their entrenched bureaucracy.

3). The complete disaster of research done early on and the insistence on pristine research and pristine conclusions led to multiple horrific treatment and pathogen identification problems. For example, multiple papers about EBOLA in 2014-2015 were completely dismissed because the peers would just submit to the journals “There is no Ebola in West Africa. These people do not know what they are talking about.” These were papers about the large numbers of antibody positive patients for Ebola in West Africa. And we all know what happened in the West African countries of Liberia and Nigeria and how that reached out to touch the USA just months after these “experts” dispatched these papers.

4) In almost every case, the public health officials in the USA tasked with telling the truth and being a calming influence did the exact opposite. It is way more common than not for complete panic to rule rather than calm and cool responses. Visible panic and emotionalism was often seen in these leaders during many of these events.

5) The people at the very top of the public health and federal health agencies during many of these epidemics were shown eventually to be complete political hacks.

6) Pushing miracle cures and magic bullets during the heat of the moment ON EVERY SINGLE OCCASION led to tears. This is true of even the polio vaccine which was consumed in disaster right out of the gate. Those in the federal health apparatus that figured out BEFOREHAND what was going to happen were subjected to howls of derision. But happen it did.

7). The miracle of antibiotics and vaccines has led to very elevated expectations among the population. These expectations are completely unachievable with novel agents and new organisms. Once this is exposed, the loss of trust, anger, and feeling of betrayal can set back the pandemic efforts for years.

8). Polio is the one disease that was likely handled the best. But even the 1950s vaccination effort was beset with multiple disasters. And it took 27 entire years for the USA to be cleared of the virus.

I just thought some would be interested. This book will be required reading for my students this year. History is very important to teach us lessons about where we are now.

IM DocAugust 29, 2021 at 1:40 pm
Yes
Either I am getting too old to proofread or a spellcheck event occurred
That line should have been TWENTY WHOLE YEARS.
Sorry all.

IM DocAugust 30, 2021 at 5:11 pm

John Barry – who wrote The Great Influenza – the best book about the Spanish Flu of 1918 – had a very important quote that he found somewhere around that time – and I cannot remember who he was quoting –

“When you combine politics with science, all you have left is politics.”

It is absolutely NOT the vaccine that these folks think is the Mark of the Beast. Not at all. It is the concept of the vaccine passports – and then the next extension would be to have a chip placed with your vaccine and other information that then communicates with the 5G network. It is the same concept as the social network score being brought out by the Chinese Communists right now on their people. Once you quit listening to Rachel Maddow et al making fun of these people for being 5G tin foil hatters – and really listen to how this is actually their worst prophetic nightmares coming true, you begin to have a bit more understanding. But all the other side gives them is laughter and derision and downright ugly mean bullshit behavior.

I came from this world. My family were not quite snake handlers – but close. To ask me to turn on them and denigrate them is something I will just not be able to do. As much as I do not agree with their worldview – I still love them – and they are what made me who I am today.

Denigrating and making fun of them is just going to make it worse. That too is part of their world view.

Because the other part of their prophecies that get so little attention – is that Jesus himself told them all that the righteous would be spit on and laughed at. And they would be considered BLESSED when this happens. Look around you right now. And FYI much of both the African and Latino communities have this same end-times belief. It is not unique to Southern Whites. Folks, these people are ready to rock and roll. They are locked and loaded and quietly preparing themselves to fight the Beast. I attended a Zoom meeting for a family funeral last week. He did not die of COVID – but it was as fire and brimstone and preparing the troops about these issues as I have ever heard. If they are doing this at funerals, God only knows what is going on during Sunday services.

I cannot believe the absolute incompetence of our health officials has led to this. But here we are. I hope and pray that something changes. If not, this is going to get real ugly real quick.

Not really here because of the IM Doc comment, but he liked the previous poster's charts, so I thought I'd include the thread:

RickAugust 31, 2021 at 4:51 pm

For those in Oregon, I have compiled all the Oregon Health Authority bulletins on the county cases since the beginning of the pandemic and created a number of graphs and visualizations. There is a stark difference between the large counties that have half of the population and the small counties with half the population.

And yes, this latest wave of cases has been the worst in Oregon.

Many restrictions were lifted on the July 4th weekend and the graphs tell the tale of how that went.

Coronavirus in Oregon since 3/2020

LaughingsongAugust 31, 2021 at 6:10 pm
Nice work! I’m bookmarking that one, and thanks for doing the work for everyone. And my goodness, I have never seen an unemployment graph look like the one for 2020. Holy guacamole….
IM DocAugust 31, 2021 at 6:53 pm
If only the CDC or national health agencies could put out as meaningful charts like this.
Just incredible work – this must have taken you forever to do.

comments

IM Doc pt 25

2021-12-12T01:15:48Z

IM Doc

August 1, 2021 at 4:32 pm

I am sorry – this response is going to be somewhat long. But I feel like what I have to say is becoming more and more important for folks to think about.

I appreciate so much the tolerance that Yves and Lambert and the commenters on this blog have given me for my comments here.

30 years ago, I walked across the stage to get a diploma. I stood up in a large group of classmates, raised my hand in the air and swore to God that for the rest of my life, the only professional priority for me would be the health and welfare of my patients and my community. That is the alpha and the omega. I did not take an oath to corporate medicine, to Dr. Fauci, or to Pfizer. I took an oath to every single one of my patients to do my very best for their interests. My fate was sealed from that day forward. I have been endeavoring to do this from day one, and I will not back down from those ideals embodied in that oath – nor will I ever.

My professors of medicine taught me well. And I have done all I can do to return the favor to the next generation. I have been given more than a dozen teaching awards on faculties that have included Nobel Laureates and members of the National Academy of Science. I taught my students to think always with their patient’s interest at heart, to question everything, and to always follow the scientific method. But to always remember that we are dealing with human beings – sometimes at the very worst moments of their lives. I also taught them to live by a very important fact in their professional careers – no matter if they do clinical medicine, research or public health – truth is the very foundation of what we do. Without it, everything will come crashing down. I have literally thousands of former students, interns, and residents on forums that I keep up with often. They are some of the leaders of this profession. They are located in every corner of this country. It is through them that I have been able to keep a pulse on what is going on medically in this country. And it is through them that I realized early on in this pandemic that all was not as it was being presented. Fear mongering, lying, panic and hysteria were rapidly becoming the order of the day. Absolute mistruths were being told to the American people. Numbers and figures were being quoted completely out of context and historical perspective to scare people to death. More importantly, critical issues about the virus and the disease it causes were not being discussed at all. For example, as was true then and is true now, the overwhelming risk factors for bad outcomes are old age and poor health habits such as obesity, inactivity, and immunocompromised status. That was true at the beginning and is most certainly true now. But to this day, and especially since the vaccine push started, we hear ABSOLUTELY NOTHING about this from our officials. And I saw absolutely no one in the media lifting a finger to do a thing about it; rather, they were happy participants in the whole affair.

I am not now nor have ever been an investigative journalist. But I am a foot soldier on the ground and I have been trained by the best to make observations, to think of possible hypotheses to explain them, to look for critical evidence to support or falsify hypotheses, and to act accordingly. That is the very essence of the scientific method. It was hammered into my brain as a young physician in the AIDS wards, when we literally had no idea what we were doing for years on end. We had to learn to let that method flow through our veins in order to do the best we could do for patients while our whole profession was trying to figure AIDS out. And that experience was critical for me when this whole thing started. I could see that my patients were getting a horribly warped view of the whole situation, so I decided all those months ago to start putting my observations on here as comments. I have then shared with everyone hypotheses that a rational scientist/medical doctor would come to, and how I was going about falsifying or supporting them. Some of the thoughts have been critically wrong, and I have endeavored always to make sure all know that. Many of them have stood up over time. Everything I have done or said in these comments has been in good faith. I view this group of commenters as my very own.

But now, my friends, we have reached a critical juncture in this entire situation. As has always been the case in human endeavor, when you start down the road of lies, it will be no time before you have painted yourself into a corner. And that is where the medical establishment finds itself today. Along with the elite/political establishment that prodded, aided, and abetted every step of the way. This is all about to blow up in their face and they are acutely aware of that. They have two choices, admit their mistakes, ask for forgiveness and understanding, and begin the rectification process OR double down.

It is very clear to me that the elite have decided to double down. The FSMB proclamation is just but one part of doubling down. I will bring your attention to a few other things this weekend that are emblematic of the current elite thinking –

The Brooks & Dionne sequence from PBS Newshour on Friday night – We have two commenters – one ostensibly from the Right – and one from the Left. Both have clearly agreed that it is high time to get nasty on the deplorables refusing to get vaccinated. There is not a comment made about all the facts that have come to light this past week – as in all the breakthrough cases, as in all the vaccinated positive patients being just as likely to transmit as the unvaccinated. I am going to make an argument right now – GIVEN WHAT WE KNOW RIGHT NOW ABOUT THESE VACCINES, WHAT EXACT PURPOSE IS BEING SERVED IN A PUBLIC HEALTH PERSPECTIVE OF FORCING THESE VACCINES ON EVERYONE? There is certainly no longer evidence that it is any safer to be in a crowded grocery store with vaccinated or unvaccinated patients. As for individual risk, I have been on my knees for months literally begging all of my high risk patients to get vaccinated. My contacts are telling me that the overwhelming vast majority of the ill in the hospitals are in these same high risk groups – OBESE DIABETIC and IMMUNOCOMPROMISED. 25 year old jocks are not in that high risk group. Outside of vaccinating every single soul that is high risk, given what we know now, what is the purpose of vaccinating every single human?

FSMB or anyone else – that is a scientific argument, based on observations and facts – please I am all ears, tell me what is wrong with that argument? Please present your own observations and facts.

Please look at the Bill Maher show on Friday when he had his roundtable. I cannot find a video of this. He had the US Rep from the Virgin Islands. And some guy who was the very essence of the elite PMC. They got around to vaccine hesitancy among blacks – and he blamed it on Tuskegee. The US Rep from the Virgin Islands was like – NOT SO FAST. THAT WAS GENERATIONS AGO. THAT IS NOT REALLY ALL THAT APPLICABLE HERE. THE PROBLEM IS THE AFRICAN AMERICAN COMMUNITY HAVE NO FAITH IN THE GOVERNMENT TO DO THE RIGHT THING. And I looked at my wife and said – PREACH IT SISTER. That is a woman who is in touch with her constituents and knows what she is talking about. I would add the following – the same exact thing is true of the majority of the Bubbas out there that are being denigrated all day by the press – THEY HAVE NO FAITH IN THE GOVERNMENT TO DO THE RIGHT THING – WHY WOULD THEY???? It has been my contention all along that Blacks and Working Class Whites have so much in common. Maybe the upcoming turmoil will make them all realize that. The best however was the PMC guy. Mr. Maher and I are obviously marinating in the same cultural stew. After going on for a while about Bubbas and Blacks, Maher made the point that another group of vaccine holdouts were the pristine body, man bun Bernie Bros. THE PMC guy did not even acknowledge the comment. Maher said it again. And again the PMC guy was literally dumbstruck. Never had entered his mind. Maher, seeing it was hopeless moved on. THESE PEOPLE HAVE BEEN MARINATING IN THEIR OWN NARRATIVE FOR SO LONG THEY HAVE NOT A CLUE WHAT IS REALITY. It is clear they have all convinced themselves that enforced vaccine mandates are such a great idea. Why, there will be no consequences, everyone will just buckle under. THEY HAVE NO IDEA WHAT FIRE THEY ARE PLAYING WITH. I have been hearing from multiple contacts all over the country that the mass resignations in health care are just beginning. It is not the RNs and MDs. Nope it is the CNAs the front desk people, the housekeeping. They are just walking off the job – going over to the Piggly Wiggly or Kroger and getting more money and less bull shit from the boss. It is happening among police, firemen, teachers and other workers as well. WHAT KIND OF MORONS WOULD DO THESE MANDATES IN THIS ECONOMY? THEY ARE COMPLETELY OUT OF TOUCH. And again, the reason for mass vaccination for public health has literally fallen apart with the evidence coming out the past few days. WHAT PURPOSE DOES IT SERVE FROM A PUBLIC HEALTH STANDPOINT TO VACCINATE THE ENTIRE POPULATION WITH A NON-STERILIZING VACCINE?

Again, FSMB and any others, that is an argument based on observation and evidence…. Please address the argument with your own observations and evidence and let’s talk. I am all ears.

Thirdly – this little chestnut from Andrew Sullivan If you read his substack entries from early this year, several times he writes that very soon, as in this summer right now, we will be living in the Roaring 20s again. COVID will be over. All his elite friends were telling him that. Imagine his surprise when the event in the town he was in for the summer popped the lid off the narrative. Because of the incompetence of our press, there is no real reporting about how many “bears” were actually involved. I, however, have taken care of a lot of “bears” in my life. Obesity, glucose intolerance/diabetes, and sedentary lifestyles are very common in this group. As is fitting with the truth of this whole pandemic, those are all critical risk factors for bad COVID. What a perfect opportunity for the press or medical establishment to hammer this point home with this group of folks that have fallen ill. NOT A PEEP. Could that lifestyle choice be a reason why so many of them, vaccinated or not, fell ill? How many “bears” were actually involved in getting ill? And is so fitting of the whole elite attitude, Mr. Sullivan’s impulse is to blame the unvaccinated – and “let it rip”. He looks right through the habits of his friends and blames the unvaccinated for ruining his promised party summer. My favorite quote – “So the obviously correct public policy is to let mounting sickness and rising deaths concentrate the minds of the recalcitrant. Let reality persuade the delusional and deranged. It has a pretty solid record of doing just that.” Mr. Sullivan, do the delusional and deranged include the over 700 of these people who were actually vaccinated? Mr. Sullivan, are you listening to yourself? Delusional and deranged? What a perfect encapsulation of these people and how they think. He has pontificated so much in his life about all the indignities that happened in the AIDS crisis. I guess “let it rip” was actually the lesson he learned from that nightmare. I learned some lessons too. You tend to do that when you sign 8-10 death certificates every day of your intern year. All I can say is “I’ll do me. Mr. Sullivan, you can do you.”

FMSB – or anyone else – please point out to me any misinformation in the above paragraph.

I want to finally explain a very important concept that is going to become even more important the next few weeks. We clearly have a non-sterilizing vaccine. There is now continued and mounting evidence that the vaccine helps symptoms and keeps some people from becoming extremely ill. (That is why I am strongly encouraging everyone at risk in my practice to take it NOW). However, there is evidence now, the Provincetown affair being the best example, that these vaccines do nothing to stop transmission. The vaccinated and unvaccinated alike can share the wealth and harbor viruses in their bodies. Viruses do not just sit around. They replicate at literally a logarithmic rate. They are not bacteria who reproduce at a 1-2-4-8 pace. No indeed, they are replicating at a 1-1000-1000000-1000000000000 pace. Since mutations happen when replication occurs, when you have this logarithmic rate of replication you have much higher levels of mutation. You are much more likely to have viruses develop mutations that will allow them to be more transmissible, more toxic, and more vaccine evasive. And when you have a vaccine that does not clear the virus from the vaccinated but instead allows it to be replicated and spewed you have just logarithmically elevated your chances of having real problems occur. That is where we are with these vaccines folks. At least with the information we have now. I did not just make this up out of my head. These are things I read just this AM in textbooks of medicine. Latest editions. Textbooks are there not for latest research – they are the repositories of wisdom and knowledge acquired over generations. They are the foundation. This is not new knowledge. This was known during the polio pandemic. That is why there were 2 vaccines – one was nonsterilizing(Salk) and the other sterilizing(Sabin). Both were given to every patient because they understood the wisdom of not having vaccine escape viruses in the wild. This entire concept has been known for generations.

There are two big differences now –

First of all, polio viruses and their ability to mutate are like a dice roll. Coronaviruses are more like a Rubik’s Cube.

Secondly, Jonas Salk was loud and proud about donating the polio vaccine to the world. He could have been minting gold. However, he hit one out of the park for the ages. Pfizer, Moderna, and their executives are indeed minting gold – how many new billionaires have been created by these vaccines? And oh by the way – the third world can just suck it – losers. And the elite wonder why “the delusional and deranged” as Mr Sullivan puts it, have a trust issue.

FSMB – please point out any misinformation in the above paragraph. Since the discussion about viruses is directly from Mandell’s Infectious Disease – we may have problems if you believe that is misinformation.

Folks, if you are high risk, obese, old, diabetic or immunocompromised – please go and get vaccinated right now. We all need to monitor our risk factors going forward – LOSE WEIGHT, GET YOUR BLOOD SUGAR DOWN, EXERCISE, GET SUNLIGHT – GET VIT D EVERY DAY. HUG YOUR KIDS AND YOUR SPOUSE. LAUGH ALL YOU CAN.

And America – we are either going to do this together or not at all. Please act accordingly.

Stay safe everyone – and God Bless.

Tom Collins' Moscow MuleAugust 1, 2021 at 7:00 pm

“Can we predict the limits of SARS-CoV-2 variants and their phenotypic consequences?”

The above is posted in the ‘links’ and seems to coincide with at least some your [IM Doc] concerns.

I am interested in narratives, the facts, the interpretation of those same facts, the telling and retelling of the narratives as the availability of the facts and information changes and their interrelated long term outcomes. In this case we observe the interplay in real time as the narratives change with the further addition of new facts and information. Fascinating to be sure, if one can remain intellectually and emotionally detached from the negative personal outcomes, that is, death, or compromised long term function for at east some individuals. “The word adventure has gotten overused. For me, when everything goes wrong – that’s when adventure starts.”– Yvon Chouinard Has the adventure started yet?

So, the public has ben recently told that, “CDC warns that delta variant is as contagious as chickenpox and may make people sicker than original Covid”

https://www.cnbc.com/2021/07/30/delta-cdc-warns-variant-is-as-contagious-as-chickenpox-may-make-people-sicker.html

“CDC Director Dr. Rochelle Walensky confirmed the authenticity of the document, telling CNN: “I think people need to understand that we’re not crying wolf here. This is serious. It’s one of the most transmissible viruses we know about. Measles, chickenpox, this—they’re all up there.”

https://www.newsweek.com/how-contagious-chickenpox-measles-cdc-document-delta-variant-coronavirus-r0-1614661

That being the current CDC case, then it is assumed and understood according to the following, that, “For highly transmissible pathogens, such as those causing measles or pertussis, around 95% of the population must be vaccinated to prevent disease outbreaks, but for less transmissible organisms a lower percentage of vaccine coverage may be sufficient to have a substantial impact on disease (for example, for polio, rubella, mumps or diphtheria, vaccine coverage can be ≤86%).” Does this same line of reasoning then apply directly to the delta variant? Why or why not? Does it even matter?

“A guide to vaccinology: from basic principles to new developments”

https://www.nature.com/articles/s41577-020-00479-7

Regarding the virtue(s), or lack thereof of a non-sterilizing vaccine and/or sterilizing immunity
in this instance, some individuals believe it is neither of great concern, nor even realistically possible [at this point in time]. See for example,

“Michael Mina, an infectious diseases epidemiologist at Harvard’s T.H. Chan School of Public Health, thinks achieving sterilizing immunity with a vaccine will not be possible for Covid-19. Experience with human coronaviruses — and with multiple pathogens that cause colds — shows immunity that develops after infection with respiratory tract infections is not lifelong. In some cases, the duration is measured in months, not years. If [infection with] natural coronaviruses doesn’t do it, I don’t think that we should necessarily expect or have the anticipation that we’ll be able to get there with the vaccine,” said Mina, who is also associate medical director of clinical microbiology at Boston’s Brigham and Women’s Hospital. Munster agreed trying to develop vaccines that confer sterilizing immunity would be a heavy lift with this coronavirus.”

https://www.statnews.com/2020/05/22/the-world-needs-covid-19-vaccines-it-may-also-be-overestimating-their-power/

“Vaccines Need Not Completely Stop COVID Transmission to Curb the Pandemic”

https://www.scientificamerican.com/article/vaccines-need-not-completely-stop-covid-transmission-to-curb-the-pandemic1/

IM DocAugust 1, 2021 at 9:20 pm
What I will say or add to your discussion.
From what I have heard in multiple conference discussion this past week or so is that exactly how non-sterilizing the vaccines are is now critical. If it is really true that their sterilizing activity is equal to unvaccinated status – then we have issues. If it is just allowing 5% of the viral load of a non-vaccinated patient that is a completely different story. The flu shots to some degree are non-sterilizing each and every year, but my understanding is they are nowhere close to parity.
When that article came out from the CDCs own MMWR this week that the viral load in Provincetown was the exact same as the unvaccinated, it sent chills down my spine. That is most definitely not a good finding. They need to be looking at this aggressively to confirm or not. Also, as I alluded to above – was there something unusual about that cohort of patients? If it truly was a “bear” convention – they are older, more obese and much more likely to be diabetic. Did those pre-disposing conditions possibly factor into the parity with viral loads? Furthermore, it is critical that actual virologic counting be done on the samples. cT is very suggestive but not expositive.
But the point that it is apparently so close in parity to unvaccinated status is profoundly disturbing. This was completely unexpected and concerning to every one I have talked to this week.
I am awaiting further data – assuming they will be forthcoming with it. It has the potential to be a very interesting week.
And per your quote above, “If infection with natural coronaviruses doesn’t do it, I don’t think we should necessarily expect or have the anticipation that we’ll be able to get there with the vaccine.”
I have been hearing those sentiments all this past week from many people I know and respect. Basically – we are going to have to learn to live with this virus. How are the American people going to take that?
I have multiple overarching concerns right now ——
1). There is absolute signal that this is a completely non-sterilizing vaccine. If so, there is precedent but not certainty that this could make this whole thing worse. In a normal world, I would have expected a pause and reflect moment. Instead, we are doubling down on vaccinating everyone. Is that a wise course?
2). There is all kinds of talk in the air about boosters right now. I have not spoken to a single patient – not one – many of whom lined up willingly in December – who are remotely interested in this at this time. A direct quote from my old lady neighbor from less than an hour ago – “I got vaccinated once – and I did that for my country. I will never let this clown car brigade get near me with another one. They cannot keep their lies straight.” And she is a loyal Dem – Biden signs all over her yard last year. All these people like Rachel Maddow and Sean Hannity towing the line of the official narrative never get near an actual citizen. I do so every day all day – and I am telling you that is just not going to fly.
3). The idea of mandating vaccination in this unsure environment is really a sign of the medical establishment not realizing the position they are in. I just got off the phone with the nurse taking care of my patients in the hospital. One of the CNAs told the charge nurse she would not be back tomorrow. She quit. The stress is already overwhelming and now this. My hospital has already had its little mandate attempt – and it ended in disaster for the administration. So they tried the humiliation and loss of privileges approach – and people are quitting in the droves. I am sorry to say – this could literally cripple some of our hospitals far better than a crush of COVID patients. And at this juncture, unless more evidence comes to the fore, universal enforced vaccination does not make much sense medically.
4) When we have these things going on with the vaccines, other measures are going to become much more important. Let’s talk about masking. That was when the first lie happened – and the first domino dropped. Fauci lied. He then admitted it. It was a noble lie. But a lie nonetheless. Done by a government official in the middle of an establishment orgy of lies starting with the Mueller investigation. How much better it would have been to say something like this – “Yes we all need masks. But right now, we do not have enough for our HCW. Americans, stay home. If you do have to get out, use towels, whatever. We will get masks soon enough. I am going to ask Pres Trump today to do an emergency authorization to make billions of masks ASAP.” He may have taken flack yes – but when the lie was told and then revealed later – in the environment in which it was told – it led to half the country believing masking was right up there with faked moon landings.
And on so many things this year – one lie leads to another and before long you are in looney land.

AcaciaAugust 1, 2021 at 7:03 pm

If I may add another comment, Matt Ford’s article “Vaccine Mandates Are as American as Apple Pie” in today’s links offers an interesting juridico-historical perspective, beginning in 1777 with an order from George Washington to inoculate soldiers against smallpox in the battle for independence. In this way, Ford neatly links “freedom” with the vaccine, and later in the article “civilization” with vaccination. Now, I’m no expert here, but a quick search suggests that the history of the smallpox vaccine is said to begin in 1796, with the work of the British doctor Edward Jenner. So what was being given to soldiers of the American revolution in the 1770s? It seems that it was an earlier treatment called variolation, which is not quite the same as vaccination. The difficult part (which Ford doesn’t address) is that insofar as the current Covid vaccines are non-sterilizing, it doesn’t really work to compare them to the smallpox vaccine or, assuming it conferred lasting and sterilizing immunity, the earlier techniques of variolation. Again, non-expert here, so by all means correct any mistakes.

IM DocAugust 1, 2021 at 10:46 pm
This was an article written by someone who has no concept of medical history.
As is so usual in today’s world, we tell things that are somewhat true, without any context whatsoever.
You are correct, in the 1770s, the process would most definitely have been variolation. This was a widespread practice in England, Scotland, France and the American colonies. It did work but it had two big drawbacks. If not done correctly, it actually produced a smallpox outbreak. AND it had a very uncomfortably high fatality rate.
It did work for the most part, but true records like we keep today were absolutely not done at the time.
It is also important to note that Washington’s order came during a time of war and was strictly for the military men. It was never dreamed to be forced on civilians. That is a markedly different situation in which we find ourselves today – again there is ZERO context in some of these opinion writers.
As my great uncle who survived kamikaze raids in Okinawa wrote in his memoirs – “There were over a thousand of us on that ship. Every one of us had already come to the realization we had given our lives to our country. It is only a twist of fate that any one of us arrived home intact.”
Military matters in a time of war is much different than we find ourselves today. As Alfred Lord Tennyson said about the enlisted – “Ours is not to wonder why….Ours is just to do or die.”
By the time the Vermont case came up that he described – the actual smallpox vaccination had many years of safety information behind it. It is absolutely farcical to compare that to our current situation. First of all the mortality of smallpox is astronomically higher than COVID. And secondly, the safety of the vaccination process was very well established – something that has not even been close to being done with the COVID vaccines.
Another absolutely ridiculous article written by someone who has little to no understanding of medical history. Twisting facts to make a point that does not exist. I have gotten very used to the sight of these kinds of things this year. As someone who taught Medical History for decades, I find the whole thing very very discouraging.

TinkyAugust 1, 2021 at 8:49 pm

Many thanks Doc, as always.

Here is some hard evidence supporting some of your basic concerns. It is from Dane County (Wisconsin, I believe), and was collected from July 12-25th. The Viral Load in Breakthrough Cases section is of particular interest. Here’s the key excerpt (bold emphasis mine), followed by a link to the full pdf of the data collected and conclusions.

We can see that there are far more samples from the unvaccinated group— this is expected because unvaccinated people are more at risk of getting COVID. We can also see that the gray and yellow dots are distributed similarly. This is evidence that fully vaccinated people have viral loads similar to that of unvaccinated people, and may be more capable of spreading COVID than was previously known. This is a very recent discovery that is also being supported by recent research done by the CDC, but more research is still needed.

https://publichealthmdc.com/documents/2021-07-29_data_snapshot.pdf

IM DocAugust 1, 2021 at 10:03 pm
I know nothing about this county. But this is exactly the kind of data that will need to be really evaluated.
I would like to point out something very important though. They report the collection time was from JUL 12-25.
If this county is anything like my own, the reason there are so many more unvaccinated samples in the cohort is not because “they are more at risk of getting COVID”. That may be the case – but we can not know that in my county because no one was even acknowledging these breakthrough cases at all. That did not even begin in earnest until about JULY 25th or so.
Since that time, there has been a marked change in that process. Every single positive, vaccinated or not, is now being thoroughly evaluated. The datasets in huge swaths of this country are completely worthless for case counting from mid May until about last week because of this.
I do not know if that is the case for your county. They may have not been following guidance from the CDC and actually counting the cases.

Questa NotaAugust 3, 2021 at 9:06 am

Matter of time before many hospitals will need some National Guard or similar reinforcement as nurses, and docs, continue exodus. That may conflict with similar call-ups for different skill sets to reinforce the dwindling, defunded, police forces.

COVID-driven martial law next, not as far-fetched now, is it?

Once upon a time, people went into public service with goals including the help of their fellow human beings.

IM DocAugust 3, 2021 at 9:51 am
It is not really the RNs and MDs that are refusing vaccination – although that is happening to some small degree..
It is all the ancillary staff – the CNAs, the receptionists, the orderlies, the housekeepers. All right in the middle of patient care. Many of the legion of desk jockeys in health care are also refusing but their absence would not be so critical. It may actually help things out.
If this ancillary staff begins to walk out en masse, and I have very good information that it is already happening to some degree in some places, we will have way more of a crisis on our hands than a COVID surge would ever be. You can count on it.
Nursing homes and rehab centers are already feeling the pain everywhere.
Unlike the RNs and MDs, these employees take no oaths. They have been shat on by the MBA crowd for the past decade. The ones I have personally spoken to are finding the pay much better at the local grocery store and they do not have to deal with all the crazy in the hospitals.
This is indeed an emerging problem. In some places, these employees have to wear Scarlet Letters – UNVACCINATED or get to eat their lunch in the broom closet. Brilliance! And I see all of those in charge just doubling down. The problem just simply does not exist to them. But if they are not careful, it soon will.

Sloppy Pfizer Booster Clinical Trial Consent Form Provides Way to Exclude Reactions That Require Emergency Care

Posted on August 3, 2021 by Yves Smith

Bloomberg Law complained recently that the consent forms for Covid 19 vaccine clinical trials are larded with unimportant information and difficult to understand. Based on our reading of a Pfizer consent form for a trial of a third shot of its Covid-19 vaccine, those aren’t the biggest causes for pause.

We’ve embedded a Pfizer consent form for a Covid-19 booster vaccine clinical trial below, which as of posting time was available at careidresearch.com. We strongly encourage you to read it in full.

We’ll discuss first how the form does not appear to have been reviewed by the oversight body tasked by the FDA to do so, and then will discuss why key parts are troubling.

The biggest issue, flagged in our headline, is that the consent form allows for participants who need emergency care and go straight to their doctor or hospital to be ejected from the study. But it’s not the only one.

Pfizer Consent Form Too Obviously Not Reviewed, Let Alone Negotiated, by FDA-Designated Overseer, the Institutional Review Board

The FDA has tasked Institutional Review Boards, aka IRBs, to provide independent oversight of biomedical research projects to protect study participants, as you can see on the agency’s website.

Historically, academic medical centers and large local hospitals operated most IRBs. IM Doc, who was on an IRB for nearly two decades and its chairman for several years, explains how major drug companies have successfully shifted many over to private sector players to gut oversight:

In our IRB we oversaw usually between 250-400 active trials at any one time. There was a staff of 6 RNs dealing with all the documents, the patient contacts, and any other work needing to be done.
The Board itself consisted of a committee of LOCAL individuals. There were 15 people on ours. 3 were doctors, 3 were nurses, 3 were clergy, 3 were professional people from the community (lawyers, accountants, business owners) and 3 were blue collar workers. You notice the majority was ALWAYS NON-MEDICAL. We were tasked with going over any new research studies in our center, and coming up with a document called an “Informed Consent”. The researcher always had a template for this from either the NIH or other agency or Big Pharma. But the committee went over it with a fine tooth comb. To make certain that the patient was being informed exactly what the study was and how it was being conducted, what the risks and benefits were, what to look out for, and who to call if there were problems. A complete chain of command for problems was essential. It was also vetted to make certain that every person on the committee could easily understand the language. There were usually on average of multiple dozens of revisions made. The entire document was retyped and reformatted by our staff and then sent to the investigators for their approval. This process almost always took 2-4 weeks.

Over time, Big Pharma has obtained more control over IRBs by moving Phase III and Phase IV clinical trials over to more cooperative private sector operators. A big motivating factor is that if an IRB (and historically there would be multiple local/regional IRBs supervising a clinical trial) suspended a study, every other IRB involved would have to be informed of the suspension and the reason why. Needless to say, that would have the potential to generate other suspensions or calls for revisions of study procedures midstream….which would be tantamount to having to go back to the drawing board. 1

One of the side effects was to weaken, and as appears to be the case here, effectively end IRB review and negotiation of consent forms.

Have a look at this image, which is at the top of every page of the Pfizer consent form:

The document is on the website of a research company that has engaged a doctor as the investigator and is working with Pharma companies to recruit patients. What is striking is that there is no attempt to pretend that the consent form is anything other than a Pfizer document. IM Doc stresses that every IRB he was ever involved with would at a minimum rework the drug company templates and create their own documents.

Confirming IM Doc’s view that this document was simply rubber stamped: The Pfizer ICD date is July 2, a Friday. The IRB “approval” date is July 7, the following Wednesday, after the Federal July Fourth holiday on Monday July 5. There is no way a request for changes in language could have been developed, sent to Pfizer, reviewed, and approved (or a letter explaining the rejection generated) in such short period.

Red Flags in the Consent Form

While one has to assume that this Pfizer form is pretty typical, it’s alarming as a statement of the disdain Big Pharma and its hired hands have for clinical trial participants.

As IM Doc described, what has happened over time is that the major drug companies have turned the IRB watchdogs into lapdogs. The evisceration of independent oversight has the effect of elevating the importance of the consent form as a vehicle of informing and protecting study participants. But the consent form retains its apparent original form of being a user-friendly document describing the clinical trial process and risks. The teeth were intended to be at the IRBs, not in the consent forms.

Nevertheless, the consent form is clearly meant to have legal significance, as in most importantly to shield Pfizer from liability. Yet it is slipshod and incomplete. For instance, it fails to define terms and is inconsistent in the way it refers to concepts, does not specify governing law, and has no dispute resolution process.

The latter issue matters because Pfizer says the study doctor will “provide or arrange for” medical treatment for what is refers to as a “study-related” or “research” injury (it at least does define “research injury” on p. 17, if not all that crisply). But what if a study participant thinks he has suffered a “research injury” and the study doctor disagrees? Or the participant believes the level of care Pfizer provided is inadequate?

It’s not hard to wonder if the sloppiness of this document is deliberate, that it’s the Big Pharma answer to Nigerian scam letter. As professor of information and spam expert Finn Brunton put it:

By making them really obviously fraudulent, you’re weeding out the skeptics. You’re only getting truly gullible responses.

This consent letter looks designed to put off the legally savvy…who could be effective trouble-makers if anything went seriously wrong.

Below are some eyebrow-raising provisions. Note that these shortcomings have the potential of impairing the health of participants and their close contacts, by not giving them the most complete information about whether the participant has Covid, as well as the completeness and integrity of this Covid booster study.

1. Unlike the Moderna clinical trials, where participants were checked for Covid weekly, Pfizer participants are tested for Covid-19 only if they report symptoms to a study doctor and then the doctor deems they warrant testing. That assures asymptomatic cases will not be tracked.
Given that the CDC has raised its alert on the Delta variant to DefCon 1, based on evidence that asymptomatic patients carry Covid in their noses at the same level as symptomatic victims, the study data-gathering does not reflect current public health concerns.
2. Study participants, and importantly, their doctors, do not have access to any of their test information or samples from the trial, including if they report Covid symptoms and the study doctors run a test. Pfizer makes no commitment to tell them if they have a positive test result. They are instructed to get their own test from their MD if they think they have Covid.2/sup> But participants agree to let Pfizer obtain information from their doctor and any medical provide about care the participant receives.3
3. Pfizer can remove participants who seek emergency room care on their own. The document instructs participants repeatedly to contact the study doctor “immediately” if they suffer any of the listed Covid-19 symptoms. Note that the “immediately” means “Pfizer first”. That means if you contact your own medical professional first about one of the long list of Covid symptoms, you have violated Pfizer’s directives and can be removed from the study (p. 16):
The study doctor or BioNTech/Pfizer may also decide to take you off the study vaccine and/or remove you from the study (even if you do not agree) in the following situations:
• You are unable or unwilling to follow the instructions of the study;
While we are harping on sloppiness, did you catch “The study doctor or BioNTech/Pfizer may also decide to take you off the study vaccine”? Huh? This is a one-shot trial. “Take you off the study vaccine” instead appears to contemplate withholding a shot from non-complaint participants. In other words, this looks like language from the consent forms from the clinical trial for the original two-shot regime that wasn’t cleaned up for this study.
And if this isn’t what Pfizer means, that language is still defective. “Take you off the study vaccine” is meant to be punitive. Trial subjects shouldn’t have to guess what that means.
Now back to the issue of trial participants making emergency room visits after getting the third Pfizer injection. This is not a theoretical concern. We know of one participant who received a shot and in less than 24 hours had a high temperature plus debilitating digestive and neurological distress and went to the emergency room in haste. I am told this subject was escorted to the ER. That makes it unlikely the participant was alert enough to say “Oh, have Pfizer sort out my ER visit” even if that level of delay didn’t appear to be health-jeopardizing.4/sup>
Thus thiis participant did not “follow the instructions of the study” if as I infer the individual didn’t have Pfizer “arrange for” care.
To put this more directly: the odds are not trivial that participants who had severe side effects would go to the ER and worry about Pfizer later. Any who behaved this way could be excluded from the study. In other words, Pfizer has the opportunity, and clearly already has the motive, to avoid reporting so-called Stage 4 (potentially life threatening) reactions by invoking this provision of their consent form.5
4. The study is designed to minimize reporting of side effects. Remember that the study doctor is to be contacted only in the event of Covid-19 symptoms, and not other symptoms that have been attributed to the vaccines, like worsening of autoimmune symptoms or early and very heavy menstrual periods. From p. 8:
COVID Illness e-diary
At your first visit, you will either be given an “e-diary” (similar to a mobile phone), or you will download an e-diary application (‘app’) to your smart phone if you have one. You will also be given a thermometer. The study team will provide training on how to use the e-diary and thermometer.
The e-diary has questions related to any potential COVID-19 symptoms that you have.
You will need to complete the COVID-19 illness e-diary once a week for the whole time you are in the study, or until your study doctor tells you that you no longer need to complete it, to report if you have any COVID-19 symptoms or not. You will also need to complete the COVID-19 illness e-diary if you have COVID-19 symptoms outside of the weekly question.
You may receive alerts to the device or your own smartphone to remind you to complete the e-diary.
The e-diary is secure, and your confidentiality will be maintained.
In other words, the consent form does not describe any mechanism for reporting side effects. And even if participants try using the “Covid Illness e-diary” for this purpose, weekly the weekly format will favor under-reporting of symptoms during first 1-3 days6

Other Issues with the Consent Form

These concerns are not as dramatic but are still worth logging:

1. This clinical trial is not double blind. Is Pfizer too broke to do the extra work to execute a study at the highest research standard?
This is an ‘observer-blind study’, which means that you and the study doctor will not know whether you are receiving the study COVID-19 Vaccine or placebo injection, but the person who gives you the injection will know because the COVID-19 Vaccine and placebo do not look the same. The person that gives you the injection will not be able to talk about it with you. In case of urgent need, the study doctor can learn quickly whether you have received COVID-19 Vaccine or placebo.
Clever Hans the horse could read unintended non-verbal cues plenty well.
2. Not only are pregnant and at-risk-of-becoming pregnant women excluded, so to are men who might impregnate a woman. Tubal ligation, anyone? P. 14, emphasis original:
If you are able to have children and you are sexually active, you must use birth control consistently and correctly for at least 28 days after you receive your last vaccination. This applies to men and women who take part in this research study. The study doctor will discuss with you the methods of birth control that you should use while you are in this research study and will help you select the method(s) that is appropriate for you. The study doctor will also check that you understand how to use the birth control method and may review this with you at each of your research study visits.
Birth control methods, even when used properly are not perfect. If you or your partner becomes pregnant during the research study, or you want to stop your required birth control during the research study, you should tell the study doctor immediately. You may be withdrawn from the research study if you stop using birth control or you become pregnant.
If you are a male, you will not be allowed to donate sperm for at least 28 days after your last vaccination.
These restrictions seem at odds with a June 2021 of this New England Journal of Medicine article.. It starts by explaining that pregnant women are elevated risk for bad outcomes if they contract Covid compared to women who aren’t pregnant:
Therefore, clinicians relied on developmental and reproductive animal data from Moderna that showed no safety concerns, and there was no biologically plausible reason that the mRNA technology would be harmful in pregnancy…
Among 827 [V-safe] registry participants who reported a completed pregnancy, the pregnancy resulted in a spontaneous abortion in 104 (12.6%) and in stillbirth in 1 (0.1%); these percentages are well within the range expected as an outcome for this age group of persons whose other underlying medical conditions are unknown. A total of 712 pregnancies (86.1%) resulted in a live birth, mostly among participants who received their first vaccination dose in the third trimester. Among live-born infants, the incidences of preterm birth (9.4%), small size for gestational age (3.2%), and congenital anomalies (2.2%) were also consistent with those expected on the basis of published literature. There were no neonatal deaths. These are reassuring data based on reports from pregnant women mostly vaccinated in the third trimester.
…and with a March article in Nature that summarized other research.
If Pfizer wants to calm concerns about possible reproductive risk from taking its Covid vaccine, this is not the way to go about it.

Before you attempt to defend Pfizer, recall that it has a record before of playing fast and loose, including paying one of the largest criminal fines ever imposed on a drug company for the arthritis drug Bextra. It would not be hard for Pfizer to develop a legally sound and clearer consent form, or test all participants weekly for Covid, or inform participants if they test positive for Covid. But God forbid anyone interfere with Pfizer’s lock on the information flow, even if the result puts patients at risk.

And more generally, this consent form speaks volumes about the care in which Pfizer has placed people’s lives when evaluating these vaccines. It’s not hard to conclude this also represents the care Pfizer is taking to assure the vaccines are safe for you. Hire a bunch of local physicians at thousands of dollars a pop, and have an IRB rubber stamp the protective documents like an expense receipt. And set up the study so that if any participant sees a doctor they chose rather than Pfizer about Covid or a possible bad reaction, they can be excluded.
_____

1 More background from IM Doc:

Big Pharma has hated this system since the beginning. They tried to sabotage it in any way they could. At the same time, an entirely different approach began to be more common. For Phase III and Phase IV trials, Big Pharma began to pull away from big academic centers and big hospitals, and employ local physicians to do all the patient recruitment and research work often right out of their offices. Initially, the same IRBs were used – however, the rapid turnover pace that Pharma wanted was just not happening, so large centralized IRBs came into existence. Big Pharma had also become very tired of what they felt was pesky interference in their trials.
These were national IRBs – for profit corporations – often approving hundreds of trials a week. I will leave it to the reader to ascertain for themselves how thoroughly these trials were evaluated for problems. The two biggest ones were known as Western IRB and Copernicus.
At the same time this was going on, the uptake of “research” grew into a big business for community physicians. Many often made hundreds of thousands a year on this type of work. Each patient recruited in a trial would be rewarded by Big Pharma of often 5-10 thousand dollars. The patients of course got nothing. They were enticed with the promise of being put on an awesome new study drug – but as I found out so often – no one likely discussed with them the concept of a placebo – either the physician or the IRB. A practice would have hundreds of patients enrolled in trials, and often, the only employees doing any kind of follow up or paperwork on these patients were the same ones harried with all kinds of regular work in a physicians’ office. And unlike before in the academic IRB model, there was absolutely no follow up or concern given to the subjects by these national IRBs. NONE AT ALL. Eventually, many physicians doing this kind of work gave up clinical medicine and began to do this full time. It is highly lucrative and very little time is involved for them.
On multiple occasions, when I was the chairman of the IRB, our hospital IRB got dragged into a fiasco because a patient had a bad outcome in one of these trials approved by a national IRB. And the hospital made it mandatory that for the community physician to retain privileges – he had to hand his disaster over to the local IRB. What was invariably found was sloppy work, virtually no records, and certainly no meaningful follow up with the patients. Indeed, an example of the sloppy work can even be found on this document presented by Yves. What kind of business would have a confidential document laying around on the Internet for all to see?
You can read all about this process here or in many other places across the Internet. The complete domination of these outside IRBs has now been assured.

2 P. 9:

The result from this nose swab will be provided to the study doctor once it is available, but this will take some time, and cannot be used to diagnose if you have COVID-19. This is why it is important that you contact your usual provider if you have COVID-19 symptoms and think you need medical care.

3 This qualifier on p. 27 is ambiguous and not satisfactory:

What are your rights to your personal information?
You may have the right to access your personal information that is held by the study site.
However, by signing this authorization, you agree that your right to access certain of your information held by the study site will be suspended until after the study is over. After the study is finished, your right to access such information will be reinstated.

This section discusses “personal information” and “certain of your information.” Other parts of the consent form discuss “health information”. None of these terms are defined. This section can mean whatever Pfizer wants it to mean.

Oh, and there isn’t a clear duration of the study either. P. 5, emphasis original: “People taking part will be in this study who are given COVID-19 Vaccine (BNT162b2) will be in the study for about 1 year.

4 P. 17:

If you are injured or get sick because of being in this research, call the study doctor immediately. If you experience a research injury, your study doctor will provide or arrange for medical treatment. BioNTech/Pfizer will cover the costs of this treatment. A research injury is any physical injury or illness caused by your participation in the study.

5 As the post discusses shortly, Pfizer also requires sexually active men to use birth control methods approved by the study, review with the doctor that they know how to use them properly, continue to use them for 28 days after their shot, and “may” review the birth control practices at regular sessions with the study doctor. How many men do you think will be as compliant as the consent form requires? While the main point of these provisions is to make sure no way, no how can any pregnancy bad outcomes be pinned on Pfizer, non-compliance with the birth control requirements, even if they didn’t result in a pregnancy, could also serve as a basis for removal from the study.

6 This is a well-documented effect of the “empathy gap,” when individuals in “hot” agitated states can’t relate to what it is like to be in a “cold” detached state, and vice versa. One manifestation is people who are not currently in pain or discomfort typically do not fully recall how bad it was when they were miserable. From Wikipedia:

Hot-cold empathy gap is also dependent on the person’s memory of visceral experience. As such, it is very common to underestimate visceral state due to restrictive memory. In general, people are more likely to underestimate the effect of pain in a cold state as compared to those in the hot state.

IM DocAugust 3, 2021 at 8:14 am

All I would add is when I was on IRBs, someone like Yves was exactly who we were looking for to join the committee. Someone who could look through these documents and ask multiple important questions just like she has here. Non-medically trained insights were often critical.

The difference in our IRB then and this IRB now – the committee would have addressed these concerns, made changes to the documents as voted on by the majority and then submitted theses changes back to the the company like Pfizer.

If they did not want to address the issues, our answer would have been See You Later. Or at least some reasonable compromise would have occurred.

But that was a different era.

CocomaanAugust 3, 2021 at 8:38 am

I’ve sat on IRBs in higher ed in my time as well. Earned my CIP from PRIM&R. Mostly social behavioral research but strayed into FDA sometimes. I don’t like the Western IRB/centralized for profit system either. Academic medical centers have their lumps but they’re also bound by mission.

It’s an INSTITUTIONAL review board, meaning you pull people from your institution to review protocols. This gives you local flavor while regs and internal policies are also empowering the board for independent work. The regs specifically look for non scientists (like myself) on the committee, as well as local community members. Outsourcing IRB activity is, at the least, not following in the spirit of regulation.

I’ve reviewed at least a few thousand consent forms in my career, again, mostly behavioral research. What I’ve always stressed, and what is in regulation and guidance, is clarity and maintaining a low reading level, grades 6-8. obfuscation as described in the post is something I’d crack down on.

The informed consent document is the most important ethical piece of any trial, no matter how benign. Screwing it up is tantamount to unethical behavior.

Unfortunately, IRBs have, at the level of this vaccine, become disempowered, whereas in non medical centers they’re far overpowered for the risk level of the studies they oversee. I’ve seen out of control boards in the small institution context.

CocomaanAugust 3, 2021 at 8:44 am
Sorry to reply to myself, but the disempowerment of the most important IRB oversight and the draconian oversight of the smallest IRBs is going to hurt research and development in the long term, because of a lack of trust.
An IRB has to walk a delicate line of slowing down research for ethical review but also helping investigators understand risk. We are going in strange directions here.
IM DocAugust 3, 2021 at 9:42 am
The problem you allude to was a very important determinant in the development of the really bad research system we have created.
There were indeed way too many IRBs at way too many really small local hospitals. Some of these IRBs would have made Chairman Mao blush. And they were often way out over their skis with the research going on. The answer was not to ditch the entire IRB system. The answer would have been for the FDA to insure that criteria were in place for institutions only to do research they were capable of following and to have qualified people doing the research and the oversight. That was not done and here we are today with this mess.
The other issue you bring up that in my mind is absolutely paramount is TRUST.
In our world today we have dozens/hundreds of independent non-affiliated investigators. We have the Big Pharma rubber stamped IRB in another time zone across the country. FYI, many of these IRBs are owned by Guess Who – venture and vulture capitalists. And we have everyone involved knowing if too many problems happen or too many questions asked, Big Pharma will just erase you from their list of investigators (that is exactly what happens by the way). Your gravy train will end.
So, in that environment today, if there is a death or complication, there is no local IRB. Nope – in the case of these vaccines, it gets reported to a faceless computer program called VAERS. It may or may not be reported correctly, the employees may get around to it next year. Some inexperienced manager may decide it has no merit. And that is the nightmare we find ourselves in today. Everyone hears about complications all the time, but no one, not even the CDC seemingly, knows how to appropriately monitor or react with them.
Compare this to 20 years ago on my IRB. Any hints of complications were thoroughly documented by the research nurses. The patient’s charts were made available anonymously to every board member. Those board members were Lawyer Bob, Preacher Bill, Trixie at the Dairy Queen and your postman. There were enough real people to make a difference in getting questions asked. The local investigators and even sometimes the Big Pharma people were required to present themselves and explain the problems and offer solutions. There was no nebulous complication list on a vague national website. Only if the Board was satisfied would things continue. The entire process engendered trust.
Look around you now. What is horribly missing? I would say the majority of Americans have zero trust in our medical systems at this critical time. I understand that this is a national crisis. Rapid movement is essential. But the old system did indeed manage rapid movement and expedited reviews all the time. I was there.
I am going to make a prediction. When the roll is called up yonder and this has passed us by, the term “Operation Warp Speed” is going to enter the infamous lexicon of “The Gulf of Tonkin”, “Gallipoli” and “Dunkirk”. I am also very confident that my profession is going to get a long-needed reckoning not unlike the Flexner Report of a century ago.
1. cocomaanAugust 3, 2021 at 12:04 pm
  100% agree with you. Baby and bathwater thrown out.
  We cannot afford to have this system become dysfunctional. It is about the protection of human subjects, first and foremost. The benefits of research must arise AFTER the Do No Harm principle is applied.
  This national conversation is inspiring me to finally undertake a project I’ve been meaning to work on: a sort of novelized look at the Belmont Report (link for those unfamiliar), delving into the drama that caused it, the players involved, and the eventual production of the report.
  We’re straying from our source material in this country, and it’s scary. Maybe it’s time for a reminder of why we did all this in the first place.
  The answer would have been for the FDA to insure that criteria were in place for institutions only to do research they were capable of following and to have qualified people doing the research and the oversight. That was not done and here we are today with this mess.
  I still remember when we were all awaiting DHHS’s reforms of the IRB review criteria for expedited and exempt studies. When the rule change came through, it was an absolute disaster and implementation took another two years. It’s leveled out somewhat, but that was under the Obama administration, which supposedly was forward-looking in terms of managing the bureaucracy. A local IRB I contract with for administrative purposes is STILL smoothing out the 2018 rule change.
  1. marku52August 3, 2021 at 5:27 pm
    There is a paper linked to by the Dark Horse folks, an investigation of the first 250 vaccine deaths reported into VAERS. Investigators tried to nail down what actually happened to these people (well, other than “they died”).
    Most reports were from people associated with the health care industry, so it wasn’t random folks stuffing noise into the system. For the over 65 age group, 50% of deaths occurred within 48 hours of vaccination, so pretty clear what happened there. In fact, only about 20% of the deaths could be clearly found NOT to be from the vaccine. Also, the Doses Per Death has fallen from about 220million doses for one death, down to about 5million. Huh. This sudden drop began in 2018, so something other than COVID maybe going on there.
    You would think data like that would lead someone at the FDA to see what might be going on there. Apparently not. According to the Dark Horse pair, even though only about 20% had either COVID positive tests, or symptoms, the reg agency has logged them all (all 250) as COVID deaths.
    Way to make us believe in your data.
    Paper is here
    https://www.researchgate.net/publication/352837543_Analysis_of_COVID-19_vaccine_death_reports_from_the_Vaccine_Adverse_Events_Reporting_System_VAERS

IM DocAugust 3, 2021 at 3:04 pm

This is just my opinion.

I know from talking to numerous patients daily that work related or social vaccine mandates are just not going to work. This is true for the vast majority of the vaccine hesitant I see every day.

I do not feel these elites have really thought this all through.

Because of the immense bumbling and the orgy of lies, these people are just not going to do it. So I guess they will be fired, and those that cannot find other employment (not very difficult in the economy right now to find other work) are going to join the already massive homeless problem.

What really bothers me is the next step that they must take if they pursue this strategy. Something like calling out the National Guard, holding people down and forcing the shots in. I can only imagine what would happen in the South – places like Joplin or Baton Rouge. But, my God, what is going to happen when they start into inner city Atlanta or Houston and start doing this to the minorities. Again, if they keep going down the road they are on, this is exactly where we will be.

I am not sure the law enforcement authorities will be obliging themselves to follow the elites over that cliff. Oh, the elites will have CNN covering it as “mostly peaceful” – but I do not think that is going to work this time.

Even beginning to go down this path like they are now is all the proof I need to know that these people have completely lost their marbles. We are being led to the abyss by complete numbskulls. I do not believe they have a thing to be ashamed of when compared to the Romanovs or the French nobility circa 1785.

Just my two cents. Lord help us all. They really do seem to want a civil war.

Phillip CrossAugust 3, 2021 at 8:16 pm

“Something like calling out the National Guard, holding people down and forcing the shots in. ”

Are you for real? As if.

Forced vaccination is the new critical race theory. A scary story to get the base riled up.

campbelnAugust 3, 2021 at 8:38 pm
I was in a local firearms store in early March 2020. We have a 14 day waiting period so I asked what happens if they are ordered to close, how would I pickup my purchase.
They laughed at the suggestion that they could be ordered to close.
I picked up my purchase on the first day of the ordered lockdowns and the guy I asked recognized me and remembered my “ridiculous” question. We exchanged an understanding nod.
At this point, I put NOTHING past them.
IM DocAugust 3, 2021 at 9:27 pm
I now consider myself a “former” Dem. My wife and I more than once in our lives have sat on a dais with Democratic Presidents and First Ladies. So, please do tell, who is my base?
They are investing quite a bit of political capital in these vaccine mandate declarations. There are many many of my colleagues who are horrified because unlike the PMC elite class we actually sit with and talk with these patients all day long.
When they have invested all this political capital, and it does not work, truly, what is left for them to do? They either totally lose face or call out the cannons. If these mandates fail, there is little else for them to do. One thing about decadent elites that I have observed is they do not lose face for the serfs.
So, Mr. Cross, please with all your discussions you are having with patients all day – what do you think is going to happen when this does not work?
Just FYI – the IDSA has now moved the goalposts once again – it seems we now have to vaccinate 90% of the population to reach herd immunity. How many of the members of the IDSA (Infectious Disease Society of America) have actually read the foundational textbook in Infectious Disease – Mandell? That is the accumulated wisdom and knowledge of the specialty. In the very first section of the coronavirus chapter and again in the respiratory virus chapter, it is explicitly stated that herd immunity does not exist in these viruses. If it does, it is only very transitory and the viruses are back again in the next season. I would argue that the evidence we already have is very supportive of what the textbook is stating. Things are much more severe with COVID because it is novel to us – we are still trying to figure each other out. So why are they pushing this so hard? I have no idea. But it seems in our climate today – that mandating vaccination programs to reach a 90% threshold that the foundational textbook says is pixie dust is the height of hubris.
I am all for vaccination of high risk individuals. I am begging people all day. I am not so OK with taking away people’s livelihoods when there is little evidence that even if we reach the goal of 90% now that it would matter for longer than a few weeks/months.

just for fun, I'm including this snippet because this guy is always singing the praises of the vaccines (and trying to contradict IM Doc) and it amuses me to see him brought down a notch:

Phillip CrossAugust 4, 2021 at 12:04 pm

It’s really not that complicated.

The data we have seen shows that, while some portion of vaccinated people do end up being carriers, they also have a greatly reduced risk of developing a severe case and dying.

Based on the data from Israel and the UK; if everyone was vaccinated then the r0 would be halved, and hospitalizations and deaths would be an order of magnitude lower than if nobody had a shot.

tegnostAugust 4, 2021 at 12:20 pm
Leaving the mask mandate in place would have been the right thing to do. It’s this desire to punish the unvaxxed, even though many of them aren’t even eligible, such as children and justifiably concerned, such as young women thinking babies, and a wide array of others. The unvaxxed is not a monolith, despite the hand wringing of those worshipping that particular obsession. If they cared they would have left the mask mandate in place saying it’s a shared sacrifice, rather than getting rid of masks and forcing an experimental product, which you can see that it is, if you can tear your eyes away from that monolith. It’s become like hanging with alcoholics…it’s 10:30 and you want to go home and they’re like ” Everybody has to do a shot! All for one and one for all! ARRRR!”
1. Phillip CrossAugust 4, 2021 at 1:51 pm
  I am not concerned whether you, or anyone, takes it or not.
  The facts are clear, if you are at risk, the vaccine helps a lot. That’s why I find it upsetting seeing people spread disinformation, especially when they imply they are speaking in an expert capacity when they do it.
  How many elderly and infirm are going to read this stuff, not get the shot, and then die as a result?
  1. hunkerdownAugust 4, 2021 at 3:35 pm
    Those are judgments, not facts. That you successfully rehearse moral indignation discourse affects nothing.
  2. c_healeAugust 4, 2021 at 7:34 pm
    Masks help a lot too. Ivermectin might too. Why are only vaccines prioritised?
    1. Phillip CrossAugust 4, 2021 at 10:38 pm
      Masks get taken off, vaccines don’t, and there is strong evidence that the vaccine works, so they want people to take it to avoid stress on the economy and the health system.
      The only strong evidence for ivermectin comes from tropical, third world countries where the recipients may have just had their worms cleared, and been better able to fend off COVID-19 as a result. Does that translate to temperate, first world nations with functional sewers and clean running water? Maybe, but I haven’t seen anything of substance to support the big claims many make about it.
      1. Yves SmithAugust 4, 2021 at 11:26 pm
        IM Doc’s county has a higher rate of vaccine deaths than Covid deaths as a result of his hospital using Ivermectin. And his population skews very affluent and health-minded, so I doubt you’ll find many with worms.
        Your increasingly emotional and factually strained assertions suggest you have a personal stake. This is what happens when people are losing arguments.
        Ivermectin has one of the best safety profiles in the world. It’s safer than aspirin. Literally billions of doses have been administered. And it’s cheap. Why not let people use it? And why get so agitated at the prospect of it being used widely?
        And I am tired of minimizing the vaccine side effects. Our aide had to go to the ER in less than 24 hours. Not only did the ER attribute her reaction to the vaccine, the attending MD also said if she had gotten there much later, she would have had serious consequences. Everyone I know with an autoimmune disease has had their symptoms get markedly worse, including a young MD who was very gung ho. This is confirmed by practitioners who’ve seen the same thing. But for most GPs, this will be a handful in their practice.
        It’s one thing to say the vaccines make sense for most given the risk/return, but your black and white advocacy glosses over real issues. And the CDC and the press not tolerating discussion of sub-populations that are having reactions reeks of propaganda and having something to hide. It’s feeding concerns rather than assuaging them.
        
        Phillip CrossAugust 5, 2021 at 12:05 am
        I would hardly call it black or white advocacy. I said, if you are at risk of a severe case of COVID-19, the vaccine protects you in most cases.
        I would prefer that my elderly relatives took something that offered proven protection, than take a leap of faith with ivermectin, but each to their own!
        It may not be poisonous, but if it doesn’t provide the strong effect that the enthusiasts claim, than that’s where the danger comes in. A kevlar-free bullet proof vest won’t kill you by itself, but I wouldn’t want to take a bullet wearing one. No matter what I read on a message board.
        
        Yves SmithAugust 5, 2021 at 12:18 am
        You are now engaging in bad faith argumentation. You’ve shifted grounds markedly from your blanket assertion to saying that the vaccines “work’ (and what is that supposed to mean?) to now making a much MUCH narrower claim, that you’d favor its use for your elderly relatives. Help me!
        And you are ALSO imputing a position that no one here has taken, of using Ivermectin instead of a vaccine. Given that the efficacy of the supposed best in breed Pfizer vaccine is down to 39% in Israel due to some combination of lower efficacy after 5-6 months and lower efficacy v. Delta, and no third shot having yet completed clinical trials, why not allow Americans to use Ivermectin until we have third dose data in? Can’t hurt, might help.
        What happens, as GM has said Moderna data has already shown, that the immune response to the third shot looks to be 50% of the initial immune response>? That means even if the third dose doesn’t provoke stronger short-term reactions (a known issue with second shot v. first), its protection will be weaker and wear off faster. Then what?
        You appear to have fallen in with the Biden/CDC position of putting all your eggs in the magic vaccine basket.

Phillip CrossAugust 4, 2021 at 3:32 pm

n = 89.

With a sample of 89 people, you could have given them Pop Rocks, and sometimes seen similar results. You would need to study thousands to get a representative sample of the 10m population of Israel.

IM DocAugust 4, 2021 at 3:50 pm
Does your Pop Rocks comment also apply to Sequanavir – the very first protease inhibitor for HIV approved in 1995.. and the very first component of HAART? I am looking at the very first study that came out on it about 18 months earlier – the N was 44.
Does your Pop Rocks comment also apply to carvedilol – a Beta 1 agonist for HTN – that is also used for CHF – the very first trial showing carvedilol had any benefit for patients with CHF had an N of 60.
Both drugs saw wide wide usage and were/are very effective for their underlying condition. Of course – much further study was done on both of them – something that our officials seem absolutely hell bent not to do with ivermectin despite the overwhemingly positive signal coming from everywhere.
And I could go on all day with all kinds of different pharmaceuticals.
I guess the two that I mention above are Pop Rocks to you – but I have any number of dozens of patients that would beg to differ.

IM Doc (in reply to the pop rocks guy Philip Cross above)August 5, 2021 at 6:58 am
You really don’t get it, do you?
I could go on for the rest of the day with these examples but I will spare you all day – here are two.
Sequanavir – the first approved HAART med for AIDS came out in summer of 1995. The first paper describing its use had an N of 44.
Carvedilol a cardio specific beta blocker widely used for CHF now to increase the ejection fraction and make patients able to move and breathe again came out in the early 90s. It’s first paper had an N of 60. This one is even more important because at the time it was thought that using beta blockers in heart failure was tantamount to killing people.
Both drugs have helped literally millions of patients. I can go on and on with similar trials for others.
Small N in early papers is the rule and not the exception in medicine. Your comments reflect the fetish we have today that the only things that matter are “perfect” RCTs with 10000 subjects.
The difference now as well is that historically compounds with amazingly positive signal like ivermectin has would have been immediately jumped on with big trials.
I will ask you, why is that not happening now? There are literally dozens of historical examples where breakthrough meds were found this way and NOW we are literally turning our back on this process ….. please answer WHY?

antidlcAugust 4, 2021 at 2:25 pm

https://www.csis.org/analysis/conversation-dr-anthony-fauci-antiviral-program-pandemics

A Conversation with Dr. Anthony Fauci on the Antiviral Program for Pandemics

Yes. I don’t know whether it’s going to be the home run that we got with HIV when we, in 1996 – the transforming year when we had the triple combination and we went from modest suppressant of virus to complete durable suppression of virus with HIV, which totally changed the landscape. But you know, I want some of the listeners if not all of them – because I know many of them already appreciated it – why it’s so important and a bit different than what we faced with HIV, Steve. And the reason is with HIV we’re talking about lifelong therapy for an individual to keep the virus suppressed to below detectable, to get the person to return to some form of normality. And we have been spectacularly successful.
We’re looking at a different type of a profile now. We’re looking at an orally administered maybe seven to 10 days, given to person who is early on in the course of their infection before you get to the cascade of events that lead to the aberrant activation, inflammatory response that kills people, because we know now from a lot of experience with the care of these individuals that if you can keep that virus from going to the upper airway, from going down into the lung and other organ systems, you can change what can be a devastating disease and make it an upper airway common cold type approach, which is really what we need to do. We only need to knock out that virus for about seven to 10 days, rather than lifelong, what we have to do with HIV.
…
The thing that I think is going to be a real somewhat of a game changer, Steve, is as soon as the FDA gives full approval for the vaccines, those people who are hesitant to get vaccinated because they perceive the emergency use authorization as not being proof enough that it’s safe and effective, even though we have ample, ample evidence that it’s highly effective and highly safe, I think you’re going to see more people get vaccinated. And then you’re also going to see enterprises feeling much more confident in local mandates for vaccines. You’re not going to see a central mandate coming from the federal government, but you’re going to see more universities, colleges, places of business who, once they get the cover of an officially approved vaccine, they’re going to start mandating vaccines. So we’re going to see an increase in vaccines, and that’s going to be the solution to the problem, because if you get the overwhelming majority of people vaccinated, we wouldn’t even be having this conversation now.

urblintzAugust 4, 2021 at 3:07 pm
https://www.theautomaticearth.com/2021/08/the-vaccines-dont-work/
IM DocAugust 4, 2021 at 3:24 pm
You must also note that he was really pushing research for vaccines for opiate addiction (yes you read that correctly) as recently as 3-4 years ago.
He has never met anything that a vaccine would not fix. I have been following his career for a long time. He alludes to the HAART therapy for AIDS in the above comments. At least in part, not the whole, the reason that those medications took so long to come to fruition is because he was so hellbent on an HIV vaccine for so many years early on. It took the air out of research for antivirals for nearly a decade. Despite multiple early warnings that we just simply did not have the technology at the time for a vaccine for HIV. The grand rounds about this topic at the time were numerous and Fauci did not come out looking so well. Even now almost 40 years later, has there been an effective HIV vaccine developed?
It was not just him that did not shine in that era. People like Nancy Pelosi and Dianne Feinstein did things during the AIDS crisis in San Francisco that should have banned them for life from public service. But yet in this country, we always seem to be OK with horrible people failing upwards. I have never figured it out. If you need to know how you could have predicted that Nancy Pelosi would be such a horrible stain on our republic right now – all you have to do is look at any of the written histories of the AIDS crisis in San Francisco. She is not alone in the shame, believe me.
My profession and this country may not have it within them to fix the overwhelming problems going on. But one thing is for sure, no one person, whether Fauci or whoever else, should have anywhere near the power that he has over the entire medical establishment. This is the power of the purse strings. I talk to leading national ID figures frequently. I do not believe any of them would feel OK with the plans outlined in your quote above. They can say absolutely nothing or they will have all their grants pulled and their job in jeopardy in no time. It really is a bad situation.
1. IM DocAugust 4, 2021 at 5:57 pm
  Here is a basic description of the opioid addition vaccine.
  https://heal.nih.gov/news/stories/OUD-vaccine
  Let’s just say – things have not been very successful.
  Here is the NPR commentary on this –
  https://www.npr.org/sections/health-shots/2017/08/10/542605039/a-vaccine-for-addiction-is-no-simple-fix
  The problem is the vaccine against the opioid (and others like nicotine etc) is also to varying degrees active against many different receptors. That is not a good scene.

Here, I'm not sure what article IM Doc is referring to:

IM DocAugust 5, 2021 at 7:27 am

I want to state this for the record again today. It is imperative now that non-medical people have perspective of medical history and traditions. I commented yesterday about this but it was late in the day.

This is about the above linked Israeli ivermectin paper.

A commenter yesterday downplayed it stating that the N is only 89. He felt that was all he needed to torpedo the whole effort.

Profoundly faulty and unscientific thinking. I would have given any student who said anything like that in rounds an F for the day.

I will explain. I could go on all day with examples – but here are just two:

Sequanivir – the first approved HAART drug for AIDS came out in 1995. It’s first paper had an N of 44.

Carvedilol, the cardioselective beta blocker used now to increase heart performance in CHF had an N of 60 on its first paper. In an era when using beta blockers on patients with CHF was viewed as murder.

Both drugs have been used by millions. Again I could go on all day with examples.

I have seen this “the N is only 89” tactic used again and again this year. Be aware people who do that are not arguing in good faith and they have zero perspective of medical history.

Low N numbers in early trials of any medications are the overwhelming rule in medicine and not the exception.

The insistence that a trial is poor because the N is 89 is part of the same fetish that only RCTs with tens of thousands of subjects are any good. This thought process is deluded.

Dozens if not hundreds of medical breakthroughs have been birthed with papers with Ns much less than 89.

The big difference in what is going on now is that compounds with amazingly positive signal in these early studies like ivermectin is showing would have been jumped on instantly and larger trials started months ago.

I think we should all reflect on not only why this is not being done but also the exact opposite is being done – an active censoring and propaganda campaign.

The medical history chapters on this COVID interlude are going to be for the ages. This is just not going to look good in comparison to Sir Alexander Fleming, Jonas Salk, or Banting & Best.

GrumpyOldManAugust 5, 2021 at 8:39 am
Sorry Doc, but your argument nets you the same F that you’re so eager to give out. Your medical knowledge unfortunately doesn’t seem to translate well to Statistics, and your arguments are, ironically, “profoundly faulty and unscientific.”
The gist of it should be that the initial trial at N=89 is fine to point out a strong enough effect (and their effect is fairly strong, 72% in the ivermectin branch versus 50% in the control one for viral load reduction, for ex.) so that the likelihood of different distributions is high in spite of the rather large confidence intervals. This makes it worth investigating with larger samples at the very least.
Instead, you used false analogies – the historical examples are irrelevant for this trial and the approval in those cases was likely not based on those initial papers alone; also “hundreds of medical breakthroughs have been birthed with papers with Ns much less than 89” tells one nothing about the number of false effects published in “papers with Ns much less than 89.” Perhaps you’ve heard of the reproducibility problem that plagues the published corpus in a lot of fields, including the medical one. Each paper should stand or fall on its own merit, anything else is an example of “unscientific thinking.”
The unfortunate truth here is that supporting the right conclusion with wrong arguments is just as bad as supporting the wrong conclusion with the wrong arguments – you might as well flip a coin for it. It’s not just bad science, it’s bad for crafting policy decisions, for building trust, and so on and so forth. Please stop doing it.
1. IM DocAugust 5, 2021 at 12:54 pm
  My goodness.
  When I was a little kid and my grandma caught me saying absurd things, she would often sit on the porch in the hot summer evening and look me in the eye and state the following – “When the hot air is blowing, sometimes a girl just needs to sit on the porch and fan herself.” Then I would be often asked to go get a switch.
  Your comment somehow brought me that flashback.
  I have been doing medical statistics for three decades now. Long before the advent of “Evidence Based medicine” we were actually doing REAL statistics not the current format forced upon us all by Big Pharma.
  And the fact of the matter is that medical research by and large follows the same pattern especially when pharmaceutical or therapeutic procedures are employed. We do SMALL studies first based on hypotheses and findings coming out of basic research. Once signal is obtained in both efficacy and safety, ever larger studies are done until we do indeed very large randomized controlled studies. This is the way it is – and I am sorry you do not agree. You must be living in a different world. Not just this study – but multiple dozens of others have found very positive signals with ivermectin for COVID. And the safety of this agent is out there for 30 years for all to see. A few dozen real problems out of billions of doses given – and most of those were the Jarisch Herxheimer reactions because it worked so well on worms and other parasites.
  The fact we are not doing further studies on this drug is a supreme example of this entire establishment not practicing the tenets of science and medicine but instead practicing the tenets of business.
  The “false analogies” I used were actually very carefully chosen. Along with hundreds and possibly thousands of other agents/procedures when they were first being studied in humans, the N was very small. One of those “false analogies” is an antiviral just like what we are currently dealing with, the other is a drug with great amounts of trepidation at the time being safe/effective in the intended group. I could have easily added things like Bactrim for PCP or Zithromax and doxycycline for H pylori – they all started the same way – with a very small N.
  What would be your choice for a “true analogy”. By that comment alone, I am not sure you are undertstanding the entire point.
  And I will add that it is Big Pharma itself that is the great traitor to this concept. Please go read the book “Bad Pharma” by Ben Goldacre – it is chocked full of example after example of how Pharma does these early studies with a low N, the results are not what they wanted, and the studies never see the light of day. Furthermore, they have become expert at manipulating study methods and arms to make their products look way better than they every would – or worse making other drugs look worse. The “big study” prospects that I have been able to read for COVID/Ivermectin appear to be in that category, purposely being designed to not be fully transparent about efficacy or lack thereof.
  Again – your statement about papers published with “false effects” with numbers of less than 89 is in today’s world almost always a role played by Big Pharma. They have become expert at disappearing things that do not fit the narrative they are trying to push about their product.
  I would just say again. This is EARLY research on ivermectin. If you cannot see the overwhelmingly positive signals coming from these dozens of papers, you do not understand statistics. In medicine’s past, when this was seen from a drug or procedure, people would have been falling over themselves to really get the compound into bigger studies to really see what was going on.
  We are not doing this at all. We are censoring, suppressing, confusing and propagandizing. We are not practicing medicine or science. WE ARE PRACTICING BUSINESS.
2. Yves SmithAugust 5, 2021 at 7:53 pm
  How DARE you insult a respected commentor, whose articles here have been praised by professors of medicine at top universities. As IM Doc explained, your assertions are false and you demonstrate no knowledge of statistics. This is basically a long and unsubstantiated finger wag, compounded by a groundless personal attack. Take your bile elsewhere.
  1. HotFlashAugust 5, 2021 at 8:45 pm
    Standing on my chair clapping for IM Doc and Yves. Thank you both more than I can say.

IM DocAugust 5, 2021 at 10:53 am

I want to make something very clear that I failed to do so in the original comment.

I am referring to EARLY trials. When drugs are coming out of basic research into the clinical research that is then warranted because something in the or early clinical research was very strong. No one in their right mind would enroll tens of thousands in these early studies – these are put in place to see if there is indeed a signal – and more importantly to follow through on any signals on safety issues. THEN we proceed with really large clinical trials with hundreds or thousands of subjects. Those are then the sentinel studies that we see in places like NEJM and JAMA. Please note – there are lots of things that look very good in early studies that do not pan out. But this is one of the paths that new things do get discovered – small trials – lead to bigger trials – lead to sentinel trials – lead to the standard of care. My point being – we are very early in Ivermectin research for COVID. These small studies with bright signals should be driving larger trials with more statistical power. SHOULD BE. THAT IS HOW IT IS DONE. We do not disparage studies in this stage of the game because the N is small. The fact that this work and this process is not being done for ivermectin is a very strong indicator that we are not practicing medicine or science. We are practicing business. It is that simple.

But even fundamental sentinel studies found in NEJM or JAMA do not have to have large Ns to be considered landmark. One example that comes right off my head is Professor Warren Jackman’s landmark study for catheter ablation of bypass tracts causing rhythm problems. This was published in NEJM in the very late 80s or early 90s. He had less than 100 patients. Had we thrown that study out because of an insufficient N, the next 30 years would never have happened or been delayed. The initial work on that procedure was done only for a very rare heart condition called Wolff Parkinson White Syndrome. Because it was demonstrated to work so amazingly well in this small subject study and others like it, over the years, it has now become a standard of care for things much more common like A FIB. It is used probably 100s of times daily for A FIB patients and has helped tens of thousands. The procedure today is often just referred to as “ablation”.

Again, the strong signal from ivermectin is just that – a strong signal for benefit. Physicians my age have gone on much less during the AIDS pandemic for things that seemed just as promising. And as I have repeatedly stated, the signal has been repeated in my own practice. There really are no significant safety issues with ivermectin – and I was able to keep way more people out of the hospital during our fall/winter surge here than my colleagues who were not using it. To the point that I was asked by the administration of the hospital what I was doing – because in the crisis – they noted how many less patients of mine were being admitted to the hospital.

IM DocAugust 8, 2021 at 8:33 am

This week has been a bit busy – so I have just put the whole week into one big comment.

We continue to have quite a bit of infection in the community. In my own practice, I am usually seeing 5-15 cases a day of COVID. The majority of these cases are vaccinated breakthroughs. There have been 2 whole days this week where the entire day were all vaccinated breakthroughs. Please note – this is the outpatient side. Despite Dr. Walensky’s reassurance to Americans that these are very rare, this has not been my experience at all. These breakthroughs continue to happen in clusters. While the unvaccinated positives tend to be more isolated and far less likely to spread and sicken contacts. The clusters are almost always vaccinated as well. I have no explanation for this. It is my feeling the virus is trying to tell us something. This seems to be consistent with constant news reports of cluster events among the vaccinated all over the country.

The unvaccinated positives are likely underrepresented in my office sample. They are likely younger. They are likely to have no insurance or high copays so very hesitant to get tested. They are likely to get fired if they miss a day of work so they just do not want to know if they are positive. Furthermore, it seems that every effort has been made to make it very difficult for anyone to get tested. Why bother?

As far as the hospital – it remains about 50/50 vaccinated/unvaccinated. The percentage of vaccinated patients seems to be slowly creeping up daily. I am hearing from my friends all over the country that the same is true. You no longer hear about 1% vaccinated anymore in the hospital. A slow but surely increasing prevalence of the vaccinated in the hospitals. The vaccinated inpatients tend to be older and vaccinated at the beginning in DEC or JAN. The unvaccinated are younger – usually 40-60 – almost always with obesity or diabetes. Unlike the last wave, the majority of these patients are in and out in a day or two. I am not saying there are not sick people – there are. Just not nearly as many as before. This too is confirmed by my friends. The critically ill are few but are almost entirely made up of the unvaccinated. We have had but 2 vaccinated in the ICU this whole time. The stories you are hearing of crashed hospitals in the big cities are happening because large numbers of non-critical patients are being admitted and discharged – with continued large numbers coming into the ER. The other factor is staffing. Nurses have become depressed and are leaving in droves. And the ancillary staff in many places has been decimated by employees leaving because of the vaccine mandates. There is more at work than patient numbers by the panic porn that is all over the MSM.

The vaccines are clearly not working as promised. Large numbers of vaccinated patients are getting sick. I remember when I did the guest post back in December about the Pfizer trials. I was and am gravely concerned about the medical establishment in the guise of the Editors of NEJM referring to these miraculous vaccines, perfect in every way, as a “triumph”. There are lots of things in medicine the past decades that are indeed miracles. But calling something a “triumph” before a shot was in the first arm betrayed to me a certain level of hubris – and I knew in my heart at that very moment that Nemesis, Hubris’s best friend, would soon be making a visit.

We should all remember where the word TRIUMPH actually comes from. https://www.youtube.com/watch?v=whbI55Q1KB0

One of my very elderly classics professors in college had worked as an adviser to Hollywood during the “Sword and Sandals” extravaganza of the 1950s. In his opinion, that clip was from the film that got the whole concept of triumph closest to reality. Quo Vadis. The Roman General is on his chariot going through the streets of Rome, past the Vestal Virgins. The throngs are going ape. But there is something there in Rome that we are sorely missing today – a slave on the chariot holding the Crown of Gold over his head. And please note what the slave is whispering in his ear the whole time. In Latin the words were Memento Homo! Memento Mori!. In English that means – REMEMBER THOU ART BUT A MAN! – REMEMBER THAT THOU ART MORTAL! – Unlike the medical triumph of these perfect vaccines, the Roman triumph was done for things that were very well deserved. And with all the Hubris going around, do we ever need that slave in the chariot today……..

As our Ancient Greek forebears taught us, when Hubris is let loose in the world, the Gods would have but one remedy to clean up all the delusions and insanity, and that would be to let loose Nemesis.

And I am beginning to see a lot of Nemesis coming right down from the sky. These vaccinated patients that are sick are not very happy at all. Many of them are profoundly angry. The lies and misrepresentations are very soon going to start catching up with our leaders. And what I never dreamed would happen has begun to happen this week – close to half of my positive COVID patients – in an unsolicited manner are demanding to be placed on alternative therapy such as ivermectin. In a very angry manner.

I have no problem using this drug. I used it quite a bit in the first big crash in the fall and winter and started using it again about 6 weeks ago. Using the scientific method as I was so carefully trained to do decades ago, and with the limited tools I have, I have been able to make some observations.

Once a patient, vaccinated or not, becomes positive for COVID in my practice, my nurses or myself call them once in the AM and once in the PM. There is a form we fill out on each of these calls to describe their clinical condition with parameters – fever, congestion, shortness of breath, coughing, pulse ox, etc. When the patients have cleared every single one, we quit calling them. We usually have between 15-20 active cases this past few weeks daily. A pattern became very obvious very quickly in this process – and I have distilled it with 2 raw numbers. The Ivermectin patients are cleared of symptoms (N of 44) in average of 2.4 days. The Non-Ivermectin patients (N of 19) are cleared of symptoms after 5.7 days. Furthermore, on day 5 of the illness, we always have the patients go and get tested again. The Ivermectin patients have literally a 100% negative rate by Day 5. The non-Ivermectin patients have a 58% clearance rate by Day 5.

I want to make one thing very clear. This is the scientific method. These numbers are consistent with the overall signal that all kinds of studies are showing with this drug. However, I am just one clinician in one office. Nothing dispositive can be said or done with these numbers.

However, it is an indication of yet another complete fail on the part of our medical leaders. These signals have now been out there for about a year. It is at this point, a national embarrassment that nothing has been done to fully evaluate this drug. I will say again, our leaders are not practicing medicine, they are practicing business.

I have a moral obligation to my patients. I must always do what is in their best interest. Our MSM is screaming the panic porn daily about hospitals and critically ill. On the ground, I am seeing already an alarming incidence of post-COVID symptoms (mainly now brain fog, depression, suicidal thinking, and severe headaches) in many of these patients WHO HAVE BEEN VACCINATED and then were infected.

Dr. Fauci & Dr. Walensky and Pfizer/Moderna – your vaccines have FAILED these patients. They still got sick. In numbers that are alarmingly high compared to what was promised. Post-COVID syndrome is a real thing – as real as it gets – and again your vaccines have failed. You would tell us to do NOTHING. Your whole plan is seemingly VACCINE VACCINE VACCINE. Well, they failed. Is it not my obligation to do everything possible to spare these patients POST COVID syndrome? With a drug with decades of safety behind it? With all the signal behind how well it works? Confirmed by my own eyes in my own practice?

Patients and the general public are profoundly angry and are beginning to lose all faith in our medical establishment. I see it every day. Nemesis is indeed upon us. If the Biden Administration does not quickly act to chart another course, I guarantee you, Nemesis will soon be unleashed upon them. It is going to be Reagan/Mondale 1984 landslide all over again.

Not Even WrongAugust 8, 2021 at 11:35 am

I’d like to join in thanks, IM Doc, for all your time and effort to give us your informed view.

Are you hearing anything in the medical community about legal mandates for minors in some states after FDA approval, as a requirement to attend school?

I’d hoped the treatment of minors would be held to a higher standard of evidence and caution, given minors’ very distinct risk profiles, legal status, medical needs, and the general ethical obligation for their care.

Though adult mandates get most of the press, there’s plenty of legal precedent for minors in school, post-approval. The enforcement machinery is there. Vocal cadres of parents and staff assert that COVID-unvaccinated children endanger their school communities. Political appetite is strong– example, DeBlasio’s recent edict is already a de-facto mandate on minors.

Thanks again for your insights.

PS On your mention I ordered on eBay, used, Mandell 7th ed. for ~$12– all 20lbs & 4K pages of it. I’ll never pretend to have answers, but I hope to ask better questions.

IM DocAugust 8, 2021 at 4:02 pm
This issue is rapidly becoming a very big mess.
First of all – if you read some of the comments below, there is growing and alarming concern about the number of kids getting really sick from COVID which did not happen the last time. There is of course little evidence that vaccinating the kids would make them less likely to get this sick.
There is also severe safety concerns in vaccinating kids. This is largely because we have seen the bad side effect issues grow in intensity as the subjects are younger. There is little hope this will not get worse with the kids. Many Western countries who are not as beholden to Big Pharma as the USA – Germany, Norway, and the UK for example – have taken one look at the data so far and said NO WAY ARE WE VACCINATING KIDS.
This is going to be a hellacious experience for us all. My wife and I have school-age kids. We went to the first parent meeting of the year this past week. Mandated vaccination was discussed. A straw poll was conducted at the door of who will be allowing their kids to be vaccinated. The vote was 112-2 for NOT vaccinating their kids. It was clear to me a huge number of parents will be pulling their kids from school and home schooling if this is mandated. This could be a real blow to our entire public education system.
I do not know the answer other than it is clear this will be a big huge mess. As far as FDA approval, anyone who takes approval by the FDA of any pharmaceutical after the debacle of the Alzheimer’s drug this past few weeks, is a moron.
There is no way at all that safety issues have had any kind of time for full evaluation. NONE WHATSOEVER.

IM DocAugust 8, 2021 at 4:16 pm
Oh and about Mandell – I believe that the one you are getting is a few editions ago. Still good to have around.
The whole reason I brought up Mandell was the discussion of herd immunity in respiratory viruses.
The whole “herd immunity” issue is the 2nd biggest lie that has been told to the American people. The biggest lie was the constant spouting of the Relative Risk Reduction of 95% in these vaccines as meaning that the patient was 95% protected. I have never heard a bigger lie in all my years of medicine.
“Herd Immunity” in polio or measles is just that – you either through natural infection or vaccination have a process whereby the members of the herd cannot pass the virus to one another. It is a bulwark that will eventually completely stop the spread.
That is not the way things work with respiratory viruses. They have a different relationship with our immune system. Your body does remember some things, so that each successive infection is likely to be less symptomatic but you will still likely get infected multiple times through your life. And you will be able to spread it to all around you when infected. In the setting of an acute pandemic with a novel agent – things are a bit different in the beginning. The agent and the immune system of both the hosts and collective humanity must do a dance for a little while to get used to one another. I have heard immunologists describe this as a “hot war.” This is what we are doing right now – and as you can see it can get very very ugly. Eventually, things calm down into a “Cold War”. The agent keeps coming back to each an every one of us. But is not nearly as lethal. COVID will eventually do this as well.
This is most assuredly what will happen – and as you can tell has no relation to “herd immunity” as in the polio or measles virus that is being promised to the American people.
It must be noted, we as humanity have never introduced a vaccine into a hot war like this ever before. No idea how that will affect the process in the long term. One thing is for certain – the same immunologists are now stating emphatically that we are just going to have to get used to living with COVID.

skkAugust 8, 2021 at 12:19 pm

Interesting. Thanks – a question – from the patient perspective:
Do your patients speculate where, when they got it ? Or more crudely who they got it from ?
and if they share their speculations, anything of generality one can come to ?

IM DocAugust 8, 2021 at 4:03 pm
The vaccinated patients almost always come from a family cluster or some kind of social group or event – and most if not all the other people are vaccinated. They have no clue.

PelhamAugust 8, 2021 at 12:46 pm
In my estimation, IM Doc is the single best source of Covid information. Thank you. One question: At this stage, since my family and I are fully vaccinated, our biggest personal concern is focused on long-Covid. Your sample sizes are small, I understand, but have you observed any difference in the occurrence of long-Covid symptoms among those who’ve been treated with ivermectin and those who haven’t? And if long-Covid is just as likely regardless of ivermectin as a treatment, would you advise use of ivermectin as a prophylactic? Thank you.
1. IM DocAugust 8, 2021 at 7:28 pm
  I am keeping a very close eye on this situation with how the COVID positive patients on Ivermectin do going forward. I do not think enough time has passed for me to be really sure one way or the other – but when a pattern emerges I will be on here telling everyone – one way or the other.

mtt1029August 8, 2021 at 12:49 pm
Sir, I would like to thank you for all that you are doing here. With your commentaries you’ve done me great service and I wish that I could repay you in some fashion.
I have two questions that I haven’t seen addressed (forgive me if you have covered them previously):
1) Do you have any sense about whether the decline in the efficacy of the vaccines due to waning of antibody levels in the vaccinated (implied by your comment about Dec-Jan vaccinated driving current inpatient levels) or to the Delta variant having mutated around the vaccine?
2) Amongst the MSM panic porn, there’s increasing reporting about children’s hospitals being full, etc., is this actually a real issue right now?
Thank you.
1. IM DocAugust 8, 2021 at 7:31 pm
  I think there is little doubt that the effectiveness of the vaccines begins to wane after time. Thus, all the talk about boosters.
  As I stated somewhere else today, the children’s hospitals are indeed getting slammed. There is a raging RSV outbreak in which we are in exactly the wrong time of the year for that. But on top of that I am hearing that kids are getting really sick with COVID – way worse than the last surge. I do not have any kind of handle on accurate numbers – but when I get any kind of feeling will share.
  To be honest, this is really concerning to me – this kind of game change if this turns out to be significant is exactly what we do not want this virus to be doing right now.

neo-realistAugust 8, 2021 at 2:09 pm
The vaccinated inpatients tend to be older and vaccinated at the beginning in DEC or JAN.
It’s possible that the neutralizing antibodies generated from the vaccines in those patients have dissipated after about a six month run. I think that if the vaccines weren’t working as promised, those patients would have been hospitalized earlier.
1. IM DocAugust 8, 2021 at 7:36 pm
  I think you are correct.
  However, I do not recall anyone saying in the initial rollout that 3-6 months would be the efficacy window. If this is anything like animal coronavirus vaccination attempts in the past, the next round of boosters will yield 2 months, the next round 1 month – you get the point. This is not a good sign. How many polio vaccines or measles vaccines have you had in your life? The flu shot is indeed annual. Influenza is a much less complicated virus, however, and corona viruses are one of the best families for mutation.
gc54August 8, 2021 at 2:27 pm
I have first-hand reports this weekend from a PhD nurse cousin of my spouse in Florida and a doc in North Carolina, both working hard in pediatric ICUs. Both ICUs are now full w/ COVID cases, the doc has all 7 of their ECMO machines in use constantly and other kids a little less far gone on ventilators. My neighbor is trying to get his 4 and 2 year old daughters into vaccine trials. Fearful because the eldest is in day care. We are both confronting large college classes starting in 10 days with no possibility of remote instruction because of administrative greed and the pent up desires of students who are being told that they really must vaccinate. 80% of faculty have been vaccinated, only 49% of staff even though free and time off work for a day or two with pay.
1. IM DocAugust 8, 2021 at 3:00 pm
  The other very concerning issue going on that I am hearing is that many of these children’s hospitals are getting slammed with RSV.
  I have actually seen 2 RSV adults in the past month or do. They were both very ill but not quite hospital level. Adults with RSV and very sick in the summer. I have never seen this in my entire career,
  This is being seen elsewhere and lots of theories going around but nothing concrete. Both of these people were COVID vaccinated.
  An RSV epidemic with kids in the summer on top of sick COVID kids is not a good sign for the upcoming fall.

Don MidwestAugust 8, 2021 at 2:39 pm
IM Doc, do you use the protocols posted by FLCCC – Front Line Covid Critical Associates?
Their preventive and early treatment phases have other off the shelf drugs — vitamin C, vitamin D, mouth wash, etc.
There is a lot of excellent information on their web page flccc.net
Including a 50 page manual for doctors which has important graphs of phases of the disease and treatments for various phases. 15 pages are references.
https://covid19criticalcare.com/wp-content/uploads/2020/12/FLCCC-Protocols-%E2%80%93-A-Guide-to-the-Management-of-COVID-19.pdf
1. IM DocAugust 8, 2021 at 4:29 pm
  The answer is yes.
  In my opinion, when all the dust is settled – those brave folks will be the heroes of this entire situation.

AumuaAugust 8, 2021 at 3:00 pm

I think saying the vaccines have FAILED is a step too far. Maybe they have failed to live up to the promises that some people have made. I personally never got the impression that being vaccinated would prevent me from getting COVID, or even having symptoms. Now perhaps I’m exposed to overall better information and am able to read between the lines better than a lot of people. Perhaps it’s because I am a reader of NC that I am able to filter various claims being made into categories of truthfulness. But suffice to say that my expectations of the vaccines have always been realistic, once they started coming out at any rate. And those expectations did come from official channels, to some degree.

So the (mixed) messaging around the vaccines and other COVID public health points is a giant FAILURE, I’ll grant you that. But not necessarily the vaccines themselves, which I still see as having a positive effect on the pandemic.

LupanaAugust 8, 2021 at 3:37 pm
It seems like on an individual personal level they have a positive effect but as far as slowing or stopping the pandemic, I’m very confused and not so sure..
1. AumuaAugust 8, 2021 at 4:22 pm
  I’m not sure either! It’s just my best educated guess that they seem to be having an effect on deaths and serious illness at the very least.
IM DocAugust 8, 2021 at 3:54 pm
If you carefully read what I was saying – they have failed for those patients who are now breakthrough positive. And their now very likely possibility of having long-COVID syndrome. I do not know if there is any evidence whatsoever to support a vaccinated positive patient having a lower chance of developing long COVID. Ergo, my attempt to do whatever I have available to rid their body of the virus as quickly as possible. And we have had an entire year and a half to look into this very issue. There is absolutely zero guidance from the CDC what clinicians should do with breakthroughs – NOTHING. We have had signals on ivermectin and actually several other agents that could be helping right now – but because of the monomaniacal focus on vaccines, absolutely nothing has been done. And now I have a rapidly growing cohort of patients with COVID where the vaccines have failed to prevent infection who are at risk of long COVID. I do not recall Fauci or Walensky saying one word about long COVID, if you have please let me know.
I am encouraging as many high risk patients as I can to get the vaccine. But as far as protecting the population, I think everyone can see for themselves and make their own determination.
1. Yves SmithAugust 9, 2021 at 2:19 am
  To his point, NEJM article on medical workers in Israel:
  https://www.nejm.org/doi/full/10.1056/NEJMoa2109072
  19% of breakthrough cases had persistent symptoms, aka Long Covid.
  I had argued with a reader about long Covid risk and vaccinating.
  This seems more or less on par of the odds of getting Long Covid if you get sick and are not vaccinated. I’ve seen estimates on the 1/6 to 20% level.
  Now admittedly there is sample bias here:
  1. Health care workers will skew younger and healthier than the population as a whole because their work demands that most of them are on their feet and moving about.
  2. Israel, so Pfizer vaccine, so immunity waning due to early vaccinations v the US, and health care workers would have been close to the head of the line.
  3. Pfizer vaccine question again, it may be less effective v. Delta than AZ or J&J (J&J is claiming that).

Talking about Obama's birthday party:

IM Doc

August 8, 2021 at 1:01 pm

I guess I want everyone to have in their mind when they view these videos of one thing.

I am not seeing a whole lot of masks and social distancing. In fact, I cannot see a mask at all.

These are the self same people at this party who are out telling every American parent that it is unsafe for their kids to go to school without a mask. You can literally bathe in the hypocrisy and the evil.

My God, what a bunch of losers. I will have to answer to God one day that my wife and I were such ardent supporters of his. It really is deeply troubling on so many levels.

More of August to come in the next post.

comments

The stories that accompany "Pilgrim"

2021-11-18T02:24:44Z

A slightly modified version of what I posted over on the ecosophia main blog:

A year or two ago I published a small collection of five short stories, called Shifted Visions. If anyone here wants a short read to add to their day off, hanging-out, and munching leftovers plans, I have .mobi and .epub versions available to give you (blurb below). Just email me at the gmail account that is preceded by my username here.

A paperback version also exists, but I don't have the ability to conjure free copies of those.

If you'd like a teaser and didn't see the previous post, the one flash-fiction-length story in the mix is here.

Genre: magical realism/mythic fiction/urban fantasy-ish

rated probably pg-13 for one light cuss word (that is integral to the storyline :-) )

Back cover blurb as follows:

"Not everything is as it appears…

and what appears will shift everything.

From a river-shore park in the heat of summer to the stillness of a dense, ancient forest; on an early commute or at the door of a hardscrabble apartment, five striving, committed people find their lives turned upside down when the impossible intrudes on reality.

A bored civil servant tries to spice up the daily grind and accidentally invokes an out-of-practice trickster-god...

An up-and-coming intern's likely promotion threatens her link with an affirming and mysterious apparition...

A lonely man, consumed by emptiness, meets a miracle-working woman who quotes Mother Goose and requires his most closely guarded secret...

A devout acolyte undertakes her order's sacred pilgrimage and goes astray into an encounter with the profane...

...each must decide whether or not to trust their senses, and each must make a life-altering choice."

comments

the path of the lonely ones, these days

2021-11-17T19:54:28Z

[This is seeming more and more relevant these days than it did when I first published it.]

Pilgrim

“The pilgrim is tried by the pilgrimage.”

—66th Canticle of Bothemius

Since her childhood initiation and later pledge to Silence, that phrase in the Canticle had fascinated Aranna. She had imagined that the path itself, hewn through ancient trees, would buck and heave, throwing pilgrims hither and yon like dust scattered by a hunted serpent writhing in a soundless owl's grasp.

Later, of course, she recognized that Bothemius had been speaking metaphorically. At the start of her own long-awaited pilgrimage, she had known herself to be prepared and strong, had made certain that she’d be able to handle blisters and meager rations. She was also adjusted to the possibility that she’d be in a center-of-the-crowd position and unable to get a glimpse of the holy relics—until her own purity was recognized and she would be called to the front.

But now, lost in a place unmarked and unrecognized, Aranna truly understood. The pilgrimage was testing her by removing the path completely. It was gone.

Trembling, she dared not call out. Even if she could have found her voice after decades of training to extinguish source and perception of sound, none would hear her. Those committed to the path no longer had the capacity to hear such impediments to their Pilgrimage to Pure Silence.

But this was the pilgrimage for which Aranna had prepared her whole life!

For a moment her training wavered and unease welled up within her. Then, focusing on the remembered image of trees towering high enough to stop the wind’s slightest sigh on the forest floor, she stilled her mind. She felt for the path.

And came up empty.

Empty was certainly silent but this silence gave her nothing. Where was the sign? The inner indication and surge of knowing? Which way to the Deeps? Which to the Beyond? She couldn’t tell.

She thought back to what she had last observed of the way. Each day’s Station of Divine Stillness was marked, the next preordained in the markings, but somewhere between Days 25 and 26 the banners had come down. Her companions had thinned out and the path had simply vanished. Now she stood among mere saplings that dappled the ground in light and shadow. The edge of the old forest was impenetrable due to the thicket. She was alone. No miracle had transported her. She had not magically flown to the Farthest Beyond.

Aranna, alert after years in heavy cloistered rooms, approached a stand of young trees and put a hand out as though they might take it and guide her. Their bark was smooth and to her surprise they seemed to vibrate. The longer she touched the louder the vibration grew in her mind until it reached a pitch that took her training and crushed it underfoot like chalk under the imperious headmistress’s foot. She whirled from the trees and crashed through the brush, her head filled with the clamor of it all, her heart pounding in her ears, her breath ragged and wheezing, and she collapsed. Maybe, she thought, this was to be a pilgrimage to death. She would be felled by noise.

A moan escaped her lips, and a word, and she knew it was all over.

“Help,” her disused throat rasped. “Please!”

And then, by her own sound, she knew she was very much alive. Her heartbeat surging through her entire body proved it. It was full of messages of rhythm and tone that could only be deciphered with the kind of silence that danced between sounds and did not deny them. She reached for the trees again and found in them the same liquid rushing contained in her own body. The living sound thrummed through the trunks, from a source beyond their roots, branches and leaves, throbbing into a deep-drum earth and a bird-song sky. Everything around Aranna pulsed with strength and direction and pointed a way through.

Three decades of training, but only afterward—in the way of sapling, sky, and heart’s song—had she found her voice.

She made her way deeper into the woods.

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IM Doc pt23

2021-11-12T21:14:56Z

IM Doc

July 15, 2021 at 9:18 am

In my part of the country, the current large contingent of unvaccinated are avocado toast eating man bun wearing deep blue liberal young people.

They simply refuse to think about exposing their bodies to any kind of toxin. In general terms, this is one huge arm of the entire anti vaccine movement.

It is not the elderly Fox News crowd as the vaccination rate in the over 70s here and almost everywhere is 80% or higher.

The other large group are the younger evangelicals who in my experience are far more likely to be convinced to be vaccinated – they are not in general anti vaccine. They have just watched like everyone else the horror of the gross incompetence of the CDC and have trust issues. If they were really serious a move like firing Fauci would do wonders.

And yet another large group of racial minorities who are just not interested in another experiment.

And then the other gigantic group of workers who will be on the streets if they miss a single day of work.

The problem is these two groups for the most part live in very different geographic areas. In days old, the local health departments would employ vastly different outreach programs.

We no longer have local health departments that function alone. We have nationalized everything.

We are now enjoying the feast of consequences.

You can resent all you want but nothing will change the gross incompetence that got us here. I have become increasingly resentful personally about the resentments of the PMC crowd who spew all the time and then do absolutely nothing to help.

The lies that continue to be spewed by our media that this is just a deplorable MAGA problem will be the end of us all.

***

The following comments relate in some way to this post on NC

Hospital ‘Trauma Centers’ Charge Enormous Fees to Treat Minor Injuries and Send People Home

Posted on July 16, 2021 by Yves Smith

IM Doc quotes another comment (the original post and the comments are all worth reading)...

IM DocJuly 16, 2021 at 2:56 pm

Our Medical for-profit-system has gone completely off the rails and I find it more than a little frightening.

You do not know how frightening I find it. And the very sad thing for me is I have living memory of what it was like 30 years ago before all this stuff really got going.

I tell people all the time that I work in the biggest wealth extraction machine that ever existed.

I would make sure everyone knows about another huge scam. In big non-profit systems, for every single visit from a physical to a sore throat, you as a patient will get to sit through a litany of someone asking you have you had this done or that done…..

The doctor you are seeing, let’s be clear, has a huge part of his income riding on whether or not he/she has strong-armed you into getting these things done. Whether the evidence is flimsy or not matters not. And you as a physician get monthly reports on how you are doing – and what your bonus will be and you better pick up the pace.

It would be one thing if these things were dietary education, elder care, mental health care, obesity training, exercise programs. I would be the first in line for that. BUT as you can tell, every one of those things is going to cost the system lots of money.

What are the things you get asked about? Colonoscopy, PAP smear, Mammogram, vaccine status, PSA, Lipid panels, bone density studies and on and on. They laughingly refer to these as “Quality Care Indices”.

Can you tell the difference? Every single one of the things they do are cash machines. Some of which are very iffy on the evidence. All the others I mentioned previously would be cash vacuums.

Let me make sure all understand what I am saying – THIS IS NOT ABOUT YOUR HEALTH – this is about maximizing every dollar from every “profit center” they can.

This is all the doing of the MBAs who started taking the system over in the 90s – they are now so entrenched it will take a nuclear bomb to get them out.

I see no hope for the entire system until it finally meets the brick wall. Not sure how long it will take – but I know for sure it is on the way.

****
re: a link provided in the day's NC entry,

IM DocJuly 16, 2021 at 3:22 pm

About the US County Case count map – Area of Concern Continuum. The numbers are assuredly very unreliable because the CDC is not counting the vaccinated positives – but it is what it is.

Is it just me – or is there a rather obvious contingent of Blue State America represented there in red or orange? All the places we have been hearing from our media that are so much further along because they have so many more vaccinated….

I see LA and all of Southern California, The Bay Area, Portland, Seattle, Las Vegas, Phoenix, Denver, Austin, St Louis, Chicago, Detroit, Philadelphia, Boston, New York, DC and Atlanta all in red or orange. Blue areas all. Even blue counties in red states like Dallas and Harris ( Houston) in Texas are red. And yes – there are plenty of red areas that are red on these maps too. But it is certalnly not lopsided like the media would suggest.

I have been a physician for 30 years. I have never seen a campaign in public health pitting one political faction against the other – like our media and politicos and health officials are doing now. And now the White House has admitted they are doing things with Facebook that would make Joseph Goebbels green with envy. This is simply unprecedented. I think we can all face reality and allow that the strategy is clearly not working and is indeed making things worse.

This is a test for this nation. I can assure you that the vaccine balkers in Seattle are a much different crowd than the vaccine balkers in LA or Dallas or Kansas City or Miami. We must begin to realize that a one size fits all approach is just not going to work. And coercion and threats are certainly not the answer. From a physician of 30 years, threatening people in any way about health decisions is just a complete imbecile move. You will completely alienate the patient, you will illicit extreme anger or other bad emotions – and you will almost assuredly make things worse.

We have limited time to get this right – but from the tone of the past few days it is clear to me that we are headed right to the brick wall.

I am hoping that the days ahead are not fraught. This may all very well blow over. But it may not. And if this does get ugly – we are going to need one another and not to be at each other’s throats blasting off blame cannons. I simply cannot believe that our health officials and media and politicos cannot see this – and by their actions over the past year allowed it to happen in the first place.

Jason BoxmanJuly 16, 2021 at 4:23 pm

Gods, these people:

“We have come a long way in our fight against this virus,” Jeffrey D. Zients, the administration’s Covid-19 response coordinator, said at the briefing. “Because we have fully vaccinated more than 160 million Americans, we’ve fundamentally changed the course of this pandemic, from one that puts the lives and livelihoods of all Americans at risk, to one that predominantly threatens unvaccinated people.”

So I can think of no bigger moral failing here, than leaving unvaccinated people to die, as this administration is content to do through the CDC and OHSA; Federalism aside, there is still much that could be done/undone at the federal level, from proper mask guidance, to workplace safety requirements, to funding for recovery from side effects for workers, to universal health care (ha). Not to mention study of treatments.

As the highly contagious Delta variant of the coronavirus fuels outbreaks in the United States, the director of the Centers for Disease Control and Prevention warned on Friday that “this is becoming a pandemic of the unvaccinated.”

And just who exactly gave that outcome a huge assist, with nonsensical masking policy?

These people are just nuts. And I’m sure they’re saddened, just saddened, by all this needless suffering. Whatever could have been done?!

Covid News: C.D.C. Director Warns ‘This Is Becoming a Pandemic of the Unvaccinated’ as Delta Fuels U.S. Outbreaks

IM DocJuly 16, 2021 at 6:40 pm

Thank you kind Sir –
I could not have said this better myself.

“Leaving the unvaccinated to die.”

Here is the thing – I have been to this rodeo before with two different viruses – and this is not going to be pretty.

As a young intern, I was on the AIDS wards in a big urban American hospital. I would often sign 8-9 death certificates a day. COVID has nothing on that. Yes – it was that bad. To make things much worse – they were all young 20 somethings. They were for the most part completely abandoned by their families, left blowing in the wind. I have seen the evil that happens to people when we decide as a culture that x-group has it coming and just needs to die. I had believed that we had gotten past that as a culture. I was clearly wrong. It is more disturbing that the side that I thought I was on is now the one perpretating the shame on the country.

There have been two rather large flu epidemic years that have happened in America in just the past 15 years. Many hundreds of thousands died both times, hospitals and ICUs packed, millions sickened. I need to refresh my mind on the numbers but I believe in general the 2009 epidemic was a bit worse than COVID has been as far as deaths (not certain about that). Believe it or not, the amount of patients that just flat out refuse flu shots is staggering even in those horrible flu years. And even when weeks or months later the unvaccinated came into the hospitals sick as a dog, neither myself, the nurses, nor their culture at large treated them with disdain or as deplorables. The unvaccinated issue never was even mentioned. They certainly were not being maligned on TV by Rachel Maddow et al every night.

I often look in the mirror every day in the AM , and think to myself – What has happened to us? What has happened to my profession? How is this all going to end?

DagnarusJuly 17, 2021 at 7:57 am

On the Ivermectin study. The fact that the Elgazzar study was included in the meta analysis (especially with a low chance of bias rating) does not speak well of the meta analysis’s quality. Their stock has definitely gone down in my opinion.

I will state this in their defense however, (assuming they all aren’t grifters) they have come across a treatment method, which on, alot of the data, suggests it can safe lifes. The response from authority hasn’t been to quickly ramp up large RCT trials to quickly either confirm or deny, it hasn’t even been quiet indifference. It has been to attempt to stamp out this particular treatment. I personally think that people would be able to think a lot more clearly if needless pressure were not being applied.

On a related note https://bbcgossip.com/health/remdesivir-does-not-improve-covid-19-mortality-rates-study-finds/. Nobody is talking about removing the EUA on remdesivir. Nobody is talking about making it illegal for a doctor to prescribe it to their patient out the cost of $3000 for a cause.

IM DocJuly 17, 2021 at 8:39 am
I agree with every point you make.
I do not believe any of these people are grifters. There really is not an ounce of grift in ivermectin to be had.
And you are correct in your suspicion of remdesevir. I have not seen personally in any patient any benefit at all. I have maybe used it 40 times. The same can not be said for ivermectin where I have seen people improve dramatically.
Unfortunately, we have had to start using it again the past two weeks. I had a husband and wife on Tuesday. Both vaccinated both positive and both having coughing SOB and fever. Husband took ivermectin and improved in one day. Wife did not and is still sick as of last night.
I have too many stories like this for this to be just random chance.
I have a moral and sworn obligation to my patients health. Not Fauci. Not Pfizer. I will continue right on using this until there is clear data not to. The safety profile is just too good and the risk benefit ratio is overwhelming.
That is called the art of medicine.
I know these fits and starts are frustrating. I take it in stride because I have seen this all before several times.
Bactrim is now standard of care for PCP in AIDS. When I was a young Doc that was not the case. The evidence for its use came bubbling up from below and took years of bad trials and good trials and tons of obsstruction from Fauci et al before the proof was finally there.
Ivermectin is almost the same story. Both drugs were considered “out there” at first. But Ivermectin has actually a much better safety profile. Medicine was not enthralled to the “RCT only” fetish back then so the thinking by medical practitioners on the ground was much more clear and ethical than it is now. That to me is the big problem we are facing other than the obvious stonewalling by our agencies.
This remains a clear no brainer until there is real evidence either way.
PedroJuly 17, 2021 at 7:34 pm
Anecdotes are not data.
First do no harm.
The ‘I will use until I have evidence it is bad’ makes me think of lobotomies.
1. ambritJuly 17, 2021 at 8:41 pm
  That’s a false equivalence.
  The cases of Ivermectin versus lobotomies are vastly different. The Ivermectin use actually saves lives. The other side of the equation does not “lose lives.” Lobotomies are medical intrusions aimed at changing personality permanently. For that purpose, it works. That it does so with significant side effects is another issue, separate from the original design. Either way, lobotomies or their non-use do not lose lives. To turn your argument ‘on it’s head,’ we can compare the use of lobotomies with the non-use of Ivermectin. Lobotomies have gained their negative reputation because they often destroy psychic lives. The non-use of Ivermectin also destroys physical lives. People die due to the blocked use of the drug. Do no harm indeed.
  Stay safe.
  1. norm de plumeJuly 20, 2021 at 6:58 am
    Very. Well. Said.
2. IM DocJuly 17, 2021 at 8:48 pm
  The problem with your reasoning is this drug has harmed less than a few dozen out of the billions that have taken it. The same could never have been said about lobotomies.
  And since there is virtually no harm issues and multiple very strong signals that it is at least helpful somewhat by medical ethical standards it must be given.
  I learned this lesson well in the AIDS pandemic with drugs of unknown efficacy then that are the standards of care now.
  This line of reasoning is especiallly germane during a worldwide pandemic.
  1. Phillip CrossJuly 18, 2021 at 12:19 am
    Mentos mints are very safe to ingest, but no statistically significant evidence exists that they help cure or prevent Covid.
    Wouldnt it be a serious ethical issue if you tell people they work, and prescribe them anyway?
    What of the high risk people who hear you and then go to Safeways and buy Mentos, thinking it will protect them. They feel safe and then put themselves in harm’s way, and end up dead after getting Covid19?
    
    IM DocJuly 18, 2021 at 9:07 am
    The problem with this reasoning is that Mentos mints do not have dozens of studies out there already showing some efficacy.
    This is both in clinical medicine as well as bench research showing in vitro effectiveness that ivermectin has against SARS COV2.
    In other words, there are multiple studies that seem to suggest it does work.
    I guess I would remind you that the standard of care right now for people that real doctors are telling people to do all over this country is to go home and come back if you turn blue.
    In that kind of environment with no good options – I am willing to give my patients a safe compound that does seem to have some effect. As I have stated above – what I have seen with my own eyes seems to be more than random chance.

ajcJuly 17, 2021 at 8:20 am

https://blogs.bmj.com/bmj/2021/01/04/peter-doshi-pfizer-and-modernas-95-effective-vaccines-we-need-more-details-and-the-raw-data/

In light of the Israeli government admitting the vaccines don’t work as advertised, maybe we can ask why our regulators and public health authorities ignored the substantial evidence that the mRNA vaccines are nowhere near as effective as has been repeatedly parroted for the last 6 months.

Furthermore, it appears that spike protein specific immunity induced by the ‘vaccines’ might be creating the next covid wave

https://twitter.com/holmenkollin/status/1415989536933490688?s=19

IM DocJuly 17, 2021 at 9:14 am
I would like to give credit where credit is due.
There is an obvious statistical manipulation among the treatment arms that is evident in the original Pfizer trial. It greatly puts into question the results of the study. It would tend to make the touted relative risk reduction of 95% much lower – but it is impossible to know how much lower unless one has access to the primary data.
I will repeat once more – I do not recall a single time in my life that the relative risk reduction has been used a a primary statistical endpoint for vaccine efficacy. My experience with that statistical contrivance is that is mainly used by Pharma for their glossies to bamboozle people. The RRR rarely comes up in journal clubs. It has very limited utility. But it sure looks good – even when the reality-based results are not so good.
I have watched in horror as this RRR number has been touted to the American people for the past 6 months – giving them a completely false feeling that they are “95% protected”. That is just not what that number means. The fact that our public health authorities were not out in front of this misrepresentation and explaining this to the people will be an indelible mark.
But who was it in my world who first noticed the problem with the management of the trial participants that could really goose the efficacy numbers?
Why – that would be Yves. And she put these concerns in comments and maybe even a post. I just cannot find it now. Yves is one very intelligent person – but forgive me – if Yves can see it – why can not medical statisticians? Well – Dr. Doshi – whose blog you highlighted in your comment came out with a blog post discussing this issue in the BMJ a few weeks after it was noted here – and was laughed and censored out of the room by “experts”.
I think we can look right now at the vaccine efficacy issues – and ask ourselves who was right?
Citizens of the world, do you want your medical experts and medical debated muzzled by Big Tech under the direction of Big Pharma and governments? Is it becoming clear why this is a very bad idea?
I sure hope so.

an important lesson on medical statistics:

Angie NeerJuly 17, 2021 at 1:30 pm

IM Doc, your comments have been a quite an education for me, and I’m sure for this whole community. Thank you! But I am still confused about what is wrong with RRR as a measure of effectiveness, and what is the better alternative? I’m not a dummy about statistics, but I’m missing something here.

IM DocJuly 17, 2021 at 6:57 pm
I have been teaching medical statistics for 30 years – so I will be happy to do my best here for the commenters.
This is usually done with graphical tables and white boards – trying to do this in text will be interesting but I think it can be done.
This is probably going to be a bit long – so grab some coffee.
I start off every group of students I have ever taught with a simple statement – “Statistics are very simple if you do not turn off your common sense.” If one is trying to be dishonest or to make his claim look better that it actually is – it is often very easy to find all kinds of statistical contrivances to do that for you. My job for decades has been to show students every dirty trick in the book. The relative risk reduction trick is one such thing that Pharma uses constantly to overstate their results. In and of itself it is not a problem, as long as you know exactly what it means and what you are looking at.
In the original mRNA vaccine trials, the endpoint in the analysis was the relative risk reduction of about 95%. That does mean something. But it is not what is being presented to the American people. How do I know? I talk to them multiple times daily. They clearly have not a clue what this means. They are being told the vaccines are “95% effective” which is interpreted as you take the vaccine and you have a 95% chance of not getting COVID. THIS IS ABSOLUTELY NOT TRUE. That is a blanket efficacy statement and has nothing to do with the relative risk. This has never that I can tell been explained – and I can see easily how uninformed laymen can make this assumption.
The original Pfizer trial had more than 40000 participants. For simplicity sake for your understanding, I am going to make the denominators a round number and make sure the numerators are ratioed exactly the same as the Pfizer endpoints. That way you can understand better and wrap your mind around the numbers easily.
Let us say that the vaccine arm had 1000 participants and 1 got COVID.
The placebo arm had 1000 participants and 20 got COVID.
So actually in the vaccine arm 999 people did not get COVID – so the efficacy number if we were doing this by the blanket approach that the vast majority of Americans would understand is that vaccine actually has a 99.9% effectiveness. That is correct. But wait a minute – that is not 95%.
BUT THIS IS THE CATCH and this is the IMPORTANT part. When you make this blanket kind of comparison – you then have to have a second sentence. That would be the following – However, THE PLACEBO in the other arm prevented 980 people from getting COVID. That is right – a saline injection prevented 980 out of 1000 or 98% from getting COVID.
IN OTHER WORDS, using a SALINE INJECTION has a 98% effectiveness for preventing COVID – if you use the numbers the way this is being presented to the American people.
But the difference between the two arms is really quite minimal when you put them side by side:
99.9% in the vaccine arm ———- 98.0% in the placebo arm –
An actual reduction in risk (known as the absolute risk reduction) of 1.9% The actual number is 0.019.
The relative risk reduction is a statistical contrivance – generated by taking the number of events in the placebo group (20) and subtracting from that the number of events in the vaccine group (1) – and placing that number (19) – over the placebo number ( 20)
20-1/20 19/20 0.95 95%
That is where the 95% comes from.
The way most normal people think, again because I talk to them daily, they would understand the absolute risk ratio – the vaccine prevented 1.9% more COVID than the placebo. That is right 1.9%. The relative risk though is 95% – and that is what Pharma uses all the time in its glossies and ads. Please note (think about this the way the American people are being led to believe) the placebo success is 98% – which is even higher than 95%.
Because of this discrepancy – another way to look at the data has been derived from statistics – and it is called the Number Needed to Treat – in other words in this case – how many people need to be vaccinated to prevent one person from getting COVID. This is very easily calculated by this equation 1/absolute risk reduction — in this case it would be 1/0.019 which works out to 52.63. 52 people are being vaccinated with no benefit for every 1 person that gets benefit..
The big problem here is that relative risk reduction becomes more worthless the higher the number of subjects are compared to the actual signal. Having a placebo group of 20/1000 and a vaccine group of 1/1000 really skews the value of the relative risk reduction because they are so close together in a sea of people who were never affected. Accordingly, it is a very very poor way to describe efficacy in any vaccine trial – not just COVID. But they used it because it sounds so good. 95% sounds so much better than 1.9% ( They have been doing this for years – trust me).
Let me give you two simple examples from history about drug efficacy and these numbers.
In the early 1950’s a drug called isoniazid – or INH for short was introduced into the market for TB. In one of the very earliest studies done by researchers to Tulane in a Louisiana TB asylum, there were 70 patients (not 40000 as in the COVID trials). They were split into two blinded groups – 35 given INH for 6 months – 35 given a placebo for 6 months.
The end goal was eradication of TB from the sputum..
In the INH group – 33 out of 35 had eradication. 94% or 0.94
In the placebo group 1 out of 35 had eradication. 3% or 0.03
The absolute risk reduction is 91% or 0.91
The relative risk reduction is 33-1/33 32/33 97%.
The number needed to treat is 1/0.91 0r 1.1
So in other words 1.1 patients needed to be treated for every 1 with benefit. The drug is a magic bullet – almost everyone benefited.
And the absolute risk reduction (which most people would understand) and the Relative risk reduction were both above 90. An absolute stellar performance – and the drug was indeed foundational for TB therapy.
Now – let’s do another drug that is not so successful – but was profoundly marketed by pharma using the relative reduction.
That would be FOSAMAX for osteoporosis.
The original study came out in the 1990s. There were 560 women on the drug – and 542 women on the placebo. The endpoint of the drug was prevention of hip fractures or vertebral compression fractures.
In the FOSAMAX arm – 22 fractures out of 560 patients – 22/560 4% 0.04
In the placebo arm – 36 fractures out of 542 patients – 36/542 7% 0.07
We have an absolute risk reduction of 0.03 or 3%
We have a relative risk reduction of 36-22/36 or 0.39 – 39%
There is a number needed to treat with this drug of 1/absolute risk reduction – 1/0.03 of 33. What does this mean? 33 women had to take the drug – pay the 900 dollars a year, endure the side effects of GI issues, and brittle bones, and jaw necrosis, teeth falling out – for 1 women to avoid a fracture. Not too impressive.
But all the while – Pharma glossies – and the TV were screaming at women – there is a 40% improvement in your bones. Oh yes, oh yes they did. If you look at ads from the era the 40% is big and bright and there is a little footnote – with microscopic type telling you this was a relative risk reduction as if your average American had a clue what that meant. It really is a scam. And the same thing has been done with statins, with psych meds, with diabetes meds, you name it. I can pick up any pharma ad right now – and this tactic will be there.
I am very sorry that is so long – I know no other way of doing this. I have gotten to the point that I have written out a handout for my patients. I feel it is imperative that each and every one understands exactly what these numbers they are being shouted down with daily mean.
Vaccines are usually measured on how they affect the immune response and how they affect morbidity and mortality. The only other one I can think of that ever used Relative risk reduction of case numbers is the shingles vaccine – and for obvious reasons – that disease process really is a case number kind of thing.
The relative risk reduction of case numbers is a very very poor measurement of any other type of vaccine because we are usually dealing with tens or hundreds of thousands of subjects and cases that may number in the dozens. The more stark this contrast is the more useless is that relative risk number.
The other important thing to realize is that because the way the relative risk is calculated, small differences in the numbers are actually quite large on a population basis. So when Israel came out this week and announced that the Pfizer vaccine is only 64% effective against Delta – I want everyone to understand – that is a HUUGGE discrepancy – far more than the “31%” implied. (I am assuming that the 64% is actually the relative risk reduction they are seeing in their current numbers – they never actually said – which is another entire issue that I am getting really tired of).
I am mortified that our agencies are playing this Pharma game of using these statistics to goose their vaccine’s efficacy in the public mind. I really should not be though – this has been standard operating procedure for as long as I have been a physician.

ambritJuly 17, 2021 at 11:07 pm
Thank you for the lesson. I’m printing this out to keep handy for when I see similar tactics tried.
CarolinianJuly 18, 2021 at 1:09 am
I follow what you are saying but leaving aside the vaccines and their marketing it all circles back to the original debate about whether the danger posed by this disease is at all proportionate to the overwhelming response that has resulted. If society is going to heroically intervene to make sure covid is reduced to zero then even that 1.9 percent is significant. Perhaps it’s the goal itself that should be debated but this of course will get you kicked off Youtube.
Myself, I’ve given up on arguing about this but just want to make that point.

Sorry, for some reason the formatting stopped being carried over starting here - hopefully it'll be obvious which comments refer to which.

IM DocJuly 17, 2021 at 9:07 pm
I have been a Dem my entire life.
I have seen the major transformation of my profession into a wealth extraction unit.
In almost every case, it was my Dem party that initiated these changes and could not wait to make it worse.
Probably the worst that occurred was the dismantling and centralization of our public health system that the Obama administration was largely in charge of.
We are now paying for this dearly.
In the early stages of this pandemic In feb and March of 2020 when things that would have helped to cause the virus to go to extinction, Trump was stymied at every turn.
Close international travel to China.
You’re racist screamed Biden.
Go eat in Chinatown said Pelosi.
That is when it really mattered.
Now we are just figuring out the best path to endemic status.
Yes I cannot stand Trump. With regard to Carlson – he has had on guests that at least make you think.
I quit listening to Rachel Maddow last year. The constant “all truth only flows from the government sctick” got really old and Chairman Mao and the Red Guard were so much better at that.
What I am saying – there is no debate on the left – seemingly only suppression and towing the line.
That is so not what I wanted in a liberal progressive party.
I do despair sometimes. It seems every part of our polity is headed for disaster.
I guess my rage is so much more focused on dems because I expected so much more.

LifelongLibJuly 17, 2021 at 6:44 pm
Most of the so-called PMC live off paychecks and can be fired. That makes them “workers”. Yes, there are social/cultural barriers between (say) “physical” and “mental” workers, people who went to college as opposed to trade school, and managers vs the managed. But all are very much in the same economic boat, and float or sink together. Separating out the “PMC” as a separate group with unique economic interests obscures more than it reveals.
AhimsaJuly 18, 2021 at 2:49 am
@IM Doc
Thank you so much for this!
I have been pulling my hair out trying to explain this to friends and family about the Vaccine Efficacy numbers that are repeatedly touted and how BOTH the Absolute Risk Reduction AND the Relative Risk Reduction are critical to understanding.
If you will allow me a short trivial example I use to when speaking to friends:
Imagine an unvaccinated control group of 1 million where 10 people get a fatal disease infection.
Now imagine a vaccine test group of 1 million where 1 person gets the fatal disease.
Relative Risk Reduction 9/10 = 90 % (looks great, right!?)
Absolute Risk Reduction 9/1,000,000 = 0.0009% (absolute effect is much less impressive)
Therefore, it is critical to know the Abolute Risks involved before you can make an informed choice around a vaccine touting Relative Risk Reduction.
(Note: Obviously, the numbers used above in my trivial example do not relate to Pfizer’s actual numbers but are designed to highlight the potentially misleading nature of RRR values.)
And as you alluded, the metric of Number Needed to Treat has been completely underreported.
I really recommend an article currently in WIRED magazine which is highly critical of the CDC and its director Rochelle Walensky. It goes into some detail on the nuances when considering the individual risk-benefit analyses for healthy teenagers. IM Doc will appreciate that the article also challenges the very idea of “mild” myocardiatis cases in teenagers. https://www.wired.com/story/the-cdc-owes-parents-better-messaging-on-the-vaccine-for-kids/
The CDC Owes Parents Better Messaging on the Vaccine for Kids
The agency’s strange math and blunt statements are missing key nuances—and may be underplaying myocarditis cases in teenage boys in particular.
…Walensky cited a string of statistics that showed “the benefits of vaccination far outweigh any harm.” But some epidemiologists, public health experts, pediatricians, cardiologists, and other scientists dispute the CDC’s numbers, characterizations, and conclusion. The agency, they variously contend, is both exaggerating the risks of Covid-19 to young people and underplaying the potential risks of the vaccine to them.
…The absolute risk of the vaccine still appears to be extremely small for young people but, on balance, when the data are seen through a different frame, the relative individual risk from vaccination, particularly for healthy young males, may be higher than it is to not be vaccinated at this time.
…frankly, being in the hospital at all, is not a condition most people would associate with the word “mild,” even if some clinicians may describe it this way. Even on that point there is some dispute. Anish Koka, a cardiologist in Philadelphia, put it plainly: “There is no such thing as mild symptomatic myocarditis that puts a young person in the hospital.” He continued, “If you want to redefine ‘mild’ in the context of the pandemic, fine, then say you are doing that. I’m not against vaccines. But we need to be nuanced about how we talk about this.”
AhimsaJuly 18, 2021 at 3:22 am
To follow up on something IM Doc alludes to – there is a perhaps non-intuitive progression of Vaccine Efficacy.
99% Vax Efficacy means 1/100 risk ratio (between unvaxxed and vaxxed
95% Vax Efficacy means 1/20 risk ratio (tho’ only a drop of 4% in VE)
90% Vax Efficacy means 1/10 risk ratio
50% Vax Efficacy means 1/2 risk ratio
64% Vax Efficacy (as reported in Israel this week) means ~1/3 risk ratio.
And another bug bear of mine is that Vax Efficacy numbers are differentiated against a specific outcome. That is to say, the Efficacy varies depending on whether we are talking about efficacy against infection/symptoms/hospitalisation/death!
Brian BeijerJuly 18, 2021 at 6:08 am
Thank you for this! I am also going to save this for the future. The only thing I didn’t quite understand is:
the Pfizer vaccine is only 64% effective against Delta – I want everyone to understand – that is a HUUGGE discrepancy – far more than the “31%” implied.
So, are you sayiing that Pfizer had implied that their vaccine was only 31% effective against Delta and that Isreal was disappointed it was only 64% effective? Where does the 31% come from? Sorry if this is a stupid question. I just can’t get my brain to understand that sentence.
1. IM DocJuly 18, 2021 at 8:03 am
  The 31 is the difference between the initial 95 in the original study and the 64 the Israelis reported last week.
  Assuming that 64 was also a relative risk reduction.

Stephen the tech criticJuly 18, 2021 at 8:54 am
Thank for your this detailed explanation of your reasoning about relative vs. absolute risk reduction and how Pharma uses the former to promote drugs which are not necessarily in the best interest of patients.
The two examples you gave make clear that relative risk reduction (RRR) is not the “end of the road” for deciding whether a particular treatment is medically indicated. Now please correct me if I’m wrong, but I believe that the Number Needed to Treat (NNT) isn’t really the end of the road either. The real goal is to balance the potential treatment benefits with the potential treatment risks (from side effects, among other things). NNT directly indicates the proportion of patients who benefit from the treatment *over the trial period*, but careful consideration of those words I just wrote points to some crucial caveats, a couple of which I will highlight here as both are relevant to the vaccines.
First, with regard to the FOSAMAX trial, while I’m inclined to be highly skeptical of the drug’s utility, given the data you provided, I’d want to know other things before reaching a firm conclusion. (I’m speaking rhetorically here. I’m not requesting anything more from you.) I’m not just talking about rates of side-effects but also, the *duration of the trial*. Why? Because the longer the trial, the more likely patients will fracture their hips or vertebrae during that period. So if the trial period was only 1 year long, the benefit (if any has to be had) may not be nearly as apparent as it might be after 10 years when a lot more hips will (hypothetically) have been saved from fracture. The absolute risk reduction (ARR) often increases with duration in this way unless it’s normalized with respect to time somehow, for example in the way economic stats, collected at different intervals, are often “annualized” to make them easier to compare.
Recall a few months ago all those extremely rosy “breakthrough ratio” figures like 0.04% that the CDC and others were hyping through the media to show “how well” the vaccines were doing. The problem? The trial period, between when each subject became “fully vaccinated” (plus two weeks) and the end of the sampling period was extremely short for most subjects. Most fully vaccinated people had just gotten their shots, which was clearly evident by looking at the daily vaccine trends. Furthermore, by the time most people had become “fully vaccinated”, the daily case rate had already plummeted from its wintertime high, meaning people were encountering the virus in the environment much less as well. Both the duration of the data collection period and the daily case rate (effectively, the *baseline risk* of catching COVID) impact those percentages substantially. The hyping of these figures was extremely misleading to the public. In fact, I attempted to estimate the *real* breakthrough ratio (which is just 100% minus the RRR, I think) using a crude model, and time series data of daily cases and vaccinations. I came up with around 75-80% RRR, but then I noticed that the two datasets I was using had major consistency problems that I could not reconcile. Hence, I did not bother to publish my work here.
So not just the trial period but also the background risk of catching COVID affect the absolute risks and the ARRs where the vaccines are concerned. The latter is very much in contrast to the two examples you gave. In the TB trial, everyone was already sick and not likely to recover without intervention. Their “baseline risk” was almost 100%, so any relative reduction translated readily to absolute reduction as well. In the FOSAMAX trial, the baseline risk of fractures (normalized for time) likely remained fairly consistent between the trial and “real life”. Unless older women collectively engage in an extreme sports fad or go through other major nutritional or behavioral shifts, the baseline risk of fractures likely remains about the same between the trial and the “real world” at times in the near future.
Contrast this with the pandemic and the vaccines. In the pandemic, the baseline risk is extremely variable depending on the prevalence of COVID (modified by some NPIs like masks/ventilation) wherever you are at any given time. Not only were the vaccine trials short in duration but they occurred during a time in which baseline COVID risk was actually quite low compared to where things went in the winter. Suppose we kept in place all the NPIs like distancing, contact tracing, restricted travel, masks, etc. which were widespread then and we managed to keep variants from evolving too much. This would keep the baseline risk low enough as to make the net benefits of the vaccines questionable. Until recently, places like Australia continued to follow stringent elimination policies, and for them, the vaccines made essentially no sense—that is until their recent public policy changes that is!
Now, with the public policy shift toward ending all NPIs, and given that the vaccines don’t stop transmission, we are basically being subject to or about to be subject to a very high baseline COVID risk. If the virus is allowed to spread everywhere, which is where policy in the US and other places seems to be taking us to, then we’ll be more like the TB patients, and even “65%” effectiveness will mean a lot if it means staying out of the hospital. Let me emphasize that this “benefit” from the vaccines is entirely contingent upon the highly dangerous and irresponsible public policy that we have!
Think about that for a moment. The assault on our health by TPTB through our corrupt and negligent government is what is enabling Pharma to “save us” with their “technology miracle” vaccines (or so we hope). When the vaccines were first being hyped, I speculatively compared them to the Boeing 737 MAX debacle and suggested there was a high likelihood of a catastrophic outcome. I am still in wait-and-see mode in that regard, but I nevertheless “boarded the MAX” myself (via Moderna) as I could see where the public policy was going. I saw the metaphorical gun barrel being turned on me.
I likely caught COVID back in March ’20, and the “95% efficacy” reported by Pfizer was based on a very narrow definition of “symptomatic” disease which did not include *any of my symptoms*. (I couldn’t get tested then because I didn’t have the “right” symptoms and it was early. More recently, I spoke with the people I think I caught it from and they too suspect they had COVID but couldn’t get tested to confirm.) Furthermore, the “not symptomatic” case I suffered was followed by waves of additional symptoms over the year. Both the acute and extended phase of symptoms were mild relative to what a lot of people suffer, but they were still substantial. Some were quite concerning, such as numb toes (which I eventually traced to muscle and/or joint inflammation in the leg and ankle), brain fog, multiple episodes of conjunctival bleeding (“Pence eye”), and fits of dizziness after eating (which in hindsight may have been indicative of hyperglycemia). By the time I got vaccinated in May, I had been feeling almost back to normal for a few months, but unfortunately the vaccine triggered both a strong acute reaction (~75% of the original symptoms plus a new fever delirium) and more long-haul symptoms (mostly the muscle / joint inflammation, fatigue, brain fog, and disturbed sleep patterns). These persist to today.
So on a very personal level, that 95% figure is pretty much rubbish because it says nothing about protection from what I experienced, which has definitely degraded the quality of my life more than a cold or flu would have. I presume that, in general, reducing the severity of illness also reduces the severity of after-effects, but I think we’re all in the dark as to how well the vaccines really work in this regard as well as with regard to how long these symptoms will typically last in people and how they will affect morbidity in the long-run. The recent numbers I saw suggesting (IIRC) ~0.6% morbidity after 6 months in *all* COVID recovered patients were not encouraging. Many of those who made it to 6 months may still end up prematurely dying given more time, and it wouldn’t surprise me if ultimately “long COVID” ends up being the more deadly form of the disease.
1. IM DocJuly 18, 2021 at 2:11 pm
  All of your comments are very important.
  I hope you can understand how complicated medical statistics are and the care which must be taken when interpreting and sharing them with patients.
  Hence my extreme disappointment with the way we have just been throwing numbers around.
  What I did above is just the basics. Going into the woods is not appropriate for this kind of forum.
  With regard to your last paragraph. My biggest fear after months of taking care of covid is actually long covid. Unfortunately, I am now beginning to see many patients with similar symptoms after the vaccines. We have a lot to learn about covid and we have a lot to learn about this first if its kind in world history vaccination program.

karenincaJuly 19, 2021 at 2:27 pm

A 24 year old whom I know through zoom church meetings has caught covid. He does not seem to be having a terrible time; he is mainly coughing a lot, but of course who knows if there will be long term effects. He’s in England; he was not vaccinated due to the shot not yet being available to him. He was working as a substitute mailman so he was out and about, but I’m sure he wasn’t partying in big groups. But here’s the thing – he has infected both his father and his boss. They were both fully vaccinated (I don’t know which vaccine), but they caught it from him anyway. I don’t yet know how sick they are. I presume this is the Delta variant.

This anecdote has sunk into the consciousness of an older church member I know here in Silicon Valley. He really felt as if being fully vaccinated made him safe; last week he went to a graduation party. It was outdoors, but it’s been clear for a while that being outdoors doesn’t help as much with Delta. I’ve told him countless times that he can still catch and transmit, and he’s well educated and otherwise rational but he just didn’t “get” it. He also read about the Texas Democrats on the plane and that helped open his eyes as well. Now he does “get” it.

Now people like him are bargaining with fate – “but it won’t be a serious case!” I hope they’re right but looking at who is hospitalized in Israel I don’t think they will be.

MikelJuly 19, 2021 at 3:40 pm
Outdoor events…no one mentions that they all had to go to the bathroom.
Not event talked about much in return to office conversations.
What kind of air filters and other ventilation is being talked about for restrooms? What about lids for toilets foe when they are flushed?
1. Lambert StretherJuly 20, 2021 at 3:31 am
  Fomites are a logical concern, but there is no epidemiological study I know of that shows actual transmission, even if not the main means of transmission.
  I would have expected a study to have shown up from India at this point, given that they have big problems with sanitation.
  I think it’s good to be careful in general, but the days where we were obsessively cleaning our doorknobs and washing vegetables are gone.
  NOTE Fomites were, of course, what the ~~dinosaurs~~ experts at WHO and CDC blamed for tranmission at the famous Skagit Choir cases, but further study ruled them out:
  At the time of the chorale rehearsal on 10 March 2020, because of emerging concern about SARS-CoV-2, person-to-person contact and touching of surfaces was consciously limited, and hand sanitizer was used. No one reported direct physical contact between attendees to the County Public Health investigators.22 Although some choir members helped arrange the chairs and ate snacks during the intermission, the index case did not participate in these activities, and many other members reported not eating the snacks.22 Thus fomite transmission from the index case via chairs or snacks can be excluded. The index case used one of the bathrooms during the event and thus touched the door handle and other surfaces there, but only about six other choir members used that restroom (see Supplemental Information), and many choir members who did not use any of the restrooms were also infected. Indeed, the clustering of infected cases on the seating chart does not support transmission from a point surface contact(s) unless the people who sat together all touched the same contaminated surface. Thus, it appears highly improbable that the direct and indirect contact routes could account for a significant fraction of the transmission during this event.
  1. drsteve0July 20, 2021 at 10:20 am
    I suspect what Mikel meant is that when a toilet is flushed a lot of aerosolization can occur.
  2. square coatsJuly 20, 2021 at 11:44 am
    I had been wondering about public bathrooms too with regard to aerosols, since it turns out that when you flush a toilet it has an “aerosol effect”.
    From webmd: “According to the research team, flushing can generate large amounts of airborne germs, depending on flushing power, toilet design and water pressure.”
    Aerosol generation in public restrooms (Phys Fluids, 2021): “Covering the toilet reduced aerosol levels but did not eliminate them completely, suggesting that aerosolized droplets escaped through small gaps between the cover and the seat. In addition to consistent increases in aerosol levels immediately after flushing, there was a notable rise in ambient aerosol levels due to the accumulation of droplets from multiple flushes conducted during the tests.”
    (not sure if maybe Mikel was alluding to the aerosol effect as well)
    Apparently also known as a “toilet plume”, MIT offers a possible answer: “we have to acknowledge that live virus may sometimes be present in feces, though it’s possible this occurs only rarely or only in the case of very severe illness. This makes it theoretically possible that live virus could be present in a toilet plume, resulting in aerosolized droplets and contaminated surfaces. […] Individuals would also have to inhale a sufficient amount of the virus to become infected, he points out. “Even in the unlikely case that a toilet plume aerosolizes some viral particles, you probably wouldn’t be in the vicinity long enough to come into contact with enough virus to make you sick,” he notes.”
    1. Lambert StretherJuly 20, 2021 at 12:04 pm
      Yes, I know about fecal plumes and I understand the logic. (IIRC, there was a SARS fecal plume that went up a chase in a Hong Kong apartment building and infected several platforms.)
      Put the lid down when you flush!
      That said, although again it makes sense to be careful, there are no epidemiological studies that show fecal transmission for Covid.
KeithJuly 19, 2021 at 3:59 pm
That’s the thing I have been wondering about. Is the jab really about not getting COVID or just not getting hospitalized from it? I tried looking into it before I got it, but couldn’t really find much, aside from authorities saying to just get it.
I think it is an important issue, if true. I supposed the other issue is the seriousness of the delta variant. Is it as bad as the original, or like others have said, it is much more milder.
1. CuibonoJuly 19, 2021 at 4:45 pm
  sadly that was NOT studied in the RCTs. lots of real world data that is subject o all sorts of problems
2. drumlin woodchucklesJuly 19, 2021 at 4:54 pm
  That was my understaning. The mRNA neo-vaccinoid was designed to keep you from getting less sick from the covid it was never even intended to actually keep you from getting, technically speaking.
  It was only meant to make you get less sick.
  At my age and with my co-morbidities, I decided it was worth the risk. So I got the moderna brand mRNA neo-vaccinoid.
  1. MiltonJuly 19, 2021 at 7:45 pm
    So it’s less a vaccine and more a prophylactic?
    1. chrisJuly 19, 2021 at 10:11 pm
      The vaccines we have were developed to prevent severe disease and death from COVID-19. It seems that they confer other benefits too, but, they do not provide sterilizing immunity to SARS-CoV-2.
    2. drumlin woodchucklesJuly 20, 2021 at 12:19 am
      Its not a classical dead virus or attenuated virus vaccine. Its a new and different technology. So I tried to create for myself a new and different word to describe the newness and difference of this not-a-classical-vaccine.
      And “mRNA neo-vaccinoid” is the best I could come up with.
3. Lambert StretherJuly 20, 2021 at 3:38 am
  > Is the jab really about not getting COVID or just not getting hospitalized from it?
  To me, the jab is about:
  1) Really good odds of not being hospitalized or being very sick
  2) Good odds of not getting sick
  3) Less good but still real odds of not transmitting.
  To me as a personal matter, #1 is sufficient.
  As a policy matter, #3 really, really worries me.
  Adding, I don’t know if the Delta variant is inherently milder, or (a) we have better treatment now, so people don’t get as sick, or (b) it’s hitting a younger and stronger population.
  1. drumlin woodchucklesJuly 20, 2021 at 8:43 pm
    Could there also be a choice 4) . . . . that widespreading Delta cases will seemfeel mild in the acute now, but will leave behind body cell microdamage which will show up as “premature onset” chronic diseases of old age or other chronic disease? Or also leave organ systems with zero margin of safety so that an otherwise survivable disease becomes non-survivable?
    Like if Delta covid silently attrits my kidney function down to 50% and then I get something else which removes the other 50%, I will be left with 0 % kidney function where otherwise I would still have had 50% kidney function left if not for getting Delta covid?
    Is that also a mass-demographic outcome we should expect and will see starting in 25-30 years?
IM DocJuly 19, 2021 at 4:00 pm
I think you are very right.
I studied the stages of grief from Elizabeth Kubler-Ross years ago when I was a medical student. It has served me well with individuals dying or undergoing some other tragedy.
Now, unfortunately, I think we are going to be experiencing these stages as a society the next few weeks. The first stage is denial – I think our media and federal officials are still there – but the people for the most part are beginning to move on. The next stages are bargaining like you stated above and anger/rage. In my experience with individuals those two often happen at exactly the same time. I do think this next few months has the potential to be a very fraught time. Please take care everyone.

IM DocJuly 19, 2021 at 2:35 pm

I have been providing updates on the situation from my little slice of small town America for the past several months. Since we now seem to be entering an impending wave or at least “something” I am going to write this out in the comments weekly. I do think it is important to know how this virus is being lived out in the real world of flyover country and away from the large metropolitan areas. And the bumbling on the TV is about as alien to what is happening on the ground here as if it were being broadcast from Alpha Centauri.

I live in a county where the vaccination rate among those over 70 is right at 90% and those from 18-70 is right at 50%. That seems to be way better than most of America.

In my own personal practice from the last week – JUL 12th through JUL 18th there were exactly 27 positive COVID patients – 70% vaccinated, 30% unvaccinated. As has become apparent for the past few weeks – the vaccinated patients are more likely to be a bit more ill. They have much deeper coughs, X-ray changes and fever more commonly than the unvaccinated. One thing that has also become clear for the past few weeks is how often the vaccinated come from clusters of groups that have multiple members fall ill – ie social events, civic events, church activities, etc. The unvaccinated are mostly lone events.

Please note – the reason there may be more vaccinated – is the unvaccinated are trending toward younger people – and they may not come to the doctor. But the facts are that there are plenty of vaccinated patients becoming positive as well – and going all over the community sans masks and spreading the wealth.

Not one of my patients has become remotely ill enough to be in the hospital. We had a close call a week ago – but that individual has had a full recovery. In the community, however, we have had 3 vaccinated patients become very ill and need to be transferred to a higher level of care. No one unvaccinated has been in the hospital. All 3 were very high risk, older, obese, diabetic, etc. At the time of this writing, all 3 are doing very well.

The tempo seems to be picking up dramatically, however. So far we have had 11 patients just this AM calling in with colds and coughs and fever. All are being tested – no idea what the results are yet.

As of now, it seems there is a high percentage of vaccinated who are becoming ill and positive – much higher than advertised. At the same time, the level of illness has remained relatively low – so at least we have that good thing.

But there is a bigger problem brewing.

Life in small town America – can be quite clarifying – as in crystal clear.

I have been a denizen of big mega-cities all my life – so this is all new to me. But I am able to see aspects now of why rural America may have a bit more skepticism toward the authorities.

You see, it has been being reported in the local news that we have very minimal cases and all the positive patients are mostly unvaccinated – go and get the vaccine and save your town, etc. All of these positive vaccinated people are just not being counted – but that does not stop them from these misleading statistics being broadcast.

And I know Kamala Harris laments the fact that we in rural America do not have the ability to do photocopies – but trust me – these are among the brightest people I know – they can do math.

So, the Mrs and I were in our Sunday School Class of 150 yesterday. The preacher got done with the lesson early – and looked at the crowd and basically announced that we are going back on the war footing in the church effective today. Absolutely none of his widows, widowers, anyone over 70 or anyone with severe medical problems will be going out for groceries or mail or drugs or anything – we are starting the church plan again where the young people will get their stuff and deliver it. And by the way – those helped will include anyone in the town at high risk. (They did this for 9 months last year – I could not be more proud of these people – there is a reason my county is in the top 5% of mortality statistics).

And then he looked right at me – Doc – do you know why I know of personally more than 20 vaccinated positive patients and our papers are not talking about that? Should we be careful with these people too? —- Jaw dropped to the floor – but for sure – I am not going to get involved in this misrepresentation – I have been pissed for months about the whole situation….. NO SIR – I have no idea why that is happening – but I applaud your efforts. Everyone needs to be told to get out in the sun, VIT D 2000 units daily, exercise, lose weight, get your blood glucose down. The most important thing – LOOK OUT FOR ONE ANOTHER. I want this whole mishmash about vaccinated vs unvaccinated to just pass us by – We need to rely on each other now more than ever. AMENS from every corner.

The issue – the powers that be are just not going to be able to hide anything from people forever – public health is all about brutal honesty – and the blowback will be severe once the deception is obvious and once the storms have passed. Things like this become much more obvious in small towns – way before they do in the big cities where the media denizens are located.

Did I ever think I would live to see an old clergy member making more sense than our federal public health?

Commenters, I do not know what we are going to be facing in the next few weeks. It may be bad. It may be a nothingburger. But please – take care of yourselves. Take care of your families and friends. Look after one another. We are all actually in this together.

Godspeed.

Lambert StretherJuly 19, 2021 at 3:32 pm
> 70% vaccinated, 30% vaccinated.
I think that’s 30% unvaccinated?
1. IM DocJuly 19, 2021 at 3:35 pm
  Yes – sorry – 70% vaccinated – 30% unvaccinated
  
  KeithJuly 19, 2021 at 4:07 pm
  Thanks for all the info you share. Not sure if this is a proper question, but do you notice break through cases happening more with one vaccine than another? Is it even something the medical authorities are looking at?
  1. IM DocJuly 19, 2021 at 4:12 pm
    I would guess (and it is a guess) that we are about 50/50 Pfizer/Moderna – there is a very small contingent of J&J. And, no, I am seeing no difference between the vaccines at all.
    
    kazyJuly 19, 2021 at 4:23 pm
    “the vaccinated patients are more likely to be a bit more ill. They have much deeper coughs, X-ray changes and fever more commonly than the unvaccinated.”
    Why do you think that those who are vaccinated are more severely ill when they have the virus than those who are unvaccinated who contract COVID 19? Are you suggesting that something in the vaccination is making them sicker?
    
    IM DocJuly 19, 2021 at 4:39 pm
    At this point – I am not suggesting anything –
    In my personal dealing with patients – I am observing – and reporting what I am seeing. I am sharing what is happening on the ground in my life. Answers to this would require virology labs and lab staff – completely unavailable to 99% of America. When/if I ever have any clue why this might be happening – I will let everyone know. Or it may change and I will let everyone know this as well.
    I am reporting only that which is seemingly happening too often to be random chance.
    I am hoping that everyone who is vaccinated (and unvaccinated for that matter) will pay attention and realize that if they are feeling ill in any way they really need to stay at home and call their doctor. And I mean that. Anyone at this point who is having a cough or congestion should be at home and not walking around the grocery store with or without a mask. I think we are all taking this a little too lightly.

TinkyJuly 19, 2021 at 4:43 pm

Thanks Doc. I join the chorus in praising your efforts.

As the evidence mounts suggesting that there is actually quite good natural immunity derived from having been infected, are you getting any sense of its durability?

Also, is there any way to test for previous, though relatively remote (i.e. many months or greater than one year) infections, without having to accept a syringe through the sternum?

Thank you.

IM DocJuly 19, 2021 at 4:53 pm
Again, I do not have a virology or immunology lab handy in my office so those answers are simply not knowable. I am certain, however, this work is being done all over the country in these types of facilities.
However, one can assume things in roundabout ways from other evidence. I have been very careful to note if any of the positive patients (both vaccinated or unvaccinated) have been previously diagnosed with actual COVID. In my panel of patients, that number is right at 18% – counting all cases since JUNE 1. So there does seem to be a fairly significant number of breakthrough from previous COVID infections as well. I have not broken this down as far as timing. I have no data if these patients were infected 3 months ago or 18 months ago. But that does seem to be a fairly high amount regardless of the timing.
As I have heard from the beginning from many many virologists, in this family of viruses, and other respiratory viruses as well, herd immunity is just not a realistic endpoint. There are other commenters that can speak to this issue from much better expertise than I.

AumuaJuly 19, 2021 at 5:24 pm
I still don’t see that there’s anything new appearing about the vaccines and their effectiveness, that we didn’t know months ago. They don’t necessarily protect you from getting COVID, from transmitting it or even from having symptoms. They do protect from life threateningly serious symptoms. I believe also that they do prevent infection altogether in at least some and probably the majority of exposure cases. Just look at the numbers. Infection and deaths have fallen massively in the U.S. since the vaccine rollout began. Yes in the U.K the cases have rebounded quite a bit, but deaths still remain very low (order of magnitude) compared to Jan and Feb. The vaccine may be less effective against some variants. Also not really a surprise.
The amount of speculation running rampant in the wild is very high about all this, and I would hope that we try and stay as grounded as possible here. I am willing to consider that my beliefs about the vaccines might be wrong, and that even the craziest theories could be true. But just because something could be true doesn’t mean it is true. I’m willing to accept even anecdotal data points too if they are coming from someone who has significant first hand experience like IM Doc. But even so that is still only one data point among many. It’s probably going to take a lot of evidence to move me from my basic position that the COVID vaccines are generally effective and safe, with some exceptions.
1. Basil PestoJuly 19, 2021 at 5:49 pm
  The problem is when you say ‘nothing we didn’t know’, who’s ‘we’? The magic bullet theory of the vaccine was pretty widely disseminated, and was even a future assumption being made last year – eventually vaccines would come and everything would go back to normal. It’s losing steam now, but it had enormous traction for a long time without critical consideration of the unknowns regarding this new treatment. If health authorities and the journalists covering them had been up front about this from the beginning, it would have been better for all concerned, if we go by IM Doc’s formulation of trust being the sine qua non of public health.
  The other issue remains over the questions and concerns about immune escape: That a decent vaccine in a population that takes no other controls (because the population has been running with the magic bullet vaccine theory; see eg the CDC’s Mission Accomplished performance) runs the risk of doing more harm than good in the long run, as more virulent and unmanageable variants of the pathogen develop in this amenable environment. It’s this line of thinking that led me to post this comment in Corbishley’s post late last week (reposting because I’m still interested in input):
  I remain unvaccinated but am now a lot more interested in getting one as Australia seems to be on a bit of a delta knife edge.
  A thought occurred to me this week as to how we might better conceive of the vaccinations, which has been my conception without really realising it until I thought about it this week: Thinking of them as a last line of defence, instead of a (or, in many places, the only) first line of defence. That’s to say, we should think of them, ideally, as a kind of failsafe, after taking various NPIs (border control, masking, ventilation) and prophylaxis (vit D, melatonin and the rest). This is instead of the prevailing “magic bullet” cure theory of the vaccine (although this theory is becoming less prevalent by the day).
  I’d be interested in whether you & the other medical/Covid brains trust posters think this line of thinking has any merit/utility from a public health point of view, although I suspect it’s too late to broadly change the messaging now.
  All of which is to say, vaccination remains a tool, as you rightly point out, but not the tool (because as it stands, there is no singular tool to bring this under control. The sooner this is understood broadly by the public the better off I think we’ll all be).
  1. The Rev KevJuly 19, 2021 at 7:38 pm
    Just had this medico on TV saying that we have to “learn to live with the virus” causing me to using many unchristian-like words. This was immediately after watching people wearing masks, deserted streets, lock-downs, testing ques, deaths, businesses shutting down, cancelled holidays, hospitalizations rising. That to me is what learning to live with the virus looks like. To hell with that noise. When I hear a medico talking that way, I am now never sure if he is talking advice from the medical/political establishment or whether he is talking his stock portfolio. That type of question was never on my bingo card as in ever.
  2. AumuaJuly 19, 2021 at 9:08 pm
    You are right, when I say “we” I do mean we who are probably exposed to a higher quality of analysis and opinion than many. I suppose I personally never held any “magic bullet” beliefs about that vaccines because of that (still, they are having a positive effect). And I still see the mainstream constantly pushing the idea that continued spread of COVID is all on the unvaccinated, and that “breakthrough” cases in vaccinated people are extremely rare, like this article from today does. I think it’s becoming more and more obvious that breakthrough cases aren’t all that rare.
2. IM DocJuly 19, 2021 at 5:58 pm
  I think what you are saying is generally very correct.
  The appropriate studies were never fully and completely done on these vaccines, other than minimal studies about symptom reduction and case numbers. That may be what we are seeing right now.
  The big problem is that they are clearly non-sterilizing – they do not effectively help to end transmission. The issue there is that with a virus highly efficient at mutating – that allows many many more to be infected to give the virus many many more playgrounds in which to mutate.
  We have never really introduced a non-sterilizing vaccine into an acute pandemic before. It is very unclear exactly what all consequences that will entail, if any. There are some concerns about this issue from the veterinary literature – but whether this virus has the ability to do what those animal viruses did in the past is really pure conjecture at this point.
  Again – we are all just going to have to realize that this is a WORLD problem – this is not a DEMOCRAT/REPUB problem, an AMERICA/CHINA problem – a world problem – especially now that we are clearly headed for endemic status.
  In our media I hear all the time that endemic status is fine – we just have to learn to live with it.
  Let me clarify something very clearly – MALARIA is endemic – and it kills millions every year. HIV started as a pandemic and is now endemic – and kills millions every year.
  To be “endemic” in infectious disease is not to be a “teddy bear” like it is being presented so often to the American people right now.

neo-realistJuly 19, 2021 at 10:47 pm

The vaccines were very effective against the original variant and the UK one, but less effective against delta. You’d have a lot more very ill and dead people from covid-19 w/o the vaccines. The vaccines targeting the spike protein are a decent short term measure until an effective approach that neutralizes the virus can be discovered.

IM DocJuly 19, 2021 at 11:01 pm
The problem is that if you are indeed allowing a vaccinated person to have minimal symptoms at the same time the virus is not sterilized, you have effectively turned that person into an incubator for more mutant expression.
And then multiply that person by millions. You have to think in large numbers here. Allowing this much genetic mutation capability is a real issue for future variants that could be a lot more toxic.
If the vaccines were sterilizing, the person would have no symptoms AND the virus would be inactivated and unable to change.
That is the concern with non-sterilizing vaccines. It is basically what could happen in the future.

IM DocJuly 20, 2021 at 3:15 pm

To Lambert and Yves and all commenters here –

Sorry to have another update in just one day – but I think this is so illustrative of what is going on right now that I feel compelled to share.

I did not feel well when I got home from work last night. As the night wore on, I began to have a very severe cough, very loud wheezing (I do not wheeze), a mild headache, and a fever of 101. I knew exactly what was going on. As soon as I could, I called work to tell them I was not going in and headed right to medical care to be checked – and indeed I am now positive for COVID. I was fully vaccinated in mid April.

To me, this day was not and if but when. From the very first day in my internship in the big city in the middle of the AIDS pandemic – one of the leading internists in the country told my class – “We do not run from pandemics, we run into them.” My office of fully vaccinated staff has already had one wave of COVID go through about a month ago that somehow I missed – my time was up last night.

I am in great physical shape for my age – very healthy – and am already feeling much better today – I am going to be fine. But what has happened in the interim since this AM – has been eye-opening.

I was actually called by a health department phone operator within an hour or two of my diagnosis. They then put another administrative person on the line who informed me that I was vaccinated – and therefore no quarantine was necessary. I told them right away that was ridiculous – and I would be staying at home for now. Within 30 minutes, someone from the state health department contacted me – and I will be brief – informed me that it was very reckless for me as a physician to be talking about quarantine of myself a vaccinated person – the CDC has told us this is not necessary – you cannot spread the virus – doing this would potentially discourage others from vaccination – It may cost lives – My response – “so having me, a positive COVID patient, hang out in exam rooms or the grocery store with obese diabetic cancer patients is not going to cost lives? Please if you think I am being reckless – report me to the Medical Board – I will happily discuss this with my peers.”

These are the kinds of things that occur with pathologic lying. People actually begin to believe the accumulated lies are truth. All rational thought is completely clouded. I will state for the record – that neither person who spoke to me today was an MD DO RN or MPH. All administrative. I truly believe that most health care workers are beginning to wake up. I think a real genuine health worker would have rotted in hell before making such statements.

I called one of my old students/residents right after this call. He is currently the head of the Internal Medicine Dept at one of our big universities in Blue America. I was informed that out of the 20 or so faculty members in his division – all 100% vaccinated – 7 of them had become ill with COVID in the past few weeks. We kind of laughed nervously about the 95% number for relative risk reduction – and how we as a profession were about to learn that misrepresenting numbers like this to the public was a very bad idea. Then some profound statements from him ——

“I have been dealing with this nightmare called evidence-based medicine for years. Students and residents both now tell me that only peer-reviewed RCT are what they should be looking at – nothing else matters. They would not know the difference between a relative risk reduction and an incidence if they had to – they do not even bother to look at anything but an RCT – therefore they know nothing of medical statistics. This has been on full display for the world to see the past 18 months. Just look at any Twitter feed. We have a lot of work to do.”

And I, IM Doc, have several times discussed the human theater, the “stupid human tricks” of putting your vaccination photos on Facebook or TV as a motivator. And then spend days talking about the bad reaction you had to your vaccine – “I got really sick – Hallelujah – I know it has activated my immune system”. I got so so tired of that chestnut – but it was all over the Internet for months. Any vaccinologist, immunologist – etc – would tell you that was just horse shit. And now you know why that was a very very bad unprofessional thing to be doing. It literally motivates no one, and now there is going to be lots of explaining going on.

My old student today – “Actually the Facebook vaccination meme was the second worst thing. The absolute worst was the whole health care TikTok Video dancing – often done in ERs where there were lines of sick people waiting. It made me want to punch the wall. But now all these kids that put their Facebook vaccination photos online and bragged about it – are going to get to explain to all their patients and friends how they still got COVID after the vaccines – we have quite a few housestaff and students fully vaccinated becoming positive – not just the faculty.”

“Young Grasshopper – pride goeth before a fall”. There are those of us who have been warning that all was not well with our entire approach for months – and were laughed and scoffed out of the room. We as a profession are going to have a lot to answer for.”

All that is from my old student – now a leader in academic medicine – I am so so relieved – people are starting to wake up.

The take home message from where we are today –
These vaccines are non-sterilizing. That means they may limit or eliminate symptoms – but they do nothing for the spread. There are probably all kinds of vaccinated patients harboring active infections at this very minute and they have no clue – the vaccine is making them not sick. But they are sharing it with all around them. Many if not most of them taking no measures because the CDC told them they did not have to – YOU ARE VACCINATED. The good news for today is that the symptoms, hospital, and death all seem to be low. The bad news is all of these harboring the virus are further playgrounds for the virus to mutate. And when you allow it to become more and more widespread – the more likely a really bad mutant will come to the fore. That is THE danger of non-sterilizing vaccines being used for a virus that is profoundly capable of mutating.

My advice today – DO NOT PLAY INTO THE DIVISIVE UNVACCINATED/VACCINATED GAME – at this point and in the near future – it is going to become increasingly obvious this is just not a hill to die on. TAKE CARE OF YOURSELF and YOUR FAMILY. Find and identify any elders in your community that may need help. Plenty of sleep – plenty of sunshine – lose weight, exercise, eat well – vitamin D 2000 daily. AND SMILE. It does wonders.

God bless us all.

Temporarily SaneJuly 22, 2021 at 1:12 pm

Are many vaccinated people getting sick enough to require hospitalization?

IM DocJuly 22, 2021 at 1:29 pm
Yes

Yves SmithJuly 22, 2021 at 7:32 pm

Sorry, there is evidence from Israel. Covid infections are proportional to the vaccination levels in the population. That implies the vaccines provide no/little protection against getting infected but do blunt severity:

https://twitter.com/itosettiMD_MBA/status/1413922415550291968

The US has no info because the CDC, as we have repeatedly said, is not recording cases among the vaccinated unless they wind up being hospitalized.

IM Doc says that via his regular Zoom meeting with colleagues who are affiliated with a major teaching hospital, that there are many infections among the vaccinated. They are seeing symptomatic cases and in this sample, the vaccinated are on average MORE sick. This may be sample bias, in that the elderly and those with co-morbidities would presumably have higher vaccination rates than the population overall. Recall that the elderly also have weaker immune responses. That’s why the winter flu vaccine has a separate, stronger over 65 version. And the vaccines had thin participation of older patients in the clinical trials.

This MD network is also seeing clusters of cases among the vaccinated (as in pretty much everyone in family groups) while the cases among the unvaccinated tend to be more isolated. That is a soft indicator that the vaccinated are propagating the disease (as in it is more likely that one member brought Covid into a household and it spread there than all members in parallel got it outside).

Now the vaccinated are presumed to be less infectious but there is no data either way due to the US refusal to gather any data. It is looking like they are contagion vectors, so even if less so, it doesn’t appear to be much less so.

Not IM Doc, but this one seems interesting:

Lemmy CautionJuly 23, 2021 at 10:06 am

RE: CDC Director Says Delta Variant Of COVID-19 Among ‘Most Transmissible’ Viruses Known

As I read CDC Director Dr. Walensky’s comments about the Delta variant, I noticed she was throwing around a lot of percentages, but no raw numbers. IM Doctor recently warned about this very tactic regarding Covid messaging from health officials.

For example, Walensky says:

The number of new cases has risen almost 250% since the beginning of July, and states with low vaccination rates, including Florida, Texas and Missouri, are experiencing some of the worst outbreaks.

Here’s another one:

Walensky said last week about 97% of people who are hospitalized with COVID-19 have not been vaccinated, describing the situation as a “pandemic of the unvaccinated.”

In the embedded video Walensky gets even more vague, saying:

We are at yet another pivotal moment, with cases rising again and some hospitals reaching their capacity in some areas.

It struck me that the CDC is sure interested in using case counts to scare everyone into getting vaccinated, even though they’ve stubbornly stuck to their guns about only being concerned about tracking and reporting Covid-related hospitalizations and deaths.

So this article is a case of the dog that didn’t bark. Why didn’t Walensky climb up on her hobby horse of hospitalizations and deaths because of this terrifying new Delta variant, which she says is the most aggressive and infectious she’s ever seen?

Using the graphs posted by Lambert each day in Watercooler, I took a look at what is going on in the measures the CDC says are so crucial.

Looks like new hospitalizations are about 9 people (18+ years old) per 100,000 the week ending July 17, 2021. They haven’t been that low since March, 2020.

Covid-related deaths are down to a daily rate of .76 per 1,000,000. They haven’t been that low since March, 2020.

Excess mortality rates are down to 2.63%. That is actually quite a bit below the excess mortality rate of 4.36% reported back in March, 2020.

According to the goalposts set by the CDC itself, we are in better shape than we’ve been in nearly 1 1/2 years.
I’m not saying the Delta variant isn’t something to be concerned about; just that the scaremongering from our fearless leaders continues.

Jeremy GrimmJuly 24, 2021 at 9:07 am

I wonder how young doctors feel about their choice of career. I doubt they entered medicine and assumed the large debts to pay for med-school so they could work as employees of firms run by private equity or Corporate managers. I expect it might take some of the profession out of being a medical doctor.

IM DocJuly 24, 2021 at 9:39 am
I expect it might take some of the profession out of being a medical doctor.
It has taken it right out.
I was in the big city for decades – in a large academic center. About 7 years ago or so – the faculty practices were consolidated into a large “non-profit” run by MBAs. Within a year – I realized I was in a company that may as well be run by vultures. That is literally what they are. The stated goals of the MBA profession are a direct 180 from the MD profession. The fact that these vultures are in charge of everything in a system where the “consumers” or patients are at their most vulnerable is a crime of the ages. My immediate elders when I was a young doctor that are all gone now would have scarcely recognized the current raping mantra employed by these companies. What has allowed this to happen? The pencil necked assholes in the Ivory Towers in Boston and NYC and DC who are MDs who never see a patient but tell everyone how to do it – and then it was hugely made worse by Obamacare.
I cannot stress upon everyone enough – if you have a choice – do not go to any physician that is affiliated with any kind of non-profit. They are often worse than the profit corporations, at least they have some accountability. And I know there are huge swaths of America that have no choice.
My wife was putting constant pressure on me – she was the first to realize that my job was literally killing me. We left the big city – and are now in a very small town in a very remote part of the country. The hospital is run by a board elected by the taxpayers – COMPLETE accountability to the community – and I feel like I have taken a step back in the past when I was young. It has been an incredible change in so many ways. Is it perfect? – NOPE – what in life is? But I can certainly live and thrive here – and not feel I am going to burn in Hell one day.
The elite have completely destroyed the profession of medicine – and have completely dismantled our public health system. Both were once the envy of the world. I hope and pray that we can all see in the past 18 months how vulnerable these losses have made the whole population to the predation of the elites.
I see no solution until we hit the brick wall.

re: Breakthrough Infections of SARS-CoV-2 Gamma Variant in Fully Vaccinated Gold Miners, French Guiana, 2021

IM DocJuly 24, 2021 at 8:18 am

About the French Guyana paper from the CDC

This is how science – the actual process – not the Fauci version – should be working.

I have repeatedly stated that I am seeing much much more vaccinated positives than one would ever have expected. As I have stated, they seem to be much sicker (though not critically so) and they tend to happen in clusters. For the past two months, this has stuck out from the dominant media narrative. I have never had to fight the cognitive dissonance between the media and my own eyeballs in my life.

I belong to a large non-public alumni group of my residency program that has literally thousands of IM docs all over America. The first thing a scientist does is to confirm that your observations are general or something you are just seeing. It was quickly obvious from that group that I was far from alone despite the “minimal breakthrough cases” media narrative.

So, then you do everything you can to hypothesize reasons why you are seeing what you are. I have been a physician for 30 years and that experience plays a huge role as well. Having this gigantic number of breakthrough cases just simply does not happen. I continue to see more than half the cases in vaccinated patients and so do many others. UNHEARD OF IN VACCINES BEFORE NOW.

Part of hypothesizing why is looking to the literature for evidence. Seldom is this found in RCT at this stage. Case reports and series like this paper are critical. They are seeing the same breakthrough ratio. And they have done a lot more viral research than you can. This is a gold mine for my own questions.

Is there anything in the paper that could possibly explain what I am seeing. Lots of times, it is not in the headline part but in all the test results and discussion. And yes, there is a very important finding deep in the results.

Why would clustering and sicker patients be so much more common in the breakthrough patients – there must be a reason for that?

If you look at the brief discussion of cT or cycle threshold you will see that the vaccinated patients have a SIGNIFICANTLY lower cT than the unvaccinated. That is the way the PCR test works. It basically means the vaccinated have a much higher amount of viral active particles than the unvaccinated. That would account for the breakthroughs I and my colleagues are seeing being a bit more ill. And it would explain the clustering. THe vaccinated breakthroughs have much higher viral load so they are much more contagious and the higher viral load makes them more symptomatic.

So we now have a suggestion and strong evidence that the vaccinated population may be spreading much more virus than the unvaccinated. I would say that is a critical public health issue and must be further researched immediately.

This Certainly needs much more work. THis is not confirmatory of any conclusions. But it is consistent with observation on the ground – unlike most of what the media has been spewing to the American people. But this is how science works. This paper is about the gamma variant but a conference yesterday with experts discussed that similar findings were being found in delta and lambda. The suggestion in this paper is now on the front of my mind. I am even now thinking of ways to confirm or falsify these conclusions going forward. This is science.

Another issue. The writers make the point that the breakthrough rate is extremely divergent from the expected rate. The difference is this paper documents what is happening in REAL LIFE. So much of what we are hearing on our media about vaccine efficacy is research being done in vitro. It is presented as gospel truth. I just want to scream.

I am doing great and thanks for all the kind words. More about my week later. The commenters here are the best in the internet and I so appreciate my time here.

ShondeJuly 24, 2021 at 10:18 am
First of all, thank you for sharing all your on the ground observations.
A question: You were tested for the virus and found positive. Do you have any idea where your test landed on the cycle range when you were found positive?
1. ShondeJuly 24, 2021 at 11:30 am
  After posting, I realized this is a personal question. I withdraw the question.
2. IM DocJuly 24, 2021 at 11:37 am
  Because I am a very persistent physician – they did share with me the number – 18. And later this week I did find out it was the delta variant. If the delta variant has reached my remote location – you can be assured it is now everywhere.
  The subsequent tests I have done they have refused to supply the number.
  I was fully vaccinated in mid April.

DeanJuly 24, 2021 at 10:54 am

The article discusses cT values;

“CT values were not different according to the immune status: median (interquartile range [IQR] of Ct (RdRp1) = 29 (25-35) for non-immune (n = 3),
21.5 (18-25) for vaccinated 1 dose (n=6) and 23 [21-27] for vaccinated 2 doses (n = 13), p = 0.15 with median test. For RdRp1: median [IQR] = 28 [25-33] for non-immune (n = 3), 20 [20-23] for vaccinated 1 dose (n = 5) and 23 (21-26) for vaccinated 2 doses (n = 13), p = 0.09 with median test. For N gene: median (IQR) = 32 (30-34) for non-immune (n = 2), 26 (25-28) for vaccinated 1 dose (n = 5), and 27 (26-31) for vaccinated 2 doses (n = 14), p = 0.30 with median test”

The P values do not show a significant difference. One problem is n is so small it is hard to detect a difference if it exists.

There is this Nature communication:

Initial report of decreased SARS-CoV-2 viral load after inoculation with the BNT162b2 vaccine

https://doi.org/10.1038/s41591-021-01316-7

IM DocJuly 24, 2021 at 11:12 am
Yes – these are all true – however – this was a case series – never meant to be a definitive discourse on that issue. If you read what I said – this is a possible signal. Nothing is confirmed. But a very important one. And certainly goes right along with what I am seeing. And a huge swath of my colleagues.The health departments across America should be watching for this right now. But we are not even counting vaccinated positives yet.
There are now press reports showing up about one vaccinated individual being a superspreader person among other vaccinated and unvaccinated. And this goes right to the debate of masking and mitigation. Unfortunately it is also a very important issue for the vaccination of kids in school issue. You have to assume that all the breakthrough cases are all spreading virus – and they have been told not to mask. So they are just walking around everywhere sharing the wealth. Furthermore, if there is even a chance that they may be carrying around a higher viral load – that must be investigated fully. It would in normal times completely change the operating procedure. But again – we are not even counting breakthroughs right now.
In my local area this week, we had a report from the Health Department head about our case numbers. I was on tele because I am in quarantine. It became immediately apparent that they have two books – one with the breakthroughs and one without – Let’s just say they are only sharing one to the public – and I think you know which one. The numbers with the breakthrough cases were very similar to this paper. The media is not really running this down.
1. DeanJuly 24, 2021 at 11:46 am
  I agree with everything in your original comment except the word “significantly.”
  The Nature paper and you may both be correct. You are probably seeing the delta variant while the Nature data were collected in February 2021.
  I agree that health departments and especially CDC should be monitoring and reporting viral loads for all cases.
  Thank you for all the information you provide.
  1. IM DocJuly 24, 2021 at 5:32 pm
    I would like to share with you that I used your comments today when I was debriefing the two medical students here with me this month for their rural rotation.
    A few things that people may not know – July 1 is the first day of the medical year. These kids are fresh right out of their non-clinical 1st two years and this is their very first rotation. To have their very first clinical experiences be in the middle of the mess we find ourselves in at our hospital – and on top of that having their attending succumb to the contagion and have to be quarantined has been jarring for them to say the least. This is about as “real” as real gets. We did our debriefing today on the computer. I will be back in person early next week.
    These kids walked into this morning – 6 COVID patients who were admitted all still in the ER – because there was nowhere for the new admissions to go last night – we are already full. 3 vaccinated/3 unvaccinated. None of these people are horribly sick. But these students are literally scared to death. What a way to start your career. I may be one of the better equipped to guide them through this – because when it was my first day 30 years ago – the AIDS patients were all over the ER.
    I showed these kids this thread this AM. And told them both that it is very very important to use correct and measured language when we are discussing issues with patients and non-medical folks. Little abbreviations and things we say to one another all the time are often not really going to do the job when discussing with the public. Always always remember that. And this is why I so appreciate this site. It seems like everywhere else is an ad hominem hatchet fest in the comments section – and this is such a relief.
    But I ended our talk today with something which I feel is just as important. This is not looking good at all. We may be right back where we were last fall and winter very soon. I urged them both to learn the basic mechanics of medical statistics and medical reasoning. I am afraid we are soon going to be entering territory in the next few weeks when luxuries like RCT and p- and z- scores are not going to be our lot. That is why my teachers trained my brain to look and evaluate things on the fly – ALL kinds of medical research- and to be able to wield it appropriately in any situation – I am going to endeavor to put these kids through the wringer in that regard the next 6 weeks.
    The others I am really more concerned about are the nurses, RTs CNAs front desk people, and the housekeepers. This is WWAAYY more stressful on them than any physician. We should all be keeping these people in our thoughts and prayers the next few weeks. I am already seeing severe strain develop in many of them here around me.

1. IM DocJuly 24, 2021 at 11:19 am
  The article you have given is also from March. So the datasets were likely done in DEC thru possibly JAN They way things are mutating and changing on the ground – and the way we have demonstrated now that the vaccine efficacy markedly decreases in months – I am not sure those conclusions apply. If I am reading it correctly – the patients in that trial had been fully vaccinated within about 40 days. That time window is not valid in our current situation when the vaccinated patients that seem to be the sickest were vaccinated now months ago. Many other things may be going on.
  This CDC paper – if I am reading it correctly – all the data was collected within just a few months of vaccination as well – making it even more critical that we study this issue.
  I do not know – I will ask friends of mine who are experts. But I am hesitant to put much timber into anything that was done in the early part of the vaccination program. Too much has changed.
antidlcJuly 24, 2021 at 11:44 am
“I have repeatedly stated that I am seeing much much more vaccinated positives than one would ever have expected. As I have stated, they seem to be much sicker (though not critically so)…”
Could you please clarify? “They seem to be much sicker”.
“Much sicker” than what? The unvaccinated positives?
1. IM DocJuly 24, 2021 at 12:13 pm
  For several weeks – dating back to mid May – I was seeing groups of fully vaccinated patients becoming positive – but asymptomatic. Most of these situations arose because one member of the family or group was found to be positive because of foreign travel – or having surgery or whatever.
  As this became more and more common – I began to be very concerned about what the future may hold. And the Health Department and CDC were just ambivalent.
  The guidance of the local health department was to ignore this – “they are vaccinated – there is no way they can spread, etc.”. Just as the CDC guidance was telling them to do. I do not much like to have armed nuclear warheads sitting around, and I am very persistent – so I ordered the contact tracing on my own – every close family member or close contact was checked. And to my absolute horror – large clusters of them were positive. But at that time, they were asymptomatic- almost every single one. I have been dutifully reporting these numbers to Yves and Lambert for weeks.
  Then about a month ago – something changed. People were then starting to become ill – and come to clinical attention that way. There were no longer just the asymptomatic patients. And again – on my own – ordered the contact tracing – and found the same thing. Multiple vaccinated family members positive. Multiple bridge group members positive. Multiple church members positive, etc etc. And lately – socials around the July 4th weekend were also clustered. At that point in time – there was no one sick enough to be in the hospital. But the vaccinated positives were clearly more ill than the unvaccinated positives. Heavier coughs, more SOB, more febrile. This included even the younger ones among them. But again – no one sick enough to be hospitalized.
  And then – this week – we have had a seismic shift. We have admitted multiple very ill vaccinated patients – two of which were critically ill. At the same time – we are admitting unvaccinated patients as well. Some of them too are now very ill. We have had deaths this week – all of those patients were unvaccinated. But I am not holding my breath – we now have two critically ill vaccinated patients that I am not sure are going to make it. I do not have the best handle on these situations this week because I am in quarantine. But right at this minute – we have more COVID patients in the hospital since January – and it is right at 50/50 vaccinated/unvaccinated – and I would say they are equally ill.
  It has been fascinating to watch this very orderly step up in severity over time. And then this week the bottom dropped out. And I live in a very vaccinated county – the paper reported this AM a 72% vaccination rate. The only stragglers were the 12-18 group which is below 50. The “herd immunity” concept is certainly not working here. And the local medical folks are just horrified that this is getting this bad after working so hard for this really good vaccination rate. It is reminding me greatly of the ramp up we had last summer – it is almost the same in every way – except it got much worse much quicker. I am hoping it will burn out – but not looking like that so far.
  I will share something else. I have a very small limited patient size – I am in a small town. But I am very attentive to media reports of numbers from other locations. Big cities and big sample sizes give perspective. When I heard last weekend that there were ZERO vaccinated patients in the hospitals in LA – I grew immediately concerned – because that was not our experience at all – It is basically a WHAT HAVE WE DONE WRONG MOMENT….So I called three of my old students who are now on the front lines in the LA area – to the one – the response was “I have not a clue what they are talking about – that is just not true…”. Among the three of them the averages they were seeing were about 75% – 85% unvaccinated in the hospital – and all had had very ill vaccinated patients. I did not feel so bad then. But My God, the media cannot be trusted with a single god-damn thing. I have never seen such a bunch of liars in my lifetime. It is a real tragedy – when we need them the most they are doing propaganda. And do not even get me started on the Health Dept people who are misleading the population like this.

AhimsaJuly 24, 2021 at 6:15 pm

Wishing IM Doc a speedy recovery and many thanks for the updates.

Reports 72% vax coverage in local area and also a
50:50 ratio of vaxxed to non-vaxxed in hospitalised patients.

Let’s do the math! We would really need the numbers of positive tests in both vaxxed (calling CDC???) and non-vaxxed populations to calculate and compare the hospitalisation rates for both groups in order to then calculate the vax efficacy. Of course the vaxxed population skews older and/or has more comorbidities and/or is possibly taking more risks since vaccination, so it’s not quite so simple, but…
IF we assumed equal rates of infection in both populations (i.e. 28:72)
(a big assumption meaning vax efficacy against infection is null)
Then efficacy against hospitalisation is 61%

IM Doc’s cases:
X = Vaxxed hospitalised = NON-vaxxed hospitalised patients
Vaxxed hospitalisation rate = X/72
NON-Vaxxed hospitalisation rate = X/28

=> Risk Ratio = X/72 ÷ X/28 => 28/72 = ~0.39
=> Vaccine Efficacy = (1 – Risk Ratio) = 61%

LA Story:
Colleagues seeing 75%-85% non-vaxxed in hospital.
LA reports 70% vaccination for >16 yrs old.
Again assuming equal infection rates (i.e. 30:70 non-vaxxed:vaxxed)
Then 80:20 hospitalised patients suggests
~89% Vax Efficacy against hospitalisation, i.e. 1- (20/70 ÷ 80/30)

As you can see from these simple calculations, it is really important to know the vaccination rates AND the rates of infection, otherwise there is no way to make any sense of the no’s in hospital!

Note: to produce the (acceptable?) efficacy rates above, I had to assume 0% efficacy against infection which would make a mockery of the idea of vaccination passports and dropping of masks.
Finally, if the rates of infection are greater in non-vaxxed (presumably so?) then these efficacies really start dropping off.

PLEASE REPLY if you see an error!

IM DocJuly 24, 2021 at 8:19 pm
You are very correct on how you did the numbers.
And this type of wide variation is to be expected in the real world – that is the way it goes. And another very severe confounding issue is the absolute gigantic chasm of numbers between these two data sets. I am in a very small area with a very small N. LA is gigantic. So theoretically, the LA numbers would have a much higher statistical power. However, there are an infinite number of confounding variables that must be taken into account in a side to side comparison. I have chills when I hear the media making all these god-like pronouncements about this place or the other. It is just very difficult to compare apples to oranges and they really should not be making blanket statements about every locality based on numbers coming from just one. This habit has been yet another bad side effect of our sterilization of the local health departments and the dependence on one centralized center.
The other issue left off your calculations is the number of people who are very ill and suffering at home. This is not a small number. I know this for a fact because there are about 10 patients on our call list that are COVID positive and very sick and we call them twice daily. They refuse to be in the hospital, largely for financial reasons. That is almost certainly an issue in LA as well.
Another possible confounding issue is if there is a much larger group of younger people who are not nearly as likely to be admitted whether vaccinated or not in either LA or here. The demographics and the attitudes of different age groups vary widely between different parts of the country.
The vaccine efficacy of 61% in my area is much closer to what is being experienced in Israel right now for what it is worth.
And thank you for the efforts to do these numbers – you should be a medical student.
One other little pearl to think about. ANYTIME anyone in medicine reports a 100% rate of anything – assume they are lying until proven otherwise. I would assume that to be the case in every field. There is no such thing as perfection.
When the LA report came out last week that their hospital admissions were 399 and all 399 were unvaccinated, I knew right off the bat that they were lying. That just does not happen in medicine. These people need to find better liars. For instance, if they had said 356 were unvaccinated, which is still a respectable number, I would not have raised an eyebrow. But they went for the gold, and earned hundreds of hilarious comments in my doctor’s forum that evening. The average physician in America who is hip deep into these tragedies is really getting tired of all the shenanigans.

IM DocJuly 25, 2021 at 2:39 pm

Anyone who states with a straight face that “the safety data is in” on these vaccines should be immediately disregarded and laughed out of the room.

I have had more patients with DVT and PE in the past 8 months than I have had combined for the past 9 years.
I keep very detailed records of diagnoses on computer databases for just such occasions.

Take one guess that fits together with all but one of the patients in the past 8 months.

It will only be the passing of some serious time and the evaluation of morbidity and mortality tables before we know the safety of these vaccines.

I could spend all day reciting the list of medications the FDA has approved and then years later has to pull because these facts become obvious. The difference now is the facts are actually obvious now to anyone with eyes to see.

antidlcJuly 25, 2021 at 9:17 pm
DVT — deep vein thrombosis??
PE — pulmonary embolism??
1. IM DocJuly 25, 2021 at 11:13 pm
  Exactly.

IM DocJuly 25, 2021 at 6:05 pm

His hypothesis about the delta variant causing the higher loads may be correct.

There is also another hypothesis now out there gaining some signal every day. Many people I know with expertise discussing it. And that is the increasing evidence that viral loads are much higher in the vaccinated. Since we have so many vaccinated now, it would make sense that the overall viral loads are higher. This elevation may have nothing to do with “delta”.

Again, just another hypothesis out there looking for evidence.

Funny how a board member of Pfizer neglected to mention that alternate hypothesis.

Why he continues to be carted out on national television in his obviously conflicted status is all the proof I need that our media is corrupt to the core. How much did Big Pharma pay CBS in ad revenue last year?

IM DocJuly 26, 2021 at 2:26 pm

An update today.

I came back today for my first day of work. I am officially present and not on Zoom.

There were 8 COVID patients in the hospital. 3 vaccinated/5 unvaccinated.

I have discharged all but 1. The crush we had last week is now in the rear view mirror. There are no new people in the ER right now. I have stated this for many months, this virus behaves in a very very strange way. I have made this comment before and I will make it again – this type of behavior is just not the usual situation in the middle of any kind of epidemic. The virus is trying to give us clues – are we smart enough to figure this out?

The outpatient patients continue to roll in. Right now it is about 70%vaccinated/30%unvaccinated. No one on the horizon right now needs to be in the hospital.

Overall – good news right now. We are all keeping our fingers crossed in our community. No one is taking their eye off the ball. I truly feel a lot of our seeming improvement here is due to the efforts of the local church officials stepping in and making sure we are doing everything to keep our vulnerable at home. And the civic clubs are helping this out a lot as well. Everyone is stepping up to the plate.

And guess what? We have all decided together this is a community problem. There are GOP and there are Dems doing this altogether. We are ignoring all the crazy messaging coming from the media. I could not be more proud of these people.

Again – good positive developments – we hope it stays that way.

PatJuly 26, 2021 at 3:04 pm

So I have started what may be a long journey to find a physician now that I have Medicare. With the exception of an emergency room visit I have not seen a doctor in almost a decade. My previous physician, along with other colleagues from an innovative service once offered through Beth Israel belongs to a newer practice with a $50/month fee. I think it could be considered a PMC upper middle class concierge service. I have now stumbled across a different version of that, one that has gone public on Nasdaq. They only charge $199/year, but there is no indication of that on the listings of their physicians on Medicare.gov. But the Carlyle Group liked them well enough to invest over two years ago. Dropping a Medium column on them here, but what may be of the most interest is the comment from two weeks ago.
Medium on One Medical

This wiped out more than a few on the list I made to call to see about an appointment. Like I said it may take awhile. Sigh.

PatJuly 26, 2021 at 6:21 pm
Correction. My former doctor’s subscription was $50/month last I checked it is now $100 for the first family member with a sliding scale for the rest of the family. All medical care is on top of that. I think they are full on concierge care for the wealthy.
IM DocJuly 26, 2021 at 7:00 pm
I find the whole concierge model to be very troubling.
These physicians often have panels of patients that number only in the 100-200 range. The problem is that 10-15 years ago, the residency slots were numbered and designed for the calculated population that would need them. The average internist has 1500 – 2000 patients in their panel. When these physicians switch to this model, the other 1300 patients that do not stay with them get tossed to the wind. When 20-30 of the internists in a community do this, the chaos is overwhelming. This is happening all over our big cities right now. This is part of the reason why it is so very difficult for Medicare patients to find a PCP.
I get very discouraged at times with the behavior of my colleagues. It is bad enough to do this to all those people, but then we start in with segregated waiting rooms, and “medical spas” and do not get me started.

re: “Spare Us Your Covid Hypocrisy, Republicans” [Joan Walsh, The Nation]. “Republican Alabama Governor Kay Ivey got a lot of attention last week when she urged her constituents to get vaccinated as a new wave of Covid cases crowded hospitals and ICUs…. Ivey herself is partly to blame, for waiting so long to make a vaccine pitch…” • Well, it’s Joan Walsh, so we expect this:

I just received my final dose of the @pfizer #COVID19 vaccine. I appreciate the medical staff at Baptist South for their service & professionalism. Vaccination is critical to overcoming the pandemic. I encourage those eligible to get vaccinated. #alpolitics pic.twitter.com/KjXMBYYqpI
— Governor Kay Ivey (@GovernorKayIvey) January 12, 2021

IM DocJuly 27, 2021 at 3:31 pm

About the Joan Walsh/Salon sequence above in the links – about Kay Ivey not being gung-ho about the vaccine.

As usual, these media types never surprise me any more – what a liar!

I am getting very tired of the whole blame the unvaccinated trope. Maybe it is me being a physician for 30 years – having been part of numerous epidemics of the flu which were pretty bad in their own right – and having absolutely no one say a word about anyone’s vaccine status. My job is to take care of people where they are – it is not to judge them when they are ill. The media is doing the devil’s work for sure. Psst – guys – it is not working. I am on the front lines – believe me – you are making things much much worse. It is almost like you want a civil war.

An update for today – I have had a new superspreader event that I am dealing with all morning. So far no one in the hospital – but we are getting close on two different patients. This particular time was a planned event. There were 20 invitees – and part of the condition of coming to the event was all had to be vaccinated. So far we have 12 positives for sure – and 3 more who are sick and likely positive. All fully vaccinated. Again – no one in the hospital. The sick include many 20somethings breakthroughs. Interestingly, many of these people were just vaccinated in the past month in response to being invited to this event. So at least in their bodies, the vaccine has not “had time to wear off” – but positive they are. We even have managed to infect two of the hired staff – both vaccinated. And that was it. There were no others involved. No unvaccinated deplorable to blame. Gee whiz – this virus just does not take the time to read the Salon.com narratives. Multiple others in contact with them are now being tested. I have not had time to deal with the health department yet, but almost assuredly, none of these people will be counted – they are not hospitalized nor are they health care workers.

We still have just the 1 patient in the hospital who is doing better – and there are no new ones in the ER right now. Still pretty quiet.

In my old urban core hospital before I moved to this area, the unvaccinated are about 75% of the admissions. The other vaccinated 25% are mostly diabetic, obese or immunocompromised – mostly elderly. Basically, the same crowd that fell victim last year.
This is the same city whose reddit and twitter feeds are playing one video after another for the past month of multiple gigantic night clubs of all ethnic backgrounds with thousands of people bumping and grinding with no mask in sight. And yet Joan Walsh has the gall to just blame “the unvaccinated” for this situation. There really is no shame – nor is there any medical truths in these proclamations. There are consequences when you put all your eggs in just one basket when dealing with any epidemic. We have NEVER – NOT ONE TIME – deployed this public health strategy in my lifetime.

I am pretty much telling all my patients right now on every visit – It is clear that these vaccines offer you no immunity from getting COVID. It is literally a flip of the coin. They do seem to at this point make the symptoms less. That is all I am willing to tell them – because I am now reporting truths that I am seeing with my own eyes. Long ago I realized that telling even white lies to patients is never a good strategy. So I do not.

For those who are at special risk – the elderly, the obese, diabetics, or immunocompromised – all visits are on tele – and I am encouraging them strongly not to leave the house.

I still strongly feel that high risk patients should be vaccinated – and I go through this multiple times daily.

For everyone else – out in the sun as much as possible, exercise, lose weight, vitamin D, decrease stress, sleep well, and hug your kids and your spouse as much as you can. Do not , like Joan Walsh and many others like her, be the source of contention and strife.

Sorry about the rant – it gets harder and harder to stomach the lies.

Take care and God Bless.

IM DocJuly 27, 2021 at 3:53 pm
In my last paragraph – Should have added – For everyone else – vaccination is certainly OK – I am never going to discourage it. But if you do not – get out in the sun, exercise, etc etc.
This is a decision we are all going to have to make. And I am afraid for all the Joan Walsh types out there that celebrating deaths of unvaccinated patients like I have see in the media repeatedly this past few weeks is unbecoming of a moral person. It is literally ghoulish. And is making things much much worse for those of us trying to do the right things on the front line.

JohnJuly 27, 2021 at 5:04 pm
I had the one shot J&J vaccine because that is what was on offer when I got an appointment in early March when appointments were hard to come by. The J&J vaccine is not mRNA, but the older vaccine making method. All the commentary I see and read refers to the mRNA vaccines. Are there breakthroughs with J&J? Shall I need a booster shot? I am way over 65 and in generally good health. I walk, garden, take vitamin D, hug the kids and grand kids, and am a fan of IM Doc’s commentary. I would really like to hear from the knowledgeable about the prospects for those of us vaccinated with the J&J jab.
1. IM DocJuly 27, 2021 at 5:11 pm
  There are far far fewer people vaccinated with J&J, so with most of the people we are dealing with the other two. But yes indeed, breakthroughs have occurred with J&J that I know of. I just could not even begin to comment on the numbers.
  At this point, I just view people as vaccinated fully, vaccinated partially, or unvaccinated.

IM DocJuly 27, 2021 at 7:56 pm
Dr. Walensky’s assertion today was that the virus now has the capability of having as much viral load in the vaccinated as the unvaccinated. She used the word “rare” – but they have used that word in other things this past 18 months that did not end up to be so “rare”. Furthermore, I have heard from other trusted colleagues that this issue is indeed a problem – and the word “rare” never came up in their discussions.
As I have reported earlier, there has been signal in a few case studies released over the past week that this may be the case – and that indeed the viral load may actually be WORSE in the vaccinated. I am talking about SIGNAL in studies, and not statistical significance because the case numbers in these series is so low. But the patterns are defintely there. And I have seen this same pattern in my very own patients when I have their cT numbers before my eyes in the past few weeks. My own vaccinated self had a cT of 18 when I was COVID positive last week. That is a fairly low cT indicating a fairly large viral load.
If this is indeed the case, and when that realization really hits the American public, my prediction is there will be hell to pay. We do not know what “scared and angry” has the potential to be.
Just think about it – the science is giving us at least some signal that the unvaccinated have just as much to fear from the vaccinated as what the media is trumpeting right now about the unvaccinated. Trust me, there is a reason this mask mandate issue is at the forefront again, and it is not just the case numbers.
This is why I have been urging people to knock it off with all the unvaccinated hatred. That ire may end up being misplaced. We are all in this together. This is completely unbecoming of our country.
Think even a bit further down the road. We have now vaccinated most of our entire health care system. These workers are in very very close contact with all kinds of patients daily. Masks are better, but certainly not perfect with aerosolized viruses. If this all holds up to be true, these health care workers may be spewing forth all kinds of virus loads in the hospital.
I do not know about you, but this sounds like a rather potentially explosive situation. I certainly hope this is not the case – but facts must be faced head-on. The hateful rhetoric coming from our media, our politicians, and many of our medical people needs to stop right now. They are just fueling the fire. I truly feel that some of them are doing all they can to start a civil war. I just can no longer fathom what is happening in this country.
1. Yves SmithJuly 27, 2021 at 8:34 pm
  To be clear, another reader interpreted the same study differently. I am a little nervous about reaching conclusions based on one paper with a very small sample that didn’t point strongly either way. As reader Dean noted:
  The article discusses cT values;
  “CT values were not different according to the immune status: median (interquartile range [IQR] of Ct (RdRp1) = 29 (25-35) for non-immune (n = 3),
  21.5 (18-25) for vaccinated 1 dose (n=6) and 23 [21-27] for vaccinated 2 doses (n = 13), p = 0.15 with median test. For RdRp1: median [IQR] = 28 [25-33] for non-immune (n = 3), 20 [20-23] for vaccinated 1 dose (n = 5) and 23 (21-26) for vaccinated 2 doses (n = 13), p = 0.09 with median test. For N gene: median (IQR) = 32 (30-34) for non-immune (n = 2), 26 (25-28) for vaccinated 1 dose (n = 5), and 27 (26-31) for vaccinated 2 doses (n = 14), p = 0.30 with median test”
  The P values do not show a significant difference. One problem is n is so small it is hard to detect a difference if it exists.
  What I do get is you’ve seen enough cases of high viral loads in the vaccinated in your own hospital to question the party line.
  GM also wondered via e-mail if the causality went the other way:
  Regarding the C_t values — this might be a case of a an inverse causal relationship combined with selection bias.
  For those vaccinated people to end up in the hospital, the infection has to have overwhelmed the antibodies that they have.
  So it might be that it is not the case that vaccinated people have higher viral loads, but that it takes a higher viral load to land a vaccinated person in the hospital than an unvaccinated.
  Obviously, that’s a speculation, but it’s the only way I can see to make sense of that observation (which others have made too). Because prior the vaccinated starting to fill in the hospitals, they had higher C_t values
  … in effect, some vaccinated were getting themselves in high-contagion settings. You as an MD treating sick patients would be exposed to more virus than the average person. Vaccinated people going to crowded bars (where people speak loudly to be heard) could get themselves in a similar position. The CDC basically told vaccinated people to go do stupid stuff en masse.
  1. IM DocJuly 27, 2021 at 9:35 pm
    Yes – I agree with all you said. The one thing I would point out about the above observation as related to the case study in French Guiana miners – is none of those patients were sick enough to be in the hospital and the pattern still held.
    I will repeat what I have said before. This situation is getting serious. We may not have the luxury for perfect studies. We certainly did not in the AIDS crisis. I know for sure that well-qualified people are looking into this very situation.
    Whatever happens, we must somehow find it in ourselves to stop the blame cannons and start working together as one. Or this is going to get really ugly really quickly.

The rest of July will be in the next post as I'll be including the full text of NC's next article.

comments

One way to stop annoying my subscribers...

2021-11-02T23:27:45Z

I figured out that I can post the lengthy IM Doc posts without having them show up on everyone's reading pages. Is that something you would appreciate? I know those posts are really long and they probably clutter up Reading Pages with things that aren't everyone's main interest. Then again, one or two people have subscribed to my posts since I started posting those "captures" of the NC posts.

If you would be so kind as to leave a comment below indicating your preference, I'll go with whatever seems to make most folks happiest.

The IM Doc posts will continue to go up, so you can always just click directly to my journal to see what's new.

comments

Great News!

2021-10-30T18:06:29Z

Yesterday I ventured out onto one of our nation's busiest highways and happened to spot a billboard that can allay everyone's fears. It said:

Covid-19 vaccines help
prevent death.

Folks, this is amazing - now, while in the act of driving (itself one of the riskiest endeavors of daily life), we can be assured that being injected with a magic potion can reduce the risk of driving-caused death significantly. Happy day! And we'll be protected from falls from ladders, nosocomial (and antibiotic-resistant) infections, heart attacks, and cancer. Wow!

Oh, that's not what they mean?

I don't know, sure sounds like they're digging deep into the box of fears to come up with some way to encourage the courageous to backpedal. I'm not sure this strategy of conflating vixenation with immortality is going to make thinking people suddenly agree with "expert" opinions, though.

I did laugh out loud, though, and they do say that laughter is the best medicine, so there's that.

comments

IM Doc pt 19

2021-10-02T00:27:06Z

This one features GM (another commenter) as well as IM Doc

An Indictment of US Covid Policy

Posted on May 19, 2021 by Yves Smith

Reader GM, who has an aura-of-burning-rubber resume (membership of several elite scientific institutions) and hangs with scientists who have published dozens of cutting-edge immunology papers, including on topics directly relevant to the intricacies of Covid pathogenesis, has provided, through a series of e-mails, a damning critique of US Covid policy. Thanks to America’s status in the global economy, it is well nigh impossible for other countries to pursue a markedly different path. As he described in a recent e-mail:

The question that I have no answer to is when exactly was it decided to not contain it. If you remember, some information came out about early and mid-February 2020 closed Senate meetings, after which senators were selling their shares in hotels and airlines, i.e. what was going to happen in late March was known at that time. But it was not in fact too late to contain it in early February, it could have been done with test-trace-isolate. So maybe it was perceived at the time that it could not be, assuming the decision was made as late as possible within that timeline. But the earlier that decision happened, the more nefarious motivations one would have to suspect were involved, because why would you not at least try to contain it when it was eminently doable? After all SARS-1 was contained even though it reached hundreds of cases in Canada and the US. And then what followed was the outright sabotage of testing and detection by the CDC,1 the CDC allowing strongly suspected to be infected people to just get off their flight and walk right back into the community, and a rather long list of other such absurd actions. Maybe one day internal information will leak and we will learn the truth, who knows…
Also, this all becomes even more gruesome when one realizes that the decision of the US to allow it to become endemic meant the same decision was imposed on most of the rest of the world, as the US controls it. As I said above, Eastern Europe (except for Belarus and Russia) took it very seriously early on and locked down before it had gotten out of hand, and was in fact very close to elimination. Montenegro, which eventually ended up being one of the worst affected countries, actually did eliminate it in May 2020.
But once it became clear the US will not eliminate and the EU will not eliminate, those countries had no choice, although they could have at least held out for vaccines instead of letting it rip. There was never going to be a world in which the EU and Latin America have indefinitely banned travel out of the US, not with US military bases stationed all over Europe. And there was never going to be a world in which Bulgaria and Romania ban travel from Germany.
The really sad part is that a country like Russia supposedly does have that independence, and could have gone for elimination and closed borders and a bubble with China. But modern Russia is not the USSR, it’s just as, if not more neoliberal than the US, so they let it rip too, for the same reasons as in the US…
And now some the countries that did the right thing — Taiwan, Vietnam, and Laos — are encircled and battling their worst outbreaks since the start, which is heartbreaking to watch.

Even this site, early on, inferred that both the Trump and Biden Administrations were relying on magic Covid vaccines as pretty much their only Covid strategy. Policy-makers and public health officials were unwilling and/or unable to pursue a path of eradication, which in practice is aggressive minimization: hard lockdowns, followed up by opening only areas where new infections are effectively nil, testing at-risk populations often, and engaging in contact tracing and quarantines. Our rejection of quarantines was a tell that the chosen path instead was simply to keep hospitalizations to a manageable level.2 And bugger any consideration of morbidity.

Quite a few of those who are neither in the Biden-aligned PMC bubble nor anti-vaxxers/anti-maskers, like the biggest nurses unions in America, are upset and confused by the Biden Administration’s Covid “Mission Accomplished” directive of “ditch masks and social distancing if you are among the fully vaccinated ‘cool kids’ group.”3 Even if you buy the proposition vaccines alone can vanquish Covid, this was utterly irresponsible messaging. Where was the warning that the vaccinated will need another shot by early-mid fall?

So far, the main propagator of the notion that boosters are coming has been the drug companies themselves, rather than public health officials. But my impression is that even then, no one has been willing to suggest more than an annual shot.

By contrast, former Harvard Medical School/Harvard School of Public Health professor William Haseltine in Forbes warned that booster jabs for mRNA vaccines to combat variants were probably needed six months after the second shot .

Haseltine recaps new research from Moderna, whose vaccine confers the best immunity. It shows that immunity to new variants, as shown by antibody levels, is likely to last only 6 months from the initial shots, and for The Original Covid, eight months. Some researchers argue that T cell and memory B cell immunity could last longer; Haseltine isn’t willing to bet the farm on that.

This finding is consistent with our uninformed layperson best guess. We repeatedly pointed out that experts estimated that immunity after having contracted Covid lasts six to eight months. Even though we accepted the notion that vaccine-conferred immunity would be more robust (as in would enable the recipient to combat higher viral loads and might also offer more protection against variants), that didn’t amount to proof that vaccine-conferred immunity was longer-lived.4

From Haseltine:

The majority of new infections in the US, Europe, and most other countries are now driven by variants….
A new preprint study conducted by Moderna describes both the hope and challenge of booster vaccines as an approach to the solution to the problem of variants. Their booster shots appear to be effective at neutralizing at least two of the new variants, B.1.351 and P.1. But importantly, their preprint study also revealed the first-generation Moderna vaccine doesn’t protect against the variants for as long as we initially hoped…
When tested for its ability to neutralize the P.1 and B.1.351 strains, the antibodies generated by the Moderna vaccine against the original strain dropped to low or undetectable levels six to eight months after the second dose…If two doses of the Moderna vaccine amount to six months of protection against the variants, other vaccines are likely to guarantee less.

So not only is the Biden Administration failing to prepare the public that those who’ve gotten their shots will need to take another in a few months, they’ve also effectively trash-talked what proved to be pretty effective public health strategies of masking and social distancing. Look at how New York City went from being a Covid disaster area to a good performer before vaccinations were readily available. Yet Team Biden has effectively endorsed the Covid-denier line that wearing masks is oppressive.

GM warned where the combination of infection level and vaccine effectiveness lead:

Unfortunately, with many respected scientists jumping on board of the optimism hype train (it was quite noticeable how the mood shifted on purely scientific matters that had absolutely nothing to do with politics a few months ago), the wrong message has already been once again sent to the public, and we can expect disaster in the future.
Non-sterilizing vaccines mean the virus will not only get the chance to evolve complete escape but will be channeled in that direction. But it also may be channeled in the direction of being much more virulent as a side effect of its fight with the vaccines (this can get quite detailed on a molecular level so I will not go into it right now).
The math does not look good — the unmitigated-spread R_0 in February 2020 was much closer to 6.0 than to the usually cited 2.0. But the current variants have undergone adaptation and are much more contagious. Let’s say we have R_0 = 6. And let’s say we reach 70% vaccination (it’s hard to see how we will get higher), and that transmission is cut by 80% (this, however, is simplistic — it is quite likely that transmission is cut by 80% in the first couple months after vaccination, but then the first thing that will wear off is protection from infection, with protection from severe disease going away last). That’s 56% effective vaccination. But the herd immunity threshold for R_0=6 is 85%, a lot higher, i.e. it will continue to spread. It might in fact continue to spread even with 100% vaccination with a full return to 2019 in terms of lack of social distancing.
So we should absolutely never have gone down the path of “solving” this crisis with vaccines and not doing anything to stop transmission. The vaccines should have been used as one of the tools to eliminate the virus, but in combination with NPIs.
If evolution featured in the thinking of our overlords, they would not have settled on this as the “solution” to the problem. But either it does not, or they just don’t care.
P.S. Some more sobering simple math. Let’s say the vaccine is 90% protective against severe disease over a period of two years. Then one can expect to have on average three serious COVID episodes by the time he is 60 even if he is always up-to-date with his biannual vaccinations (and there is no knowing how much more virulent to young people it will have become in the future with all the serial passaging). We now see what round #1 of mass reinfections looks like in India. So that is the “solution” being offered right now. However, it will probably not happen as one giant apocalyptic wave so it can be pushed to the background as a non-problem.

Mind you (and GM has discussed these on other threads), there is a promising nasal vaccine under development that should be able to achieve sterilizing immunity, and that could even start being distributed if everything goes right by end of 2022. That sort of vaccine could be a game-changer. The current ones are enablers of “life with Covid” and not “life after Covid”.

IM Doc has pointed out that past great pandemics had a first wave, then a more acute second wave, and somehow the virus and humans reached an accommodation. So it’s possible Mother Nature will bail us out after we go through some more collective pain.

Another avenue the US has not taken all that seriously is treatments. We reported yesterday, for instance, of a retroviral treatment developed in Queensland that reduced Covid viral loads in mice by 99.9%. IM Doc is a bit leery since he’s seen retroviral based treatments go spectacularly south in some cancer and autoimmune disease patients. But biomedical professor KLG had speculated earlier that ivermectin and another (one or two) antivirals that attack other parts of the viral replication pathway will be one answer to COVID-19, each given at a relatively low dose and working synergistically: “This is how AIDS was turned into a manageable chronic infection in most HIV/AIDS patients.”

So there is hope of eventually getting off the inertial path, but make no mistake, the one our putative leaders have put us on is not pretty. GM made this call on May 8, the week before the “Mission Accomplished” reversal:

GM made this call on May 8:

….the path forward …. “personal choice” on how much you can protect yourself, but nothing will be done to stop transmission aside from vaccination. The US will easily tolerate 100-200K deaths a year, probably even more, as long as hospitals do not collapse. And the truth is that while they were close to collapsing on several occasions, at no point did it become an India-like situation.
And that is fine as far as the powers that be are concerned – the only real constraint there ever was was that there should be no people dying on the street outside of hospitals because that is very bad PR and it runs the risk of the public waking up and demanding that an elimination program be implemented (which is fundamentally impossible without the absolutely abominable idea of taking from the rich and giving to the poor). How many people die overall does not matter (especially given that we know very well which people will be doing the dying and which people will be living comfortable secluded from it all lives). BTW, this has a corollary – expanding hospital capacity is something that we do not want in the West, because what it means is a lot more people dying and becoming disabled for life in absolute terms, as it raises that tolerance limit. This is one reason the late-2020 wave was met with a lot less restrictions than the Spring 2020 one. Even though it killed 2-3X as many people. Hospitals were “prepared”. Again, this perverse logic works in the West. In less privileged places people will be left to die on the streets.
This also highlights the more generally perverted logic of Western medicine and healthcare systems – we only care about “treatment”, not about the actual health of people.
Of course nobody wants to listen, so a lot of suffering lies ahead.

Yes, we’ll get through Covid collectively, but many people and families will suffer unnecessarily due to weak and incompetent leadership and lack of concern for the general good. This is yet another product of neoliberal cognitive capture.

____

1 From GM in a different thread:

For the record, to those of us in the molecular biology world, what the CDC was doing in January and February 2020, when it simultaneously could not put together a working test for the six to eight long crucial weeks of silent undetected spread, while preventing others from developing their own, looked like deliberate sabotage of containment. It was hard to explain in any other way — I’ve mentored high school students who were successfully doing much more complex designs of molecular biology reagents in 9th grade, it is not rocket science, plus there were already working designs from other countries, and it was quite literally a copy-paste matter to adapt those. And then there is the question of why would you possibly not allow others from working out their own tests and also demanding that samples be sent across the country to Atlanta, when literally every minute was of the utmost importance?

2 Please do not present New York’s quarantine as a counterexample. I went in and out of New York City several times while it was on (to see doctors). It was a joke. I did not have to change a single thing I had planned, for example.

3 The plural of anecdote is not data, but I am seeing even some resistance among my tiny sample here. I saw an older but fit looking woman at the drugstore wearing a serious-looking mask and thanked her for doing so. She said she was fully vaccinated but thought it was way too soon to stop masking. I assume her logic was to model appropriate behavior.

4 Mind you, getting Covid is a really bad idea; we are simply leery of the over-hyping of the vaccines.

Adrian D.May 19, 2021 at 8:35 am

I’d add to my comments regarding the ability of any country to contain the virus to ask GM what he thinks of the goings on currently in Taiwan. It’s a country with everything going for it as far as potential containment measures are concerned – an island nation with effective border controls, high compliance to government advice, indoor mask wearing and – crucially effective test-and-trace – the combination of which we are led to believe is sufficient to contain the virus.

But now we have the introduction of more serious, restrictive measures in response to a rapid increase in the rates of transmission. Yes the absolute numbers are low, but what this shows is that even with everything in their favour, this virus is very, very hard to contain without shutting businesses and locking people down/away.

GMMay 19, 2021 at 2:01 pm
Taiwan lowered their guard — they never locked down because they controlled their borders from the beginning, but then apparently they gradually relaxed some of the border control measures and that’s how it inevitably leaked back into local transmission (3 days quarantine for airline pilots is absurd).
What I don’t like is that they are not already under total lockdown with the current case counts — what is happening right now is very similar to what European countries were doing in March 2020, i.e. gradual imposition of restrictions instead of dropping the hammer immediately as Australia and NZ do. This has usually gone spectacularly bad. Once you get above a couple hundred cases a day it becomes very hard to trace all clusters and the only thing that can solve the problem is total lockdown (as in Victoria), and if you don’t impose it, COVID becomes endemic.
The question is whether this is a sign that they are giving up or they just want to preserve for as long as possible the distinction that they controlled it successfully without “authoritarian” measures, in contrast to the mainland, but despite that public health considerations will eventually prevail.
The list of ZeroCOVID countries is very very short now — Thailand, Cambodia and Mongolia have given up, so we are left with China, Taiwan, Hong Kong, Singapore, Vietnam, Laos, Australia and NZ (and a bunch of tiny Pacific Island countries), with Taiwan, Vietnam, Laos, and Singapore battling serious outbreaks now, the most serious ever for the first three.
China will be able to resist the longest, but the others are already under tremendous pressure to open up their borders (the flurry of articles calling them “hermit” countries and decrying the loss of their cosmopolitan values has already started), and it will be increasingly harder to keep the virus out.
In Taiwan there is an added complication — the computer chip factories, on which the whole world depends. Can you control the virus without hurting production there in some way? Probably not. But there is a very serious shortage right now worldwide, and thus an immense pressure to keep those open at all costs.

May 19, 2021 at 11:51 am

I’ve read GM’s comments again and I’m more baffled now. He’s talking about test-trace-isolate in ‘early February’, but how were these tests to be performed? The (in)famous Corman Drosten paper was only published on 23rd January – how could anyone expect an effective system to be in place in a fortnight? It was months before the infrastructure was available. We’re talking about symptoms common to all sorts of respiratory conditions in the months when those were at or around their peak anyway – and yes, it’s more serious than flu, but for the majority of people they’ll likely suffer no more than what appears to be a heavy one.

The most obvious response then – backed up by the established pandemic plans – was to tell everyone with symptoms to isolate. That the US & UK didn’t follow this up with immediate reassurance that whoever did wouldn’t lose their job or income was the criminal mistake then (along with kicking the sick elderly back out into care-homes & probably too lax border monitoring). That they didnt magically impose a functioning test&trace system has to be seen in the context of that time.

GMMay 19, 2021 at 1:27 pm
South Korea was up and running with TTI pretty much immediately, that’s how
1. Adrian D.May 19, 2021 at 2:07 pm
  @GM Yes, well done them for that in their for-all-intents–and-purposes Island state, with COV1 experience, arguably culturally compliant, tech-enabled, wealthy, quite urban population. Can you comment on Taiwan’s need for lockdowns now though? Effective T&T hasn’t stopped them needing that has it?
  1. GMMay 19, 2021 at 2:28 pm
    So Seattle, New York and the SF Bay Area are not wealthy, tech-enabled and urban?
    Even better examples — what is Vietnam? I don’t think they even used phone apps as in South Korea, just did it the old fashioned way. And they did it several times, not just once.
    I commented on Taiwan elsewhere in the thread but it has not gotten past moderation.
    P.S. Also, we need to keep in mind that governments, especially the US government, do not get their information from the media. If random regular people knew we have a very serious problem on our hands in mid-January, and then the events circa January 24th, when the cordon sanitaire was established around Wuhan, dispelled all remaining doubts, it is a safe bet to assume that the US government was aware of what is happening much earlier than those regular people.

Left in WisconsinMay 19, 2021 at 2:23 pm
If the claim is that an effective test-trace-isolate system could have been up and running in the U.S. in two weeks from late Jan – early Feb, then I’m with Adrian D – no way. I’m not sure it could have been done even if one is considering this as strictly an engineering problem but, and this is perhaps the one useful thing that social science has taught us, the social is part of every human activity. Does the two-week scenario account for rioting in the streets? Fox News? Having to do this over the opposition of the sitting President and most politicians? How many new public health workers would have needed to be hired? And trained? In a (pseudo) democratic country at a time when most of us knew virtually nothing? Talk about faith in science. Given what we have learned from this episode, I would not confidently claim we could do such a thing if a future, more virulent virus appears. But I do think we would do better than we did this time. (In this case, I think “we” is the correct subject.)
There is another thing I don’t understand about the eradication argument. As far as I know, everyone agrees that COVID seems to have an original single source. Is the argument really that isolation could lead to the complete eradication/die off of the virus, such that another single case at some point in the future couldn’t kick off another round of global pandemic? Skepticism about this is not an argument for doing nothing – just the opposite – but aren’t we ultimately going to be reliant on vaccines for beating this, in the same way that we are reliant on vaccines for beating polio, measles, TB, etc.?
1. GMMay 19, 2021 at 2:34 pm
  The US government probably knew about the virus in December the latest. They don’t get their information from the media, the media gets its information from them, and even according to the official version of events that has been released, they were informed very early in January.
  We are not talking two weeks to set up TTI, but two months to both close borders and set up TTI.
  Under both the direct zoonosis transfer and the lab leak hypotheses, the virus underwent major changes on its way from bats to humans and does not have an external reservoir. Thus the smallpox model does apply.
  Bats will still harbor a lot of SARS-type coronaviruses as well as a very large zoo of other nasties, but those SARS-type coronaviruses are probably more like the original SARS, i.e. not as transmissible as this one (again, it underwent major changes to make it adapted to humans). We eradicated SARS-1 and will almost certainly have to eradicate SARS-3, SARS-4, etc. in the future. But will we even try after the precedent established with SARS-2?
  1. Adrian D.May 19, 2021 at 5:09 pm
    @GM I bow to your knowledge regarding animal reservoirs.
    Regarding when the US knew about COV2 I’d first wonder whether they alone, apart from the Chinese would have this knowledge. If not just them, then why weren’t other countries taking more immediate steps then? I’d also suggest that there’s a rather large gulf between knowing about a virus and understanding it – I’m not sure we do now even a year and a half later. Yes the responses were slow, yes they were likely corrupt, but they were also (mostly) in line with what was then received wisdom regarding how to deal with such threats.
    1. GMMay 19, 2021 at 6:26 pm
      Presumably other countries knew too, that is correct.
      As I said above, I have no idea who acted when based on what knowledge, and, most importantly, what motivation.
      The events after March 2020 are easy to explain with basic political economy.
      Those from January and February are full of unknowns.

GMMay 19, 2021 at 4:40 pm

IM Doc has pointed out that past great pandemics had a first wave, then a more acute second wave, and somehow the virus and humans reached an accommodation. So it’s possible Mother Nature will bail us out after we go through some more collective pain.

This will probably be different from 1918 though. This is not the flu. Flu pandemics come and go, because immunity against individual flu strains is actually more durable, the problem there is antigenic drift, plus there are hundreds of different flu strains in fierce competition with each other, and they displace each other rapidly.

What we have here is the establishment of a completely new disease in the population — this virus has no competition with other less virulent versions of itself, and immunity against it is much more short lived, plus it does do a lot of antigenic drift, but none of the virulence properties are associated with the regions of the S protein that are relevant to that antigenic drift, so it will not lose them (moreover, they are actually important for viral fitness and thus maintained by selection).

So this is here to stay indefinitely. Which should have never been allowed.

There is a reason why smallpox was eradicated — it is a deadly pathogen with a respiratory mode of transmission, i.e. a very big problem. Once it was eradicated, there was nothing else left of similar severity and ease of spread. TB is still a big problem too, but TB is not an acute infection, it can take decades to kill you. HIV had 100% mortality initially, but it can be controlled with simple behavioral modifications as it is rather hard to catch. Etc.

Now we are likely back to where we were with smallpox. Keep in mind that so far the virus has been evolving towards worse, not better — we now have widespread variants that are probably twice as deadly as the original, and we have seen on at least one occasions the appearance of something even worse than those (B.1.616 seems to be 2.5x-3X deadlier than the regular strains). Thankfully that did not take hold, but it’s simply a matter of time that something else does. The original SARS-1 killed 5-10% of the infected, and SARS-CoV-2 likely does have the potential to eventually return to that level with enough passaging and selection.

IM DocMay 19, 2021 at 2:56 pm

With regard to the lab leak vs natural hypotheses of the origin of COVID 19.

I have sat through several lectures the last few weeks about this very topic.

From what I can tell – there are 2 main sticking points. You say correctly Lambert that nature is fully capable of producing all kinds of genetic variants – and that is very true. But there is great concern that SARSCOV2 may have broken the rules. Yes, there are rules to how this all goes down in Nature.

The genetics of this virus is the first sticking point. 2 issues there. For there to have been a furin complex placed in the RNA structure where it is would have required a recombinant event. My genetics friends tell me that the way this went down is so microscopically unlikely that it is just almost impossible. And then on top of that the furin complex has 2 arginine codons in a row. Why is that important? There are multiple arginine codons available – and the virus has 2 arginine codons just in that area that are NOT USED by beta coronaviruses except for 0.5 % of the time. Instead, the codons that are present in that location in COVID are exactly the CODONS that would have been manipulated into the virus by lab workers not the COVID virus if left to its own devices. The chances of both of these things happening together in nature (the recombination and the arginine codons) is virtually zero. This is why Dr. David Baltimore, an NIH virologist and Nobel Laureate has called the arginine codon problem a “smoking gun” for a lab leak. I am not saying they did it on purpose. There are lab leaks literally all the time. And the other problem was the Chinese Wuhan scientists were using a biosecurity status that was woefully unable to keep things clean – that has been confirmed.

Probably a bigger problem for the nature hypothesis is that absolutely no trace – NONE – of COVID or anything remotely similar has been found in any possible intermediary host animals in China or elsewhere. And believe me – they have been looking like fiends. The Chinese have a vested interest in finding an animal intermediary and it just has not been found. Not a hint. And this is unprecedented in medical science – intermediary hosts are usually identified within months and almost assuredly within a year. The lack of results here is strangely peculiar – and becomes more peculiar with each passing day.

So – we may never know – but the evidence is certainly tilting toward a lab leak. The medical community is really starting to come around on this as well. I have observed an almost 180 in just the past month. It is very very difficult to rebut either one of the above two issues.

This is really the sticky wicket we get into when we politicize the scientific method and process. When “science” becomes political it almost turns into cult-like behavior. Trump said a lot of stupid stuff all the time – and he also said the virus had leaked. Therefore – everything he says must be proven wrong – AND THAT IS NOT HOW SCIENCE WORKS.

This really matters in a big way – because our behavior toward the virus – and treatment must be tailored differently if the virus was man-made.

Lambert StretherMay 19, 2021 at 3:11 pm
On furin cleavage, I’m firmly in the “extraordinary claims require extraordinary evidence” camp. David Baltimore or no, we would never even be considering the Watchmaker Hypothesis if the adaptation had occurred in any other context but this one.
On intermediary host animals, I seem to recall that it took a good long while to trace how AIDS made its leap to humans, and back in the early days, some thought the design of that molecule was so elegant that it, too, had to be man-made.
On Wuhan Lab -> Wuhan Market, it seems to me that knowing Covid was out in the wild in Italy mitigates against the lab leak hypothesis. If the Wuhan Lab Leak was prior to September, why did the leak show up in the Wuhan Market only months later? Are we really saying that the virus leaked from the lab in Wuhan, was carried to Italy, and then carried back to Wuhan?

Jeremy GrimmMay 19, 2021 at 6:22 pm

The tail of your comment:
“… our behavior toward the virus – and treatment must be tailored differently if the virus was man-made.”
How does would a man-made origin for the virus alter the best behaviors [public health response for preventing spread of the virus(?)] and treatment?

Are there good reasons for fiddling with the Corona virus other than to build better bio-weapons? Whether the virus came out of a bio-weapons lab, from a factory farm, or a wild animal market — all of those practices seem very unwise.

IM DocMay 19, 2021 at 10:07 pm
This is very much a Cliffs Note version. This was explained to me in a grand rounds I was zoomed in on about a week ago.
Extremely complicated issues and I will do my best to make it accessible. More importantly, this is very offensive to some but it must be discussed in correct scientific terms.
Most if not all of the human cell lines that viral clones and progeny in the labs are tested on derive from a cell lineage known as HeLa. This is also the case for a lot of oncology and immunology research. HeLa stands for Henrietta Lacks. Oprah made a movie out of the book written about this a few years ago. Truly fascinating. Ms. Lacks was African American.
The hypothesis is that if the virus was indeed habituated in a lab to human tissue it would have been evolutionary selected for these cells. And those cells have other things going on unique to the gene structures of African American people. This may very well be why it seems to be much more problematic for that genetic subgroup – it may have more affinity for their cells. African Americans seem to have much different responses to this virus than even people from Africa.
That would be critical to know. I am doing my best not to offend but science is science.
A similar but profoundly more complicated issue is how a lab cultured virus may be affecting our kids. Also if it was birthed in a lab it has been through entirely way more evolutionary pressure than in nature and that would make it likely much more able to adapt in the wild. The speaker’s concern was that we may be already witnessing this.
There is also concern that this virus came right out of the chute completely attuned to human cells. That is most definitely not natural.
I think the most important issue in why this is so important is this must never be allowed to happen again if indeed it was from a lab. God only knows what other Godzillas have been cooked up.
This is an issue that goes right to our survival as a species.

RE: “Deadly Fungi Are the Newest Emerging Microbe Threat All Over the World” [Scientific American].

IM DocMay 20, 2021 at 2:19 pm
With regard to the fungal infection link above. This is really starting to remind me of my years on the AIDS wards all those decades ago.
Candida and Aspergillus are becoming increasingly common in the hospitals. They are also becoming more and more resistant to anti fungal therapy. And quite often they are very nasty and can overwhelm patients who are already ill in the ICU in a heartbeat. We do not have nearly as many anti-fungals as we do anti-bacterials and many of them are quite toxic in and of themselves – especially those for hospitalized patients.
Candida and Aspergillus are one thing. I never saw what is going on in India now coming from a mile away. They are having a mini-outbreak of another type of fungal infection called Mucormycosis. That too was not all that unusual in AIDS patients.
Here is the problem with “mucor” as it is often referred to in medicine. It is uniquely unresponsive to almost all anti-fungal therapy. It has a real predilection for the sinuses. And the only hope is usually surgical extirpation – as in cut your face off. It is an absolutely dreaded disease and in America is confined to mainly AIDS patients (which we do not see much anymore) out of control diabetics and the severely immunocompromised.
Another fun fact – at least here in the USA – mucor usually takes weeks to fully develop. This is not usually an acute 3 or 4 day process. That rapidity of development seems to be happening routinely in the cases in India – and that is giving physicians a real pause for concern. I have not a clue why COVID would be doing this in India nor have I heard any salient explanations – it is all still so new.
But that is definitely a curveball no one saw coming. Mucor is almost always associated with a completely overwhelmed immune system – and not an acute SARS-like syndrome like COVID.
We live in fascinating times.

Re: UPDATE “What Really Happened With that Weird Yankees COVID Outbreak” [David Wallace-Wells, The Atlantic].

IM DocMay 20, 2021 at 3:14 pm

With regard to the David Wallace-Wells Atlantic article –

All I can say about his commentary about the very definition of public health is YES YES YES.
Maybe, just maybe, we can start to reform our completely broken system when our citizens start to read and understand these issues.

Furthermore, this is one of the first times I have read in a national journal an issue that has concerned me from the beginning. That the cT – is really not a binary test – and many many of the COVID cases that were deemed positive may not have actually been acutely positive or acutely infectious. The discussion he does on the PCR testing is beautiful in its simplicity. We all really must understand this in the event something like this happens in the future.

I am not blaming the average guy. I have seen large numbers in the past few weeks of fully vaccinated, asymptomatic but positive patients. To this day, the cT are not reported to the clinician so we can ourselves easily determine if this is an acute large viral load or if this cT is 40 and likely represents lots of dead virus laying around. It is truly astounding that our federal agencies have not stepped in and made sure this was reported correctly. THESE PCR TESTS ARE NOT POSITIVE/NEGATIVE they are not a binary. How I would treat and react to these vaccinated PCR “positive” people would be totally different if I had the full numbers. But I do not. And after almost 18 months STILL do not.

Furthermore, it is completely unclear and what the motivation would be why they would not insist this is provided. This has been the grist for wild conspiracy theories all year. IF THEY WOULD JUST DO THEIR JOB AND GET THESE ISSUES WORKED OUT WE WOULD ALL BE IN A MUCH BETTER PLACE.

tegnostMay 21, 2021 at 8:30 am

Having just stayed up all night after my second moderna with a fever, racing heart, and body aches so that bezos and the vaccine makers among many others, can make billions. I will never take another mRNA vaccine ever again. when I told the attendant and the nurse both that I had a high blood pressure reaction to the 1st shot they were not at all interested and hand waved it off, indeed the nurse said said “your blood pressure varies so I wouldn’t worry” I pointed out that I take my blood pressure a lot and 150/95 is waaaayyyy higher than it’s ever been she was like oh that’s interesting. What this means to me is that in this stage 3 trial they don’t want to hear adverse effects. Both my sister and a resident of the island have auto immune problems, the guy on the island can’t get anyone to talk to him. I took mine for the team and that’s it.

ambritMay 21, 2021 at 9:12 am
“Vaccine shaming” is taking many forms now. I have been given the “fish eye” once already in a store by other shoppers. (I am still masking.)
The actions and attitudes on display by the public related to the Pandemic, at least here in the North American Deep South, are taking on the characteristics of a religious cult mind set. I can plainly see the physical imposition of vaccination upon the recalcitrant coming soon.
Stay safe. Keep a low profile.
IM DocMay 21, 2021 at 9:19 am
Massive extended increases in blood pressure for weeks after the vaccine have become commonplace in my practice. Fortunately no serious complications that I know of yet.
And some patients BP is being persistently high. They seem to be fairly resistant to the usual meds.
I am certain it has something to do with the vaccine’s action on the vascular endothelium.
Take care of yourself. Take it easy the next several days. And know that despite the people at the vaccine clinic, yes this is a very common issue.

Someone blasted ivermectin because it's an anti-parisitic and IM Doc replied:

IM DocMay 25, 2021 at 8:56 am

I am not understanding your point.

We also give millions of patients with lupus and rheumatoid arthritis plaquenil and that is for malaria.

We give millions neurontin for pain and that drug is just approved for seizures.

I am not understanding your point.

JürgenMay 25, 2021 at 8:48 am

Ivermectin is an interesting and probably underutilized drug. Officially it is only approved for treating multicellular parasites (roundworms and ectoparasites), but there are indications of anti-viral, anti-inflamatory, and anti-protozoic effects. I raise free-range turkeys and have been using ivermectin to treat Histomoniasis, a disease caused by a protozoan, Histomonas meleagridis, to excellent effect. Before I started using ivermectin, by the time a turkey showed symptoms he’d die within 3 or 4 days no matter what I tried. Since using ivermectin I haven’t lost one turkey to Histomoniasis. I give them a high dose, 3-5 times the dose recommended (per kg) for anti-helmitic usage, repeated once or twice in intervals of 48 hours, and the birds show no negative effects, only immediate improvement from the symptoms of Histomoniasis… within 24 hours of the first dose they start eating again, for example.

Of course this is stricly anecdotal, but for me it shows that we have here a very cheap and safe medication that may be effective for a log of things we don’t use it for, but of course there is no money to be made with it, so also no money available to research it further!

IM DocMay 25, 2021 at 9:04 am
There actually is an ivermectin product FDA approved for another condition.
Called Soolantra.
It is for rosacea of the face – WC Fields nose.
This works very well. It is in a cream form. This works by locally tapering the immune response in the skin.
So not just for parasites although that is it’s overwhelming use.
When medical or science reporters write it is just approved for parasites you can know they are willfully lying. It is also FDA approved for this inflammatory condition.
1. JürgenMay 25, 2021 at 10:32 am
  There actually is an ivermectin product FDA approved for another condition. […] It is for rosacea of the face […] So not just for parasites […]
  Apparently the FDA approved ivermectin for rosacea because it kills Demodex mites which are thought to be a contributing cause of rosacea, so still exoparasites. You may well be right that reduces immune response (or at least inflamation due to immune response), but it seems that’s not why it was approved.
  1. IM DocMay 25, 2021 at 1:51 pm
    It is used by dermatologists for all kinds of inflammatory skin conditions having nothing to do with demodex mites – and does very well – the actual indication is for rosacea. This has nothing to do with the original post – but demodex mites are not thought to be a major contributing issue in most cases of either rosacea or these other inflammatory conditions. Many patients yes – most patients no. I just spoke with a dermatologist who specializes in derm issues in people with autoimmune and other inflammatory derm issues – wanting to make certain I was conveying accuracy – and he without hesitation informed me that the main mechanism here is its anti-inflammatory properties. Anti-parasitic creams of other preparations simply do not work well if at all with many of these inflammatory conditions while Soolantra has been a bit of a game-changer for many of them. I have also sat through two non-pharma lectures about the past 3 years – and both discussed this anti-inflammatory property. That is why dermatologists are exploring off label uses with this drug for other medical conditions with inflamed skin. He even informed me that oral ivermectin is now being explored for many inflammatory skin conditions and early research is very positive. In other words it does seem to have anti-inflammatory properties – and this may very well be the reason why if given to early positive COVID patients it prevents them from getting very ill. I have seen this with my own patients and my own practice repeatedly in the past several months since I started using it for that indication.
    1. IM DocMay 25, 2021 at 2:21 pm
      And one other thing –
      I have been to two Zoom lectures in the past 6 weeks or so – one a Grand Rounds and the other an Infectious Disease conference at my old academic medical center.
      Both were a discussion of Ivermectin for COVID. As is the usual case right now, both were making the case to debunk its use. So, therefore, you must take that mood into consideration while listening. These lectures were long before all this data coming out of India. I will say the evidence coming out of other parts of the world is compelling and fully available – but largely being avoided or ignored by American academic medicine. I am not sure how they will be able to ignore the Indian data at this point.
      As is often the case with off-label drug usage, we do not really have a good explanation – at least one that is totally confirmed – as to why Ivermectin would have any affect on COVID.
      One theory is that it has a direct negative effect on the spike protein. The other theory is that has a direct effect on the immune system and tamps down the severe reaction to COVID leading people to be less sick and less likely to be admitted to the hospital or die.
      In other words we just do not know. Further information to come I am certain. Stay tuned. As is often the case, we have no idea how it works. It is a very very safe drug. And I will reiterate, with my own eyes I saw how well it worked this winter during our surge.

Phil in KCMay 25, 2021 at 2:42 pm
Is it reasonable to be agnostic on this treatment and say that we don’t yet know for sure?
At this time last year a lot of folks were hot to trot for Hydroxychloroquine, including some of the geniuses of America’s Frontline Doctors. (Remember Dr. Stella?). Now, you don’t hear much about it at all. Maybe because it doesn’t really work. Maybe because one of the more pertinent conclusions of the few clinical studies concluded that Hydroxy actually harmed some patients and there was no definite proof it helped patients. You might also remember that Trump revealed he was taking Hydroxy as a preventative, again with no clinical proof of its efficacy. Not too long after that came out, he stopped taking it on the advice of several doctors who feared it would do much more harm than good. My point is that there’s a lot grasping at straws during a pandemic. Read Defoe on the great plague of 1665.
WHO recommends using Ivermectin for Covid in clinical trial settings only at this time. Could there be another reason for not touting this treatment while trials are ongoing? Say, not wishing to raise false hopes? And also to remove yet another rationale for not getting vaccinated? (“Why get the shot when there’s a simple remedy available?”).
Not trolling here, being very sincere. We’ve only been dealing with this disease for 16 months or so. How long did it take us to figure out AIDS, for example? I want to follow science, but at the same time I don’t want to breathe down their necks.
As for the profit motive, someone has figured out how to charge thousands of dollars to insurance companies and their customers for insulin and it’s legal, so why would you expect anything different? On that front, I am cynical.
A final thought: if Dr. Campbell finds Ivermectin promising, then I’m impressed as he has been quite reliable during this pandemic.
1. Hayek's HeelbiterMay 25, 2021 at 3:15 pm
  Further:
  “When inventor Frederick Banting discovered insulin in 1923, he refused to put his name on the patent. He felt it was unethical for a doctor to profit from a discovery that would save lives. Banting’s co-inventors, James Collip and Charles Best, sold the insulin patent to the University of Toronto for a mere $1. They wanted everyone who needed their medication to be able to afford it.”
2. IM DocMay 25, 2021 at 5:38 pm
  I understand what you are saying about not raising false hopes.
  As a veteran of the AIDS pandemic – I would suggest that your concerns are very understandable – but quite frankly, now like then, we just simply do not have the time.
  A very similar analogue to what is happening now with Ivermectin was Bactrim back in the 1980s – it was absolutely shat all over as a therapy for PCP in AIDS patient by the medical establishment including Dr. Fauci himself. The medical establishment dictated that we had to use Inhaled pentamidine and other toxic therapies – ( with the similar issue that these therapies were also very toxic to the wallet). Bactrim was and is a very cheap antibiotic. I remember one lecture with an NIH speaker back then that laughed out loud – “We cannot treat the plague of the century with little old lady urine pills”.. Not unlike modern times – “Ivermectin – that is just dog flea pills you morons!”. It was only the networking of frontline docs all over the country that eventually changed the course. Today, we do not have nearly the patients with PCP that we did then – but no one would dream of using pentamidine and Bactrim is now the front line agent.
  There are too many patients dying in these hot-spots like India. The safety profile of Ivermectin is so positive that it should be used without delay in these situations. All we are getting from the USA and the EU is stonewalling and deception – not unlike what happened in the 1980s with our medical leaders.
  Go and read “And the Band Played On” – little has changed.
derechosMay 25, 2021 at 2:59 pm
From the British Medical Journal
Misleading clinical evidence and systematic reviews on ivermectin for COVID-19
https://ebm.bmj.com/content/early/2021/04/21/bmjebm-2021-111678
“Up to February 2021, the (Pan American Health Organization) identified twenty two ivermectin randomised clinical trials through a rapid review of current available literature.34 There is considerable heterogeneity in the population receiving ivermectin, with studies administering it to family contacts of confirmed COVID-19 cases as a prophylactic measure and other studies using ivermectin for treatment of mild and moderate infected cases28 or even severe hospitalised patients. Applied dosis (sic) and outcomes of interest were also highly variable. Additionally, patients also received various cointerventions, and control groups received different kinds of comparators ranging from placebo or no intervention to standard care or even hydroxychloroquine. The authors claim that pooled estimates suggest beneficial effects with ivermectin, but the certainty of the evidence was very low due to high risk of bias and small number of events throughout the included studies. Most study results have been made publicly available as preprints or unpublished, with no peer review or formal editorial process. Others incorporated their results only in the clinical trial register, but nearly half of these randomised clinical trials had not been registered.”
“Concluding, research related to ivermectin in COVID-19 has serious methodological limitations resulting in very low certainty of the evidence, and continues to grow. The use of ivermectin, among others repurposed drugs for prophylaxis or treatment for COVID-19, should be done based on trustable evidence, without conflicts of interest, with proven safety and efficacy in patient-consented, ethically approved, randomised clinical trials.”
1. IM DocMay 25, 2021 at 5:43 pm
  In India – right now – you are seeing a gigantic trial taking place for all of humanity to see. I cannot wait to see how the medical establishment tries to play those data.
  This is so so familiar to those of us in the early days of AIDS.
  1. Phillip CrossMay 25, 2021 at 8:09 pm
    Almost all the trial data is from tropical, third world areas. Places where there is a huge problem with untreated parasitic infestation because of the lack of clean water and poor sewage systems.
    It stands to reason that if you treat a patient’s parasites with ivermectin, they will become healthier, and more able to fight other infections, such as covid 19.
    1. Basil PestoMay 25, 2021 at 10:31 pm
      It doesn’t, however, stand to reason that the vast numbers reportedly seeing a benefit from ivermectin treatment in these ‘tropical, third world areas’ are only doing so because they all had latent parasitic infections. Come on.
      1. Yves SmithMay 26, 2021 at 12:46 am
        Please don’t Make Shit Up. About 2/3 of the population in Africa DOES take ivermectin regularly as a prophylactic. From IM Doc:
        Ivermectin is widely used as a prophylactic agent all over the continent – for sleeping sickness and multiple other parasitic agents. Estimated to be more than 2/3 of the population.
        It is called the Sunday, Sunday drug – because they usually take it every other Sunday. It comes in kits supplied by the country’s individual public health service.
        The first article is here – https://www.sciencedirect.com/science/article/pii/S0924857920304684
        I would direct you to FIG 1 and Fig 3 – the left is the ivermectin group – the middle is the other agent group – and the right is the no agent group – and you can see the results – absolutely striking. The authors do pretzels about the fact that this is retrospective and other things could possibly be going on – but I would say that is pretty striking. And also note – MOST of the continent of Africa is on ivermectin every 2 weeks.
        2nd article – https://pubmed.ncbi.nlm.nih.gov/33795896/
        APOC – is an organization from the UN – the African Program for Onchierasis – so these are the countries that use IVERMECTIN for that purpose – and then compared to the NON-APOC countries –
        The Conclusion – The incidence in mortality rates and number of cases is significantly lower among the APOC countries compared to non-APOC countries. That a mass public health preventive campaign against COVID-19 may have taken place, inadvertently, in some African countries with massive community ivermectin use is an attractive hypothesis. Additional studies are needed to confirm it.
        I love that word inadvertently –
        In brief – I think we must consider Ivermectin as one of the reasons Africa is straddling on the Zero line.

GMMay 25, 2021 at 4:57 pm

As a generic, ivermectin is cheap and widely available, which means there would be a lot less money to be made by Big Pharma if it became the go-to medicine against covid.

Dexamethasone is even cheaper, also off-patent decades ago, and also widely available, yet there was no conspiracy to withhold it from the public. As soon as its effect of reducing mortality by half was demonstrated, it was adopted, and that has saved millions of lives.

IM DocMay 25, 2021 at 5:47 pm
The difference being is that steroids have been routinely and widely deployed in SARS like illnesses like this for decades. To some benefit and to some detriment. But the point being – medicine was used to thinking of steroids in those terms.
Ivermectin is out of left field – and the skepticism was high. Including me. Until I started reading the RCT coming in from all over the planet, started using it – and noticing my hospitalization numbers dropping dramatically in the worst of the crisis here in our town.
What I am saying – docs are used to thinking of steroids in this way – not so much ivermectin. It has a huge hurdle to overcome.
FYI – dexamethasone is one steroid being used – budesonide – an inhaled steroid – is the one mainly being used here in the USA.

datahoundMay 25, 2021 at 7:18 pm
A rigorous new meta-analysis out today shows ivermectin does NOT work:
https://www.medrxiv.org/content/10.1101/2021.05.21.21257595v1
One problem: rigorous apparently means sloppy. They confused the control group with treatment group
1. IM DocMay 25, 2021 at 7:40 pm
  Thank you for posting this –
  Right up front – this from the abstract – Controls were standard of care [SOC] in five RCTs and placebo in five RCTs.
  My comment here – I would have a hard time distinguishing the difference between a placebo and “standard of care” – basically the standard of care at this point is to send positive patient home – and come to the ER if SOB worsens —- OR be dosed with monoclonal antibodies that cost 15000 dollars – and really does not have good data behind it either.
  But the kicker is when any research or papers are supported by “The Zuckerberg-Chan Initiative” my initial response is to use them for bird cage protection. It is by definition something emanating from the “Ministry of Truth” – I am not sure how much more of that I can take.

Stephen BunnellMay 27, 2021 at 8:06 am

From an immunologist:

Re: “ Immunity to the Coronavirus May Persist for Years, Scientists Find New York Times (David L). The triumphalism is so blinding, I’m gonna have to wear shades. Breakthrough infections among the recently vaccinated suggest otherwise.”

1) Breakthrough infections in recently vaccinated are irrelevant unless happing > 2 weeks after the second shot of a two dose immunization. It takes that long to develop and accumulate protective antibodies.

2) In the US, most breakthrough infections are from variants. This is as expected because some variants differ enough from the vaccine that we are somewhat less well protected. This can be solved with a booster for the variants.

3) Some rare people respond poorly to the vaccine because they are immunocompromised. These people are over represented in breakthrough cases. This is normal. They are best protected by herd immunity, which reduces the amount of virus circulating.

4) These are among the most effective vaccines ever produced. If everyone could be vaccinated, the virus could be largely eliminated.

PatMay 27, 2021 at 8:35 am
Said with no evidence attached.
Let’s talk about the trials and data we do have. We have had these vaccines for less than a year. Their trials have been limited. We have anecdotal evidence that there has been less interest and follow through on reports of negative responses to being vaccinated, so the greatest knowledge of the extent and causes are limited to those causing hospitalization. Even with that the responses are more numerous and extensive then covered by the press. And we have it from the CDC itself that unless a breakthrough case is hospitalized it doesn’t existing as far as they are concerned.
My point, your immunologist is making a great many definitive statements about subjects where they have limited or deeply compromised data. Unless they added a whole lot of caveats, this is At best deeply wishful thinking based on the sunniest press reports out there because otherwise…
1. floraMay 27, 2021 at 10:12 am
  from Off Guardian. (they keep moving the goalposts…) :
  MORE Flagrant Data Manipulation from the CDC New report is further evidence the CDC is deliberately hiding post-vaccine “breakthrough cases”
  https://off-guardian.org/2021/05/26/more-flagrant-data-manipulation-from-the-cdc/
  1. J.May 27, 2021 at 7:32 pm
    Um. I read that link, and it says:
    From the beginning of the so-called “pandemic”, waves of asymptomatic “cases” were deliberately created by running unreliable PCR tests on 100,000s of perfectly healthy people every day.
    The entirely predictable false positives were called “cases”, and these manufactured “cases” of Covid19 were used to build up the illusion of a global plague.
    I don’t think I’d take that site too seriously.
2. Stephen BunnellMay 28, 2021 at 10:12 am
  CDC Report
  10,000 breakthrough infections were detected in the ~100,000,000 fully vaccinated individuals in the US. That’s 0.01%. 160 died. That’s roughly 0.0002%. There have been 33,000,000 cases in the US, out of ~330,000,000 persons. That’s 10%. There have been ~600,000 deaths in the US. That’s ~0.2% of the US population. So, based on known breakthrough cases, the vaccines improve your protection from COVID by a factor of 1000x (at most). And based on deaths, the vaccines improve your protection from COVID by a factor of 1000x (definitively, see below).
  Anyone entering the hospital with COVID symptoms would be tested for COVID and detected. Therefore, the number of severe cases is *not* likely to be an undercount. However, they could be undercounting asymptomatic cases in the vaccinated. From clinical trials we estimated that most vaccines reduce asymptomatic infections by ~90% or more, so we might eventually expect to see 10,000,000 breakthrough cases. The fact that only 10,000 have been detected so far proves that real world efficacy is incredibly high.
  The viruses have a real world R value of 2-3 and some variants appear to have Rs of 4-5. At the worst case efficacy of 90%, the worst case R for variants in a fully vaccinated population becomes 0.4-0.5%. Anything below R=1 leads to viral extinction. Since real world efficacy could be as high as 99.99%, the vaccines seem awfully good.
  From the same report, 64% of breakthrough cases were from variants of concern. More recent studies post on biorXiv show even higher levels, 85% or more. But even in these cases the vaccines appear to be highly protective.
  1. Stephen BunnellMay 28, 2021 at 10:19 am
    Apologies, real world efficacious as high as 99.9% one decimal place too many above. Same point holds.
Lemmy CautionMay 27, 2021 at 9:31 am
The CDC reports that more than 10,000 breakthrough cases have occurred in the U.S., though they admit that “the number of reported COVID-19 vaccine breakthrough cases is likely a substantial undercount of all SARS-CoV-2 infections among fully vaccinated persons.”
The true number of breakthrough cases is going to get even fuzzier though, because going forward, the CDC intends to only count vaccinated people that are hospitalized and/or die from Covid as breakthrough cases. Not going to count those that have mild Covid or are asymptomatic. Trust the science!
1. Katniss EverdeenMay 27, 2021 at 9:52 am
  Wait. You haven’t heard of all those “breakthrough” cases of polio and smallpox that occur with those vaccines?
  Yeah, neither have I.
  1. FluffytheObeseCatMay 27, 2021 at 12:58 pm
    From Wikipedia, citing Smith JS (1990). Patenting the Sun: Polio and the Salk Vaccine. William Morrow & Co. ISBN 978-0-688-09494-2,
    “The results of the field trial were announced 12 April 1955 (the tenth anniversary of the death of President Franklin D. Roosevelt, whose paralytic illness was generally believed to have been caused by polio). The Salk vaccine had been 60–70% effective against PV1 (poliovirus type 1), over 90% effective against PV2 and PV3, and 94% effective against the development of bulbar polio.”
    The original Salk vaccine was only 70-90% effective in the 1950s. Which means there were breakthrough cases recorded. The post-vaccination case rate was orders of magnitude lower than the unvaccinated rate, so people kept taking it.
  2. RMay 27, 2021 at 2:28 pm
    Sorry to ruin your sarcasm but the last recorded smallpox fatality (lab leak) had previously been vaccinated. So yes, we have heard of those and now so have you.
    My asperity on this point is that, like Mr Bunnell the immunologist above, I think it is irresponsible to conflate success or failure in:
    (i) protection against infection;
    (ii) protection against disease; and,
    (iii) prevention of transmission.
    No vaccine or immunity through infection offers 100% of (i). The immune system is a lottery, a chance survival by a virion and a mutation in its reproduction and you have an infection that can potentially evade your vaccine-derived antibodies, in all their permutations.
    Most good vaccines offer strong odds of (ii), at least as far as severe disease is concerned. The latest UK hospitalisation data suggests that the Pfizer and AZ vaccination programme in the UK is offering ~98% protection against hospitalisation, despite infection.
    https://twitter.com/JamesWard73/status/1397884961227689984?s=20
    Sterilising immunity, benefit (iii), is another lottery. Indeed, some vaccines are responsible for vaccine escape outbreaks of some diseases, e.g. polio.
    Vaccination offers real hope to people of avoiding personal tragedy and some hope of offering public health benefits of “herd immunity” / elimination. To claim that vaccines don’t work because a tiny fraction of the vaccinated go on to develop infection, even severe disease, is a crazy and deeply irresponsible position.
    It is also not a phenomenon that could have been prevented / evaluated with “moar trials” because ultimately you only learn the limits of performance in mass vaccination. That’s why all drugs have Phase 4 pharmacovigilance / post-marketing surveillance.
    1. ChrisMay 27, 2021 at 3:47 pm
      Agree.
      Without intending ad hominem criticism, the comments further up the thread seem to be based in self-entitled individualism.
      The vaccination program is not intended to ensure that you as an individual are guaranteed absolute freedom from infection, illness and hospitalisation. It is a community effort, grounded in a sense of shared responsibility to each other, which we undertake to protect our community from the worst effects of the pandemic.
      Vaccination programs were ever thus. They deliver protection even to those unable to receive the vaccine (too young, too unwell).
      1. IM DocMay 27, 2021 at 4:35 pm
        I could not agree with you more about the community effort – if only Fauci and the CDC and our national media seemed to understand.
        Forcing vaccination at threat of loss of job, ability to travel, or humiliation is not anything close to the spirit of a “community effort, grounded in a sense of shared responsibility to each other.” When you actually bother to take the time to talk to those who are balking – they almost inevitably bring up all the lies and distortions that have been going on. Just look at flip-flop Fauci this week – last week NO LAB LEAK – this week – OH YEAH – LAB LEAK. And we are asking our citizens to entrust to these “no liability” liars their very lives. What could possibly go wrong?
        I will correct you on one thing – Self-entitled individualism is most definitely not the issue with the vast vast majority of the vaccine hesitant. Please stop saying that.
        Again – I will contend that anyone who is criticizing these folks needs to but spend one day in my shoes. I have never seen such incompetence from our government officials in my life – and that has consequences. All these PMC types running their mouths all the time seem to think that these hesitant people have the ability to understand the situation and also the time to even get vaccinated (see Yves post from yesterday). In reality, the ignorant and often hateful commentary coming from the PMC and their organs like the NYT betrays that they truly are just running their mouths, changing what they are saying as the wind blows. And the vaccine hesitant are not so stupid that they are not able to pick up on this instantly. Just look at how the myocarditis issue is being handled right now.
        I am hoping that we have already achieved the needed level of immunity from natural infections and those already vaccinated – because the vaccine program in this country is now DOA – trust me.
        
        CuibonoMay 27, 2021 at 7:56 pm
        DOA until mandated
        
        ChrisMay 28, 2021 at 1:17 am
        Sorry, Doc, I expressed myself poorly.
        My comment about entitlement was more about the way in which the effectiveness of the vaccine is being measured according to the safeguarding of individuals, rather than the degree of protection for the community.
        I agree entirely that the shabby management of most aspects of the rollout has eroded confidence, making hesitancy an entirely rational choice for many.
      2. Yves SmithMay 27, 2021 at 8:16 pm
        Off Guardian is very anti Covid vax and of the view that Covid is a hype. Not even remotely reliable on this topic.
IM DocMay 27, 2021 at 10:09 am
I really hope you are correct.
I pray daily that all the end zone dancing being done right now is well placed.
Like everyone else I want this thing over. And I want my patients and my community to live in health not fear.
Excuse me however if I have a few nagging concerns.
First of all I have any number of patients who have been evaluated for foreign travel or employment testing sweeps or what have you turn out to be positive. All fully vaccinated. Most without symptoms. Vaccines given months ago. Healthy immunocompetent patients. Way more than I feel comfortable with. And yet they are not being counted even in the case numbers daily. They are certainly not being evaluated for the presence of variants. In fact, the authorities could not care less about even calling them. It is really easy to have a victory celebration when you are not even counting those who do not fit your narrative.
My other problem with your take is the best vaccines ever invented line so common today. Unlike the general American public, I have had the benefit of sitting through 30 years of Pharma propaganda. OxyContin was the best pain Med ever. Vioxx was the best and safest anti inflammatory ever. Trovan the best antibiotic ever invented.
Spare me.
Again, I hope beyond hope this is over. My years of listening to Pharma propaganda and their methods of spin all being used writ large right now really give me pause. The big difference that I did not see coming was their ability to turn my entire profession into non questioning zombies.

Amid a Pandemic, a Health Care Algorithm Shows Promise and Peril

Posted on May 27, 2021 by Yves Smith

Yves here. Aside from my general allergy to AI and algos (among other things, they are only as good as their training sets, which raises questions of accuracy and consistency of inputs), another reason to be concerned with health care algos is they require collection of patient data to work, which means yet another source of data vulnerability. Our reader IM Doc pointed out:

In the USA – we have multiple large tertiary referral centers that have quite the national reputation – I would include in that list MD Anderson, MAYO, Johns Hopkins, and …… The Scripps Clinic in La Jolla, California. I have innumerable patients that are seen there – they cater to that type of clientele. I first heard about this impending disaster over the weekend – and today things appeared to get immeasurably worse there…… see the following article……
https://www.nbcsandiego.com/news/local/what-we-know-about-scripps-health-cyberattack/2598969/
I know we have a major pipeline down from ransomware now – but this is just as scary if not more so. This is a major medical system in this country – and it has been hobbled. All of my patient’s appointments there have been cancelled until June – they are admitting no one – and no one seems to know if it will be back or not anytime soon. It has already been going on for a week.
ANNNNDDDDD – they use Epic – which has repeatedly touted itself ( I have been in the meetings multiple times in my life) as completely impervious to hacking.
Again – I knew this day was coming at some point. These EMR systems are a complete disaster waiting to happen. The hackers have managed up to this point to take down non-EPIC systems at Bugtussle Memorial Hospital across the country – but nothing like Scripps.

The patient portal was among the systems taken out by hackers..and it was “Epic powered” or some such corporate jargon. While Scripps has been remarkably close-mouthed, available evidence says it’s not a reach to think Epic is implicated.

comments

IM DOc pt 18

2021-10-01T23:55:44Z

Anecdote from alert reader pq:

Thanks! Per recent NC link, I’m in the highest reaction group, but three days since Moderna #2, and still no reaction (arm still a little sore). A friend told me her father had no reaction to Moderna 2 and theorized it was because he hyper-hydrated starting the day before. I tend not to drink enough water so started guzzling Thursday for Saturday jab. While checking into the VA clinic yesterday for PT, I remarked to the admin that I was surprised I was feeling well enough to make the appointment. Without prompting, she replied, ‘The key is hydration.’ On my way out, I asked her for a source on that info. She didn’t know where the recommendation originated, but said she was working the COVID vax operation at the regional VA medical center, and that’s what they were telling everyone. They’d told me that at the clinic, too, but I took it as the standard advice for cold and flu in case of flu-like reaction, i.e., rest, take ibuprofen, drink lots of fluids, etc. She said that was also recommended, but said specifically that her group was telling people to make sure they stayed hydrated before and after being vaccinated.

IM DocMay 5, 2021 at 3:01 pm

I have looked at both the Pfizer and the Moderna vaccine handouts and physician information. I am seeing nothing about hydration on the Pfizer documentation. On the Moderna documents, there is a comment encouraging patients to be fully hydrated before their vaccination.

I will look into this later today with colleagues. If I am able to find anything more, I will certainly share. I have not heard anything about this before. Other than, in general, it would seem to be common sense to approach any medical intervention fully hydrated.

Seychelles, World’s Most Vaccinated Country, Hit by Covid Surge….Including Among the Vaccinated

Posted on May 6, 2021 by Yves Smith

The Seychelles is a tiny country, with a population of less than 100,000 people. It is nevertheless providing a cautionary tale in what happens if you relax Covid protections and rely over-much on vaccinations as your Covid firewall. It’s in the midst of a Covid outbreak so severe that it has had to reimpose lockdown-type measures like closing bars and schools, despite having over 60% of its adults fully vaccinated.

The trigger appears to have been reopening the archipelago for tourism. From Bloomberg:

Seychelles, which has fully vaccinated more of its population against COVID-19 than any other country, has closed schools and canceled sporting activities for two weeks as infections surge…
To date 62.2% of its eligible population is fully vaccinated, according to the Bloomberg Vaccine Tracker. That compares with 55.9% for Israel, the next most vaccinated nation.

Colonel Smithers added via e-mail:

The BBC article [cited below] did not mention that a few weeks ago Seychelles and Maldives opened their borders to tourism, somewhat to the envy of their competitor for tourist hard currency Mauritius.
The big Mauritian hotel operators have hotels in Seychelles and Maldives and have been lobbying for Mauritius to open, too, and cited the example of the pair.
This included getting a doctor heiress to a hotel fortune, amongst other sources of income, to write about the need to open in the island’s largest circulation newspaper. She quoted that 60% vaccination figure as conferring herd immunity, which dad challenged in a BTL comment.
Seychelles and Maldives reported that a few thousand visitors had arrived within the first week of opening and Emirates and Turkish Airlines, with their spokes and hub models centred on Dubai and İstanbul, had been the first airlines to return and to some fanfare.
Seychelles and Maldives have been advertising that they are open for business in the likes of the FT and Guardian and on CNN in the past fortnight. Not just tourism, but people able to and wishing to work from home or just sit out the pandemic for a while in the tropics, not necessarily those with any connections to the archipelagos.
One wonders if variants from around the world which render the current vaccines ineffective have caused this.

It is hard to blame vaccine choice. Seychelles used Sinopharm, which according to the BBC, has performed well, and AstraZeneca. And as you can see from the chart below, these vaccines don’t require as much special handling as the mRNA alternatives, meaning the odds of spoilage would be lower. From the BBC (hat tip vlade):

The Seychelles, which has fully vaccinated over 60% of its population against Covid-19, is bringing back restrictions amid a rise in cases.
The archipelago of nearly 100,000 people recorded close to 500 new cases in the three days to 1 May and has about 1,000 active cases.
A third of the active cases involved people who had had two vaccine doses, the country’s news agency said….
More than four-fifths of the active cases were among Seychellois people, with the remainder made up of foreigners.

We don’t have more granular data as to whether the bad outcomes occurred heavily among citizens who weren’t far enough past their second shot to have received full immunity. But this is still not a good look. Again from BBC:

By mid-April about 60% of the vaccine doses administered in the country were Sinopharm, with the rest Indian-made AstraZeneca vaccine doses, Bloomberg reported….
Trials in China and the United Arab Emirates have put Sinopharm vaccine efficacy at 79% and 86% respectively.

I have been concerned that the odds of the new variants escaping the current vaccines has been underestimated. Note that experts outside the US have argued that an inactivated virus vaccine should offer better protection against variants than the mRNA vaccines, so the use of an “old technology” vaccine does not seem likely to be the cause of these results. For instance, from LiveMint in March:

India’s mass covid-19 vaccination drive, which began on 16 January, entered its second phase on Monday to include senior citizens and those over 45 years with comorbidities. The programme includes two vaccines. Covishield, developed by AstraZeneca-Oxford University, is based on a recombinant chimpanzee adenovirus vector that encodes the spike protein. Covaxin, developed by Bharat Biotech in collaboration with National Institute of Virology, is an “inactivated” vaccine that uses killed SARS-CoV-2 virus, eliciting an immune response targeting more than just the spike protein. In an interview with Mint, Dr Shekhar Mande, secretary, department of scientific and industrial research and director general, Council of Scientific and Industrial Research, spoke on how the antibody response by a killed virus vaccine is likely to offer greater protection against mutated variants of covid-19, than vaccines generating antibodies against spike proteins….
Interestingly, the breadth of antibody response generated by a killed virus vaccine is likely to offer greater protection against mutated viruses, than vaccines that generate antibodies against the spike protein.

Note that a more technically-oriented article concedes the efficacy versus variants issue while still defending the mRNA approach. From Clinical Trials Arena:

Despite the theoretical potential of inactivated virus vaccines to offer a lead over other Covid-19 vaccine technologies against variants of concern, experts said they are unlikely to be a long-term solution. While it is logical that these vaccines could have better efficacy against variants that have mutations in the spike protein, they come with existing baggage such as relatively lower efficacy versus other Covid-19 vaccines, they noted. And though inactivated virus vaccines have an edge in initiating a T-cell response, the overall value of this mechanism is still unclear in the context of Covid-19 vaccine development, some added.

Hopefully the surge in Seychelles will focus some minds and lead to more caution about reopening. But given animal spirits and business clamoring for income, probably not.

cocomaanMay 6, 2021 at 8:35 am

What a big pile of garbage from The Atlantic. A lot like the NYT “travel to the hinterlands” except lazier.

What are they thinking, these vaccine-hesitant, vaccine-resistant, and COVID-apathetic? I wanted to know. So I posted an invitation on Twitter for anybody who wasn’t planning to get vaccinated to email me and explain why. In the past few days, I spoke or corresponded with more than a dozen such people. I told them that I was staunchly pro-vaccine, but this wouldn’t be a takedown piece. I wanted to produce an ethnography of a position I didn’t really understand.

Is Twitter representative of the population? Is it a good place to run an ethnography? Give me a break. Author is using twitter because he doesn’t want to leave his home office. And then:

After many conversations and email exchanges

Many is twelve?

1. Try something like “DoorDash for vaccines.”

Someone kill me now. The cringe is too strong.

IM DocMay 6, 2021 at 9:05 am
I will say again – I have just as many blue liberal professional patients balking as I do MAGA folks. This clearly is a take down of the Neanderthals.
But he gave away his game in striking fashion. “I am rooting for the vaccines.”
Let me ask a simple question. Are journalists supposed to be rooting for their covered subjects?
At least he admitted it. He is forever banned to the trash in my mind.
Somewhere Edward R Murrow is doing RPMs. The profession of journalism is clearly as compromised morally as my own medicine, maybe more so.
Lord Have Mercy.

CanChemistMay 10, 2021 at 10:37 am

Today in Canada, our equivalent of Fauci (Dr. Tam) was explicit:

CTV: Tam warns that full vaccination does not equal full protection from COVID-19
https://www.ctvnews.ca/health/coronavirus/tam-warns-that-full-vaccination-does-not-equal-full-protection-from-covid-19-1.5419843

“Canada’s chief public health officer reminded Canadians on Saturday that even those who are fully vaccinated remain susceptible to COVID-19. …’But it’s not absolute. There’s reduction in your risk of transmission, but it doesn’t necessarily eliminate your risk of transmission’.” More discussion in the article.

A few more points,
-Breakthrough is to be expected because we know efficacy isn’t 100%, particularly so for newer variants. Provincial modelers here have estimated 60% in their models. I agree that it makes no sense for CDC not to track this. I have also seen in Ontario an unwillingness to discuss these implications publicly – I would agree with Greg’s guess above.

-We knew it was likely to go endemic early on, and it has. We will likely need boosters 1-2x year to account for variants as well as waning immunity. We already do this on influenza vaccination and I don’t see how this will be any different. I’ve seen estimates that it will take 5-10 years to reach an equilibrium in the population, so I think in the near to medium term, yes, there will be a lot of booster shots.

IM DocMay 10, 2021 at 11:54 am
We already do this on influenza vaccination and I don’t see how this will be any different.
This approach may absolutely be required in the future – I agree.
I would completely disagree with the idea that we already “do” this with the flu shots. I have been fighting for years for people to get flu shots. 30 years of trying every way imaginable to get older people to do it. My EHR at this very moment in time – is telling me that only 18% of my 1327 Medicare patients have been vaccinated for the flu shot in either 2019 or 2020. It is undoubtedly a bit higher, because we do not capture all of them from outside pharmacies – but even that is no longer much of an excuse – the computers do talk to one another much better than they did just 5 years ago.
At best that number is 33%. I would be confident to state that yearly or every 6 month COVID vaccines would be about the same if not much lower. You will be dealing with a much younger population.

Health Care

Scripps Health CEO Confirms to Staff That Information Systems Damaged By Malware NBC San Diego. Epic fail?

IM DocMay 11, 2021 at 7:15 am
With regard to the Scripps Clinic EMR ransomware disaster.
It is Epic. It is clearly involving patient care issues such as scheduling and portal messaging and medical records. So, this is not just “internal servers”.
I cannot tell you how many times I have set through Epic meetings with their employees bragging that their systems and software are impervious to hacks.
Smaller non-epic hospitals have been hit before. This is the first Epic whale.
I have known this day was coming for a long time. These systems are a disaster.
Americans, when your Doc is putting your private medical info into a computer, as of today, he may as well be putting it online for the world to see. You have been warned.
And I am certain the CEO’s hesitation to talk is because of his EPIC contract. It is boilerplate in all of them. No matter what happens, even if Epic’s fault, you can say or do nothing.

MiltonMay 11, 2021 at 9:52 am
I’m with Scripps Health and have received no direct notification of any of this, though it may be because the entire system is crippled. My portal entry is down as are the billing sites. Those large rooms with volumes of patient records in color-coded file tabs are looking better and better.

CNuMay 11, 2021 at 11:54 am
IM Doc,
No dog in this hunt, but in the interest of clarity, the article and embedded t.v. news stories don’t give any indication that Epic platforms/applications were attacked. Rather, it is stated that the email system and portal integrations were hit by malware. This would be consistent with every other ransomware attack with which I’m familiar.
Further, most cyber-insurers implement a complete information clampdown in the event of such incidents. My guess is that industry-standard low per capita spend on IT at Scripps left Windows based systems – with which Epic is integrated – vulnerable to attack. Further, no telling how long or how extensively that email system (Exchange?) was compromised and Scripps systems surveilled – prior to the actual ransomware attack.
Going after Linux backend systems would be highly atypical, inclusive of Epic’s database and application servers.

Yves SmithMay 11, 2021 at 11:24 pm
All of IM Doc’s patients with appointments through June have had them cancelled. That is not the behavior you would see with the level of attack you describe. Scrips is not being truthful.
Via e-mail:
All of my patient’s appointments there have been cancelled until June – they are admitting no one – and no one seems to know if it will be back or not anytime soon. It has already been going on for a week.

BittercupMay 13, 2021 at 7:26 pm

“Across the country, health clinics said that many patients were uniquely excited about the one-shot regimen—due to either skepticism about mRNA technology or fear of needles. Some of that enthusiasm evaporated after the pause, doctors told The Wall Street Journal.”

Also in J&J news, CDC upped their blood clot count to 28, new doses won’t be coming anytime soon per WaPo, and Norway is considering dropping it along with AZ. Is it conspiracy-brained to wonder if it’s being squeezed off the market in favor of the mRNA vaccines? Is the safety profile for the J&J seriously that much worse than for Pfizer/Moderna that it deserves this special treatment? What is Sputnik V doing differently with the same adenovirus vector as J&J? Be nice if J&J took them up on that purification technology offer and looked at it to see if that would work better.

Yves SmithMay 13, 2021 at 8:37 pm
To your answer, our IM Doc says the VAERS database shows enough heart/stroke incidents with Pfizer/Moderna, which if you make conservative assumptions about how many were clotting induced or related, suggests that they have similar problem. This was indirectly confirmed when he described a horrific clotting case with a middle aged very healthy man who after his first Moderna shot, had a blood ox plunge in hours, tested positive, and experienced clotting that got much worse on the administration of Heparin (clotting so bad that his platelet count plunged, meaning a lot were tied up in the clots). Led to a pulmonary embolism. This was about a week BEFORE the J&J clotting story broke. Same pattern, different drug.

IM DocMay 14, 2021 at 8:51 am

Dr Walensky on Tuesday

I will not let my vaccinated son go to summer camp without a mask.

Dr Walensky on Thursday 48 hours later

Anyone who is vaccinated can get rid of their mask and no more social distancing. We’re all good.

Americans – what has changed in the scientific data between that 48 hours?

Young Americans – believe it or not, the CDC was once the envy of this entire planet.

Now it is being run by someone who is a liar, a charlatan, or a political numbskull – pick your poison.

We were so much better than this in the past. I just simply cannot believe what has happened to our public health infrastructure.

I do despair for the young of this country. They will never understand the concept of competence with leadership like this.

CanChemistMay 17, 2021 at 7:47 am

Compare and contrast with Canada – our reopening guidelines were just released by federal public health on Friday.
https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/awareness-resources/vaccinated-against-covid-19.html

I was… very pleasantly surprised. This strikes me as quite conservative and appropriate based on what we know so far especially regarding vaccines and variants. No starting reopening until 70%single / 20% double and no serious reopening until 75% double, and all with low cases. Reinforcement of mask wearing. Right now we are at about 50% single in Canada with low double.

I suspect the timing was not a coincidence, but an attempt to 1. get out ahead of this US nonsense and 2. get out ahead of provincial nonsense that’s starting to brew (since Ontario in particular just can’t seem to stop winging it about parameters for reopening, which led to our current stay at home order).

The CDC statements quite frankly amaze me. The US will certainly converge to herd immunity the old fashioned way since covid is so contagious that one’s choices appear to amount to either getting a vaccine or getting covid. But the idea that you’d just throw in the towel at this stage without even trying to mitigate things anymore, in a way that can likely never be reversed, is appalling.

ambritMay 17, 2021 at 9:05 am
The problem with the “herd immunity” argument is that there is evidence that one can both ‘get vaccinated’ and ‘get Covid.’
This is looking more and more like a sub-conscious decision to implement Social Darwinism.
1. CanChemistMay 17, 2021 at 9:12 am
  Regarding herd immunity, yes, breakthrough cases are expected, because no vaccine is 100% regardless, plus the issue of the variants. There will most certainly be some fully vaccinated people who also get covid, the question is whether it will still disable / kill them. Evidence so far is that death at least is greatly reduced. Exposure to covid after vaccination is still enormously preferable to without.
  1. ambritMay 17, 2021 at 11:05 am
    I ‘get’ the herd immunity theory, but note that this pathogen might end up like the flu viruses, with yearly ‘booster shots’ tailored to the latest estimated ‘major’ varieties. The various health authorities have a spotty record with the effectiveness of the yearly flu shot’s efficacies.
    I’m really worried about, first, the long term effects of the mRNA vaccines, and, second, the effects of “long covid” on the population. the second effect is what motivated my social darwinism comment.
    We are still in very early days with this pathogen.
    1. CanChemistMay 17, 2021 at 11:42 am
      Yes, I fully believe it will be like flu shots, as I’ve stated elsewhere. Sterilizing immunity with a coronavirus vaccine was never really in the cards. In that sense, ‘herd immunity’ will be a dynamic thing, relative to most people antibody status vs circulating strains. I’ve heard from pandemic experts that it could be 5-10 years to reach some sort of equilibrium in the general population.
      I would actually agree that there are a lot of unknowns about these newer vaccines, but right now with the data we have, vaccination still appears to be the lesser of the evils by far. People I respect and know in the scientific community (and not the talking heads) feel that it will be safe long term but of course there’s no data. It’s not a great situation. Personally I’m choosing to vaccinate.
      1. JasonMay 17, 2021 at 12:06 pm
        People I respect and know in the scientific community (and not the talking heads) feel that it will be safe long term but of course there’s no data.
        People I respect and know in both the medical and scientific community (not many, admittedly – these aren’t my circles) poo-pooed Ivermectin and continue to flippantly dismiss those in their own ranks with differing views on vaccination and how it should be used in relation to what are very different viruses. Polio is not the flu is not coronavirus is not human papillomavirus. Etc.
        The vaccine for human papillomavirus is one of the only vaccines that provides complete sterilizing immunity. The polio vaccine doesn’t. The flu and coronavirus vaccines never will. Obviously.
        Max Planck, where are you?
  2. IM DocMay 17, 2021 at 11:42 am
    Unfortunately – the concept of “herd immunity” applies to some viral infections and not to others.
    The fact that this “herd immunity” concept for coronaviruses is being whipped around in our media and spoken from the rooftops by our medical leaders is just sinful. The misinformation is causing people to make all kinds of false assumptions about their own health and the health of our communities and thereby do things that are at best counterproductive. It really is quite startling.
    Measles is an example of a virus that read the chapter about herd immunity, influenza clearly has not. To wit, having a profoundly infectious virus like influenza kill millions a year and require yearly vaccinations is NOT an example of herd immunity.
    Respiratory viruses as a rule do not follow that credo. Coronaviruses most certainly do not.
    We have 4 others in wide endemic circulation in humanity that sicken billions every year.
    The “flu” pandemic of the 1890s – the Great Russian Flu – was almost assuredly caused by Coronavirus OC43 – one of those 4. And yet – now 120 years after its release into the landscape – it kills 2000-10000 people globally every year – and is responsible for all degrees of flu and cold like illness for billions. This is NOT an example of herd immunity. You do not hear similar case studies about infections like measles.
    What happens is these viral infections are birthed when just the right mutations cause them to be able to jump to humanity. They almost all start with a pandemic. Some of them abort immediately or after a season for at times inexplicable reasons at times very obvious reasons ( MERS and SARS1 are examples). If still viable (and COVID19 appears to be winning the viability test) , the viral genome and our own immune systems do a years long “hot war” and then we settle in for a “cold war” for eternity. It has all happened before many times – and it will all happen again. There is simply no other way. It is the price of admission on this planet. It happens to humans and animals alike.
    How the vaccines will play in this “hot war” is absolutely an open question at this time. This type of vaccine intervention has never been attempted in all of human history during the “hot war” phase of the process.
    The fact that our media and our global medical leaders have not communicated these basic medical facts to the populace in any kind of appropriate and understandable way is a disgrace for the ages. These simple facts were known to us for a very long time – this was taught to me in medical school decades ago – and nothing has changed except our own hubris and ridiculous expectations.
    I would love to be able to read the exposes and head-shaking reports about this era that will be available to my children when they are 70. I am certain it will be quite entertaining.
    1. JasonMay 17, 2021 at 12:12 pm
      Thank you IM Doc, You help me keep my sanity!
    2. curlydanMay 17, 2021 at 1:44 pm
      thanks, IM Doc for your detailed perspective. I was just thinking yesterday that it’s not a case of not getting COVID-19, but more of a case of when I get COVID-19, how well will my immune system be prepared for it. Right now, since I’ve vaccinated recently, I’m guessing I’m fairly prepared. In 6 months, who knows? Can my immune system’s memory be good enough to make up for lack of antibodies?
      I think asymptomatic infections are way under-reported (or not reported at all thanks to the CDC), and knocking the masks off everyone will cause the virus to pop up asymptomatically more and more.
    3. DariusMay 17, 2021 at 3:56 pm
      This virus is avoidable. It is airborne. Prolonged exposure to high concentrations are required to contract the virus. Adequate ventilation or air filtration, along with avoiding indoor crowds or close contact appear to be enough to avoid catching the virus. This is solvable. Our leaders are choosing not to solve it.
      1. IM DocMay 17, 2021 at 5:07 pm
        I would like you to direct me to any information from any source regarding any global pandemic contagion in the history of mankind that has been “solvable” in the manner in which you are suggesting.
        There is but one solution – learn and understand how it is transmitted and educate the populace in methods to mitigate their risk as best they can. You never know, tools may in the future be determined that can help – the vaccines may be one such tool – but we are way too early to even begin to know that. Other than that – the war between the virus and our communal immune system must play itself out.
        Unfortunately, that is the only way. That has been a rule of living on this planet from time immemorial. I know that we feel we are indispensable – and we can figure any and everything out. Unfortunately that is just not the way this process works.
        Really and truly – if you can find a single case where mankind has “solved” a global pandemic in the way you are suggesting – I will be all ears.
        There will likely be some time when we have achieved the ability to “solve” this problem – and this may be the time – but at this point – there is absolutely no way to know that and so far things are not looking so rosy.
      2. Lambert StretherMay 18, 2021 at 5:15 am
        > This virus is avoidable. It is airborne. Prolonged exposure to high concentrations are required to contract the virus. Adequate ventilation or air filtration, along with avoiding indoor crowds or close contact appear to be enough to avoid catching the virus. This is solvable. Our leaders are choosing not to solve it.
        I think you and IM Doc are talking at cross purposes re: “Solvable.”
        Given a correct theory of tranmission, I would argue that Covid is “solvable” in the sense that puerperal fever (wash hands) or cholera (remove pump handle) are “solvable.”
        The risk is not zero, but I can personally and with understanding take measures to minimize it. If given the proper measures against airborne, the risk is somewhere between crossing the street (look both ways) and sex with a condom (never use baby oil) then I would regard Covid as “solved.”
        (Now, the costs of “solving” aren’t zero. I regard a CO2 meter as important.)

antidlcMay 17, 2021 at 3:21 pm
As readers have likely heard, the CDC issued new guidelines on Thursday which amount to declaring victory against Covid, with only 35% of Americans fully vaccinated and it not known whether “breakthrough” asymptomatic cases can spread the disease.
…
We have no basis for thinking that asymptomatic cases among the vaccinated operate any differently until we have evidence.
In case anyone missed it:
https://www.cbsnews.com/news/transcript-dr-anthony-fauci-face-the-nation-05-16-2021/?ftag=YHF4eb9d17
———————-
DR. FAUCI: Well, what’s happened, there’s been an accumulation of data on showing in the real-world effectiveness of the vaccines. It is even better than in the clinical trials, well over 90% protecting you against disease, number one. Number two, a number of papers have come out in the past couple of weeks showing that the vaccine protects even against the variants that are circulating. And thirdly, we’re seeing that it is very unlikely that a vaccinated person, even if there’s a breakthrough infection, would transmit it to someone else. So, the accumulation of all of those scientific facts, information and evidence brought the CDC to make that decision to say now when you’re vaccinated, you don’t need to wear a mask, not only outdoors, but you don’t need to wear it indoors.
JOHN DICKERSON: So, on that third point, let me ask you this. If I have no symptoms and I have been vaccinated, but I- but I am infected, what’s the difference between that? And if I have no symptoms and I’m infected but have not been vaccinated?
DR. FAUCI: Good question, JOHN. And what the- what the issue is, is that the level of virus in your nasal pharynx, which is correlated with whether or not you were going to transmit it to someone else, is considerably lower. So even though there are breakthrough infections with vaccinated people, almost always the people are asymptomatic, and the level of virus is so low, it makes it extremely unlikely, not impossible, but very, very low likelihood that they are going to transmit it. Whereas when people who are getting infected, who were without symptoms, who are not vaccinated, generally the titer or the level of virus, relatively speaking, is higher than in the vaccinated individuals.
—————
Where is his proof for these statements?
1. Yves SmithMay 17, 2021 at 7:04 pm
  See my reply to Jeff W. It is impossible for them to have gathered relevant data. It would require very frequent testing of the vaccinated (more frequent than weekly, which is generally the gold standard in medical orgs), which we are not doing. Among other things, we wouldn’t want to spook the horses by suggesting the vaccines might not be perfect.
2. IM DocMay 17, 2021 at 9:29 pm
  This is the same guy who just 6 months ago was stating emphatically that remdesevir was a game changer.
  A silver bullet.
  Please refer to this week’s Annals of Internal Medicine to see how that all turned out. Cliffs Notes version – not a silver bullet. No effect on mortality whatsoever and minimal change in length of stay. And all for 10000 bucks a whack.
  Oh by the way who owns the patents for remdesevir? Why of course the NIH.

And, off topic but relevant, some talk about Medicare:

gnattMay 18, 2021 at 3:28 pm

The Metropolitan Labor Council (150 unions) is selling out all New York City retirees as we speak, switching from Medicare to a Medicare disAdvantage plan to save the city 600 million a year by reducing care and adding expenses for 250,000 elderly people.
The union bosses get reelected year after year. They don’t sit down with the people they’re supposed to represent but with the politicians and CEO’s they’ve become more comfortable with.
We’re all gig workers now.

IM DocMay 18, 2021 at 6:32 pm
I could write a novel about Medicare Advantage plans – as in all the tragedies I have seen.
They hook the seniors with a big steak dinner for the pitch – and then gym memberships that they never use etc.
But in essence they have literally signed their lives and their benefits away.
These companies haggle over every little thing in the doctor’s office. The patients have literally no choice in their medications – and often the worst possible 1970s technology drugs are the only choice.
Need a referral to the rheumatologist – forget about it.
But the worst of all is what happens in the hospital. They simply do not pay for any kind of post hospital rehab care – NONE. So your grandma is in the hospital after a massive stroke – and has been deconditioned by 21 days in the hospital. This is after the Medicare HMO has told the case managers that they are only going to pay for 3 days. Grandma cannot walk – grandma cannot do her daily activites – she can do nothing – but GET HER THE HELL OUT OF THE HOSPITAL NOW. By the way, everyone else – including those still on traditional Medicare get to go to a rehab unit. BUT NOT GRANDMA. They do not pay for them. Here is the thing – if your grandma’s doc is a chump like me – and OK with getting all kinds of demerits from the hospital – grandma may be lucky to sit it out in the hospital for 2 weeks while having her Medicare changed back to traditional so she can go to rehab. If not – she is DCd home – and then starts a merry go round of ER visit hell until she gives up and dies.
Folks – this is the way it is. They have to be able to afford the 10s of millions in salaries for their executives somehow. And I have never understood the whole system. Many of these patients are transferred back to traditional Medicare during these crises. The Advantage plans get all the benefits of the “cost savings” and traditional Medicare gets stuck with the gigantic bills. The taxpayers are getting hammered.
The city workers of New York likely have no idea what they are getting signed up for. This is all such a tragic mess. I just cannot believe my country anymore.
1. antidlcMay 18, 2021 at 7:47 pm
  Many of these patients are transferred back to traditional Medicare during these crises.
  How do they go back to traditional Medicare? To switch from Medicare Advantage to Medigap part B, you usually have to go through underwriting. Or do they just drop the Medicare Advantage, stick with Part A, and just go without a part B plan?
  I’m confused.
  1. Yves SmithMay 19, 2021 at 12:35 am
    You can’t be denied Medicare Part B. You are heavily penalized if you don’t take Medicare B when you enroll in A and change your mind later. To be in Medicare Advantage, you’ve enrolled in Medicare B. You just need to switch out of Medicare Advantage:
    You must have Medicare Part A and Part B to join a Medicare Advantage Plan.
    https://www.medicare.gov/Pubs/pdf/11219-understanding-medicare-part-c-d.pdf
    Medigap plans are not Medicare B.

comments

IM Doc pt17

2021-10-01T23:35:30Z

These comments are off (covid) topic, first, a commenter references a video of Biden to which IM Doc replies. The latter part of the post is a conversation about hospital billing (and general corruption), with comments by a variety of people (and one by IM Doc). Just put here because it IS on topic for the times and their general tenor.

IM DocMay 3, 2021 at 5:44 pm

I am not present in the room – and so you must take what I am going to say with a grain of salt.

A very very important test to do on the elderly when they are in the office is to watch them walk. You would be amazed how many diagnoses can be arrived at by looking at the gait. It takes years to learn to suss this out but it is invaluable. A well-trained general internist really can be like Sherlock Holmes; there are so many things that just leap out at you in the blink of an eye if you have been trained to pay attention all your life.

This gait demonstrated in this video is very common for patients who have had a previous stroke. It may be only a very small area. But that being said – it is very characteristic.

It would be very nice to see how he is holding the feet as well (not well demonstrated in this particular video) – for another problem may be happening and this is known as tabes dorsalis. This is malfunctioning of a part of the spinal cord called the posterior columns. The classic disease that causes this problem is pernicious anemia or B12 deficiency. This would be checked on instantly if a patient was walking like this in my office.

All of these things can predate the development of various types of dementia (most notably NOT Alzheimer’s) and a general internist seeing such a patient should keep a very close eye on the gait and the mental status going forward.

Again – I am not there – but videos are very important and can predict many things. For example – I remember looking at my wife more than a decade ago – and informing her that Pat Buchanan was about to have a major cardiac problem. He has a very noticeable Frank’s Sign on the ear lobes. It was not even a month that it was announced he would be having a bypass surgery. It is always a helpful thing to blow your wife’s mind with your predictive skill every once in a while!

The Rev KevMay 3, 2021 at 7:28 pm
Been reading too how some doctors have managed to make diagnoses of people from old paintings including one very old painting that showed that the women was experiencing breast cancer (“Bathsheba at Her Bath”)-
https://www.smithsonianmag.com/smart-news/doctor-will-frame-you-now-mds-diagnose-diseases-two-famous-paintings-180959227/
Of course a past master of the art of observation was Dr. Joseph Bell who became the inspiration for Sherlock Holmes-
https://www.pastmedicalhistory.co.uk/dr-joseph-bell-the-real-life-sherlock-holmes/
1. IM DocMay 3, 2021 at 7:44 pm
  It is also important to note that it has not just been physician/writers who were expert at doing this.
  One only has to look at the works of Dickens and Chaucer to note how able they were with descriptions of medical symptoms. Dickens described a character so well with obstructive sleep apnea – Little John in The Pickwick Papers – that his description was awarded the eponym for this condition – namely “Pickwickian” which is how we refer in modern medicine to the very obese patient who is lethargic and clearly having breathing issues. Chaucer described gout and alcoholic brain degeneration in an incredibly detailed way.
  This even goes back to the Bible. For example, King Herod is described in The New Testament as being “eaten by worms”. That leads to all sorts of fun imagery in the mind when you are 11 and sitting in Sunday School. However, it was a very apt description of dying from severe congestive heart failure and all the edema this causes. In those days, open wounds and swelling like that would be covered in maggots. So in our modern world with all of our medical advances – we have taken away some of these long-standing conditions that humans have had to suffer through for millenia so completely that we do not even recognize the descriptions in the ancient literature.

CopelandMay 3, 2021 at 10:11 pm
I have Pernicious anemia and have had major problems from my lower back on down (worst in hips) for 5 years now.
Out of dozens of docs (many specialists of all stripes) that I’ve seen, none have ever uttered the words “tabes dorsalis”.
My wife and I have often thought that my pernicious anemia was “catching up to me” in my 50s, since doctors have come up with no other diagnoses for my chronic, debilitating illness.
Thanks for you insights.
1. IM DocMay 3, 2021 at 11:02 pm
  Tabes occurs in B12 syndromes. It causes pain and neuropathy in the legs. It is caused by demyelination of the big sensory trunks in the spinal cord.
  It is also more highly associated with neurosyphilis. I did not put that in the original comment because I did not want anyone thinking that of our President.
  But it can happen with both. And in our day and age when syphilis to that degree is fleetingly rare and usually treated long before that occurs, B12 is the most common cause. When you look at textbooks about it, it is very focused on syphilis but other things more commonly cause it nowadays.
2. IM DocMay 3, 2021 at 11:05 pm
  I forgot to add. The patients walk is altered not because of motor problems. They cannot feel their feet and lower legs correctly so they change their gait to compensate.

cnchalMay 3, 2021 at 3:54 pm

If your business depends on a platform, you don’t have a business, what does one make of the infamous “snowmobile” that rolls up to corporate headquarters to suck all the data out and transfer it to Amazon’s power sucking data centers. Do those corporations have a business anymore?

On the other hand, as I’ve said before, there’s a major potential headwind here. Anyone who’s spending say $1M/month with AWS has to be thinking that they’re sending $3.6M/year to Amazon’s bottom line, and that’s not a very comfortable feeling if Amazon is competing with you, which it probably is, and if it isn’t, apparently will be next year.

Timmy agrees. If your business depends on Amazon, you don’t have a business.

That $3.6 million in raw profits is then used to subsidize the money losing or barely break even torture chambers euphemistically called warehouses to sell mostly useless Chinese crapola, which ends up in the dump after a few months of use. A perfect circle. Chinese working conditions come to America at the hands of a psychopath, with massive government subsidies providing an assist to the cruelty. What’s moar is that to “compete”, working conditions everywhere else must match or be even worse, lest they fall behind.

What will life be like when Amazon “earnings” match the current stawk price? Glad I never had children.

Amazon shopper = whip cracking sadist. Where is the app that adds the whip cracking sound for those that relentlessly push the buy button?

IM DocMay 3, 2021 at 6:20 pm
I wonder where the electronic medical record corporations fit into this.
Most Americans have literally no idea that their physician offices and hospitals are storing their medical records on systems that are largely run by Amazon Web Services. Cerner does for sure – and I understand that Epic does as well. The two of them together are probably 3/4 of the market in the USA.
Do the electronic medical record companies actually have their own business? I hate to think about how that situation may come to light in the future. Nothing good that I can see.

California Bill Seeks to Prevent Hospital Administrators from Practicing Medicine Without a License

Posted on May 5, 2021 by Yves Smith

Yves here. Thanks in large measure to the diligent reporting of the Health Care Renewal blog, as well as more recently the deep digging by Eileen Applebaum and Rosemary Batt on private equity’s major incursions into healthcare, we’ve been able to keep tabs on the corporatization of medicine and its detrimental effects on the quality of care. These changes have been implemented by MBA beancounters over the objections of practitioners. In cities where it’s viable to keep solo or small group practices, like New York City, some can keep serving their current patients. Some retire early. Some are able to morph their practices outside the insurance paradigm (like endocrinologists who become “anti-aging” specialists who dispense human growth hormone) and again escape corporate minders. Others like IM Doc flee for small cities where the big hospital system tendrils have yet to reach. But the net result of all of this is fewer patient-driven practitioners. Given the importance of the placebo effect alone, this shift hurts outcomes.

The latest post at Health Care Renewal reports on an important measure to restore more power to doctors: a proposed California bill to prevent health care administrators from practicing medicine. Oddly I’ve read nothing in the press about it. I strongly recommend circulating this post to everyone you know in California and urge them to urge their state Assemblyman and Senator to support this measure. Update: I was remiss in not flagging the bill number, SB 642, and a link to its text.

By Roy Poses, MD, Clinical Associate Professor of Medicine at Brown University, and the President of FIRM – the Foundation for Integrity and Responsibility in Medicine. Originally published at Health Care Renewal

Health Care Renewal presents a guest post by Dr. Gene Dorio. Dr Dorio is a geriatric physician from the Santa Clarita Valley in California, providing house calls to older adults. He has been an advocate and whistleblower for his community leading several causes from attempting to preserve the hospital Transitional Care Unit for seniors in 2006, to today trying to allow admission of teens to the psychiatric unit.

He is President of the Los Angeles County Commission for Older Adults, an elected Assembly Member of the California Senior Legislature, serves on the Triple-A Council of California, and member of the Santa Clarita Valley Senior Center Advisory Board.

For 5 years, Dr. Dorio served on his hospital’s Medical Staff Executive Committee in several leadership roles including 3 years as Chairman of the Department of Medicine.

Doctors are highly trained medical professionals trying to survive in a complex sociopolitical system. We have been pawns utilized by hospitals and government for our knowledge and skills, yet more recently expected not to have a voice or opinion.

As a physician in private practice for 40 years, changes in the past 10 years have been difficult. It was hard for me to hear non-medical business administrators force cut-rate medicine compromising evidence-based patient care.

I was elected to the hospital Medical Executive Committee (MEC) seven years ago with the hope from the inside I could improve threats against patient care. This did not succeed and the fury coming from the hospital intensified as the self-governing MEC was swallowed up by the Board of Directors and Administration.

Doctor voices protecting patients diminished, and many whistleblowers were left to defend themselves from bullying and attacks.

Lies and insults persisted, and the only power I had was knocking out keyboard articles to social media as a shield. Throughout the country, there were scant physicians in the same situation, so we networked the best we could to survive. “Never give up” was our mantra.

Periodically murmurs could be heard, but it was always muffled.

This year in California, a law was introduced in the State Senate to keep hospital administrators from “practicing medicine without a license.” Most doctors don’t know about it, but of course the state hospital association is diligently fighting it.

It can be seen here.

At the end of April, I was asked to testify at the State Senate Health Committee, and this is what I provided:

===

Good morning Mr. Chairman and members of the California Senate Health Committee.

My name is Gene Dorio, and I am a geriatric physician in Santa Clarita serving my community for 34 years.

Until two years ago, I was on staff at a local hospital which is a non-profit, but run like a for-profit hospital. For 5 years, I served on the Medical Staff Executive Committee in several leadership roles including 3 years as Chairman of the Department of Medicine.

During my time there, I witnessed administrators use manipulative, clandestine tactics to capture each voting facet of the health facility, including the Board of Directors, contracted physician groups, and the Medical Staff so business people could make patient-care decisions.

At my hospital, business community members were appointed to the Board of Directors and provided lucrative contracts in exchange for their vote. Bankers were given hospital accounts; a real estate agent was given property to rent; and a doctor was given space for a dialysis unit.

Exclusive Contracts were signed by physician groups for emergency room care, radiology, and operating room anesthesia. The hospital could not technically practice medicine, but they coerced these groups with the threat of severing contracts if they did not adhere to their orders, or vote as told. Needless to say the administration got their votes, while the Medical Staff became only a shell of a self-governing body once devoted to improving patient care.

Eventually, the Medical Staff was taken over too, and our policies were changed to bring in more revenue—even when it was terrible for patients. My patients are geriatric, and at times clinging to life. Nonetheless, staff started to leave daily notes on my charts forcing me to discharge patients even though they were not ready to leave the hospital. These notes included a printed statement “Not a Part of the Medical Record” which was removed later by the Medical Records Department erasing hospital culpability.

Hospital administrators also knowingly wrote orders without doctor consent for Palliative Consults, to place patients on hospice care which financially benefits the hospital by getting them out of the hospital for care.

They also made decisions about medications patients could receive. They decided not to use insulin pens as they were too expensive, and instead jeopardized diabetic patient care using multi-source insulin vials which are less precise and easily contaminated. The presiding CEO was released from their previous hospital after violating State Medi-Cal laws substituting inferior anesthesia in the labor and delivery department.

Hospitals also hold regular “throughput” meetings for physicians, where they publicly display the number of referrals, expensive tests, procedures, and overall revenue that each doctor is generating. They talk about productivity and efficiency—not the quality of patient care.

Because I tried to advocate for my patients, my hospital privileges were constantly in jeopardy. Typically, privileges are renewed every two years. For me, it was every 4 months.

If hospital administrator actions were truly to improve healthcare for our patients, I would have no qualms. But instead through abusive tactics and bullying, they interfere with physician decision-making, and ultimately increase administrator salaries, bankroll retirement portfolios, and yearly bonuses.

SB 642 is an important step to removing hospital administrators from practicing medicine without a license. Their surreptitious plans taking over a non-profit hospital for their own personal benefit must be thwarted by this law.

Patients have entrusted physicians to be guardians of their health. We are professionals that have taken a solemn oath to provide care in the best interest of the patient. Therefore, SB 642 will serve Californians by putting medical decision-making back into the hands of patients and their doctors.

Thank you.

===

I have never testified before a legislative body, but this is where my keyboard has brought me. There needs to be more voices fighting for patient care diminishing hospital administration power. Doctors must be part of the balance providing better healthcare to citizens of our country, but we must hear you speak!

Follow that mantra, “Never Give Up!”

Gene Uzawa Dorio, M.D.

SUBSCRIBE TO POST COMMENTS
19 COMMENTS

Phil in KCMay 5, 2021 at 10:41 am
Dr. Dorio’s comments explain a lot about how the financialization of medicine has been to the detriment of patients–and doctors too, for their ethics are compromised by fiscal considerations. I work at a medical center nominally operated by a not-for-profit state university but actual medical care is in the hands of a for-profit corporation. I hear constantly from demoralized staff about these very problems–pushing patients out the door (at least the unprofitable ones), restricting access to therapies, and so on.
Medicine and religion are two areas of human activity that should not have a profit motive.
CarlaMay 5, 2021 at 10:56 am
Thank you for this very important post, Dr. Dorio and Yves. I will definitely share. This looks like it might be model legislation for other states.
Susan the otherMay 5, 2021 at 11:23 am
A non-profit which is run for a profit. Why on earth are these “business plans” allowed? There’s no “non” profit involved. Only non-healthcare. Hospitals contract out everything. Emergency rooms; specialty clinics; labs; surgeries; imaging; billing. What oath does the corporation take? It would be interesting to make those contracts public. The terms could be so one-sided, ultimately for the shareholders, they’d never ever hold up in court; let alone the all-pervasive conflict of interest. I know from a close source that the docs who signed on to our new “hospital” signed up to keep costs down and their contracts reward them personally for doing so. But I think the whole thing is proving to be impossible to contain. The big corporate tactic of socializing losses can’t go on forever. Already this hospital, after 10 years of trying to make it work, has “merged” with another hospital system 1000 miles away in South Dakota. That tells me that neither system is making a profit and they think they can obfuscate a bit longer by creating synergies on paper which they will put in the “productivity” column – which will not translate into good healthcare, but only into profits. It’s a blatant scam.
1. Angie NeerMay 6, 2021 at 3:47 am
  I used to work for a non-profit research business. It was not medical, but “non-profit run like a for-profit” is very familiar. I learned not to make the common mistake of conflating “non-profit” with “charitable”. As was explained to me when I was hired, “non-profit” simply means it has no external owners or shareholders. Which is nice, but the incentives aren’t that different: upper management wants to extract the maximum non-profit from the customers, and appropriate the largest possible share of the non-profit for themselves. The fact that none of the non-profit has to be paid outside the organization just makes that a little easier.
fresno danMay 5, 2021 at 12:15 pm
Nonetheless, staff started to leave daily notes on my charts forcing me to discharge patients even though they were not ready to leave the hospital. These notes included a printed statement “Not a Part of the Medical Record” which was removed later by the Medical Records Department erasing hospital culpability.
=================================
reminds me of when I worked at FDA, and the constant struggle to make the administrative record complete, accurate, and truthful. It never occurred to people at the top to ask what the people over me were ACTUALLY contributing – apparently because it was their real job to hide who really made the decision and any facts that could call into question that decision. Also kinda reminds me of all the cops who “forget” to turn on their recording cams…and how there is no real consequence for that.
The vast majority of real decisions in USA are hidden, obfuscated, or not recorded because it goes against the interest of money…
pckMay 5, 2021 at 1:42 pm
This is incredibly disheartening, but I think I don’t understand hospital administrative structures enough to fully get it – could anyone clarify:
The medical staff executive committee is presumably a group of doctors/nurses/patient-facing people who make collective decisions about how the hospital is run. Other hospital decisions are made by the board of directors and “contracted physician groups”?
Are the contracted physician groups businesses that are external to the hospital, but the hospital contracts for specific jobs? So the hospital wouldn’t employ a radiologist, they would instead contract with “radiologists-r-us inc.” to have one work in the hospital? If so – how do hospitals decide what gets contracted out and what they actually do using their own employees?
I think my confusion stems from the statement “The hospital could not technically practice medicine…” – but I’m confused about who “The hospital” actually refers to. Is that shorthand for hospital administrators? This is probably hopelessly naive, but I thought hospitals just employed doctors and nurses to take care of folks. The image I’m getting from this is that instead, a small set of administrators and accountants rent a building and contract with individual doctors (and control their “hospital privileges”) and doctor groups in order to provide healthcare, but no one is actually an employee of the hospital. Is the second one closer to the truth? Is that a new development? Is everything going to continue to get worse, forever?
1. juno masMay 5, 2021 at 2:03 pm
  Most hospitals today are organized as “non-profit” corporations. (It’s a tax dodge). CEO of the hospital may, or may not, be and MD. The hospital employs mostly nursing staff, administrative staff, and other operations staff. They directly employ “resident doctors” (new to medicine) and some “hospitalist’s” (doctors without private practice). Your personal doctor isn’t employed by the local hospital, but has “hospital privileges” to care for you in the hospital if you need to be admitted. And any specialist doctor (Heart, Cancer, Pulmonary, etc.) you encounter there is likely to have a private practice and will bill you separately.
  1. pckMay 5, 2021 at 2:41 pm
    Thank you! That helps a lot.
PHLDenizenMay 5, 2021 at 1:43 pm
By way of example: a Propublica expose on the crapification of healthcare systems. Some doctors are in a position to push back, unfortunately most aren’t.
Denizen Dad, by way of being a hospital chief, part of an enormous group of independent specialists, and being extremely well-regarded in the area, has been able to tell such PE firms to go f*** themselves and staunch the bloodletting such PE firms demand. But, as I said, he’s managed to accumulate enough clout to make that possible, as well as being able to prevent insurance companies from driving reimbursements to poverty wages.
Internists and PCPs make s*** wages, which is unfortunate because there aren’t nearly enough good ones. Tacking on med school debt and laughably tiny reimbursements, it’s almost a vow of poverty for several years. Psychiatrists are also in the same boat, which is why almost all of them require cash. Insurance companies are hostile to any form of useful treatment for mental illness.
Dad is also a dyed-in-the-wool Reagan Republican, but even he’s come around to think the AMA is completely out of touch and that universal healthcare is the only viable solution. 40+ years of watching your profession degenerate into having MBAs, who went to white collar crime trade schools, constantly destroy your ability to care for patients tends to change your perspective.
I had to fire my dentist, as her practice got rolled up into a PE money grab. And finding a good dermatologist is also a PITA because the PE vultures are attracted to the large cash flows of non-covered, cash only cosmetic treatments.
Then there were a couple of times i had panic attacks so severe I confused them with MI. And those ambo rides ended up being 2800.00 or so each, of which 400 was actually covered. I managed to get them down to a reasonable fee with enough effort, but it was exhausting.
I’ve reached the point of deciding that working out regularly is sufficient enough to avoid interactions with any part of the system. If I drop dead, I drop dead. At least I’ll have saved enough time and energy to enjoy being alive vs the full time job of dealing with the misery machine.
1. Arizona SlimMay 5, 2021 at 1:50 pm
  Your final paragraph nails it. To the point where I’m stealing it and sharing it with people who wonder why I’m not living my life in waiting rooms and going from screening test to screening test.
juno masMay 5, 2021 at 1:44 pm
Hmm. Interesting article.
Just his week i received a medical bill from my local clinic.(Paid for through Medicare.)
The billing included an amount of $17 that was itemized to a doctor I did not visit: the “doctor” is the CEO of the medical clinic, who is an MD but doesn’t provide any medical services. Could this be an effort to circumvent the “non-practicing MD as CEO rules being proposed in CA?
IM DocMay 5, 2021 at 2:44 pm
How did this legislation escape me? I have been too busy this past year with COVID and all its complications. A very encouraging first step. I wish them well.
I could write a novel about the problems. And all the ethical and moral complications that are current system engenders daily. I have heard that some scholars are re-branding physician burnout as “moral fatigue” and I could not agree more.
All I will say here – I fought the system for decades. I finally realized I was mostly alone – and in order to protect my health and be a father to my children, my wife and I left the big “non-profit” ( that name is an evil joke) and moved out to the countryside. Medicine is much different here. But I can assure you, we have made the correct decision and I will never go back.
I currently work at a taxpayer supported organization. The board members are up for election every 4 years and there is constant accountability for the leadership. It is a breath of fresh air. THEY ACTUALLY WORK FOR THE PATIENTS AND THE COMMUNITY. Is everything perfect? Of course not. Do I feel like I will burn in Hell for my daily sins like I did back in the big city? Not at all.
Anyone who believes these “non-profit” corporate healthcare leaders have any kind of accountability like my leadership does here needs to get back on their meds.
1. CarlaMay 5, 2021 at 4:34 pm
  IM Doc, I cannot tell you how enlightening and helpful your faithful commentary is, even when of necessity, sometimes, your message is discouraging or enraging. You are a vital sanity check for all of us trying to survive a crazy healthcare non-system. Many, many thanks.
MaxFingerMay 5, 2021 at 3:59 pm
I have been reading about the takeovers for sometime now thanks to the many articles here at NC.
Just yesterday I made an appointment with my PCP primary care physician only to find they have been transferred to Athena Health – Veritas Capital – Elliot Management.
I ask the person that answered the phone if the practise had been taken over by another group. She assured me that my doctor was still there and the practise had not been taken over. Maybe she doesn’t even know about this takeover???
I was told I had to login to a new portal that they just rolled out.
All my medical records were gone from the new portal and I now was assigned to a PA-C who had just graduated and was a new hire at the end of 2020.
This is a MD I have had for over 20 years.
What little trust I had in the system is now gone.
1. AcaciaMay 5, 2021 at 4:43 pm
  Recall the saintly POTUS uttering: “if you like your health care plan, you’ll be able to keep your health care plan.”
SynoiaMay 5, 2021 at 4:42 pm
The Hospital is now not there to provide Medical services. It is a real estate asset which delivers revenue to its owners.
That the activity in the hospital is medical is a side issue. If it could yield higher cash flow with some other set of tenants for the space, its medical use would disappear very quickly.
floraMay 5, 2021 at 5:21 pm
Thanks very much for this post.
Because I tried to advocate for my patients, my hospital privileges were constantly in jeopardy. Typically, privileges are renewed every two years. For me, it was every 4 months.
I can only think of this old and often recreated cartoon: “Never Give Up.”
https://www.northwoodscenter.org/wordpress/wp-content/uploads/2020/06/heronfrog.jpg
Thank you, Dr. Dorio and Dr. Poses.
Gregory EtchasonMay 6, 2021 at 4:10 pm
Primary care MDs of all description are being replaced with cheaper more compliant NP.
Corporate Medicine discounts expertise with specious MD /NP equivalence. Corp medicine also loves NP because testing and imaging are utilized inversely to a “provider’s” training and experience
Stephen TaylorMay 6, 2021 at 8:37 pm
When my mother had a heart attack in 2018, my sister and I had a terrible time dealing with the hospital where she was admitted.
A great deal of the problem came from interactions with a doctor who identified herself as a “hospitalist”–word of advice: if you see a “hospitalist” walking toward you, run in the other direction. She was one of the primary figures who led the charge to boot my mother out of the hospital, despite the fact that she clearly was not getting better and clearly needed serious medical attention.
At one point, I looked at the hospital’s website for its roster of doctors; I found most of the many doctors who attended my mother for one thing or another on the listing; the “hospitalist” was nowhere to be found on the site. I suspected all along that she was in fact not a doctor–or at least not one practicing at the time–but in fact an administrator who was there to keep an eye on the bottom line.
Between her and the director of palliative care–they worked in tandem to push things toward discharging my mom–I would not have been surprised if they had put my mother on a gurney, shoved it out the door, and just let her roll down the street to wherever she came to rest. (At one point, in a meeting with me and my sister, they threatened to “bring in lawyers” if we didn’t get mom in a skilled nursing facility on their schedule.) They could not have cared less that mom was “actively dying,” as a representative from a local SNF characterized her. It was only through the intervention of that SNF rep that we were able to get mom placed in the local hospice home–where she died two days later.
(And even after my mother was admitted to the hospice house, that ghoul who was the hospital’s director of palliative care, and was also the director of the hospice organization, was talking about kicking mom out to a SNF “if her condition improved.” Gosh, thank goodness she just up and died a day later, so that that witch was not inconvenienced any further.)
It is appalling how a mortally sick person was treated at a hospital, which has long been considered the sort of place where comfort for the afflicted is the rule. Not so anymore–it’s all about economics. One of the evil pair even said as much to us: “that’s the way it is in this country,” she said.
I don’t know if the bill mentioned in the piece above actually would directly address the question of whether or not hospital administrators actually do present themselves as practicing physicians when they’re not, but if not I would hope such an amendment could be added to the legislation. I don’t have proof, but I wouldn’t put it past these creatures to behave in such a manner. I don’t live in California anymore, but I do hope the bill becomes law, and that it can set an example of other states as well (if not the nation as a whole).

comments

IM doc pt16

2021-09-18T22:00:47Z

The CDC’s VAERS and Vaccine Complications: The System is Broken

Posted on April 19, 2021 by Yves Smith

Yves here. As IM Doc indicates in passing in this post, he’s been keeping Lambert and me (and the other members of our Covid brain trust) updated on what he is seeing in the field, via the CDC’s Vaccine Adverse Event Reporting System (VAERS) and hearing from MDs at a major teaching hospital and in his network about the Covid vaccines. Recall that IM Doc was early to warn that vaccinations would soon hit a wall after those eager to take them had gotten their shots. He saw that in his area (which has a substantial wealthy/PMC population) before the J&J “pause”.

IM Doc has also been regularly describing his frustration and that of other physicians with the dearth of data and official advice. An example from a recent e-mail:

Is it not interesting that all of the press releases and information online and on TV continually refer to “a very rare condition”, “blood clots”, “blood disorder” in very nebulous terms. That could literally encompass hundreds of different diagnoses. As one of the other docs [on an internet conference] stated out loud:
There was a time when our federal medical folks would have this kind of situation and front and center would be an EXACT description of the problem and some kind of messaging to the physicians of America of what would we should be on the lookout for – and what we can do to treat…So far NOTHING about either issue – indicating they could not give 2 fucks about patients and physicians – this is now all about protecting Big Pharma and the money machine.
Indeed, this is most unusual, extraordinary as a matter of fact. Something has drastically changed in our federal agencies in just the past few years.
The last big issue involving the CDC was the vaping/lung damage issue and I was getting daily e-mails. I am definitely on their email list. I have not received a word about any of this – nor at this point do I really expect to. I have found nothing that is an exact clinical description of what is happening to these patients and what to expect. What I am able to glean from off-handed comments in a very few of the medical articles is that the use of any anti-coagulation agents especially heparin and lovenox, make things much worse. There is also apparently great concern about the newer agents like Eliquis and Xarelto. In other words, we have no treatment options. I am not exactly sure what we are supposed to do.
To say that I find it very concerning to not be informed of what exactly is going on is unprecedented and deeply concerning.

Now to IM Doc’s overview of the sorry state of vaccine deployment. This Administration is following the established Team Dem practice of treating every problem as if it can be solve with better PR. We are seeing that in a pandemic results in bad science, bad PR, and bad outcomes.

By IM Doc, a internal medicine doctor working in a rural hospital in the heartlands

I am the son of a public health officer. As a young child, I saw my father struggle through the swine flu of 1976 and the vaccine debacle that accompanied that era.

As I grew older, and especially once I entered medicine, he had several heart-to-heart talks with me about a career in medicine and by extension public health. I can summarize what he told me in two large thrusts.

1) Integrity, truth, and honesty is EVERYTHING in public health. Once squandered, it will never return.
2) Public health is 10% science and 90% psychology. Do not ever forget that. You will get nowhere by screaming SCIENCE SCIENCE SCIENCE and you will certainly get nowhere by flashing credentials. And you must have an acute awareness of panic, fear and anxiety. They change everything and your response must always take that into account.

I have done everything I can as an Internist and Primary Care Physician to conduct myself with honesty and integrity and to respect the emotions and thoughts of my patients and my community. To conduct myself any other way would be a fool’s errand.

So it came as no surprise to watch this Bill Maher segment on Friday night with my wife.

I take care of patients that are both blue and red in their politics. I have been hearing exactly the same mood and sentiment from all of them over the past 2-3 weeks. Mr. Maher has dissected perfectly where I think most people are in this country, that they are tired of being told half truths and noble lies.

This complete and total messaging disaster is the doing of our federal public health officials and our media. The narrative has completely fallen apart in almost every aspect of this pandemic and its management. The credibility deficit keeps getting worse by the week.

For whatever reason, we in medicine and public health have allowed a bunch of corrupt, lying, discredited charlatans to be our spokespeople – often employing the age-old tactics of SCIENCE, SCIENCE, SCIENCE or worse yet – BECAUSE I SAY SO – all the while flashing their fancy credentials while being questioned on TV by smiling sycophants who seem completely incapable of asking tough questions.

Mr. Maher’s commentary ended the week in which we saw one of the vaccines (Johnson & Johnson) being halted because of safety concerns. I was interested to see how public health leaders would respond. It was consistent with the poor baseline they’ve set.

Dr. Leana S. Wen, a physician so skilled in communication and leadership that she was fired within a year as CEO of Planned Parenthood, has been a mainstay of the official medical response. Her biggest misfire was about 2 weeks ago, when she suggested on CNN that citizens should have their freedoms removed in order to be convinced to take the vaccine.

What’s up doc ???
CRAZY vaccine analogy!
Watch CNN contributor Dr. Leana Wen warn Chris Cuomo about the CDC’s shrinking window of opportunity to make Covid jab policy the “ticket to pre-pandemic life” – before the “carrot” to get vaccinated disappears. pic.twitter.com/1aamIoYcHR
— ivan (@ivan8848) April 3, 2021

During that conversation (full segment here), she asserted that these vaccines were perfectly safe, which as we all know has been the party line from the beginning. Those remarks instantly torpedoed her credibility in the minds of many of my patients who with angry faces played this clip to me over and over that week.

So, imagine my surprise that she was chosen to write the soothing Washington Post op ed to calm the populace after the J&J debacle. You can tell by the title how deluded she is – “Why the J&J pause should bolster confidence in vaccines”. It only gets worse when you read the piece. You literally just cannot make this stuff up. I just want to scream to the newspaper – THIS IS NOT SHAMPOO YOU MORONS – THIS IS PEOPLE’S LIVES.

If anyone thinks people are going to be lining up to take the J&J vaccine at this point – they have rocks in their heads. And the damage from the J&J debacle is assuredly damaging confidence in the other vaccines as well – I have heard it all week.

And not to be shown up, there was Dr. Fauci making the Sunday rounds. Again, these people seem to have no clue about issues such as public confidence. And their current stands are burning their credibility to the ground even faster. He has spent much of the past two weeks messaging that even though people are fully vaccinated, they must continue right on with the stringent masking and social distancing as if nothing is changed. For those who have been paying close attention, that’s not a surprise, but to the public at large, it comes off as a 180 degree change from exhortation by officials and pundits that getting vaccinated was the ticket to the old normal.

Worse, to the average American’s mind, it is as if Dr. Fauci, et al actually do not believe the vaccines work. When I watched Tucker Carlson for the first time I’d ever seen him, last week, his questions were very similar to those I’ve heard in my office recently from patients all across the political spectrum.

And as if right on cue, the CEOs of both Moderna and Pfizer made statements this week that further vaccinations will be required. I am not certain that anyone on the anti-vaxxer side is making more effective arguments in people’s mind than all of these official medical people.

I hear it every day all day from my patients. We are already in a bad situation in this country with trust of our officials. And then the safety bomb went off this week.

I am going to share the story of a very grim task I have had to do this week. I have given pertinent details to Yves & Lambert, but to protect the complete confidentiality of the patient and her family, I will not be nearly as specific here.

I am going to talk about safety. From the inception of this vaccine strategy, we have been told these vaccines were as safe as the other vaccines we use all the time. We were also assured that because they were not yet approved, and under emergency use only, safety issues would be stringently followed. I want to share my experience and my patient’s experience with this safety net.

It is very important to start this discussion with a federal system known as VAERS (Vaccine Adverse Event Reporting System). I have used this system yearly in my career since its advent. It has been invaluable to follow complications with the usual vaccines given in a PCP office – most usually the flu shots. During flu shot season, I keep my eyes on it frequently to monitor any complications that may be arising in that year’s flu shot. In December, I had noted that there were a few dozen deaths noted on the VAERS around the 2020 flu shots – which was right in line with previous years. No practicing physicians take these numbers as 100% accurate, the system is flawed in multiple ways – but it is very helpful to follow overall stats/ratios and specific medical issues. We all know these are not totally investigated cases – but benchmarks to guide our practice around vaccines. In other words, it is now and always has been an invaluable resource.

In early January of this year, in my own patients, I began to notice in COVID vaccinated patients a small number who were having significant complications from various blood clotting issues. These were very strange things that do not happen in the normal practice of medicine. I emailed Yves and Lambert back then that I was becoming a bit concerned that this was happening.

As has been my usual practice when there is a problem like this, I began following the VAERS system very carefully. And to my great concern, I saw a very large number of cases of death and complications similar to what I was seeing. The ratio of complications was quite startling – 100-200 times or so more than the control group of 2020 flu vaccines. The VAERS system is currently reporting over 3000 deaths related to the Pfizer and Moderna COVID vaccines. The numbers in the European registries are almost exactly in line with this as well. I would guess from a simple perusal that about half these reports – both death and morbidity – are directly related to blood clotting issues.

VAERS was never a system meant to be perfectly accurate – but having a 100-200X difference in mortality rates should be attention-getting to everyone in medicine. And yet instead of addressing this issue head-on, our medical leaders continued right on with the party line that EVERYTHING IS SAFE and GOING SWIMMINGLY – nothing to see here. There were days that I felt like I was living in The Twilight Zone.

Because the nation’s medical officials were not addressing the problems, others noticed the VAERS reporting failures and started to publicize them. Of course, within weeks, we had articles like this one in Vice showing up and completely mischaracterizing the entire VAERS system and process.

When you start your article by lionizing an individual who has happily and admittedly committed both a federal crime (by placing fake reports) and a nasty breach of medical ethics, you literally can only go down from there. And they do. Such is “journalism” in America today. I do not like to call people liars – but that article reports more misrepresentations than I have seen in this entire year of COVID reporting. And the writers revealed a complete misunderstanding of the entire system. Like so many other things in our world today, research is optional.

The VAERS system is very cumbersome to use – both reporting and data presentation. Every step of the way, you are reminded it is a federal crime to put false information. It is also clear as a clinician that there are false reports there but they are a very distinct microscopic minority. You can easily tell that most are submitted by fellow clinicians and it is very helpful to quantify issues in a general way and see if there are similar threads with your patients and the other reported ones.

Because of the novel nature of these vaccines, an app based system, VSAFE, was developed and widely implemented to report safety and side effect issues. Unfortunately, I cannot even express the number of times patients in my office demonstrated that the app does not work – all that happened was the spinning blue ball. In fact, when my own wife tried to report her side effects through the app, she gave up after 4-5 attempts. Never able to connect. The whole experience reminds one of the last time the Feds tried computer apps – the disastrous Obamacare sign up.

My grim job this week was to report a vaccine related death to the authorities. I have had to do this type of reporting on other occasions in my career, with other drugs, both approved and research trials, with both deaths and morbid complications. In every single instance in the past, without exception, I have been contacted within 1-2 hours by either the FDA or the CDC. They questioned me, discussed the particulars with me, and a collaboration was begun.

This death was much different.

A little about the patient situation. She had her vaccine about 8 AM on a weekday. It was the 2nd shot. Very soon thereafter, she felt electric shocks over her entire body. Later, she was having trouble speaking and could not stand up. She began having severe problems swallowing. I advised to go immediately to the ER. I will not go into details here but suffice it to say, she was having a profound neurologic problem. It was not a simple stroke nor was it a blood clotting issue. Because of the timing of symptom initiation, it was clear to me that the vaccine was likely involved. She was diagnosed with a condition that is very very unusual and is often associated with vaccine administration. She had 5 weeks of very severe pain and did not recover. She was eventually placed on hospice and passed away. Before she died, she told me to make sure that everyone knows that these vaccines are not as safe as advertised. Believe you me, her family is doing everything they can to make sure that this story is known all over the community. The patient herself was a very well-loved individual here – and this has been a blow to the entire area.

I am a licensed physician in a US state. I am board bertified in Internal Medicine. I made every effort to immediately report this death to the federal officials. I called the FDA and ended up in voicemail hell. I called the CDC and was literally hung up on twice. Again, please contrast that reception to what I describe above in previous “non-crisis” years.

After multiple attempts, I finally decided to report to VAERS. This was almost a week ago. To date, the VAERS has no record of my patient. All that I have received is an email to confirm my submission. No one from any agency has made any effort to contact me in any way. It was of little comfort to note in in the New York Times, that the physicians trying to report one of the sentinel J&J stroke cases got a similar “hang up in your face” response from the FDA/CDC.

I want to reiterate – a patient has died. A board-certified internist feels this is likely vaccine-related. And no one has made any effort to contact me. None. A complete departure from the past. And this is a stringent safety-reporting system?

What am I trying to say? The system is broken. Therefore, we have no idea what is the actual safety profile of these vaccines. The patients who have been affected know it. Word is getting out that there are problems. Social media is filled with all kinds of stories. And our federal officials keep right on with the same “All is well – everything is safe” mantra. We have media figures everywhere spouting out safety numbers that I can assure you are not accurate. All in an environment when they are trying to convince as many as possible to take this vaccine.

This is all so sad. The early efficacy numbers are looking good (we do not know how long that will last nor if they are effective against the variants). But because of the bumbling of the federal response, and now the safety concerns, large swathes are turning their backs. This environment is perfect for the creation of all kinds of conspiracy theories. And believe me, they are out there and multiplying every day. Things like this happen in the absence of trust and credibility. It is simple human nature. Just like my father said – public health is 90% psychology.

The primary care practitioners of this country and their patients are in a terrible situation. It did not have to be this way.

IM DocApril 19, 2021 at 10:56 am

As I stated in the piece – it is very critical to remember that the purpose of the VAERS is not to be 100% accurate. It, however, can be used as an early warning sign that things are amiss. It has in the past been vital in previous vaccine issues – such as Gardasil and RSV.

There were basically 20 vaccine deaths for the influenza virus in the 2020 year. If you look back for the past dozen years or so – that is right in line – a few dozen reports each year. Other sources tell me that approximately 130,000,000 doses of influenza vaccine were given in the year 2020. This too is not accurate – but is basically in line with previous years – even a bit higher than usual – there was a huge push if you recall to vaccinate everyone with the flu shot – thinking it would be a co-morbidity with COVID.

So the flu shot ( a good control cohort for another respiratory virus vaccine ) had deaths of about 20 in a dosing cohort of 130,000,000 making that ratio – 1 death in 6.5 million vaccine doses.

It is difficult to know where to cut off the COVID vaccine – because it is an ongoing process – so as of today – the VAERS is up to date as of APRIL 2. As of that day – the best info I can find is that 179,000,000 doses of COVID vaccine had been given around that date. And as of that date in VAERS we have 2700 or so vaccine related death reports. That is 1 death in 66296 vaccine administrations.

The COVID ratio for reported deaths/vaccine administered to the 2020 flu shot season with reported deaths is right at 98.

That is a startling differential. It is certainly not 100% accurate – but it is a very severe variance from a normal well-known vaccine like the flu shot. As I have indicated in the piece – the system is way behind, who knows what all is being processed at this time.

The point of the VAERS system is not to be 100% accurate. It is to be an early warning system – and to guide clinicians with their own witnessed complications and side effects.

It should be obvious to all that we have a problem.

It is my contention – that if the powers that be would just be straight and level with the American people that yes there is a huge safety problem associated with this vaccine – and we are doing everything we can to help and get us through this – that they would be light years ahead of where they are now. But that is not what they are doing.

The point is – in times past – the media would be jumping all over this – it is a huge discrepancy. Instead, the media is taking every opportunity to bash the VAERS system. It is telling a concerning story that they cannot fit into the SAFE SAFE SAFE narrative – and instead of dealing with the problem, they are bashing what system we have left.

I am certain that a young reporter could make his/her life’s reputation with this story like Woodward & Bernstein – but they seem to be nowhere to be found.

So people like me have to report this confidentially. Sorry – I know it is not ideal. The owners of this blog know exactly who I am – and I have been straightforward with them from Day 1. I cannot at this time risk being identified – we live in a nasty cancel culture. Maybe one day I can let it all be known – but not today.

I find it so interesting – that people dismiss things from anonymous sources that do not fit into their narratives – but are willing to soak it all in with things like Russiagate.

We live in an amazing world.

TaungerApril 19, 2021 at 11:38 am
I appreciate you breaking out the numbers and clarifying that the 100x number is in fact deaths, not just complications. Sobering material. It would be wonderful if our society could directly engage in the value of vaccination, if any, in light of these findings.
Thank you again for your response. I did not doubt your earnestness, but the weight to assign the statements was hard to discern without some additional context.
1. IM DocApril 19, 2021 at 11:48 am
  You make another point that is important.
  The numbers above are just actual DEATHS.
  The number of morbid complications when compared to the flu shot is equally overwhelming if not more so – now numbering into the tens of thousands. And no – we are not just talking about fever and chills.
  Please go read through the case reports for yourselves.

Hana MApril 19, 2021 at 4:05 pm
IM Doc, I couldn’t make head or tail of the VAERS database so I appreciate your breaking out these numbers. Could the deaths be heavily skewed because the earliest people vaccinated were frail elderly in nursing homes, and older, sicker individuals in later tranches? Thanks for commenting.
1. IM DocApril 19, 2021 at 4:12 pm
  That is a good thought; however, the controlled group of flu shots is heavily skewed to the same group – there may be some variance but not enough to account for the severe discrepancy.

Basil PestoApril 19, 2021 at 3:50 pm

If I may, I think the main takeaway here is not that the vaccines are bad and no one should take them at all (though IM Doc can certainly correct me if I’m wrong), but that they have a risk profile all their own and the obfuscation of this fact, in the interest/at the behest of the pharmaceutical companies, or for whatever reason, is bad for a few salient reasons (in my own, potentially meagre understanding):

1. It weakens trust, which ought to be a sine qua non of public health

2. By downplaying, minimising, or obscuring the risks, or just pretending they don’t exist at all and you’re an anti-vax nut if you even entertain the possibility, it makes it difficult not just for patients, but apparently physicians, to adequately understand and assess the risks and make informed decisions about these vaccines, including on how to treat patients if serious adverse effects are experienced.

3. In a similar fashion, by presenting the vaccines as some kind of miracle cure that will see normalcy restored to the world in a matter of weeks/months, instead of adequately reckoning with the real-world shortcomings of these vaccines, it has the potential to undermine genuinely effective measures that reduce individual infection and communal transmission alike, such as masking, ventilation, etc., or lockdowns and border shutdowns for those jurisdictions that use those strategies. This could have serious long term consequences on a large scale.

IM DocApril 19, 2021 at 4:15 pm
You are correct in every way in my opinion.
I am not anti-vaccination –
However – I am very much attuned to people’s risk profiles. And we should be much more clear with people that this is not a “risk-free” endeavor.

and the take of another MD:

RM MDApril 19, 2021 at 11:45 am

Thank you for the IM Doc post. I was a board certified internist who practiced in the Midwest for 35 years before retiring 22 years ago. A longer perspective than the present pandemic is necessary to understand what is and has happened in medicine and public health. My first semester in medical school the tuition was $500 which was the same as the last semester at my undergrad private liberal arts alma mater. The Midwestern state in which I grew up and had all my graduate and medical training had in the early 1960’s an understood policy that the state was responsible to provide a medical education for the medical care of its residents. That education was superb and highly individualized with several mentors and covered nine years. It served me well in Vietnam and then in private practice. Beginning roughly 25 years ago the Dean’s letter requesting donations noted that state funds provided less than 5% of the medical schools operating budget. And that hasn’t changed.
The states obligation had dropped out of sight and as it did tuition sky-rocketed. Then in the 1980’s states decided public health funding could decrease and it did at the state and national level which along with the financial crises of 2000 and 2008 ended up with fewer funds for public health. Then with the Trump administration the CDC was further marginalized, the FDA corrupted and science in general demeaned in government.

As the pandemic exploded here in the US the information we got from the President and Fox was idiotic and the info from CNN and MSNBC with dozens of epidemiologists, ER docs, pulmonologists who were not explaining to me why the protean aspects of Covid-19 were occurring particularly the clotting issue. Renal dialysis machines clotting off was particularly striking. By April 2000 I had not seen a pathology study of the lung or any other organ which in medicine has been the foundation of beginning to understand a new disease.
The idea of a “storm” inflammatory and clotting factors by its simplicity was too easy. The fact that the endothelium (the lining cells of all arteries, arterioles, capillaries, veins, the heart and lymphatics) might be involved seemed like a significant step forward. In the lung the alveolus (air sac) becomes partially fluid filled from the infection and its partner capillary necessary for oxygen exchange clots might well explain the precipitous fall in oxygen levels. I kept wondering where is the Dr. Don Seldin, the Dr. John Hickam, other Deans and heads of Dept of Medicine? These were the real critical thinkers in medicine and I didn’t hear such a voice.

It has become clear that the pandemic of early 2020 is not the pandemic of late 2020 and 2021. The moveable parts of the pandemic change and keep changing including infectivity, age distribution of the infected, hospitalizations and deaths, the attempt to develop a vaccine infrastructure on the run with its increasing evident defects as IM Doc points out.

My conclusions follow:
1. The loss of the sense of health as “the public good” for medical education and public health has corrupted health care and a significant cause of outrageous cost.
2. My hat if off to those medical personal on the front line in the doctors office, ER, ICU who have worked to the point of complete exhaustion mentally and physically
3. The loss of a sense of trust will be difficult to and may not change as IM Doc points out
4. The media has failed to educate the public by poor choice of interviewers and interviewees. A doctor held with the respect of a Dr. Don Seldin or Dr. John Hickam should be asking the tough and unfortunately many times unanswerable questions to those physicians best able to respond. Forget the happy talk that has been epidemic during the pandemic. Anything less than honesty is a problem.
5. Profiteering should be criminal whether with a vaccine, masks or other necessary equipment to deal with a public health emergency. Financial penalties and jail time required.
6. Covid-19 is teaching us much about the infection however this is just the beginning and there will be much yet to be learned. Save the happy talk for when hundreds and thousands are not dying of the infection each day. Remember: Nature bats last.

Hana MApril 19, 2021 at 7:21 pm

Bret Weinstein and Heather Heying, who view the world, society, politics and economics through the lens of evolutionary biologists. They do a free weekly video podcast and Q&A, with additional material for subscribers (mostly Patreon, I think). https://www.youtube.com/c/BretWeinsteinDarkHorse/featured

IM DocApril 19, 2021 at 7:52 pm
I could not recommend this more highly – I listen to these two on their podcast every week. I do not think there has been a single one that has not made me think hard about all kinds of various issues. And that is very rare these days.

Re: Just published @nature
The largest study of post-covid sequelae, >70,000 hospitalized, >13,000 out-patients, with controls, characterizing the significant risks across all organ systems #LongCovid https://t.co/xdapBBqvt7 pic.twitter.com/CUhdGyF51U

— Eric Topol (@EricTopol) April 22, 2021

IM DocApril 24, 2021 at 10:55 am

I will add my two cents about the above tweet. Having been informed by a patient experience I had this week.

I think it is critical to note the huge number of nursing home workers that are young women under 40 – both nursing and support staff. I do not have exact numbers but just from experience over 3 decades – I would say that demographic is 50-75% of the employees in nursing homes and rehab centers.

The NYTimes tweet above places the blame of the outbreak of COVID among vaccinated patients and staff at the doorstep of a young unvaccinated female worker. Of course – it is all the fault of the young rube making a disastrous decision. No one ever talks about the actual reasons why she is making that decision.

I have heard all these stories of the menstrual problems after the vaccine for weeks. Because I am an internist, that topic does not come up very often. However, I had my first patient encounter this week with a custodial staff member in a local nursing home. She has had a Mirena IUD in place for the past 12 months. She had minimal but appropriate menstrual flow with the device until late February. She had her 2nd Pfizer shot in late Feb – and then 1 day later began to have profound and severe menstrual flow. Way way worse than ever in her life. She has Obamacare – so she has a $10000 deductible – so she avoids doctor visits like the plague. Her husband finally dragged her in, tired of paying for literally boxes of pads every 2-3 days. She had bled her hemoglobin down to 6. My initial impression was the IUD had become somehow dislodged and damaged her. NOPE – No evidence of that found on exam by OBGYN. Perfect working order. No infections. No nothing – just a very profoundly hypertrophied endometrium. She is going to be fine and getting taken care of. Interestingly, I have NEVER not once seen this kind of thing with an IUD. I have no explanation why this or any other menstrual issues are happening with these vaccines.

BUT she has shared this finding with all the other women at work – and informed me yesterday a not so small number of them had very strange menstrual issues after their shot. Including a 60 something who had her first period in 20 years starting 2 days after her Pfizer 2nd dose.

I would make this point – there were enough women in the vaccine trials – to have noted this problem during the trials. And yet nothing was said. Was it noticed? Was it documented? I have learned from my OB GYN colleagues this week that indeed they have been seeing this issue – not in huge numbers – but definitely a phenomenon.

So you have young women with a problem like this going on at enough frequency that the rumor mill is engaged in a big way. Many know personally women who have stories.

And as usual – crickets chirping – from our federal officials. And they wonder why there is no trust.

You see – as a PCP – I deal with human nature – the human condition. One of the fundamental issues of young people is having children – especially women. You start having this issue occur and no one in authority is even making an attempt to address it – and what do you think is going to happen?

The older I get – the more I am beginning to believe that these elites are really not humans – they may be lizards in disguise after all.

And even more importantly – these young women are critical in the vaccination effort because of their jobs – as documented in the tweet above.

And unfortunately – one has not far to look to see how far the medical elites have their heads up their asses.

Dr. Gawande – I know you live in an ivory tower – and love to make proclamations from on high. Those of us who work with real patients and real people know that if you keep talking like that – the staffs of the nursing homes are just going to walk. Indeed, it has already started – talk to the HR folks in any of them across this country. You pay them so well – that they could just as easily be working at Burger King.

Keep it up – and we will have an even bigger problem than you can even possibly imagine.

My God – a little bit of trust and credibility goes along way. My profession has learned this over decades – and the medical elite in charge have just shat all over that decades of hard work in no time.

Rant off.

IM DocApril 25, 2021 at 1:07 pm

There is literally a betting pool among my academic medicine colleagues on how long it will be before Rachel Maddow begins referring to these vaccines as “Trump’s Vaccines”.

I am not a betting man. But it is intriguing to think about.

zagonostraApril 26, 2021 at 2:34 pm

>Whatever. Focus on getting them to everyone who wants them more than trying to convince MAGA chuds

MAGNA Chuds? I didn’t know that Robert F. Kennedy Jr. was a MAGNA. Marginalize those with have criticisms of WHO, Bill Gates, vaccine immunity liability, and all those other tin-hat wearing conspiracist theory aficionados and you will never get a majority to vaccinate. Yeah, concentrate on those who you can convince to get it.

I have friends/family on both sides of the issue of getting vaccinated. If you can’t be respectful, and all you can do is virtue signal, than good luck Mr. Eschaton. The true Eschaton will see who was right.

IM DocApril 26, 2021 at 3:16 pm
I have been saying this for weeks – and will say so again.
All that were freely willing to be vaccinated have been. We are now left with the doubtful, the skeptical and the downright hostile.
Some counties in America have been lucky enough to get to 50% vaccinated rates. Some are still in the 20s. All are closing their vaccine centers because that time has now passed.
I talk to these hesitant folks all the time. I absolutely assure you the LAST thing that will change their mind is haughtiness and name-calling like these people like Eschaton and others are doing. It will do far more to cement their position in place. As far as MAGA – you would be shocked at the number of blue liberals who are refusing the vaccine as well. This is really not all about politics. There are a myriad of things rolling around people’s brains and souls.
I had one in my office today – a former state health department leader. The comment she made that stuck with me – was “I notice that there are now vaccine ads all over the place. Have you ever wondered why there is not a rushed 30 second list of all the side effects at the end like all the other pharmaceutical ads are forced to do? It makes you wonder doesn’t it?”
If anyone out there can help me with an answer to that question, please do so. And believe me – equally probing questions are coming right and left all day for me.
My patients are not dumb. They are not “chuds”. They are people concerned about their own lives and the lives of their community. Many of them feel like they are being lied to. These are people who would line up at blood drives and do anything for their community. They are very likely to have taken all required vaccinations in the past. I am not sure how I will ever convince any of them. The conspiracy theories are running at a fever pitch – and the most concerning thing about that is I see no one in any position of authority doing a thing about it.
We do indeed live in interesting times.

graysladyApril 26, 2021 at 4:41 pm
IM Doc, I suspect your reasoning is correct for the area in which you live–which you have previously indicated is reasonably well-to-do. However, there are many people who can’t take off work, or don’t have transportation to a vaccination site, or don’t have someone to look after their kids while they get the shot. Others, who don’t have green cards, may still not entirely believe that someone isn’t going to find out about them and deport them. Too many people still believe it’s easy to get a vaccine now, but even here in the Chicago area we’ve seen how Walgreens has managed to discourage people by having a completely unworkable system. There has also been, imo, far too much dependence on computer-driven information. The poor and many of the elderly don’t depend on computers the way we commenting at NC do. I still believe there are many who could be vaccinated if we took a more human approach to them and understood their limitations.
1. IM DocApril 26, 2021 at 6:31 pm
  I agree.
  These issues are not common in my area. But this is an entire bag of worms which my colleagues back in the big city have been screeching about for weeks. I think the most frustrating thing to them is no effort seems to be happening to help the situation.
  There is some movement with the locked-in elderly. But all the other issues you describe are real and ongoing.

cocomaanApril 26, 2021 at 3:24 pm

As a Pennsylvanian, I can understand the bizarre reporting error. Vaccine distribution in my state has been an embarrassment. Huge surpluses of vaccines in rural mountain counties, with the collar counties of Philadelphia whining about how they couldn’t get any. Have to wonder how many went in the trash.

Most of the people I know that have gotten one has virtually gotten it by accident (showing up and seeing if they have any extra at EOB) or lying and saying that they’re a cigarette smoker (know more than one person who did this).

I know 90 year olds who couldn’t get it and 45 year olds who did because they were payroll desk jockeys for an ‘essential’ corp. Dumb.

Now, all of a sudden, there’s huge amounts of vaccine all over the place and outlets like Penn Medicine are begging people to come.

Welcome to Pennsylvania, where we’re neither #1 or #50 on any measure, but somehow manage to do things worse than everyone else.

cocomaanApril 26, 2021 at 3:33 pm
Don’t want to clutter up the comments section, so I’m replying to myself, but I wondered if the reason that we’re seeing cases/deaths going down at the same time as vaccine uptake is that all the extroverts and restaurant-goers have all gotten their vaccines. So the people doing the most hobnobbing and such are set with their vaccine and thus not spreading it anymore.
The inspiration for this idea was a meme I saw recently. It went something like this: “It took the pandemic for me to realize that many people’s entire personality was based around going to restaurants.”
Someone should institute a quick Myers Briggs at the door to see if the I or E’s are getting vaccinated.
1. Michael IsmoeApril 26, 2021 at 7:25 pm
  This helps explain it.
  https://www.msn.com/en-us/health/medical/millions-of-americans-are-skipping-their-second-shot/ar-BB1g2K7X?ocid=uxbndlbing
IM DocApril 26, 2021 at 3:38 pm
Please correct me if I am recalling this incorrectly.
One of the most hilarious stories coming out of COVID so far I believe happened in Philadelphia. Early on in the vaccine push, the county had handed over the vaccine logistics to a company of millenials. The ensuing fiasco was just hilarious to read. The fact that it was ever allowed is staggering.
I think that was in Philly – I may be incorrect.
It appears things started in PA with a bomb and never turned around.
1. cocomaanApril 26, 2021 at 3:48 pm
  Yep, you got it. 22 year old (might even qualify as a Gen Z at that point).
  https://www.npr.org/2021/01/29/962190196/why-philadelphia-gave-a-22-year-olds-startup-a-vaccine-contract-then-canceled-it
  And here’s the article about the shortchanging of the Philadelphia counties:
  https://www.msn.com/en-us/news/us/lawmakers-say-southeastern-pa-shortchanged-by-100k-vaccine-doses/ar-BB1enoKI
  And if you’re really masochistic, here’s a great incidence of “Grifters gonna grift” when it comes to wealthy Chester County and their thousands of useless testing kits. https://www.dailymail.co.uk/news/article-9312803/Pennsylvania-county-blocks-workers-sharing-job-related-info-COVID-scandal.html
  PA is the poster child for incompetence. Somehow, we have managed not to have the absolute worst numbers in the country, but it isn’t for lack of trying.

comments

IM Doc pt15

2021-09-18T21:50:16Z

Short one this time because the next one is lengthy.

I'm unsure what article this first poster is remarking on:

GeofApril 8, 2021 at 12:27 pm
A very large percentage of the population is hip to this wide-spread institutional rot, and he is practically oblivious to the fact his esteemed profession may well be deeply affected. Physician heal thyself.
I very much agree. From the article:
The problem with that establishment, as Mr. K. sees it, is not just its drug pushing and profiteering, but its censoring of people who disagree. For instance, in July . . . social media companies removed a viral video of physicians suggesting (misleadingly) that hydroxychloroquine was an effective treatment for Covid-19
The article describes this as “his perception that people questioning medical dogma are censored” and “these instances of so-called censorship.”
The removal of videos about hydroxychloroquine and ivermectine, and suppression of challenges to WHO dogma, such as early calls for masks, concern about aerosols, and the lab leak hypothesis, was not “so-called” censorship. It was censorship.
Even an article like this, calling for empathy and understanding, is unable to face the facts of censorship and the catastrophically poor choices of health officials. I have tremendous sympathy for many in the anti-mask anti-vax brigade. Our health elites have demonstrated time and again that they are not honest – this suggests they are not even honest with themselves.
My lack of trust does not push me into automatic rejection of the vaccines. I am much more concerned about the (large) risk of long covid than the possibility than the (real, but probably very small) risk that these novel vaccines might trigger something nasty. I look forward to getting vaccinated at the earliest opportunity. But every time I read something clueless like this, my general disinclination to trust anything the experts have to say increases.
IM DocApril 8, 2021 at 12:44 pm
I have said this before – and will say it again. My profession has tolerated unethical and criminal nonsense from pharma, hospital and insurance companies far too long.
The overwhelming problems are now just old hat – and the physicians especially the younger ones – behave as if they are cult members.
They have no awareness of the extreme damage this system is doing to individual people and our society in general.
What you point out is completely true. I would guess 80% of physicians have little or no self-awareness – and are just mind-numbingly trudging along as if the profession still had Marcus Welby esteem in the wider society.
Those of us able to recognize the Naked Emperor have no idea how to wake our colleagues up. After 20 years or so of trying in every possible way, I have largely given up and resigned myself to the future brick wall. It is definitely on the way.

RockHardApril 16, 2021 at 8:36 am

Re: Always Read the Methods Section

>The first question, always, should be: did the reporter read and understand the methods section?

I want to say that Probability & Statistics should be a required subject for all Journalism students, but it’s not like it would matter. Editors write headlines to get clicks because that’s really all that matters, and nobody wants to try to understand math or statistical methods, that doesn’t generate ad impressions.

——
Don’t apologize, Yves. This crew will be fine for a while, you take care of what you need to.

IM DocApril 16, 2021 at 9:21 am
I am not sure taking classes in stats would help,
As a faculty member for years at a Med school where epidemiology and stats are critical to understand, Med stats was one of the hardest for the kids to pass and these are bright kids.
I would say about a tenth are able to fully get it and this is evidenced by the abysmal thinking on display for all to see right now.
Who seemed to really get it? Kids that spent a lot of time with sports stats especially baseball and golf and kids whose parents played the ponies. I only wish I was kidding.
There is a reason someone like Nate Silver got their start in sports.

The entirety of this might be of interest (before I get to IM Doc's comment):

Welcome to the Age of Hysteria

Posted on April 17, 2021 by Yves Smith

Yves here. Synchronicity strikes! Lambert and I were discussing some of the extreme views expressed in comments yesterday. He attributed it to hysteria in the zeitgeist finally getting to the site. And now we have a theory as to why! It’s a neoliberal infestation.

By Marc Schuilenburg, assistant professor at VU University Amsterdam, the Netherlands. Originally published at openDemocracy

In 1980, hysteria died. That was the year it was removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) handbookand ceased to be considered a medical condition. But we need only look around us to see that hysteria has never been more alive – just consider the run on toilet paper at the beginning of the COVID-19 pandemic. Or the consumer hysteria every Black Friday, or the overheated discussions taking place on Facebook and Twitter every day.

We all recognise hysteria – the display of over-the-top emotions – when we see it. In fact, no sooner than it left the DSM handbook, hysteria seems to have migrated to every other sphere of our lives. No longer a medical condition, it is our era’s defining sociological phenomenon. What lessons can hysteria teach us about the societies we live in today?

Sociological Key to the World

Medical and historical researchers, psychoanalysts and philosophers, religious and gender studies scholars, as well as painters and writers, have all grappled with hysteria and tried to unravel its mysteries. From ancient Egyptian times until deep into the 18th century, hysteria was diagnosed as a convulsive disorder affecting women, caused by a ‘wandering womb’, which was believed to move freely through the body all the way into the head, emitting toxic fumes that led to hysteria.

Sigmund Freud’s work popularised the study of hysteria from a psychoanalytic perspective. Ideas like the Oedipus complex – in which hysterical behaviour is caused by a girl’s guilty feelings about her sexual attraction to her father – have become irrelevant. But a theory of Freud’s that still resonates is that hysteria is caused by traumatic events that cannot be put into words and are expressed instead through bodily complaints.

In the 1970s and 80s, feminist thinkers such as Hélène Cixous and Luce Irigaray turned sexist views of hysteria on their heads, rebranding hysteria as a female system of meaning outside official languages and cultural conventions. They considered hysterical symptoms to be a rebellion against the social and institutional order that restricts women’s freedom.

Although there are countless possible explanations for hysteria, we tend to ignore the sociological link between individual stories and the big picture. Yet hysteria has as much to do with wider political, economic and cultural changes as it does with the individual. Examining the hysteria we are seeing now and how it is being fuelled by societies that not only encourage and enjoy but also abuse and reward it, can tell us something about why people seem increasingly to fall prey to it.

A ‘Black Plague of Degeneration and Hysteria’

In 1892, the Austrian physician Max Nordau wrote in his book ‘Entartung’(degeneration) that the growing number of cases of hysteria were down to exhaustion caused by the rapid development of modern society. He argued that Western society was haunted by a ‘black plague of degeneration and hysteria’.

Nordau described an unhealthy fin-de-siècle (end of an era) feeling marked by the acceleration of technological change. Age-old traditions and stories were being pushed out by new media such as the telephone and the telegraph, which brought together people who had previously been far apart. Daily life was further intensified by the invention of the steam train, the gramophone and film, as well as the spectacular growth of cities, all of which put people in touch with new sounds, images and worldviews.

Everything that had once been small and familiar became large and overwhelming, creating a void of security and belonging, against which the body revolted through hysteria.

Who Am I, Where Do I Belong?

We are again seeing a steep decline of a primal sense of security, the social glue of society. Globalisation has cranked the speed of life into a new gear. In many countries, Anglo-Saxon neoliberalism has replaced social democracy since the 1970s, leading to a loss of solidarity and over-individualisation, raising questions such as: who am I, where do I belong, how important is my culture?

At the same time, there is ever less space in our societies for community or communal identity. Corporate chains have replaced social meeting places, ranging from public libraries to corner shops. These ‘palaces for the people’, as sociologist Eric Klinenberg calls them, reinforce public familiarity in a neighbourhood by allowing people to make connections, help one another, and offer refuge to those who feel excluded or diminished elsewhere.

The lack of a sense of belonging – often accompanied by feelings of fear, frustration and anger – is a recurrent factor in outbreaks of hysteria. In that respect, life has arguably returned to how it was in late-19th-century Europe. Not that society is the same as it was at the time of Nordau – too much has changed since then – but there are undoubtedly some very striking similarities.

Twitter Goes Bankrupt Without Hysteria

Where hysteria used to be a medical condition, we can now think of it as our era’s business model. It works by playing on these feelings of lack and insecurity. Social media is probably the most obvious case in point. Facebook’s business model is focused on offering a platform to frustration and anger, emotions that are infectious and in combination with uncertainty often lead to extreme reactions. The more hysterical your post, the more clicks and views you generate and the greater the advertising revenue for Facebook. This also goes for other social media including Twitter, which would surely go bankrupt tomorrow without hysteria.

Facebook and Twitter are increasingly viewed as addictive, and with good reason. Research shows that the chemical dopamine, also known as the happy hormone, is released in our brains when we are successful on social media. Getting lots of likes or followers activates the reward circuit of the brain, while uncertainty strikes when we are unfollowed on social media, making us feel empty.

War on Everything

The same is true for politics. We might not think of politics as having a ‘business model’ as such, but politicians constantly draw on society’s potential for hysteria, ‘selling’ citizens both the hysteria itself and their solutions to it.

Take the issue of public safety. Citizens are liable to get incredibly worked up about the issue of security and respond with vehemence to what is seen as a non-committal attitude to crime characterising their country. As a consequence, political discussions about public safety tend to end in the unanimous conclusion that more decisiveness is needed to solve all problems for good.

Such policies are spoken of in hysterical terms and with a preference for a macho military vocabulary: ‘war on coronavirus’, ‘war on drugs’, ‘war on terror’. Former President Donald Trump threatened to send in the militaryto quell the unrest in American cities sparked by the brutal killing of George Floyd by police officers on 25 May 2020.

Once the diagnosis of a ‘law and order problem’ has been made, we are flooded by a veritable tsunami of new punitive measures – only for the cycle to be repeated. Any politician suggesting that crime rates in Western countries have fallen spectacularly for years or that it is impossible to create a risk-free society, is accused of ‘looking the other way’.

The Experience Economy

It’s possible that a void, or a feeling of lack, is inherent to the human condition. Indeed, it’s this sense of lack that has driven human development, bringing us wealth and progress. But the market economy thrives off and magnifies this feeling of a void in our existence that cries out to be filled. Nothing is ever enough: four words that summarise today’s neoliberal economic order.

The experience economy, which is based on the premise that reality is the way people perceive it, expertly deploys advertising and exposure to stimulate consumers’ desires by creating a feeling of need. The launch of every new iPhone sends us running to Apple Stores in a crazed frenzy, even though everyone knows the difference between the old and new versions in no way justifies the expense.

“I can’t get no satisfaction,” as a wise man once said. Even if we obtain the thing we desire it will only satisfy us temporarily because no single object, experience or person can fully satisfy the lack that lies at the root of our desire, which is constantly recreated in the consumer economy.

Getting Hysterical About Hysteria

When exploited as a business model, hysteria brings misery. But hysteria can also have the power to turn the world upside down, just as the hysterical, uncontrolled laughter of the Joker in Todd Phillips’ film becomes a call to finish off today’s rampant neoliberalism after the Joker loses his medication and counselling because of budget cuts.

In the 19th century, women started politicising their bodies to revolt against the suffocating conventions of the Victorian era. While this ‘hysteria’ led to many of its ‘sufferers’ being institutionalised, it also produced social reforms aimed at giving women the same rights and opportunities as men. The tightly laced corset disappeared, making space for more liberal views on marriage, sexuality and the right to work.

This is not hysteria in its most destructive, sinister form, in which people tear off their clothes and pull out their hair. I am talking about a constructive hysteria which sets things in motion. Constructive hysteria is an engine for change, a way of making a contribution to the world. It acts for the greater good rather than out of self-interest.

House on Fire

It seems to me that certain issues should be treated with a little less hysteria, while others could do with some more. No one is raising the alarm over the fact that 14.3 million of the UK’s 66.4 million inhabitants live in destitution, including 4.6 million children. Nor does anyone seem too worried about a large part of this group being homeless.

At the same time, eco-barbarism is running rampant. Roughly 1,000,000 of the estimated eight million plant and animal species on Earth are threatened with extinction, in many cases within a time frame ranging from a few years to a couple of decades. As journalist David Wallace-Wells puts it in his bestseller ‘The Uninhabitable Earth’, ‘Here, the facts are hysterical.’

While the planet is hurtling towards its demise, the debate about global warming revolves around how much it will cost to go on living the way we are now, and includes painstaking calculations of exactly how much money needs to be spent on measures to preserve the planet as well as our lifestyles. This reduces an ecological issue to a bookkeeping problem, to be resolved by a flight tax here, an energy subsidy there. The real issue, that we need to develop a completely new ecological awareness as well as a new and more inclusive understanding of such matters as ‘damage’, ‘care’ and ‘responsibility’, is not addressed.

You could argue instead that the sheer scale and disastrous effects of both issues should justify a hysterical gesture – one fueled not by profit and power but by the human need for survival and togetherness. Silence and inaction are no longer options. We do, after all, live in a hysterical world – and we know it.

This article is adapted from the new book ‘Hysteria: Crime, Media, and Politics‘ (Routledge 2021)

IM DocApril 17, 2021 at 6:04 am
Dr. Nordau’s book “Degeneration” is mentioned in the very beginning of this article.
I had to look twice at the publication date 1892.
I do not believe it to be a coincidence that year is exactly the year at the end of the first wave of the last great Coronavirus pandemic. It continued on wave after wave for several more years.
This has all happened before and will all happen again.

comments

IM Doc pt14

2021-09-18T21:37:21Z

Good Friday and Easter Church Raid Attempts by Police Over Covid Intensify Conservative Christian Vaccine Hesitancy

Posted on April 5, 2021 by Yves Smith

Yves here. We didn’t expect to return to a heated topic so soon, that of conservative Christian resistance to Covid 19 vaccines, which we discussed late last week. As the post described, they have two grounds for concerns. One is the use of fetal stem cell lines. The connection to the vaccines may seem pretty strained to those not sensitive to this issue, but it isn’t fabricated.1

The second is that the proposed vaccine passports sound like the Mark of the Beast. Lambert found the relevant section in Revelation 13:

11 And I beheld another beast coming up out of the earth; and he had two horns like a lamb, and he spake as a dragon….
16 And he causeth all, both small and great, rich and poor, free and bond, to receive a mark in their right hand, or in their foreheads:
17 And that no man might buy or sell, save he that had the mark, or the name of the beast, or the number of his name.
18 Here is wisdom. Let him that hath understanding count the number of the beast: for it is the number of a man; and his number is Six hundred threescore and six.

In the last three days, as the post explains below, two heavy handed police actions against Catholic churches, both outside the US, have heightened vaccine concerns in some conservative parts of America. While the plural of anecdote is not data, IM Doc said they were major topics in his part of flyover…when vaccinations had already fallen off sharply.

Biden as a Catholic could speak to his fellow believers and Catholic leaders to try to repair the damage. But is he too far removed from ordinary people in the heartland to have the foggiest idea what is happening?

I am not able to ascertain how prevalent these attitudes are. I don’t see it in Birmingham, but this is a small city where the medical industry is the dominant employer, and Baptists are the largest religious group, followed by Methodists and Catholics. 5% are Pentecostals and we have roughly as many Mormons as Jews, both under 1%. That is a long winded way of saying that evangelicals are not a significant force here, although I imagine that varies widely in cities across the South. Since we are near the dead bottom on vaccination rates (they’ve only recently opened up vaccinations to everyone 55 or over, and distribution outside mass vaccination centers is still pretty limited), I doubt we’ve hit saturation of those keen to get a shot.

More generally, we are in the midst of a collision of religions: traditional sects versus the cult of experts. Economist and Biden supporter Paul Romer warned of the dangers of elite authoritarianism last October, and Lambert thought it important enough to devote an entire post to it. The Covid topic then was contact tracing but the same general principles apply:

6. I wish it were not so, but the evidence seems clear that in the US and the UK now, persuasion by experts is not succeeding. If anything, it is back-firing.
The public is rebelling against “preachy” expert exhortation that they perceive to be condescending.
6/N
— Paul Romer (@paulmromer) October 18, 2020

I hope we have a new administration that succeeds.
I am terrified that frustrated experts will send it on a kamikaze mission that gives expert exhortation the force of law.
Claim 4: This use of the law will not restore expert legitimacy and might destroy our democracy
15/N
— Paul Romer (@paulmromer) October 18, 2020

By IM Doc, an internal medicine doctor working in a rural hospital in the heartlands

My worst nightmare concerns are starting to come true and the media will not be able to hide this for much longer. Today, I am not concerned about the SCIENCE of medicine – I am concerned about the ART of medicine.

The ART can best be summarized as encouraging patients to do the right thing for THEM. With regard to COVID 19, that would be to meet the patient at whatever level they are and find ways to encourage social distancing rules, masking and to correctly guide them on vaccine choice. It would also include encouraging them to be engaged in the healthiest behaviors possible during this time of crisis. Eat well, exercise, sleep and de-stress.

The ART is often much more important to a physician’s medical outcomes than the SCIENCE – something our society and our medical establishment has long ago forgotten. ART requires as a foundation explicit trust and honesty between a patient and the physician. There is no other way.

Yves, I appreciated your post the other day on the Christian Nationalism aspect of COVID 19. I made a comment on the post about this not just being an Evangelical problem. I even suggested in the comment that there could be issues brewing among Roman Catholics, based on what I had been hearing as a physician.

As of Easter Sunday, there are now multiple videos being widely circulated and they all speak to the issue better than I could ever type out in a comment. I have been seeing this problem slowly brewing for weeks and it has largely been completely ignored by our mainstream media.

These videos have both gone viral on our social media in the past 24 hours:

Police in East London break up Polish Good Friday gathering in church due to it being ‘unlawful’ pic.twitter.com/AZtkYmiPfh
— Charlotte (@CharlieEmma85) April 3, 2021

This video is from a Polish Catholic church somewhere in London. To say that it reminded me of a Dalek invasion straight out of Dr. Who is an understatement. Also – it appears that Big Brother has now arrived in our Good Friday mass.

Oh but this one is even better – This is from Calgary Alberta Canada. And in my rural parish this Easter morning, this was the main event being talked about by everyone.

Canadian police tried to shut down a POLISH church on Easter. The Polish have a PROFOUND understanding of totalitarianism (fascism, communism) and sent the police away! #COVID1984 pic.twitter.com/TYMDYrujhC
— Geopolitics & Empire (@Geopolitics_Emp) April 3, 2021

At the time I put this tweet here – there were 1.2 million views – and I am certain many of them were at our Easter Mass this AM. There is a phrase used here to express the people’s reaction that is so apropos – “whomper-jawed”.

I will state for the record officially today – the public health authorities have lost the narrative. They apparently have also lost their minds. If they think this type of behavior on the most Holy Days of the Church is not going to go unnoticed – they have rocks for brains. This kind of thuggishness is not going to help their cause in any way; rather, it will make these people dig in more. And trust me – as of this Easter Sunday AM – they are digging in. Bunker-style. A clarion call has gone out and it could not be more clear. And I am talking about Roman Catholics – not my Evangelical family – they went off the reservation long ago. Now even my Orthodox friends have taken notice.

As I have been stating over the past few days – the authorities have repeatedly allowed discredited, hypocritical and lying Hoohahs to be their voice in the national media. Outside of our big blue cities and states – NO ONE AMONG MY PATIENTS COULD GIVE A RAT’S ASS WHAT THESE PEOPLE HAVE TO SAY ANYMORE ABOUT THIS PANDEMIC. I hear this refrain constantly every day. The lying, dissembling, crying, misstatements, backtracking and hypocrisy have taken their final toll. If they are not careful, they will soon be public enemy #1.

We have made many errors as a society in the past 12 months, but probably the most important mistake is hardly ever mentioned. One which our forbears in public health, like my father, worked to eradicate for decades. It is very simple – national “one-size-fits-all” narratives and plans in public health do not now nor have they ever worked. Never have. Never will.

There is a very good reason we have local health departments with trusted and elected figures to run things and to communicate. These people have their ears to the ground in their communities. They are trusted neighbors, often elected. That means there is accountability.

Over the past generation, we have largely decided that this is a system that we could no longer afford. So instead we have installed a national “one size fits all” bureaucratic octopus – and this fiasco is what has been wrought. And obviously not just in the USA. Combatting a pandemic in urban blue America is very difficult to do as we have all seen this year. But combatting a pandemic in the Rockies, or in the South is not even closely the same.

As just one example of many, who in rural America could forget our hospitals standing empty for a good 6 weeks last Spring with zero patients in many places while NYC was in a crisis? It was just a sign of mass disorganization which likely would never have happened a generation ago. Trust me – I could go on and on with examples for an entire novel-length discussion. The centralized bureaucracy “model” has been a complete bomb. I am not suggesting there should not be a CDC or an NIH. I am however suggesting that my people in my county should be much more attuned to their local authorities rather than Rachel Maddow or Dr. Fauci.

The tenor of what I am hearing from the MSNBC types, the UMC, the professionals, has become deeply disturbing. To wit, just call these stragglers names – yeah – then they’ll take the shot and willingly comply with orders. They’re just stupid after all. Or better yet, just let the dullards die. “Science” is telling us to take the vaccines – and only morons don’t get it. I have absolutely had to remove dailykos.com from my toolbar because it is obvious those people really do not have a clue. The partisans in our country have completely lost the gift of empathy for the other side. Those of us in the middle are left to just shake our heads and “fan ourselves” as my grandma used to say.

One of the founding tenets of public health is that shaming and name-calling have no place, certainly not in an emergency. I hope we are all beginning to understand this simple concept. I had the opportunity to speak with someone from the CDC this week. He asked me about vaccine hesitancy and loss of stringency in social distancing and masking that is becoming apparent in my area. I told him – and I will tell you all – the strategy must change and do so now if there is any hope of salvaging this situation. The MSNBC crowd have largely been the ones lining up to get vaccines. Most of them have now gotten their shots. Our agencies must immediately yank the HooHahs off the air – and get someone else to reach the rest of this country without all the backtracking and theatrics. I just do not know who that would be, nor do I know if the damage is already permanent. In my opinion, a big move like firing Dr. Fauci would likely do wonders. At this point – who cares what the MSNBC crowd thinks?

A few data points to consider out here in flyover country.

My wife has decided to take the J&J vaccine. I have too. We are going to take them on separate weekends so someone will always be well to take care of the kids. The J&J vaccines are available in our county. My wife called the pharmacy early thinking there would be a wait for an appointment. Not at all, just show up anytime. And we were there yesterday AM. The pharmacist informed us that this was only the 10th COVID vaccine of any brand administered the whole week. They have boxes of vaccines – and no one is taking them. The rush about a month ago is long over.

During the homily this AM, the guest Roman Catholic priest, an emigre, showed the above videos on the monitors and informed the crowd to be prepared to “fight for the faith”. He never thought he would see behavior like this in the West – behavior that was very common when he was a young priest in his home country.

He also suggested to think twice before taking the vaccines – they had all been tainted with fetal abortion cells. I know this is true of the J&J vaccine.1 I am also aware the Catholic Bishops have said it is OK to take the vaccine. In the minds of the majority of Catholics out here in the netherlands these days – they also remember that the Catholic Bishops vehemently said that raping boys by priests was supremely uncommon and when found would be taken care of with an iron fist. We all know how that worked out.

In brief – I am finding it ever more fascinating to live in a culture where everyone is trying their best to do the right thing – but the level of trust in our institutions is now approaching ZERO. That includes political, health, medical, media/entertainment and now sports – just about everything. I never thought I would be living in these days in America – but here we are. Our elites have been working diligently on this banquet for decades – now, the feast of consequences is being served.

James P.April 5, 2021 at 6:52 am

First this from the author:
“The partisans in our country have completely lost the gift of empathy for the other side.”

Followed by:
“At this point – who cares what the MSNBC crowd thinks?”

Ironic. Clearly the author has taken a side. The new popular approach: pick a tribe but decry tribalism.

IM DocApril 5, 2021 at 7:04 am
I am most definitely not on any side. I find both sides grotesque. What I meant there and what is clearly stated in a clumsy fashion is that one group has largely complied. If this is as critically important as we are being told we should be concentrated on the other side which has up until now by anyone viewing this with a fair lens been given short shrift by our media and leaders.

Kurt SperryApril 5, 2021 at 8:08 pm

Are dissenting opinions actually welcome here or is this another bubble? I guess we’ll soon find out.

The anti-vaxxers (and I am deliberately avoiding misleadingly anodyne euphemisms like vaccine-skeptical or vaccine hesitant) are going to pay no more attention to what I or anyone outside their hermetic ideological bubble think than frankly I will to their batty opinions. This is intrinsically a tribal binary divide with very little middle or shared ground to work in. Either you believe in and take the vaccine or you refuse it; pick a side, there’s no equivocating this time.

Anyone who’ll voluntarily get into a car to drive across town to do something unnecessary and not tremble in fear at the danger yet will at the same time pause before the unambiguously far lesser danger of getting a vaccine quite likely not only to save their life but to protect those of their family, friends, neighbors, and fellow citizens is manifestly incapable of assessing relative risks in a rational manner. And this is leaving out the pure selfishness of thinking and acting this way.

Yves SmithApril 5, 2021 at 9:52 pm
You clearly did not read the post, or at least not with care. These are religious objections, and they go beyond assembling.
We mentioned at the top The Mark of the Beast concern. The vaccine passport threat is now being bandied about as a compliance measure. That’s despite the fact that many of its promoters have not checked on its legal status (you cannot require people to take a vaccine approved only under an EUA under Federal law, so not in any Federal or governmental context, as well as in employment).
Some commentators claim that private businesses can still impose them under the “no shirt, no service” standard. But that fails because this isn’t a status you can ascertain based on public/visible information. It runs afoul of civil rights and privacy statutes in many state and even cities (no way is this legal in Denver, for instance).
So we have a lame-assed idea that at most could be imposed only in certain states in a pretty narrow context. Yet this is being bandied about in the US as something imminent, when it triggers evangelicals who otherwise might be persuadable (they don’t have issues with fetal stem cells).
1. Kurt SperryApril 5, 2021 at 11:04 pm
  “Mark of the beast concerns” are for me as an agnostic on a par with “invisible unicorn concerns”, “disembodied voice in my head concerns”, or “alien lizard people concerns”.
  I have no opinion on the legality of “vaccine passports”, a subject I never broached in my post, but I’m hoping they are found legal as I think they might likely help nudge some fencesitters over to the vaccinated side if they allow access to events, travel, and recreational opportunities that cannot otherwise be responsibly held. Plus I’ll feel a lot more confident having the freedom to choose attending events and traveling knowing I’m not sharing enclosed spaces for hours with anti-vaxxers, as even after I’m fully vaccine-protected some small contagion risk will inevitably remain.
  Additionally, and perhaps most importantly, the anti-vaxxers, if sufficient in numbers, will unnecessarily keep the pandemic ongoing far past the time it should and as a direct result cause a lot of completely needless and gratuitous death, life-long disability, and massive economic harms that will inevitably disproportionately effect the poorest and most vulnerable among us.
  1. Yves SmithApril 6, 2021 at 2:17 am
    Wow, you are a bigot. Glad we have that clear.
IM DocApril 5, 2021 at 10:38 pm
I will tell you that anti Vaxxers do not bother to talk to me about this. The people I see all the time are folks who have dutifully taken vaccines for years and this one has them concerned.
I would urge everyone not to conflate these two groups. Completely different

Tom StoneApril 5, 2021 at 9:05 am

When you are dealing with the morally and intellectually inferior firmness is a necessity.
And so is the occasional “Noble lie” for the common good.
The deplorables can either get in line or get hurt, it’s traditional.

IM DocApril 5, 2021 at 1:00 pm
For 30 years in my professional career, I walked among those with credentialed education and Ivy League paticulars. Our PMC has decided that that intelligence and wisdom only flow from those with such a background. Yet another almost daily mistake I see being made by our media figures.
I believe, and I may be wrong, that it was Noam Chomsky who several years ago wrote a nice long passage about this very issue – indeed he suggested that it was actually easier to prove that intelligence and wisdom were mainly to be found in the non-credentialed.
Now that I have been out among the “deplorables” as you call them – and as so often they are referred by the credentialed class – I can assure you that I cannot agree with the good Dr. Chomsky more vigorously.
Non-credentialed does not equal moral and intellectual inferiority. Indeed, I have learned the past 3 years that if I was ever stuck on an island Survivor-style, I would want to be surrounded with the folks I stand with now – and not the ones I spent the past 30 years with. And most certainly I am so relieved that my children are learning values from these deplorables rather than the educated fools that populate our cities.
Our move to the hinterlands has been probably the most illuminating journey in our lives.

occasional anonymousApril 5, 2021 at 2:27 pm

“Non-credentialed does not equal moral and intellectual inferiority.”

No, it doesn’t. But being a petulant Karen or manchild who aggressively refuses to do something as simple as wearing a freaking mask does.

I’m breaking hard with NC on this. Yes, our leaders, the media, and our ‘healthcare’ industry have failed over and over and over again over the last year. But that doesn’t excuse the fact that an apparently significant portion of our population have chosen to act like fools. In the end personal responsibility is a thing, and I’m tired of us trying to come up with systemic reasons to excuse the idiocy of individuals. As Lambert has said repeatedly: Russian roulette is risking your own life, while American roulette is risking other people’s lives. I actively resent these morons; they’re putting everyone else at risk.

IM DocApril 5, 2021 at 4:59 pm

These morons as you call them are the ones who risk life and limb dealing with animals so you can eat – and with oil pipelines and down the mines so you can heat your home.

We seem to lose sight of this constantly.

Their day to day life and jobs are so incredibly physically difficult and complete disaster is always around the corner – that many of them do indeed have the attitude of “What is a virus going to do to me that these bulls have not already done?”

They are not morons. They are not going out of their way to inconvenience you or anybody. They laugh out loud at this kind of preening. Many of them stare death and dismemberment straight in the face daily. And have the scars to show for it.

I used to think like you do. Those days are long gone. I deal with these people every day. Maybe you should get out into the rural areas of this country a bit more. It has sure changed my perspective.

IM DocApril 5, 2021 at 5:19 pm
I do not know who you are. I do not want to come off as harsh on you either. Believe me I understand. I have learned over the past year to deal with people where they are. It is my job. It is my profession. There are thousands like me all over this country doing their very best to deal with this situation.
I have learned a lot about how to deal with these “morons.” It has been a whole year of a step forward with me and then three steps back with the chaos in our media. I have been able to make great strides with many of them. But it has certainly not been done by name-calling or virtue signaling.
Indeed, I have found this to be the best way to live life outside of medicine as well. Time and experience teach us quite a bit if we keep our minds open.
occasional anonymousApril 5, 2021 at 5:57 pm
I work on a farm. Don’t give me this ‘so I can eat’ crap. Being a laborer doesn’t necessitate someone to be a stubborn fool.
Good job just throwing all workers under the bus like that though. So in your mind ‘covidiot’ equals ‘working class’?
1. floraApril 5, 2021 at 6:03 pm
  Strawman much?
2. IM DocApril 5, 2021 at 6:06 pm
  Not at all – I usually do not refer to anyone as a covidiot. It does not get one far in my business.
  All I can say I am relieved I am the one trying to deal with these people. Not all of whom are farmers, ranchers, or roughnecks by any stretch of the imagination.
  People with your attitude have been dealing with them all year on the legacy and social media – and you can see where it has gotten us.
  1. occasional anonymousApril 5, 2021 at 7:29 pm
    My frustration is one created by a year of observing and trying to interact with these Cro-Magnons who are not just stupid, but aggressively stupid. Being polite to them hasn’t worked. Trying to handle them like children and talk down to their level hasn’t worked. No, continuing to insult them isn’t going to work, but freaking nothing else is working either.
    Here, can we please stop the pretense that the reason many people are are being idiots about this epidemic has anything to do with the (many) mistakes of the WHO, CDC, etc etc? Compiling a list of the many elite and institutional errors misses the key point that many people who refuse to even do basic things like wear masks aren’t even aware of those many errors, because they were never paying attention to official pronouncements to begin with. They were getting their news from Fox and Facebook groups. They were refusing to wears masks from jump. And in fact if you go back to the Spanish flu epidemic a century ago we see literally the same kind of stubborn stupidity.
    I’d throw up my hands and say ‘just let them kill themselves’, but unfortunately diseases don’t work like that.

IM DocApril 5, 2021 at 7:53 pm

I cannot say it enough – the people are no longer listening.

To the federal public health authorities – The people are no longer listening. At least enough of them to make any difference. This has been caused by many things – but not the least of which has been the outright bumbling incompetence you have so expertly displayed repeatedly this past 12 months. It will be fodder for management, marketing, and communication classes for a generation – as in how not to do things.

I am not sure what to make of this. Thankfully, this event is largely outdoors with an open roof so hopefully lots of ventilation.

If I were you – I would be moving to PLAN B. And I would be getting input from as many local health authorities and providers as I could.

I cannot say this loud enough – you have completely lost the narrative.

2:00PM Water Cooler 4/5/2021

Posted on April 5, 2021 by Lambert Strether

IL: “How many fully vaccinated in Illinois have still gotten COVID-19, been hospitalized?” [Daily Herald (marym)]. “Illinois Department of Public Health officials reported Wednesday that 17 people in the state who were considered fully vaccinated against COVID-19 have since been hospitalized by the respiratory disease. Additionally, of the more than 2.1 million people who have been fully vaccinated against COVID-19 in Illinois, 399 have tested positive for the virus — or 0.0185% of those fully vaccinated, IDPH officials said.”

WA: “Of 1.2 million fully vaccinated people in Washington state, 100 have gotten COVID-19” [ABC (kareninca)]. “Out of the 1.2 million people who are fully vaccinated against COVID-19 in Washington, epidemiologists have reported evidence of 102 breakthrough cases in 18 counties since Feb. 1, representing less than 0.01% of all fully vaccinated individuals in the northwestern U.S. state. Most cases were patients who experienced only mild symptoms, if any, according to a press release from the Washington State Department of Health…. The Washington State Department of Health is investigating reports of the so-called breakthrough cases, which it said are expected with any vaccine.” • Alert reader kareninca writes: “My new obsession is ‘breakthrough cases.’ I will now be doing searches for stories on that every day.” What an unfortunate term, “breakthrough.” For whom?

IM Doc April 5, 2021 at 2:29 pm

This data on the two states – IL and WA – is actually very positive. It is reflecting very good news which we need right now. And as far as I can tell, does not appear to be manipulated like so many other things I see every day.

Raw data is always the best.

We will see if this trend continues to hold elsewhere. We still have 3 big tests to go – first of all, how long is the immunity going to last, and secondly, how well this appears to be working with the various variants we have floating around. Of equal importance – is if the vaccinated are able to spread the virus.

But indeed this is encouraging data.

nimmpauApril 5, 2021 at 3:16 pm

It’s almost as if, when they say the vaccine is 92% effective, that means it is also 8% non-effective.

IM DocApril 5, 2021 at 4:11 pm
This is a classic example of the way that Big Pharma manipulates data for public consumption. The entire 92 and 8 and 95 and 100 % effectiveness reporting is very much not what the average person thinks it is. It is the old ABSOLUTE vs RELATIVE schtick. The RELATIVE numbers are much higher – 92 95 etc – and much easier for the vast majority of people to digest – but it is actually not representative of what most people think it is.
I have literally had to explain this hundreds of times since the vaccines came out to my patients in person. Pharma has been using this statistical contrivance since way before I was an intern in their ads and glossies – one of the very first lessons in medical epidemiology class is how to cut through this to get to the real numbers.

antidlcApril 6, 2021 at 10:57 am

Interviews on the news last night re: sold out Rangers game.

Granted, it was just a couple of people who were interviewed.

The people who were interviewed said they felt “safe” going to the Rangers game because they were vaccinated. One also mentioned that since they would be outdoors, they would be OK. (Hope they didn’t have to use the restroom.)

From my own experience, I had to explain to a family member that going to a restaurant for Easter was probably not a good idea even though said family member was vaccinated.

Response was, “Well, I’ve been vaccinated.” I tried to inform said family member that large groups should really be avoided (like going to a restaurant on Easter).

Response was, “Well, I’M GOING.” (very emphatic)

I think people have this feeling of invulnerability once they have been vaccinated and either don’t understand or just don’t want to hear about the risks of going out in large groups.

I really think there are a lot of people who think their lives can return to “normal” once they’ve been vaccinated and they can resume their pre-pandemic activities and go back to doing whatever they want. I don’t think they understand (or just choose to ignore) the risks that we still face.

My two cents.

IM DocApril 6, 2021 at 2:03 pm
I must add that last night was a real epiphany for me with my Facebook friends.
I have quite a few physician contacts in the DFW area. Some of them have been repeatedly on Facebook loud and proud since December, showing off all their lovely masking efforts, putting up videos to shame and humiliate social distancing scofflaws, showing themselves getting the vaccines, shouting down anyone in their comments asking legitimate questions about safety and efficacy. You get the point and probably have your own to follow.
Yesterday evening right before bed I glanced over my Facebook feed. There were two of these self-same physicians at that game. No masks, hugging others around them and they were proudly posting these pics. When confronted about the fact that indeed masks and social distancing were supposed to be employed at that game by commenters ( their own family members and in one case an actual patient) , the commenters were loudly screeched down – WE ARE VACCINATED – BUG OFF! GO GET VACCINATED, DULLARD- and THEN YOU CAN HAVE FUN TOO! – Those are not exact words – but that was the general message.
I want no one to have the impression that I feel it is just our national medical leaders who have exhibited issues during this pandemic. I have come to realize that my profession is slowly but surely taking up almost cult-like behavior. And actually believing it. I am waiting to see who will be the Jim Jones figure that blows it all up.
2 thoughts that kept going through my mind as I was going to sleep last night –
I know personally the old professors who trained these people and they would be hanging their head in shame. I really do not fit into this old world anymore.
More importantly –
I hope this all works out with the vaccines the way they believe it will and that we are all hoping. If not, GOD HELP US!
1. Lambert StretherApril 6, 2021 at 2:09 pm
  > WE ARE VACCINATED – BUG OFF! GO GET VACCINATED, DULLARD- and THEN YOU CAN HAVE FUN TOO!
  Well, if that’s the baseline, and it’s a pretty low baseline, the vaccination numbers should keep steadily rising, hopefully outrunning the variants. And one has to admit that, stupid as “you can have fun” might seem to an introvert like me, peer pressure will result from it, and cut down on the hesitancy.
  1. IM DocApril 6, 2021 at 2:39 pm
    Again, I am hoping that these early good-looking numbers will hold and also hold up with the variants. I would just not be so cocky and arrogant about this type of thing.
    1. Lambert StretherApril 6, 2021 at 2:55 pm
      No, neither would I, but if previously hesitant Joe Sixpack gets vaccinated because he wants to have a few beers with his friends, I’ll take the win. Perhaps, also, the great unwashed are showing us a better form of messaging than weeping or shaming.
      1. IM DocApril 6, 2021 at 3:00 pm
        I will agree to that 100%

IM DocApril 7, 2021 at 1:18 pm

One little observation that is tangential but very germane to this article.

Our health officials and Big Pharma seem hell-bent on vaccinating teens and kids as soon as possible. Despite the fact that kids have just a miniscule chance of getting ill. I believe the numbers from the CDC in the past week revealed a total of less than 150 serious illness or death in kids in America out of 85 million kids.

It seems completely absurd – and I feel unethical – to be contemplating vaccinating kids in this country before every old or infirm (in other words high risk for death/morbitity – but also high risk for variant production) person in this entire world has been vaccinated.

I have seen this concern repeatedly stated by epidemiologists in this country accompanied with a face palm – it is just they are not the medical “experts” pumping Pfizer stock on the TV.

This problem is going to have to be solved by the world – not individual countries. If that advice is not heeded – the consequences may be severe.

Furthermore, as it was nicely pointed out by someone on CNBC this AM – the average blockbuster drug in this decade in this country is a 20 billion dollar generator over 5-10 years. This vaccine has already put SIXTY BILLION or so into Pfizer’s coffers – risk free. They are going to do everything they can to keep that cash coming – whether it improves the health of the world or not. Hell – three boosters a year – why not?

The corporate money grubbing – what is it going to take to reach its event horizon?

comments

IM Doc pt13

2021-09-18T21:22:26Z

MichaelmasApril 1, 2021 at 6:06 pm

I’m being rude and shoehorning this in here up top because I want to ensure other NC readers see it and give their input. It strikes me as pretty questionable, but maybe I’m missing something. As follows —

I’ve just been reading the paper ‘A Prothrombotic Thrombocytopenic Disorder Resembling Heparin-Induced Thrombocytopenia Following Coronavirus-19 Vaccination’ which is the German study released on Monday arguing for a correlation between the AZ-Oxford COV19 adenovirus vector vaccine and blood-clotting.

Link is here, w. option to download PDF —
https://www.researchsquare.com/article/rs-362354/v1

Six researchers have co-authored it. I read their conflicts of interest statement down at the bottom.

[A] Two of the six co-authors make the following statements —

Dr. Thiele reports grants from Deutsche Forschungsgemeinschaft, during the conduct of the study; personal fees and other from Bristol Myers Squibb, personal fees and other from Pfizer , personal fees from Bayer, personal fees and other from ChugaiPharma, other from Novo Nordisk, personal fees from Novartis, other from Daichii Sankyo, outside the submitted work

Dr. Eichinger reports personal fees from Bayer, Bristol Myers Squibb, Daichii Sankyo, and Pfizer, and Pfizer, all of which are outside the submitted work.

[B] One co-author makes the following statement —

Dr. Greinacher reports grants and non-financial support from Aspen, Boehringer Ingelheim, MSD, Bristol Myers Squibb (BMS),Paringenix, Bayer Healthcare, Gore Inc., Rovi, Sagent, Biomarin/Prosensa, personal fees from Aspen, Boehringer Ingelheim, MSD, Macopharma, BMS, Chromatec, Instrumentation Laboratory, Portola, Ergomed, GTH e.V. outside the submitted work.

———

Me again. it’s sometimes inevitable that a limited number of experts exists in certain areas and at some point many of them have taken money from the obvious big players.

Nevertheless, is this level of conflict of interest — three of the six co-authors have taken or are now taking money from Pfizer and Bristol Myers Squibb (a latecomer to the COV19 vaccine game, with their own candidate on the way) — really considered acceptable and legitimate?

IM DocApril 1, 2021 at 6:46 pm
If you look at every member of the FDA advisory panel that approved the Pfizer and Moderna and J&J EUA – you will find more conflicts of interest than you could write in a novel. This would have never been tolerated a generation ago. And that is just one example.
What I am saying is it is not just the journals and the medical literature – the corruption is everywhere at the highest and lowest levels.
I have many friends and colleagues who work in our large national medical agencies – when I talk to them I often become nauseous. The exact same is true in our great medical universities and centers everywhere. All corrupted by Big Pharma and Big Hospital and Big Insurance bucks. This fact is a large reason why I personally am no longer in academic medicine. My forebears on this planet instilled in me the idea that I am going to have to stand and account for my life one day when I meet my maker – and I could no longer fathom working in that environment. The corruption is tentacled everywhere in ways you could never imagine.
Sorry to be so depressing – but it is truth.

DJG, Reality Czar

April 1, 2021 at 3:54 pm

Trends in COVID infections. I am highly concerned that we are going into a new wave.

Last weekend, Illinois had inched up to 1,800 to 2,000 new cases a day. Two days ago, the number reported was 2,500 new cases. Now I see that yesterday’s report is 3,500 cases.

Something is going seriously wrong. Are people just dropping their masks and going to indoor dining? Is it some false sense of security? Is one of the vaccines that much less effective than reported?

NotTimothyGeithnerApril 1, 2021 at 4:07 pm
Immunity from the winter surge wearing off. So much for that herd immunity.
savedbyironyApril 1, 2021 at 4:20 pm
It is the effect of variants and especially B.1.1.7, at least in Ohio. Our numbers are rising, quickest up north by the Michigan boarder. Virus fatigue and slight loosening of some restrictions are not helping but the B.1.1.7 is spreading here, becoming the most common strain detected.
IM DocApril 1, 2021 at 5:34 pm
I really hate to say this – but I believe you are correct. It is all of a sudden happening in my little area of the world. Very slowly – just like it did before. Until we have better clarification – I would urge all to continue taking precautions and be safe.
There is a voice in the back of my head that is becoming increasingly worried about one little piece of data that seems to be missing from all these press reports.
I have seen several releases today from Michigan and the NorthEast that are discussing that the case numbers are going up substantially. I have a very simple question. Are these mostly vaccinated or unvaccinated people that are involved in this surge? It is actually a very important question to be asking right now.
I worry that the fact that this is not being discussed anywhere in these news reports is a bad sign that there are more vaccinated patients becoming ill than our media/political/health leaders would like to admit.
I am very untrusting of anything that has to do with Big Pharma – and increasingly our national health agencies – you can call it thirty years of very hard lessons.
I will reiterate. I feel this is a very important question for EVERYONE to know. I have no knowledge of this one way or the other. However, I fear that if this was mainly unvaccinated people, we would be hearing this blasted from the rooftops. The fact that this is not being discussed out loud – is concerning at best.
And again – this just may be my PTSD from Big Pharma paranoia speaking.

antidlcApril 1, 2021 at 10:26 pm
“I have seen several releases today from Michigan and the NorthEast that are discussing that the case numbers are going up substantially. I have a very simple question. Are these mostly vaccinated or unvaccinated people that are involved in this surge?”
https://www.beckershospitalreview.com/public-health/young-unvaccinated-adults-fuel-covid-19-hospitalization-surge-in-michigan.html
COVID-19 hospitalizations are steadily increasing in Michigan, largely driven by a jump in cases among younger adults who have not been vaccinated yet, the Michigan Health & Hospital Association said March 24.
1. IM DocApril 1, 2021 at 11:15 pm
  I HAve read this article just now.
  Unfortunately, this is a standard issue example of a strategy used repeatedly by those trying to obscure things.
  Raw numbers please.
  So the 30-39 age group has increased 500% and the over 80 has just gone up 30% according to this article.
  The baseline in this situation of hospital patients would be very low in the 30s but high in the 80s.
  The latest data I can find suggests that overall hospitalization for Covid is about 100 times more likely for 80 year olds than 30 year olds. The actual number is 82.9 times but using 100 makes my following example much easier to understand.
  I have no raw numbers but we will pretend there were 10 hospitalized thirty somethings in the state 2 weeks ago. That would make the 80 year olds at 1000.
  The 10 have increased by 500% for a total of 50 so 40 more.
  The 1000 80 year olds have increased by 30% or 300 more.
  40 likely non vaccinated young patients vs 300 likely vaccinated old patients. Now we have a much worse story for the vaccines than the headline would suggest.
  I have simplified this greatly with the 10 and the 1000 but this was derived from the fact that the difference between the age groups is really right at 100 times.
  These pharma people really know how to manipulate numbers to make things really benefit them – I have watched it for 30 years.
  I have done journal clubs my entire career to expose this for students. When raw numbers are not given – just percentages – the likelihood of games being played rises exponentially. When you see anything from medicine expressed in just percentage forms without raw numbers your skepticism red alert should go off.
  Until a news outlet is telling us the actual raw numbers of vaccinated or not, it is really difficult to know what to make of the situation.
  In this situation, it would also be helpful to see case numbers as well not just hospitalization numbers. Limiting to just hospital numbers leads to other obscuring issues.
  1. Lambert StretherApril 2, 2021 at 7:53 am
    > When raw numbers are not given – just percentages – the likelihood of games being played rises exponentially.
    Good litmus test!

Here, a full write-up first:

Christian Nationalism Is a Barrier to Mass Vaccination Against COVID-19

Posted on April 2, 2021 by Yves Smith

Yves here. I’m running this post with its original headline, although the article doesn’t make terribly clear what “Christian nationalism” is. The author defines is at extreme evangelism but I’m at a loss to understand what makes that “nationalism”. The reason I am running this article is that it discusses an specific issue that IM Doc mentioned back in early February.

And even though we are discussing different subcultures in America, we might as well be talking about different countries. One of the lessons I learned by virtue of deciding to see the world on the McKinsey plan, was that virtually without exception, US companies entering a foreign market would royally screw things up. Even if they’d managed to hire good managers from the new market, the top brass would reject recommended changes to the product or branding to cater to local tastes: “They can’t possibly want that! Of course they’ll prefer our superior dog food!” They almost always had to fail before they’d listen to how the locals thought about things and understand why they wanted what they wanted.

I had sent a link from the Ghion Journal, which was and is pretty up in arms about the Covid vaccines, as an example of vaccine alarmism in the black community. IM Doc said then that he was hearing a lot of reports from doctors in his network in big cities of vaccine hesitancy among blacks and if anything more so among Latinos at that point. But he was the first to alert me to opposition among conservative Christians, beyond those based on the mistaken belief that fetal cells had somehow been used in vaccine development (true in a very strained sense with the J&J vaccine). From his e-mail:

We are seeing all this rage and rush to get vaccinated right now. It is easy to assume there is widespread demand. That is not true…. And then the fun will begin. If you think the anti-mask, anti-lockdown people have been ridiculed and shamed – you have not seen anything yet. I know my Big Pharma and it is obvious they have a stranglehold on our agencies and politicians. They have gotten so used to complete acquiescence that they are becoming supremely over-confident. Trust me, if they think they will get away with forced vaccination of kids for school, they have no idea what they are stepping in. Also, I can think of no quicker way to bankruptcy for airlines and cruise companies then to demand a vaccine passport. They will instantly cut their customer base by 30-40%.
It is not just blacks and Latinos. Our medical and public health elites have their head so far up their ass that they are missing critical cultural and religious issues going on all over this country with regard to the vaccine. For example, my oh so Protestant family members and all their friends back home have zero intention of taking this vaccine. All the talk of vaccine passports and vaccine cards to get in and out of stores and restaurants and events have convinced them that this is the first manifestation of the long anticipated Mark of the Beast. To take the Mark of the Beast is a certain trip to Hell for Eternity….And because of our elites’ complete bungling insensitivity, they have already completely and permanently alienated these people. Again, this is being preached from their pulpits, and no amount of coercion or threats is going to work. I grew up in that environment. I know what I am talking about. They will starve to death before they take The Mark of the Beast.

I have no idea how large this population is. IM Doc gave an estimate for rural America and the South that struck me as high, having lived in the rural upper Midwest, Oregon, and spent a lot of time in Maine. But the point is this is a cohort that is not trivial in size, and its existence has finally gotten the attention of some in the officialdom, too late in the game for them to change course. You’ll see the out-of-touch recommendation in the piece:

…faith leaders can guide their followers and use their pulpits to encourage parishioners that the vaccine is safe and in line with religious doctrines.

That could work with concerns that are based on misinformation, but not ones based on views that see social control/surveillance as evil. There’s no way of prettying up the more heavy-handed schemes to get citizens to take the shot.

And IM Doc, then as now, argued that the bureaucrats have done a terrible job with general practitioners by failing to give the information needed to give honest answers and “best available data” assessments of outcomes and risks:

And again, I will remind you – as a primary care physician I have been tasked with educating patients about these vaccines. I have little if any information about safety. I have zero information on how these vaccines will help death or hospitalizations. I have zero information on how long the immunity will last. I have zero credible and often wildly disparate information about whether it will work on these variants, which are now this month’s panic porn topic on the news. I have very educated patients who come to ask questions all day every day. I will not lie to them, nor will I smile and pass out happy horse shit like so many of my colleagues seem to be doing. The medical elites have put the normal PCPs of this country in a very difficult if not impossible situation.
I hope and pray that all goes well. I, like everyone else, want this to be over. However, if something goes majorly wrong with this gamble, God help us.

By Monique Deal Barlow, Doctoral Student of Political Science, Georgia State University. Originally published at The Conversation

While the majority of Americans either intend to get the COVID-19 vaccine or have already received their shots, getting white evangelicals to vaccination sites may prove more of a challenge – especially those who identify as Christian nationalists.

A Pew Research Center survey conducted in February found white evangelicals to be the religious group least likely to say they’d be vaccinated against the coronavirus. Nearly half (45%) said they would not get the COVID-19 shot, compared with 30% of the general population.

Some evangelicals have even linked coronavirus vaccinations to the “mark of the beast”– a symbol of submission to the Antichrist found in biblical prophecies, Revelation 13:18.

As a scholar of religion and society, I know that this skepticism among evangelicals has a background. Suspicion from religious conservatives regarding the COVID-19 vaccine is built on the back of their growing distrustof science, medicine and the global elite.

‘Anti-Mask, Anti-Social Distance, Anti-Vaccine’

Vaccine hesitancy is not restricted to immunization over COVID-19. In 2017, the Pew Research Center found that more than 20% of white evangelicals – more than any other group – believed that “parents should be able to decide not to vaccinate their children, even if that may create health risks for other children and adults.”

Meanwhile, there are concerns that many white evangelicals are becoming more radical. Faith is not in itself an indication of extremism, but the attack on the Capitol on Jan. 6 showed that there is a problem when it comes to some evangelicals also holding extreme beliefs. White evangelicalism, in particular, has been susceptible to Christian nationalism– the belief that the U.S. is a Christian nation that should serve the interests of white Americans.

Those who identify as Christian nationalists believe they are God’s chosen people and will be protected from any illness or disease.

This proves problematic when it comes to vaccinations. A study earlier this year found Christian nationalists were far more likely to abstain from taking the COVID-19 vaccine. It builds on research that found Christian nationalism was a leading predictor of ignoring precautionary behaviors regarding coronavirus.

Christian nationalists tend to place vaccinations within a worldview that generally distrusts science and scientists as a threat to the moral order. This was seen in the response of many on the religious right to guidance on masks and social distancing as well as, now, vaccines.

And in some cases it was driven by church leaders in the wider conservative evangelical community. For example, Tony Spell, a minister at the Life Tabernacle Church in Baton Rouge, Louisiana, defied authorities in holding mass church gatherings even after the state deemed them illegal. He has also rejected warnings that the pandemic is dangerous, stating, “We’re anti-mask, anti-social distancing, and anti-vaccine.”

He believes the vaccine is politically motivated and has used his pulpit to discourage church members from taking the vaccine.

This anti-vaccine attitude fits with the anti-government libertarianism that predominates among Christian nationalists. Many within the movement place this belief in freedom from government action within a traditional religious framework.

They feel that COVID-19 is God’s divinely ordained message telling the world to change. If the government tells them to go against that idea and vaccinate, many of them they feel they are either going against God’s will or that the government is violating their religious freedom.

Such a view was also seen before the vaccination rollout. White evangelicals were the least likely religious group to support mandated closures of businesses, for example.

Countering Misinformation

The problem isn’t just that Christian nationalist beliefs will be a considerable barrier to herd immunity. To dispel myths about the COVID-19 vaccination among conservative religious communities, church leaders need to be enlisted to communicate facts about the vaccine to their parishioners – who may trust church leaders more than scientists and the government.

For vaccination rates to be increased, messages must come from trusted people in the community. The opinion of a government official will in many instances matter far less to a Christian nationalist than advice from a church leader.

As such, I argue, faith leaders can guide their followers and use their pulpits to encourage parishioners that the vaccine is safe and in line with religious doctrines.

To enable this, church leaders need to both understand and communicate to parishioners the origins of the vaccine. Many evangelicals are under the mistaken impression that vaccines were developed using fresh fetal tissue and are immensely troubled by that fact.

In reality, none of the vaccinations for COVID-19 available in the U.S. was manufactured using new fetal stem cells, but the Johnson & Johnson one was developed using lab-created stem cell lines derived from a decades-old aborted fetus. Many evangelical churches have determined that it is ethical for anti-abortion Christians to take the other vaccines when there are no other options for the preservation of life.

Some within the wider evangelical movement have begun sounding the alarm over the influence of radicalized Christian nationalism.

After the Jan. 6, 2021, attack on the Capitol, a coalition of evangelical leaders published an open letter warning: “We recognize that evangelicalism, and white evangelicalism in particular, has been susceptible to the heresy of Christian nationalism because of a long history of faith leaders accommodating white supremacy.”

And many high-profile evangelical leaders acknowledge that they can maintain their personal and biblical integrity while also supporting scientific breakthroughs by connecting what they see as the wonders of God’s universe to science.

For example, Francis Collins, head of the National Institutes of Health and a devoted evangelical Christian, has said: “The church, in this time of confusion, ought to be a beacon, a light on the hill, an entity that believes in truth.”

“This is a great moment for the church to say, no matter how well intentioned someone’s opinions may be, if they’re not based upon the fact, the church should not endorse them.”

The Pale ScotApril 2, 2021 at 5:15 pm

Every infected animal is an unguided experiment for the virus, like monkeys typing. I don’t know where the idea that viruses become less virulent as time goes on. Certainly didn’t happen to Small Pox, Measles or Ebola. More likely treatments become more effective resulting in less harm. Flu viruses are unstable enough to mutate themselves away (Spanish Flu). In the big picture there are models that indicate that a quick killing virus will die out simply because victims are dead before they can effectively shed large amounts virions so theoretically the disease will moderate. That goes out the window when there is a large reservoir of unidentified asymptomatic infected people. Every infection results in billions of virions being created, each an individual genetic experiment. Despite the optimistic talk that COVID has a slow rate of mutations, quantity has a quality all it’s own. 130 million infected globally times billions of virions made in each individual are a countless number of experiments.

A none significant number of young previously healthy people are getting intubated. Coolidge athletes that tested positive but were asymptomatic are presently lung and heart anomalies. Some of the vaccinated will get infected, some of those will shed. But the number of experiments/mutations will go down the more widespread vaccinations become, making it less likely that a more harmful variant will emerge.

Don’t let perfection be the obstacle to effective. Get vaccinated and keep wearing surgical masks. You won’t get sick, and there’s little chance of you infecting someone else

Larry GilmanApril 2, 2021 at 7:57 pm
Well said. It’s simple: we should just get the damn vaccine, not because the demigods of authority say so but because the scientific data are copious, supportive, and publicly available. Complaints that we are being told to obey blindly baffle me: the opposite is true. Studies are being released daily into the peer-reviewed literature, and reported in the scientific and general press, on every aspect of vaccine efficacy and safety. The journal Nature summarizes key papers as they appear: https://www.nature.com/articles/d41586-020-00502-w Also of current note: “CDC Real-World Study Confirms Protective Benefits of mRNA COVID-19 Vaccines” — https://www.cdc.gov/media/releases/2021/p0329-COVID-19-Vaccines.html . The information problem is glut, not dearth.
1. IM DocApril 2, 2021 at 9:11 pm
  I would love if someone – anyone – in our federal agencies or media could begin to explain this to the American public rationally and without panic or fear or crying.
  I am not seeing it. What I see is chaos, confusion, walk backs, lies, statistical contortions and distortions. I get to listen to my patients every day, many very bright people, struggle with this and what they should do.
  I never dreamed I would live to see the day that our CDC and other agencies were such a cluster. I literally heard the very same official say something on one station today and the exact opposite on another station.
  It has been gross incompetence. I was looking forward to this getting better with Biden. I am seeing no indication that is happening.

IM DocApril 2, 2021 at 9:13 am

As far as the family members I have talked to they could care less about passports and foreign travel.

We use the word passport unfortunately in our conversation today about entering stores restaurants and events. A restriction of buying and selling. That is their concern – and it is in black and white in the 13th chapter of the revelation of St. John.

And FYI also ingrained in this theology is the concept that this will be a time of great coercion.

These Bobos in our public health leadership have truly hit all the marks. Having grown up in it,
I often get triggered when I hear theses officials talking.

The whole foreign travel issue means nothing to them. They view it as just one more way the elites are condescending. So continuing to talk about that issue further by the national media will just drive the wedge further. But when do they care about that?

Gregory EtchasonApril 2, 2021 at 10:49 am

It’s past time for Public Health Authoritarianism

floraApril 2, 2021 at 11:45 am
“getting rid of the Unvaccinated is not a question of ideology. It is a question of cleanliness,” …or something like that. (Did I read this in a history book? )
1. IM DocApril 2, 2021 at 12:59 pm
  I know exactly to what you refer –
  And so do my family members. And they are feeling it every day.
  Here is the thing that most people do not understand. They have been getting ready for what they perceive as their “time of trials” as long as I have been alive. (And hint – so have others – similar things are going on right now in Amish/Mennonite and even more rural Mormon communities – hell I have even heard Catholic patients say things that have frozen my eyeballs). It is not just the vaccine. They view their culture and their way of life as under full frontal assault.
  And who can blame them? Most of these people live in the exact same areas that our public health officials and medical establishment have let rot with opiates while the Sacklers were laughing their way to the bank. We have allowed their economy and jobs to be shipped overseas. We are now telling them – many of them as dirt poor as I have ever seen – get over it ass wipe – leave your white privilege at the door. We have all got to watch the spectacle of our culture this year celebrating WAP and gay rappers being sodomized by Satan while doing lap dances on a stripper pole to hell. All of this has been foretold by their spiritual leaders to be the signs to get ready – here it comes. And you just have to trust me – they are getting ready.
  The elites of this country can laugh and condescend and make fun and name-call all they want – it is being duly noted. They are completely ignoring you at this time.
  I have been a liberal Dem most of my adult life. I thought they represented the little guy and the common man. Those days are now over. The left wing in this country today seems to be congenitally unable to pull their heads out. I certainly am not enamored of the GOP. It is a true indication of where we are that our polity is getting worse as the need for it to be functional grows every day.
  I may not believe with my family anymore – but I can certainly see their perspective in life. How hard would it have been to find folks that understood them – and were able to talk to them at their level? I am afraid that time has passed. Trying to get their preachers on board at this late stage is LOL funny and is evidence of what I am talking about – these officials and pundits literally have no clue.
  This is not going to go down without a fight – and threats of coercion and authority are only going to make it worse. There is a reason that guns and ammunition have been selling like hotcakes for the past year or so. This is not going to be the same story as Nazi Germany and the Jewish people. I am sensing a much closer correlation to the French Revolution and the rot of the elites during that time frame.
  I may not like it – I may personally abhor it. But to ignore it, to try to talk over it, to try to sweet talk is just not going to work. To try to “woke” our way out of it like this article above is the last thing we should be doing. The sooner the officials learn that the better.
  Sorry about the rant. I have deep respect for my family members – even with how much I disagree with them. I feel strongly that their voices need to be heard in any conversation like this.

IM DocApril 2, 2021 at 5:03 pm
As if we needed more evidence of the severe emotional strain that our young people are under – and that I have been seeing all year – Everyone should look at the tweets put out recently by the young man who assaulted the Capitol today.
His name is Noah X – and he is apparently a follower of Luis Farakkhan. But he referenced in his tweets Elijah Muhammad (Jesus) – and the Beast and the End of Time.
How ironic that this post was put up this AM.
I am telling you, I have never seen anything like this in the 30 years of medicine. The extreme mental stress this pandemic and all the issues surrounding it have placed on our young people. I am seeing it every day of my life. I am many days as dark as I ever felt in my life. If you want to know why many health care workers are at the breaking point – this is why. I would not at all be surprised when this whole story comes out that there is a physician or provider somewhere who saw this young man – and his suffering. And felt powerless to do a thing about it. All I can say is that after awhile – it really begins to get to you.
What gets me is that so many older and more well off seem to be totally blind to what is going on. What is more deeply disturbing in the face of a tragedy like this that all sides are rushing to politicize this on our broadcast and social media. WINNING!
Last night was Holy Thursday. We watched as the feet of the lowest among us were washed. Man, do we all ever need to absorb that lesson in our souls.
As I have said many times – I appreciate this website – it allows thinking people of all stripes to vent, to explain, to learn from one another with respect and dignity – I wish the rest of the country were like that.

comments

IM Doc pt12

2021-09-01T00:47:08Z

Last of the March 2021 comments.

See also, this post https://www.nakedcapitalism.com/2021/03/a-covid-tragedy-wholesale-discrediting-of-our-health-science-institutions.html

Comments are open.

Kevin Smith MD

March 31, 2021 at 8:18 am

Re: covid immediately after vaccination
1. I just got my appointment for Covid vaccine, and felt like loosening up on the precautions [and I am a doc!] I reined myself in, and reminded myself that the shots will be just one more layer of protection, and are sure not a license to abandon precautions. Knowing patients as I do, I imagine that some folks may loosen up before they get a shot, get infected, then get sick right around the time of the shot.

2. It is possible that some immunizations [not just for Covid] may transiently depress cell-mediated immunity in some individuals, facilitating the emergence of incipient infections [notably viral infections like Covid] and/or the emergence of latent infections [for example, herpes simplex = cold sore; or herpes zoster = shingles.]

The above may also explain why some folks have a nasty case of the flu very shortly after having a flu shot.

SKMMarch 31, 2021 at 12:12 pm
I`m really puzzled by the statement in links :”the most fascinating problem that has no obvious explanation is a surprisingly large number of patients that get sick and are COVID positive within hours/days of their first injection. I have heard all kinds of lame excuses why this may be happening – but none of them really ring true for the numbers that are occurring…”
There is no immune protection for about 12 days after the first shot – just puzzled a doctor seeming not to know this. Protection then builds slowly over the following weeks etc
“Lots of people” coming down with Covid very shortly after the first vaccination, if true (ie if statistically true that is compared with the rest of us) might suggest they caught it at the vaccination centre (see occasional photos of overcrowded centres and under-nose mask wearing)….
just perplexed at the statement…..
1. IM DocMarch 31, 2021 at 2:00 pm
  That was my comment – so I will be happy to explain.
  I have had actually numerous patients sealed up in cars double masked at the vaccine center in the parking lot far away from anyone – with the vaccine attendants in CAPR PPE – get very ill within 24 hours of the vaccine and end up positive for COVID. These are not people “letting their guard down” which is the main excuse for this phenomenon. Furthermore, they are people who have been holed up at home – at no risk for exposure. At least in the time frame that it takes for COVID from exposure to illness. They are certainly not vaccinated fully until 2 whole weeks from the last vaccine.
  But the timing and their exposure make no sense. I can see this happening to a few patients – but this is just happening way way too often.
  This phenomenon of getting ill with COVID within 24 hours of the vaccine has become so common across the country that I am seeing Twitter threads among my colleagues about what is going on. It is happening repeatedly in my practice. Many are noticing this – and many are discussing.
  I had a couple this AM who got their shots on Monday – again in a car with no exposure sticking their arms out the window to a CAPR clad attendant. They have not been out of the house in 6 weeks. Their groceries and mail are left on the doorstep every day. They called yesterday evening – a day after their shots – both very ill – and their rapid tests were positive this AM.
  The leading theory on this that makes any sense at all was alluded to by the other physician above – Kevin Smith MD – some kind of viral reactivation. In other words, patients may have deactivated COVID particles lying around their upper airways or lungs that get activated when the immune system is distracted by the vaccine. The herpes virus family does this type of thing all the time. There is evidence that this could be happening in coronaviruses as well – although not as well worked out. There are other theories that are too abstruse to go into here. NO ONE is suggesting the vaccines are giving them COVID. NO ONE is suggesting that the vaccines should be effective in 8 hours. It is just the fact the timing and access to infection is all wrong – and something else must be going on to explain this scenario. It is much much too common to ignore.
  It is almost like an Agatha Christie locked-door mystery.
  I am a veteran of the AIDS crisis. These kinds of issues in the times when not much was known were common. The insights that came from many of these scenarios back then were critical for learning about the virus and its life cycle. I am certain this will be no different.
  It is imperative that when everyone runs across discussions among physicians on Twitter about these things – restrain yourselves. Do not insert yourselves unless you know what you are talking about. Read and learn and think. This is how we in medicine are going to get to the bottom of this pandemic. People in our time seem to forget the years it took to unravel AIDS; COVID will be no different. And it is still very early.
  1. HarryMarch 31, 2021 at 3:27 pm
    Thank you.
    Very useful
  2. GFMarch 31, 2021 at 3:29 pm
    IM Doc:
    Which vaccines seem to be the worst offenders?
    1. IM DocMarch 31, 2021 at 9:44 pm
      I have experience only with Pfizer and Moderna – and I can see no difference.
  3. drumlin woodchucklesMarch 31, 2021 at 6:50 pm
    Would it make sense for people scheduled for vaccination to marinate their bodies in the appropriate anti-virals so that they are full of anti-viral chemical when getting the vaccine? So that the anti-viral will keep suppressed any dormant coronavids which the vaccine distracts the body from keeping suppressed?
    1. IM DocMarch 31, 2021 at 9:45 pm
      I think that would be a bad idea. Dormant or inactived viral particles are going to engender no immune response – so I think that would not be indicated.

comments

IM Doc pt11

2021-09-01T00:43:05Z

Very nearly this entire post and comments section https://www.nakedcapitalism.com/2021/03/its-time-to-talk-about-ivermectin.html are relevant to the topic at hand and IM DOC's comments are embedded deeply within and are pertinent to much of the article and ensuing conversation. Sorry, this is long - and it gets weirdly and incurably narrow for a while there. Comments are open.

It’s Time To Talk About Ivermectin

Posted on March 30, 2021 by Nick Corbishley

I’d like to start this article with a couple of disclaimers and a caveat. First of all, I am not a medical doctor. This article is not intended as medical advice. It’s a layman’s account of how an extremely cheap, safe and widely available off-patent medicine called ivermectin appears to be saving the lives of countless Covid-19 patients across Latin America and beyond. Yet hardly anybody is talking about it.

Here’s the caveat: The first section of the article, which was completed on Friday, is about Mexico City’s recent deployment of ivermectin in its fight against Covid-19. On Saturday, Mexico’s Ministry of Health jacked up its total excess death count due to Covid (for the whole country) by 60%, from 182,000 to 294,000. However, most of these deaths took place before Mexico City began using ivermectin as part of its its test-and-treat approach to Covid.

Covid-19 vaccines are reaching most emerging and developing economies in only drips and drabs, with a few notable exceptions such as Chile. In many countries, locking down entire cities or regions and paying millions of non-essential workers not to work while front-line doctors and nurses battle to contain the virus is not an option. There simply isn’t enough money available. This has left doctors and health authorities with little choice but to try out cheap, widely available generic medicines. Those drugs include ivermectin, a “well-studied, well tolerated,” (in the words of a 2013 FT article) off-patent anti-parasitical.

The results have been extremely promising, according to almost all of the clinical studies conducted thus far. Many of the studies took place in Latin America where around half of the countries in the region have used or are using ivermectin to some degree or another. A meta analysis of 42 clinical trials, involving approximately 15,000 patients, found that 83% showed improvements with early treatment, 51% improved during late-stage
treatment and there was an 89% prevention of onset rate noted. Yet the studies have received scant attention in more advanced economies — so much so that the vast majority of the people I talk to here in Europe have still not even heard of the medicine.

Bucking the Trend

On December 29th of last year, Mexico’s Institute of Socal Security (IMSS) allowed ivermectin to be prescribed to outpatients with Covid. On the same day the Secretariat of Health of Mexico City and the State of Mexico decided to adopt a protocol in which anyone testing positive at any one of the city’s 250 rapid testing sites would be given ivermectin. As you can see in the graphs below, courtesy of Juan Chamie, a data scientist from EAFIT University in Colombia, based on data provided by Mexico City authorities, the number of hospitalizations due to Covid and excess deaths peaked shortly after the New Year and have been falling sharply ever since. They are now almost back to their prior base line.

Mexico City is the first major global city to adopt what amounts to a test-and-treat approach to covid-19 involving ivermectin. But it was the largely indigenous southern state of Chiapas that led the way last summer. In July 2020, as Mexico was buckling under its first wave of the pandemic, the state decided to distribute ivermectin as a Covid-19 treatment, having already deployed the medicine in its battle against mosquito-borne RNA viruses such as Zika and Chikungunya. Since October Chiapas has consistently occupied the lowest risk level on the federal government’s coronavirus stoplight map.

Thanks to ivermectin’s apparent success in Chiapas, IMSS allowed the medicine to be prescribed nationwide. It also helped launch the pilot program in Mexico City, for which it received a barrage of criticism. An official group of health experts argued that there’s no scientific evidence that the drug is effective, and called for the immediate repeal of its use. To their credit, both the Secretariat and IMSS have stuck to their guns.

Playing With Lives

Of course, there’s no way of definitively proving that the rapid falloff in hospitalizations and deaths, first in Chiapas and then Mexico City, is due to the use of ivermectin. Correlation, as we well know, is not causation. It’s also true that Mexico City authorities have introduced tougher social distancing measures and travel restrictions since December. But similar dramatic drop offs have been witnessed in other regions and countries where ivermectin has been used widely, including across the length and breadth of Peru and Iran as well as parts of Brazil, Paraguay, Bolivia, the Dominican Republic and India.

In Peru, ivermectin was used in eight states during the very early stages of the pandemic (May-July). Its use was then extended to the whole country except Lima, which did not start deploying the drug until months later. For the 24 states with early IVM treatment (and Lima), excess deaths dropped 59% (25%) at +30 days and 75% (25%) at +45 days after day of peak deaths. But in October, after the first wave had been brought under control, the new government in Peru took the inexplicable step of withdrawing a number of medicines, including ivermectin, from its treatment guide for the disease. Within weeks hospitalizations and deaths were soaring once again.

The following graph, taken from a study by Juan Chamie, Jennifer Hibberd of the University of Toronto and David Scheim of the US Public Health Service, shows the sharp rise, fall and resurgence in excess deaths (among the over 60 year-old cohort) in Peru as the virus waxed, waned and waxed again. Between August and December case fatalities dropped sharply in all states but Lima, yet six indices of Google-tracked community mobility rose over the same period, before rising once again. In other words, the treatment appeared to be working even as the country reopened.

In the Brazilian city of Belem authorities began using ivermectin way back in June 2020. Since then the city has managed to escape the massive surge in covid-related deaths that has plagued Brazil since early November, as the graphic below shows. In another study a like-for-like comparison of cities in similar regions of Brazil showed that the cities that began distributing ivermectin in June last year were, by September, registering much lower case counts than those that didn’t.

Iran has also seen a sharp fall in covid-related deaths since late November followed by a flattening of the curve. Earlier that month the country, with a similar population to Germany and an urban population density twice as high, succeeded in gaining the technical knowledge to produce ivermectin and began distributing it to hospitals in the country.

What is Ivermectin?

First discovered in 1975 and launched onto the market in 1981, ivermectin is a safe, broad-spectrum anthelminthic drug registered for the treatment of a number of neglected tropical diseases (NTDs) including river blindness (onchocerciasis), strongyloidiasis, trichuriasis, ascariasis, and lymphatic filariasis. It is also used widely in veterinary medicine. In recent years it has been discovered to have strong anti-viral properties against RNA viruses such as zika and yellow fever. In its use against river blindness in Africa it is estimated to have prevented 7 million years of disability.

The medicine is not only extremely effective in treating a broad range of illnesses, including RNA viruses; it is also well tolerated. To date, more than 3.7 billion doses have been distributed with an excellent safety profile. Most adverse reactions are mild, transitory and associated with parasite death rather than with the drug itself.

“The reason why this medicine is distributed in Africa not by doctors and nurses but mainly by volunteers is that it is extremely safe,” says Japanese microbiologist Satoshi Omura, who jointly with the Irish parasitologist William C. Campbell, led the team that isolated a strain of Streptomyces avermitilis that produce the anti-parasitical compound avermectin, the active ingredient in ivermectin. Omura and Campbell were awarded the Nobel Prize for Medicine in 2015 for their discovery.

Dr. Omura himself believes there’s already enough evidence of the benefits of ivermectin against Covid-19 for it to be granted approval as a therapeutic. One of its biggest benefits is that it appears to work in the early stages of the disease, he co-writes in an article published earlier this month in the Japanese Journal of Antibiotics:

“Currently, there are no therapeutic agents available for mildly ill patients who are being treated at home (or in self-isolating accommodations) or for moderately ill hospitalized patients. Nothing is as helpless as a disease without a cure.”

Anti-Viral, Anti-Inflammatory, Anti-Long Haul

Another major ivermectin proponent is the Frontline Covid-19 Critical Care Alliance (FLCCC), which has been trying to repurpose medicines already on the market for the treatment of Covid-19. In October it created the I-MASK+ protocol for prevention and early outpatient treatment, which includes ivermectin, vitamin D3, vitamin C, zinc, melatonin and quercetin.

The FLCCC believes that ivermectin is not only “one of the world’s safest, cheapest and most widely available drugs,” it is also the most effective against Covid. “The studies we presented to the NIH revealed high levels of statistical significance showing large magnitude benefit in transmission rates, need for hospitalization and death,” says Dr. Pierre Kory of the FLCCC, who twice gave testimony to the US Congress on Covid-19.

Besides the dozens of clinical studies conducted so far on the efficacy of ivermectin against Covid, the FLCCC also cites “natural experiments” in Peru, Brazil, Paraguay, the Dominican Republic and Mexico where ivermectin was distributed widely, with “large decreases in case counts … soon after distribution began.”

Another recent convert to the cause is Dr Alessandro Santin, a renowned cancer researcher who runs a large laboratory at Yale. Santin believes that ivermectin is a game-changer that could significantly reduce Covid’s toll on human health.

“The bottom line is that ivermectin works. I’ve seen that in my patients as well as treating my own family in Italy,” Santin said, in reference to his father, 88, who recently suffered a serious bout of COVID. “We must find a way to administer it on a large scale.”

In an interview with Italian daily Il Fatto Quotidiano, Santin explains why he believes ivermectin is so effective against Covid:

Its powerful anti-viral properties: “The theory behind the main mechanism of action is that ivermectin attaches itself to Sars-Cov2’s Spike1 protein as well as at various strategic points used by the virus to bind and enter our cells. This is why it can also work against variants, unlike monoclonal antibodies.”
Its anti-inflammatory activity: “Ivermectin has a powerful anti-inflammatory effect similar to that of cortisone. But unlike with cortisone, the effect is not immunosuppressive. Therefore the immune response of both T cells and B cells (producing antibodies) continues to function under ivermectin, acting on the transcription factor NF-KB (which informs our body to produce cytokines and causes a real cytokine storm when hyperactivated by Covid). This is why the drug also works well during the advanced phase of the disease”.
It even seems to help long-haulers: “I have treated and am treating ‘long haulers’, including people who have been sick for a year and who do not breathe well, who have tried out everything to no avail. Within two weeks of starting them on ivermectin… these people have started to live again, with practically no side effects. The virus is an intracellular parasite; only if it enters our cells can it use the cellular machine to replicate. If it can’t get in and hack our immune system, then it stays out on the doormat and gets attacked by our immune system much more easily.”

More Evidence Needed, Say Regulators

Yet despite the growing body of evidence supporting ivermectin’s therapeutic effects against SARS-Cov2, national and supranational health authorities, particularly in more advanced economies, are dragging their feet. The European Medicines Agency (EMA) concluded this week that the available data “do not support its use for COVID-19 outside well-designed clinical trials”. The decision comes just two months after Slovakia and Czechia became the first EU countries to approve the temporary use of ivermectin against Sars COV-2.

In the US Ivermectin is not yet FDA-approved for the treatment of COVID-19, but in January the NIH changed their recommendation for the use of ivermectin in COVID-19 from “against” to “neutral”. This is a major step forward. As a result, doctors are at liberty to prescribe ivermectin for Covid patients.

But most regulators and expert panels insist that definitive proof is still lacking, despite the abundance of real world data, and have called for randomized placebo controlled double blinded studies. But that is time consuming and time is a luxury most doctors and their patients can ill afford right now. As covid continues to rage and patients continue to die, growing numbers of doctors feel that the risk of doing nothing, particularly in the early stages of the illness, significantly outweighs the risk of doing something — especially if that something has already been shown to work across multiple trials and real-world experiments.

“Clinical trials take time, but because of the abundance of overseas data, it may not be necessary to conduct clinical trials in Japan,” says Omura. “Experts have shown the numbers and announced that they are working. Therefore, I would like [the Japanese health authority] to grant it special approval. If you do not use it here, what is the special approval system for? Some people will die if they are waiting for a clinical trial.”

According to a WHO-sponsored review and meta-analysis of 18 clinical studies, the drug could cut the number of deaths from Covid-19 by as much as 75%. Crucially, some of the studies suggest that it is effective not only as a treatment in the early and later stages of the virus but also as a prophylactic. Yet the conclusion of the WHO-sponsored review is that more studies are needed.

Contrast this with the FDA and EMA’s mad rush to approve the anti-viral medicine Remdisivir for use against SARS-CoV-2 last October, despite the medicine’s lackluster performance in clinical studies and unproven safety record. On October 15, results from WHO’s Solidarity trial suggest that remdesivir does not even reduce mortality or the time COVID-19 patients take to recover. Yet a week later the FDA approved the drug for use against SARS-CoV-2 in the US, becoming the first drug to receive that status.

With a five-day course of treatment costing around $2,600 per person, there’s a lot of money to be made for remdesivir’s manufacturer, Gilead. Once remdesivir was approved in the US and the EU, it set off a cascade of approvals across the world, including in countries such as Brazil and Mexico whose public health systems cannot possibly afford to administer it on a large scale. In this case that is a good thing given how ineffective the drug appears to be.

Meanwhile, a Nobel-prize winning medicine that has been used extensively for four decades and costs just a few dollars per course of treatment could prove to be one of our best lines of defense again covid. Time and again it has been shown to work. Yet for the moment most health authorities in advanced economies — and quite a few in less advanced ones (South Africa, the Philippines, Peru…) — do not seem to be interested. In the coming days the World Health Organization is expected to come out with a definitive recommendation for or against ivermectin. If it opts for the latter, the pressure on doctors to stop using it will only increase.

John SimanMarch 30, 2021 at 10:13 am
John Day, M.D., “Treat Your Own COVID” — article in The Automatic Earth:
… Ivermectin has a remarkably broad safety profile, and has been served up about as many times as McDonald’s hamburgers, to man and beast alike, for various forms of worms and parasites. It does cause birth defects in rats, when given at high doses, so don’t use it in pregnancy, please. Like most medicines to treat coronavirus illness, ivermectin does different things against the virus, than it does on regular days. Ivermectin inhibits the transport of the viral RNA into the cell nucleus, where it would be transcribed, manufacturing new viruses. It does other things, like reduce inflammation during cytokine-storm, in the second and third weeks of illness, helping the people who get really badly sick. Ivermectin is effective in prophylaxis, in early illness and also in later, severe illness, and through multiple mechanisms. Ivermectin is what I prescribe since last August.
Ivermectin is now available mail-order from India, and from a reliable source. https://www.medicinesdropshipper.com/antiparasitic-drugs.html#iverlast-12mg-tablet
The preventive, “prophylactic” dose of ivermectin is based upon body weight, and it can be taken weekly, once an initial level inside of the cells is established. Ivermectin leaves the cells very slowly, so it can just be topped-off once per week. There are some slight variations on this, but I’ll describe the one I prescribe. It uses the same body-weight dosing that you will find wherever you look up ivermectin dosing for humans or animals. For every 5 kg, or 11 pounds of body weight, a person takes 1 mg of ivermectin at that dose. For most people I treat, that is 12 to 18 mg of ivermectin per dose. For COVID-19 prophylaxis, this dose is taken Day #1, Day #2 and then every seventh day after that. If you forget, take it when you remember, and get back to the original schedule after that….
https://www.theautomaticearth.com/2021/02/treat-your-own-covid/
Steven J Kunasek IIIMarch 30, 2021 at 10:50 am
I learned about ivermectin’s use for Covid from Chris Martenson at Peak Prosperity at least six months ago. Through him I also became aware of Dr. Pierre Kory and Paul Marik at Frontline Covid-19 Critical Caregiver’s (FLCCC). They were using ivermectin clinically and were having great success. Dr. Tess Lawrie at Evidence-Based Medical Consultancy in Bath, England became aware of ivermectin when she watched Dr. Kory’s testimony at a Senate sub-committee hearing. She and her staff took it upon themselves to do a meta-analysis of ivermectin and found that it was significantly effective for all stages of Covid and as a prophylaxis. At the same time, the World Health Organization hired Dr. Andrew Hill at the University of Liverpool to do a meta-analysis of ivermectin which is now completed. WHO is supposed to be issuing a statement concerning ivermectin shortly.
I visit Naked Capitalism everyday and would notice an occasional article about ivermectin in the Links or Water Cooler. But I was disappointed that no major article on ivermectin was forthcoming. Until today. Nick’s article is excellent. The cat is now out of the bag. Evidence from around the world is showing that ivermectin is safe and effective against Covid-19.
1. Lambert StretherMarch 31, 2021 at 4:38 am
  > Dr. Tess Lawrie
  Lawrie article (not peer-reveiwed) and video interview. Here is Lawrie’s company.
IM DocMarch 30, 2021 at 10:51 am
I believe this post and the comments are perfectly emblematic of unfortunately where my profession is and where my country is. I have to admit, I would have never dreamed this possible just 10 years ago.
I will start by quoting one of my medical professors years ago when I was an intern….You have to imagine it in a very hard Danish accent….”Young man, if research or scientific findings make you angry in any way, you must immediately examine yourself. You are by definition not practicing science or medicine, you are practicing dogma. You must put down your test tubes and go to the nearest closet and in private examine your soul.”
I have thought of this old man often this past year – and the tenor of some of these comments have brought him yet again to mind.
We have created a world where every side has their own facts. Unfortunately, I believe we are all going to find the hard way that science is not going to work like that.
We have done everything possible to politicize medicine and science this year in this country – and look where it has gotten us. People not just here but all over Twitter and our media screaming at one another about things they have no clue about – just because their side says so. It has been a revelation.
I would also like to echo one of the above commenters – decrying the fact that most practicing physicians have just been cut loose to flap in the wind. Trust me – there are many days when I feel just like that. We have not had time for science in this pandemic to give us real answers – but the more unfortunate thing is that our national agencies have not even tried. The minute that these overwhelmingly positive studies were coming in from other countries about Ivermectin – our NIH and other agencies should have immediately been on the ball – working on our own rigorous studies. They have been nowhere. That has led physicians like me to use the drug despite our own credulity in the beginning (Lice pills? You have got to be kidding!) – guess what – it seems to be working to keep people out of the hospital. And it is not nearly as scary as the other option, monoclonal antibodies (MONOCLONAL ANTIBODIES, WTF?) to keep people out of the hospital. And I remind you – the monoclonal antibodies are on an EUA just like the vaccines – and are considered the same status as Ivermectin by the NIH. This is a safety no brainer – and yet my profession and our country seems hell bent on laughing off the 8 dollar a month safe 40 year experience pill for something that is equivalant to a dose of chemotherapy – with really no strong efficacy numbers to balance out the risk. And they are thousands of dollars a dose.
Our nation’s medical leadership has been all over the place this year – wear masks – don’t wear masks. 3 foot social distance – 6 foot social distance. You all know exactly what I am talking about. Instead of leadership, they have often gotten on national TV to fear monger and even cry like yesterday.
Meanwhile, there are thousands of physicians like myself in communities all over this country doing our best to hold it all together for our patients. Not just the COVID patients, the countless others who have lost jobs and livelihoods and lifelong businesses. We are seeing all kinds of vaccine complications – while the media and medical elites are screaming that they are 95% effective and perfectly safe. I am praying every day that the vaccines work – and it was worth the risk – the backlash if not will be unforgiving.
That is where I am today. I will continue to use ivermectin to keep people out of the hospital. It seems to be as effective as any other modality we have right now. I will keep my eyes peeled for studies and evidence about this issue. Antivirals are going to be as critical going forward as vaccines.
And for those questioning why doctors are remaining anonymous ( a trend that was never dreamed of during AIDS) – you really must be dense. Look at the cancel culture in which we live. We as a country need some serious introspection when good faith questioning leads to job loss and career suicide.
To Yves and Lambert – like everyone else – you are not 100% right all the time. The definition of humanity. But you have given thinking people a forum to discuss and learn. For that we should all be eternally grateful. You are doing a great service to our world.
1. antidlcMarch 30, 2021 at 1:01 pm
  “We are seeing all kinds of vaccine complications ”
  Could you be specific? Maybe I missed prior posts of yours.
  Also, just wanted to say “thanks” for your contributions.
  1. Yves SmithMarch 30, 2021 at 8:57 pm
    Reactions by those with autoimmune diseases. Multiple reports from people who are one degree of separation removed from me of a significant worsening of symptoms after getting the Pfizer and Moderna vaccines, and that not abating over time.
    1. SEMarch 31, 2021 at 7:43 am
      Just an anecdote but good to know from someone with an autoimmune condition. I have been worried about this and can’t get any information from doctors or the internet. I figure I have to wait a year until the shit hits the fan (or not) to see what shakes out. So frustrating.
  2. IM DocMarch 30, 2021 at 10:28 pm
    What am I seeing?
    The most fascinating problem that has no obvious explanation is a surprisingly large number of patients that get sick and are COVID positive within hours/days of their first injection. I have heard all kinds of lame excuses why this may be happening – but none of them really ring true for the numbers that are occurring. I would predict this is going to be an interesting story when the full story of COVID comes out in a few years. By the way, they tend to be WAAAAY more sick than a regular COVID patient. No hospitalizations yet.
    I am seeing blood clots in both venous and arterial systems. This is happening mainly to younger people. I have 4 so far – an unexpected DVT, a PE, a very strange problem in a young healthy man having unstable angina with positive enzymes within hours of his first shot, and a young woman who clotted off the main artery to her arm on the injection site leading to a compartment syndrome. None of these patients have died – and all are doing well now. But it was scary when it was happening. No proof the vaccines did it – but the timing is very concerning, especially in the last 2. I would reiterate that the PCPs of the world are flying blind in this regard. We have no guidebook of completed and well-done trials to guide us with what are common problems. We are literally just taking it all in as we go along. I will reiterate – in a decades long career – these things I have just outlined are 3 times as many severe complications as I have seen after giving 10s of thousands of other immunizations. This is the truth.
    A handful of patients with sudden flares of their dormant autoimmune syndromes – one of which is turning into something possibly bad. Multiple patients with COVID negative and severe URI symptoms. And multiple severe issues with lymph nodes almost to the point of being bubos. I have also seen a severe Ramsay Hunt syndrome in an elderly woman and one episode of anaphylaxis.
    That is all I can remember off the top of my head. Maybe these all have nothing to do whatsoever with the vaccines. The timing, however, is very suspicious. And please note – this is a handful of severe problems in probably 1500 to 2000 vaccinated already. The number of people with fever, chills, flu-like illnesses, etc has been very high, just as predicted in the protocols. But the vast majority of patients have no obvious long-term problems. It is my contention that the patients of the world should have had this presented to them correctly – and we would all be better off emotionally. But alas – it is what it is. Younger people seem to be having a much worse time with side effects – now that we are moving into the younger age groups, I fear this is going to become a much more significant issue.
    1. Lambert StretherMarch 31, 2021 at 4:35 am
      > the patients of the world should have had this presented to them correctly – and we would all be better off emotionally.
      It does seem that, at least at the top level of the public health establishment, lying to the public to achieve an acceptable outcome is considered best practice (see Fauci on masks). Those lying must not perceive the practice as maladaptive from a career perspective, so one shudders to think of the state of the institutions through which they rose.*
      * “Everything is like CalPERS.”
    2. Good enoughMarch 31, 2021 at 6:13 pm
      Actually we have precedents for the observation you mention on cases cropping up early from other vaccine trials and we now have DATA from two vaccine studies for this vaccine that document what you are saying.
      JerryDenimMarch 30, 2021 at 1:11 pm
      I adopted a rescue dog from coastal North Carolina in 2012 that had a bad case of heart worms. The universally accepted treatment is a dangerous (and very expensive) two-dose injection of arsenic to the dog’s spine followed by cruelly immobilizing the dog in a tiny crate for six weeks. The shots leave many dogs with permanent paralysis and many more die from blood clots formed by rotting masses of dead heart worms which die off suddenly from the injections. A small town Vet in North Carolina who was very skeptical of the cruel and high-risk injections tipped me off to a University of Georgia study where dogs were successfully cured of heart worms using a standard prophylactic dose of Ivermectin and intermittent Doxycycline. I ran the idea by my very caring, intelligent and open-minded Vet in Manhattan and after reading the study said he was willing to try the alternative treatment. The one-two punch of the Ivermectin and three-cent-a-pill Doxycycline worked like a charm and my dog was heart worm free after six months without being cruelly confined or running the risk of paralysis or sudden death. The vet was amazed and swore he would never recommend the standard heart worm treatment again. I saved myself about $3000 as well, and while the amount was significant to me, that was just icing on the top not the prime motivator for seeking an alternative treatment. However, for many pet owners, that sum could be the difference between seeking treatment and letting a dog slowly succumb to parasites. I researched the dangerous and expensive shot and why it was universally accepted in the United States as the only legitimate cure for heart worms and the answer seemed to be strategically placed board members among prestigious Veterinary Schools and a quite few lavish Marlin Fishing junkets funded by the pharmaceutical company producing the arsenic shot. Yes, veterinary medicine I know, but from what I’ve learned Veterinary medicine and Human medicine operate exactly the same in the US. Never treat anything with a pill that cost pennies if you can use a shot that costs thousands, even if the more expensive treatment paralyses and/or kills the patient – large profits are far more important to the functioning of the system than curing disease or minimizing harm. When it comes to medicine trust no-one receiving payment, do your homework and plan on advocating for yourself at every turn.
      
      BaldandersMarch 30, 2021 at 3:02 pm
      This story is heartwarming, but it’s no proof ivermectin is a good covid treatment.
      It’s amazing how skeptical folks are of Big Pharma’s PR, but how incredulous they are for “heartfelt anecdotes.”
      
      JerryDenimMarch 30, 2021 at 3:42 pm
      Never said my story was proof Ivermectin is a COVID miracle drug. Just a real world example of how Ivermectin has been dismissed as a treatment option by the (Veterinary) medical establishment due to a Capitalist preference for a more expensive, but less desirable treatment. Furthermore this isn’t a ‘heartfelt anecdote’ but a firsthand account. I think the treatment regime I detailed has gained a bit more acceptance for heartworms now, but it was virtually unheard of in 2012 despite published research showing efficaciousness dating back several years. The other parallel of my story is the economics and availability of the preferred medicine of western doctors in highly developed countries frequently mean nothing to those without the financial means to obtain the treatment, and in some countries the drugs simply aren’t available to people, necessitating alternative treatments and experimentation, which most I think most would agree is preferable to dying. I have no dog in this fight ( pardon the pun ) but I do have experience with Ivermectin being sold short as a drug by credentialed medical experts in the pursuit of profits.
      
      Lambert StretherMarch 31, 2021 at 4:32 am
      *** crickets *** in response…
      
      Blue PilgrimMarch 30, 2021 at 6:36 pm
      Reminds me of Doris Cully talking about ivermectin talking about river blindness and allowing time for clearing the parasite from the eye — about 14 minutes into the podcast. Sounds like the mass of dead worms you mention.
      About 3 minutes in Doris Cully relates her background working with ivermectine when it was discovered.
      
      Blue PilgrimMarch 31, 2021 at 12:50 am
      forgot to give link https://www.microbe.tv/twiv/twiv-599/
      
      Jeremy GrimmMarch 30, 2021 at 2:50 pm
      Thank you for this and your other comments. I watch for and greatly value your insights and revelations offered through your view from the trenches of medical practice.
      Before the Corona pandemic I had been growing pessimistic about how Humankind would respond to Global Warming and the impending limits to growth, and about what prospects the future held. After a year of the Corona pandemic observing the incompetence, greed, and cruelty of the US Government, and organizations, agencies, authorities, and disciplines that once held my highest regard, mishandling the pandemic and the ongoing economic disasters it created, my pessimism nears fatalism regarding prospects for the future of Humankind, myself, and my children.
      
      UnfinishedMarch 30, 2021 at 10:53 am
      A recent addition to the FLCCC website is a page “How To Get Ivermectin” offering a list of physicians who will prescribe ivermectin.
      https://covid19criticalcare.com/guide-for-this-website/how-to-get-ivermectin/
      
      CarlaMarch 30, 2021 at 4:34 pm
      Thank you very much for this valuable information.
      
      RMarch 30, 2021 at 11:32 am
      I grew up stock farming in the great Ivermectin boom when every farmer was recommended to drench his cows (forced oral administration) with it against liver flukes and the like.
      Ivermectin, IIRC, is notorious in the organic farming community for producing “plastic cowpats” – cowpats that do not degrade and support insect populations but dry into frisbees. The difference between organic cow manure and intensively farmed is profound.
      So, if you do take it off-label, just be aware your microbome might need some serious restoration of your commensal bacteria and parasites. Low parasite loads are linked with many autoimmune diseases and gut disorders.
      I still think the data on Ivermectin justify proper randomised clinical trials. The examples and counterexamples are just too noisy. Even the argument about effective concentration is not clear: in vitro is not in vivo because compounds exhibit preferences for different tissues (volume of compartmentation), which is why chloroquine reaches effective blood cell concentrations on low regular doses and, after many years, can lead to blindness because of the effects of high retinal concentration.
      
      Lambert StretherMarch 30, 2021 at 3:26 pm
      > I still think the data on Ivermectin justify proper randomised clinical trials.
      They do indeed (though many of the RCTs for HQ seemed almost designed to produce a negative outcome, not being designed to test for prophylaxis).
      However, given the givens, I think the threshold could be — is, obviously, already in many countries — lower than RCT. Zeynep Tufecki writes, of RCTs and masking:
      The effectiveness of some interventions can be shown even without randomized clinical trials. How? First, there must be a physical theory of the mechanism of the intervention. In this case, the theory holds that the disease is spread by virus-laden droplets and aerosols–and that masks dampen the spread of droplets and aerosols that we emit out of our mouths when we breathe, talk, shout, and sing. Second, we must have a way to test and examine that mechanism: in this case, it’s through lab studies, which we definitely do have, finally, at this stage of the pandemic. Third, there should, hopefully, be indirect epidemiological evidence. Do mask-wearing places fare better than non-mask wearing places? As I write in the piece, this issue is thorny because of confounding effects: places where most people wear masks are probably doing many other things as well.
      So far as making public health decisions in a pandemic, I don’t see why the enornous natural experiments listed in the post aren’t enough to go forward on, RCT or no RCT.
      
      Blue PilgrimMarch 30, 2021 at 6:44 pm
      To do it right, studies for all the possible drugs should be funded, and research funding, which is pitifully stingy, should have been ongoing for decades, including genomic research and such into possible vectors for zoonotic diseases, such as bats. This is a constant complaint among researchers (corona virus among deer mice, for one example I heard). We seem to be too preoccupied with finding new ways to blow ourselves up for that however.
      
      John SimanMarch 30, 2021 at 11:55 am
      Reality check from the CDC’s Mortality and Morbidity Weekly Report: “Among 148,494 U.S. adults with COVID-19, a nonlinear relationship was found between body mass index (BMI) and COVID-19 severity, with lowest risks at BMIs near the threshold between healthy weight and overweight in most instances, then increasing with higher BMI. Overweight and obesity were risk factors for invasive mechanical ventilation. Obesity was a risk factor for hospitalization and death, particularly among adults aged <65 years.”
      Body Mass Index and Risk for COVID-19–Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death — United States, March–December 2020 | MMWR
      https://www.cdc.gov/mmwr/volumes/70/wr/mm7010e4.htm?s_cid=mm7010e4_w
      
      SynoiaMarch 30, 2021 at 12:39 pm
      AKA: If you are already “ill” (Obese) it take less effort for disease to kill you.
      That’s not a surprise.
      I suspect there is a causal link between Obesity, Air Conditioning and Driving, as both air conditioning and driving appear to eliminate exercise appear to promote obesity (through lack of exercise) and its attendant ills.
      
      HopelbMarch 30, 2021 at 12:32 pm
      I used the site AmericasFrontlineDoctors which takes you to speakwithanMD.com to get my 80 year old father ivermectin. After the consult, they sent him hydroxychloroquione/zinc instead, and they have not responded to any of my emails/texts inquiring if that was done due to possible interactions with my father’s other medications.
      
      floraMarch 30, 2021 at 2:01 pm
      From my reading, and I’m not an MD or biomed person, I believe there are a few ivermectin contraindications – like pregnancy and liver disease – and drug interactions – like Warfarin and coumadin. Don’t take my word. This is one reason it’s so important to talk to your doctor about whether it’s an appropriate med for your medical condition.
      It’s infuriating the US pharma/med/govt nexus is trying to stop your local MD who knows your med history from prescribing ivermectin when appropriate.
      
      Lambert StretherMarch 30, 2021 at 3:16 pm
      > I used the site AmericasFrontlineDoctors which takes you to speakwithanMD.com to get my 80 year old father ivermectin. After the consult, they sent him hydroxychloroquione/zinc instead, and they have not responded to any of my emails/texts inquiring if that was done due to possible interactions with my father’s other medications.
      Well, so much for them! (One of the disadvantages of being an outsider is lack of resources, and one of the dangers is zealotry.)
      
      BaldandersMarch 30, 2021 at 3:17 pm
      So why do you trust “America’s Frontline Doctors” over Big Pharma?
      Or is this organization NOT selling you something?
      As alternative treatments always do, this reeks of “we care, not like horrible Big Pharma!”
      Great bedside manner is the entire foundation of a quack’s practice. A great mild example is Cancer Treatment Centers of America. Expensive, but they support you with alternative treatments! And there survival rates look great! Must work, right?
      They get those rates by not admitting folks with low survival probabilities. It’s much money for a kinder, more pleasant environment. Which feels “healing.”
      “Well, it can’t hurt..”
      Sorry, TANSTAAFL applies. The cost may be low, but there is a cost. Quackery crowds out resources for real treatments.
      
      Lambert StretherMarch 31, 2021 at 4:30 am
      Ignoring the actual evidence in the post entirely. But you do you.
      
      ambritMarch 31, 2021 at 7:14 am
      TANSTAAFL is Libertarian code speak for Neo-liberal Rule #2.
      (Here we go again!)
      Update: Yay! It worked! I have no clue as to why the previous comments were eaten by the Internet Dragons. Oh well. Perhaps the “gods” are trying to teach me something about the quantum nature of reality.
      
      lyman alpha blobMarch 30, 2021 at 12:38 pm
      Since there is now an article dedicated to this subject, here is a related link from an MD who specializes in bioweapons: https://anthraxvaccine.blogspot.com/2021/01/first-country-bans-ivermectin-lifesaver.html
      She first came to my attention after the anthrax mailing scare years ago as a skeptic against the official narrative. I thought of her again when Covid started and I’ve been reluctant to post anything from her here before, since she is once again going against the official narrative. I have no idea how she is regarded within her field, she does get tend to hyperbole a bit in the link above, and I don’t know nearly enough about medicine to evaluate what she says in this and other posts of hers I’ve seen across the interwebs over the last year. That being said, while I’m not a regular follower of her blog, I have checked in over the years when microbes are in the news and she does seem to have a lot of knowledge in her field and comes across as a genuinely decent human being. Also, she is from Maine!
      Her other writings on the coronavirus topic, including what I thought was decent argument debunking a study claiming chloroquine was not only ineffective but dangerous (she said it is dangerous when they drastically overdose people like they did in the study, but not when used in proper dosages) can be found with a quick search for anyone interested. Or you can just read more on her blog linked to above, but the blog may not have the most detailed and scientific arguments compared to other writings.
      I would be genuinely interested in what others with a better understanding of virology/vaccines make of her take.
      
      vwMarch 30, 2021 at 2:14 pm
      Of so many tragedies to come out of the COVID-19 pandemic, one of the saddest to me – and probably the one with the longest-reverberating consequences – has been its wholesale discrediting of our health science institutions.
      Here we are, over a year into this pandemic, and we cannot get a straight answer on whether or not this relatively cheap and safe drug saves human lives from COVID-19 or not. Worse, we can’t even seem to properly investigate it. All questions bring hysterics, or hardly-believable obfuscation, or (informed?) outrage, no matter what authority we turn to. The fallout in my own life from watching all this unfold has been… dramatic.
      I don’t trust what the CDC says. I don’t trust what the WHO says. I don’t trust what the FDA says. I don’t trust Pfizer and the rest of the pharmaceutical companies any farther than I can throw them. I look with suspicion on my own scientist acquaintances, wondering if they are really following the data, or if they are clinging to a chosen worldview that science in America still works, oh god it still works, oh god it hasn’t been completely discredited, no it cannot be, my life work must have meant something, it must still work, it must still work….??
      None of this means that ivermectin works–or for that matter, that it doesn’t work. It means that I have realized, slowly and then all-of-a-sudden, that I cannot know. Nor can any other layperson. We are alone, our economy is collapsing in slow-motion, and our lives are at stake. Or so we think! If we doubt so much, how much more should we really be doubting? I believe, for what it’s worth, that COVID-19 is real and that these experimental vaccines probably won’t kill us. At least… not that many of us.
      But I wonder now, in my darker moments, whether the claim of those who don’t believe such things that refusing the vaccination is a “Darwin’s test – pass it and survive” have grokked something that was beyond me, in my previous worldview. How could it have come to this…? And if I am feeling like this, how must people with less scientific background (I attended a science magnet school) be feeling about it all??
      Will my children be safe from measles, etc in the years to come? I have vaccinated them with the whole slate, and feel fine about that choice, but will the fallout from this debacle mean the end of herd immunity in America, as trust in the ‘health experts’ collapses into dust? How can we get it back, then – at gunpoint? With all that would imply… is it even worth such a high price…?
      NC is doing the Lord’s work in finding the high quality news sources it continually brings forth for our viewing. But – pardon me – this isn’t something that should need to be be argued over in the comments section of a news site. This isn’t something that laypeople should have to suss out, with their own lives on the line. That it has come to this is a shame, and a shame so complete, that every time I really contemplate it I get the shivers. Our government has failed us. It has failed us. Yet we elected it. Oh, the shame…!
      Is it my fate to live the rest of my life ashamed, utterly ashamed, of my own country? There has been no feeling reoccurring more regularly over the course of this past dreadful year, than that one. When, if ever, will the day come where I can live free of that dreadful emotion, attacking me every time now when I catch a glimpse of that flag flapping in the wind…?
      
      IM DocMarch 30, 2021 at 2:49 pm
      I could not have expressed many of my same feelings better. Thank you. And I am a medical professional. You should not feel alone in the chaos. Anyone who has a brain and the ability to reason has felt the same way all year.
      
      Jeremy GrimmMarch 30, 2021 at 2:56 pm
      My feelings echo your despair.
      
      Lambert StretherMarch 30, 2021 at 3:08 pm
      > Is it my fate to live the rest of my life ashamed, utterly ashamed, of my own country? There has been no feeling reoccurring more regularly over the course of this past dreadful year, than that one.
      I have had the same feeling all this year, too.
      
      tennesseewaltzerMarch 30, 2021 at 4:03 pm
      My first comment from a long time reader. This heartfelt comment is exactly what has concerned me throughout this year. I thank you for so eloquently speaking what I consider truth.
      
      CoryPMarch 31, 2021 at 5:21 am
      Here’s another “Amen” from a healthcare person who is feeling dazed and confused by this year and is having a bit of an epistemological crisis — I feel much the same about the organizations you referred to.
      As for the original post, I could hardly believe the vehemence of the reaction against hydroxychloroquine last year, since in my experience it’s not known to be overly dangerous. But I thought, “Ok, well, Trump Derangement Sydrome, Plus, it’s probably bad news to give it to someone really old who’s critically ill and
      has a bunch of electrolyte disturbances etc..”
      Now the pushback against Ivermectin. I have to wonder where it comes from. Who knew there was such widespread simmering emotion about a drug that most wealthy Westerners never encounter in their lifetime!
      I don’t know. I’m probably just internet-poisoned but this whole thing stinks and now my question-everything paranoia directly affects my work life, so now I can’t get away from it. Argh!
      I am so glad I am not having to administer the AZ vaccine yet! I’m supposed to be able to give patients an intelligent recommendation on these things, but I mostly feel like an idiot.
      
      ambritMarch 31, 2021 at 7:23 am
      You have captured the essence of the New American Experience.
      It feels like what someone losing a life long religious conviction must experience.
      Are we going to have a “Lost Generation” like the West did after World War One?

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