Iatrogenic

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What a beautiful word, iatrogenic. How better to characterize the origins of the COVID19 Pandemic.

Understatement

Share |April 25, 1953 Nature Magazine #4356 page 737, probably the greatest British/English understatements of all time. In publishing the structure of deoxyribose nuclei acid, James Watson defined the formula for life.  “It has not escaped our notice that the specific pairing we have postulated immediately suggests a possible copying mechanism for the genetic material.”

Public Health Failure

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Once upon a time, Public Health kept the water safe and enforced quarantine for highly contagious diseases. Physicians were highly educated, judgmental and organizationally disciplined.

Since the HIV epidemic, liberal planing introduced two changes. 1. Liberals passed legislation forbidding routine testing for HIV and tightened the rules insuring patient’s medical confidentiality to the point of stiffening both continuity of care and medical education. 2. An overgrown medical bureaucracy introduced rules based medical care based on guidelines with disciplinary measures against physicians not following those guidelines. 

If nothing else, the CoV2 pandemic exposed these failures. Firstly, the inertia of Public Health in reacting to the pandemic lead to a faster and broader spread of the disease. Rules based guidelines became obsolete by the time they are published. Contact tracing and quarantine was overwhelmed. Secondly, guidelines denied the use of treatments not supported by as yet incomplete double blind studies. 

Universal rules forgo regional variability and the magic of multiple trial and error, an end of the scientific method. Medical bureaucracy insisted on a negative interpretation of the relevance and validity of many published clinical trials, not completed and interpreted by themselves. These acronymous agencies, CDC, FDA, NIH, HHS and a plethora of others placed greater value on population wide studies, statistics and completion of years long studies. The inertia of time alone rendered their judgments irrelevant. This egregious denial of care from government entities resulted in many unnecessary deaths and continues to do so today. 

Traditionally, the consideration of multiple clinical trials and clinical judgment was the prerogative of individual clinicians viewing multiple variables. Any clinical physician knows that treatment is highly individual and enhanced by the presence of a trusted physician, and that most clinical studies contain a bias of one sort or another: independent variables, clinical bias, incompetence, statistical or just plain inertia. Then enters political bias. Hospital employers even licensing agencies got into the act threatening  consequences for any deviation from their negative guidelines.

The generations long history of treating Influenza included off label drugs with antiviral efficacy and support with multiple strategies including optimal treatment of underlying conditions and support of the immunize system. The same could apply to COVID19. With a death rate over 20% for patients over 70, physicians needed to be free to treat early and try options.

In the heat of the pandemic, with rigid guidelines, other serious conditions were neglected. Guidelines, algorithms and artificial intelligence fell far short of adequate management of the multiple problems and fast changing threats.

Protocalized Medicine

Share A new term from NEJM Hospital Medicine, promises wider hospital gross profit margins, decreased continuously of care and frequent disregard for coexisting conditions. 

Early Treatment COVID19

Share | I’m disappointed in ID coverage of early treatment of COVID 19.

Physicians have been marginalized or fired for attempting early treatment. Various treatment modalities were discounted and later revised. Early treatment might have saved many lives. I don’t think the journal gave adequate clinical coverage of either the controversy or the lost opportunity for early treatment. Never mind the damage done to physicians attempting to practice traditional medicine. Even the laying on pod hands and the reassuring presence of a trusted physician has a positive neurohumeral strengthening of the immune system. 

Was this failure of early treatment not a shortcoming of overly rigid evidence base, standardization and protocols?

Authoritarian Medicine

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It was three am in Nandi International Airport in Fiji. All of the passengers had cleared customs and left the terminal. Only three of us remained. It was not hard to spot the other doctor, an ENT from Homberg, Germany. The third gentleman was a British Health Service bureaucrat from England in Fiji to share the English version of central management of healthcare with the emerging Fijian Healthcare system. We were all waiting for rides which may not have anticipated our early arrival.

Wolfgang and I immediately hit it off. We were both volunteers with Rotary International, in Fiji to participate in a Health Fair throughout many of the underserved villages. After a few minutes, the Englishman came over and introduced himself enthusiastically presenting his views on standardized healthcare. Wolfgang and I spent the next two hours arguing that standardization negated the scientific nature of clinical practice, where in trial and error takes place massively throughout the profession resulting advancements in care for the patient, communicated almost by word of mouth on a realtime basis. We argued that statistics and scientific studies were a necessary reference but not a certain conclusion. Many studies were selected for or conflicted by those conducting the studies and many studies proved wrong by subsequent trial but with substantial time lag.  Neither side won the argument back then, and our rides soon arrived.  This airport debate was twenty years ago, and the evolution of  authoritarian medicine dominated English medicine and now distorts healthcare in the US. 

The American version of authoritarian medicine features additional elements of greed and politics, along with massive bureaucracy. Starting with the theory of "Evidence based Medicine," medical science became the purview of the growing medical bureaucracy, then hospital administrators, corporate medicine, politicians and big pharmacology. The burdens today's physicians face, match or exceed the burdens of various religious dictates during the Dark Ages. No longer medical science and patient care, doctors now practice with political correctness, censorship and manipulated evidence. Today, I read that the AMA has come out in support of Critical Racial Theory. Politics and greed have no business in medical practice and patient care. Patient care, patient satisfaction, current science, treatment outcome, the physicians judgment and local medical societies should be the only authority in medical practice. Authoritarian-guidelines negate the scientific method and inductive reasoning. Evidence is good. guidelines can help, but bureaucratic regulation or administrative regulation cannot. Now the AMA wants to replace merit based medical school admission standards with social standards. Such a move favors corporate medicine and social medicine producing young obedient feldshers who will not question the authoritarian mandates or the political and economic motives -- over clinical judgment, medical science and patient care. We desperately need to reaffirm the Aesculapian mandates of Western medicine and resist the Marxist authoritarianism, greed and politicalization of medicine.

Ivermectin

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"YouTube videos mentioning ivermectin in treatment of Covid-19 were removed or demonetized, as well as Twitter pages locked. Further, in Big Media, even the most credentialed independent and expert groups who recommend ivermectin based on a large body of irrefutable evidence are labeled as “controversial” and purveyors of “medical misinformation.” (My own Face Book and Twitter posts as well -- arguing for early physician treatment of COVID19, even if only holding hands.)

A health system structured to function in this manner is clearly vulnerable to and overly influenced by entities with financial interests. Further, in Covid, such systems have evolved into rigidly operating via top-down edicts and widespread censoring. This allows little ability for emerging scientific developments not funded by Big Pharma to be disseminated from within the system or through media or social media until years later when, and if, a Big RCT is completed. This barrier has presented as an enduring horror throughout the pandemic given the widespread loss of life caused by the systematic withholding of numerous rapidly identified, safe and effective, repurposed medicines for fear of using “unproven therapies” without “sufficient evidence” for use. Alternatively, and for the first time in many physicians’ careers, those who seek to treat their patients with such therapies, based on their professional interpretation of the existing evidence are restricted by their employers issuing edicts “from above.” They are then forced to follow protocols that rely predominantly on pharmaceutically engineered therapeutics." From the FLCCC, https://covid19criticalcare.com/videos-and-press/flccc-releases/flccc-alliance-statement-on-the-irregular-actions-of-public-health-agencies-and-the-widespread-disinformation-campaign-against-ivermectin/

Starting with the theory of "Evidence based Medicine," medical science became the purview of the growing medical bureaucracy, then hospital administrators, politicians and big pharma. The burden todays physicians face matches or exceeds the burden of various religions in the Dark Ages. No longer medical science and patient care, but now political correctness, censorship and manipulated evidence. Today, I read that the AMA has come out in support of Critical Racial Theory. Politics and greed have no business in medical practice and patient care.