Existentialism

Share |

I think truth, fact and meaning are three distinct things. I think some of the willingness of journalists to engage in fake news comes from projecting and confusing meaning with truth or actual fact. I read statements such as, “It is an existential threat.” From my interpretation of existential, that would mean only a threat the journalist’s mind.

Listening to Jordan Peterson at the Oxford Union, I would ask him his interpretation of the above and his definition of existential. Think I’ll check out his book on meaning. Peterson has an interesting suggested book list.

Mexican Border Crisis

Share |Is this the masked image of American Communism?

Globalization or Democracy

Share |

https://www.amazon.com/dp/B08M1XBXFZ

HIV the Hidden Pandemic

Share | https://www.jwatch.org/fw117539/2021/02/21/lancet-series-tackles-us-hiv-epidemic?query=pfwTOC&jwd=000020094311&jspc=GP

The Lancet takes aim at the US HIV burden, the highest of any of the G7 nations. In dramatic contrast to the quarantine, contact tracing, social isolation, distancing and masks demanded by Public Health for the COVID19 pandemic; HIV patients and those living an alternative lifestyle demand and receive the exact opposite. Hospitals, clinics and physicians can not test for HIV without written permission. While hospital admitting lab tests still include a routine test for Syphilis, routine testing for HIV is not included. Only a difficult strategy of universal precautions affords protection for other patients and hospital personnel. Surgical and obstetric cases must be carried out with the assumption of risk, requiring extensive shielding against the inevitable spattering of blood. The risky behavior, personal privacy and confidentiality if not silence demanded by the HIV community was political from the start. If testing, quarantine, contact tracing and isolation had been required from the first case of HIV, there would have been no epidemic in the US, or if HIV did spread by undiagnosed immigration, it would have been contained. Indeed, COVID19 would have been contained too if China had not deliberately denied its threat and encouraged its spread.

As a nation, we were more than willing to suffer quarantine and contact tracing for Syphilis, Tuberculosis, Poliomyelitis and even Mumps. The contrast between the protocols for HIV and COVID19, however, illustrate the compromise needed between Constitutional freedoms of choice and the suspension of that freedom in the face of a highly communicable and highly fatal disease. The choices needed to balance a fair compromise might better be made by medical judgements than by politicians. Even so, there will be an inevitable difference between clinical opinion and that of public health. It becomes even more problematic when public health becomes politicized or politicians intervene. 

New England Journal of Medicine (NEJM)

Share |

This is a slow take on some serious questions. First of all what is the NEJM doing writing a political editorial accusing the president of mismanaging the COVID pandemic? The assertions, largely untrue, beg both academic and scientific credibility. NEJM publishes Journal Watch and other CME articles and enjoys an authoritative role at the heart and sole of academic medicine. 

 

The second thing that seemed strange was NEJM’s guidelines for treating COVID19. The guidelines have come to be a treatment imperative for a number of reasons mainly medical-legal. These published guidelines restrict treatment with antiviral drugs to when the patient requires high oxygen flow rates. By then it’s too late. One might assume that some if not most hospitalists will follow those guidelines. So doing, goes against all intuitive medical judgment and appears to be in contradiction to all experience in treating influenza and Vanderbilt’s rather spectacular success in containing Ebola, 11 cases, 4 deaths, 2 nurses and a doctor recovered.

 

Directing criticism of President Trump’s management of the Chinese virus seems misplaced. Trump cut off travel from China well before WHO condoned it and shortly after CDC trace managed and guaranteed the first known US case in Illinois. The president furthermore held daily public briefings with CDC physicians and evoked the emergency measures act to manufacture personal protection supplies, drugs, test kits and respirators all of which were cut off from the Chinese manufacturing and supply chain. US manufacturers came through in heroic fashion.

 

Guidance for masks, testing, distancing, isolation and quarantine were driven home from the podium. The economy shut down and the rest is history. The responsibility for balancing deaths from the pandemic with deaths and displacements from the shutdown is awesome and there may never be an acceptable solution, but not for lack of leadership.

 

Public health is a state run institution, a fact largely misunderstood by the media. Furthermore, masks and isolation authority runs contrary to the legality of individual freedom of choice. What ever mandate that’s legal, comes at the state level. Also, public health is not a clinical specialty. There was always a disconnect between clinical medicine and public health. Most physicians choosing public health do so not to see patients. 

 

It’s a matter of opinion, but at this point in the pandemic, management might better be directed by clinicians, medical schools especially. Public health has exhausted its role in preventing the spread of the virus, maybe it was a lost cause from the time the CCP deliberately encouraged its worldwide spread. Clinical medicine can do much to reduce the death rate with early treatment. The case for early treatment was dramatic with Trump’s rapid recovery at Walter Reed.

 

Googling publication of NEJM, revels  mass distribution if not publication of the NEJM in China, in Chinese. I wonder just how much investment, domination and ownership the Chinese Communist Party (CCP) now enjoys with what amounts to the backbone of continuing medical education (CME) in the US. 

Not a conspiracy theory but serious questions about the integrity and possible subversion of the NEJM.

 

Time for Clinical Medicine

Share | We should be focusing on the various immune antibody cocktails  and early treatment. Prevent deaths, lung and organ damage more than the spread of cases, a transition from public health to clinical medicine. Get bureaucracy out of the way, and deliver massive amounts of the early treatment modalities to primary care physicians. Treatment > prevention, family physicians should have access to these treatments, treat early and treat often. The President has it right. Treat early like the first line physicians treated him, when hospitalized with shortness of breath, it’s already too late.

Early Treatment

Share |Pure speculation, based in part by POTUS’s rapid recovery and apparently greater success rates in under developed or what we thought of as under developed countries in treating COV-2

Our reluctance to use unapproved off label therapies in the treatment of COVID19 in the US, seems both endemic and contra intuitive. The guidelines published by the NEJM limit initiation of remdesevir to patients requiring high flow rate oxygen. Physicians have been sanctioned for advancing off label treatments, and I wonder how patient care came to depend on bureaucratic permission. Furthermore, Science Published an article suggesting dysfunctional FDA approval processes and questionable studies causing major delays.

Clinical medicine often conflicts with Public Health interests, and the treatment phase of this pandemic may be such a conflict with the, can I say, less respected health care and public health authority. Have we failed to make the transition from public health measures to serious aggressive individual patient care?