Thoughts of a retired physician

  There has never been a war on Christmas. This should be the season of peace and harmony. There are NO concentration camps for prisoners… Multiple religions celebrate around the winter solstice. Nonbelievers join in. Saying Happy Holidays! Is not a slur on Christians.  So, Happy Holidays to all of you, whatever your beliefs are. Peace should be everyone’s goal.

  I remember in early January 2020 when the first reports appeared in the news about an outbreak of disease in Wuhan, China that had similarities to SARS. Margan and I thought here we go again with memories of the response that was mounted in 2003 for SARS. It quickly became apparent this was SARS on steroids with the added problem of infected people being infectious before they were symptomatic. We all remember what happened. The president, Trump, declared repeatedly this was not a problem and would be gone by Easter. It wasn’t. Covid-19 spread like wildfire with huge morbidity and mortality. Public health authorities responded with their playbook for pandemic respiratory disease because that is what we had on the shelf. Unfortunately, Covid-19 did not play by that book’s rules. It took time to fully understand that SARS-CoV-2 spread by aerosols, just like measles, rather than by respiratory droplets and contaminated surfaces. By the time it was realized that what was needed was the

  Below is the oath of office for a Naval officer . I took this office when I entered Naval service and each time I was promoted. The oath is the same as the one taken by elected officials of the federal government, judges, and federal employees. The President also affirms that they will faithfully execute the laws of the United States. I have been accused of having “ Trump Derangement Syndrome ” by others because of my vehement dislike of Donald John Trump. DJT faces prosecution for his role in the 6 January 2021 insurrection and storming of the Capitol Building as well as feloniously retaining classified documents that belong to the American people. In both of these cases, Trump did not uphold his oath. In her Substack for 3 December, Heather Cox Richardson includes his comment from “Truth Social” (I have to put it into quotation marks because truth and social it isn’t) calling for the termination of the U.S. Constitution.  I will say this to Trump supporters. You may call me wha

  Margan and I host a Current Events group here at our retirement community twice a month. This coming one will be mine to prepare and I chose the little noticed event this month that we now have 8 billion fellow humans as neighbors on our spaceship Earth. That is a lot of humans. When graphed out, the population on Earth looks like this over time: I joined the club in 1948 when the estimated global population was 2.5 billion. It was 4 billion when I graduated from medical school and you can see the rise on the graph since then. I am drawn back to my first microbiology course in 1967 (3.5 billion humans then) and the concept of the bacterial growth curve. If one inoculates a test tube containing appropriate nutrients with a bacterium such as E. coli one can calculate a growth curve that looks like this over several days: Initially the bacteria do nothing spectacular as their metabolism accommodates to the conditions in the tube (lag phase). Then they become active and divide as rapid

  One of the joys of retirement is more time to read books. I always was a bookworm so this is nothing new for me. I still try to keep up with medicine, especially infectious diseases, but the lure of other reading is always there. I wanted to jot down a few recent ones I have read for fun. After the Ivory Tower Falls: How College Broke the American Dream and Blew Up Our Politics—and How to Fix It by Will Bunch was most interesting. Bunch is a Pulitzer Prize winning Philadelphia journalist who explores how we came to believe that the ultimate goal for everyone should be a college diploma. He traces it to the G.I. Bill of 1944 and articulates well how this idea was transmuted over time and became a dividing point in our society. It was interesting to me that Kutztown University occupied one chapter since I began my college education there in the mid-60s. He ends with some interesting ideas about how we can fix this. Universal public service after high school features prominently there.

The midterms are over, at least so far as casting ballots is concerned. Some races remain undecided as ballot counting proceeds in some western states. So what is the outcome? First and foremost, democracy seems to be the main winner. Despite oceans of ink spilled and airwaves filled with political ads (now radiating out to the universe), Donald Trump once again failed the political party he hijacked. It appears the public, including a healthy swath of independent voters, tired at last of his stolen election schtick. He is too much a narcissist and sociopath to admit that but the cracks in the GOP are widening. In two days he will probably announce he is running for President again in 2024. The announcement is probably as much about his fear that he will be indicted for his myriad crimes while in office; he views being a candidate as some sort of talisman that will prevent the law from seeking accountability. We will see. Second, although there were many election deniers that Trump lin

  VOTE!!!

  Two days ago, Margan and I had a disturbing experience. She saw an ad on Facebook for an RSV vaccine study. RSV is respiratory syncytial virus, and cases in the U.S. are exploding . Along with covid and flu, some are predicting a very bad respiratory season dubbed a “tripledemic” . As a pediatric infectious disease physician, Margan has lots of experience in dealing with severe RSV infection in infants and I am well aware it is also a threat at the other extreme of life. In the mid-1960s a formalin-inactivated RSV was developed but quickly dropped when it became apparent that it enhanced RSV disease rather than protecting from i t.  Researchers have been trying to understand this problem and construct vaccines that truly are protective against RSV disease. Now multiple vaccines are in trials that seem to have overcome the problem of that 1960s-era vaccine. Bavarian Nordic has developed an RSV vaccine that uses its Modified Vaccinia Ankara to deliver 5 RSV antigens and create neutr

  Several weeks ago the California Department of Social Services lifted the masking requirement for residents of residential facilities for the elderly. MonteCedro, our home, is one of those facilities. While masking is still encouraged , it was plain that a majority of our residents promptly shed their masks. After 30 months of required masking, that was no surprise. What is interesting is the response of the non-maskers to those of us who still take the mask precautions seriously. On more than one occasion, other residents have either suggested or plain asked that my wife and I remove our masks, saying “You don’t need to wear them anymore.” My prediction is that those seven words will lead to interesting problems. We have a pretty much fully vaccinated and highly boosted population here. But we also have an active population here that enjoys going to see family and friends on the outside, attends activities outside, shops outside. Family members and friends visit every day. It is not

  We got home after an almost 2-week road trip to New Mexico, with stops at Santa Fe, Ghost Ranch, Abiquiu, Taos, and Albuquerque. Highlights were seeing Georgia O’Keeffe’s home and studio in Abiquiu and Ghost Ranch, where I grabbed a shot of Kitchen Dome from where she painted it numerous times. It is in this link as My Backyard . New Mexico is an interesting state with great views, indigenous culture, non-Anglo history, and great food. We enjoyed the trip immensely. We did keep up with current events. It was a very, very bad, awful, horrible week for Donald Trump. The January 6 Committee subpoenaed him as well as provided a chronologic recap of his involvement with the attempted coup. Trump will of course continue to lie, obfuscate, and delay but the rebuke from SCOTUS regarding his illegal possession of classified documents (a single sentence sufficed) and AG James’s motion to stop the Trump Organization from moving assets to avoid liability (to the Trump Organization II, a name

  I read two articles in the New York Times this week about hospital groups that appear to have put profits over patients even though they are nonprofit entities. One is Providence and the other is Bon Secours Mercy Health. I have long been a proponent for universal health care as opposed to the profit-driven fragmented “system” we have in the United States. What is perhaps surprising is that the two hospital groups the Times explored are nonprofits . The quest for dollars by the medical industry in the U.S. knows no genuine boundaries. A table and two graphs for context. The source is World Health Systems Facts . First a table comparing developed countries national health systems: Lots of numbers but the United States has the highest total health spending as % of GDP, among other data. How about healthcare spending per capita?  Well, the United States spends more per capita than the other developed nations in this comparison sample. But what counts is outcomes, right? Check out

Covid-19 has NOT disappeared. The trend for cases, hospitalizations, and deaths from Covid has been downward but today’s New York Times tracking page shows (as of 17 September 2022) a 7-day average for the U.S. of 62,037 cases (down 29% over 14 days), 32,168 hospitalizations (down 12% over 14 days), and 465 deaths (down 6% over 14 days). The cases have been declining since late May. Sadly, vaccination rates have not materially improved. For all ages in the U.S., 68% have been fully vaccinated (2 doses) but only 33% have received a booster. The numbers for those older than 65 are somewhat better: 92% are fully vaccinated and 65% have been boosted.  The head of WHO said on 14 September “We have never been in a better position to end the pandemic. We are not there, but the end is in sight.” As an infectious disease physician and epidemiologist, I will simply say I am hopeful but prefer to keep my powder dry. At the moment, there do not appear to be new variants emerging that would cause