Thoughts of a retired physician

  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

  Twenty-one years ago I sat at our morning report at JTF-CS, then located at Fort Monroe, Virginia. Our J2 (intelligence) burst into the room to announce that an airplane had just hit the World Trade Center. Our CO ordered him to get more info and he came back to tell us another plane had hit the second tower. The event changed world events in an instant and reverberates to this day. Let us remember it and also remember that we were united then. 9/11 was a foreign foe. Now the foe is internal fascism. I hope we are able to overcome the domestic threat that faces our democracy.

  This is the Sunday of the 2022 Labor Day weekend. The labor movement is once again stirring after going into the doldrums starting in the late 1970s. A few thoughts came to mind as I opened my laptop today. The first is that what we see today in the United States has been built over the centuries by the working men and women of this country. While some praise the work of the (primarily) men who provided the capital for business, we must never forget that we would not have what we see today without the workers. From the early canals like the Erie to the railroads that opened this vast country to commerce in the late 18th and early 20th centuries and the steel and petroleum industries that led to the automotive industry , names like Clinton, Vanderbilt, Carnegie, Rockefeller, and Ford readily come to mind. As with military history, this is remembering the generals and forgetting the soldiers.  The labor movement’s histor y is long in our country. It is checkered with many episode