I’m not panicking over the coronavirus

It has the potential to be a serious pandemic, but with a strong medical infrastructure, robust public health response, and a sensible, informed public, we can minimize…wait. What the heck…PANIC! Not over the virus, but over the ongoing dismantling of those very things vital to keep the citizenry as safe as possible.

Trump is making massive cuts in biomedical research.

Multiple organizations expressed shock and disappointment at Trump’s budget proposal, which adds $54 billion in defense spending but would slash nearly $6 billion from the National Institutes of Health, which funds most basic medical research in the country, as well as eliminate entirely dozens of other agencies and programs.

It would cut the overall Health and Human Services department budget by 18 percent, including the 20 percent budget reduction at NIH, and reassign money from the Centers for Disease Control and Prevention to states.

In response to concerns that we might not have enough doctors if a crisis arises, he has said that we’d just hire more doctors in that case. Doctors are not fungible. They require years of training, and their expertise requires constant maintenance.

Trump seems to think creating a task force and appointing a “czar” is a smart response. We already have experts in infectious disease at the NIH and CDC…you know, those agencies he is defunding. Appointing an ignoramus like Mike Pence, who has no qualification and has a history of botched public health management does not inspire confidence. Nor does having Ken Cuccinelli, Steven Mnuchin, and Larry Kudlow on the task force.

Also, this:

As for our informed public, Corona, the Mexican beer, has taken a substantial hit to their revenues because people are associating it with the virus.

Please note that the beer and the virus have nothing to do with each other.

We’re gonna die.

When leadership matters

There are legitimate fears of a coronavirus pandemic — don’t panic, it’s an emerging threat, not a full blown emergency — and that’s when it’s a good idea to prepare. We should have a strong medical infrastructure, plans in place, people organizing now, just in case. In the US, however, our plan to respond to potential medical threats is a shambles.

For the United States, the answers are especially worrying because the government has intentionally rendered itself incapable. In 2018, the Trump administration fired the government’s entire pandemic response chain of command, including the White House management infrastructure. In numerous phone calls and emails with key agencies across the U.S. government, the only consistent response I encountered was distressed confusion. If the United States still has a clear chain of command for pandemic response, the White House urgently needs to clarify what it is—not just for the public but for the government itself, which largely finds itself in the dark.

Who is to blame for the chaos? It seems Obama had a thorough, if flawed, response team in place. One man and one party have been actively working to dismantle the entire system.

In the spring of 2018, the White House pushed Congress to cut funding for Obama-era disease security programs, proposing to eliminate $252 million in previously committed resources for rebuilding health systems in Ebola-ravaged Liberia, Sierra Leone, and Guinea. Under fire from both sides of the aisle, President Donald Trump dropped the proposal to eliminate Ebola funds a month later. But other White House efforts included reducing $15 billion in national health spending and cutting the global disease-fighting operational budgets of the CDC, NSC, DHS, and HHS. And the government’s $30 million Complex Crises Fund was eliminated.

In May 2018, Trump ordered the NSC’s entire global health security unit shut down, calling for reassignment of Rear Adm. Timothy Ziemer and dissolution of his team inside the agency. The month before, then-White House National Security Advisor John Bolton pressured Ziemer’s DHS counterpart, Tom Bossert, to resign along with his team. Neither the NSC nor DHS epidemic teams have been replaced. The global health section of the CDC was so drastically cut in 2018 that much of its staff was laid off and the number of countries it was working in was reduced from 49 to merely 10. Meanwhile, throughout 2018, the U.S. Agency for International Development and its director, Mark Green, came repeatedly under fire from both the White House and Secretary of State Mike Pompeo. And though Congress has so far managed to block Trump administration plans to cut the U.S. Public Health Service Commissioned Corps by 40 percent, the disease-fighting cadres have steadily eroded as retiring officers go unreplaced.

But here’s what worries me most: the systemic incentive to continue to wreck what system we have. There is no price the Republicans will have to pay. People will die, the country could be thoroughly disrupted, and the demagogues will just blame it all on the Democrats, or the Chinese, or Islamic terrorists, or filthy disease-ridden immigrants, and people will want to believe them, and everything will just get worse. In fact, catastrophe will strengthen their grip on the country.

Heckuva job, Trumpy.

It’s an anniversary!

Ten years ago today, the Lancet issued a formal retraction of Andrew Wakefield’s notorious bogus paper claiming a link between MMR vaccinations and autism. The paper was wrong, it was shoddily done, and the work hasn’t been replicated.

Ever since, Wakefield has been living in shame, no one treats him as an authority anymore, and of course no one would claim that vaccines cause autism anymore.

Why didn’t she get vaccinated?

Now I’ve got the heebie-jeebies. A woman undergoing safety training for a lab tech job was offered a smallpox vaccination because she’d be working with Vaccinia virus, and she turned it down. She didn’t understand the possible consequences at the time of training.

Naturally, what happens next? She’s trying to inject a mouse and accidentally pokes herself with the syringe needle. There are graphic photos at the link! It looks like some nasty ulceration of her finger and some systemic problems as well.

Although she continued to be treated, by day 10 her finger was looking very swollen, and she wasn’t feeling well.

“On day 12, she was treated at a university-based emergency department for fever (100.9°F or 38.3°C), left axillary lymphadenopathy [swollen lymph nodes], malaise, pain, and worsening edema of her finger,” a case report explains.

“Health care providers were concerned about progression to compartment syndrome (excessive pressure in an enclosed muscle space, resulting from swelling after an injury), joint infection, or further spread.”

She survived and is healing.

Vaccinations are important for people dealing with dangerous pathogens, but also for everyone else. Have you gotten your flu shot? If not, what’s your excuse?

Lack of access to health care does lifelong harm

Well, if this isn’t the most horrifying story to start my morning ever.

After three decades of progressive symptoms, a 43-year-old man from Panama was rushed into emergency surgery with a massively swollen scrotum that hung past the level of his knees and had begun to rot and ooze foul-smelling pus, a team of Texas doctors report.

I’m not so much hung up on the clinical symptoms as on the fact that this man suffered for 30 years, for most of his life, with a condition that would have crippled his social options and destroyed his opportunity to be a productive part of his community, and that would have been a painful, constant reminder of his state. It wouldn’t be something he could ever get away from.

And it was treatable, especially if it could have been caught early. This is precisely why health care ought to be a human right.

Doctors advising doctors

Hey, I guess people have known about that cutting entry in the index to an obstetrics text for a good long while. Here’s an article on the book and general ob-gyn attitudes, in which we learn that the indexer was … the author’s wife! I guess she’d know. But doctors know better now, right?

Recall that preeclampsia was once called toxemia because it was thought to be a build-up of toxins in the maternal blood that had not been secreted through the normal monthly purification of the menstrual cycle. Miscarriages must be caused by the woman doing something she shouldn’t have done, like picking up a bag of groceries. Bottle feeding was superior to breast feeding because men had used science to outsmart the female breast. In fact, for about half of the twentieth century, obstetrics consisted of rendering pregnant women unconscious, cutting a procto-episiotomy, and ripping the child out with forceps. Sounds very efficient and modern. [Yikes. That’s how I was born.]

But surely we don’t think this way today. Have you ever recommended that a woman be on bed rest for any condition in pregnancy? Have you ever mocked a woman with a birth plan? Have you ever told a woman to “take it easy”? Do you believe that a Cesarean delivery is an improvement over vaginal delivery? Do you believe that when women suffer from depression or anxiety it is related to abnormal hormone levels? Much of the worldview of modern obstetric practiced was formed with the belief that women were inept and incapable and that science needed to fix them. Think about that next time you integrate old myths into your practice.

Ritualized child abuse: circumcision

Want to spend an hour cringing and twitching? This is the abridged version of “Cut: Slicing Through the Myths of Circumcision“, and you will suffer if you watch it. It is a wasteful, terrible thing to do to a child.

One rabbi interviewed is at least honest about circumcision: “It’s painful, it’s abusive, it’s traumatic, and if anybody does it who isn’t in a covenant ought to be put in prison…I do abusive things because I’m in covenant with god.” What nonsense. What a wretched excuse for abusing children.

(Warning: lots of shots of babies getting chopped, as well as closeups of adult penises.)

The arguments for circumcision are pathetic and awful.

  • “You either believe [in the covenant of circumcision] or else nothing is true”. I’ve heard that before: it’s the argument creationists use to defend the absolute literal truth of the book of Genesis, because if that’s not true, the story of Jesus falls apart, and therefore the whole of Christianity is false. Yeah, so? Then it’s false.

  • “The mystery of circumcision is profound”. Ignorance should not inspire the kind of awe that motivates one to mutilate another person’s body.

  • The health benefits. Total bullshit. As one of the speakers in the movie explains, there have been progressive excuses: from it prevents masturbation to it prevents cancer to it prevents AIDS. The benefits all vanish with further studies and are all promoted by pro-circumcision organizations. It doesn’t even make sense: let’s not pretend people have been hacking at penises for millennia because there was a clinical study. Hey, let’s chop off our pinkie toes and then go looking for medical correlations!

  • It’s tradition. Grandpa and great-grandpa and great-great-grandpa did it, so I’ll perpetuate the cycle of abuse to my children. I have to reject that: it reduces a decision to do irreparable damage to a child to repetitive, superstitious, mindless behavior.

There is no reason, other than certain rare and specific medical conditions, for maiming anyone’s genitalia. Don’t do it to your children.

(Also on FtB)

What killed Steve Jobs?

You’ve probably heard the story going around that Steve Jobs’ death was avoidable, if only he hadn’t been so gullible as to steep himself in quack medicine. It turns out, though, that the story is a lot more complicated than that: David Gorski has written the best summary I’ve seen so far.

In short (because it is Gorski, after all, so it’s exhaustively long), there was an element of woo in Jobs’ early response. After his pancreatic cancer was first diagnosed, he delayed surgery for 9 months to try out some improbably dietary approaches. It was a massive operation that was strongly recommended, so it’s a little bit understandable that he wanted to avoid it, but surgery was also the best and most demonstrably successful approach to take. So first point goes to the verdict of gullibility against Jobs.

However, his cancer was a slow-going kind with a reasonable prognosis, so the delay can only be said to have possibly contributed to the worsening of his condition. Jobs made a poor decision, but not necessarily a fatal one. And subsequently, once he saw that the diet nonsense wasn’t working, he threw himself thoroughly into science-based medicine, getting the best treatment oodles of money could buy, getting the surgeries recommended to him, and even trying out some experimental therapies (real experimental therapies, the stuff where scientists monitor and evaluate the results honestly, not the random shenanigans quacks like to flatter with the word “experimental”).

So the final result is that real science kept him alive and healthy as long as possible, and that an early flirtation with ‘alternative’ medicine might have contributed somewhat to lowering the odds of survival, but that what killed him is cancer. And cancer is a bastard.

(Also on FtB)

Some students should not go into a health profession

I’m afraid Ben Cochran is one of them. He’s a nursing student who wrote a column in a newspaper because he was upset at the time it took for the emergency medical services at his local clinic to help him with his sneezy, phlegmy cold (which, I would have told him, is going to put a low priority on something they can’t really treat anyway). He places the blame: the clinic offers women’s reproductive services, and they were busy helping a “gaggle of preemie sluts [] get a free pass on harlotry” and treating their “cunt problems”.

But he really doesn’t have a problem with these women, he says. He just wants to end women’s medical services and the distribution of condoms on campus.

I don’t take issue with sex mongers. They serve their place. Hell, according to the bible, it’s
the oldest known profession on earth. So you sultry sex fiends are clearly established, but
this is a place of higher being. Please take your gaping holes elsewhere for medical services,
and leave the real health issues to those that actually belong on a college campus.

Yeah, he’s going to make a greeeeeat nurse. He’s already an expert on triage: men with runny noses must be treated before sluts with gynecological issues.

He’s going to have a tough time doing the work, though, with all the holes Ema ripped into him.

(Also on FtB)