bnuckols

Right to Life, COVID, 16 May, 2020

The “Right to Life” means the negative right not to be killed by intentional acts. It’s not the right to force others to invest our life, liberty or property other than the duty to intervene against infringement. This is a basic negative right, not a positive right.

There’s a huge difference between personal responsibility in avoiding a risk to yourself and actively causing harm to someone else. Self-defense rather than selfish demands, using only appropriate force on others.

You know, the old “your right to swing your fist ends at my nose!” (Especially Appropriate in this case.)

*You* take the actions *you* believe are responsible. Only frequent places/businesses that require masks if you want, do the work necessary to maintain the social distancing you are comfortable with. Don’t force everyone else to do your work for you.

In-Justice “In like Flynn” (after 3 years)

This all makes me physically ill. Documents withheld for over 3 years.

Hand written note “get him to lie.”

Special ProsecuterMueller’s investigation had some of these documents. Did Horowitz?
I have said that justice died the day that Kelo was decided and Terri Schiavo was killed by medically pulling her feeding tube & threatening her mother with Sheriff’s deputies guarding her to ensure dehydration.

Then, Comey pulled his Hillary stunt and the DOJ handed out immunity like candy. Then, the Russia hoax, and impeachment with Schiff claiming ownership of interview documents.

Law enforcement forcing the elderly to sit on sand rather than beach chairs and parents arrested for playing with their own children.

Now FISA courts subverted, 66 yo’s are arrested in their homes in SWAT assaults, and this, with Flynn. The FBI leadership planned to go after Flynn, in order to prosecute or get him fired.

Then, the documents and others proving the plan were held – hidden – for over three years in spite of a judge ordering them turned over.

The real story is the lies they told, and especially the fact that they hid these documents 3 years after they were ordered by a judge to turn them over!

They didn’t appeal the judge’s rulling: they obstructed justice, hiding and denying their existence! The Sztrok/Page texts were supposedly destroyed, remember? Then some were turned over as if the complete record.

Justice is dead and the body has been repeatedly mutilated.

Edit: 509 PM AST 30/04/20 To add 2nd & 3rd to last paragraphs BBN

Test the story! (COVID-19 Fake News)

#BVILove, #Coronavirus Delayed, not “beaten.” (One small country’s COVID-19 story)

Here in the small Nation of the British Virgin Islands, we’ve delayed, but we haven’t “beaten,” or completely avoided, the disease caused by the novel, or new, Coronavirus, COVID-19. Everyone who hasn’t yet been infected is still at risk. A lot of us will eventually catch the virus if and when we once again interact with the world at all.

If you want to learn about the current state of the science, this video is excellent by a fantastic teacher.

The Nation has done an excellent job of blunting the effect of the disease, beginning with closing all ports of entry to everyone except residents, back in March, followed by a 6 day “lockdown” with an in-home curfew at night and limitedbusiness and shopping.

Beginning about April 2, Government began enforcing a 24 hour in-home curfew, shutting business and forbidding residents from leaving our homes.

There have been 5 people with positive tests. 4 of them caught the disease in other countries and one person may have caught the disease from the last of those 4. The first 3 had mild cases and appear to be recovering.

Unfortunately, that last case was a woman whose disease was only discovered when she became very sick and had to be admitted to the hospital. She died the next day. One of her contacts has tested positive, but has mild symptoms. Unfortunately, not all of the people she might have interacted with have been identified and tested.

Hopefully, over the last 6 weeks, the BVI health department has had time to plan and prepare for multiple sick patients.

Even more: I hope that researchers around the world will come up with good treatments and discover why some patients get so sick so fast.

If there’s ever a vaccine, it’s years away There haven’t been any successful vaccines for other human strains of coronavirus.

It appears from some recent random testing in the US, that about 25% – 30% of an exposed population contracts the disease. Most either have no symptoms or mild symptoms. A small minority gets sick enough to be hospitalized, and a fraction of those end up in the ICU.

You may have heard about the high “case fatality rate,” reported anywhere from 0.01 to 10. Remember that this statistic only counts those who have been tested, predominantly those sick enough to be admitted to the hospital.

There is good news in addition to the fact that most infected people have mild or no symptoms: evidence that we have immunity after recovery comes from one of the treatments undergoing research: serum containing antibodies from the blood of recovered patients helps other people get well.

The scary part of the story is that the virus is very contagious, largely because people without symptoms can spread the disease. Medical personnel have been surprised by what appears to be the unprecedented, rapidity of the onset of Acute Respiratory Distress Syndrome (ARDS) in some patients, usually about day 12 to 14 of the symptoms. In a matter of a few hours, patients become very short of breath, requiring intubation. 80%- 90% of those intubated have died in the ICU.

The virus can also cause the body to produce proteins causing increased coagulation (the tendency for blood to clot). It also can directly infect the heart muscle and brain.

As our country opens up, and goes back to (relatively) more normal interaction, it’s important to remember that infected people may not have symptoms, but are still able to share the virus and spread the disease. They don’t know they have it and you certainly can’t tell by looking at them.

We will probably see our neighbors continue “social distancing” and wearing face masks when we leave our homes. And yes, inevitably, some of us will get sick.

“Mostly False,” Politifact “Fact Check”

Researching the what-about-isms & dueling accusations about who didn’t take the novel coronavirus seriously enough, soon enough, I came upon a “fact check” on PolitiFact that defies understanding except as a lie. An intentional lie.

Let me tell the story with screen shots, no more.

“Mostly False”

Biden quote Number 1:

Biden quote link, here

Biden quote Number 2:

Link, here

Biden quote number 3:

Link to this quote, here.

Front lines in the ICU with COVID-19

Reality is teaching a hard reality lesson with COVID-19.

This video concerns the minority of COVID-19 patients who require intensive care and the less than 1 percent who die of the disease. The discussion about the course of the disease and treatment is possibly too technical and brutal for the general public, so watch the whole thing with care.

However, I’m hoping to spur conversations about end of life in light of the broader COVID-19 crisis and specific crisis events.

This is a tough, highly technical discussion between Dr. Zubin Damania, a blogger otherwise known as “ZDoggMD” and Barbara McClean, MN, RN, CCRN, NP-PC, an expert in Critical Care & Intensive Care medicine in an Atlanta, Georgia teaching hospital with over 100 ICU beds. The first few minutes show Barbara McClean as a compassionate caring practitioner and educator. I believe and trust what she says about the worst case (stressing, again: fortunately these are the minority!) outcomes with COVID-19.

If you want to get to the meat of the video, there’s a “philosophical discussion” about the very real, unique in this modern age, futility of CPR in COVID-19 patients whose hearts stop due to the disease at 35:00 to 41:00.

There’s also interesting information about Personal Protective Equipment (PPE) difficulty (not shortage, but the physical reality) at the segment 30:00 to 35:00 minutes.

COVID-19 is, as Ms. McLean says, an unpredictable, sometimes deadly disease. Currently, patients can go from minor symptoms to death due to respiratory failure and cardiac arrest in as little as 4 hours. There is very little success to date in attempts to resuscitate patients who “code,” whose hearts stop, while in distress due to the virus.

I can’t stress enough that we need to talk, we need to make decisions among our families and to understand that this disease takes some options, some autonomy we have come to assume are our rightful “choices,” completely off the table. This disease doesn’t care what we want.

I’m unable to turn comments back on for this post. Please post comments to my Facebook page and I will try to keep up with replies. Let’s keep this on the level of philosophy and medical ethics. I will delete political criticisms.

Let’s keep this on the level of philosophy and medical ethics. I will delete political criticisms.

People ‘shed’ coronavirus early, but most likely not infectious after recovery

A study of only 9 people, but it’s a start.

Essentially, you can spread the virus even when your symptoms are mild, but probably won’t after 8 days.

Don’t eat the COVID-19 (Coronavirus)

The good news is that we were warned and it’s Spring, not Winter. (And we don’t routinely greet acquaintances with real kisses in the US.)

The really good news is that you aren’t helpless.

Chances are, most of the people who get sick picked the germs up with their hands and put them in their mouth, nose or eyes. (Gross, I know, but, trust me, I’m a doctor and a mother. I can be more gross than that when I want to get your attention.)

I tend to be a skeptic about panics, and so much of the news coverage about coronavirus is political hyperbole, but … I’m reading some worrisome stories from doctors dealing with the outbreak of COVID-19 in Italy.

Don’t panic, and don’t share! The coronavirus is spread by particles, droplets that have to enter your body by way of your nose, mouth or eyes. While it’s possible that someone might infect you by sneezing or coughing in your face, most viral infections are spread because of poor personal hygiene.

Virtually no one is immune to this coronavirus and we won’t have a vaccine for months, so people are panicking. I’m not, and here are some reasons why:

The US isn’t Italy. For one thing, we have a younger population. And, although the Lombardy region in Italy is modern and advanced, we have a higher intensive care capacity.

After all, we easily absorb the burden of influenza: up to 49 million infections, half a million hospitalizations, and 50,000 deaths every year due to influenza and hardly anyone even notices.

And we’ve had more warning than they did.

Here’s how fast influenza spreads each year in the US. If we don’t practice excellent self- protection, it’s a preview of how fast COVID-19 could spread.

Confirmed hospitalization history for Influenza in the US. Red = 2019-20, Orange =2017-2018

What’s the rate of spread of influenza in the US each year? This year? The graph above shows the historic rates of confirmed hospitalizations in the US. The red line is this year and reflects just over 16,000 patients, so far. The bright orange at the top is 2017, when we had a poorly matched vaccine.

There have been 200,000+ positive influenza tests reported to the CDC this year, 16,000 hospitalizations, and 136 pediatric flu deaths – not elderly patients with chronic diseases – this year.

We call it “seasonal” influenza for a reason. People tend to share the virus more in winter because of Thanksgiving and Christmas gatherings (and travel) and because children are in school. Sharing germs.

The coronavirus cases in the US sometimes have unknown “patient 1,” but the bulk have all involved clusters of patients with known physical and/or close contact with someone who was sick. The deaths have mainly been patients in one nursing home and a (different) hospital. In these sites, sick people were exposed to the droplets much more than you or I might be, because medical treatment accidentally aerosolized secretions.

COVID-19 symptoms are a fever over 100.5, a dry cough, and, for some, rapid onset of trouble breathing. Ther might be a runny nose or diarrhea, but there isn’t vomiting.

Use common sense and easy-to-achieve precautions. Wash your hands, don’t touch your face (eyes, nose, mouth), stay out of crowds, kindly and gently use what influence you have to encourage others to do the same.

If you get a fever, don’t go to the ER unless you are having trouble breathing. Call your doctor, and “self-quarantine.”

Most of all, Don’t share your germs and don’t pick up others’ viruses and put them in your body.

(Comments are closed. Please comment on my Facebook page.)

To kill or not to kill – or even to call it killing?

It seems that an advocate of Euthanasia and Assisted Suicide (EAS), which is legal in Canada since 2016, complained to the “The Protection of Conscience Project” administrators about their use of the word, “killing,” rather than “Medically Assisted Death” (MAD) when writing about the law. The wording of the objection exposes the potential limitations even on thoughts, much less the act of refusal, of physicians who object to participating in EAS.

More thoughts on Texas Advance Directive Act

I was asked about the #BabyTinslee case and what we should do, what can we do, in the disputed cases.

We need to educate more. People don’t understand basic medical ethics in this day of “choice.”

Autonomy doesn’t supersede nonmaleficience. In other words, the First Principle of medicine, “Cure when possible, but first do no harm,” always should guide us, rather than “wants” or “choice.”

In the end, doctors are the ones actually performing the acts and we’re most likely to understand the projected outcome. We benefit from oversight by colleagues and the community, both informally and in the process prescribed by the Texas Advance Directives Act.

Some people demand that every one of these cases go to court, for “due process” and “cross examination.”

But judges and courts can’t be as knowledgeable as doctors are. Their decisions are necessarily informed by dueling (paid) lawyers and (hired) medical experts.

In all the cases that have gone to court, the family has had quite a lot of notice, but the 48 hour notice before the committee meeting is perceived as too abrupt, especially since the relationships all appear to be adversarial by that point.

(And who could get your family to a meeting in 2 days?)

The 10 days isn’t thought to be long enough to arrange a transfer, either. Again, in many of the Court cases, the attempts to find another doctor willing to accept the patient’s care has begun before the committee meeting.

Doctors acknowledge the great trust and privileges we are given by agreeing not to abandon our patients. When we have a disagreement with a patient or surrogates (usually a familymember), we accept that we must continue treatment for a period of time. But not indefinitely.

If we could get the reforms that have been attempted to lengthen the statutory timeframe (multiple times) since before 2005, the TADA would be much better. It’s still the best process we have, currently.

A Lawyer, A Life, A Lie

Lawyer Wesley Smith has done good work in the past on end of life issues, but he is once again lying in order to score political points.

In his January 7, 2020 op-ed column for National Review, Smith accuses the doctors in the Tinslee Lewis case of wanting her to die, writing, “continued life is precisely what the doctors/bioethicists don’t want.”

Smith laughably misnames Texas’ Attorney General, Ken Paxton:

(He’s also evidently unaware that Tinslee’s “parents” are actually a single mother. Which would be irrelevant other than the fact that he refers to the “parents,” so often.)

Mr. Smith is so wrong. The doctors do not want Tinslee to die. They want to stop causing her near death several times a day.

They want to do for Tinslee,  not to her.

Tinslee’s doctors report that due to the delicate balance of Tinslee’s lung capacity and heart function she has 2-3 “death events” every day, each of which requires aggressive resuscitation efforts.

The difference between doctors and this lawyer in the tragic case of Tinslee Lewis is that the doctors are at the bedside all day, every day.

The doctors are the ones putting their hands on and minds to work for Tinslee while  Smith sits in his office calling them murderers and writing about coercing them to act against their best medical judgment. Her medical records submitted to  the court report that her doctor and nurses often spend time educating and counseling Tinslee’s single mother.

Shame on lawyer Smith for once again distilling months of highly competent, complicated and excellent care down to an accusation of murderous intent.

That’s a lie.

Miracles in a predictable universe

We are blessed with a universe that’s predictable and testable, yet we pray for miracles. And we pray for miracles, but act as though human actions can block them. Is the will of the Creator Who spoke the physical laws into existence limited by humans if they act as though the universe is predictable and testable?

Those of us who practice medicine are limited by the physical laws, the predictable and testable, with an emphasis on the tested. Our education and experience is based on these tested predictions and guide our decisions, and we’re watched and sometimes redirected by our colleagues, patients, laws and the community.

And then, there’s the best test of all: time.

In fact, I once noted that a patient who outlived the “10 Day Rule” might have proved the doctor (who instigated the process from the Texas Advanced Directive Act) wrong. There might have been a few cases like this, just as I believe there have been miracles. 

However, can you tell me how to measure these events and predict their occurrences, much less practice medicine based on them?

In the majority of TADA cases when treatments weren’t withdrawn, the patient died in the exact manner the doctors predicted, after the same interventions -and sometimes more invasive and tortuous “treatments” than the ones the doctor originally objected to. 

Doing to, not for (Baby Tinslee & TADA)

“We’re doing things to her. Not for her.” (Wini King, spokesperson for Cook’s Children’s Hospital, January 3, 2020) This may be the best description of a very sad case. 

Tinslee Lewis was born prematurely on February 1, 2019, with severe heart and lung defects. She had cardiogenic shock and was admitted to the Cardiac ICU at Cook’s Children’s Hospital immediately. ♡(See Cardiac Pathology ♡below.)

Even after three open heart surgeries, a fourth to close her sternum, a short time on ECMO (essentially, heart-lung bypass) and constant ventilator since July, of 2019, Tinslee’s enlarged heart and small, damaged lungs can’t keep up with the necessary blood circulation and exchange of oxygen and carbon dioxide, even with the assistance of multiple blood pressure medicines, diuretics and the ventilator on high, except when she’s still and quiet with the help of sedating and paralyzing drugs.

In response to a lawsuit against Cook’s Children’s Hospital,  where Tinslee has been in the CICU since birth, Tinslee’s medical records were submitted to the Court.  I’ve been able to review approximately 200 pages that are now public record, describing the constant,  repetitive interventions necessary to keep Tinslee alive on the ventilator.  

Tinslee’s doctors (and, the notes show, the nurses and staff) believe that they are being forced to cause Tinslee pain and suffering, while keeping her paralyzed and sedated. They report increasing difficulty with managing the ventilator so that her damaged heart & lungs can maintain oxygenation. She requires repetitive heart, lung and blood tests to guide adjustment of meds & treatments and has had several infections requiring treatment. In contrast to my earlier presumption, the notes in the records show that the ventilator and all its required meds and manipulations are indeed causing undesired problems, including fluid overload, infections and cardiopulmonary distress, in addition to her underlying lung disease. Even the baby’s growth, something we usually celebrate, increases her risk of cardiopulmonary insufficiency. 

Those records also contain notes from many attempts to explain and council Trinity Lewis,  Tinslee’s mother,  about her baby’s underlying problems and prognosis and the reasoning behind, in contrast to some past media reports.

Ignoring the fact that doctors, not hospitals, practice medicine in Texas, Texas Right to Life Lawyer Joe Nixon is quoted, claiming that the “hospital ” has decided to withdraw treatment. Texas Attorney General, Ken Paxton, is shown to have Tweeted that the problem is a “legal issue,” rather than an ethics and justice matter of forcing doctors (and by their orders, nurses and other staff) to cause pain and suffering for a little girl who is dying as her body fails to heal, in spite of every intervention possible.

Many people, out of compassion, object that “the family ” should decide when to withdraw life support. Yet, the family  members aren’t watching the oxygen levels drop while they rinse Tinslee’s airways with a bicarbonate solution to keep her lungs clear. And it’s certainly not the lawyers that are probing, injecting, measuring and adjusting constant, innumerable hourly interventions done to a baby who must be sedated and paralyzed to prevent cardiac and respiratory distress. 

In spite of the diligent  complicated interventions and care of the doctors and nurses at Cook’s, there have been comments in blogs and social media that the “hospital” wants to “kill” Tinslee. Startlingly,  AG Paxton called the latest Court ordered, indefinite hold on removal of life support  a “Stay,” as though the doctors, not her multiple medical problems, would kill Tinslee. He also misrepresents the process that Cook’s Children’s Hospital and Tinslee’s doctors followed,

“The statute fails to require that physicians provide an explanation of why they refused life-sustaining treatment and provide the patient’s family with adequate notice and opportunity to argue their position prior to the committee reaching a decision, effectively allowing the government to deny an individual’s right to his or her own life and to do so without due process.”

In fact, though, it is the lawyers, particularly at Texas Right to Life, who are turning a little girl’s tragedy into a continuation of their legal battle against the Texas Advance Directive Act. I’ve covered the benefits of and the struggle to improve the Act – repeatedly blocked by TRTL and their lawyers – for years on both WingRight.org and Lifeethics.org

The Act, TADA, was hammered out in 1999 by a group of stakeholders   including  patient and disability advocates, hospitals, doctors, ethicists and lawyers. Texas’ prolife organizations,  including TRTL and the organization for which I served on the Board of Directors for 15 years, Texas Alliance for Life, and for whom I wrote this essay.  

Briefly, TADA allows a balance and legal options when there’s a difference in opinion between a patient’s desire for a given treatment and the medical judgment (a combination of education, experience, and the standard of care) of the doctors who are tasked with the most difficult medical and surgical cases. 

I’ll admit that it’s my opinion – and only my opinion – that the lawyers hate that TADA provides a safe haven from lawsuits if doctors follow the law (!). I slowly came to this conclusion over the years because at virtually every Legislative hearing and stakeholders’ meeting about any changes to the Act, the lawyers bemoan the fact that doctors don’t have to go to court over each of these cases and that they face no legal penalty or “liability.” 

Poor Tinslee Lewis will most likely never leave the hospital alive. Disease and death don’t respect “due process,” but, they are predictable and an inevitable part of life. Hopefully,  we will see her mother and those who love her come to find peace with her death, celebrating the time they’ve had to be with her, especially these last 2 months. However, I fear that the lawsuits will continue for years, adding to their grief.

Edited 1/19/2020 for a typographical error: in the secondparagraph, “cardiogenic” replaced “carcinogenic.” BBN

♡Ebstein Anomaly – Cardiac Pathology 101, about as simple as I can make it (and understand,  too);

Babies born with Ebstein Anomaly have a malformed right and atrium and ventricle and misplaced (tricuspid) valves between the right sided ventricle and atrium. The larger right ventricle can’t pump efficiently. 

In addition,  the blood the right ventricle tries to pump into the lungs leaks/flows/churns (risking blood clots) back into the right atrium, which grows even bigger, with even thicker walls. The ventricle also grows bigger. When the  muscle fibers of the chamber walls get stretched apart enough, they are less inefficient. (Think of two hands gripping at the fingers. The farther out the grip, palm > 1st joint  > fingertips,  the less strength and pull on the opposite hand.) (For the geeks: Frank-Starling law.

The lungs aren’t efficiently filled with blood, they don’t expand, the pressure builds up in them and efficient exchange of gasses doesn’t take place. 

In the meantime, the blood backs up in the body, the liver, kidneys and extremities & eventually the left side of the heart, which can hypertrophy , too. 

The enlarged heart puts pressure on the lungs and nearby soft tissue,  including the blood vessels coming to the heart.

The combination of leaking high pressure blood vessels and the body’s increasing fluid in order to try to pump what oxygen there is, leads to edema or swelling of the body.

Sometimes,  the fetal atrial-septal defect stays open, allowing mixing of the un-oxygenated blood from the right, with the oxygenated blood. This malfunction can help, temporarily. 

With the high pressure, poor flow, and actual physical damage due to the mass of the heart, none of the organs can function well. Increased activity, stress, and growth will increase the demand for oxygen, kidney & lung function.

Experimental Abortion – Schrodinger’s Fetus

What ethics review board approved a randomised trial to temporarily prevent the ending of the life of a human embryo or fetus, with a planned surgical abortion as an end point?

Horrifying report about human experimentation: Obstetricians at the University of Southern California have announced that they stopped a study using progesterone to reverse the anti-progesterone effects of mifepristone in medical abortions.

According to the NPR:

“For the study, the researchers aimed to enroll 40 women who were scheduled to have surgical abortions. Before their surgical procedures, the women received mifepristone, the first pill in the two-medication regimen that’s used for medical abortions. The women were then randomly assigned to receive either a placebo or progesterone, which advocates claim can block the effects of mifepristone.“

Ignore the fact that only 12 women signed up over 6 months, that in spite if the claims if the researchers, the mifepristone was the actual, immediate cause of the complications that included 3 women needing ambulance transport to a hospital for excessive vaginal bleeding and 2 others dropping out due to some other side effects.

But you should certainly – they hope – forget that 4 of the babies exposed to progesterone and 2 who received placebo after the mifepristone continued to live for 2 weeks until their death at the hands of an Obstetrical surgeon. That’s half of the study group!

There’s no question that I consider it unethical to cause the intentional, interventional death of any human who isn’t a threat to life for another. It’s heinous that our laws allow the best medical technology in the world to kill members of our species, because they aren’t considered human-enough to possess the inalienable human right not to be killed.

But there’s an additional ethics problem in this case: a strong “yuck factor” (aversion) to the idea of purposefully experimenting with ¢ lives of humans, both the mother and her child, planning to monitor the signs of the prenatal human’s life, anticipating his or her death by surgical abortion.

Half of the original mothers had planned two weeks (14-16 days)delay with serial ultrasounds, confirming her baby’s heartbeat. (Remember this experimental protocol the next time an abortion advocate complains about State-mandated waiting periods and pre-abortion ultrasounds.)

Let me repeat: half of the nascent human beings experimented upon/ lived two additional weeks after exposure to the mifepristone poisoning. Only one of the 12 pregnancies resulted in what would be considered a “normal” medical abortion.

Eventually however, all of them were finaly “terminated.” After two weeks of observation – Schrodinger’s humans.

Note: Due to some sort of technical problem at the website, I wasn’t able to purchase the article, so this is based on the abstract and NPR report.

Edit 12/9/19, BBN: I was able to purchase access to the article (24 hours for $60!). There’s no change in the facts other than to note that the authors report continued life of the prenatal humans as 6 of 10 subjects: 4 of 5 who finished the trial and received progesterone, and 2 of 5 who were randomized to the placebo arm.

Parachutes don’t save lives?

Not when the jumper starts only 2 meters from the ground.

“Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial
BMJ 2018; 363

“”Ah, but the method of madness matters! The non-participating passengers flew at 800 km/hr at an altitude of 9,146 m, but the trial participants jumped a whopping 0.6 meter (2 feet) from a plane traveling at an incredible 0 km/hr. The authors point out their trial’s glaring limitation — an inability to generalize to higher altitude jumps — and use it make a point that health journalists would be wise to remember:

“When beliefs regarding the effectiveness of an intervention exist in the community, randomized trials might selectively enroll individuals with a lower perceived likelihood of benefit, thus diminishing the applicability of the results to clinical practice.

This study was conducted in response to a Christmas, 2003 BMJ article decrying the lack of RCT (Random Controlled Trials) for the efficacy of parachutes. As the authors of this article point out, even RCT’s have their limits.

As one review explains,

Put plainly, if most people already think an intervention works, then an RCT may end up with enough bias in its design that the conclusion ends up clinically meaningless. Sometimes, an RCT is truly unethical, and other times an RCT really might be needed to test an intervention taken for granted. Health journalists should scrutinize an RCT’s methods closely.

I’ve disabled comments on the blog. Please leave your comments on my Facebook page, “Beverly Nuckols.”

Cook’s Children’s Press Release on Tinslee Lewis

The Press Release is published in .pdf on the hospital’s website. Here’s the text:

Cook Children’s Statement Regarding Patient Tinslee Lewis Fort Worth, Texas (November 10, 2019) –

Tinslee Lewis is a beautiful baby who has captured the hearts of many at Cook Children’s since her premature birth nine months ago. She was born with a rare heart defect called an Ebstein’s anomaly and has undergone several complex surgeries at Cook Children’s in an effort to improve her heart function. Further complicating matters, she also suffers from chronic lung disease and severe chronic pulmonary hypertension. Due to these complications, she has spent her entire life hospitalized in Cook Children’s intensive care unit. She has required artificial respiratory support throughout that time, and has been consistently on a ventilator since July.

In the last several months, it’s become apparent her health will never improve. Despite our best efforts, her condition is irreversible, meaning it will never be cured or eliminated. Without life-sustaining treatment, her condition is fatal. But more importantly, her physicians believe she is suffering.

To maintain the delicate balance necessary to sustain Tinslee’s life, and to prevent her from pulling out the lines that are connected to the ventilator, doctors have had to keep her constantly paralyzed and sedated. While Tinslee may sometimes appear alert and moving, her movements are the result of being weaned off of the paralyzing drugs. We believe Tinslee is reacting in pain when she’s not sedated and paralyzed.

Cook Children’s has made heroic efforts to treat Tinslee’s condition, all while being very transparent with her family regarding her poor prognosis. Despite those extraordinary efforts, Tinslee’s condition has not improved. At the request of Tinslee’s family, we have reached out to nearly 20 facilities across the country to see if any would be willing to accept Tinslee as a patient. Some of the facilities include:

 Texas Children’s  Children’s Memorial Hermann Hospital  Dell Children’s  Dallas Children’s  Medical City Dallas  Children’s Medical Center Oklahoma City  Children’s Hospital of Atlanta  St. Louis Children’s  Children’s Hospital of Philadelphia  Johns Hopkins  Methodist Hospital San Antonio  University Hospital San Antonio  Boston Children’s  Children’s Hospital of Los Angeles  Arkansas Children’s  C.S. Mott Children’s Michigan  LeBonheur Children’s Memphis  Rady Children’s  Children’s Hospital San Antonio CHRISTUS

All have said our assessment is correct and they feel there is nothing more they can provide to help improve this precious child’s life.

A team of Cook Children’s doctors nurses and staff have given their all to help Tinslee. While, we believe every child’s life is sacred, we also believe that no child should be sentenced to a life of pain. Removing this beautiful child from mechanical ventilation is a gutwrenching decision for Cook Children’s physicians and staff, however we feel it is in her best interest to free her from artificial, medical intervention and suffering.

Winifred King

Assistant Vice President of Public Relations Cook Children’s Health Care System

Baby Tinslee Lewis and the Texas Advance Directive Act

I was a relieved to hear that the doctors caring for 9 month old Tinslee Lewis decided not to remove her ventilator on Sunday, November 10, 2019. Their decision, most likely due to public outcry, was announced 2 hours before removal was planned. Later in the day, and a local judge issued a restraining order that mandates continuing the ventilator until at least November 22 unless an appropriate transfer to another facility can be arranged.

Timeless Frederick Douglas

Texas transgender (7 yo) case

I don’t believe it’s appropriate for a child to undergo transition at such an early age, but there’s a few gaps in this story.

There is very little media coverage of the case, with opinion from only one side published online. I picked the report about the court decision that’s most comprehensive, even with some errors.

Mostly, this appears to be an especially ugly divorce battle. The dispute about transition has been going on since the child was 3 years old.

The child is one of two twins conceived by in vitro fertilization using the father’s sperm and a donor egg. The mother carried the two to term and delivered.

The mother filed the suit to end joint custody, but the father demanded that the jury decide custody, rather than the judge.

The jury was charged with 2 questions: should one parent have sole custody and should that parent be Mr Younger. They answered yes and no: one should have sole custody, but it shouldn’t be the father. The judge will rule this week on who gets custody & conditions.

I’m not sure, but I’m reading that there’s no immediate plans for puberty blockers & finding quite a bit of info that the blockers aren’t permanent.

I can’t help but hope there’s more to this story, because I still can’t accept a decision like this, at this age.

Eat the Rich (with the rest of us for desert)

Dems used to just act as though government owns your current and future earnings. Now, they want to know the value of your wedding ring, grandma’s China, the homestead, & your golden parachute. The plan is to tax them *every year* until you have to sell them (to them?) to pay those taxes.

Entire abnormal human genome in vaccine?

Replace male statues in Central Park with women?

If everyone gets a trophy, why should anyone get a statue? Especially men?

Yes, here’s the next woke thing:

The New York Post reports that a City commissioner proposes to “Replace male statues in Central Park with women.”

“”A member of the commission that oversees art and architecture on city property suggested Monday that instead of simply adding statues of historical female figures to Central Park, the panel yank out some of the male ones first.

““There are what, five or six [male] statues that I think could easily be replaced by individual statues of each of these women,” said Hank Willis Thomas, a painter who serves on the Public Design Commission, at a hearing at City Hall.

“Thomas appeared to be specifically fingering statues including that of Scottish poet Robert Burns, in the park’s Literary Row, and the one of Christopher Columbus in the park, near the famed second one of the explorer in Columbus Circle, for removal.”

Goodbye Columbus indeed!

Texas Governor Abbott on “Suspicious Activity”

Texas’ Governor Greg Abbott ( @GovAbbott ) isn’t trying to change Texas law with last week’s Executive Order – in contrast to the claims I’ve seen on my Facebook news feed.

Instead, he called for law enforcement agencies under the executive branch to establish policies and training, and financial incentives to encourage “improving reporting channels and closing ‘information gaps’ when members of the public or law enforcement agencies worry that a person might be a threat to commit violence.“

The last three mass shootings in Texas tell us that we need to improve how our law enforcement and agencies follow current law on following up on reports and investigations.

The Sutherland Springs Church shooter in South Texas should have been rejected at point of sale background check because of his prior conviction and incarceration for domestic violence crimes while in the military. Unfortunately, he was never reported to the Federal database. (And so, Texas law probably couldn’t have made any difference.)

However, the Odessa shooter threatened and brandished a weapon at his neighbor, but local Law Enforcement Officers didn’t follow up because his house wasn’t on their GPS maps and was difficult to find!

The El Paso shooter’s mother tried to report him, but the LEO who spoke to her on the phone dismissed her concerns. No record of the call was made, according to the Allen police department.

I’m not sure that current laws would have (or should have) allowed any action against the (future) shooter by authorities, but it looks like that question and reporting procedures are what Governor Abbott wants clarified. From the Executive Order:

“”Within thirty days of this order, the Texas Department of Public Safety shall develop standardized intake questions that can be used by all Texas law-enforcement agencies to better identify whether a person calling the agency has information that should be reported to the Texas Suspicious Activity Reporting Network.

Within thirty days of this order, the Department of Public Safety shall develop clear guidance, based on the appropriate legal standard, for when and how Texas law-enforcement agencies should submit Suspicious Activity Reports.”‘

The question should be whether the “standardized questions” and reporting processes might have made a difference. Unfortunately, I’m not reading questions: I’m reading accusations that the Governor wants to impose “red flag laws” and confiscation of guns without due process of law.

The Governor previously directed the Texas Department of Public Safety to implement the “iWatch app” in June, 2018, allowing the public to report suspicious activity. There was no outcry then, and there doesn’t appear to be any “red flag” incidents because of this initiative.

Why do people think the Governor wants gun control now?

There’s no change in citizenship! None!

OIG finds Comey violations. No big deal?

Children born overseas (No change)

The “Highlights:”

Not the hype you’re reading about in the news.

Edit: Penultimate sentence: “18” instead of “28.” On September 3, 2019. BBN

Heterosexuality: oppression or happiness

Washington Post attacks Life via Texas

Vacationing for health

It’s good to have confirmation.

But jobs that don’t allow vacation probably have different effects than jobs that do allow time off.

Leftist liars gonna lie about abortion –

‘“It’s not the baby’s fault for the sin of the father, or of the mother,” King said.‘

Remember this statement when you read or hear that Congressman Stephen King “defended” rape and incest.

In reality, he “defended” every child at risk of being killed because they are the result of a pregnancy after rape or incest.

And all the descendents of past pregnancies due to rape or incest.

Politicians and laymen alike should beware when publicly supporting the ethical position that all humans are, indeed, human at all stages of life and that they shouldn’t be killed: The Leftist liars will attack. In force.

Representative King wasn’t just defending the children of tomorrow: he was defenfing all of their descendents.

“What if we went back through all the family trees and just pulled out anyone who was a product of rape or incest?” King told a breakfast meeting in Urbandale, Iowa. “Would there be any population of the world left if we did that? Considering all the wars and all the rapes and pillages that happened throughout all these different nations, I know that I can’t say that I was not a part of a product of that.”

King was obviously referring to retroactive killing. After all, elective interventional abortion is the ending of a human’s life by intentional acts that are licensed and regulated under the medical codes of the various States.

Regardless of how they were conceived, every human is created equal and endowed with inalienable #HumanRights.

The faithful Left can’t tolerate equal rights endowed on all humans. They will invariably takeba any firm statement against their sacrament of abortion and their tools in the media will pull out sections, ignore the context, and turn it inside out, to spread the big lie.

So much the more if they can twist their lie into a defense of one of their own. Congresswoman Ilhan Omar cited the lying reports as proof of Republican “filth.”

(Nevermind that her own hometown paper, the Minnesota Star Tribune and her Somalian communityare the ones accusing her of biggamy as well as marrying her own brother to commit immigration fraud. Or that she’s been fined for filing false tax returnswith one of her husband’s. Y’all move along, there’s nothing to see, here.)

So tell me: how many people would be left alive if we killed every person who has an ancestors who was conceived in rape or incest?