How did the 75th Anniversary of VE (Victory in Europe day, May 8) & VJ (Victory over Japan day, August 15) pass with so little acknowledgement, no celebration?
My mother was 8 years old in 1945, Daddy was 9. They each told us about the celebrations, the relief, the joy that accompanied the end of the War.
Thank you to all the men and women who sacrificed and died to protect our inalienable human rights from being infringed by demagogues and tyrants who dehumanized innocents as well as combatants.
If I were in charge of the public health response to COVID-19, I would implement the following:
Pharmacy Boards should never get between a doctor and patient except in matters of life and death or illegal practice. Politicians, State Medical Boards and our House of Medicine professional organizations should defend our legal practice of medicine rather than threatening physicians and changing the rules during a pandemic.
2. Encourage shared information & fact-checking among physicians as part of our missions of education & transparency.
JAMA review of masks, August 2020
4. Where a high percentage of the local population tests positive, local authorities should consider – and have the ethical responsibility to – impose higher isolation measures like masks and public distancing. The threshold for mandates must be locally determined with public input, and explained – clearly, frequently.
This means you, anti-maskers!
5. Stress that surgical procedure masks are nearly as effective as N95 masks, blocking nearly as much aerosols and viral particles for both wearer and those around us. Medical providers and those with a high risk of prolonged close contact need fitted N95 masks, the rest of us don’t.
Single layer cut-up T-shirts and homemade masks, balaclavas or bandannas, aren’t very effective protection at all, either for the wearer or the people around us. N95 Masks with single valves are a money-maker, but not nearly as effective as surgical masks, even with an added filter layer.
8. Begin early prophylaxis with hydroxychloroquine/zinc and/or inhaled steroids for the willing & likely exposed.
Treatment dosing (always allowing treating physicians who prescribe determine need & frequency of alternate doses & monitoring)
This isn’t a prescription!
Hydroxychloroquine: 400 mg. twice on day one then 200 mg. twice a day for either 5 or 10 days;
Azithromycin: 250 mg. tablet, 2 on day one, 1 on day 2 to 5;
Budesonide: unit dose via hand held inhaler or nebulizer twice a day. (I’m looking for references for this one. )
Zinc 150 mg. to 250 mg. a day indefinitely. (Best evidence for lozenges or syrup multiple times a day. See references.)
Vitamin D, 1000 IU a day, up to 4000 IU is safe
Vitamin C, No set dose, but extra will be excreted in the urine or feces, can cause diarrhea.
Journal of the American Medical Association review. Published August 11, 2020. (Free, with Tables)
CDC recommendation on cloth masks:
John’s Hopkins recommendation:
Journal article on treatment for the common cold: https://www.acpjournals.org/doi/10.7326/0003-4819-125-2-199607150-00001
Unpublished, non-peer reviewed: https://www.researchgate.net/publication/47794995_Zn_Inhibits_Coronavirus_and_Arterivirus_RNA_Polymerase_Activity_In_Vitro_and_Zinc_Ionophores_Block_the_Replication_of_These_Viruses_in_Cell_Culture
International Journal of Infectious Diseases (Henry Ford or Ashad report):
On synergistic effect of hydroxychloroquine plus steroids:
Description of study in progress on treatment for loss of smell in patients without severe symptoms:
Vitamin C safety:
Note: comments are off. Please comment on my Facebook page, Beverly Nuckols.
Edited 31/08/20 12:30 for mis-spellchecked word. BBN
A long post written for Facebook, pretty much self explanatory:
Although I seriously considered tagging you, I decided not to. I certainly don’t add the heading, “to my Democrat friends.”
I enjoy discussing ideas, ethics, and politics, but try to avoid disharmony and criticising personalities as much as possible. I’ve muted your posts because the hostile tone and – frankly – the rude and sometimes obscene posts from your other friends.
Did you hear about the peace deal brokered by President Trump between Israel and the United Arab Emirates? The expectation is a domino effect among other Middle East nations.
As to the new Postmaster General: Mr. DeJoy ran a successful and profitable freight and supply chain business for 35 years.
The mail delivery horrors you list are pure politics and distraction. We have a PO Box in the USVI, but, as with our businesses in the US, we have always used FedEx for time-sensitive mail. Even Amazon had slowdowns over the last 5 months, due to volume, staffing difficulties, and the practical matter of barriers to product delivery from (China) foreign manufacturers.
The collection box removals have been going on for years. The changes in the USPS are reportedly being made to improve productivity, but politics…
Assume Democrats that oppose the President, as well as Republicans that support him, work for the post office and that Republicans want every one of their ballots properly and efficiently delivered, too.
For the response to COVID-19, I recommend the interview between Dr. Atlas and Peter Robinson on Stanford University’s Hoover Institute “Uncommon Knowledge.”
The facts are that most virus mitigating measures were State responsibilities and there is no legal way for Federal involvement.
It’s not “all age groups.” Under 60 years old, the risk of severe illness is equal to the risk from influenza.1/2 of cases are asymptomatic or very mild symptoms. 99% of deaths are in people over 25 years old.
2/3 of deaths in many states were nursing home patients. 80% in Michigan. (The latest rumor is that it was *intended* by the Democrat Governors to cut the elderly population.)
The “killing” happened due to 1.) failing to protect our elderly and forcing nursing homes to accept COVID-19 positive patients and 2.) lost lives and years due to the lock downs, closing schools, and destruction of the economy. Excess deaths are greater than those explained by the virus. (Deaths due to delayed treatment for strokes, heart attacks, cancer, but as high as a 35% increase in some areas of Michigan, in ER visits for severe child abuse.)
California served as a lab for testing draconian methods like prolonged lock downs, chained parks & banned beaches, even requiring masks while exercising out doors, i.e., running and cycling! Yet, the hospitalizations, and deaths equal or exceed States that reopened, like Texas.
I had hoped that naming Harris as nominee for VP candidate would stop the Democrat talking points about adultery. At least no one claims that Trump built his career by an affair with a married power broker.
And, since you bring it up, “bullying” should be off the table, too. Harris put people in jail for marijuana, blocked possibly exonerating DNA evidence in a death row case and kept people in jail after they should have been released. This fact check from January, 2019 about Accusations made by Biden and others, is actually very fair,
The Epstein talking point conveniently skips the history: Trump banned Epstein from his properties back in the early ’90’s, after the sexual predator was exposed. The one woman who claimed to connect Trump & Epstein filed and dropped 3 suits in 2016, using a fraudulent address in the first.
Trump explained the comment about Maxwell: his 1st thought, like that of many of us, was that Epstein didn’t kill himself.
My politics focus in ethics and defending inalienable human rights and the Constitution. Abortion infringes the right not to be killed and mocks the concept of all the rest.
Even the 2nd Amendment goes beyond defending and enforcing the 1st Amendment and the rest of the Constitution: the right to self defense is a corollary to the right not to be killed.
You should really lose the accusation about children in cages since those pictures were from 2014, Obama’s ICE. The result of the huge caravans.
The rest of your comments are pure opinion, even going so far as to ask whether Melania is happy.
Ending on a positive note: Trump isn’t racist!
Dr. Scott W. Atlas, former Chief of Neuroradiology at Stanford University Medical Center, current Senior Fellow at Stanford’s Hoover Institute, author, and public health policy consultant was added to the White House COVID-19 task force this week. Unfortunately, he and his appointment have already become a political target by some.
Far from being unqualified, or someone who “clearly wouldn’t know science if it kicked him in the atlas” (see above link – I refuse to give clicks to the original source or the ignorant woman who spoke those words), Dr. Atlas speaks common sense, science-based truth, as in this video from 23 June, 2020 interview with Peter Robinson of the Hoover Institute’s. “Uncommon Knowledge.”
In fact, Dr. Atlas states what I’ve been saying since I heard about the virus outbreak in Italy, while attending Carnivale parades just a few miles away in
Nice, France: the reaction by governments and fearful people has been just as bad if not worse than the results of the infection itself.
The initial lockdown was correct, but we have new data – and new models – every day. Yet, we are still acting as though the early models were accurate.
Worse, instead of “flattening the curve,” the call is to conquer or eliminate the virus “at all costs.” The latter has never happened and will never happen with a Coronavirus. There is the possible exception of the elimination of smallpox, a much more deadly disease, at the cost of egregious human rights violations and even deaths.
I’m surprised that anyone would attack Dr. Atlas or his qualifications. Before you dismiss him, please listen to his testimony and critique the facts rather than the source.
14 minute interview with Houston TV reporter.
She’s a warrior, all right! Worth your time!
I would like to see some data, but lots of other doctors report the same results, and I’d like to see some of their patient information, too. (Ages, other meds, vitals, timing, symptoms.)
She does say wear a mask if you can’t be on prophylaxis and to make other people comfortable. I would call her regimen a “treatment” rather than a “cure.”
But the biggest fuss has been about Dr. Immanuel’s religious beliefs. I’ve heard Baptist, Assembly of God, even Church of Christ preachers say much the same about the hidden powers in the world. Maybe not the origins, but their existence and, as Jesus Himself said, the need for prayer and fasting to deal with them.
I’ve been told that her religious views are a distraction and counter-productive for the Medical issues and “science.” But Dr. Immanuel doesn’t even bring up her religion until she’s questioned in this interview and didn’t bring it up at all in DC.
The detractors don’t understand the cultural background and how many Christians – across the spectrum from those who believe in the indwelling of the Holy Spirit to those who only remember the story of St. Michael – will recognize the theme.
Were you triggered by the religious views of Nigerian born and trained, Texas licensed and practicing, Dr. Stella Immanuel?
(As of Midnight, 30 July, the video was available at https://www.bitchute.com/video/09K3kIwzeewO/?fbclid=IwAnR2E-LChNhpqOktcV4GPeT0ZS79cdf1tjdlnfNSlpGNWMCW6vVYYnHLCbjU so I was able to watch the rest of the docs.I am impressed especially by Dr. Joseph Ladapo, beginning at minute 33.)
CNN has an opinion piece disguised as a report on yesterday’s “hearing” with Attorney General William Barr. Even as the author, Jerry Herb, repeatedly declared statements by Barr and President Trump as “false,” he took note of the poor treatment of Barr by the Democrats.
“Jerry Nadler of New York and the panel’s Democrats did not offer Barr any niceties congressional witnesses typically receive. Democrats repeatedly cut off Barr’s responses, accused him of being wrong or lying and made clear they weren’t interested in the explanations he was offering. Barr wasn’t allowed extra time at the end of each lawmaker’s five minutes to respond to questions that witnesses typically receive — forcing Republicans to use their time to let Barr push back on the Democratic accusations.”
(“I’m reclaiming my time!” “I’m reclaiming my time!” “I’m reclaiming my time!” It started sounding like one of the rioter’s chants.)
There were few questions with an opportunity to answer, only
character attacks and accusations that the AG is guilty of politics and doing the bidding of the President. (Wingman?)
More than once AG Barr was accused of racism and causing people to die. One man flatly declared that the Attorney General of the United States was guilty of breaking his oath of office. And, of course, there were threats of impeachment.
Is there supposed to be a “quota?” Isn’t hiring according to race the definition of “racism?”
I kept waiting for someone to have a stroke – not the AG, he was usually amazingly cool and calm.
(Or spontaneously combust?)
General Barr is, however.
(This is an edited version to clear up typos.)
39 of the studies were peer-reviewed.
“Police made no effort to interfere…” This is happening to Americans all over the US and multiple factions compare their opposition with the abusers of Nazi Germany.
There’s been looting and vandalism in broad daylight, and 2 months of nightly destruction of property and fires in Seattle, Washington and Portland, Oregon. (And Atlanta, Georgia, New York City, Chicago, Minneapolis, St Louis and virtually every large city in the US) This weekend in Columbus, Ohio, a peaceful rally was disrupted by obscene “Black Lives Matter” protestors, with one woman waving what looks like severed male genitals (here, at about 6:35).
Local police are being *ordered* to stand down and limit their efforts to interfere by Mayors and Governors, but when they do – or Federal law enforcement is sent in – who is criticized, even called the “Gestapo?”
Sometimes, even “Black Lives” are victims of both vandalism and assault.
The parallels with Kristallnacht are not precise, but they’re there: the rioters have unofficial approval from the same local governments that are throttling down law enforcement. Only, this time, another governing body would stop the vandalism if allowed.
The question is not whether Godwin’s law has been broken, but whether we learned anything from history in general. I’m also reminded of the chair of the French Revolution which ended when the original leaders were sent to the guillotine, and George Washington’s response to the Whiskey Rebellion with an army of Federal soldiers attacking members of the mob who were accused of harming Federal agents and burning the home of one a official.
How long will the voting public allow their elected officials to be “distracted” by the anarchy and politics?
(Edited for grammar 21/07/20 17:30. BBN)
This 2001 article about the 1998 kidnapping, rape, murder by stabbing, and dismemberment of 16 year old Jennifer Long takes my sympathy away.
We made every decision in Stone’s case, as in all our cases, based solely on the facts and the law and in accordance with the rule of law. The women and men who conducted these investigations and prosecutions acted with the highest integrity. Claims to the contrary are false.
Mueller must live in some alternate reality. Since we know that Mueller’s team didn’t uncover the lies used against Carter Page or Michael Flynn – and some of them actually were the ones who lied – how can anyone believe that the Stone prosecution was more honest? Why are we supposed to accept that no evidence in favor of Stone has been withheld, no accusations are known to be false?
The Mueller investigation and charges and even the whole FBI surveillance of the Trump Campaign reminds me of 1995/96 when I was foreman on a Federal District Grand Jury in San Antonio during Bill Clinton’s impeachment hearings for perjury & obstruction of justice. Many times, when I swore in a witness, some jury members and even the witness would laugh. “Nothing but the truth.”
Integrity? Laugh or cry.
“”You had this political conspiracy theory that the deaths in nursing homes were preventable,” said Mr. Cuomo.””
At a press conference today, New York Governor Andrew Cuomo insisted that his March order requiring NH’s to accept COVID positive patients from the hospital didn’t cause deaths – in spite of the fact that it’s estimated that those orders caused more than 6300 such transfers.
Click to view the percentage of death in NH by State
NY didn’t mandate NH testing until mid-May. NJ required testing by May 26th!
There’s a right way and a wrong way to change a law. The Constitution doesn’t provide that the Courts make the big decisions, leaving the inconsequential matters to Congress. And yet, nominally “textualist” Supreme Court Justices Gorsuch and Roberts joined with the”living document” Progressives to do it the wrong way.
Gorsuch wrote the majority opinion in Bostick v. Clayton County and got at least two points right:
- “When the express terms of a statute give us one answer and the extratextual considerations suggest another, it’s no contest. Only the written word is the law, and all persons are entitled to its benefit.” and,
- There’s no way that the 1964 Congress would have intended for the word “sex” to include sexual orientation or gender identity.
In his 37 page argument, Gorsuch stuffed and fluffed strawman after strawman to fit an extratextual interpretation of “because of …sex” into the redefinition of “sex.” As noted in the dissents by Justices Alito & Kavenaugh, his is a redefinition that wasn’t even attempted when SCOTUS redefined “marriage” in Obergefeld.
In other words, as Justice Alito wrote in his dissent, Gorsuch and the majority “legislated.”
I agree that this law needed changing to give more protection to employees in the public market place. Congress should have been encouraged to work out those protections, while also preserving religious freedoms and single-sex spaces and even women-only sports. I can’t help but wonder whether – perhaps – both political Parties took a dive, hoping the Supreme Court would do exactly what they did.
And the Country will witness lawsuits, year after year, that might have been averted.
In the meantime, though, I’ll bet Senator Chuck Schumer feels caught in a whirlwind of his own. What price, now, Chuck?
“the sharing of one’s point of view on a social or political issue, often on social media, in order to garner praise or acknowledgment of one’s righteousness from others who share that point of view, or to passively rebuke those who do not. “Instead of “tolerance,” the virtuous demand positive affirmation of their superiority, and in fact seem (to me) to be expecting and finding offence. It’s too often weaponised, used to “cancel” previously unsuspecting people, especially on social media.
The Democrats and their allies in the media lie about the small things, it shouldn’t surprise us when they ruin lives by lying about the real issues.
From just one weekend, just three of the petty lies:
About that tear gas, there’s proof in the photos and videos they didn’t falsify (yet?): the police aren’t wearing gas masks.
And, here, where neither the horses nor the police are affected the way they would have been by tear gas.
Please leave comments at my WingRight Facebook page.
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.
This all makes me physically ill. Documents withheld for over 3 years.
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.
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
Right at the top of the page is this disclaimer: “”Anyone can publish on Medium per our Policies, but we don’t fact-check every story. For more info about the coronavirus, see cdc.gov.'” Good advice.
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.
Biden quote link, here
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.
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.)
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.
(*EDITED An earlier version stated that licences were at risk. Not yet.
BBN 11 February 2020 12:30 AM)
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.
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.
“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.
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.
“Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial
“”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:
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.”