The Texas Abortion Law is contrary to women, to science, and to human values

The new Texas abortion law and the Supreme Court tacit endorsement of it is the latest (as of this writing – there will be more!) assault on science, medicine, and the will of the people, in an almost unbroken string of such actions. Another example of this process is the effort to spread COVID by opposing mandates for masking, vaccination, or social distancing, under the pretense of “individual liberty”, by a variety of jurisdictions, mostly at the state level and mostly in Republican-controlled states.

First, a quick review: the Texas law prohibits abortions after 6 weeks without exceptions for anything, including rape and incest, or ability of the fetus to survive outside the womb. It employs a cute (in the sense that the term “cute” can be applied to, say, a giant, mean, ugly, evil, violent ogre) trick to try to get around potential lawsuits that would be based on fact that the Roe v. Wade decision gives women a Constitutional right to abortion. The law does not mandate that state officials enforce it. Instead, anyone, from any state, is empowered to be a “whistleblower” and turn in anyone enabling the abortion (doctor, nurse, counselor, taxi driver) with the potential reward of $10,000 (from the state, of course) if successful.

Neat, huh? The Supreme Court majority thought so too, and, using another trick (called the “shadow docket”) declined to invalidate it. This method obviates the need for a hearing, presentation of arguments on either side, questions from the justices, and thought-out opinions which present the reasoning of the majority and the dissenters. It thus does not require the identification of those voting in the majority (we only know in this case that it was 5-4 and who the 5 and 4 were because each of the 4 issued their own dissenting statement). It also does not allow the lower courts to know what the reasons and arguments were, resulting in inconsistent interpretation of the decision by those courts. This, of course, was on purpose. Justice Sotomayor (one of the 4) put it succinctly “The court has rewarded the state’s effort to delay federal review of a plainly unconstitutional statute, enacted in disregard of the court’s precedents, through procedural entanglements of the state’s own creation.”

Several of the justices who created this problem have defended their action, and Justice Alito, in a speech at Notre Dame, not only defended the shadow docket but portrayed himself and the other members as the actual victims. This is another neat trick, which has been employed by the right, including former president Trump, and billionaires and corporations who have been criticized for such things as underpaying their workers and not paying taxes. The best defense, it is said, is a good offense.

 Let’s review the science:

1.      a large percentage of pregnant women do not even know that they are pregnant, particularly if they usually have irregular periods, before 6 weeks,

2.      the assertion in the Texas law that the fetus has a heartbeat at 6 weeks, thus why they chose that timeframe, is incorrect. In fact, the embryo is not even a fetus at 6 weeks.

There is in fact a lot more relevant science, but let’s move on, since the science is only an issue for those of us who believe in it.

The reason for the restrictive abortion law in Texas (and all the other states’) is not in the least because they have any respect for science or medicine. For different individuals, of course, there are different reasons. For some it is because of their religious beliefs, Catholic or otherwise, that all life is sacred and thus abortion is murder. That this may result in the death of the mother, or that it should then require the same level of commitment to helping the parents ensure that children have a reasonable chance at life (housing, food, clothing, education) may be positions supported by some Catholics, including the current Pope, but is not a corollary of opposition to abortion for most of these people. This is important, because in the case of taking a human life by say, murdering them with a gun, the public is not empowered to sue anyone who might have enabled them, like the gun dealers or manufacturers.

For others, the abortion restrictions are, explicitly or not, about restricting the rights of women and relegating them to their place. This is so essentially the results of such laws and policies that denial of it is virtually always disingenuous. Even those who take the “life is life” Catholic anti-abortion position find themselves in this situation (arguably, this position on women is part of the justification by an entirely male-run church). None of these laws or policies create any penalty or responsibility for the male whose role in creating the pregnancy was central. And 100% of unintended pregnancies are directly caused by men.

Finally, the reason for these laws is political. They garner support for a generally right-wing, pro-corporate political agenda from those who would not support it as such. This trend has always been part of US politics, but more explicitly so since Richard Nixon. Ultimately, of course, whatever the ostensible position of any individual is, the issue is essentially about politics. You put together a coalition, and then you implement the laws you want to. Make no mistake, this is what it is about. Nationally, a large majority of Americans oppose overturning Roe v. Wade (about 60%). In individual states, it may differ. A good history of the right-wing of the GOP looking for an issue that would mobilize the evangelical community in support of them, and their segregationist, pro-corporate agenda, is found in a recent issue of Politico. Abortion turned out to work after other issues didn’t, despite evangelical ambivalence on the issue at the time.

For nearly two decades, [right-wing activist and segregationist Paul] Weyrich, by his own account, had been trying out different issues, hoping one might pique evangelical interest: pornography, prayer in schools, the proposed Equal Rights Amendment to the Constitution, even abortion. “I was trying to get these people interested in those issues and I utterly failed.”

To the extent that the Texas anti-abortion law is about a rejection of science to achieve a political or religious or misogynist agenda, it is not entirely a separate issue from COVID and opposition to mask or vaccination or distancing mandates. The politicians want what they want – mainly power – and are willing to pander to whoever to get it, even fomenting anti-science agendas. Truth no longer matters, and it has gotten beyond an abstract concept to the point where people are dying, and yet others are still unwilling to believe in the cause-and-effect. A recent article in Rolling Stone notes that in parts of Oklahoma, hospitals are not only full of people with COVID and its complications but with people who are overdosing on ivermectin, an anti-parasitic drug that has widely -- and falsely – been promoted as a treatment for COVID. Since ivermectin requires a prescription for people (and it is indicated for certain kinds of worm infestations and actually does work to treat scabies), people are buying it at feed stores where it is sold for deworming horses! If the RS article is correct, many of these hospitals are even too full for gunshot victims!

COVID is a virus, and one that mutates and evolves (whether you believe in evolution or not) and can create more dangerous strains like the Delta variant. It is infectious. Immunization offers great, if not perfect protection; while it is possible to get infected after being immunized, it is less likely and, more important, it is much less likely that you will be hospitalized, ventilated, and die. This is  a fate reserved almost exclusively for the unvaccinated. Masks do help, although they are better at protecting others from being infected by you than protecting you from others – this is why OTHER people wearing masks makes a difference. This is science. On abortion – a “6 week” pregnancy is measured since the last menstrual period, which could easily mean 4 weeks since ovulation, 2-3 weeks since fertilization, and less since implantation, not to mention a positive pregnancy test. A very high percent of women don’t yet know that they are pregnant.

Scientific answers are arrived at through experimentation and re-experimentation; “truth” changes as more information becomes available. It is messy, not simple and easy to understand like a “belief”, or something you read on the internet. If it is one-dimensional and simple it is probably wrong.

But more important, it is usually out there to accomplish another agenda.

Should hospitals and doctors make value judgements about who deserves treatment?

I heard on NPR’s “Here and Now” (Sept 9, 2021) that Jimmy Kimmel, the late night TV host, had expressed anger and frustration with people continuing to refuse vaccination for COVID-19. He noted that many hospitals no longer have available Intensive Care (ICU) beds available, and were going to have to triage who was admitted to them. According to the host, Robin Young, Kimmel said the decision was easy: you have a heart attack, you’re in; you have COVID and didn’t get vaccinated, you’re out. (His monologue is summarized by The Hill, among other sources.) Kimmel is not the only one to express outrage at the unvaccinated -- “shock jock” Howard Stern has responded to those who would cite their freedom to not be vaccinated with “F—k their freedom; I want my freedom to live!”— and is also not the only one called for such “ICU triage”.

Daniel Wikler, a professor of medical ethics from the Harvard School of Public Health was Ms. Young’s guest, and he said that, while he understood the anger that Kimmel and others were expressing, and empathized with it, he did not believe that it was the business of doctors or hospitals to make such decisions. It was the tradition and history of medicine, he said, to treat the illness of the patient if it was treatable, not to decide that someone had done something to themselves to make them undeserving of treatment. As an example, he noted a skier who might ignore all warnings, ski down the back of the hill, and get injured. There are lots of other potential examples, and they are valid.

I agree with Dr. Wikler on both points. First, I understand and empathize with Mr. Kimmel and others who are furious that those who have refused vaccination not only threaten the health of the rest of us but also end up utilizing a huge amount of health resources and services that not only can limit access to these services for others in need, and in any case cost huge amounts in time and effort by health professionals as well as in money. But I also agree that doctors and hospitals have no business refusing to care for these people, and that a core ethical value in medical care has been to provide care, if you are able, to help the illness of the patient, not to judge whether they are worthy of care because of their previous actions. One of the most dramatic and important examples are medical facilities in war zones, which are obligated by the Geneva Convention to treat all injured on the basis of need, not which side they fought on. To treat one’s own soldiers and not injured enemy soldiers who are prisoners is a war crime.

Many of those people who have the heart attacks that Mr. Kimmel thinks should get them into the ICU smoked cigarettes, or ate a very poor diet, or did not exercise, or all of these. While I’m sure that there are some people who are judgmental and smug enough to believe that they should suffer the results of their own life decisions and not receive care, this is not the approach that doctors and hospitals take.

There are certainly many people whose illnesses are at least partly a result of other poor decisions, including use of alcohol – both heavy lifetime use and even one episode which led to the car accident that has them in the emergency room – or other drugs. In addition, while less common than from alcohol, illness and death related to illegal drugs such as opiates and opioids and stimulants is still very common; we have all heard of the “opioid epidemic”. And there are infinite possibilities for blame when you go beyond “sins of commission” – things you did that were bad for you – and enter the realm of “sins of omission” – thing that you didn’t do that are, at least in the view of the one making the judgement, would have been good for you (e.g., diet and exercise).

Back to domestic hospital use, I would like to discuss two examples from my own experience. Suicide attempts are definitely self-inflicted, but the motivation to act is often transient, and many people who attempt suicide and survive do not attempt it again. Guns are very lethal, however, with well over 90% of suicide attempts by gun being “successful”; drugs are less so. My son killed himself with a gun, but if his attempt had been with a less lethal method, I  certainly would have wanted him treated.

On our inpatient services, residents and I have cared for many people who are repeatedly admitted with the effects of their use of alcohol or other drugs. One person I remember well. Regularly admitted for the toxic effects of alcohol overdose, on treatment and release he always pledged to get treatment for his disease, most strongly motivated by caring for his daughter, but never followed through. After many admissions, some residents thought it wasteful to continue to treat him and argued against it. My position was not only was recovery a difficult process, often with many failed attempts, but that our role was to treat his medical condition and refer him for treatment for his alcoholism. We could make the judgement that he was at fault, and each of us might have our own opinion about whether he “deserved” treatment, but that was irrelevant to our obligation to take care of it. It would be a slippery slope indeed. And I would be remiss to not point out the most common reason people are “triaged” to not receive care, at least in the US, is financial: they do not have money or good insurance. That is totally immoral and unacceptable.

There are some differences with those who refused to be vaccinated against COVID or wear masks or distance, but these are variations on a theme. Yes, they put others as well as themselves and their families at risk, but so do those who drink and drive or use other drugs, or who do many other things. It is our job to take care of them to the best of our ability. To do otherwise is to risk great hypocrisy, thinking that those who do the dangerous things we ourselves do are less culpable than those who do dangerous things we do not do and decry. I call it the “Jesse Helms fallacy” after the former powerful North Carolina senator who both opposed treatment for people with HIV/AIDS, who he said were suffering God’s punishment for their homosexuality, and also smoked like a chimney and fought for the tobacco industry. When he had developed heart disease, he sought and received treatment, despite being largely personally responsible for it.

That so many are refusing vaccination and care that there are no beds in ICUs in many states (as a person from Alabama did from heart disease after being unable to get a bed in 43 hospitals in 3 states, and as is occurring across the poorly-vaccinated South) is shameful, discouraging, and incredibly dangerous. These people are misguided, stupid, and many are even evil. But we also hear of those who (because they are dying, to be sure) regret their decisions. We can feel some sense of self-righteousness when we hear about anti-vax personalities who have died. If we are in institutions where there are not enough beds and patients have to be triaged, that triage must be on the basis of their condition and our ability to help them. The social/political fight cannot be waged at the bedside of an individual patient.

As much as we might be tempted to do so.

Twenty years after 9/11: a health worker perspective

This is a guest post on the 20th anniversary of September 11, 2001, by Seiji Yamada, MD, a family physician at from the University of Hawai'i John A. Burns School of Medicine

All those of us who are old enough recall what we were doing when we heard of the attacks of September 11, 2001. Since I live in Hawaiʻi, I was awakened by a friend living on the East Coast. He called to tell me to turn on my TV. When I did so, I saw the two towers of the World Trade Center on fire. I then watched the towers collapse.

On the following day, the University of Hawaiʻi Department of Family Practice (before the name was changed to Family Medicine) held a debriefing session with all staff, residents, and faculty in attendance. We came to some conclusions that we wrote about in the medical school newsletter:

We are humans before we are healthcare workers; our humanity is still a core component of our effectiveness as healers. Thus, our presence and genuineness, in the form of compassion and, when appropriate, openness about our own feelings, are therapeutic. When we can share some of our feelings about a recent disaster, it encourages a healing partnership by making the relationship less hierarchical. . . .

 

We must seek productive ways that translate our responses to distant suffering into a medicine more responsive to the suffering before us.  In this way, we can strive to incorporate social justice, equality, and compassion into both the practice of medicine and into the political response to acts of jarring violence.  We suggest that we should feel, think, and act not as members of a particular ethnic group, religion, or nation - but, rather, as humans.[1]

One participant, a Muslim and Arab woman, was silent through most of the session, but at the end, she related that she first wanted to hear what others had to say. She told us that she had grown up with, and constantly lived with anti-Muslim, anti-Arab sentiments being expressed around her – such that she often found it most prudent to hide her ethnicity.

We wondered what the future would hold.  Would this tragedy make Americans ponder why their country is hated by many around the world?  Or would the U.S. hunker down like Israel and embody the national security state, arms pointed in every direction?  The fearful consensus was, as has been borne out, that this trial would only serve to strengthen the impetus to meet force with force.

Indeed, 9/11 was followed by much flag-waving and George W. Bush’s declaration of a “War on Terror.” As the mastermind of the September 11 attacks, Osama Bin Laden (a Saudi), and the training camps of Al-Qaeda were in Afghanistan – the U.S. military began to plan for an assault on Afghanistan.

Richard Horton, the editor of The Lancet, wrote in a commentary published on October 6, 2001, suggesting that “The war against terrorism, announced by President Bush and endorsed by western political leaders in the immediate aftermath of the Sept 11 assault on America, will fail.” He suggested instead that “health, development, and human rights” be the objectives of a public health approach to Afghanistan.[2]

The U.S. started bombing Afghanistan on October 7, 2001.

I attended the American Public Health Association in Atlanta in late October 2001. Against the backdrop of daily bombing runs projected on the megascreen of the CNN Center, I thought that I might find fellow health workers opposed to the war. After all, UN agencies such as the World Food Program and UNICEF had been drawing attention to the humanitarian crisis in Afghanistan that pre-dated 9/11. Severe drought and twenty years of war in Afghanistan had led to conditions bordering on widespread famine. Shouldn’t public health workers, who are concerned about the health and well-being of people, oppose the U.S. war on Afghanistan?

I buttonholed Victor Sidel, grand old man of social medicine, and invited him to chat over a coffee. His take on bombing Afghanistan was, “The U.S. has to do something.  It can’t stand by and do nothing.” He criticized what he saw as my pacifist stance.[3]

It has taken nearly 20 years for the U.S. to leave Afghanistan. September 11 also served as one of the pretexts for the Iraq War of 2003-2011. All told, the first ten years of the “War on Terror” took on the order of 1.3 million lives.[4]

Since September 2001, we have endured twenty years of U.S. invasions of Afghanistan, Iraq, and wherever else the U.S. deploys its Special Forces, whether it is Africa or the Philippines. Twenty years of drone attacks, reaching its height under “Hope and Change” Obama, who devoted his Tuesday mornings to choosing the week’s targets for extrajudicial assassination (“Sorry about the wedding party collateral damage”).  Twenty years of torture chambers at Guantanamo and Abu Ghraib and Bagram Air Base and those hidden black sites around the world (“Yeah, Gina Haspel, you sure did a bang-up job running that black site in Thailand - we’re going to give you the top job of CIA Director”). Oh, Julian Assange, Chelsea Manning, Edward Snowden, do you think you’re going to let the people know what’s really going on? Well, for your troubles, you’re going to be psychologically tortured and placed in solitary confinement or exiled.

One economic sector saw its stock prices jump upward after 9/11, those of the arms manufacturers. As soon as the generals who oversaw the destruction of Afghanistan and Iraq and Libya retired from the U.S. military, they moved straight onto the boards of the weapons manufacturers. Lloyd Austin went from being commander of CENTCOM to the board of Raytheon. Meanwhile, the other pillar of the U.S. economy was the gambling house of debt financialization. When the casinos (i.e., the investment banks and their insurers) couldn’t cover their own debts and crashed the world economy, the U.S. taxpayers (via Congress) bailed out the banks, and workers were foreclosed on their houses. Subsequently, the Affordable Care Act (ACA, or ‘Obamacare’), touted as expanding the social good of health care to more people, essentially turned it over to the insurance and pharmaceutical industries.

However much the fabric of U.S. society has deteriorated in the twenty years since 9/11, it does not compare with the deliberate kinetic destruction wrought on the health services, access to water and food, infrastructure, and economies of Afghanistan and Iraq. Prior to the Gulf War (1991-1992, waged by George H.W. Bush), Iraq had been a thriving society, a leader in science in medicine in the Arab world. [5] Now, subsequent to the U.S. invasion (2003-2011, started by George W. Bush and Dick Cheney), and the war against ISIS (2013-2017), Iraq is a shambles. And thanks to Donald Trump’s utter incompetence, George W. Bush is now looked upon as a statesman. We are reminded that the U.S. destruction of the Middle East has been going on for much longer than the past twenty years. As Noam Chomsky often says, massive reparations are in order.

As noted by Chris Hedges, as the U.S. leaves, Afghanistan is, like when the U.S. invaded, in the midst of another humanitarian crisis:

Things are already dire. There are some 14 million Afghans, one in three, who lack sufficient food. There are two million Afghan children who are malnourished. There are 3.5 million people in Afghanistan who have been displaced from their homes. The war has wrecked infrastructure. A drought destroyed 40 percent of the nation’s crops last year. The assault on the Afghan economy is already seeing food prices skyrocket. The sanctions and severance of aid will force civil servants to go without salaries and the health service, already chronically short of medicine and equipment, will collapse.[6]

As Hedges points out, the response of the civilized world is to freeze the assets of the Afghan central bank and deny the new government access to loans or grants.

In retrospect, it is obvious how the desire for revenge in the immediate aftermath of 9/11 has led us to where we are now. What if, instead, the pain engendered by 9/11 had encouraged us to recognize the pain of others - those who suffer from hunger, poverty, ill health, and exploitation? What if narrative and images death and destruction had prompted us health workers to demand an end to war?[7]

What if we had sought instead to alleviate social ills and sought to ensure clean water, good nutrition, education, and health? Might we not all be better for it now?

---

[1] Yamada S, Maskarinec G, Bohnert P, Chen TH.  In the aftermath:  reactions to September 11, 2001.  News from the John A. Burns School of Medicine 2001 Winter;2:1-2. https://www.researchgate.net/publication/354116332_In_the_aftermath_-_reactions_to_September_11_2001

[2] Horton R. Public health: a neglected counterterrorist measure. Lancet 2001 358:1112-1113.

[3] Yamada S. On The Responsibility of Health Workers to Oppose the War. ZNet. Nov. 2, 2001. https://www.researchgate.net/publication/354116411_On_The_Responsibility_of_Health_Workers_to_Oppose_the_Afghanistan_War

[4] International Physicians for the Prevention of Nuclear War. Body count: casualty figures after 10 years of the “War on Terror” Iraq Afghanistan Pakistan. 2015 March: International Physicians for the Prevention of Nuclear War. https://www.psr.org/wp-content/uploads/2018/05/body-count.pdf

[5] Yamada S. Health workers and the Afghanistan-Pakistan War. ZNet.  December 14, 2009. Reprinted at Medicine and Social Justice. January 11, 2010. https://medicinesocialjustice.blogspot.com/2010/01/health-workers-and-afghanistan-pakistan.html

[6] Hedges C. The Empire does not forgive. ScheerPost. August 30, 2021. https://scheerpost.com/2021/08/30/hedges-the-empire-does-not-forgive/

[7] Yamada S, Smith Fawzi MC, Maskarinec GG, Farmer PE.  Casualties:  narrative and images of the war on Iraq.  Int J Health Services, 2006;36(2):401-15. http://web.mit.edu/humancostiraq/further-reading/casualties.pdf

COVID is still with us. Vaccine resistance is real, and it is dangerous

That there are a lot of people who are vaccine-resistant will be news to no one at this point. I wrote about this on May 17, 2021 (COVID, Vaccine, Racism, and Masks: Changing for better or for worse?), and while many people who were initially resistant have now changed their minds and have gotten (or in many cases, are trying to get) vaccinated, there is a hard-core residual group. There are a variety of reasons that people have, and sometimes articulate, for not getting vaccinated.  These include a lack of knowledge (hard, I know, given the amount of discussion) and a mindset that disbelieves those who are in power (also in some ways understandable; they do lie a lot). This is complicated for some parts of the population, particularly members of minority groups like African-Americans and Native Americans, by the fact that the US history is loaded with stories of exploitation and oppression and infection, from the passing out of measles and smallpox-infested blankets to Indians to the Tuskegee experiments that denied treatment for syphilis to Black men and many other crimes.

But at this point, there are no responsible people at all who are urging folks to not get vaccinated. Virtually all doctors, epidemiologists, and scientists have been (with some effectively evil exceptions, such as Joseph Mercola, DO (The Most Influential Spreader of Coronavirus Misinformation Online). Inversely, I mean anyone who is (which unfortunately includes many politicians, FoxNews personalities, and other “influencers”) is not responsible. COVID is real, it is infectious, the Delta variant is more infectious, it makes people really sick, and it kills people. A lot of people. Irrespective of whether they believe it is “real” or “dangerous” or not. Indeed, most of the people dying now (over 95%) in the US are those who have not been vaccinated. There is definite evidence that people who are vaccinated CAN get infected, and maybe even a few of them will die, but this is also definitely being overplayed by the media. Most of the media does not lie, exactly, but most people don’t go beyond the headlines and a very large number have no concept of relative risk or odds (I would assume, therefore, that poker players have been vaccinated!) You can cross the street very carefully, on a green light, at a corner, looking both ways, and still be hit and killed by a car driven by a lunatic speeding around the corner. But it is pretty unlikely compared to, say, running across a busy 6-lane highway without looking. Most folks can get that kind of relative risk, and it is not really unlike the risk of being vaccinated or not. This graphic illustrates that risk:                                                

Another way to express it, with a more traditional line graph, by county:

A recent article in the NY Times, “Workplace vaccine mandates reveal a divide among workers” describes another way that workers are being divided, not just by whether they are willing to be vaccinated, but by whether their employers are willing to mandate (and pay for) vaccination for them. Apparently, they are for white collar workers who they want back in the office (not clear why) but not necessarily for the blue collar workers, those who actually do work that cannot be ‘phoned (or Zoomed) in’ but requires their physical presence, those people who have often been called essential workers. Walmart, for example, ‘announced mandatory inoculation for employees at its headquarters and for managers who travel domestically. For a sense of scale, about 17,000 of Walmart’s 1.6 million employees are expected to work in new headquarters in Bentonville, Ark.’ The argument for this seems to be that companies like Walmart need lots of workers and don’t want to alienate those who don’t want to be vaccinated by mandating it. But somehow it is ok for office workers. I am not sure that I understand this, but it must have something to do with pay: if you get paid a reasonable living wage you are more likely to be willing to get a mandatory vaccine, and you should anyway. It seems to me that if Walmart and other companies wish to increase the demand for their jobs, the better way to do it is: pay more!

We read that ‘Trump's COVID-19 testing czar warns the unvaccinated: 'You’re going to get the delta variant' (The Daily Kos article’s author notes that they didn’t remember that #TFG had  a testing czar. Neither did I.) Of course, a lot of people regret having not been vaccinated once they end up sick, hospitalized, and on a ventilator, like conservative radio talk show host Phil Valentine and others covered in a recent article in Rolling Stone. The NY Times also had an article titled “They Spurned the Vaccine. Now They Want You to Know They Regret It”. I heard from a friend about a hospital-based health professional (not a physician) they knew who had been vaccinated but ended up on a ventilator, which was very concerning. A few weeks later, we called to follow up. Guess what? Turns out they weren’t vaccinated; they and their whole family were lying. Embarrassed. Reassuring, in one sense, but also very worrying that folks are lying.

I hope that others who have reservations will take their advice and get vaccinated. It is, of course, a bit disingenuous; if they knew they were going to get sick and maybe die they would have gotten vaccinated. If we had known  that the roulette wheel was going to come up black, we would never have bet on red! You can’t be sure what will happen to you, but the important point is that you have to do it because you might, and at least as important, because you can infect others.

But there are many people who steadfastly believe that being vaccinated is not for them, and some who believe that it is not for anyone. They are getting sick, and will continue to get sick, and infect others, and cause others to die. They will not wear masks, and they will not wear signs. When they say that vaccine mandates, or mask mandates, are oppression, they are being, frankly, ridiculous.

The pandemic is not over. Delta is very serious. Get vaccinated. Wear a mask indoors.

I cannot resist including two other posts that make that point: 

  

Drug and device makers: Obscene profits and kickback -- a big part of why our "healthcare" costs so much

 

Drug companies are greedy parasites. This is well-known to everyone. Even the shock troops of the Republican right know about and decry it.

The drug companies start with the capitalist model – sell something at a profit – and take to an extreme: make as much profit  as possible no matter who it hurts (as long as it doesn’t hurt them).

They have a great business plan: people need their medicine, they (or mostly their insurance companies, including government insurers Medicare and Medicaid) are willing to pay for it, even if truculently, and they’ll pay whatever is asked.

While we are all shocked periodically by stories of individual dramatic greed, such as Mylan and its CEO Heather Bresch jacking up the price of EpiPen® to over $600 (Epi-Pen® and Predatory Pricing: You thought our health system was designed for people’s health?, Sept 3, 2016) or Martin Shkreli and his company Turing brazenly raising the price of Daraprim® from $13.50 to $750 (Drug prices and corporate greed: there may be limits to our gullibility, Sept 27, 2015), the fact is that this is the standard business model of pharmaceutical companies. Think of colchicine, an anti-gout drug first used by ancient Egyptians at least since 1500BC, having its price jacked up from $4/mo to $5/pill (VISA and colchicine: maybe the banks and Pharma really ARE in it for the money!). 

Or, to get to one of the biggest scandals of all, the price of insulin!  Should there be anyone who does not know, insulin was one of the most important drugs ever discovered. Unlike the newest drugs that I have recently discussed, which sell for thousands (or tens of thousands) of dollars a month, insulin is not for a niche market. It is for diabetes, one of the most common diseases. For people with Type 1 diabetes, who produce no insulin of their own, it is simply an absolute requirement for life. For the larger group of people with Type 2 diabetes, it is often a critical part of controlling their disease. It was discovered by Canadians Banting and Best in the 1920s, who sold the patent to Eli Lilly and Co. for -- $1! (Not sure if that was a US or Canadian dollar.) This drug – the impact of which is HUGE – now is over $100/month for the cheapest generic forms if you have a coupon, and, depending upon the formulation, can be hundreds!

So, we have predatory pricing on products people absolutely need for their lives. Check.

We have outrage among millions of people of all political stripes. Check.

We have the ability to control these prices, starting with the largest payer in the US, Medicare. Check.

We have done what we can, as a government and a society, to address this issue. Um, uncheck. Nope.

In fact when Congress passed the Medicare Drug Plan, (MMA, Part “D”) in 2003, it specifically forbade Medicare from negotiating drug prices. Good deal for the drug companies! Guaranteed payment and no ability for the purchaser to negotiate the price! Where can you or I get that deal? Nowhere, of course. We do not have huge piles of $$ for paying Congressmen. Every time the drug manufacturers suggest that they need their profit to pay for Research and Development (R&D), we need to note how much MORE they spend on Marketing (including lobbying and contributions). It is also worth noting that contrary to their propaganda, MOST drugs are not developed in the US. It is the large plurality, but Japan and Western Europe also contribute a lot. (see, e.g., Light and Lexchin Pharmaceuticals as a market for “lemons”: Theory and practice and Pharmaceutical research and development: what do we get for all that money?, also for another take US Pharmaceutical Innovation in an International Context) More important, perhaps, is that most of the basic (high-cost, high-risk) research is funded by you, the taxpayer, through National Institute of Health (NIH) grants; drug companies most often buy the patents only after the original research shows promise.

Of course, in recent years, there has been a change. In labeling. Some expenditures that used to be included as marketing are now included as R&D. Not that the amount that they spend on lobbying, political contributions, marketing to physicians, and direct marketing to consumers has changed. And of course we have the FDA approving incredibly expensive and profitable drugs against the recommendations of their scientific panels (FDA approves Alzheimer's drug against the recommendation of its scientific panel. Be very concerned, June 21, 2021). This is corruption, this is your government selling you down the river to increase the profits of an industry that everyone, justifiably, hates.

And then, of course, we need to consider the device makers. You know, the companies that make stuff that is stuck into your bodies by surgeons, from artificial hips to cardiac defibrillators. Just to make sure that they do not continue to fly under the radar, getting cover from the excesses of the drug manufacturers. This is important; unlike drugs, if it turns out that your  implant  is not the best choice, or is not working well, or is really inferior, or is harming you, it is not as easy to just stop and put a new one in. That artificial hip? They opened you up, cut out the top part of your thigh bone (femur), and part of where it inserts into the pelvis (ilium) and put in this new hardware. Replacing it is a big deal. So getting the best one available is important. Usually, this decision is left up to the surgeon. So how do you get surgeons to use your device if you are a device manufacturer? Marketing! Telling them how great it is! Showing them testimonials from other surgeons!  Oh, yes, and, of course good old kickbacks, paying them for using your product! This is reported on in a recent piece in Medscape, “Device Makers Have Funneled Billions to Orthopedic Surgeons Who Use Their Products”, June 17, 2021. That is how you wanted your surgeon to choose the new part that is going to replace part of your hip, or spine, or knee, right? Bribery?

Of course, it is not listed as bribery on the companies’ balance sheets, and I’m sure that the individual surgeons do not report it on their income tax under “kickbacks”. Back in 2012, surgeon and writer Atul Gawande, in an article in the New Yorker called “Big Med” (discussed by me in Quality and price for everyone: Bigger may be better in some ways, but not all, Aug 24, 2012) reported on an effort in a Harvard-affiliated hospital to standardize the hardware used by orthopedic surgeons. Rather than having each surgeon pick their own favorite and having the hospital have to stock several – or sometimes more than 10 – versions of, say, an artificial hip, a committee researched the quality and the hospital stocked 1 or 2 of the best, and each surgeon had to use them. This improved outcomes. There was no suggestion that the surgeons were, at that time, getting kickbacks, but it is certain that the manufacturers whose products were not chosen were not happy about it.

It is not hard to see why the American people distrust the healthcare system, and the hugely profitable drug and device industries that supply it, and the healthcare “providers” – hospitals – that deliver it, and, sadly with news like these kickbacks, even the doctors and other clinicians caring for them. And I haven’t even gotten into  (today) the insurance companies! As in so much else, it often appears that both our major political parties are the parties of Corporate America, although one is at least making some efforts to limit those corporations. The other is, like the drug companies, totally shameless.

It is not hard, but it is sad. And worse, destructive to our health, as individuals and as a society.