Volume 78, no. 5 May 2022
Many (most?) Americans are apparently becoming NPCs.
A feature of video games, the non-player character says whatever the computer algorithm directs. The NPC meme, based on the Wojak meme, appeared on 4chan in July 2016, with this description of the type of person the meme represents: “If you get in a discussion with them it’s always the same buzzwords and hackneyed arguments. They’re the kind of people who make a show of discomfort when you break the status quo like by breaking the normie barrier to invoke a real discussion. It’s like in a when you accidentally talk to somebody twice and they give you the exact lines word for word once more.”
The meme is a gray head with a blank stare and a triangular nose. One Twitter post depicted the robot head being opened and the old chip (such as COVID pandemic) being replaced by the latest Current Thing (at this moment Ukraine). Other chips are for climate crisis, systemic racism, LGBTQ rights, unrestricted abortion (“reproductive health”), and disparities.
Having attended nearly every House of Delegates meeting of the Arizona Medical Association (ArMA) for about 30 years, your editor has observed the progression described by Minnesota physicians (p 4). At this year’s meeting, held by Zoom for the third time, the NPCs seemed to me to be clearly in the majority.
The 22 resolutions, mostly Woke, came primarily from the Medical Students Section. No individual claimed authorship; they were likely lifted from the AMA, with lengthy, referenced “whereas” clauses. The reference committee recommended adoption. The few extracted from the consent agenda passed 80 to 20.
Unanswered questions: What will the Diversity, Equity and Inclusion Committee do with $5,000 (the only fiscal note in the resolutions)? What is its measure of success? [No, there will not be discrimination against straight white men, and it is not like the old Jewish quotas.] Does “gender affirmation” include surgery or off-label use of dangerous drugs like puberty blockers in minors?
ArMA has, with few objections, changed its “aggressively neutral” position on abortion. Now it can simply say abortion is “essential to reproductive health” when opposing any legislation that might decrease the number of abortions, instead of contriving a reason such as “interference with the patient-physician relationship.” If it loses members, so what; it may gain more.
Medical Assistance in Dying (MAiD) was the most contentious issue. Dedicated physicians have been fighting valiantly to prevent the AMA from dropping its opposition and taking a neutral position. ArMA committees have also been debating this for years, and the division of opinion has been about 50:50 (AAPS News, August 2018). Proponents may acknowledge the potential slippery slope, but deny the existence of problems in Oregon, Canada, or Europe (AAPS News, August 2019). They do not see a red line, an absolute moral prohibition against prescribing lethal medicines to end a patient’s life, but only a discussion of the acceptable conditions. As with abortion, what is permissible may become “essential,” and supposed conscience protections may prove meaningless. The ArMA resolution was referred to a task force to be appointed by the incoming president and instructed to report within 6 months.
No Right to Dissent
Only one resolution received a “do not pass” recommendation: one that the AAPS board of directors will present at our upcoming annual meeting (p 2). One discussant said it was like saying “the sky is blue,” as doctors already have freedom. Another said that freedom has limits—we need to protect against “harmful misinformation.” It was “referred,” likely to be memory holed.
The takeover by cultural Marxists is virtually complete. They have discovered that they only need a small majority to rule. In Western democracies convincing 51% is as good as convincing 99%. But the Narrative can be implemented without a majority; all that is needed is to convince the brainwashed college graduates whose connections and status will propel them into leadership positions in academia and industry. They will be selected, not elected. They cannot be voted out and can choose not to follow the orders of elected officials—and can cancel people who do not obey them. So far the right-wing upper middle class is going along.
In 1924 American billionaire James B. Duke established the Duke University Endowment and virtually built from scratch a brand new conservative university on par with the Northern Ivy League Sisters. This plan worked until the 1960s when cultural Marxists imported from Europe cannibalized academia from the inside. Since then conservatives abandoned academia and professional managerial institutions. Duke University like others fell into the hands of the enemy. While important smaller institutions have been founded, no one has undertaken to challenge Harvard and other established elites (https://tinyurl.com/bddzfyns).
The average middle-class conservative employed in a relatively secure industry, living in a sheltered conservative community, is content—until he has to go to a university hospital and be treated as a “bigot” by Woke students and residents, or finds out that his daughter is scheduled for an “affirming mastectomy.”
Conservatives are cheering that Elon Musk bought Twitter for $44 billion, and leftists are in a panic about the possibility that free speech might be allowed, even in 240 characters.
Will that suffice to destroy false Narratives? As the late Nino Camardese, M.D., said: “Truth + 1 = a majority.”
Slippery Slope—or Moral Cliff?
Proponents of medical aid in dying generally reject the slippery-slope argument by claiming that safeguards work or that one should not deny some patients this relief just because abuse might happen (tinyurl.com/5fhvsbwp). But once the premise is accepted that physicians may ethically kill their patients, medicine is fundamentally changed. Then, “the progression from death-on-demand to death-at-doctors’-discretion makes a grim kind of sense.” As Justice Neil Gorsuch pointed out, “physician-assisted suicide always relies on the physician to make the fatal decision.”
“Compassionate motives don’t make something morally right, nor can they prevent horrifying abuses of human dignity.” It’s a drop off a moral cliff. “Once death is a treatment option, patients can no longer trust their doctors, their insurance companies, or even their families to have their best interests at heart” (https://tinyurl.com/4frkwpeu).
COVID Shots Suppress Immunity
The safety signals for COVID jabs are “out of sight,” write Stephanie Seneff, Ph.D., Peter McCullough, M.D., and others. An Indian study suggested that the shots might suppress the innate immune system by inhibiting type-1 interferon. The mRNA in the shot is modified to look more like human RNA rather than viral, so it persists longer and does not trigger the interferon pathway. Worse, the pathway is actively suppressed by the large number of spike proteins produced and by the microRNAs in the exosomes released by the stressed immune cells. Peptide sequences in antibodies produced by the jab may result in autoimmune disease through molecular mimicry. Associated neurologic problems include tremors, tinnitus, Bell palsy, and migraines related to trigeminal nerve inflammation. We might see an explosion in Parkinson disease, demyelinating disease, Alzheimer’s, and Creutzfeldt-Jakob disease (https://tinyurl.com/muyymnmk).
A detailed description of the mechanisms emphasizes their importance in cancer suppression (tinyurl.com/mt6w7m5h).
Florida Warning on Transgender Therapy
In a Department of Health statement, Florida Surgeon General Dr. Joseph Ladapo said: “Current evidence does not support the use of puberty blockers, hormone treatments or surgical procedures for children and adolescents experiencing gender dysphoria.” The statement notes such treatments have “an unacceptably high risk of doing harm” to minors, and that 80% of children seeking clinical care lose their desire to identify with the “non-birth sex” (https://tinyurl.com/5epa7656).
DOH guidance was praised by Liberty Council, which cited FDA reports of 25,645 “serious” reactions to leuprolide acetate (Lupron), including 6,379 deaths (tinyurl.com/yc8y8yzx). The drug is FDA approved for advanced prostate cancer and precocious puberty, but is being used off-label in children diagnosed with gender dysphoria, despite the absence of peer-reviewed studies on its long-term effects (tinyurl.com/2p9ck3st).
“In the main it will be found that a power over a man’s support (salary) is a power over his will.”
Free Debate and Physician Prescribing
Resolution to be presented at AAPS annual meeting:
Science is a method for seeking truth, not a dogmatic creed handed down by approved experts;
Experts have been proved wrong, and what was a minority or individual opinion proved correct many times;
Science requires free, open debate;
There are enormous conflicts of interest involving experts and the pharmaceutical industry;
Physicians undergo rigorous training that equips them to independently evaluate evidence;
The randomized controlled trial is not the only kind of evidence; is itself subject to bias and other flaws; and is often unavailable, especially for a newly recognized disease;[Under the Hippocratic ethic, the physician] has pledged to “prescribe regimen for the good of my patients according to my ability and my judgment and never do harm to anyone”;
The ethical physician places patients first;
Physicians may be subject to severe pressure from employers, hospitals, insurers or others to conform to a protocol that may not be in the best interest of an individual patient;
BE IT THEREFORE RESOLVED THAT:
AAPS supports the right and duty of physicians to prescribe according to their own best judgment, with the commitment to do no harm to anyone, and defends this right in its positions on legislation, regulation, hospital medical staff bylaws, or licensure board actions.
Students for Total Transformation
No fringe organization, White Coats for Black Lives (WC4BL) has more than 70 chapters at U.S. medical schools. It claims that “dominant medical practice in the United States has been built on the dehumanization and exploitation of Black people.” Ridding the medical system of this allegedly pervasive racism requires “dismantling anti-Black racism, white supremacy, capitalism, imperialism, colonialism, and cisheteropatriarchy,” and also “dismantling fatphobia,” embracing “Black queer feminist praxis,” and “unlearning toxic medical knowledge.” WC4BL blames “the professionalization of the medical field” for the utilization of “violence” to “oust women and femme healers.” The Association of American Medical Colleges’ (AAMC) recent guide to anti-racism planning highlights WC4BL by name, and many medical schools approve of WC4BL’s demands and incorporate them in their curriculum (https://tinyurl.com/2ts4v9c2).
June 25. Texas Chapter, Ft. Worth, TX, https://texasaaps.org.
July 9. Missouri Chapter, Lake Ozark, MO, https://moaaps.org/.
October 13-15. 79th annual meeting, Springfield, MO.
Does the Nuremberg Code Apply?
While often referred to in the context of vaccine mandates, the Nuremberg Code has never been codified in U.S. law. In the years immediately following the Nuremberg war crimes trials, most commentators believe the influence of the Code in the U.S. was imperceptible. The prevailing view was that the medical defendants were Nazis first and last; by definition nothing they did was relevant to the U.S. Their conduct was so extreme “as to have little or no bearing on civilized people who conducted scientific research according to their consciences.” The longstanding tradition of medical ethics embodied in the Oath of Hippocrates was regarded as a generally adequate basis upon which the medical profession could police itself (tinyurl.com/9ddrcbdf).
In 1952, a Pentagon lawyer recognized the Code as good law that applied to the U.S. Department of Defense. However, courts have viewed it as being superseded by national security concerns. In 1966, Dr. Henry Beecher published a paper in the New England Journal of Medicine contending that there were numerous examples of the abuse of human subjects in the published medical literature. The Tuskegee study in the 1960s and 1970s forcefully showed the need for concern. The Code was influential and has contributed to a “growth in moral perception” (ibid.).
In the case of Abdullahi v. Pfizer, the U.S. Court of Appeals for the Second Circuit wrote in 2009 that “states throughout the world have shown through international accords and domestic law-making that they consider the prohibition on nonconsensual medical experimentation identified at Nuremberg as a norm of customary international law.” The case concerned Pfizer’s testing an antibiotic in Nigerian children, resulting in many deaths and serious injuries. The court concluded in a 2-to-1 decision that jurisdiction existed under the Alien Tort Statute (tinyurl.com/yrz2vzwj), and Pfizer eventually settled for $75 million.
The opinion noted: “As Justices of the Supreme Court have recognized [in U.S. v. Stanley], ‘[t]he medical trials at Nuremberg in 1947 deeply impressed upon the world that experimentation with unknowing human subjects is morally and legally unacceptable.’”
Also, “the fact that the prohibition on medical experimentation on humans without consent has been consciously embedded by Congress in our law and reaffirmed on numerous occasions by the FDA demonstrates that the United States government views the norm as the source of a binding legal obligation.”
Federal Judge Strikes Down CDC Mask Mandate
Citing violations of the Administrative Procedure Act, federal district court judge Kathryn Kimball Mizelle struck down the Center for Disease Control and Prevention (CDC) mandate requiring travelers to wear masks on airplanes and other forms of public transportation in Health Freedom Defense Fund v. Biden (https://tinyurl.com/mr33rtm4).
The CDC failed to give the required notice-and-comment period. “At the time when the CDC issued the mandate, the COVID-19 pandemic had been ongoing for almost a year and COVID-19 cases were decreasing,” Judge Mizelle wrote. “This timing undercuts the CDC’s suggestion that its action was so urgent that a thirty-day comment period was contrary to the public interest.” Moreover, she wrote that the mandate exceeds the agency’s statutory authority, for which it cites the Public Health Services Act of 1944. Forcing individuals to wear a face mask does not meet any reasonable definition of “sanitation.”
“Before COVID, the CDC had really played more of…[an] advise and consent role to the state public health authorities. It had never before…said we’re going to…directly dictate how people can conduct themselves and…use their property,” said Brant Hadaway, an attorney for the plaintiffs (tinyurl.com/ymmdsf54).
The Dept. of Justice has appealed the ruling, even though the mandate has expired, “to preserve the government’s public health authorities” (https://tinyurl.com/4tuemu7d).
Airlines are offering refunds to some passengers who don’t want to be on a flight with an unmasked person. So far, few requests have been received (https://tinyurl.com/y66j2pz8).
Lawrence O. Gostin, J.D., writes that “We’re Toying with a Ruinous End to COVID Travel Masking” and “CDC’s powers to protect the public during health emergencies hangs in the balance.” He compares the unprecedented power to force healthy people to wear a mask to the long-held power to detain persons infected with smallpox, tuberculosis, or Ebola. “The judge’s opinion literally handcuffs the CDC” (tinyurl.com/ycks47ew).
Conscience Rights Hang in the Balance
The Biden administration is preparing to scrap a Trump-era rule that allows medical workers to refuse to provide services that conflict with their religious or moral beliefs. A spokesperson for the Department of Health and Human Services said: “HHS has made clear through the unified regulatory agenda that we are in the rulemaking process.” The conscience rule, unveiled in 2018 and finalized in 2019, was blocked by federal courts and has never been implemented. It would have allowed doctors, nurses, medical students, pharmacists, and other medical workers to refuse to provide abortions, contraception, “gender-affirming” care, vasectomies or any procedure to which they object (https://tinyurl.com/ykc746ay). Refusal to do an abortion or to treat a minor with off-label hormones might be called “discrimination.”
The Law on Off-Label Prescribing
Off-label prescribing is perfectly lawful. In general office-based practice, 21% of prescriptions are off-label, and 40% to 80% of recipients of commonly prescribed psychotropic medications are receiving these medications off-label. With antidepressants, more than 80% of off-label prescriptions had no strong evidence of efficacy for the indication, and there is significant risk of adverse drug events. The statutory and regulatory framework affecting off-label prescription and especially anything that might be construed as “promotion” is very complex. Physicians need to familiarize themselves with the rules (tinyurl.com/zstnkujz).
Tip of the Month: Hospitals exploit employment contracts to impose sham peer review, thereby circumventing the bylaws. Sometimes hospitals enter into a one-sided contract with a group of physicians, and the group contracts with individual physicians including a termination-without-cause provision. When the hospital wants to exclude a physician who stands up for patients, the hospital CEO merely calls the group CEO and tells him to terminate the physician. Avoiding employment contracts, particularly ones that allow termination without cause, is preferable.
Scarred Hearts. The CDC reassured the public that sufficient time had passed to conclude that there are no significant long-term adverse effects of the COVID-19 vaccine. “Long-term” had not occurred yet, and they knew it. Just another lie. Now, young healthy boys are scarred and injured for life. A follow-up study (tinyurl.com/3struzhc) of patients 18 or younger, who had been treated for cardiac inflammation within a week of the second dose of the Pfizer jab, showed that nearly 70% had persistent late gadolinium enhancement on MRI three to eight months after they were first examined—even though most patients appeared to respond to treatment (https://tinyurl.com/3pc3f6nw).
A Nordic cohort study (JAMA, tinyurl.com/zmd85fp7) showed that the rate of myocarditis/pericarditis in persons receiving Comirnaty™ was 5 times that of the unvaccinated; for Spikevax™, the risk was 15 times higher. Nordic countries have halted the use of the Moderna product (Spikevax), but researchers write that benefits outweigh the risks (tinyurl.com/2p8men9k).
Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY
Record Deaths in Young Athletes. Tragic events are hampering the joy of spectator sports. Even the media can’t hide players suffering cardiac arrest on the game field, shortly after receiving a COVID jab. Football giants, soccer stars, tennis pros—hundreds of them are being forced to end their careers because they took the shot (https://tinyurl.com/bdzfur63).
Steve LaTulippe, M.D., Salem, OR
Who Is to Blame for Price Hikes? The Biden administration is blaming Vladimir Putin for March’s 8.5% year-over-year increase in the Consumer Price Index (CPI). But prices were surging long before Russian troops entered Ukraine. The previous excuse was “greedy corporations.” The main culprit is actually the Federal Reserve’s unprecedented spree of money creation. The welfare-warfare-fiat money system will end. We don’t know when, or whether it will be replaced by an even more authoritarian government or by a return to limited, constitutional government.
Ron Paul, M.D., https://tinyurl.com/7n73nzpp
Wokeness. How did “monolithic theology,” the mixture of morality with consumerism that favors preferred business and political interests, get into medicine? How and why did the Minnesota Medical Association convert from representative physician advocacy to woke corporate ideology? As Vivek Ramaswamy, author of Woke, Inc., writes: “The modern woke-industrial complex divides us as a people. By mixing morality with consumerism, America’s elites prey on our innermost insecurities about who we really are. They sell us cheap social causes and skin-deep identities to satisfy our hunger for a cause and our search for meaning, at a moment when we as Americans lack both.” Most American physicians are now at risk as employees of woke corporations. As such they are enmeshed without power in the politics of a woke-industrial complex. A final solution for MMA was to disband the House of Delegates.
Lee Beecher, M.D., Maple Grove, MN
The Source. I think that the genesis of medicine’s adopting the “woke” ideology comes from the World Health Organization final report that came out in 2008: “Closing the gap in a generation: health equity through action on the social determinants of health,” narratives constantly cited by the AMA and MMA. The assumption is that all health outcome differences are created by the doctors or the system. It is racist to believe otherwise. Not only the usual suspect institutions, but science and medicine too, are in the grip of a monolithic theology. Woke medical students believe that only government can overcome the inequities. I expect our federal constitutional republic to become an authoritarian non-democratic government within my lifetime.
Robert Koshnick, M.D., Detroit Lakes, MN
The Way We Were. Until the time of COVID, I thought that free speech was a fundamental right. Having been assigned core texts like 1984, Brave New World, Animal Farm, Lord of the Flies, and The Trial and Death of Socrates in fifth grade in the California school system, I believed there was no way anything like that could happen in the U.S. Internet censorship and government-controlled propaganda were unfortunate things that happened to those who lived in China. I believed that physicians were deeply committed to upholding the Oath of Hippocrates, and that doctors had freedom and responsibility to diagnose and treat patients as individuals and were guided by ethical principles codified after WWII in federal law as the “common rule.” Patients had medical autonomy, and informed consent for any medical procedure was ethically critical. Dissent and discussion was a time-honored tradition with a long history of leading to improvements in medical care. Then everything changed.
Robert W. Malone, M.D., https://tinyurl.com/2cf4epd4
Tyranny of Ideology. Unlike philosophy, which recognizes reality, ideology rejects common sense in favor of unyielding belief in the perfectibility of man, explains Thadeus McCotter (tinyurl.com/4p2uf5sv). The first casualty of ideology is truth.
John Dale Dunn, M.D., J.D., Brownwood, TX