RFKJR and True Believers

 Cleaning out the drains in the sinks and shower of my bathroom this morning put me in mind of autopsies and biology and ultimately, of Robert F. Kennedy, Jr. 

I know the connection may not be obvious, but bear with me.

Pulling up the black mold and fungi and hair surprised me, as none of it was evident until I unscrewed the drain screen, and got down into the pipes with an old tooth brush. Then the source of that faint moldy aroma became obvious. 

Tradesmen are never surprised to find stuff behind the dry wall--yards of wires completely denuded of their insulation by mice, which the home owner had no idea had lived in the attic. Mechanics finding undetected, unseen stress fractures, rust and other injuries to the mechanisms.

When I was a sophomore in college, one of my classmates, looking over the shoulder of our professor, a man with a PhD in biology, as he dissected a frog, trying to show us the spiral valve in its heart, asked him, seemingly out of thin air, "So, you know when someone is ninety and is found dead in bed, or some guy just drops dead walking down the sidewalk, what killed them? Was it just nothing?"

And the professor, without looking up from his work, said, "No. Everyone must die of something." But he had, presumably, never taken a course in pathology. He was an amphibian expert. 

Which seemed eminently logical to me, and the ten students all nodded: That makes sense. Everyone dies of something.

But to Robert F. Kennedy, Jr. that something is not a COVID virus, or measles or tuberculosis or HIV. People with healthy immune systems are not going to die from infectious agents; they will live forever...or something. 

As long as they don't eat processed foods.

It made me think of two other people.  Both were patients of mine when I was still training. One was a twenty-two year old woman at Memorial Sloan Kettering Hospital with Hodgkins Disease. The oncologists had had a devil of a time trying to get her lymphoma to respond to their poisons, but she seemed to have finally gone into remission. This was in the days before CT scans, but her chest X rays were clear and she felt better, and she was eating again and her skin was rosy and she was sitting up in bed with her lunch tray just delivered, and I happened to be in the room and her aunt was sitting by her bedside, and she raised her hand to her head and said she did not feel well, and I took her blood pressure which had plummeted, and I rolled the head of her bed down and pushed the bedside button for help, and then she looked over to her aunt and she said, "Remember when Carol died? And we got out all those little white cards to mail to all the cousins and relatives, and we filled them out, dozens of them, one by one?"

And her aunt looked alarmed and looked from her to me.

"I think you're going to have to get out those cards now."

And, sure enough, she arrested right in front of us and despite all our efforts, she died. 

She knew there was something going on we could not see. At autopsy, they found every organ riddled with Candida, an organism which can cause vaginal infections in healthy women, but ordinarily doesn't cause much problem,  but she had it everywhere, and I looked through the microscope in the pathology lab and lung, eye, liver, virtually every tissue just overwhelmed with these cylindrical shaped, ghostly Candida organisms.  It is true, her immune system had failed her--if you have a marginally functional immune system it can fight off Candida, but after all that chemotherapy, and the lymphoma itself rendered her immune system kaput.

Another patient, a twenty one year old woman was brought to the ER by her fiancé, short of breath. She was a little dusky, but in the fluorescent lights of the ER it was always tough to judge skin color. The ER resident had done blood gases which showed her blood oxygen levels were low and her carbon dioxide levels high, and I was sure he had hit vein, not artery as these levels would have been characteristic of venous blood. This was before those pulse ox devices they put on your finger now which measure blood oxygenation, or some equivalent, and the only way you could know about arterial oxygen saturation was to puncture an artery, usually done at the wrist, and sit there and watch as the plunger in the syringe pulsed up, heart beat by heart beat, until you had about five cc's and then plunge it into ice and run it up to the lab. So, I did that, and the oxygen was still low so I accepted her to the intensive care unit. In those days, even a big hospital like The New York Hospital only had one ICU on the medical service and one on the surgical service. There were only twelve beds in our medical ICU and so someone had to judge who was sick enough to warrant a bed and that night it was my job as a senior medical resident.  She was a little drowsy, but she was answering questions and she didn't look all that sick, but those gases were atrocious and I had drawn them myself so I trusted them, and I took her up to the ICU. 

She died within about an hour. 

We were all pretty shocked. We had not thought, for some reason, to intubate her, that is to put her on a respirator. I don't know why. It just happened so fast. One minute she's talking to you, respiratory rate a little fast, but blood pressure and pulse not bad and then, poof!

At autopsy, she had lungs which had the consistency of liver. Just thick and soppy. Lungs are usually like big sponges, with lots of air and , well, spongey, but her lungs were simply not compatible with life--no way they could exchange air. I felt dreadful about not intubating her, but all the old attendings (who were younger than I am now, I'm sure, but they seemed like old wizened men to me then, the kind who had seen it all) all of them, to a man said, "That's what influenza does." Wouldn't have mattered if you had put her on a respirator. She could not move air through those lungs.  Her influenza titers were high. There was an epidemic going round and our wards were filled--we had patients on gurneys in the hallways.

Influenza just does that. 

Many of our influenza patients seemed to get better and then they relapsed severely; their blood gases went south and they died from "superinfection" with staph aureus. The lungs had been so blasted by the influenza, they were defenseless against the staph.

Bobby Kennedy, Jr, having read an article by Tony Fauci which reported staph superinfection in some patients dying of influenza, concluded that even Tony Fauci "admitted" that influenza does not kill patients, staph does. Which is, of course, like saying if you bleed to death in the emergency room after an auto accident, you died from bleeding, not from the auto accident.

But back to microbiological cause of deaths: None of the microbiology is, of course, visible to the naked eye, nor even knowable by the bedside interns, residents and attendings. You just know what these patients look like on the autopsy table, when the invisible, the microbiology, become evident.

It's what pathologists do. Internists know everything but can do nothing. Surgeons know nothing but can do everything and pathologists know everything and can do everything, but too late.

That was the old joke among the wags at the hospital.

So, all I'm saying is, when you're talking about disease, what makes people sick, there's a lot to learn and a lot which is unseen by people without training, technology and experience.

So when Bobbie Jr. denies measles kills kids, or when he says COVID does not kill anybody, except for people who have damaged their own immune system by eating processed foods, or when South African President Mbeki says HIV does not cause AIDS, but it was poverty and homosexuality that causes AIDS, somehow-- they are people who have never taken a course in pathology and they have certainly never done a year's internship at The New York Hospital, or the Mass General or anywhere else.

Before the germ theory of infectious disease, there were all sorts of explanations--God's wrath, bad air, the universe being out of balance in an individual. 

Alexandre Yersin

The Black Plague was punishment for bad deeds until Alexandre Yersin found Pasturella pestis (later named Yersinia pestis) in the buboes in 1894. Centuries of mystery were solved by a man with a microscope working out of a straw hut during a plague outbreak in Hong Kong, alone, because the British masters of Hong Kong dismissed him as some French speaking nerd, and made the hospital available only to a more respectable scientist, who never bothered to cut into the buboes and missed the offending bacillus.

The story of Alexandre Yersin should be taught in every middle school in America. The guy was a Swiss student who spoke French and German and wound up working with Louis Pasteur in that famous Paris lab. But Yersin, who may have been on the autism spectrum, maybe not, yearned for adventure, and although Pasteur wanted him to continue his work on tuberculosis in Paris, Yersin inveigled a letter of reference from Pasteur and then hopped a boat to French Indochina, where, from his clinic in Na Trang, he had been delighting in listening to the tigers roar at night. When plague broke out in Hong Kong he hopped a boat to go there. 

He not only figured out which bacteria caused the disease, he raised anti serum to it, so when it broke out in Indochina (now Vietnam) he was able to save the villagers. Chance favors the prepared mind.  He also figured out the connection to rat fleas. Quite a guy. Ask  any American middle school child you know if he's ever heard of Yersin.

For that matter, ask any middle school student you know who Banting and Best were, and what they did. You can give them a hint: University of Toronto, 1922. Another hint: Diabetes.

Banting & Best

Theories about what caused plague, type 1 diabetes, AIDS are a textbook of mistaken ideas, but methods which are rigorous enough to lead to the truth ultimately prevailed.

One thing all these stories share is difficulty, how hard it is to learn anything in biology and science, and how what you think you know one day may change the next until the implacable method we call "the scientific method" gets applied, and it's not enough to be correct, you have to show how you came to your conclusion, how you excluded other possibilities and why your explanation and your evidence, which other investigators can reproduce, makes the most sense.

For Bobby, none of this applies. He just says it.  As Christopher Hitchens noted: statements without evidence can be dismissed without evidence.  Big claims require big evidence.

The temptation to skip all that hard work, to skip the arduous steps of sitting through classes, lectures, labs, of listening to "experts," is immense.  You know these experts are going to be wrong about a lot of stuff, so why bother listening to them at all?

Just get out there and say something, like, it's all about your diet. People who eat well and have strong immune systems as a result never die. Certainly not from COVID or influenza or measles.

Just say it. It's so easy.

 It's simply enough to cry out: Do you BELIEVE!?!

 I BELIEVE!

Not in God, necessarily, but in whatever Mr. Trump or Mr. Musk or Mr. Miller or Mr. RFK Jr says.