January 6th: Snowflake History or Pulling Back From the Brink?

 

Watching clips of the testimony of Capitol Police before the House Select Committee today, I could not get out of my mind a single number attached to the 20 year Weimar Republic, which emerged out of World War One as an interregnum between that war and the next:  Over that period there were roughly 500 assassinations, which is to say murders of politicians, public officials in Germany, mostly in Berlin and almost all of them murdered by right wingers, Nazis.

There were also innumerable beatings by Nazi street thugs we often tend to write off as sort of "boys will be boys" sort of stuff, but as Christopher Isherwood describes one beating, he noted the eye of the Jew attacked hung out of its socket,  drooping on his cheek and his skull was clearly fractured. 

The videos released recently show the thugs attacking the Capitol stabbing at police with flag poles, battering them with clubs, but nowhere evident are the attack rifles or other guns we have heard were carried by the attackers.  And we hear no gunfire.

Watching the losers parading through the Capitol, sitting in Nancy Pelosi's chair, there was almost a clownish atmosphere of the inmates in charge of the asylum and not quite sure what to do with the place. Oh, they smeared feces on the walls, which a certain type of mental defective will do--feces are often the calling card of that sort of derangement. 

It has been widely reported that of the 2300 sworn officers only about 800 were on duty that day despite the widely advertised intent of organizing a mob to overwhelm the Capitol. No National Guard lined up to protect the building. 

There was a time, some of us remember, when the National Guard did line up with rifles pointed and fired and shot down unarmed students at Kent State. And there were ample examples of Trumps troops festooned with T shirts saying, "The Civil War Starts Now!"  So you know there were provocateurs in that crowd, hoping to start something which would ignite a real conflagration. 

It doesn't take much imagination to think there were rifles under those jackets, men just hoping for a firing line from the government so they could finally use all those attack rifles and rocket launchers they had been cherishing and collecting for the great apocalypse they so desired.

                                                                

Some of the half wits floating before the cameras smiling and sending pictures home to their mothers were nothing more than men with the mental age of children playing a sort of "Role Playing Game" the same  guys who play with foam swords on weekends.

For others, more adult plans were no doubt afoot.

When the crowds in Idaho gathered before the Randy Weaver homestead at Ruby Ridge, to block the federal police, they shouted out slogans about the apocalypse and Weaver had attended meetings of Aryan Nation types who predicted an Armageddon conflict, a war between the races for control and supremacy over America. 

One Capitol Police officer testified today, repeating the words of his attackers: "This nigger here voted for Biden!" But on national TV and NPR the word "nigger" was bleeped out and reporters told us in stricken tones the attackers had used the "N word." 

As if the Republic would come crashing down if America heard the word "Nigger."

As if we are all just such delicate flowers, such snowflakes, that we could not tolerate hearing that word. 

Well, maybe we ought to hear that word in public. Maybe we need a raw image, a raw sound. After all, it was only when the video of that police knee on George Floyd's neck was shown that justice got done. 

Which makes me think again about Weimar and how Germans heard every day about murders by thugs and became inured to it; when you do the arithmetic  there must have been roughly two murders of public officials, those who believed in democracy as opposed to a strongman, every month during the Weimar years. 

Now, of course, we have suffered through random mass shootings/murders in America for at least 20 years, but there is no clear political aspect to this; the slaughter thus far is simply deranged men shooting or guns gone wild, depending on your thinking. 

Suppose, for a moment, some national guard unit had shown up, or that the Capitol police had been issued rifles and when that crowd of 3000 or so breached the barriers, the assembled government had fired and the men in the crowd brought out their attack rifles and hundreds of police, Guardsmen and civilians had been shot dead.  Would the election have been confirmed and would Joseph Biden have been inaugurated on time? 

Or would we have seen a Weimar Republic collapse like the one following the Reichstag fire? 

Perhaps it was best that cop had to suffer the "Nigger" slur but did not shoot anyone and perhaps the smartest tactic was allowing the crowd into the building, avoiding conflict, as some officers did, allowing the deplorables to smear feces and carry off souvenirs of their rampage. 

But that leaves us with the problem of the attackers looking more like simpletons out doing their Role Playing rather than serious threats to our democracy and social order.

The problem is that such a crowd always contains some Timothy McVeigh's, who will blow up a federal building given the chance, along with many boy/men who live in their parents' basements, who work as shelf stockers at warehouses and play with foam swords in the parks on weekends with their friends. 

And when we complain about that onslaught we get Republicans saying, oh, it wasn't so bad, just some rowdies letting off steam, a normal tourist group, or just a little more than that maybe, but certainly not Nazis on a rampage.

The challenge for the Democrats to to figure out which image will hurt the Trump crowd the most: The wacky, trailer trash Buffalo man with his horns shouting in the face of the police, a pathetic looney, but basically harmless, like a streaker exposing his own inadequacy. Buffalo man as the image is just not the same as that girl, arm outstretched kneeling by the body of a dead student at Kent State.  

What image could become as potent as that girl at Kent State?  To my mind, it was that image which brought Nixon down. He was connected to that dead student, who he had called a "bum." 

                                                   

To what image can Trump or Jim Jordan or McCarthy be connected? 

The question is: Is there any lowlife form low enough which would hurt the Republicans at this point?

It wasn't until the townspeople were marched out of their villages and forced to help bury the dead at the concentration camps that the German folk really had to face what their gentile hate had wrought. American Army commanders made sure the Germans, who had to be able to smell the camps from their cozy little towns, were made to rub their faces in the filth they had ignored and tacitly endorsed. 

Somehow, Democrats have to figure out how to do that with Republicans--preferably before the bodies stink and the air is filled with death. 

A Tale of Two Towns: For Profit Medicine & The Demise of Community Medicine

 

Recently, a spate of articles appeared in the USA Today remnant of the local seacoast New Hampshire papers telling of the shock at Rochester, New Hampshire, when the Frisbie Hospital there, recently bought by Hospital Corporation of America, (HCA) lost 14 of 15 primary care physicians, so all the patients who were cared for by these doctors lost their doctors, and these patients were not pleased. In fact there was much hue and cry.

Of course, Mad Dog read about this with a different set of lenses than the hapless reporter who was free lancing this story.

It took Mad Dog back to a time 7 years ago and to a town 30 miles down the road from Rochester: Portsmouth.

Portsmouth had, in the 1970's been a scruffy Navy/Air Force town, with a red light district and bar fights, but the Air Force base closed and the Navy yard across the river quieted and the town began to gentrify. A new young group of doctors arrived and it didn't take long for them to go to the city fathers, and the board of trustees which ran the hospital to say the town needed a real hospital, rather than the tumble down cottage hospital with vermin running through the basement tunnels. 

The Cottage Hospital 

Eventually, a deal was struck with Hospital Corporation of America--yes, that HCA--and a new hospital was built. HCA at the time ran scores of for profit hospitals across the country and was one of the largest employers of physicians in America.  Physicians were leaving private practice in droves, getting out of running their own businesses and seeking to become employees.

Inside the Hospital 

For some years, things seemed to be going well for the community: They had an attractive new hospital with no vermin in the basement; HCA hired lots of primary care doctors and specialists and attracted two spectacular cardiac surgeons--one from Columbia University and one from Mt. Sinai and with the surgeons in place, several groups of cardiologists joined the staff and you really could get a patient with chest pain from the Emergency Room to a catheterization table within an a hour, the gold standard met by very few hospitals.  

Pulmonary, infectious disease, neurology, endocrinology and oncology practices arrived and thrived. Patient no longer had to go to Boston 90 minutes away but could be treated locally and with a level of excellence rivaling Boston. 

New and Improved

But then something happened. The accountants noticed the outpatient practices were not bringing in a profit and in fact, in sum, were actually costing HCA more money than they brought in. When you added up the rental for office space, salaries for doctors and staff, the outpatient practices were not earning their keep.

Of course, the model for hospital associated practices across the country in not-for-profit systems did not expect the outpatient practices to turn a profit because the only source of income was collection of fees for services in the office, and that was no way to make money.

The practices, however, sent plenty of money "downstream" to the hospitals by referring patients to the emergency room, to the MRI and radiology departments, and for admission to the hospital. The outpatient practices "fed" the hospital practices.

Upgrade

One day, a meeting was called at the hospital and the HCA regional director, a 30 something man from Richmond, VA--call him "Ben"--arrived to speak with the doctors and the CEO of the hospital. 

Mad Dog arrived early and he sat down and listened to Ben instruct the local HCA manager--call him "Tony"--with a whiteboard he filled with Venn diagrams. Mad Dog did not understand it completely, but it had to do with the "markets" for medical care and it seemed to fit the clauses in the HCA contracts which told the doctors who had to sign them the patients "belonged" to HCA and if the doctors ever left the practices they could not continue to care for any patients they might have met when in the employ of HCA.

When the CEO of the hospital arrived, she said the meeting was to establish better communications between the practices and the hospital. People made nice noises about how much they  loved each other and the CEO said she had not been able to meet a budget in 3 years. Finally, Mad Dog commented that his practice had lost a doctor because when it came time to renew her contract HCA cut her salary and as an endocrinologist she was in a seller's market, so she simply got a job elsewhere, but that meant the hospital no longer got the $850,000 in lab billing which every endocrinologist sends the hospital's way.

August Macke

Well, the CEO said, she didn't want to hear about that. What the CEO was concerned about was that she cannot meet her own budget, not that people are leaving practices "across the street" (in the outpatient offices.)

"But listen to what you are saying," Mad Dog persisted. "You want to open lines of communication but you don't want to hear about our problems."

"The problem is," Ben the regional director interjected, "You guys are just not productive."

"What does that mean, exactly? Productive? How do you define 'productive?' We don't make enough money for HCA?"

"You don't see enough patients."

"So, let me understand. You are talking about bodies through the door?"

"Yes."

"So, if I see a patient for a thyroid nodule as a new patient, which takes an hour, and I do a thyroid ultrasound and see a nodule, which I then biopsy in the office, that's a $1,500 consult. In that same time, I could see 4 return patients for a grand total of four time $80 or $320 for that hour. So which is more productive for HCA?"

Ben seemed perplexed. "Let me think about that. I'll have to consider. "

Mad Dog considered Ben, the man from Richmond, the regional director who was schooling the young Portsmouth manager on Venn diagrams and health care markets who did not know this most basic thing about what he wanted from local medical practices: volume or income. 

A year later, as new contracts came up for renewal, doctors left Portsmouth. Cut salaries and doctors will leave.  Because HCA had insisted on "non compete" clauses in the contracts the doctors could not remain and simply open private practices in Portsmouth but they had to move at least 25 miles away. Portsmouth lost neurology, pulmonary, endocrinology, hematology/oncology among others.  And it lost multiple primary care practices It was called "the purge." 

Hearing about Rochester, all Mad Dog could think of was what happened at Portsmouth.

They are doing the same thing to Rochester they did to Portsmouth. 

At least, that's the way it looked from afar. 

Mad Dog did keep in touch with one of the few primary care doctors who remained at Portsmouth, who told him about "Tony," the manager who Ben had been schooling.

"Wow," the PCP had said  to Tony, "You've lost fourteen practices. You must be feeling the heat from Nashville. You hardly have any practices left to manage any more."

"Oh, no. I'm a hero down in Nashville," Tony told him. "I've cut down so much on overhead up here." 

"Well, if they eliminated all the practices, they could cut overhead to zero," I told the PCP.

"That might be their plan. They apparently think the real money is in level three hospital medicine. Out patient practices don't have enough procedures so they'd rather get rid of those. The next big thing is emergency care, trauma and ICU care. That and residency training programs."

"Residency programs?" Mad Dog asked. Residency training programs have been, for the most part, confined to university teaching hospitals where full time faculty taught interns and residents of the next generation how to care for patients based on the research and practices of a teaching faculty. 

But now, apparently, there is money from the government for teaching residents in the community hospitals, like Portsmouth, where there are patients but no faculty. At my residency training program, at a large university hospital we had 30 departments with chairmen, faculty and research projects. Faculty made rounds on all our patients, taught us at the bedside and at formal lectures.

At Portsmouth Regional Hospital, the faculty consists, far as Mad Dog can tell of a single physician whose academic credentials are, to put it generously, anemic.

"What kind of training can these residents get at this hospital?" Mad Dog asked the PCP.

"What kind of residents can these training programs get?" the PCP asked. "Mostly, they are graduates of foreign medical schools or American schools of osteopathy or places you never knew existed."

"So why would the corporation want anything to do with this?"

"There's money in it," the PCP said. "That's the game."

Hampton, New Hampshire Establishes The Catholic Church as the Town Church

 

Fans and readers of Mad Dog will by now know that the town of Hampton has, every year for the past several years, voted to establish the Catholic Church as the town church by way of voting to award a tithe to the Church from town accounts.

Mad Dog has pointed out to anyone who will listen that this is establishment of a state religion, which is forbidden by the establishment clause of the First Amendment. Because the federal government cannot write checks to churches, by the Supremacy Clause (Article 6, Clause 2) no local government can do what the federal government is forbidden from doing.

But there is law and then there is practice: Until someone forces the town to comply with the Constitution, the town is free to violate whichever of the articles or amendment the town pleases to violate.

Mad Dog has contacted all the folks you might think would be interested: the American Civil Liberties Union (no response at all) and the organization Americans United for Separation of Church and state. 

The lawyer from AUSCS (aka AU) responded that if the church used the funds for strictly non religious purposes, there would be no problem. He was quite emphatic on this point, as settled law, and he is sure how the Supreme Court would rule.

Here is a representative email:

First, AU has not “failed to respond” to your requests.  I personally emailed you three months ago, explained the law, and told you that I would need to know more about what the funding was specifically being used for.  Without that information, it’s not really possible for us to determine whether this is a violation or not.  It might be!  It might not!  This answer isn’t going to change even if you email every single staff member and email address you can find on our website, as you seem determined to do.  Find some more specifics on the funding, and we will be happy to take a deeper look at it.

 

Second, you keep bringing up Justice Jackson’s dissenting opinion in Everson.  I’m going to assume that you aren’t a lawyer and explain something that may not be obvious: dissenting opinions have no precedential authority.  No court in this country is allowed to use Justice Jackson’s dissent as controlling authority, save the U.S. Supreme Court, which will not do so.  You may find Justice Jackson’s opinion to be well-reasoned, compelling, and utterly convincing, but until a majority of the U.S. Supreme Court overturns Everson’s majority opinion and adopts Jackson’s reasoning, it is not the law.  Whether or not you think Everson’s majority opinion is correct is irrelevant. 

Of course, the lawyer for AU is quite correct: Mad Dog is not a lawyer.

Justice Jackson's dissent likely has no "controlling authority." 

But let's look at the case this way: Precedents in cases brought to prevent towns from supporting churches with money have been concerned with a different set of circumstances, as in Everson. The Court has found that when a town makes funds available to students or children in a town, say for bus transport to school or for playground equipment repair, the town cannot deny use of town funds to church schools simply because they are connected to a church because the town has to provide services and repairs equally to all children in town regardless of their religious affiliation.

Fair enough, so Everson does not apply to the current Hampton case for 2 reasons: 1. Jackson in saying support of a church school is the same as support of the church which encompasses the school is a dissent not a majority opinion.  2. In the case of Everson a service provided (school buses) was supported for all students.

But in the case of Mad Dog v Hampton, the money is not for a service provided for all Hampton children, only for those who attend the church school.

Suppose, for example, the town of Hampton decided to buy a boat to rescue swimmers in trouble off the Hampton Beach shore. No problem there: a service for all the town's people funded by taxpayer funds.  But then, the Church of the Miraculous Medal/Sacred Heart School decides it wants to launch a rescue boat and it gets the money for the boat from the town of Hamtpon account. Now, the church uses its rescue boat to rescue drowning Catholics only, not drowning Protestant, Muslims or Jews. 

Would you have a problem with that? Well, the Church argues, our mission is to care for our flock, our Catholic flock, and we like our boat for that purpose.

Now the lawyer for the Americans for Separation of Church and State argues, well, if the money was used for non religious purposes, say painting the boat, or buying better oars or a walkie talkie for use with the lifeguards on shore, no problem. Only if the boat is used for sermons delivered from the boat as it patrols the beach would that be a problem the AU would be interested in involving itself in. 

And one last thing:  The fact that a truth is contained within a dissent does not make it less true. If,  in fact, distinguishing a church school (whose main purpose in life is to promulgate faith) from the Church itself, is like drawing a distinction between the jet engines and the jet. If the town pays for the jet engines for the papal jet, but not for the jet itself, would you still say we have no "controlling authority"?

To the Editor:

The Sacred Heart School community would like to extend a sincere thank you to the Hampton voters and Seabrook voters who supported our child benefit service (CBS) funds article. The yes vote from the Hampton voters on the warrant article guarantees Sacred Heart School’s continued support for the Hampton students. The no vote from Seabrook was close and we hope for success from the Seabrook voters in March 2020.

These funds are applied towards non-religious textbooks, school supplies, technology, testing materials and school nurse services and supplies for our SHS students that reside in Hampton.

We’d also like to express our gratitude to the budget committees and school boards of each town for recommending and supporting the CBS funding for the Sacred Heart School students from each respectful town.

A sincere thank you for your continued support.

Teresa Morin Bailey

Principal

Sacred Heart School

Government Doublespeak and Abundance of Caution: FDA Approval of Covid Vaccines

 

                                                                          

Obadiah Youngblood

                 

Today's New York Times carries a letter to the editor from Peter Marks, director of the FDA's Center for Biologics Evaluation and Research, the group which gives or withholds approval for new drugs or vaccines.

He says:

"Any vaccine approval without completion of the high quality review and evaluation that Americans expect the agency to perform would undermine the F.D.A.'s statutory responsibilities, affect public trust in the agency and do little to help combat vaccine hesitancy.

This approach helps to ensure that the F.D.A. has all the available data from clinical studies and provides the public with trust and confidence in the quality, safety and effectiveness of any vaccine that the agency approves." 

So what is the FDA saying here? We do not yet have confidence in the quality of the vaccines? Is it saying it has doubts about the safety of the vaccines?  Or is it saying something very different: That the jury is still out about the safety?  Is it saying "we are the jury and we are still deliberating?" Which is to say: we haven't heard enough yet to make a judgment.

And if the FDA says it is still unsure of the safety, then why should any citizen or parent be willing to take action and get the vaccine? 

Reading this I thought immediately of a conversation I had with a patient and his wife yesterday when I asked why he had not got his vaccine and he said, "It's not FDA approved."

He was angry at me because I refused to see him in the office because he was not vaccinated. What he argued, of course, was I was insisting he take a vaccine which even the federal government had not yet said was safe and effective. He was correct, too. The FDA has not yet given it's seal of approval, so how could I as an employee of a private company, or a public hospital insist employees of the health care facilities or patients being treated there take a vaccine not yet certified as safe?

We have a dietician in the office who refuses to get vaccinated for the same reason.

Of course, if you probe a little more, you understand this is just a legalistic argument which fronts for a world of conspiracy theory, the government-always-lies and Hillary- runs-a-pedophile-ring thinking, but it is difficult to deny the government is saying the FDA watch dogs have not yet become convinced this vaccine meets all the safety requirements.

Is should not be lost on anyone that the very same people who now point to the FDA, who so vociferously claim "The FDA has doubts, so should we!" are the people who in the next breath will tell you you cannot trust anything the government tells you about anything. (As my patient did, in the next sentence. So he believes the government--the FDA--when it suits his paranoid view, but not when the government says something which conflicts with his paranoid view, like wearing a mask and avoiding indoor crowds is a good idea. Government taking my freedom!)

A letter from a professor of pharmacy at the University of Maryland appearing in the British Medical Journal says, 

If the FDA listens to us, they won’t give serious consideration to approving a covid-19 vaccine until 2022. Our first request is that the FDA require manufacturers to submit data from completed Phase III trials—not interim results. Trials by vaccine manufacturers were designed to follow participants for two years, and should be completed before they are evaluated for full approval, even if they are now unblinded and lack placebo groups. These Phase III trials are not simply efficacy studies; they also are necessary and important safety studies (as the study titles say), and all collected data remain invaluable.

We also call on FDA to require a more thorough assessment of spike proteins produced in-situ by the body following vaccination—including studies on their full biodistribution, pharmacokinetics, and tissue-specific toxicities. We ask the FDA to demand manufacturers complete proper biodistribution studies that would be expected of any new drug and request additional studies to better understand the implications of mRNA translation in distant tissues. We call on data demonstrating a thorough investigation of all serious adverse events reported to pharmacovigilance systems, carried out by independent, impartial individuals, and for safety data from individuals receiving more than two vaccine doses, in consideration of plans for future booster shots. We ask the FDA to request necessary studies in specific populations, including those previously infected with SARS-CoV-2, pediatric subjects, and those with immunological or other underlying medical complexities. Given the nature of the novel vaccine platforms, our petition asks for experts in gene therapy to be included among the external committee advising the FDA.

What all this is saying is there may be troubles with the vaccines which do not become apparent for two years.

Photo: Mary McCarthy

Of course, as Charity Dean, MD, the intrepid public health officer of Santa Barbara, California noted, by the time the CDC was ready to act, anything it decided to do would be too late. She was speaking about a variety of actions she needed the CDC to take during the first weeks of COVID 19 rampaging on the West Coast,  like allowing and approving tests to detect COVID 19 which had been created at a University of California (SF) lab which she needed immediately to track and trace the epidemic, and to prevent it from spreading. She ultimately forbade her staff to deal with the CDC because that institution was worse than useless, acting like a university which was only interested in science, in proceeding, plodding through to an answer with unassailable results when people were dying in California and the public could not afford to wait for the results of a scientifically pure study. 

Charity Dean, MD

When a fire is raging along the street, you cannot wait to open the fire hydrants and hook up the hoses until the inspection tags on the hydrants have certified there are no leaks in the hydrants and the water used is free of environmental risks.

August Macke 

When Alexandre Yersin developed a vaccine against the Black Plague (Yesinia pestis) at his clinic in Vietnam in 1895, he did not submit it to an FDA panel. People were dying all around him and he saved the village of Nha Trang.

The FDA has faced the need for urgent action since at least the HIV epidemic, when people dying of a lethal disease demanded it allow the use of AZT early on, because if it took 2 years to be sure it was safe and effective thousands would die who might have lived. So the FDA made an accommodation, as it did with the "Emergency Use Authorization" for the current COVID vaccines.

The EUA was issued because the FDA and the CDC realized the country did not have the luxury of time.

But now we have people saying "Well, if there are still questions about the vaccine in the mind of the FDA, why should I risk taking it or allow my kids to take it, if 2 years from now something bad may happen?"

What you want to ask the pharmacists who wrote the BMJ is: what exactly do you expect might happen in 2 years?  The experience with the swine flu vaccine comes to mind: In 1976, after 100 million people were vaccinated for swine flu to head off what was expected to be a devastating pandemic. 300 people got Guillain Barre syndrome, a sort of month long polio like paralysis. This is the classic example of a fools rush in scenario which actually is not what it has been said to represent. 

The fact is swine flu itself causes Gullain Barre, and by the numbers fewer cases were seen in the vaccinated group than in the non vaccinated group; so far from causing GB, the vaccine may have protected against it. But the big fact is that apart from one vaccine, every adverse effect of vaccines going back to the first vaccines occur within 6 weeks of vaccination, so a 2 year waiting period is not justified by experience.

The exception is the vaccine against Respiratory Syncytial Virus in some patients actually enhanced the severity of disease in some children receiving the vaccine rather than diminishing the severity of the disease. This remains the cautionary tale of vaccinology, but nothing like this has been seen in COVID vaccination and we have had enough time and cases to see it if it occurs.

Obadiah Youngblood 

The pharmacists who authored the letter asking for delayed approval until 2022 wanted to see more data on "bio-distribution" of the vaccine within the body, which is nice to know about most drugs: does the drug cross the blood brain barrier, does it get into the gut, does it penetrate the heart? But what practical difference could this information possibly make in the decision to deliver the vaccination to a population? There is an old clinical adage: Don't do a diagnostic test if there is no therapeutic implication. The same applies here, mostly. Yes, we need to continue to study what happens long term to patients getting the vaccine, just as we do "post marketing" studies on most drugs, to see if 5 or 10 years later we see things we hadn't expected.

Metformin, a diabetes drug, has been used since 1969 but only in the past few years has it been recognized it may have an anti-cancer effect; cholesterol lowering statin drugs may increase bone density. Who woulda thunk?  Does that mean we should have delayed the use of metformin or statins until we knew these things?

But these are drugs which are taken every day for years; the vaccines are administered but once or twice. Of course, vaccines interact with the immune system, which is a memory system, and which, hopefully will continue to have ongoing effects.

The fact is, we have loads of examples of the good things vaccines do: Measles killed more than many battles during the Civil War; influenza killed more people in 1918 than all the battles of World War I; diphtheria, tetanus killed thousands and are now seen only in the unvaccinated. And even today, the images of wards filled with children in iron lungs keep the idea of polio vaccine fresh.

TWiV Team

In fact, polio was rushed to market far more precipitately than COVID vaccines. Jonas Salk gave it to himself and his children without FDA approval. The first polio vaccines were "inactivated" or "live" viruses and there was an incident where one factory failed to inactivate the virus enough and children given the vaccine got polio. Even the oral vaccine, which lives in the guts of its recipients can "revert" back to virulent polio occasionally, and there are some vaccine associated outbreaks of polio, but rarely.

No thing made by man is without potential for failure or mischief.

So what does the FDA mean when it says it would be failing in its mission if it gave approval before all the usual steps had been completed? Is this not an agency publicly stating it cares more about "Cover Your Ass" than about the public health?

As far as I can see what the FDA is saying is "Our mission is not public health. Our mission is to certify the safety and efficacy of the drugs presented to us, dispassionately, without regard to the urgency or need for action. But once our seal of approval is affixed, you can be sure the vaccine is safe. If thousands die, awaiting that process to play out, that is not our concern. We are focused on one thing, not the other."

If we approve of that fire hydrant, then when the firemen hook it up we and they can be sure the hydrant will work, the water flowing out is clean and when you shut off the hydrant, it will stop. 

Nice to know. 

But when your house is on fire, all you want is access to that hydrant. 

American Babylon

 

"It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way – in short, the period was so far like the present period, that some of its noisiest authorities insisted on its being received, for good or for evil, in the superlative degree of comparison only."

Tale of Two Cities, Dickens

Attention Deficit Disorder can be a blessing.

 In Mad Dog's case it means he cannot simply read one book at a time but he reads several, switching back and forth, interspersing with viewing TV shows, reading newspapers, listening to talk radio, so his brain is like an orbiting satellite, constantly bombarded by gamma rays, space junk, random asteroids. And out of this comes a sort of stew of ideas, which occasionally coalesce into a coherent thought, however briefly.

Recently, Mad Dog has read "Before the Deluge," --a book Linda Ronstadt gave Jackson Browne to read in 1974, oddly enough, but that is totally irrelevant to today's blog post, just an interesting random ADD thought--and he's read Michael Lewis's "The Premonition" and he's gone back to watching the fantastic German series, "Babylon Berlin" and he visits Twitter whenever he gets twitchy and he's read "The Great Influenza" about the dysfunctional American response to the influenza pandemic of 1918 which killed more people than all the bombs and bullets of the war which preceded and helped spread it. And he's re-read parts of the Constitution and he's thrown in a little Jill Lepore ("These Truths" and her excellent podcast "The Last Archive.") 

And out of this has come a unifying vision, or, one might say, a glimmer of a fever dream.

World War I happened at a time when empires organized the planet in some ways and it spelled the end of some of those empires, the fall of German monarchy, and the winning side were semblances of democracies (America, Britain, France) but that war really did not finish the job; the armistice which ended the military shelling was simply a pause between rounds of fighting, when the fighters returned to their corners to be patched up and watered. 

The interregnum from 1918 until 1939 did not much change governments or attitudes in the Allied states--America, France, England went back to business more or less as usual and America held the debt of their allies and of Germany, more or less as the banker controls his debtors. 

Germany during these years was by  far the most interesting place, as it underwent the greatest changes and faced with the greatest challenges, it did the most interesting thinking and acting. It's monarchy was deposed, and a new Republic emerged, struggled to be born, or as Dylan would say, "It's dying and it's hardly been born."

There was, of course, no one Germany: there was rural (peasant) Germany, the Germany of Berlin and other cities and there were violent divisions between alternatives: Communists (with a stronghold in Berlin), monarchists and fascists.

Berlin during the Weimar Republic (1919-1933) was as much like America today as we have ever seen any other historical analogy: pulsing with great scholars and scientists (Einstein, Heisenberg, Bohr) artists (Kandinsky, Klee, Ballhaus), movie stars (Marlene Dietrich et al), philosophers (Heidegger, Wittgenstein) , writers (Thomas Mann, Eric Maria Remarque) and a cabaret scene which allowed for gay nightclubs and heterosexual free love, paid sex, gender bending. Berlin was magnetic, pulling Isherwood, Auden, a slew of British, American and Russian expatriates. Hemingway and his crowd in Paris had nothing on Berlin.

If Americans know anything about the Weimar Republic's brief life it is the images of people hauling s wheel barrels of nearly worthless Deutschmarks to buy a loaf of bread during the hyperinflation of the early days. But the economy actually stabilized after a few years.

No, what killed the Weimar Republic was structural flaws:

1/ Like any Republic the elected government reflected the flaws in the population which elected it. And most people do not want to live and breathe politics. They want their government to function like their water heaters and automobiles--just turn on; do the job and let me enjoy hot showers, easy transport and live my life. 

And the Weimar had an unwieldy structure: A President who appointed a Chancellor, a Reichstag parliament which could be dismissed by the Chancellor any time he did not like the make up of the representatives.  Like the American Constitution, its flaws could be exploited. The American Senate, of course, represents not people but territory and borders drawn on maps, so that 40% of the voting citizens in the country claim somewhere between 50-60% of the Senate seats. And the Senate forms the Supreme Court, so 2/3 of the government can be controlled by a 40% minority of the citizens. The resentful rural vote suppresses the 60% urban population which wants a government which functions and which believes in cooperation among people rather than picturing itself as the lone cowboy or the plantation owner. 

2/ Deep divisions in belief tore at the cohesion of society:  If you have half of the country believing Black people are subhuman and are happy as slaves, you are going to have trouble forming any government which gives voice and form to that belief. In Germany's case, there were those who believed an authoritarian government, with a king/Kaiser would provide reliable law and order and there were Communists who believed government should and could provide for justice, prosperity and spiritual purity and there were the fascists who believed in various things, but ultimately believed in just one thing: Hitler.

Nobody could bring all these oil and water elements together into an emulsified mix, so they got Hitler.

Trump & Company clearly recognized the likeness between Weimar and America today. Trump aped everything from the pouting image of Hitler to his insistence on simplified messages, to his long harangues about how how everyone--except his true believers--is out to get him, to the Big Lie, to the use of scapegoats, to the embrace of fear of the other, white supremacy and the Republic of Anger. 

During Weimar there was one phenomenon we have not yet seen in America: assassinations. There were roughly 400 political assassinations during Weimar and  of those 400 murders, only about 20 murders were of right wing politicians and those murderers were swiftly punished. But virtually none of the fascist/monarchist murderers of left wing politicians were punished for their acts. 

When Hitler finally took over, in 1933, having bene duly elected, he massacred the leadership of the SA faction of the Nazi party, the storm troopers, whose leadership contested Hitler's control of the Nazi party. The SA had 300,000 men under arms, more than twice that of the German army. Hitler purged his rivals in the Party and consolidated his control, much as Mr. Trump is doing now, without the physical murder (yet.)

Reading through "Before the Deluge" and watching "Babylon Berlin" it all looks so familiar.  Mad Dog has long thought the Germans, although they speak another language were much more like Americans than the British or the French.  Reading "Band of Brothers" and other military memoirs Mad Dog was struck by how often American soldiers commented on their dislike of the French civilians they encountered as they swept across Europe. They liked the Dutch but not the French, except maybe some in Paris, but they liked the Germans, who were apparently more concerned about cleaning up, being tidy and orderly. Well, some soldiers were partial to the Germans; some remarked that they kept running into Germans who insisted "Nicht Nazi"--not Nazi"--and as David Webster said, "It's remarkable: We've been across 500 miles of Germany, countless towns and villages, and we haven't met a single Nazi in Germany yet!"

But, reading about Berlin during the Weimar (1919-1933) the Germans seem so much like us. Anyone who has ever lived for more than a month in England knows the English are not simply Americans who talk funny. They are very different from us.  You have to love the Scotts and the Irish, but they are not us, either. The Germans, much more like us. And reading about how they rejected democracy eventually is a little creepy. 

Minimum Wage: Minimum Gain?

 Listening to the Freakonomics podcast on the minimal wage, Mad Dog experienced the delight of being pulled first in one direction, then the other, as if the winds shifted with each speaker in a lovely debate.

August Macke

Bernie Sanders has been hammering away at the minimal wage since forever and Mad Dog had simply accepted this was simply a matter of economic justice, of doing something to assuage some economic injustice on behalf of those at the bottom of the economic ladder, the immigrant working three jobs to pay the rent, feed the family.

And Mad Dog has dismissed out of hand the idea that those storied "job creators" would simply pack up and go home if they had to pay $15 an hour to their employees. What MacDonald franchise owner is going to shut down his shop over paying that sort of wage?

But then, Mad Dog had pause. Mad Dog once ran a small business and he had one employee. He had to pay a contribution her Unemployment insurance required by the state, Social Security and in order to have a simplified employee pension plan for himself, he had to pay into a plan for her.  And he paid into an "Injured Workers Fund" and there were several other assessments Mad Dog cannot even recall at this point, which the state required Mad Dog pay into for the privilege of having an employee. At one point Mad Dog asked himself: Did I hire an employee or adopt another child? Mad Dog's profit margin was perilously thin for at least a dozen years and increases in insurance rates more than once threatened to scuttle his entire enterprise, not to mention increases in office space rent. He was enormously relieved and happy to not have to be an employer when he finally got a real  job with benefits, after 27 years as a small business owner.

August Macke

But Mad Dog always paid his empolyee more than minimal wage. He had to. Without her, he simply could not run his business. She was valuable and he didn't want her to be hired away and right within his own building there were plenty of other small business owners who would have been happy to do that. So Mad Dog paid for a parking space in the building for her and he gave her a two week bonus at Christmas and he advanced her a loan for the new car she bought every 3 years.  And he felt good about that pension, after a while, because she was married to a no good derelict and that was the only way she could make it, that plus Social Security when she retired and she was 40 when he hired her. Of course, best laid plans--Mad Dog discovered her no account husband had raided that retirement account so he could buy himself a brand new Ford F 150 truck. He claimed he needed it because he had a part time gig delivering flowers. But that's another story.

August Macke

Back to the debate: The economists arguing against the minimal wage increase did not try to say small business owners would shut down rather than pay higher wages. There was some evidence that happened for certain marginal businesses, like the pizza shop or the dry cleaners, but what they did argue was this: The guy who bears the burden of the minimal wage increase is the guy least able to afford it: It's the guy running a small business like the coffee shop, the barista, the flower shop, while the guy at Golman Sacks couldn't care a whit about an increase in the minimum wage. And Mad Dog thought of his own experience: yes, he was one of those marginal "job creators." And there was some data, although it's devilishly difficult to tease out, showing there were some job losses associated with raising the minimum wage in some states. 

August Macke

But if those who do get the higher wage are benefited and now can work only one job, does that not mean the economy and the people are better off as the jobs that do survive can pay a living wage?

Actually, two problems with that. The higher minimum wage only raises the real, expendable income by about 9%, so the change in life for the wage earner is not affected as dramatically as Mad Dog assumed.

The other problem is who are the minimum wage earners? A lot of them are teenagers, whose income may or may not be critical to the family income. Some percentage are the children of privilege, just looking for extra cash. We are not talking about the minimum wage eliminating poverty there.

Obadiah Youngblood

And for some small businesses this means they will only hire experienced employees rather than first job teens, if they have to pay higher wages. The teenager who may not show up for his shift because the job is not critical to his life is not a good bet. But some of those no experience hamburger flippers do need the job to put food on the table and they are locked out.

August Macke

The argument for higher minimum wage to fight poverty is hurt by the observation that most families living in poverty have nobody in the family working. For these families free or low cost day care would make more difference. Or a guaranteed income. But not $15 an hour for a job nobody in the household even has.

One proponent argued that if businesses operating on such a tight margin they could not afford to pay $15 an hour then maybe they should not be in business at all, sick little businesses with no long term prospects--the laundry, the car wash, the coffee shop, the pastry shop. Our own downtown in Hampton has had a succession of business along High Street and Route One which, when they opened, selling surfboards or comic books or board games based on great battles in history or vacuum cleaner supplies or flannel garments or knick knacks in a gift shop, everyone in the neighborhood started up a pool to guess how many weeks those places would remain open.

August Macke

In the end, Mad Dog came away thinking exceptions could be carved out: The big one is for restaurants where the owners ask for an exception for waiters who get twice in tips than the salary they receive. Or maybe for a company with fewer than 20 employees. 

One thing Mad Dog came to accept: Bernie's $15 an hour will not make all that much difference this economy.  Day care, cheap and available, transportation public and low cost and maybe some tax credits for the poor may make a difference but the minimum wage is not much of a solution.