Scott Atlas’ book, “A Plague Upon Our House.”

I read this book this week and found a good book review in “City Journal,” titled “Three Blind Mice.” Atlas began as an academic neuroradiologist and then transitioned to a 15 year career as a health policy researcher. I did something similar when I was forced to retire at age 55 with an old back injury. I spent a year at Dartmouth learning methodology and biostatistics. I don’t know enough about Atlas’ story to know if he did something similar. Quite a few academic physicians have done similar transitions, especially as they get older.

In Atlas’ case, once he was recognized by the Media, he was immediately denigrated as “a radiologist.” He was also labelled as “not an epidemiologist.” It did not matter that none of the other three MDs on the Task Force was an epidemiologist, either. Atlas was in contact with many epidemiologists who were feeding him data and statistics.

He found the “Three Blind Mice” of Birx, Fauci and Redfield were uninterested in data or the scientific publications he kept bringing to the meetings. Eventually, he gave up going to the meetings. He found Trump receptive and he agreed with Atlas’ program of protecting the high risk population, especially nursing home residents, plus others with pre-existing conditions, one of which has turned out to be obesity. He blames Trump and his team for being afraid to sack Birx who was the one telling all the Governors to lock down their states. As he says in conclusion, “It didn’t matter. They still lost the election.” They feared a firestorm in the press if she was demoted.

Atlas was in despair as they continued to emphasize testing the asymptomatic and neglect the nursing homes where almost 50% of the deaths occurred. The psychological and economic damage from the lockdowns may last for years. Masks are useless and he quotes many studies to prove it. The one study quoted by Birx all along was based on two beauty parlor employees. That was it.

In the end, he quit after the election although Trump wanted him to stay. He continued to communicate by email. He describes the insane abuse he took from the Media and may spend a little too much time on it in the book. Some professors at Stanford (not the epidemiologists) sent out an email letter attacking him for working with Trump.

He has one section about Florida Governor DeSantis who, he writes, was already familiar with the literature and who implemented most of Atlas’ policies on his own. I remember the Media attacking DeSantis when he set up treatment facilities at a large retirement community, accusing him of treating supporters first. He was following the science they ignored in their identity politics frenzy. Florida could have been as big a disaster as New York with their huge senior population. The fact that DeSantis followed the science and not the Media prevented that outcome.

Other books are beginning to come out now but this one seems authentic by an insider. Here is the book at Amazon. I read the Kindle version. The hardcover came out a few days later.

Medicine and Obama’s Third Term.

Obamacare changed American Medicine forever. I am becoming convinced that was a major purpose. Since 1978, Medicine and doctors have become the most regulated sector of the American economy.

Five years ago, I predicted one consequence. A doctor shortage. Why ?

A few years ago, it was reported that 10,000 doctors were leaving UK every year. How has the NHS dealt with this shortage?

By importing third world doctors.

The UK’s National Health Service (NHS) will soon begin a major campaign to recruit health workers from other countries to meet growing staff shortages.

Reports suggest a strategy has been drawn up to target a number of countries around the world, including poorer nations outside Europe.

One estimate in March this year said the NHS will need 5,000 extra nurses every year – three times the figure it currently recruits annually.

But what about the countries that it will recruit from – what impact will it have on them?

Where do non-UK staff come from?
The NHS already recruits globally to meet its staffing needs.

More than 12% of the workforce reported their nationality as not British, according to a report published last year.

How are we dealing with our doctor shortage ? By adding “Practitioners” instead of doctors.

How did this begin? In 1978, a new federal program was created called “Professional Standards Review Organizations.”

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A Corona Virus Timeline.

It is now becoming a theme on the left that Trump was not quick enough to recognize the coming epidemic.

For that reason, I think it valuable to keep a record of the time line.

Here is the January 12, 2020 WHO report on the virus epidemic in China.

The evidence is highly suggestive that the outbreak is associated with exposures in one seafood market in Wuhan. The market was closed on 1 January 2020. At this stage, there is no infection among healthcare workers, and no clear evidence of human to human transmission. The Chinese authorities continue their work of intensive surveillance and follow up measures, as well as further epidemiological investigations.

Here is the January 30, 2020 report by WHO on the epidemic in China.

The Committee believes that it is still possible to interrupt virus spread, provided that countries put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures commensurate with the risk. It is important to note that as the situation continues to evolve, so will the strategic goals and measures to prevent and reduce spread of the infection. The Committee agreed that the outbreak now meets the criteria for a Public Health Emergency of International Concern and proposed the following advice to be issued as Temporary Recommendations.

The Committee emphasized that the declaration of a PHEIC should be seen in the spirit of support and appreciation for China, its people, and the actions China has taken on the frontlines of this outbreak, with transparency, and, it is to be hoped, with success.

Trump stopped incoming flights from China on January 31, 2020.

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It is time to start the economy again.

I have previously described the COVID 19 virus, which is also referred to as Wuhan virus, to the annoyance of the China friendly US Media. The consequences for the US economy have been severe. The most affected states, New York, California, Illinois and Washington, have virtually shut down their population. Arizona is less affected with 78 positives cases as of today, and no deaths.

Italy and China have had the most deaths. There are a number of factors that probably affect these cases. China is notorious for air pollution and smoking, especially men smoking. There has been a dearth, so far, of listing comorbidities but age has been a major one.

One study lists mortality at age 80+ at 15%. The overall death rate in China was listed at 2.3%, which may reflect smoking and air pollution. South Korea, which has had a big spike as testing progressed much more rapidly than in the US, has a case mortality of less than 1%

South Korea has the dubious distinction of suffering the second-highest number of Covid-19 infections after China – but can also boast the lowest death ratio among countries with significant numbers of cases.

According to the WHO on March 6, the crude mortality ratio for Covid-19 – that is, the number of reported deaths divided by the number of reported cases – is between 3-4%. In Korea, as of March 9, that figure was a mere 0.7%.

AS US testing finally gets going, after the FDA and CDC delayed matters for a month, we will see a big spike in number of cases but, I am convinced, a big drop in mortality rate.

Telephone consulting services, drive-through test centers and thermal cameras – which, set up in buildings and public places to detect fever, swiftly came online. South Korea has undertaken approximately 190,000 tests thus far, according to KCDC Deputy Director General Kwon Jun-wook, and has the capacity to undertake 20,000 per day. Turnaround times are six-24 hours.

Tests are highly affordable. “The test kit is about $130, and about half is covered by insurance the other half by individual,” Kwon said. Those who test positive get the test free, “So there is no reason for suspected cases to hide their symptoms,” he said.

We should be doing the same.

At the same time, we are risking severe economic damage to the country by shutting down business activity. I believe that much of the drastic steps taken by governors, especially in New York and California, is unnecessary. High density cities like New York City and Chicago may have more reason to fear spread of the virus. Most of the country, a source of annoyance to left wing politicians, is of low population density.

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Russia to healthcare in one day. What now ?

Last Friday, the Mueller report was submitted to the DOJ. Monday, left wing media saw ratings collapse.

What next ? Why Healthcare, of course.

Obamacare, which is a form of expanded Medicaid, costs too much and provides too little care (high deductibles) unless you are a Medicaid recipient. It was designed to shift costs to the insured from the poor. It also was a gift to certain sectors of the healthcare industry. Ted Kennedy criticized healthcare as a “cottage industry” with lots of independent doctors doing their own thing as small businesspeople. That is why doctors have traditionally been conservative. Obamacare changed that. Healthcare is now an industry with doctors mostly on salary and controlled by administrators.

I talked to a young ophthalmologist last week, who had treated a mild eye disorder. He told me he moved to Tucson to work at U of Arizona medical center, which used to be called “UMC” by everybody in Arizona. He explained that the UMC administrators had gotten deeply into debt installing a new “Electronic Health Record” system and sold the UMC to Banner Health. This is a chain that runs the former UMC and has seen an exodus of university faculty physicians. Even my barber noticed. He told me several weeks ago that his surgeon, who had operated on him, got tired of constantly being told he only had 15 minutes to see each patient and left for the VA. The ophthalmologist was disappointed as he had looked forward to working at the academic center.

Traditionally, administrators hated doctors. We made their lives more difficult by advocating for patients. I once told an administrator that if the hospital did not reduce the markup on pacemakers, I would testify for the patient if they sued him for the balance of the bill. They didn’t like it but knew I could go elsewhere,and take my patients there. If I had been an employee, I would not have that choice. Several years ago, I explained how we started a trauma center in our hospital. Since then, the hospital has been sold to a non-profit run by nuns. The surgical group that ran the trauma center for 35 years was fired two years ago. They had declined to sell the group to the hospital. They were replaced by six female surgeons no one had ever heard of and who had never applied for privileges at the hospital or been evaluated by the Surgery Department. No one knew anything about them except one member of this new group had applied for a job at the trauma group and been turned down.

There were a few comments about some less satisfactory results on trauma cases but that has quickly gotten quiet.

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