Trying to Make Sense of the World We Live In

Michael Baumgartner, a professor of Orthopedic Trauma at Yale University, has provided one of the most important discoveries to orthopedic surgery in modern history. For several decades, avoiding failure in intertrochanteric hip fractures was an elusive conundrum, and it required several decades of compounding information to finally discover the most significant variable associated with implant failure in this common injury. Certainly there are multiple variables associated with fixation success, but his discovery has provided the most profound impact. Today, we take this elementary information for granted, but to figure out this seemingly simple concept, it required decades of encounters and numerous failures. I have had the opportunity to listen to him lecture; his humility and understanding of our cognitive limitations are profound. He wisely said that, “he feels sorry for his patients 30 years ago and he feels sorry for his patients today;” understanding that every successive decade of orthopedic practice, with rapidly improving knowledge and technology, had given him an entirely new fact pattern required to more successfully and better treat his patients. Ego negatively impacts our ability to learn and creates an environment unfavorable to meaningful progress. There are four categories of cognition: known-knowns, known-unknowns, unknown-knowns and unknown-unknowns. Accumulating more known-knowns and trying to minimize the volume of unknown-unknowns is our intention, but it is a continually fluid process. The more we understand a topic, the more esoteric and elusive mastery of the subject becomes.

The Dunning-Kruger Effect is a cognitive bias describing the correlation between confidence and competence.  People tend to be overconfident in a particular domain with little competence. As the level of competence increases, there is a paradoxical decrease in confidence, as recognizing nuance and complexity generates less certainty and absolutism.  Complex systems are often simplified to help facilitate understanding, but oversimplification does not appropriately appreciate the intricacy of a given system or domain. As an individual, or a collective research field, gain more knowledge about a system, there often become more questions than answers.  

It is imperative to understand that all facts have a half-life. As an example, if I say, “the earth is round,” this fact has nearly an infinite half-life. Likewise, if I say that “my daughter wears a 2T shirt,” the half-life of this fact is much more abbreviated. This concept has been quantified by the Lindy Effect. The Lindy Effect essentially explains that the longevity of a technology or an idea is proportional to its current age. It separates signal from background noise, but only passage of time can expose what is signal and what is noise. As a result of this phenomenon, it is necessary to be open to unlearn or modify our thought processes and be open to the idea that previous conceptions may actually be wrong. Learning is a temporal process without ever being able to achieve mastery. As time passes, our understanding of dynamic systems becomes more accurate because finite facts will change. For example, we understand that subjects exposed to an average of 20 mSv units of whole-body radiation are more likely to develop malignancy (here). Longitudinal studies and econometric analysis were necessary to recognize that the radiation exposure was the most significant variable that led to leukemia and solid tumors, several years following radiation exposure. Biological systems can resist acute stressors, but manifestation of disease may not become evident years to decades after exposure. The longer the period from exposure to disease manifestation, the more difficult it can be to correlate the two variables.

Our brains subconsciously assimilate information from a given trivial concept, even if these inferences cannot ever be corroborated.  The Nobel Prize-winning physicist, Richard Feynman, in his book “Surely You’re Joking, Mr. Feynman,” gives an example: if you are presented with a brick, we can reasonably assume that this is a solid structure in its entirety, but we can ultimately never see inside of the brick to prove it.  Even if we shatter the brick into 1,000 pieces, we are only observing a new surface, never the inside of the brick.  Therefore, we can reasonably assume, through inference, that the brick is solid in its entirety, but are unable to prove this with absolute certainty.  Through this example, he demonstrates that even if we are presented with a trivial fact, “this is a brick,” we often make inferences about these facts based on previous experience without understanding the ultimate complexity of such perceived triviality. Obviously this analogy is inconsequential, but it provides a reference to a level of complexity that is not overtly obvious. As the complexity and importance of certain factual information becomes, avoiding false inferential reasoning is more critical.

Richard Feynman was a theoretical physicist, awarded the Nobel Prize in Physics in 1965 for his discovery in quantum electrodynamics. He had originally worked out an equation for his quantum electrodynamic theory, but when tested in the laboratory, was unable to reproduce his hypothesis.  Feynman took many sabbaticals in his career, many of which had nothing to do with physics. When his experiment did not corroborate his hypothesis, he lost his passion for physics and went to Africa to learn how to play certain instruments and how to create specific sounds with his voice.  Upon his return to America, he was having a difficult time rediscovering his passion for physics.  While he was gone, it was discovered that there was a slight misrepresentation of a constant in Bernoulli’s Equation.  Because he was out of the country at the time of this discovery, he was not made aware that a slight correction had been made in this equation.  After being informed of this correction by a colleague, the recalculation of his theory was now consistent with the laboratory findings which ultimately led to his Nobel Prize.  In this particular situation, his theory had always been correct, but reliance on previous information, that later was found to be slightly incorrect, made all of the difference. 

Developing fact patterns and understanding complex systems is a dynamic process that is always being refreshed with new information. For anybody that has used a compound microscope, there is a course adjustment and fine adjustment that can help bring the object of interest into focus.  As we learn and develop knowledge and experience, randomized controlled trials are akin to the course adjustment, while trial-and-error, pattern recognition and personal anecdote become our fine adjustment.  Both functions are vitally necessary when trying to understand the world in which we live and operate. We make inferences about our observations and the magnitude of variability minimizes as the exposure to number of events increases.

Successful science is a function of passage of time, appropriate interpretation of data and accurate data analysis. It is imperative to avoid confirmation and desirability bias, that will inaccurately affirm an individual’s desired outcome. All information must be considered, both affirmative, and more importantly, negative data. Feynman once said, “The first principle is that you must not fool yourself — and you are the easiest person to fool.” Only the passage of time will provide the necessary information needed to understand how a biologic system will respond to a specific environmental or pharmacologic exposure. Universal, mandatory treatment of a highly complex biological system, without appropriate passage of time is deeply concerning policy. Mandating this treatment in children, with infinitesimal risk of developing severe viral illness, is malicious. If we are to make a truly informed decision regarding consent to receive a treatment, ALL information should be disseminated to make this decision. Delaying the release of this information for 55 years should elicit more skepticism and outrage than our current state.

Medical Biochemistry 101

From my previous posts, I have highlighted the importance of nutrition on human performance.  The typical medical approach for “preventative” illnesses is to provide medications rather than identify and address root cause. There are several reasons for this approach, but the data trends are demonstrating that this method is failing our patients. In my last post, Let Me Be Clear, I had listed many physicians and researchers that have had tremendous success with improving metabolic health through a nutritional approach.  Our ad libidum Standard American Diet (SAD) has significantly disrupted normal intended bodily biochemical processes and created physiological dysfunction. Biochemistry can explain development of many of these processes, which I will highlight in this blog.  Hypertension (high blood pressure), hypercholesterolemia (high cholesterol), type II diabetes mellitus, gout, peripheral artery disease, non-alcoholic fatty liver disease (NAFLD) and obesity all share a common origin. 

There are several genetic disorders (familial hypercholesterolemia , Niemann-Pick Disease, etc.) or other pathological conditions (Cushing’s Syndrome, Multiple Endocrine Neoplasia Syndromes, etc.) that do not follow these patterns.  Fortunately, acquired pathological conditions and genetic diseases are quite rare. As you will see, most of these diseases manifest from carbohydrate consumption, mainly fructose, which is predominant in processed and convenient foods. Interestingly, there are significant subsidies for junk food (and here) and diseases are linked to consuming subsidized commodities. I have mentioned before that the American Medical Association and American Hospital Association are perennially top financial contributors to the federal government in lobbying funds. At some point, we have to question the intent of our medical associations and the federal government.  As patients continue to get sicker and physicians suffering more burnout, with no good answer to reverse any of this, we are headed in a bad direction.

Metabolic Syndrome diagnosis requires having three or more of the following criteria:

  • Large waist: Men with a waistline >40” and women with a waistline >35”
  • High triglycerides: >150 mg/dL
  • Low HDL-C: Men <40 mg/dL and women <50 mg/dL
  • Increased blood pressure: >130/85 mmHg
  • Elevated fasting glucose: >100 mg/dL

Unfortunately, we rarely address conditions for our patients prior to achieving this level of metabolic dysfunction. There are several other subtle laboratory findings that should be scrutinized (some of which the insurance won’t pay for), to assess for worsening metabolic health, prior to achieving fulminant metabolic syndrome. Subtle changes in metabolic health can be assessed through ALT (>25), uric acid (and here) >5.5, triglyceride:HDL ratio (here) , fasting insulin level (>15 mIU/L) and an oral glucose tolerance test (here) to evaluate for insulin hyper secretion (if fasting insulin levels are normal). Our threshold diagnosis for Metabolic Syndrome is akin to our diagnosis of many types of cancers. Many cancers have rapidly advanced prior to their detectability, which makes them difficult to cure.  By the time we have reached the diagnosis threshold of Metabolic Syndrome, the disease has progressed to a level that is difficult to reverse. The strategy has been to identify each of the metrics independently and treat each of them with a medication, failing to recognize a common origin in the majority of patients.

Biochemistry is a discipline of chemical substances and vital reactions in living organisms.  The study is the combination of cell biology and physical chemistry involving sustainment of life. Enzymes, are proteins, used to facilitate reactions, and help to create a homeostatic equilibrium in response to external stimuli.  Some of the most understood biochemical reactions surround carbohydrate metabolism.  Fructose (5-membered ring monosaccharide only metabolized in the liver) metabolism has been demonstrated to be the most disruptive to cellular functioning.  With the addition of high-fructose corn syrup in processed foods that eliminate fiber and add sugar into our diet, our health has not been so poor.  Removal of sugar from the diet ameliorates many of these ailments (given that the patient is not suffering from any genetic disease or other pathophysiological condition leading to inappropriate functioning).

Hyperuricemia, is taught in medical school to come from red meat or alcohol consumption, but this is a small percent of how we create uric acid. Uric acid, the crystals that cause gout, is a byproduct of purine (nucleic acid) metabolism. When fructose is introduced into the hepatocyte (liver cell), it is immediately phosphorylated (energy given in the form of phosphate donation) by adenosine (purine) triphosphate, through the enzyme fructokinase, creating an adenosine diphosphate (ADP).  This ADP is then converted to adenosine monophosphate (AMP) through the adenylate kinase enzyme.  AMP has two destinations, it can either become dephosphorylated by adenosine kinase into adenosine or could be phosphorylated to become ADP and the fate of AMP is reliant upon the activity of AMP kinase (AMPK)which is activated when cellular ATP (energy) is low.  In the fed state, energy levels are high and insulin, in addition to high ATP levels, promotes the creation of adenosine and ultimately metabolized into uric acid (see diagram). Elevated uric acid is intimately associated with increased blood pressure and risk marker for cardiovascular disease by the disruption of nitric oxide synthase and affecting production of nitric oxide that relaxes arterial smooth muscle tone. Disruption of nitric oxide synthase causes vasoconstriction and elevation in blood pressure.

In addition to the increased uric acid production, insulin is an anabolic (promoting growth and proliferation) hormone secreted from the pancreas in response to carbohydrates or, to a much smaller degree, branched-chain amino acids. Insulin stimulates many pathways in the body, promoting energy storage and growth. Glucose storage is the most acknowledged role of insulin, but it also inhibits AMPK, inhibits fatty acid mobilization, promotes fatty acid storage (in the form of triglycerides), promotes glycogen synthesis, indirectly stimulates mTOR (enzyme complex in growth and proliferation) and promotes renal sodium absorption which causes an increase in blood pressure. Although insulin is vital for cellular functioning, too much insulin contributes significantly to diseases of civilization (atherosclerosis, NAFLD, type II diabetes mellitus, obesity, gout, hyperlipidemia, coronary artery disease, etc.). 

There are two types of diabetes mellitus (DM), type I and type II.  Type I DM is characterized by beta cell destruction in the pancreas, leading to hyperglycemia as insulin is imperative to activate GLUT receptors on the cell surface for glucose to gain entry into a cell.  If insulin is absent, glucose accumulates in the blood and cannot be used for cellular energy.  This is an example of internal starvation and ketone bodies are generated from lipolysis (fatty acid metabolism) at such high concentrations, to provide energy for cells, that it can create a decrease in the pH leading to a pathological, sometimes fatal, condition known as ketoacidosis. Giving insulin to these patients (in a controlled fashion to prevent electrolyte imbalance) is life saving. Type II DM, conversely, is a disease characterized by hyperinsulinemia (until pancreatic exhaustion), insulin resistance and obesity.  Obesity is a symptom of disease, not the cause. Insulin is an anabolic (growth and storage) hormone that contributes to energy storage and appositional growth after osseous physeal arrest (closed growth plates). Foods and other stimuli that increase plasma insulin levels will result in growth or fattening. Restriction of such agents will cause the opposite effect. Adoption of a low-carbohydrate, high-fat (healthy fat, coming from real food sources), modest protein diet will ameliorate these conditions, which you will see evidence of from my previous blog (here). 

It has been reported that 88% of the US population is metabolically unhealthy. This number continues to climb by the substances we continue to eat. Packaged and processed food is easy (readily available), cheap (due to government subsidies), quick, has a long shelf life (due to addition of sugar and other preservatives) and is flavorful (due to added sugar). The addition of sugar in the diet, primarily fructose, with the subtraction of soluble and insoluble fiber has led to the health demise of our population and akin to smoking unfiltered cigarettes. The pharmaceutical industry has financially triumphed at the expense of our worsening health, without a reversible solution. Healthy living isn’t achieved by the addition of numerous medications. Health is achieved by the subtraction of the offending agent. With all of the evidence I have presented in my previous blog, Let Me Be Clear, and experienced through my own personal dietary changes, I have no reason to suspect otherwise and the science corroborates this hypothesis. Added sugar and subtraction of fiber from our food creates and perpetuates disease. Even seemingly packaged “healthy foods” have hidden sugar in them as there are 262 names used in processed food and beverages. Until these “foodlike substances” are removed from our diets, we will not be able to adequately address metabolic derangement and the addition of numerous medications will continue to be a game of chasing our tail.

Let Me Be Clear

After disparaging remarks regarding my rudimentary basic science explanations of diabetes mellitus and lipid transport, I was graciously told to “stay in my lane.” I would like to make it clear that I do not treat people FOR metabolic disease, but I treat way too many patients WITH metabolic disease. My practice consists of managing patients with such poor protoplasm that they’re unable to heal wounds or their fractures, which sometimes leads to multiple surgical procedures, delayed recovery and prolonged recumbency. Management of wound dehiscence, delays in wound healing, atrophic nonunions, infected nonunions, wound infections, osteoporosis, osteoporotic-related hardware failure and fragility fractures are all associated with overall poor health and metabolic disease. Failing to realize that these conditions, as well as the myriad medical problems these patients suffer, are a manifestation from a common origin is willfully missing the point. Because of the necessity to address patients’ abysmal metabolic derangement in order to achieve a healing environment for their tissues, this is a lane in which I belong. There are many talented physicians that have dedicated much of their life to helping patients and this is no attack on their practice, I’m suggesting that there is an important nutritional component in which we are all improperly trained. Our training is disease-centric, not health-centric. Patients often do not present to our offices without symptoms, unless they are having their annual exam. With the limited time we have to spend with patients in order to be profitable, we are unable to provide individualized care, unless in a unique clinical setting. Additionally, the remarks also attempted to educate me on the physiology of pancreatic exhaustion as a necessary pathophysiological state that requires insulin. If we fail to recognize that pancreatic exhaustion is not end organ failure from chronic overconsumption of carbohydrates, specifically fructose, then we will never succeed in our quest to obtain optimal health for our patients.

Being an orthopedic surgeon, it is implied, by some, that I do not have the properly enumerated credentials to present a reasonable argument regarding sickening patients and worsening metabolic aberrancy. Choosing orthopedic surgery as a career path does not preclude me from understanding metabolism or health. I currently measure many parameters of my metabolism on a daily or continuous basis with a Dexcom G6 continuous glucose monitor, Lumen (to understand what I’m predominantly metabolizing through my respiratory exchange ratio), Oura ring (for sleep analysis, heart rate variability and body temperature changes as they relate to certain living conditions) and occasionally checking my ketones with a ketometer to ensure that I remain in nutritional ketosis and continue metabolizing free fatty acids, depleting my overabundant fat stores. Orthopedic surgery is my profession, but I have taken a particular interest in keeping myself healthy to avoid chronic conditions that a lot of my patients suffer from. Suggesting that I am in the wrong profession to discuss metabolism is irresponsible as the people making these comments have no idea how much time I spend educating myself about leading a healthy life.  Because I don’t treat lung cancer, chronic bronchitis or emphysema, should I not tell people to stop smoking?

I do not provide this information in haste or without providing reference to the claims that I make. There are a group of individuals that I find very intelligent that provide a wealth of knowledge and research about metabolic syndrome and obesity.  Most of them are physicians, some are researchers, and they have extensive knowledge and expertise in this field.  Here is the list (not comprehensive) with a few of my favorite links to their lectures or podcasts: 

Steve Phinney, MD, Ph.D. 

Jeff Volek, Ph.D, RD 

Sarah Hallberg, D.O., MS 

Peter Attia, M.D. 

Thomas Dayspring, M.D., FACP, FNLA 

Gary Taubes, MS 

Robert Lustig, MD (pediatric endocrinologist) 

David Ludwig, MD, PhD (pediatric endocrinologist) 

Eric Westman, MD (fellowship in obesity medicine) 

David Perlmutter, MD (Board Certified Neurologist and Fellow of the American College of Nutrition) 

Jason Fung, MD (Board Certified Nephrologist) 

Nina Teicholz

Ray Cronise  

Dominic D’Agostino, Ph.D. 

Valter Longo, Ph.D. 

Ronald Krauss, MD (Board Certified in Internal Medicine, Endocrinology and Metabolism) 

Independent researchers from McGill University (in 1994), Harvard University (in 1987) and UCSF (in 1994) all found that cutting 25% of fat in our diets and 33% of saturated fat in our diets, to lower our LDL, would increase our lifespan, on average, from a few days to a few months. Marshall Becker, a professor of public health at University of Michigan suggested that avoiding dietary fat to prevent heart disease is “analogous to stewards rearranging the deck chairs on the Titanic.” I’m not claiming that I’m a nutrition or obesity expert, but I read a lot about it, listen to many experts and follow the true experts in an attempt to increase my lifespan and health span. Gary Taubes’ work is particularly interesting as he has been researching diet and disease for over 20 years.  He has looked at dietary recommendations from a public health, governmental and disease (mainly heart disease) manifestation perspective and how the implementation of carbohydrates (mostly fructose) into our diets have negatively impacted our overall health. His work looks at pre-World War II and post-World War II studies on diet and disease.  The contemporary research doesn’t always tell the whole story.  Ben Hecht, a famous screenwrite/director/journalist said, “trying to determine what is going on in the world by reading newspapers is like trying to tell time by watching the second hand of a clock.” This applies to our concentration on the contemporary scientific studies, but not understanding historical perspectives. 

The term “misinformation,” that has recently been thrown around carelessly, allows people to bury their heads in the sand and avoid understanding, comprehensively, the counter argument. It’s not “misinformation,” it’s simply alternate information that some people choose to ignore because it doesn’t fit the hypothesis they have worked out in their heads. Negative data is more important than affirmative data.  When we are so sure that we are right, we tend to focus on data that affirms our hypothesis/opinion. We call this affirmation bias and we are all guilty of it. To be clear, this blog is my opinion with supporting evidence. I’m not treating patients outside my scope of practice, I’m trying to educate people that are interested in reading what I have to say. They may not agree, and hopefully this will lead to fruitful debate, but not anonymous online attacks without evidence to the contrary, saying that I’m spreading “misinformation.” Citation of my sources I find important so people understand the information in which I base my opinion.  I appreciate all that have taken interest in my blog, positive or negative, hopefully the former is more abundant.

Metabolic Basis of Disease and a Nutritional Solution

We are facing a significant physician shortage by the year 2030. This shortage will be accelerated with vaccine mandates as there are fewer physicians getting vaccinated than the AMA reports. In order to maintain access for the growing number of aging Americans and increasing prevalence of chronic disease, it behooves the government to relax their stance on these mandates in order to maintain reasonable access to medical care for the population. It should be concerning to all that many American’s health condition is in an uncontrollable free fall. When we evaluate our contemporary treatment strategies for chronic disease, from a bird’s-eye view, it becomes quite evident that our efforts are failing. My interpretation of this failure has to do with the inadequate education in understanding pathophysiology and health, in general. Physicians are not formally educated to understand healthy states, we are educated to understand disease states and how to intervene. Our patients seek our service after their disease process has reached an intolerable threshold; then, in most scenarios, we prescribe a treatment to achieve a condition of “less disease,” not reverse its course. Because our education focus is on disease and not health, we are unequipped to provide the ultimate benefit to our patients — restoration of health. 

With the copious and rushed amount of information required to cover in the first two years of medical school didactics, it is impossible to ensure material mastery, or even reasonable competence. Scholastic achievement in medical school encourages rote memorization, not comprehensive understanding. Intoxicated by the allure of obtaining a degree that will lead to a career of fulfillment and a lifestyle of abundance, the former being a fallacious fantasy, the medical educational paradigm often goes unchallenged. Acknowledging and correcting the shortcomings of our discipline will ultimately improve the health and wellness of our patients. Instead, our approach has contributed to slowing disease progression by oversimplifying disease pathology and following some futile metrics with little insight into detailed understanding of pathophysiological processes.

As an example, the standard lipid panel, which includes LDL cholesterol, HDL cholesterol, total cholesterol, and triglycerides is a useless laboratory panel. Colloquially, we know LDL (low density lipoproteins) as the “bad” cholesterol and HDL (high density lipoprotein) as “good” cholesterol, but this understanding is profoundly oversimplified.  Patient’s are instructed that they want to lower their total cholesterol, LDLs and triglycerides, while increasing their HDLs. LDL cholesterol has been identified microscopically in arterial atheromatous plaques and therefore recognized as “bad.” In actuality, LDL cholesterol is vital in providing necessary components to the cellular phospholipid bilayer as well as precursors for production of steroid hormones. Low density lipoproteins provide a package for lipophilic material to be transported in an aqueous medium to peripheral tissues and deposit triglycerides and cholesterol to the cells to maintain membrane fluidity, provide energy and supply metabolic precursors. When we order these labs, they are returned to us in weight-based units (mg/dL), but this tells us nothing about the QUALITY of this important blood component. As it turns out, LDL particle size and number is much more important in determining its pathophysiologic risk, than simply obtaining its weight per unit volume. Increased residence time in the blood also would increase its susceptibility to advanced glycation and oxidation, rendering these particles more pathologic and driving atheroma (clot) formation.  

HDL cholesterol is considered “good” because their function is to scavenge cholesterol and phospholipid byproducts and deliver it back to the liver for excretion through the bile acids. Interestingly, our terminal ileum (last portion of our small intestine) resorbs 95% of the bile secreted for emulsification of fat during digestion. If cholesterol was detrimental to our survival or health, the body would not design a robust mechanism for resorption. Cholesterol ester transfer proteins are involved in transfer of cholesterol and triglycerides between VLDLs, IDLs, LDLs and HDLs, making our simplistic version of LDL “bad”/HDL “good” hypothesis more complex and unlikely. Oversimplifying the complexity of lipid and cholesterol metabolism has come at a detriment for the patients that we treat. Sadly, most clinicians do not understand cholesterol metabolism beyond this simplified version.

Another common disease process that is poorly approached and mismanaged is type II diabetes. Type II diabetes mellitus is the predominant form of all diabetic patients (90-95%). Type I diabetes, is characterized by destruction of pancreatic beta cells (where insulin is manufactured) and absence of insulin production, requiring exogenous (derived externally) insulin administration to provide glucose to the cells for energy. In contradistinction, type II diabetes is a pathophysiological state resulting from hyperinsulinemia (too much insulin) and desensitization of peripheral tissue to insulin resulting in hyperglycemia (high blood sugar). Contemporary treatment options include insulin sensitizing agents (metformin, rosiglitazone, pioglitazone), secretagogues (glimepiride, glipizide, glyburide, repaglinide, nateglinide), or exogenous insulin. Adding insulin to an already hyperinsulinemic state only encourages the body to “hide” excess sugar into the intracellular compartment, evading detection of our testing methods. This provides no health benefit whatsoever, but it “appears” that our biological milieu has improved, when it has only gotten worse. This is equivalent to telling a child to clean their room and them stuffing all of their toys under their bed to avoid detection.

Overabundance of sugar, over decades, contributes to the body naturally trying to rid the body of excess sugar and regain homeostasis. Excretion through the urine is the easiest way, but pharmacologically, we inhibit this mechanism and drive more glucose into cells that don’t need it. This only leads to production of advanced glycation end products and non-enzymatic glycosylization of proteins within the cell. The introduction of high-fructose corn syrup into our diets in the 1970’s contributed heavily to the increase in diabetes and obesity epidemics that we are now suffering from today.  Fructose, unlike glucose, can only be metabolized in the liver and has a distinctly different pathway of catabolism than glucose. During the metabolism in the liver, fructose has three destinations: 3-phosphoglycerate, 2-phosphoglycerate or glycerol.  3-phosphoglycerate and 2-phosphoglycerate can be utilized in the glycolytic (breakdown of sugar) pathway to create energy, but when energy is abundant, glycerol is the predominant end product.  

Glycerol provides the backbone from triglycerides and is intimately associated with VLDL (very low density lipoprotein) production (high triglyceride to cholesterol ratio).  As the body is bombarded with fructose and cannot keep up with the production of VLDLs, the liver accumulates triglycerides and leads to a condition known as non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH). Development of NAFLD further worsens the insulin resistance of the body and this condition is closely associated to development of diabetes. An abundance of VLDLs being produced by the liver in response to large intake of fructose leads to numerous, small, dense LDLs as the triglycerides are dispersed to the fat tissue, leaving cholesterol in the LDLs. These small, dense LDLs, in the presence of hyperinsulinemia, drive the oxidized LDLs into the arterial walls, creating atheromatous plaques, leading to carotid artery stenosis, coronary artery disease, heart attacks, vascular dementia, strokes, etc. There are numerous other pathological states that fructose catabolism leads to, but this is the most significant.

Most readers will not follow the complexity of these biochemical and pathophysiological pathways, and that is not my intent; rather it is to highlight that we are unable to appropriately treat these diseases through broad generalizations or simplifications. Complex problems don’t always necessitate complex solutions. It is quite evident that our food source is the culprit, contributing to our declining health. Calorimetry oversimplified the idea of fattening and assumed that our bodies functioned similar to rudimentary combustion chambers. Without understanding hormonal influence on fat deposition, simple calorie excess was thought to be the cause of obesity. Until relatively recently, we have started to understand that fattening is not a simplified mathematical equation.  Michael Pollen, in his book “In Defense of Food,” discussed the Standard American Diet (SAD) as containing an abundance of “edible foodlike substances.” Hormonal influence has a profound effect on fat deposition; men and women have far different fat deposition patterns. Men typically deposit fat in the gut and around the viscera (abdominal organs), where women tend to have fat depots in their hips, buttocks and breasts. Our country has faired very poorly in health since the introduction of synthetic food into our diets. However, it is suggested that more synthetic food is our best option. Pharmaceutical companies have taken advantage of this situation and introduced medicine to disguise symptoms without solutions for disease reversal. Currently, there is no financial incentive to create a population of healthy people. Keeping people sick has been lucrative for many businesses and there is little desire for change. Empowering the general public through education and encouragement is where we should start. Eating real food, not marinated in pesticides or genetically modified for more appealing taste and appearance, should be our focus. 

The COVID-19 Conundrum, Part II

The Delta variant is old news and we must brace ourselves for the more vaccine-resistant mu variant. As the COVID-19 story continues to mature, our knowledge about treatment strategies are also evolving.  If we critically examine the data from Israel, with almost 80% of their population vaccinated, we have to acknowledge that vaccine efficacy is demonstrably waning, especially against the new variants. Israel is not the only example of vaccine failure; Cornell University, has a 95% vaccination rate with increasing cases above baseline modeling. I anticipate that this trend will continue as we approach this virus with blinders, believing that universal vaccination is the ONLY way to beat it.  Our health departments (WHO, CDC and FDA) and pharmaceutical companies are doing a major disservice to 46% of the population by not investigating alternative therapeutic options and only advocating vaccination as the sole treatment option. There are currently enough vaccine doses available to fully vaccinate every American, but it turns out that not every American wants it. It is time that we start to consider ivermectin and hydroxychloroquine as viable substitutes to the vaccine-reluctant patients. With emerging clinical data suggesting reasonable efficacy of these two medications in the treatment of COVID-19, I find the AMA statement disgusting and lacking in curiosity.

The AMA statement addresses concern for risk of toxicity as the reason to avoid Ivermectin use. It should be recognized that Ivermectin has been used in humans for over 25 years with a well-documented safety profile. In the COVID-19 treatment protocols, it suggests 12mg/day for 5 days or 60mg total in 120 hours. When evaluating toxicity of a pharmaceuticals, they represent this information as LD50 (lethal dose of 50% of subjects). For Ivermectin, the LD50 is 10mg/kg.  Given the average physiologic human, reported in medical textbooks is 70kg, the median 50% lethal dose is 700mg (58x the therapeutic dose). The actual LD50 dosage is much higher because 70kg is a 154 pounds. Most people suffering from severe COVID are much larger than 150 pounds. With a half-life of 18-hours (excretion through feces, so kidney function plays no role in the pharmacokinetics) and a dosage of 12mg/day, this dosage is well below the toxic range. Current dosing schedules for parasitic infections is 0.2mg/kg.  Taking our same, arbitrary 70kg individual, the dosage suggested for treatment is 14mg/day. Recommending 12mg/day for 5 days clearly is within the safety and therapeutic threshold.

Some studies have suggested efficacy of ivermectin (here, here, video and here) for treatment of severe COVID-19 and hydroxycholorquine (here and here) might be a prophylactic agent or provide some symptom relief for mild cases. Either way, therapeutic options need to be investigated for people that are staunchly vaccine averse, cannot receive the vaccine for medical reasons or for those with breakthrough infections of new variant strains. Myopic treatment strategies and reliance on a single approach for an unstable viral genome is poor practice. Resistant strains of microorganisms is not uncommon. If an antibiotic or chemotherapeutic agent demonstrates poor response to an infection or neoplasm, respectively, we alter the treatment for a more appropriate, desired response.  A patient that receives the influenza vaccine, but then gets infected with the flu, doesn’t require an influenza booster, this is illogical thinking.

Dissent to vaccine mandates does not imply that this subpopulation is villainous, nor dangerous.  If someone chooses to get the vaccine, they can anticipate less aggressive symptoms from COVID-19 if infected, despite a 0.04% risk of severe COVID symptoms in the unvaccinated.  People who choose to remain unvaccinated have accepted the consequences of their choices and the 99.96% chance of being asymptomatic or getting mild disease. We have seen a toxic, divisive culture where some people advocate that physicians should not treat unvaccinated individuals, which is malevolent and disgusting. This type of medical discrimination could set a dangerous precedent. Do I have the right to refuse treatment to a patient involved in a motorcycle accident because I think motorcycles are too dangerous and people that ride them are being unnecessarily careless? Are we not obligated to treat emphysema, chronic bronchitis or lung cancer in patients that smoke? Smoking is universally understood to cause significant health consequences and physicians routinely educate their patients about the dangers, but some patients still choose to selfishly indulge. Can we refuse venereal disease treatment to polygamists?

Practicing medicine via oversimplification and absolutism produces standard care practices and ignores individualized patient needs.  Universal, mandatory “vaccination for all” is the epitome of oversimplification and absolutism. Clinical practice guidelines have been useful in developing strategies for treatment of common causes of certain diseases, but this doesn’t mean that we should treat a specific disease as it has manifested the same way in every patient.  For example, common practice and first-line treatment for hypercholesterolemia is a HMG-CoA reductase inhibitor (statins). Statins do work well for people that hyperproduce cholesterol, but not for hyperaborbers. In order to identify patients that would respond well to statins, we need to know if the patient is a hyperproducer or hyperabsorber of cholesterol. Elevated desmosterol levels would indicate hyperproduction of cholesterol, while elevated phytosterol levels would indicate hyperabsorption; blocking synthesis of desmosterol in a hyperabsorber (elevated phytosterol levels) would be detrimental to their production of steroid hormones (estrogen, progestins, testosterone, cortisol, aldosterone, etc.) as the phytosterols are poor precursors for steroid hormone production and potency.  However, we have chosen the “statin for all” as our initial approach; often never providing an ultimate solution for the patient’s biological aberrancy, but ordain them to pharmacological dependence in perpetuity. For the hyperabsorbers, a bile acid sequestrant, like cholestyramine, would be more appropriate. One key to making sense of the universe is knowing that the answers we get are dependent entirely upon the questions we ask. We’d better be asking the right questions before we conclude we got the right answers. Often instead of getting laboratory results and acknowledging how high the value is, we need to understand WHY the value is what it is. There are myriad reason as to the cause.  Understanding WHY will determine our treatment direction. Targeted trial therapy is far superior to generic “trial and error.”

Falsification of evidence in science can occur in two ways; 1. overt fraudulent reporting of the results (uncommon); 2. inadequately understanding the background. Our COVID story has been riddled with mishandled information and a murky background understanding.  In the general population, we identified the virus through ultrasensitive PCR testing (I have written about this in a previous blog — A 30,000′ View), which catches way too many asymptomatic individuals and therefore overrepresented presence of illness. A positive PCR test (presence of virus) is not synonymous with symptomatic disease.  Producing this falsified, artificial background has provided much of the lay public with a false understanding of the true reproductive rate of the virus.  The Pfizer, Moderna and Janssen studies identified SYMPTOMATIC disease, not PRESENCE OF VIRUS.  There is a clear distinction between these two outcomes.

Moving forward, we need to acknowledge and respect those that choose to rely upon their God-given immune system, rather than a rushed, unfamiliar, new technology for vaccination. Alternate, successful treatment strategies would also greatly benefit those with a lethargic immune response to the vaccine. Realizing that antibody production wanes in the elderly population, protein-calorie malnourished individuals and other immunocompromised states make it more important to discover therapeutic treatment options. As physicians, we need to respect our patients’ lifestyle choices and provide a service to them, without judgment, that allows them to live their lives freely and return them to the activities they enjoy. It is not our position to be authoritarian dictators to our patients; we provide information, to the best of our ability, and let them decide how much violation to their body they are willing to accept to obtain a desired result. “My body, my choice,” has been used (although I would argue inappropriately) vehemently for women’s reproductive rights, but this same ideology is not applied to mandated COVID vaccines, which is profound cognitive dissonance. If individuals don’t have the right to determine, with informed consent, acceptance of a treatment (their body), then we have completely destroyed our social culture and given credence to our government that they know what is best for us. Benjamin Franklin aptly said, “Those who can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety.” Freedom is not often lost through large, overt political overreach, it occurs in slow, incremental, deliberate steps; after decades of small, seemingly meaningless concessions, one day you’ll wake up and wonder where your freedom went. Questioning arbitrary, authoritarian rules should not be discouraged, especially when they do not apply to the dictators formulating them.

Modern Medicine, Healthcare Fatigue and Our Desire to Avoid Failure

Modern medicine has taken a dichotomous, lewd departure from its noble origins.  Hippocrates, considered the father of western medicine, systematized medical practice and robustly trained physicians establishing it as a dignified and altruistic profession.  Science has advanced our understanding of modernity, but consequently we have relinquished the decorum of our profession through commoditization and standardization. The “complete” physician is a product of the past; our current medical system has been infiltrated by hyperspecialists, numerous referrals, delays in medical care for payment authorization, “work arounds,” and the wonders of the electronic medical record – resulting in ultra-transparency that scares many patients with digital access to all of their records, detailed in verbose medical jargon. Convoluted payment schemes, decentralization, lack of breadth, dogmatic groupthink and the tort system have produced a complex care model that confuses patients and necessitates transportation to myriad locations in hopes that they will find answers to their ailments.

Physician autonomy has disintegrated into compliant bureaucratic servitude; the idea of personalized, individual medical treatment has morphed into a “one size fits all” approach. This loss of autonomy creates an environment of monotony, through “standard work,” circumventing our obligation to think. Instead of thoughtful curiosity to determine manifestation of disease, there are diagnostic and treatment algorithms that have been created; following all the steps to ensure maximum reimbursement and consistency in outcome. This standardization produces a system that allows mid-level providers (NPs and PAs) to perform the same functionality as a physician. This is in no way diminishing the critical role that mid-level providers contribute to our team, but the educational rigor of medical school SHOULD be more profound. Memorization of flow charts have replaced cognitive reasoning. As physicians master and endorse this algorithmitization of their particular discipline, they are rewarded with leadership titles and occasionally compensated for their acquiescence. This doesn’t foster a rewarding work environment; it creates productivity demands, which become even greater as physician reimbursement diminishes and bloating of hospital administration continues.

Medicine has always been intriguing to me and a perfect professional fit for my personality.  I consider this profession to be an intermediary between scientists and the general public. It provides a satiation for my intellectual curiosity, an opportunity to create lasting relationships with patients and colleagues and provide service to patients in need.  Little did I understand the psychological consequences of such a seemingly prestigious position. It has been demonstrated that at the time of matriculation into medical school, depression levels are lower and quality of life is higher than age matched peers, but this deteriorates shortly after medical training begins (here, here and here). Sleep deficits from studying demands, constant competition for residency positions and numerous tests every week was onerous and can lead to significant psychological decline.

“Burnout” is a common term used to describe the demoralization of a physician’s existence. Medical school and residencies have conditioned doctors to be resilient, mentally tough and durable. “Moral Injury” is a much more appropriate term for the condition. Hospital systems and physicians have competing interests in the overall health of the patient. Physicians truly want to improve the health and lives of their patients, prolonging health span and lifespan, avoiding incarceration of patients into our medical system.  Health systems benefit from recurrent customers; therefore it is of no interest to have these patients leave, but rather be tethered to the system, managing chronic disease instead of reversing its course.  This is why there has been such effort and emphasis from the health systems to control physician practices. If they are able to control physicians’ practices, they can control treatment algorithms and ultimately all of the money associated with it.

Traditional methods in the treatment of metabolic disease have failed miserably, but we continue the same course (only introducing new pharmacological therapeutics). For example, treatment for type II diabetes continues to be metformin (a drug that sensitizes tissues to insulin), various secretagogues (stimulating pancreatic beta cells to release excess insulin) or exogenous insulin.  Hyperinsulinemia has always been the underlying problem, not the lack thereof.  Insulin caused the problem, but we continue to pour fuel on the fire through disease perpetuation by sensitizing the tissue to insulin or providing strategies to deliver MORE insulin to the body. As people on insulin recognize, exogenous insulin causes fat accumulation, not depletion.  However, we have concentrated our efforts on decreasing extracellular glucose concentration, but haven’t sufficiently understood that intracellular glucose concentration goes up consequently; this effect results in cellular damage through non-enzymatic glycosylization of functional proteins and cellular oxidation through the metabolism of glucose and fructose. Administering insulin drives glucose into the cell and “hides” it from detection in the extracellular fluid. The disease manifests from too much sugar, not that it’s just in the wrong compartment. Fructose (a 5-carbon ringed carbohydrate) can only be metabolized in the liver and if too much is consumed, can lead to non-alcoholic fatty liver disease and worsening insulin insensitivity.  What is the definition of insanity?  Doing the same thing over and over again and expecting different results.

Medical education is to blame for our lack of understanding. When I started medical school, many professors would say that the flow of information will be equivalent to taking a sip of water from a fire hydrant.  While this is accurate phraseology, it is a defeatist approach that preconditions successful, smart students with the permission to fail.  When dealing with others’ health and lives, it is imperative that we succeed.  Our culture has become too adamant with protecting people from failure, to the point that we are reluctant to allow our children to suffer any sense of defeat.  Winning and losing is an integral component of learning and will help direct important life choices.  Artificial scenarios that protect children or young adults from losing is not adequately preparing them for the harsh reality of the real world.  Inappropriate preparation for the real world only promotes feelings of anxiety, depression and a host of other psychiatric manifestations, as these young individuals have never developed an ability to cope.

There are myriad pathophysiological and biochemical processes that mainstream physicians poorly understand, but can follow algorithms based on laboratory findings. Instead of understanding and reversing disease, our focus has been short-term symptom resolution. We are trained to concentrate on inappropriate outcome measures, but these measures help guide pharmacological treatments; they are not designed to address root cause. This perpetual, progressive decline in our patients’ health, when we are actively trying to prevent it, causes angst, concern and demoralization to physicians. It is the true definition of “insanity” and we are seeing a significant impact of psychological health in our healthcare workers. It is necessary for physicians to better understand the medications we prescribe and alternative treatments that our patients would like to try. Often, we catch ourselves say, “there is no evidence,” but what we really mean is, “I’m not aware of any evidence,” when we are asked about alternative, unorthodox treatments.  It’s incumbent upon us that we search for evidence and answers for things we don’t know.  If we choose to continue to be apathetic in our quest for knowledge, our patient’s health AND our mental health will continue to suffer.

Mask Mandates and Perverse Interpretation of Science

When we breed pseudoscience, chaos, hysteria and bureaucratic policy, the creation is an obscene and illogical product. Masking children, the least susceptible population to COVID-19 and highly unlikely to serve as a reservoir for transmission, is proving to be more damaging than protective. I dropped my son off at school last week and there was a hybrid of masked children being delivered, for a day of indoctrination, by their unmasked parents. The educators demonstrated inconsistent masking practices with most masks not covering the nares and some masks below the chin so the children can understand instruction. A sea of mask-free older children, that share the same building with the younger, masked children, entered in droves. The explanation is that children that are older than 12 are eligible to receive the vaccination, so masks are unnecessary for this age group. Current data demonstrates that only 50.36% of Michigan residents have been fully vaccinated. We know that severe COVID cases and mortality primarily effect the elderly population, with few exceptions, and this is the group that is likely to be more heavily vaccinated than young children in middle or high school. Therefore, we can assume that more than half of the unmasked children in the 12-18 year age group are likely unvaccinated (I would contend, appropriately unvaccinated). Aren’t we in the midst of the most deadly pandemic in history? As some people insist, mask-wearing is an essential practice; if that is the case, then mask etiquette, mask quality and hand hygiene practices should be standardized and strictly enforced. If masking works (which the research does not support), it needs to be consistent, universal and performed appropriately. It is of no utility to muzzle children in school, then have them remove their mask to visit the grocery store, restaurants or their friends’ houses. This review is the best evidence that I have seen citing all of the randomized controlled trials (RCTs) regarding efficacy (or lack thereof) of mask wearing practices in an attempt to prevent aerosolized viral illness.

As I have pointed out in a previous blog post, Communicating Fear, children have a minuscule risk of mortality from COVID-19.  Further complicating these statistics is the concept of “dying of” or “dying with” COVID. I have first-hand knowledge that hospitals have reported suicide, motorcycle accidents and car accidents as COVID deaths, if the patient tested positive and perished as a result of their injuries. The federal government subsidized hospitals handsomely for diagnosing and treating COVID patients or reporting COVID deaths. Hospital systems were actively searching for this disease in order to receive significant government financial support. Interestingly, there are >6,000 hospitals in the United States and 417 health systems. If we reasonably assume that the overwhelming majority of the hospitals are within the 417 health systems, this equates to approximately $23,980,815/system for 2020. It is unlikely that these funds were distributed evenly as the larger systems with higher volumes were more likely to produce higher positive PCR results (true positives AND false positives). Testing every patient that enters the hospital for COVID with a testing method known for high false-positivity rates, it became a race for the winning lottery ticket. It is no coincidence that the American Hospital Association is one of the largest lobbying groups in Washington and has been for over two decades.

Remote learning, social distancing, quarantine and religious masking rituals MAY (but most likely not) have reduced some disease transmission, but certainly wreaked havoc in the arena of mental health (here, here, here).  Additionally, non-verbal social queues, important for any human interaction, are negatively affected (here and here). Chronic masking for many hours a day is an additional social experiment with unknown long-term effects.  There is a significant negative psychological impact to wearing masks, but it is unclear as to the long-term physiological effect.  One could reasonably assume that altering the local CO2 concentration during ventilation would have a negative impact.  Hypoxia and hypercapnia do have known consequences to the tissues, most sensitive to decreases in oxygen concentration is the nervous system. The review article posted above provides a comprehensive list of the RCTs available for masking, but I recommend you also watch this video for a visual.

To better understand the deception, we must examine the original articles research articles about the safety and efficacy of the vaccine.  Here is a summary and review of the three original studies that were granted EUA status:

Pfizer (click on hyperlink for study)

This trial enrolled 43,448 subjects, 21,720 in the treatment group (receiving the COVID-19 vaccine injection) and 21,728 in the placebo group (saline injection).  Each group would receive two injections, 21 days apart.  Final two-month follow-up was completed for 37,706 people (86% trial completion rate). All of the subjects enrolled in the study had no prior serologic detectable antibodies, which they deemed as a COVID-naive individuals with no prior exposure.  It is unlikely that ALL seronegative individuals would produce a negative PCR test due the level of sensitivity that PCR testing in the presence of small amounts of ribonucleic acids. The other caveat to this particular study was that the criteria they used to detect confirmed COVID-19 cases was through symptomatic manifestation of disease, not asymptomatic detection of the virus in an otherwise healthy individual (which is how hospitals are reporting their numbers). In this study, 8 patients in the treatment arm developed symptomatic COVID symptoms (0.04%); the placebo arm showed a total of 162 symptomatic COVID symptoms (0.8% chance of developing symptomatic COVID symptoms WITHOUT the vaccine). However, this ratio (1 – 0.04/0.8) demonstrates a 95% reduction in the treatment versus placebo group.  This type of reporting is abhorrent and we need to understand absolute risk in this particular setting.  COVID-19 has a 0.8% chance of causing symptoms in unvaccinated individuals.  There is a 99.2% chance of any person, unwilling to receive the vaccine, that will demonstrate no symptoms over any given 2-month period (given the pathogenicity stays constant). Additionally, this study mentioned that there were 10 severe COVID cases seen in this study; 1 in the treatment group (0.005%) and 9 in the placebo group (0.05%).  Of the number of cases in the placebo group (9/162), 5.5% of the cases were severe.  Overall, in the placebo group, there is a 0.04% (9/18,846) chance of developing severe covid symptoms. 94.5% of cases are mild in symptomatology. Conversely, 12% (1/8) of the vaccinated individuals demonstrated severe COVID symptoms (this was obviously not a highlight of this article as the design method and data analytics was performed by Pfizer, not a third party).

Moderna(click on hyperlink for study)

This study included 30,420 subjects, 15,210 each in the treatment and placebo groups. Similarly to the Pfizer study, this study is evaluating “clinical signs indicative” of disease.  They are not performing serial testing to identify asymptomatic cases. Overall, there were 196 symptomatic individuals, 185 in the placebo group (1.2%) and 11 in the treatment group (.07%).  With this scenario (1 – 0.07/1.2), this demonstrated a 94.1% reduction in risk, although the absolute risk in this study demonstrated a very low risk in each group also. Thirty cases of severe COVID were reported, all in the placebo group (16% risk of severe disease, therefore 84% chance of mild illness in placebo group). One death was also reported in the placebo group (0.5% risk of mortality).

J&J/Janssen (click on hyperlink for study)

This study included 39,321 participants, 19,630 in the treatment group and 19,691 in the placebo group. Prior to initiation of the study 9.6% or the patients were seropositive (had COVID illness resulting in a previous immune response). Like the two other studies, this study also was only identifying patients with symptomatic disease, but specifically moderate to severe cases.  There were 464 moderate to severe COVID cases amongst all subjects in the study population, 116 in the treatment group (0.6%) and 348 in the placebo group (1.8%).  This demonstrated a 66.9% (1 – 0.6/1.76) protection with the vaccine. Mild and asymptomatic symptoms were not reported in this study, which makes it useless when comparing its overall efficacy to the other formulations. 

The ongoing hysteria surrounding this virus continues to boggle my mind. Vaccination mandates to maintain employment is disgustingly poor policy and could actually be more harmful than helpful. If the brilliant scientists were able to create a useful vaccine in 6 months, with a technology we’ve never used before, when will be seeing cures to cancer? We’ve loaded much more time and funding toward cancer research; cancer has killed far more people than COVID ever will. We also see that natural immunity outperforms vaccine-associated immunity to the more virulent strains, which is great news! Our bodies have impressive capabilities if adequately fueled and allowed to perform as designed. If we are interested in saving people’s lives, we would put as much effort and resources in preventing diabetes, heart disease, obesity, high blood pressure, etc.  Reversal of these disease states and education on maintenance would save countless lives and provide people freedom from the Medicine Machine. Constant monitoring, accountability techniques, support groups, sleep hygiene and stress reduction modalities are all important in restoring good health.  It is time for us to recognize that medicine is failing the masses and we now time to rethink health and healthy living.

Unity Wins – It ALWAYS Will

As we approach the 20th anniversary of 9/11, I reflect on the overwhelming unity that resulted from one of the greatest crises on domestic soil. “Together We Stand, Divided We Fall,” was a common mantra echoed ubiquitously.  Race, gender, sexual orientation, wealth or vaccine status was of no consequence.  On that particular day, and several months that followed, we lived in a utopia of united people with compassion and understanding.  It was one of the most encouraging times to be alive. Many people were desperate and very creative finding unique ways to help one another. Our nation was stronger than ever before, unfortunately a terror attack was required to spawn universal altruism. Why was a crisis necessary to create such an environment?  Shouldn’t this be the inherent state of affairs?

The COVID-19 pandemic has created fear, concern, sickness and, since the introduction of an experimental vaccines (Pfizer study end date July 30, 2023 here, Moderna study end date October 27, 2022 here, Johnson & Johnson study end date January 2, 2023 here), immense segregation and division. Vaccine hesitancy will ALWAYS exist as there are many parents and individuals that alter vaccine schedules for their children, choose not to get any vaccines and many who decline the annual influenza vaccine. Avoiding vaccines, even vaccines with billions of subjects over countless years, with appropriate safety profiles (in the acute setting) are still not universally accepted. Because we have had numerous early adopters with the willingness to receive inoculation with an experimental mRNA vaccine, it doesn’t mean that EVERYONE will eagerly accept it. Alternate therapeutic strategies will be warranted. Ridicule, disdain, bribery and villainous attacks will not change the minds of the skeptics, it will just cause further divide. A divided population provides a model for further government rule.

Has the division in our country been perpetrated by design? Although this may sound a bit conspiratorial, we need to understand the intent of government-funded operations such as Project Mockingbird (here), MKUltra (here), Operation Paperclip (here), Operation Popeye (here), Operation Northwoods (here), and Operation CHAOS (here). In addition to the Operation CHAOS spying regime, President Obama authorized NSA surveillance of innocent citizens as well (here). If you research these projects, you will see that government entities, most specifically the CIA, has orchestrated nefarious experiments on unwilling subjects, primarily Americans. There are patents for creation of hurricanes and tornadoes (here). Even though this patent has an “abandoned” status, this demonstrates the science and technology are available. As you can see here, our government has superfluous patents on weather manipulation first initiated in 1891. “Global warming” (now “climate change”) has been a hot topic to drive division, but our government and special interest groups have plenty of knowledge and resources to control this narrative (and our weather patterns).

The Trading with the Enemy Act of 1917 was signed into law, making it illegal to trade with an enemy to the United States in a time of war or other State of Emergency.  Following the Great Depression, in 1933, an amendment to the law was created by Franklin D. Roosevelt to expand the enemy to include United States citizens.  This was an attempt to prevent US citizens from hoarding their own money from the government.  A great analysis of this law was created after it’s 100 year anniversary (here). In addition, the Act of 1871 converted the sovereign country of the United States of America into a publicly traded company (here). This corporation filed Chapter 11 bankruptcy on October 15, 2020 (here).  The conclusion was a dismissal of the debtor, which means that the debtor is liable for paying back their debt (here).

From this brief history lesson, I hope this makes it more clear that our government has never had an interest in unifying our nation.  Only WE have that interest and capability.  In fact, in some situations, it has been imperative to manufacture crises (Operation Northwoods) to impose a State of Emergency and wield Executive privileges.  We have been deemed “enemies” to our own country and numerous experiments have been forced upon us by coerced consent or without consent. We would be naive to believe that this progression of corruption has existed at least since 1871, but it no longer occurs.  Unfortunately, I think it’s become more sophisticated and much more difficult to detect.  The only way to avoid this perpetual cycle is to become unified. We The People inherently possess the power to unify, but we are fighting a very strong, refined force that is promoting division. Do not allow this to happen!

A 30,000′ View

When the magnitude of deception becomes so grandiose, the truth is much more difficult to disguise.  The pandemonium of another COVID surge is among us and we’re struggling with the new “Delta” variant. Unvaccinated individuals are the vector for viral genomic instability. Natural immunity is no match for this virus; the only hope is universal inoculation of every human on Earth to eradicate the invisible enemy (even though it possesses a zoological reservoir).  It is incumbent upon our federal government to limit interstate travel of the unvaccinated, mandate vaccination for our workers and military, and strip as many liberties from its citizens until every American succumbs to the pressure of getting “vaxxed.” Under no circumstance should we question this approach or infringement upon our liberties; it is imperative to follow the CDC guidelines if we want to survive. In fact, if you do question it, you’ll be deemed a domestic terrorist (here).

Those that have been infected with COVID-19 often want to know if natural immunity will protect them.  The CDC tells us that vaccination is the ONLY way. It is important to understand that 100% global vaccination is impossible; there will be individuals, due to medical conditions or anaphylactic reactions, that will be unable to accept this vaccine.  Total vaccination coverage at a global scale won’t happen, so alternative treatments must be discovered.  Contrary to this idea, prior to existence of vaccines, we have plenty of evidence to suggest convalescent plasma (plasma from previous infected individuals) demonstrated great promise and was our treatment of choice for critically ill patients (here, here, here, here, here, here, here, here, here, you get the point). Some studies have also suggested natural immunity provides protection against COVID-19 that can last for several months or longer (here, here, here, here, here, here, here, again, you get the point). What’s the difference between conspiracy and the truth?  About 6 to 12 months.  When we once were conspiracy theorists to believe that COVID-19 was a manufactured product of the Wuhan Institute of Virology, it turns out to be the most plausible explanation (here, page 3187, page 522, and page 1150). I also turn your attention to page 2286, “Subject: Coronavirus bioweapon production method.”

If our government is truly interested in slowing/stopping the spread of the virus, we need to look no further than our southern border.  The flood gates are wide open with seemingly no strategy to ameliorate the problem (U.S. Customs and Border Protection) and it continues to worsen each month.  Interestingly, many of these illegal crossings are eluding any sort of COVID testing and our government is not mandating vaccination to illegal immigrants (here, here, here, here). Consequently, we are depriving U.S. citizens of their God given rights to stop the spread, but illegal immigrants are savoring the freedoms that noble, taxpaying Americans once enjoyed. This is the most incomprehensible and illogical policy to defeat this pandemic, IF that is actually the intent. Strong border security seems important in order to combat the virus, or a detailed, thorough health screen prior to welcoming them in.  We have neither. This is not the first poor health policy that the federal government has endorsed.  In 1977, George McGovern released the Dietary Goals of the United States, without scientific consensus, reducing fat consumption from 40%-30% and focusing on saturated fat reduction to below 10%. As a result of this report, our health has suffered immensely.

My disparaging remarks and skepticism regarding mandatory vaccination has perturbed a few people. I should clarify that I’m not anti-vaccine, rather I’m pro medical choice. Informed consent is a necessary formality in medical practice to prevent inadvertent battery on an unwilling, innocent patient. It is not my position to tell a patient that they will receive surgery, against their will, because I think it is their best option. Patients have the ability to choose what they feel is best for them, not relinquish all decision-making to the “almighty” physician. This adversarial, “radical” approach to “science” may seem counterintuitive because of my educational background, but there are fundamental reasons for my stance. C.S. Lewis once said, “When the whole world is running towards a cliff, he who is running in the opposite direction appears to have lost his mind.” If we examine our declining health condition, despite advanced technology that should protect us against worsening disease, it begins to make more sense. The cost of diabetic care in America in 2017 was $327B ($327,000,000,000); this is up from $245B in 2012 (Diabetes Cost Statistics). The prevalence of type II diabetes in adults AND children is on the rise (National Diabetes Statistics Report, 2020 and Type 2 Diabetes Mellitus in Children). Obesity, hypertension, heart disease and hypercholesterolemia rates have commensurately followed the diabetes trend. Could it be our food supply (or is this too simple of a solution)? We consume more chemicals and processed food than any other time in history. Our bodies are not designed to metabolize the synthetic food that we continue to consume in such large quantities. Complex problems don’t always necessitate complex solutions.

An exercise that I have found quite interesting (and disturbing) is heading to Yahoo! Finance (here) and selecting a large company, at random, to see the largest stock holders.  As you will find out, our tech industry, food industry, banks, news outlets, pharmaceutical companies, oil industry, transportation, or any other industry I am forgetting, are owned primarily by three companies – Vanguard, BlackRock and State Street. This monopolization of our consumption of EVERYTHING should be concerning to everyone (except for the executives of these companies). It suggests that we have lived in an illusion of freedom, but are not actually free.  With the current size and control of our government, this illusion is becoming more clear.

There have been several occurrences that have led to the deterioration of contemporary medical system. Decreasing reimbursement of physicians by CMS and other private payers (here) have made it challenging to pay overhead and produce a decent wage to pay off student debt and other expenses. Hospital employment has become more attractive for a comfortable, stable income without concern for overhead costs (here and here). Doctorate programs have been created for physical therapists, nurses, and pharmacists which has complicated patients’ perceptions of the term “doctor.” Nurse practitioners and physician assistance have provided a larger role in our new, more complex system and administrators now use the all-inclusive term “providers,” that has ultimately diminished physicians’ contribution. The divergence in reimbursement trends, between private physicians and hospitals, continue to widen and I submit this is by design to provide more government control over the health care system. If we study the lobbying funds of the American Medical Association, Blue Cross/Blue Shield, American Hospital Association and Pharmaceutical Research & Manufacturers of America, they have been top contributors for at least the last 23 years (Lobbying Contributions).

Government entities focus on regulating acute toxins, but do not regulate chronic toxins. There was once a time when we didn’t recognize the association between cigarette smoking and lung cancer, and it was not an easy problem to solve at the time. This correlation is now very well understood as the causal link. It should be understood that these vaccines have escaped normal scientific scrutiny and done with a technology that has never been used on human subjects before. The major argument in favor of the mRNA technology it that they have been studying its use for over 20 years; this is true, but success in bench research doesn’t always correlate with clinical success. Yogi Berra coined the phrase, “In theory there is no difference between theory and practice. In practice there is.” Vioxx was a popular non-steroidal anti-inflammatory medication that provided profound relief for orthopedic patients with joint pain. After being FDA approved for market use in 1999, it was then discontinued in 2004 because of increased risk of myocardial infarction (heart attack). Here is a list of drugs that were FDA APPROVED and then removed from the market due to adverse side-effects, many were on the market for several decades before being removed (here). Understand that these drugs went through the rigorous FDA approval process and were still found to be dangerous later. In addition to the discontinued medications, there are numerous medications on the market with known significant risk profiles that are continually being used; Tylenol in high doses can cause liver toxicity and death; Ibuprofen, or other NSAIDs, can lead to gastric ulcers, acute kidney injury and bleeding; opioids can cause respiratory depression, dependence and death; anticoagulant medications can lead to hemorrhagic stroke, bleeding ulcers and death. Medications are not entirely benign; we often emphasize their positive effect while ignoring their potential negative consequences.

Dr. Robert Malone, the inventor of mRNA vaccines, has openly raised concerns about the COVID-19 vaccines (video, article). Kary Mullis, the inventor of PCR, also strongly dissuades PCR testing as a means for diagnosis of a virus (watch). Because PCR testing is the method we chose to identify the virus, it has greatly skewed our pre-test probability. The CDC has issued a laboratory alert suggesting no more use of RT-PCR testing because of its inability to differentiate between influenza and COVID-19 (here). This could likely explain a drop in nearly 38,000,000 influenza diagnoses in 2019 and only 1,822 in 2020 (here). I will remain unconvinced that lackadaisical masking and social distancing has selectively filtered out one aerosolized viral particle over another. We are in dangerous times, especially with the suppression of contradicting information. Censorship and invasion of privacy is being forced into normalcy with little resistance (here). Large companies and NGOs (non-elected individuals) are taking action against formerly free individuals and using fear as its canvas. Benjamin Franklin aptly said, “They who can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety.” Our current political climate in America is frightening as a parent. This is not the condition I will tolerate or accept for my children. It is my duty to fight for them to maintain the liberties our country were founded upon. If we succumb to this tyranny, our great country will set the new bar for the Chinese Communist Party.

We Need to Start Thinking Like Engineers

Conversations surrounding surgical plans and procedures to patients or patients’ families is always more painstaking in the presence of an engineer.  They are often not satisfied with the mundane, rehearsed speech that you have delivered countless times, to other patients, that accept your words as gospel.  Most patients do not take particular interest in the nuance involved in the intimate violation of their body; rather, they grant universal consent, to a complete stranger, to perform an unconscious (under anesthesia) assault on their body assuming the surgeon has altruistic intent.  It is a prodigious privilege to care for patients and humbling to understand that most patients give us the authority to protect their most precious asset.  How have we earned this privilege without more scrutiny or concern of our character?  Does a degree alone entitle us to this high level of moral integrity and trust? I submit that it should not and more patients should be emboldened to ask more questions and truly understand the proposed violation of their body.

Whenever I discuss a procedure with a patient, and an engineer is present, the conversation often becomes a dissertation defense. It is important for them to know the modulus of elasticity of the particular metal being used and number of stress cycles it can sustain due to concerns of fatigue failure.  They want to know intention of every screw, if the defect from the drill bit will weaken the structural integrity of the bone, and how much nickel is in the stainless steel implant to ensure corrosion resistance. I have literally spent 90 minutes with an engineer about how a specific screw aperture size in a femoral nail will be more resistant to fatigue failure than an implant with a larger aperture size; in addition, we discussed the necessity of antibiotic-impregnation to treat an active infection, in addition the cement would subsequently increase its structural integrity of the construct by increasing the functional radius of the nail.  I find mechanical engineering to be a fascinating field of study; success in orthopedic trauma requires detailed understanding of its principles.  Although these conversations can be onerous and laborious, they solidify understanding of the discipline, encourage stimulation of thought and provide an opportunity to better articulate principles. Engineers are trained to think, not accept information as dogma given to them by authoritarian figures; they are strong data analysts with a desire to understand “how” and “why.”

Contemporary education is failing children in the United States. This is not at all diminishing the importance or expertise of educators; they do not have jurisdiction of curriculum development, it is determined by the state and they are mandated to meet specific benchmarking requirements. Kids are not being taught how to synthesize, the education system is not conducive to this environment that foster these skills. Instead, they are taught rote process to solve math problems and buzzword recognition to answer questions on a multiple choice test. With declining annual budgets, increasing class sizes and unappealing salaries (for the amount of work that is required), this has resulted in the fundamental destruction of education. We have not adequately equipped our educators with the resources necessary to achieve excellence for our children. Multiple choice and standardized testing as a gauge of aptitude is the most unauthentic and illogical method to assess students’ understanding of material.

I have been attacked from multiple people regarding my position on COVID-19 and the efficacy and safety of the vaccine. As a physician and scientist, it is imperative to evaluate ALL information, not just some of the information, or echo our ignorant politicians’ rhetoric. As I have written about in previous posts, statistical graphical analysis can often deceive the interpreter. At first glance, the data may look compelling in one direction, but upon scrutiny, you may identify how the data has been misrepresented. This is classic Dunning-Kruger effect. What is most concerning to me is that some of the highest vaccinated countries are seeing a significant resurgence of disease. When conflicting data appears in the dataset, it must be accounted for, not ignored or censored. Richard Feynman, the Nobel Prize winner in physics in 1964 once said, “The first principle is that you must not fool yourself and you are the easiest person to fool.”

Recently I was labeled a conspiracy theorist for an explanation of basic science and another for showing specific patents that the CDC and Richard Rothschild have on COVID-19 methods for testing (both issued many years before 2019). Data is not a conspiracy; it is extra information that needs to be assimilated into an existing paradigm or an alternate hypothesis needs to be considered. Inconsistent messaging and changes in policy from the CDC has further disrupted true understanding of this disease and confidence in this agency. Because the CDC has so badly handled the data and produced policy originating from emotion, rather than science, it has destroyed confidence in the medical system as a whole. Instead of respectful, healthy debate, those that are skeptical about the inoculation of a substance that has never been used before (lipid nanoparticle as the delivery vector and mRNA as a means to produce immunity), it is a full on assault of bullying in an attempt to change the mind of the skeptics. Science progresses through skepticism, detailed questioning and trying to prove your hypothesis wrong (not right). If a scientist actively works to try to disprove their hypothesis, but cannot, the assertion is that the hypothesis must be correct. Working to prove a hypothesis as correct is fraught with significant bias.

There is superfluous information circulating regarding COVID-19, but we have to be suspicious when some institutions become aggressive with censorship of information. Our fabulous Facebook fact-checkers have labeled this as “misinformation.” It was once “misinformation” about the Wuhan lab leak theory, but now that appears to be the most plausible explanation as to its origin of dissemination. The more data points we have, the better we will understand the pandemic. If there continues to be censorship of information, this leads me to believe we are not interested in the truth. We need to continue to ask detailed questions and look at ALL of the data and not take graphical representation of data at face value. It is imperative to assimilate the data – scientific, political and financial – to generate a hypothesis and make decisions based on cumulative understanding. We need to have better discernment and not accept authoritarian doctrine. Accepting affirmative data while ignoring negative data will opacify the true results due to implicit or conformation bias. For instance, there has been plenty of evidence to suggest that natural immunity provides robust immunity to COVID-19 over vaccine immunity. Herd immunity should include those that have been previously infected as we have demonstrated lasting antibodies to far more surface proteins than spike protein in isolation:

Why are public officials (not physicians) so concerned about getting every person in the world vaccinated if natural immunity has demonstrated adequate, robust immunity?

If natural immunity is equivalent or slightly better than vaccine-associated immunity, why do naturally immune individuals get enticed with free donuts, free money, free college, free fast foot or, now, a vaccine passport to enjoy freedoms that vaccinated people can enjoy?  Should I sign up for the varicella vaccine if I have already had the chicken pox?  Why have I demonstrated robust natural immunity from the chicken pox, but I won’t from COVID-19?

What are the long-term consequences of the lipid nanoparticle incorporating into our host cells? Is this an inert synthetic lipid particle? We know that the phospholipid bilayer is active in metabolism with creation of steroid hormones, production of prostaglandins and other hydrophobic reactions. What is the metabolic end point of the lipid nanoparticle? How many copies of the spike protein are being made prior to enzymatic destruction of the mRNA? Why are we seeing hypercoagulable phenomena with these vaccines? Why are more people not concerned about this?

The narrative that all humans need to be vaccinated is the most ridiculous assertion in all of vaccine science.  This is clearly not how vaccines work.  Natural immunity has always been associated with reaching herd immunity, but the World Health Organization changed their definition this year, conveniently, to only include vaccinated individuals.  We must ask ourselves, why are public officials pushing so hard to ensure EVERYONE is vaccinated (especially with the volume of concerning VAERS data)?

Let’s start thinking like engineers and asking many more questions to get to the bottom of this.  We should also be outraged by the continued censorship that will prevent a strong understanding of the natural history of exposed individuals and not just be provided with information of vaccinated individuals.