The Coronavirus and How We Communicate

Everything is shut down but the one thing we continue to have plenty of is online communication. I think we should, for a while at least, forget the politics and use that ability to keep each other informed about their personal status and what's going on in their local community. Clearly, we want government agencies to do their best but it's up to the individual people to let each other know if they're having problems, give assistance and solutions that they've found for themselves. Americans have been through much worse than this, but these days we have the advantage of widespread communication to help. Let's use it positively.

That goes for the news media as well. They've got to be broadcasting helpful stuff, like who's being hurt financially and ways we can help, where we can get services, and especially virus testing. Testing is supposed to be coming online, but I still don't know the details of where to get it done and how to go about it. Pretty clearly the government leaders and agencies are going all out to do what is needed, so if the news media have something to say let it be in the way of positive suggestions and stop the blame game. There'll be plenty of time for that after the crisis is over.

 

 

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Government Regulation and Coronavirus Testing.

For those of you who call for the current administration to get out of the way and let the scientists handle the coronavirus problem, let's clarify things.

As I (and obviously many others far more knowledgeable than I) have been bitching about for some time, widespread testing to determine who has and doesn't have the virus is a big key to making appropriate public health measures and the delay of large-scale testing was frustrating.

South Korea, which first had the largest outbreak outside China, and was initially slow to respond, got smart and initiated drive through testing early on. They additionally took serious but voluntary "social distancing" actions such as we are now doing, and they are now experiencing a drop in cases and I hear are going back to work.

President Trump's administration over the past 2 weeks has been meeting with a large team of key private medical and non-medical businesses to put together a public private partnership to ramp up testing and we should see the effects of that this week. I watched the press conference about this yesterday and their work in addressing the logistical problems that were involved was truly impressive.

The genome for this virus was put out by the Chinese in early January. Once this was available the ability to devise an accurate test should have been a matter of days. But the CDC, staffed by the government scientists who critics contend we are to rely on for leadership, had regulations. They, not commercial labs who do this for a living, were to first devise the test, be its sole source and then test its validity. In fact, their initial test ran into big problems with false positives. It was not until 6 weeks after the genome was available, in late February, that the regulations were called off, to allow commercial and state labs to run with it.

So, this week we'll see how the plan to ramp up testing works out in actual practice. From what I saw at the press conference yesterday, I'd be surprised if it doesn't come off as planned. And, by the way, in response to those who scoffed at the idea of putting V.P. Pence in charge of this issue, I think he seems to be doing a masterful job.

 

 

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Who is to Blame for the Ukrainian Plane Disaster

We see on the news today that thousands of Iranian citizens, at some considerable personal risk,  are protesting the recent shooting down of a Ukrainian passenger plane by their own military. They apparently see their own leaders as the problem, blaming them for their decades long fomenting of terror and aggression and for wasting their precious resources on such activities and they are calling for the downfall of their present government. Here's a quote from one news article I saw: "They are lying that our enemy is America, our enemy is right here," one group of protesters chanted outside a university in Tehran, according to video posted on Twitter.

 

American liberals are blaming Mr. Trump. Their explanation is that by killing the terrorist leader Soleimani, who was responsible for the death of thousands, including hundreds of our own soldiers,  the President upset the Iranian leaders causing them to send missiles our way, including the errant one that hit the plane.

 

Who has a better handle on the actual cause of the situation?

 

 

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My Idea of Jesus's Birth. The Stable and the Manger.

Here's an aspect to the Jesus birth story that I thought was interesting.

According to biblical scholars Jesus was indeed born in Bethlehem and that Mary and Joseph were there visiting. But rather than an inn, where observant Jews would not stay, they were likely housed in a private home, presumably with friends or relatives. But were they unceremoniously sent out to the barnyard? That's how we tend to interpret it in modern times, but actually the situation seems to be that since the house was crowded, probably from other visitors, they were put up in the lower level where some of the household animals were kept. To us it seems strange, but to a society which was 90% agrarian, and in which farm animals were very valuable, keeping them in the house was ordinary and routine.

It's not so strange to me either, and here's why. The house pictured on my home page is very special to me because it is the ages old stone house on a plot of farmland where my father told me he was born in Palazzo, a little town in the plain below the breathtakingly beautiful city of Assisi. He was brought to Scranton by his father in 1906 at age 18 months, and finally went back for a visit in the 1970's to see his cousin who was still living there. He visited the old house which was then occupied by a tenant farmer who evidently was still using oxen to plow the fields since he showed me pictures of the animals, sure enough on the ground floor, what the Italians call pianterreno. The family lived on the upstairs level. My dad told me there was no heat in the house, the climate being something like Northern California, but the animals gave off a lot of heat which rose upward in the cooler months.

I finally got to visit the house in the early 1990's. At that point it was unoccupied since it had been damaged in an earthquake, and I didn't try going upstairs but I did open the door, which was a little off kilter, to look around the pianterreno. It was empty, stone plastered walls, and sure enough, along one wall, the feeding trough, or if you'd like, the manger. So, in a pinch, to people of that time, being put up in a room downstairs, near the animals, wouldn't seem so strange.

So this place, now completely boarded up, which still chokes me up to visit, gives me a bit of an idea of what the scene might have been like in the countryside around Bethlehem, 2 millennia ago, when the one we celebrate today was born.

 

 

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The Great Impeachment Show

I hate to give any attention at all to the impeachment fiasco, but I can't help myself. The actual articles of impeachment that the Democrats have come up with are so contrived and inconsequential as to reveal the true nature of what is going on, namely that they are driven to distraction and so desperate that they will grasp at any straw to make themselves feel better. That fact that their efforts are certain to fail in the senate has not deterred them. It's likely that another motivation is that they have felt that they will blemish the President enough to make him fail in the pending election, particularly since none of the Democrat candidates that are presently offering themselves seem likely to do it. The public response to their efforts so far seems to be having the opposite effect.

 

Mr. Trump's personal qualities grate on their nerves, as to be sure they do on some of the Republicans, most especially the small group of never-Trumper "conservatives" who find themselves being replaced as the philosophical spokespersons of the party. But his real crime is his success, not only in being chosen over a very substantial group of establishment Republican candidates and then, against all predictions and assumptions, over Mrs. Clinton, but in also his ability to articulate and carry through his policies.

 

The whole affair is obvious fakery. From the moment of his inauguration there were calls for impeachment, and since then a variety of justifications have been put forth to remove him before fulfilling his first term. Appeals to the 25^th amendment, the emoluments clause, the 2-year Russia investigation have all failed. In 2016, however, the new Democrat controlled House seized its opportunity and have relentlessly investigated, seemingly to the exclusion of all other activities, to come up with something that would fill the bill. The result is totally unconvincing to anyone who is not hopelessly biased and likely would not pass muster even if the Senate was not Republican controlled. I suspect that the ultimate political result will be for the Democrats the same thing the Republicans suffered after their failed impeachment of Bill Clinton over lying to a grand jury about his sexual peccadillos.

 

Ms. Pelosi has cautioned her followers not to gloat or appear jubilant. Accordingly, the Dems are wearing long faces, black clothing and announcing that they feel sober and solemn, another indication of subterfuge since they are no doubt gleeful and high fiving in private. In this I agree with them that there is a sadness to the occasion. The body of the elected representatives of the people of this great republic, whose duty is to debate and legislate over matters that concern us, has become a circus show. We can only hope that eventually they will be chastened enough from their actions that the show will not now be repeated in each successive administration.

 

 

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New Diabetes Medications

Medication recommendations are changing rapidly. The usual strategy for beginning treatment of mild to moderate type 2 diabetes has been an initial trial of diet and exercise. These things remain of great importance but present-day thinking is that, unless they are completely successful, they should not be carried on very long before starting medications. Appropriate medications to get control of the diabetic condition as soon as possible appears most effective in the long run in producing good results long term and preventing diabetic complications.

 

Metformin is still the commonly accepted starting point for almost everybody. It is effective, low cost and has little serious toxicity. I like it because it directly addresses what appears to be the primary problem in type 2 diabetes, insulin resistance.

 

However, unless metformin, with diet and activity measures, is perfectly effective after 3 months or so, it's becoming standard recommended practice that one should consider adding one of the two new groups of diabetes medications, the GLP1 agents or the SGLT2 inhibitors (explanations of both of these coming). This is because both, when added on, not only reduce blood glucose but have also been found to produce significant reductions in major diabetes complications. As usual with new medications they are expensive and of course have their own side effects in some who use them.

 

GLP1 agents – We've discussed these previously. GLP1 is a hormone normally produced in the intestine that works when eating to decrease blood glucose and also to control the appetite. It is usually deficient in those with type 2 diabetes and seems to be an integral part of the diabetic problem. Multiple medications have now been developed which replace this action. Most patients, particularly those who are overweight, have significant improvement in blood glucose and lose some weight. But these medications have an additional important benefit in that several studies have now shown that they also reduce the risk of heart and vascular problems, a big issue with diabetes.

Those presently being sold are Victoza, Bydureon, Trulicity, Adlyxin and Ozempic, the last one seeming to be a little more effective than the others. All are given by injection once weekly except for Victoza which is injected daily. Most people tolerate them well but an occasional side effect is nausea.

A new development in this group is that within the last couple of months the FDA has approved an oral form of Ozempic (generic name – semaglutide), which seems to be just as effective as the injected form. It is taken daily and will be marketed under the name of Rybelsus. So those who want to avoid injections will have this alternative and I suspect it will be the way most will want to go.

 

SGLT2 inhibitors – These medications block the uptake of glucose by the kidney and cause a large output of glucose in the urine, in turn causing a lowering of glucose in the blood and some weight loss, and usually some lowering of the blood pressure. Due to the increased urine glucose there is some increase in urine output but usually not too bothersome, although the dose of other diuretic medications may have to be reduced. Also, because of the increased urine sugar, there is a problem in many women of vaginal yeast infections.

Those presently on the market are Invokana, Jardiance, and Farxiga. These are all taken orally and all of of them are also marketed in combination with metformin under different names.

The big news here is that these medications now have also been shown to significantly reduce heart problems as well as kidney complications. Most of the heart benefit has been shown to be primarily a reduction in the development of congestive heart failure (CHF), at present an increasing problem in the U.S. In fact, the improvement in CHF has now been shown to also be a benefit in non-diabetics, so that these are now being considered as an important new CHF treatment by cardiologists.

The finding that they also reduce the development and progression of kidney damage in diabetics has been a big pleasant surprise, and this benefit, along with the heart benefit is causing many experts to strongly recommend their use, particularly in those with some element of kidney involvement.

 

 

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The Trump Zelensky phone call and Mr. Schiff's impeachment hearing

The Dems hate Mr. Trump and from the moment of his election have called for his removal from office by the impeachment rather than the election process. And to this end they've continued to fish around for a suitable reason. It's sort of like the Alice in Wonderland scene in which the King of Hearts calls for the verdict first and then the evidence.

 

The most recent eruption was brought about by a "courageous" whistleblower, who however is not courageous enough to identify himself or submit to questioning, talking about Mr. Trump's traitorous behavior in a congratulatory phone call to Ukraine's newly elected president. Since then other Trump opponents have come forth who are familiar with the conversation and have reported similar impressions. However, their revelations are no longer necessary since the entire transcript of the call was declassified by Mr. Trump and is readily available to those who are interested to read for themselves.

 

It's hard to avoid the constant commentary about the significance of the phone call, but I'm almost ashamed to say that I never actually read the transcript until today. I'd recommend you do it and judge for yourself whether it's contents should call for impeachment. I don't. To me it's not even a close call. Here it is if you're interested. It takes less than 5 minutes to read:

 

https://drive.google.com/file/d/1uyWKAGgHIqDEORgjOyo0uq7JOXzhxOQf/preview

 

On the contrary, it seems to me that Mr. Schiff should lose his office for the "parody" hoax of the phone call, just after the transcript had been released, that he read in his committee hearing. I happened to be listening to the hearing at the time and with most others was fooled into thinking he was reading the actual text until part way through it became obvious that it was a bizarre fantasy which sounded like a script from one of his movie producer friends. Judge for yourself:

 

Schiff, Sept. 26: It reads like a classic organized crime shakedown. Shorn of its rambling character and in not so many words, this is the essence of what the president communicates. We've been very good to your country, very good. No other country has done as much as we have. But you know what? I don't see much reciprocity here. I hear what you want. I have a favor I want from you though. And I'm going to say this only seven times so you better listen good. I want you to make up dirt on my political opponent, understand. Lots of it. On this and on that. I'm going to put you in touch with people, not just any people, I am going to put you in touch with the attorney general of the United States, my Attorney General Bill Barr. He's got the whole weight of the American law enforcement behind him. And I'm going to put you in touch with Rudy. You're going to love him. Trust me. You know what I'm asking. And so I'm only going to say this a few more times. In a few more ways. And by the way, don't call me again. I'll call you when you've done what I asked.

 

 

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