Not Just COVID That’s Killing Americans - A Physician's Diary From The Trenches Continues...

I have been very busy, first with the coronavirus pandemic, then servicing the need for COVID testing while keeping our teams safe from harm. And now, it was the Coronavirus vaccine distribution effort that kept me away from writing a post on LinkedIn. A cousin suggested several months ago that I needed to write LinkedIn articles instead of the numbered posts I was making. It would have a wider readership, he felt.

Here we are then…

I can report that I have never felt more fulfilled in my life than when I was giving an elderly person a vaccine last week. Never as a physician have I had the opportunity to drop the mortality of another human being so much. A 75-year-old who had a 1 in 4 to 1 in 5 chance of dying from COVID, would now have that risk reduced to nothingness. Because, 14 days after a Pfizer or Moderna vaccine, there have been zero cases reported of COVID-cases requiring hospitalizations.

To be part of that life-saving process, was a matter of personal joy and satisfaction. And all this is before I count their hugs, blessings. Before their personal stories of isolation, a curse that I was helping alleviate.

Somehow my wife and I survived coronavirus exposure followed by quarantine and re-exposure, again quarantine! Our lives were run amok by this virus. Somehow we got to December 23. The fateful day we got our first dose of the vaccine at 6 AM in a city hospital. It was as if we had managed to finish a marathon. Of survival against all odds. The plight of your everyday ‘frontline worker’. Our daughter got COVID. COVID ripped through our entire family in India like a tornado, sending some to the hospital and others getting their Dexamethasone injections, Remdesivir injections, and high flow Oxygen at home because there weren’t any beds to put them into.

I kept up with the Indian way of managing COVID-19 while following closely what we do here in the US. And I have to say, COVID patients in India are luckier than Americans. They get better treatment. Faster treatment. More objective data points in monitoring. That they have better outcomes, is hardly a surprise!

Take for example the window period when the cytokine storm is likely. In India, they won’t just check pulse oximetry and send you home. To decompensate and die or come back far worse off. They will do a CT Scan to see the extent of the disease and risk-stratify you. They jump on treating you early. They give you Vitamin D, Azithromycin. Steroids. Redes Vir. Oxygen. All based on your blood tests and the CT scan reports. The blood tests include a Cycle Threshold (CT Value). Ask that of an American colleague and they wouldn’t have heard of it. The CT value tells you the contagiousness based on the number of copies the virus is making in your blood. In real-time.

In some Asian countries, they give Ivermectin, too.

The doctors themselves have been taking hydroxychloroquine and working on COVID-floors. Rarely getting COVID infection themselves.

All this has been a rude awakening, for me personally.

Remember the horn we all were tooting, all along? That America has the best and most cutting edge treatments available for treating COVID-19? Well, that was a myth that crumbled for me during this pandemic.

Let me elaborate.

Recall how ambulances in California were recently asked to triage and reject the transport of fellow Americans. An EMT technician could now decide that your grandpa, grandma, or parent wasn’t worth saving! Yeah.

Governors of a few states in this pandemic, at different times, asked ER doctors in hospitals to play God. “Admit whom you think can make it” was their mantra. Doctors who are about saving lives were now granted the charge of rationing life.

And before that, was the insane rush to ventilate everyone. American medicine and its knee jerk response were no different from the politicians who preached from their pulpit. As a country, we left it to individual hospitals to come up with their own protocol for the treatment of COVID-19.

If you were a commoner, the State you lived in decided your fate if the EMS liked that you weren’t panicking. And if you were the President, you not only had the kitchen sink thrown at you, you were even given monoclonal antibodies! Meanwhile, some of my physician colleagues could only enroll in it after calling many hospitals and then too, only as part of a “clinical trial”.

This leads to the mind-boggling question - what happened? Every day that I practice or speak about it to someone or some group, I have worked on the same question, myself. Trying to seek some answers for our failures.

One conclusion I have arrived at is that ‘Western Medicine’, esp. in the US and UK has become fairly arrogant. Medical professionals in these countries believe they have all the right answers. Their narcissism prevents them from acknowledging their failures. The same narcissism also prevents them from recognizing the successes of countries like India, Bangladesh, Taiwan, and Singapore.

I’m not just talking about the ‘spread’ of the coronavirus. That event is long past. And we all know the autopsy report on that one.

I am talking about the low mortality in these countries. Their successful treatment and discharge of patients from hospitals.

The arrogant epidemiologist here will say there is under-reporting of cases. An equally self-absorbed and judgmental media will say these countries don’t test as many people. 

The media in western countries have not been able to shed their colonial lenses, you see. Some say “Dr. Jain, you got it all wrong. America was colonized, not a colonizer”. I invite such folks to look up Liberia whose capital too has a Presidential name.

The point I am trying to make here is that there is and remains a persistent narcissism in ‘western’ medicine and this pandemic has highlighted it for me even more.

We, in the west, have lost our way.

We won't acknowledge that perhaps low grade infections contribute to higher immunity in India and Pakistan.

We won't acknowledge that childhood BCG perhaps does work somehow in preventing COVID.

We won’t acknowledge that the treatment of COVID patients is better in India, where they come to your home not just to administer the COVID test but also perhaps give you Remdesivir if you need it next week! Can you imagine the scale at which millions of people are being served like that? And they aren’t the most advanced healthcare system in the world by any standards.

In Seoul, they stamped out the spread by having mobile testing units in streets. Block by block. Everyone was tested. Imagine a country like ours couldn't even make the swabs available for our practices in New York, let alone the testing machines. We were testing swab by swab while others did ‘batch testing’ to speed things up. They were using mathematical probability to speed up results while my patients were getting results of a PCR in 10 -14 days at one time last year. The bureaucracy here kept the PCR machines licensed only to reference labs. The same bureaucracy that gave CVS the contract to vaccinate all elderly in Nursing Homes, rather than their physicians.

Some more examples of our arrogance, follow.

We won't accept that hydroxychloroquine is something that does work preventively as it has for so many physicians worldwide; especially doctors practicing in India. I, myself have taken it weekly through the pandemic and remained a COVID-virgin, if not a COVID-survivor.

We won’t accept that Ivermectin perhaps works, as it has in Bangladesh and India.

We won’t accept that high dose Vitamin D given early enough may have a role.

We won’t accept that perhaps Azithromycin has a role either.

We continue to chase only brand name-new drugs with patents in COVID therapy. That is our blind spot. We won’t fund a study that looks at other options.

Instead of looking, seeking, finding, and acknowledging a world unknown to us; in our arrogance, we find fault, we find flaws in every nation and their approach.

We even have reasons and explanations on how Taiwan, Singapore, and Japan can do it - that which we somehow cannot ever do. Or imagine doing here, in America. Such as quarantining all arrivals from other countries in hotels. Even when we have had the lowest hotel occupancy in decades.

If you were to travel to Taiwan, they will test you at the airport, then in the hotel a few times. All the time, feeding you and paying for lodging you in a hotel. What about us in America? Not possible!

Until recently, you could just land at JFK and walkthrough with no questions asked. We have had many friends whose parents and relatives came in, shocked and surprised at the callousness they saw at empty airports in the US.

In Seoul, when faced with a dire prediction of the spread of coronavirus through its dense skyscraper apartment buildings, the government sent out mobile units to conduct a massive scale testing. Almost a million tests a week. They used the wifi history between devices and cell phone towers to notify every possible exposed person that they better check themselves as someone they had been in close proximity based on the phone data, had tested positive. Here, we had laws that prevented such sharing even in the midst of a pandemic!

Silicon Valley may have started the tech revolution, it surely doesn’t live there anymore. Nor does it live in the US, either. If anything, poor laws, higher taxes, and business-unfriendly government after government, have made sure of the exodus of American innovation and ingenuity continues.

One would have expected our news-hungry ‘western’ media to send its reporters to Seoul. Or India. Or Pakistan. Or China. They would rather cover hunger and conflict in foreign nations, than their successes. Our ‘western’ media has decided we need to ‘look good’.

I used to go to gymnastics tournaments with my daughter. I could see firsthand how kids were growing up coddled and spoiled by awards and trophies for every rank in the sports they participated in. Not only such kids have a distorted view of reality or the bubble they grow up in, but they also end up having very fragile self-esteem.

Our ‘western’ media feels that it is their duty to maintain if not propagate this myth. Americans need to be protected from themselves.

Please turn on the news, sometimes. You will hear them spew how American leadership on the world stage is under threat. The harsh truth is that the world is leaving America behind!

Another problem I noticed through the past several months was how even the CDC and the FDA started to serve a government, rather than the people.

I also feel that our CDC and FDA have started to ‘believe’.

Believe that somehow they and only they themselves have all the right answers.

I would challenge them to consider if they even have the right questions to ask?

The right question to ask is how is it that when half a million Americans are dead, we haven’t sent over our scientists to look at the Indian success? Or to Pakistan and Bangladesh and see what they are doing right? Countries where the overcrowding far exceeds Elmhurst, the epicenter of the surge in New York, are doing far, far better than us! Why? How?

For purposes of discussion, I will contrast some features that are unique to western countries. Such as their looking at the human body as a car with independent parts.

Transmission issues? Go to Lee Miles.

Need oil & lube? Go to Valvoline.

Got a plumbing problem? Go straight to a Urologist.

An engine problem? Go straight to a Cardiologist.

And soon, you have every specialist treating their favorite body part.

In isolation. Soon, no one is paying attention to the whole body. That is the world I live in, I should know.

Also, medicine in these countries is not practiced with any context for a decision to be made. Cancer? Follow this protocol of chemotherapy. There is hardly room for the social or cultural context. Talking about peace, consciousness, or nutrition and its role in one’s happiness or medical well-being is relegated to the abyss. Those who practice holistic medicine can’t even get reimbursed for their time whereas the one who approaches the human body like a fireman, running a hose up and down one’s openings gets rewarded rather handsomely.

We leave our dying unprepared for the inevitable end. There is no discussion of spirituality or its role in closure and acceptance of our common final outcome. We use statistics in trials like dogma. Instead of taking each individual scenario, we quote the prognosis of the group and subscribe the individual to it.

Imagine telling a hundred cardiac patients about the mortality statistic from a bypass (CABG) surgery. And not exploring their socioeconomic status which would impact their 30-day mortality post-CABG in a big way! And imagine telling everyone the 3% mortality statistic. The Cardiac surgeon who made it without losing his first 96 patients, needs to do a full disclosure to his 97th, 98th, and 99th patients. You will die under my blade on the table!

We have made meaningless data our God. And we have unshakeable belief in it. Doctors like myself prescribe one poison after another wearing a white coat. You find that shocking? Why should you? Take anything prescribed as medicine and pop a bottle of it like m&m’s and you will know what I am talking about. I am in the poison business. Except that I prescribe poisons in small amounts to get a therapeutic benefit. The poison still is a poison. And in a weird way, I have a license to poison you, my patient! Any wonder why we wear white coats as a disguise? Would you take a prescription from a gel-head, wearing dark shades and a black suit? In case you didn’t know I am the incarnation of witch doctors of the aborigines, v2.0.

The chemotherapy my fellow witch doctors give is no different from killing a million 'innocent' people to get that one terrorist. Quite akin to ‘collateral damage’ in armed conflict. Yet we pride ourselves on this form of medical treatment and market it to the whole world. There is nothing modern in ‘modern medicine’. It is antiquated, I feel. Companies like Moderna are changing that. Until that change happens, my descendants will not be wrong in talking about people like me as having lived in the dark ages of ‘American Medicine’ of which I am a shining example.

There needs to be far more humility in ‘western’ medicine than there currently is. We call it science. Yet, what we call science is merely how we could explain our observed phenomena through our vantage point of observation. It explains only what we know that explains what we asked of. 

It doesn’t explain why a trillion cells live in perfect harmony when a few billion people cannot. It doesn’t explain why some revolt and their conflict gets labeled a disease.

It doesn’t explain why I remain ‘Sandeep’ throughout my life when all the cells that gave me my identity at birth have turned over, every 7 years. Actually, over 90% of cells in our body are new every 28 days, yet my identity of self perseveres in ‘Sandeep’!

Our science cannot explain why a few hundred trillion cells inside of me can communicate in real-time and lean on each other to make ‘Sandeep’ work or even write his thoughts down in a LinkedIn article. Mind you, all the while, each of those tiny cells is doing almost a million things in a day - repairing, fixing, making, dividing, creating, destroying, communicating, reacting, and responding. With each other across the ocean of blood, the vacuum of thought, even reaching out in physical contact and caress. Healing inside our body takes a village! Yet, we talk of it as isolated events and individual chemicals, removed from their context.

I should have clarified that when I say ‘western countries’ I am speaking about the US, Canada, European nations and Australia. Similarly, my use of the term, ‘eastern countries’ would mean the Arab world, East Asia, Central Asia, South Asia, including India and China - countries with a storied heritage of holistic medicine.

Pranayam makes news only because the Indian Prime Minister, Narendra Modi, practices it. Meditation isn’t part of ‘western’ medical training. Yoga is probably a better form of daily Physical Therapy for your muscles and joints than anything out there. However, Yoga too; doesn't make it to any ‘western’ medical text dealing with joints or muscles. Yin, Yang, and the concept of Chi are not mentioned in any ‘western’ medical text, whose sole focus is the body part business. There is this pervasive concept in ‘western medicine of looking at the human body in isolation. From the viewpoint of a mechanic dealing with a broken part. An automobile. And we all know the human body is more than just a physical body.

That is the background I had to share with you so you can get the next observation I made as this pandemic unfolded in front of my eyes and I watched our scientists and doctors making headlines in the media.

I realized that our ‘western’ scientists seemed to have an unshakeable ‘belief’ in their abilities. Their knowledge. Their science. Their view was the only view worth viewing. Such arrogance!

May I remind the reader that perhaps we know better…...

All of us do know a thing or two about beliefs or faith, don’t we?.....

After all, the word ‘faith’ is most often paired with ‘blind’.

‘Blind faith’ is for a reason, isn’t it?

Our ‘western’ scientists are no different from the fundamentalists with their dogma that we went to war against on foreign soil.

Any inquiry has to be accompanied by a willingness to step into that which we may know nothing about. The ability to relinquish all ideas one may be morbidly attached to with an umbilical cord of sorts. I don’t see that anymore, here.

Our ‘western’’ scientists are the same scientists whose lineage has one root in Louis Pasteur, the father of germ theory and perhaps even the father of vaccination. The vaccinations we are so used to today are descendants of a practice called ‘variolation’. In this, an infectious agent was scratched into the skin of another to cause a mild infection. That infection would provide protection going forward as the body, once exposed; could now be counted on to build its defenses and be ready.

Our ‘western’ medical texts continue to propagate Louis Pasteur and ignore facts such as the Ebers Papyrus of 1500 B.C. Just as they ignore contributions like rhinoplasty by Sushrutha in 600 B.C. You see, ‘western’ medicine no longer honors tradition. Or contributions of those before us. We are too self-absorbed.

The history of how we got here in medicine is no longer a subject of interest. Not the venereal self-inoculations by John Hunter or William Halstead’s gall bladder procedure on his own mother. A cholecystostomy that not only saved her life but also became the gold standard in bringing down the mortality in gallbladder surgery from 100% to almost 2%. Yet, we won’t speak of such giants who carved our paths for us. The Hippocratic oath is all we teach in medical school.

Talking about history, it is ironic enough that the British made the young Wadiyar Queen Devajammani of Mysore, the poster woman for inoculation. Inoculation - a version of variolation that was in practice in that part of the world for 150 years before the red coats brought it back as ‘new’.

Recall that we still say India was ‘discovered’ by Vasco Da Gama....as if Indians never existed until the first white man discovered it! Or America before being ‘discovered’ by Leif Erikson. I know, I should say Christopher Columbus; for that is whom we honor. We even have his statue overlook the roundabout in his name, right here in Central Park. As an American, it is probably as heretic to discard this slave owner or his claim to fame as it is to assign the middle eastern face to Jesus Christ. No idea how, National Geographic pulled that one off on its cover page, in a country where religion and politics do mix. Oops, can’t say that, as well. Sorry!

Anyways, back to variolation...

Our ‘western’ medical texts continue to ignore that variolation was practiced by Chinese and by Indian brahmins long before Louis Pasteur. The physician ‘Dununtary’ was just the anglicized name of Dhanvantari the Hindu God of medicine. In Bengal, you had ‘Tikadars’, the ‘giver’ of the shot, long before I became a ‘vaccinator’.

And that ‘great’ nation France; whose son was Louis Pasteur, what about that country? Well, it has the ignominious reputation of being the last country to adopt variolation!

We won’t mention these facts anywhere in our medical texts now, will we?

Another observation that I would like to invite you to consider is how eastern countries don’t view the human body in isolation from the context in which it lives, breathes, and operates. Western countries do. Any wonder why immigrants have generational homes? To them, home means more than parents and kids. Ask a South Korean or a Chinese. It means having grandparents live with you as well. Home and what it stands for is a matter of context. A context ignored by Cuomo’s advisors when they bundled 75-year-olds in COVID vaccine phase 1B with everyone else. They just didn’t have the context that in New York, home of immigrants, there are healthy elderly living outside of nursing homes and adult homes. And they needed at least a week by themselves alone, to get vaccinated. Just like the healthcare workers did.

Let’s take the example of Kiki, our dog. Having had Kiki as a pet must have protected me from having premature death like my father. Pets, especially dogs, reduce heart disease, improve survival and decrease anxiety disorders in the family better than most drugs. Yet it is not therapeutic advice noted in any medical textbook that I have read.

It is our ‘western’ medicine that ignores these kinds of context and worships at the feet of discontinuity. Why should it surprise us when a tiny country with poor internet connectivity like Bhutan ranks high in happiness and we don’t?

And whereas earlier, we could claim to be good keen observers of natural phenomena, this coronavirus pandemic has proved otherwise. People like myself, ‘western’ medical professionals; are rather poor observers of natural phenomena like this coronavirus outbreak and its evolution, its mutations, and vaccines thus far.

How is it that we have no explanation for what has happened? I know coronaviruses mutate in nature. I even acknowledged that in my interview on ITV a few days ago and various zoom calls the week before. The mutation isn’t the issue I’m talking about here even though that is what people jump to nowadays.

I am talking about the spread. From one species to another. This is called zoonosis. And it has a set of observations and a timescale that they usually follow.

No matter how implausible it sounded initially, I got the part where the bat pooped on a pig. And I got the part that perhaps the starving ‘piglet’ ate that bat poop too.

I even get the part that ‘piglet’ was eaten by humans. After all, we grow and ruthlessly kill the most intelligent and emotionally sensitive animals without thought or feeling.

From bat to pig to human; that much I can still swallow as being very ‘natural and plausible’ especially after watching how all these species were kept close to each other to be sold in food markets. Got that.

What I can’t get is how this zoonosis is so unique.

The same coronavirus that came from bats to pigs to humans (that is already three species), that same coronavirus now jumped into minks causing their owners to cull 20 million of them in Denmark, much to the chagrin of the fashionista craving her mink coat. Ok. I might gulp that down with some water too. Coronaviruses do have cats, dogs, ferrets, etc. as hosts. All right, so what if it jumped and went into minks? Got that.

However can some epidemiologist please stand up and explain how this zoonosis, mutated in the minks and jumped right back across that species, all in a span of a few months?

Has there ever been such a zoonosis observed in nature - from ‘horseshoe bat’ to pig to human to mink and then back to human in a deadlier mutated form - transmitted across all these species and that too, all inside a span of a mere ten months? And here is the real kicker. I left out the pangolin which was perhaps the species between the pig and humans! Go figure!!

Add to this the Shitou Cave and RaTG13 from 2012, and you end up with a virus with 96.2% similarity to the one that has killed half a million Americans.

I am not a statistician, so I don’t understand probability. But are all these just meaningless coincidences?

To me, these are not one, but several ‘black swan’ events in a series. And our ‘western’ scientists are yet to offer a plausible theory that I could swallow, let alone hope to digest over time.

It was known to be an airborne contagion from Day 1 as many of you who have read my numbered posts will agree. Yet our arrogance and need for looking good and ‘in control’ kept this information from the public. Narcissism and science seemed to be two sides of the same coin. And no one had the honesty or integrity to stand up and state the simple self-evident and inalienable truth.

New England Journal of Medicine (NEJM) is the world’s leading medical journal, before the time I entered the profession. In October 2020, it published an editorial "Dying in a Leadership Vacuum," which was signed by each and every one of the editors. And I must say this made me more proud to belong to the flock of physicians than anything ever in my career. For only the second time in all its history spanning centuries, these physician editors had the courage to stand up and say it like it is.

The NEJM editorial declares: “…..the issue here is around fact, not around opinion. There have been many mistakes made that were not only foolish but reckless and I think we want people to realize that there are truths here, not just opinions…About our leaders, it said, they “have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs."

Those thousands of Americans have become hundred of thousands. As I write this, more Americans have died in this pandemic than in World War II. A sobering thought.

I also know that soon it will be a million fellow Americans. Looking up at the long line of practitioners before me, who served humanity, I have to concur with NEJM editors. It is time for all of us to hang our heads in shame. Our scientists and leaders in government agencies abandoned the people they were supposed to serve. Sycophants who did not have the courage to stand up for what was right. Instead of helping fellow Americans survive, they sought self-survival.

And American medicine isn’t what it is touted to be.

Not anymore.

Not just yet.

American medicine has lost its way. It isn’t just the politicians who demonstrated narcissism. We need humility in our doctors and scientists too. It isn’t just the politicians who were found sowing seeds of divisiveness. Medical practitioners have been learning how to divide the human body up and treat parts of it in isolation. It is time for us to take a hard look at ourselves and the training we provide in our storied medical institutions. Hospitals have become the final stop before the grave, instead of beacons of hopeful return to the families and communities. A few jumbo jets of people die from medical errors every day. Medicare data suggests at least three medication errors per patient per day of hospitalization. I served on almost all hospital committees and have seen even worse statistics unfold week on week.

It is time for me to sign off and get back to the work ahead of me. A thousand years ago, Hasan Ibn al-Haytham, the founder of the scientific method of investigation, left us a prescient message; one that I would like to leave you all with today: “Don’t take my word for it. See for yourself”