…and Nina’s got him:
[NOTE: The title is a reference to the advertising slogan for this film.]
Republicans may win in the mid-terms? Solution: cancel them!
(The mid-terms, that is, not the Republicans.)
Thus saith an op-ed by David Schanzer and Jay Sullivan appearing in today’s NY Times.
Of course, they don’t actually say to cancel them because Republicans stand to do well. Their argument is that they should be canceled because midterms negate the power of the president. However, to most people of a non-tyrannical nature, that would be a feature rather than a bug. The midterms are one of the only checks the people have on a president such as Obama—or any other president, for that matter—who throws them a curve by doing the opposite of what he/she promised or pledged, and a Congress that goes along with it.
But no:
The main impact of the midterm election in the modern era has been to weaken the president, the only government official (other than the powerless vice president) elected by the entire nation. Since the end of World War II, the president’s party has on average lost 25 seats in the House and about 4 in the Senate as a result of the midterms…
The realities of the modern election cycle are that we spend almost two years selecting a president with a well-developed agenda, but then, less than two years after the inauguration, the midterm election cripples that same president’s ability to advance that agenda.
Well, maybe the public has decided it doesn’t want that agenda, as events have played out. Or maybe, just maybe, the agenda that was promised is not the one that was delivered, and the people want the president stopped. Or maybe even impeached.
Another problem Schanzer and Sullivan see is that midterms tend to attract the whiter, older, wealthier, more educated voters:
Another quirk is that, during midterm elections, the electorate has been whiter, wealthier, older and more educated than during presidential elections. Biennial elections require our representatives to take this into account, appealing to one set of voters for two years, then a very different electorate two years later.
There’s an obvious, simple fix, though. The government should, through a constitutional amendment, extend the term of House members to four years and adjust the term of senators to either four or eight years, so that all elected federal officials would be chosen during presidential election years.
Hey, I’ve got an idea for an even better fix! Only allow voters to vote in strict proportion to their racial and socioeconomic category percentages in the population, so that no one group is over-represented because of its suspiciously greater voting zeal.
The sort of thinking Schanzer and Sullivan espouse is frightening but not surprising. And the Times has a tendency to publish these “enough with the Constitution, already” op-eds now and then, as experimental feelers for how far the public is willing to go to enable the leftist agenda, and to get the people used to the arguments therein. They like to use professors to accomplish this.
The curious thing in this case is that Schanzer, although a Democrat, does not seem (at least by my reading of his resume) to be an extreme leftist—for example, the Congressional Democrat he advised was a Blue Dog Democrat from Texas. Why, then, is Schanzer so hepped now on an imperial presidency, unaccountable to the people [hint: rhetorical question]? Did he advocate that same position back in 2006? I certainly doubt it.
The PC crowd and academic freedom
One would think that Robert Oscar Lopez, “Latino child of lesbians” who is also bisexual himself, might be in with the PC crowd. But questioning some of the tenets of their narrative trumps even those identifying credentials. Mr. Lopez is that relative rarity, a man who thinks for himself, one who actually believes in academic freedom rather than just academic freedom for those who espouse goodthink.
Lopez is guilty of the thoughtcrime—actually, of thinking—and that meant he must be destroyed. He’s not a researcher himself (he’s an English and classics professor), but he supports airing research and thoughts that dare to question the LGBT party-line on gay parenting:
But it was really only at the October 3 event that my life as a scholar came full circle. Tenured, well-published, and connected to international allies who could give me a serious chance at disseminating my commitment to the rights of children, I felt I could address a serious gap in research””the question of whether gay parenting as it has evolved is ethical””through the mix of testimonial sincerity and scholarly rigor that I felt had been missing for over 20 years.
The conference was consciously not structured as a rebuttal of gay parenting, and that made me very happy. For too long, an overemphasis on statistics and excessive pressure from the gay lobby had skewed scholarship on children…
Oftentimes when I was interviewed or when I debated, people would tell me, “But, Mr. Lopez, all the social science indicates that children do just as well in same-sex households.” Citations of the American Pediatric Association or the American Medical Association typically ensued. As a humanities professor, I faced a conundrum: I was arguing not only against an individual who was telling me that I had no right to feel the way I actually did about being deprived of a father; I was also arguing against a technocratic, deeply anti-humanist philosophy that felt comfortable reducing the higher aims of life to statistics.
He found himself under attack by LGBT activists, his words misquoted and his work misrepresented, as they tried to whip up a Two Minutes Hate against him. Lopez observes:
Under these conditions, research will die soon. Maybe it is already dead. Scholars cannot forge new ideas if they are punished for writing too much, publishing too much, considering too many ideas. There is no way for one lone scholar to prevail against full-time investigators paid by a massive lobbying organization to comb over that scholar’s work in search of embarrassing quotes. If every sentence must be written with safeguards against misquoting and interpretive abuse, then every scholarly study will sound the same, argue the some points, and support the same conclusion. That is how the field of sociology arrived at its now famous “consensus” about same-sex parenting, which Loren Marks deconstructed in 2012.
If people cease to take thinking seriously, the LGBT lobby wins. The cost of their victory will be, tragically, far more than the many careers and personal lives they destroyed in the effort to, as Josh Barro put it, “stamp out” dissenters. The cost will be the great marketplace of ideas that nourished scholarship since the days of Socrates and long before.
Lopez writes “maybe it is already dead.” I agree, and I think it’s been dead for quite some time. I first noticed the PC-attitude beginning to dominate the field of social science research several decades ago. The phenomenon has only grown since. What else was the firestorm over Larry Summers’ remarks on women at the highest reaches of science about? All the man did was notice an actual, bona fide phenomenon (the scarcity of women at the very upper levels) and call for research in the area, and it got him booted from his post as Harvard president because the tender sensibilities of the PC crowd could not stomach shining the light of science into an arena where they had an agenda.
It is ironic that universities have become the champions of irrationality and prejudice. But irrationality and prejudice are doubleplusgood as long as they’re for the right causes.
[NOTE: Personally, I have nothing against adoption and childrearing by gay and lesbian couples. There’s a lot of variation there, just as there is with heterosexual couples, some of whom are good parents and some not. Social science research might actually be able to yield information on makes for more successful parenting, of course (for any parent, of any sexual orientation), if it could be entered into with a spirit of intellectual honesty—although social science research (even of the unbiased sort) is deeply flawed because of the problems inherent in studying human beings and in coming up with objective measures for concepts that are difficult to operationalize.
Lopez mentions father absence, for example, as a potential problem. Of course it can be, even for children of divorce in heterosexual couples. How much of a problem, and how often? And how could this inform policy decisions? What might some solutions be? If we can’t be allowed to discuss these things rationally—and apparently we can’t—we’re sunk.]
Bronx Obama
It’s not easy learning how to talk like Obama, if you’re from the Bronx:
The Romney impersonator is nowhere near as handsome as the real deal. Wonder if he’s still employed (the Romney impersonator, that is; I know about the real Romney). The documentary was made during the 2012 campaign.
Vaughn Meader (you older folks might remember that name, but here’s a link if it doesn’t ring a bell) had a meteoric career that completely tanked after Kennedy was assassinated.
Here’s a refresher:
When the female voice first comes on, did you think it was meant to be Marilyn Monroe? Some people may have forgotten—or never known—that Jackie Kennedy sounded quite a bit like Marilyn, especially in her breathiness. I had noticed the resemblance when I first heard Jackie, during the televised White House tour. An excerpt:
[NOTE: More here on Bronx Obama.]
Brittany Maynard postpones assisted suicide
Assisted suicide is a huge topic about which I have tremendously conflicted feelings, including compassion for those who are suffering so greatly that they feel the need to consider it.
But this isn’t going to be a long, complex article on the topic in general. I will note, however, that I don’t think doctors (or other health professionals, or any official of any sort) should be involved in assisting patients who want to kill themselves. It blurs the role of a doctor, which should not involve outright killing. I say that although I’m well aware that there already is a gray area in which doctors often give pain-relief medication (morphine, for example) in doses that could hasten death, although death is not the goal, pain relief is. That seems a very different thing to me.
It is also easy to see that in countries such as Belgium, where physician-assisted suicide is the law of the land, it has been abused. The slippery slope is very, very real. I’ve written before about Belgium’s law, where it isn’t even necessary that a patient be considered terminal.
Here at home, American Brittany Maynard has gotten a lot of attention recently, in part because she has gone public with her assisted-suicide plan, and in part because she’s a young, telegenic person whose case is especially heartbreaking. She has a brain tumor that will almost certainly kill her fairly soon, but not before it takes away a great many of her faculties and causes her a great deal of suffering.
Maynard and her family moved to Oregon after her diagnosis, because Oregon allows physician-assisted suicide. She had previously announced her plans to kill herself today, November 1, because she could feel herself becoming more and more symptomatic and wanted to go before things got too terrible. But she has postponed her suicide:
I still feel good enough and I still have enough joy and I still laugh and smile with my family and friends enough that it doesn’t seem like the right time right now…But it will come, because I feel myself getting sicker. It’s happening each week.
She indicates she will do it when the time is right. I have no idea whether she will or will not. But I have noticed that in many people (including some I know personally) who have resolved to kill themselves when the medical going gets rough, it’s not unusual for them to change their minds much as Britanny has for now. Life seems to continue to have attractions past the point where they had thought it was time to give up. This seems to me to be a good thing.
When I was younger I had a fascination with the people who were then called the Eskimos, but have since become known as the Inuit. You may recall that they were known for the prevalence of suicide among the old, when they could no longer contribute much to society and were considered a drag under the very harsh conditions that prevailed in that climate.
But I discovered, when I actually studied their mores, that it wasn’t quite like what I had thought. What usually happened was that the older person would state, in a code for suicidal intent, “I think I may just take a walk outside in the snow for a while”—uttered, for example, on a night when the wind was howling and the temperature was 50 below zero. In other words, to go out to freeze to death.
The usual response from the family, though, was something like this: “We still want to see your face among us.” In other words: please don’t go yet; we’re not ready to say goodbye.
Love is tenacious of life, and does not want to let go.
Ebola in the US: some trends
Been wondering about the condition of Dr. Craig Spencer, being treated at Bellevue? There hasn’t been all that much in the news about him, but here’s a relatively laconic article saying he has been upgraded from serious but stable to stable condition.
It also says that he “is receiving therapies that have been effective in treating Ebola patients at Emory University Hospital in Atlanta and at the Nebraska Medical Center.” In other words, (my translation), he’s getting some antiviral drugs and/or transfusions from survivors of ebola.
Fortunately, we haven’t had very many ebola patients in the US so far. But I can’t help but notice a couple of things about the group of patients we have had.
The first is that all of them except Thomas Eric Duncan seem to have contracted ebola while caring for other ebola patients. And if “carrying to a cab to go to the hospital” is defined as “caring for” (although I don’t think it actually does), that would include Duncan as well.
Note that I wrote “seem to have contracted ebola while caring for other ebola patients.” That’s because Dr. Rick Sacra, who contracted ebola in Liberia, was not caring for known ebola patients at all: he was treating pregnant women. So we must conclude that both Dr. Sacra and the staff at the hospital where he worked in Liberia, although they are medical professionals in a country currently experiencing an epidemic of the disease, have encountered patients who are ill enough to transmit ebola to others and yet whose symptoms are either not serious enough, or are atypical enough, that their ebola status has gone unrecognized by the medical people treating them.
Dr. Sacra’s case is a sort of mirror image of Thomas Eric Duncan’s case, because Duncan also helped a pregnant woman who was not known or recognized to have ebola at the time (look to all my previous posts on the matter if you disagree with me about that), but who turned out to have been highly contagious. This fact sequence points out something that health professionals here have mostly been mum about: although ebola is an extremely serious and often-lethal disease, it is not always recognizable as such, even by highly-trained (including Western) doctors and nurses.
There are many reasons for this (one is that what we think of as “typical” symptoms are not present in a significant number of cases), but for our purposes right now it’s enough to state that it is a troubling fact.
Another pattern that leaps out is that so far the death rate in the US has been much lower than in other places. This also includes all the US citizens who got their initial treatment in Africa and were only flown here after they had become quite ill. The good results might just be a coincidence, because the number of patients treated here has been very, very small. But if we assume there’s something to it, it could be some combination of early treatment (for about half the patients here, anyway), the high quality of our medical care in general (effective rehydration, etc.), and the aforementioned “therapies” which seem to include antiviral and other special drugs and survivor transfusions.
The only ebola death in the US so far has been Thomas Eric Duncan. He missed having the advantage of an early diagnosis because his case went unrecognized by the Dallas hospital ER he first visited. He also had the misfortune of not matching the blood type of the available survivor donors, so he got no transfusion. It’s also possible there was something different about his physiology; perhaps other illnesses had weakened his immune system, or there could even have been genetic factors that made him more susceptible to the illness.
It may be that we risk becoming a little too cocky, though, about our ability to treat ebola. Our success so far appears to depend in part on the tiny number of cases. It wouldn’t take much to completely overwhelm our ability to give patients the sort of care these first victims have gotten, and then things could change dramatically. What’s more, the fact that almost all the cases here have been among health care professionals caring for already-diagnosed ebola patients is in a strange way a tremendous advantage, because it has enabled us to monitor them from the start and to treat them almost the moment they display symptoms—symptoms that in a person not known to have had prior contact with ebola would cause no alarm. That, in turn, has two advantages: early treatment almost certainly makes it more likely that they will survive, and early isolation makes it less likely that they will spread the virus into the general public (or to other health care professionals, who will be wearing protection almost from the start while treating them).
A nightmare scenario would be if ebola were to get out into a population that was unaware they had been exposed to it, and who therefore could easily interpret early symptoms as commonplace flu and therefore would be far more likely to infect others in the public before being diagnosed. That’s the way ebola could get out of control in this country. And that is why so many people (including me) are in favor of quarantining returning health care workers, and placing a moratorium on the issuing of visas to citizens of the ebola-affected countries of West Africa, except in compelling circumstances. This is not because we are unaware of the fact that ebola is alleged to be contagious only in symptomatic individuals. It is because we realize that symptoms are not always heeded right away, the contagion is a continuum rather than an “off/on” phenomenon, and that there is a small percentage of African ebola cases where there has been no previous known contact with a symptomatic ebola victim.
Being extra-careful makes sense, because the stakes—and the risks if things get out of control—are tremendously high.
Kaci Hickox wins in court
The lower court had upheld state authorities wanting to restrict her movements, but a District Court judge in Maine has overturned that ruling and let her go about her business. The reason? The science is settled:
Judge Charles C. LaVerdiere ruled Hickox must continue daily monitoring and cooperate with health officials if she chooses to travel. The judge said there’s no need to restrict her movements because she’s not showing symptoms of Ebola.
In his ruling, the judge thanked Hickox for her service in Africa and wrote that “people are acting out of fear and that this fear is not entirely rational.”
Maine Gov. Paul LePage disagreed with the judge’s decision, but said the state will follow the law…
The judge…acknowledged the gravity of restricting someone’s constitutional rights without solid science to back it up.
“The court is fully aware of the misconceptions, misinformation, bad science and bad information being spread from shore to shore in our country with respect to Ebola,” he wrote. “The court is fully aware that people are acting out of fear and that this fear is not entirely rational.”
No doubt the judge is also “fully aware” of certain facts I wrote about in yesterday’s post, such as for example this from the irrational and unscientific Nobel-prize-winning immunologist Dr. Bruce Beutler:
It may not be absolutely true that those without symptoms can’t transmit the disease, because we don’t have the numbers to back that up,” said Beutler, “It could be people develop significant viremia [where viruses enter the bloodstream and gain access to the rest of the body], and become able to transmit the disease before they have a fever, even. People may have said that without symptoms you can’t transmit Ebola. I’m not sure about that being 100 percent true. There’s a lot of variation with viruses.”
This could go to a higher court, but I don’t think it will, for two reasons: the state of Maine (and its governor in particular) doesn’t appear eager to do so, and Ms. Hickox’s restrictions were due to expire on November 10th anyway.
So, this is the way the argument is going to go: for the Hickox defenders, it will be “you stupid anti-science morons, we are the scientists who know best.” And this despite the terrible track record scientists and public health authorities have so far in this epidemic, both in controlling it in Africa and in preventing the disease from reaching the US, and then in preventing it from being transmitted to health care workers in the US.
That said, I’ve stated from the start that I think the chances of this particular person, Kaci Hickox, having ebola are very very very slim. So I would bet a fairly large amount of money that she and her supporters will say, on November 10 or even before, “See, dummyheads, she’s fine! Therefore a quarantine would have been wrong.”
Which of course would be a stupid and unscientific argument, although I doubt that will stop them. A quarantine is a game of numbers. It restricts an individual, but it does not require that every restricted individual develop the disease in order to justify the imposition of the quarantine. It doesn’t even require that most of them develop the disease, or even that any of them do so. It merely requires that it is possible they might have developed it, because they have had some exposure to the disease and are in the incubation period, and that the risks of that disease to the public are great enough to justify a very time-limited restriction on their physical movement and freedom of association. Returning health practitioners from ebola-affected countries all have a small but nevertheless actual possibility of infection, and since we are not certain at exactly what point a person becomes contagious, and since people (even health professionals) are not necessarily reliable at reporting and restricting their own movements the minute they are demonstrating symptoms, and because the disease is so unusually dreadful in both its symptoms and high rate of mortality, it could certainly be argued (scientifically and rationally) that a 21-day quarantine (or, as in this case, restriction from being around the public, which is what authorities were asking) is justified.
[NOTE: As one might suspect, Judge LaVerdiere appears to have been appointed by a Democratic governor, John Baldacci.]
[ADDENDUM: On the subject of the possibility of further court action, I just read this:
The current ruling supersedes the earlier order and will be in effect until a full hearing on the issue. The court papers set no specific date for a full hearing, but they noted that such a proceeding must be held “no less than three days and not more than 10 days” from Thursday.
As I said, it’s not clear to me whether the state will try to go further with its legal action.]
Reconciliation and Obamacare: what goes around comes around?
I certainly hope we get to find out:
In a private meeting with Americans for Limited Government (ALG) staff, senior aides to Senate Minority Leader Mitch McConnell (R-Ky.) promised that should Republicans reclaim a majority in the Senate on Tuesday, they would use the budget reconciliation process to go after Obamacare.
It was unclear whether that meant full or partial repeal of the law under reconciliation, but according to ALG vice president of public policy Rick Manning who was at the meeting on October 29, “Aides acknowledged the only way to get any type of repeal or even major changes to the law would be reconciliation.”
The matter was further clarified in an October 30 statement by McConnell spokesman Brian McGuire: “if Republicans are fortunate enough to take back the majority we’ll owe it to the American people to try through votes on full repeal, the bill’s most onerous provisions, and reconciliation.”
The rest of the article is about the finer points of outright repeal vs. change through reconciliation, as well as the question of tax vs. penalty, the probability of an Obama veto, and tactics. But the strategy is to use the Senate majority to shake up Obamacare in a big way.
As I’ve said before: hope we get a chance to see.
Back when Obamacare was being passed, I wrote a ton of posts about the use of reconciliation as a process to drag that thing through. Without reconciliation—which, if I recall correctly, had never before been used to force a major and controversial piece of legislation—Obamacare would have remained in the dustbin of history. Reconciliation could be the first step towards putting it back there again, at least in its present form.
Obama would veto either repeal or a bill passed by reconciliation, of course, if the latter made anything other than tiny changes. But it would be quite the confrontation—and, as the article says, “would set up the 2016 presidential election as a clear referendum on whether or not to keep the law.” While Obama is president, there’s no way for Congress to actually get rid of Obamacare. Even mere defunding would be a disaster, because Obamacare has by now dismantled much of the system it replaced, and that system no longer exists. And even impeachment and conviction of Obama wouldn’t do it, because Biden would then become president, and he would probably veto a repeal or reconciliation bill as well.
But let’s say Republicans take the Senate in 2014. Let’s say they are determined to use reconciliation to change Obamacare into something better, which would at least challenge Obama and let the American people know what they’d do if they had the presidency and Congress in 2016. How much better would those changes be? Can they make it into something a conservative could be pleased with (inasmuch as conservatives can ever be pleased by a government program)? How market-based would it be, and how much of an entitlement program? How would it be funded? Would it reinstate or restrict choice, and how much?
This is all in the nature of counting unhatched chickens, of course. But let’s hope the reconciliation chicken begins coming home to roost.
More thoughts on this Tuesday’s election
When I saw the title of this New Republic piece by Brian Beutler—“It Won’t Be Obama’s Fault When the Democrats Lose the Senate”—I practically snickered.
More sycophantic Obama apologia, I thought. But when I actually read it I changed my mind, because that’s not what the article is at all. Beutler rightly points out some trends in the 2014 election that I had noticed but not really thought about all that much before, trends that should disturb anyone on the right: the relatively poor performances and close races in many states where the Republican candidate ought to be running away with it.
A win is a win is a win, but some of these should be routs, and they’re almost certainly not going to be:
In 2012, Obama lost Alaska, Arkansas, Louisiana, and North Carolina by 13, 24, 17, and 3 points respectively. Right now in the states’ Senate races, also respectively, polling aggregators show Mark Begich trailing challenger Dan Sullivan by one to four points; Mark Pryor trailing challenger Tom Cotton by four to eight points; Mary Landrieu trailing Bill Cassidy by four to seven points; and Kay Hagan beating Thom Tillis by one to three points.
These Democrats are all outperforming Obama by significant margins, in states where Republicans have natural advantages, and in a year in which those advantages should magnify Democratic weaknesses.
The counterpoints to this observation can be found in Colorado, Iowa, and (to a lesser extent) New Hampshire. Obama won those states in 2012 by four, six, and six points respectively. Right now, also respectively, Mark Udall is trailing challenger Cory Gardner by about two points; Bruce Braley (running to replace retiring Tom Harkin) is trailing Joni Ernst by one to two points; and Jeanne Shaheen is leading Scott Brown by only one to two points.
The conservative narrative of a nationwide Republican wave is incubating in these states, where Democrats are underperforming Obama. It must therefore be true that allegiance to Obama is a decisive factor everywhere.
But that narrative cannot account for the GOP’s remarkable underperformance in Georgia, Kansas, and Kentucky. Mitt Romney won those states by eight points, 22 points, and 23 points respectively. Right now, also respectively, Republican David Perdue is leading Democrat Michelle Nunn by two to six points; GOP incumbent Pat Roberts is running behind Independent Greg Orman by about a point; and Senate Minority Leader Mitch McConnell is leading Democrat Alison Lundergan Grimes by three to five points. Grimes is outperforming McConnell’s 2008 challenger Bruce Lunsford, who lost by six points in a Democratic wave year. Kraushaar attributes this better-than-the-fundamentals resilience to “her attempts to appease both the party base and more-conservative voters in her state,” which have been “painfully awkward.”
If I had to, I’d put money on Democrats losing all three. But you have to be really invested in a certain conception of politics to explain races that close in states that red as evidence of a national anti-Obama wave. Or to attribute their losses to insufficient Obama bashing.
I think much of it comes down to candidates and their personal characteristics. For example, notice that in at least two of the states where the Republicans are outperforming what might be expected from their states’ 2012 vote (Colorado and Iowa), the Republican candidates are considerably more personable and magnetic than their opponents. That could also arguably be true in New Hampshire. Then there are people like Roberts in Kansas and McConnell in Kentucky, who are probably doing more poorly because they are less than compelling, and who have probably been coasting on their incumbencies in recent years.
I confess to not being keenly aware of the finer points of the dynamics in every one of the states with hotly-contested races, so I could easily be missing something. Some of you might say it boils down to “RINO bad, conservative good,” but that doesn’t explain some of the races I know best, where New England’s (formerly Massachusetts’, presently New Hampshire’s) very own supposedly RINO Scott Brown is doing better than expected against the widely-liked Jeanne Shaheen.
But I fear it’s more than the particular characteristics of these particular candidates that explains the phenomenon. I fear that what we are seeing is not some profound and thoughtful ideological shift in the electorate, but a free-floating disgust and impatience with the whole process that is both shallow and fickle, and can just as easily turn back the other way if things don’t go swimmingly well.
I leave you to duke it out about the reasons, but those are my guesses. But I’d like to see Republicans not only win on Tuesday, but win big. And then, of course, they have to perform.
Should be “interesting.”
The Times wonders whether Obama may replace some aides
It has come to the Times’ august and rarefied attention that:
At a time when the Obama administration is lurching from crisis to crisis ”” a looming Cold War in Europe, a brutal Islamic caliphate in the Middle East and a deadly epidemic in West Africa ”” it is not surprising that long-term strategy would take a back seat. But it raises inevitable questions about the ability of the president and his hard-pressed national security team to manage and somehow get ahead of the daily onslaught of events.
Poor beleaguered folk, buffeted by all these crises that they had no part in bringing about.
And love that construction: “it raises inevitable questions.” Passive voice. Does the Times have any such questions, too?
The article’s headline is “Obama Could Replace Aides Bruised by a Cascade of Crises ” Note that word “could.” He could fly a kite on the White House lawn, too, but I doubt he will.
The Times may be trying to hint that he should (replace the aides, that is, not fly a kite). But the author doesn’t seem to think it will happen:
There is little evidence that the president plans a wholesale shake-up…Mr. Obama is also leaning more than ever on his small circle of White House aides, who forged their relationships with him during his 2008 campaign and loom even larger in an administration without weighty voices like those of Robert M. Gates, the former defense secretary, or Hillary Rodham Clinton, the former secretary of state.
When Hillary Clinton is your deeply-missed “weighty voice,” you’re in trouble. Of course, the Times is engaged here in burnishing her resume.
But I’m in agreement that Obama has no intention whatsoever of a shakeup. These are his trusted people, and they do his bidding.
Dr. Rick Sacra to Megyn Kelly: about those ebola patients without fevers
[NOTE: I’d like to get the following information to Megyn Kelly, so she can do some further investigating on this point. Just emailing her seems futile, because it will get lost in the shuffle. Any ideas?]
Last night I watched Megyn Kelly’s interview with Dr. Rick Sacra, a Massachusetts doctor who contracted ebola in August while working in Liberia and who was flown to this country and recovered. His answers during this part of their exchange especially interested me:
DR. RICK SACRA, SURVIVED EBOLA: You know, [Kaci Hickox is] not ill. She’s not sick. She doesn’t have a fever. She doesn’t have other symptoms. And the science suggests that she’s really not a risk to anyone at this time. So in that sense, yes, I support her contention. She’s not a risk.
KELLY: OK.
SACRA: The reason you confine someone is because they’re a risk. She’s not a risk.
KELLY: Here’s why people are concerned about her and other workers, I think. Because, first of all in 13 percent of an Ebola cases, you have no fever. So not having a fever isn’t the end-all tell-all about whether you have Ebola, right?
SACRA: I think, you know, you can’t take a statistic like that in the absence of context. Sometimes people with Ebola at the end of their lives will no longer be able to mount a fever because they’re so weak. So when someone arrives at the tent for treatment in West Africa and they’re about to die, they may not be having a fever.
Generally, healthy people like Miss Hickox, when they develop Ebola, they will have a fever. I think they will look behind those kinds of statistics.
KELLY: OK. Understood.
That seemed plausible. However, Dr. Sacra didn’t cite from where he got his information. Perhaps there is a bona fide study that backs up what he’s saying, but I couldn’t find one (which of course doesn’t mean it doesn’t exist). What I did find was much more curious.
Before I go into that, let me say that for quite some time I’ve been doing online research about ebola itself, particularly transmission and early symptoms, as well as symptoms in general. I now have enough information to write about twenty posts, which means I despair of ever getting the information all out there, although I certainly plan to write a couple of lengthy ones.
But the summary version of what I’ve found is that the bulk of the information we have so far about ebola is based on data from past epidemics, plus animal research. The first source is hampered by the fact that this epidemic seems to be going differently and spreading further and faster, although what has caused that difference is as yet unclear . The second source is hampered by the usual caveat that a disease acts differently in different species, although some species (in the case of ebola, non-human primates) are more similar to humans in their responses than others.
There’s also a third problem with the data, which is that the the data from previous ebola outbreaks is sketchy, to say the least. That’s because record-keeping in medical facilities in those parts of Africa has been haphazard (plus some patients may not be coming in for care or even recognized as ebola patients):
Everything we know about Ebola since the disease’s two dozen or so outbreaks since 1976 comes not from a rich, deep database of scientific evidence that’s been carefully collected and recorded. With few formal health care systems in the areas hardest hit by the disease, there were no medical records, no charts and no standardized ways to document patients’ symptoms, vital signs, treatment regimens and whether or not they survived. Instead, much of our knowledge comes from the haphazard scrawl of doctors’ notes and their recollections about treatment and survival rates.
But for the past 10 years at Kenema Government Hospital in Sierra Leone, the country’s Ministry of Health has been working with a group of international researchers to establish a meticulous medical records system””originally for patients with Lassa fever, another common infection in the region. So when the first Ebola patient walked through the door on May 25, the same procedures for documenting vital signs and treatment information stayed in place. Now, for the first time, doctors have a robust record of the first Ebola patients in the current outbreak treated at Kenema beginning in May””and the results of that record-keeping appear in the New England Journal of Medicine.
The article goes on to discuss some of the findings, none of which seem to deal with the main subject matter of this post: fever’s reliability as a symptom of ebola.
Back to Kelly, Sacra, and fevers—here’s a discussion of the study Kelly is presumably referring to when she asks the question of Dr. Sacra—the research that suggested that around 13% of ebola patients don’t appear to exhibit fever. Note, when you read it, how “garbage in, garbage out” the data seems, due mostly to lack of resources in that part of the world. Note, also, that “fever” was defined at a suitably low level (100.4) rather than the higher 101.5 level previous protocols have laid out [emphasis mine]:
The official assumptions about the frequency of fever in Ebola patients have not been challenged publicly. But Dr. Paul D. Stolley, former chairman of the University of Maryland’s Department of Epidemiology and Preventive Medicine, said the matter “requires further investigation.”
Given the stakes, he said, the “absolute” assumption that Ebola can be spread only when an infected person displays fever should be reevaluated.
“It may be true,” said Stolley, a member of the Institute of Medicine, part of the National Academies. “It just doesn’t sound very plausible to me.”…
The authors of the recent World Health Organization study said they analyzed “a detailed subset of data” on confirmed and probable cases, including information from forms completed by doctors and other healthcare workers in the affected countries, indicating whether a patient had a fever and at what temperature and whether the reading was taken by armpit, by mouth or rectally.
The study defined fever as 38 degrees Celsius ”” 100.4 degrees Fahrenheit.
“To create the fullest possible picture of the unfolding epidemic,” the authors said, they collected additional information from “informal case reports” and other sources.
The researchers described imperfections in some of the data. In a footnote, they wrote that “in practice, healthcare workers at the district level often do not have a medical thermometer and simply ask whether the person’s body temperature is more elevated than usual.”
Yet the lead author, Dr. Christl Donnelly, a professor of statistical epidemiology at Imperial College London, stood by the findings on the prevalence of fever.
Asked by email whether the study found no fever in 12.9% of confirmed and probable cases, Donnelly replied: “Yes.”…
Three studies of previous outbreaks, cited in the same World Health Organization report, provide further grounds to question whether fever is a fail-safe signal.
Researchers studying an outbreak in Uganda in late 2000 and early 2001 reported that “the commonest symptom ”¦ was fever, which occurred in 85% of the cases.”
Another study of that outbreak, focusing on 24 confirmed cases of Ebola, found fever in 88%.
The third study, which examined a 1995 outbreak in the Democratic Republic of Congo, found fever in 93% of 84 people who died and in 18 of 19 individuals who survived.
Asked Friday how many people infected in the current outbreak should be expected to display fever, a CDC spokeswoman, Sharon Hoskins, said “the vast majority” would, but added that it was “impossible to give an exact percentage.”
For doctors and nurses fighting the epidemic in West Africa, the risk of encountering Ebola in the absence of fever is more than academic.
Dr. Nick Zwinkels, a Dutch physician, last month closed a hospital he had been running with a colleague in central Sierra Leone after five nursing aides contracted Ebola ”” possibly from unprotected contact with three patients who were not promptly diagnosed with the virus.
Four of the nursing aides died, as did all three of the patients belatedly found to have Ebola.
Interviewed by email, Zwinkels said that hospital staff members took the temperature of one of the doomed patients four times a day for three consecutive days, and the patient never showed a fever. The readings were taken by a digital thermometer placed in the armpit, he said.
Based on what his staff observed, Zwinkels wrote, “it seems that only measuring the temperature as a form of triage is insufficient.”
He added: “It seems that Ebola can present without fever especially in the first phase.”
Zwinkels said that without fever as a trustworthy marker, it is difficult for medical professionals to treat the many West Africans suffering from everyday maladies…
If Ebola cannot be readily identified, Zwinkels wrote, “Ebola patients will be admitted in the normal ward and possibly contaminating health staff and caretakers. This is why a lot of hospitals in West Africa are closed.
I wonder how Dr. Sacra would square those findings with his statements to Kelly about the absence of fever in ebola patients. I’ve seen no evidence that the absence of fever involves those in late stages only; on the contrary, experts in this article state that it tends more to involve the earlier stages (although there were also patients in late stages who lacked a fever, they seem to have never had a fever, which delayed their diagnoses, although after death they were finally documented as having had ebola). There is no discussion whatsoever of the sort of phenomenon Dr. Sacra describes.
Who is Dr. Sacra? According to this, he’s a family physician from Massachusetts. He doesn’t seem to be an ebola researcher or even an ebola expert, although I would imagine he certainly knows something about it, and not just from his personal experience of having suffered from the disease.
I had assumed that Sacra had gotten infected in Liberia treating ebola patients. But this was not the case:
Sacra, a family physician from Worcester, Massachusetts, wasn’t treating Ebola patients when he got infected. He was helping pregnant women. Like Writebol and Brantly before him, when a fever came on, he desperately hoped it was malaria and not Ebola.
I can only conclude that the most likely way Dr. Sacra contracted ebola was from treating a pregnant woman whose undiagnosed ebola was advanced enough to be contagious (diagnosis of ebola in pregnancy is easier to miss, by the way). Dr. Sacra’s story would appear to be evidence that ebola isn’t necessarily easy to diagnose or recognize even in contagious stages, and that symptoms do not always point so clearly to the disease, even when Western physicians are treating the patient in a hospital or clinic setting (much less when laypeople such as Thomas Eric Duncan are dealing with a similar patient presentation).
In terms of judgment, denial, and quarantines—it’s fascinating that Sacra, Brantly, and Writebol all thought and hoped they had malaria, a disease far more common in Africa, and certainly a possible diagnosis at the beginning. This shows that doctors and nurses are not always the best judges of what they have contracted. You know the old saying: a physician who treats himself has a fool for a patient.
[NOTE: As I said, I’ve got a lot more information on transmission and symptoms. Rather than deal with it all now, I’ll just offer a smattering.
This:
“It may not be absolutely true that those without symptoms can’t transmit the disease, because we don’t have the numbers to back that up,” said Beutler, “It could be people develop significant viremia [where viruses enter the bloodstream and gain access to the rest of the body], and become able to transmit the disease before they have a fever, even. People may have said that without symptoms you can’t transmit Ebola. I’m not sure about that being 100 percent true. There’s a lot of variation with viruses.”
What’s more, we assume that diarrhea and vomiting are always present, but apparently they’re not:
Ebola virus RNA levels in the blood increase logarithmically during the acute phase of illness and significant numbers of EVD patients have vomiting (67.6%), diarrhea (65.6%) and unexplained bleeding (18% and generally late in the course of disease) presenting opportunities for EVD transmission.]
And speaking of candy corn…
…which I was—this article, which chastises us for our Halloween indulgences, purports to give better candy alternatives to substitute for worse ones.
But why bother? I figure that, once you’re into Halloween candy, you may as well have the type you want, because you’re already sunk. However, I did notice that the authors helpfully offer candy corn as the better alternative compared to something that sounds pretty nasty to me, Reese’s Pumpkin thingees:
WORST SEASONALLY THEMED CANDY: Reese’s Pumpkin
170 calories, 10 g fat, 3 g saturated fat, 16 g sugar
MORE CALORIES AND SUGAR THAN FIVE NABISCO GINGER SNAPS!
This one should send your gimmick radar into the red zone. If it were flavored with pumpkin puree that would be one thing, but it’s not. It’s an oversized peanut butter cup shaped in a pumpkin-like mold. And what price do you pay for such fanciful novelty? Nearly two-thirds more calories than a regular Reese’s peanut butter cup. If you want to create a festive atmosphere, stick with Candy Corn and you’ll save yourself the calorie hangover.
Eat This Instead:
Brach’s Candy Corn (11)
81 calories, 0 g fat, 16 g sugar
Of course, the only people who eat only eleven pieces of candy corn are those who already hate it, although apparently their numbers are legion.
I can’t even eat Reese’s cups now, although I used to love them, because they contain peanuts and chocolate, the two main things that give me migraines. Double whammy. I had thought from the title of the pumpkin version that they had some actual pumpkin in them. But apparently not.
That’s okay. I’ve found that although pumpkins themselves are visually great, they leave a lot to be desired in the flavoring department. It’s not that the taste is so bad. It’s just that anything made with pumpkin tends to be better without the pumpkin.
Pumpkin makes you feel all warm and fuzzy and fall-like, but does it really enhance a single food? Muffins, doughnuts, candy, pie? Give me blueberry for the first, old-fashioned sour cream for the second, candy corn for the third, and almost any sort of pie but pumpkin for the fourth. Pumpkin pie is probably the only type of pie I don’t care for—I even like mince pie, so there.
Another seasonal thought: I wonder whether anyone is dressing up as Kaci Hickox for Halloween. That could be a way to scare a lot of people.