Wednesday, February 24, 2021
Monday, February 22, 2021
The BBC reports they are now doing non brain dead transplants. They pull the plug and wait for the person's heart to stop and then take the heart and other organs out...
I support organ donation: it is life saving for many people. But to ignore that the need for organs is making elite ethicists to try to broaden the criteria of who is dead so they can get more organs is a dirty little secret.
This will not be the final step in broadening the way they "harvest" organs.
And if the "experts" are allowed to get their ideas into law, the criteria will be "cortical death" instead of whole brain death, meaning harvesting organs from those in "coma", or patients who are awake but in "persistant vegetative state" (which is frequently over diagnosed by "experts") will be considered "dead" so you can harvest their organs. So far, this has not been done legally in the USA...
However, the BBC report about the increased use of "brain alive heart dead" criteria is just another way to muddy the discussion.
This is a very controversial practice, since for lay people, it confuses the difference between full brain death and what a lay person interprets as "Dead". There are already urban legends of people being declared brain dead and while arrangements were being done to remove their organs, the patients woke up...
There are two reasons that these urban legends/fake news stories could be true:
One: the diagnosis of brain death was not done properly
Two: The person had received sedation which confuses the diagnosis of brain death and then the sedation wears off.
But there is a need for organs, so what is a doctor to do?
But often you have someone who is profoundly brain damaged but does not meet the criteria for "brain death". So how can you harvest their organs?
You remove their machines and let the heart stop beating. Which is what the BBC article suggests they are doing.
Again often lay people get the impression that these people are brain dead (they are not). And again, there is that little problem of sedation, either by pain medicines, medicine given for seizures, etc. that can make a person look dead.
So there is confusion about what is going on.
As more cases of non brain dead people being taken off machines to get their organs, there will be more questioning of if doctors are killing people to get their organs. And this will have the unfortunate side effect of lowering the willingness of people to donate their organs when they die.
Twenty some years ago, when Dr Arthur Caplan, a famous bioethicist, moved to Pennsylvania where they had an option on the driver's license to check if they wanted their organs to be donated in case of death. When the clerk was instructing him how to fill out the forms for a drivers license, she warned him not to check this "or they will let you die".
I suspect the clerk was Afro American, since that community remembers the Tuskegee study and faces racism in hospitals and clinics, and of course, there is that matter of when a Pennsylvania governor needed a heart/liver transplant, he got it quickly... from a black donor who had died of a brain injury.
But most donors are not from the inner city minority community: in Western Pennsylvania, often brain damaged people from car wrecks (which were alas common on the winding dangerous back roads) were transferred to Pittsburgh, which is a big transplant center. The air ambulance guys would cynically call these transfers "body runs".
When I worked there, locals (mainly poor ethnic whites) still trusted the system, but this could change. And confusing brain death with stopping machines to kill the person so the donor's heart will stop so the docs can remove their organs is one way to increase the suspicion of the medical establishment, which is already losing it's trust due to the economic emphasis, with some of my relatives complaining that their doctor seems more interested in filling out the form on his computer than in actually listening to them.
In traditional brain death, if done properly, the entire brain and brain stem is dead, so the body is essentially brainless and will die the moment that you remove the machines.
But if you stretch the criteria of whole brain death to "upper brain death", or worse, to people who are in a coma and will die when you take them off the machine, then you might be killing people who otherwise might survive... but with the pressure on the medical community to get organs for all those poor dying patients, you can see the problem of maybe being a bit lax in the diagnosis, or even helping the person along.
There was even a case where the patient didn't die fast enough for the doctor so he helped him along (but hey, the guy was mentally disabled to begin with so no the nice doc didn't get prosecuted).
and that is the dirty little secret that no one wants to discuss: If you are mentally handicapped, some people figure you are better off dead, and hey, if your death will help save another's life, why not?
(and this mind set isn't just seen in organ donation: There are too many disturbing stories of the mentally or physically handicapped who were denied full covid treatment because of their handicap, because hey, the hospital needed these resources for people who are not handicapped... except, as this NPR report reveals, there was no shortage of beds and equipment.)
The problem is even more complicated by the idea that all treatment, including food and water, should not be given to a person if they are "terminal" (where people often don't want to eat, just want to be pain free).
In the UK, patients dying of painful diseases such as cancer were put on a "terminal sedation" aka Liverpool pathway that was originally devised to help control severe pain...except that this practice quickly started to be used for those who were not terminal, or in severe pain, just old and weak.
The UK has socialized medicine of course, so they have a "QALY" quality of life criteria that lets doctors decide if your quality of life is good enough for them to waste taxpayer's money by treating you... the organization that makes these decisions is called the N.I.C.E... an Orwellian name for a cold hearted bureaucracy.
Sarah Palin, whose son is both a minority (part Eskimo) and also has Down's syndrome, correctly labeled those using these criteria as a "death panel" and of course she was ridiculed.
But the dirty little secret is that using "quality of life" criteria to decide if a person should get treated for an illness is a real danger, not just to the mentally and physically handicapped, but the elderly, and minorities (including the poor whites and the AmerIndian communities, where I spent most of my time practicing medicine).
Minorities are also less likely to get transplants: We had an active "organ donor" drive at the local Indian festivals to encourage people to sign donor cards, because the need for transplants, especially kidney transplants because of genetic Kidney disease, auto immune renal failure and diabetes meant that kidney disease was a major problem for those of us working in the Indian Health Service.
But again, there is a need to trust the medical system.
and this is where the "slippery slope" to get sloppy in deciding who is not merely dead but really really dead comes in.
Brain death is accepted by most folks, but when the diagnosis is not done accurately, you confuse people.
You read of stories of prolonged life after "brain death"... this is especially true in children, whose brains are more able to regenerate. The Jahi McMath case is especially disturbing, not just because of her prolonged survival, (and possible regrowth of brain tissue that meant she no longer met the brain death criteria)...
but because her "death" was essentially due to a medical error, or rather a problem that happened that sometimes happens despite the best care, but could be considered malpractice in today's court system. A disabled child gets a much larger payment than a dead one, so the hospital involved had a monetary reason to declare her brain dead...
and the problem that Jahi's case revealed: That she actually had some brain recovery by the time she died of other complications.
So when you read the BBC article that they are making plans to use the "non brain dead" criteria for child donors, one does wonder how this can be done without people suspecting their donor child is not really dead, but you need her organs so you are lying.
And if you really want to be paranoid about doctors willing to kill children for organs: Well, here in the third world people actually sell organs to rich people. (Here it is illegal, but hey that never stopped anyone). And because it's common knowledge that people will buy organs, there is a persistent urban legend/ fake news story about gangs kidnapping street kids to remove their organs.
Trust is a delicate thing. The reason for the Hippocratic Oath was so people knew that their physician would not kill no matter what.
Since I graduated from medical school 50 years ago, much of that oath has been discarded by those who thought their newfangled ethics were wise than that old Greek guy. But I wonder...
Trust is a delicate thing, and when it's lost, it takes years to rebuild it.
And the BBC's happy story of saving lives by blurring the ethical line of who is dead and who is alive will have more negative influence on medicine in the future.
Sunday, February 21, 2021
Michael Martinez has a long essay on balrogs, and if Aragorn and Boromir could have helped Gandalf fight Fred the Balrog on the bridge in Kazadum.
the essay is a long discussion of what is a Balrog, and how the concept of Balrog changed in the 50 years when Tolkien was writing his tales.
But essentially a Balrog is a fallen angel of the Maiar class who has taken a bodily presence in Middle Earth. And it is doubtful that human heroes, even one with elven/maiar ancestors like Aragorn, could have stood out long against Fred the Balrog of Moria.
Fred? Yes, that's what the fans named him sort of a jest, in the same way that the Great White Shark in Jaws was named Bruce. (or in the modern world, Hitler was Herr Shickelgruber and Xi is Winnie the Pooh).
Because laughing at the devil really really makes him mad,
and the warrior of legends of east and west jest as they fight evil, knowing that they will probably be defeated or at best win a battle that will only be a temporary victory in the long defeat of history.
But they chose to fight nevertheless...
Tolkien's theme of the long defeat is a variation of the Northern myths, where even the gods know that at the end of time, the Giants will destroy Asgard and the world, but they will oppose the evil anyway, joined with the warriors of Valhalla.
But one difference between Tolkien's world view and the world view of the Northern myths: in his worldview there is hope that good will conquer in the end.
Tolkien had two words for hope: One was the same as our idea (short term hope that things will go well). But the other term he uses is Estel: This is the long view of history, the hope that assures us that in the end God wins: that after the death on Good Friday comes the resurrection. And after Armageddon comes the New Jerusalem at world's end:
He will dwell with them, and they will be his people, and God himself will be with them as their God. He will wipe away every tear from their eyes, and death shall be no more, neither shall there be mourning, nor crying, nor pain anymore, for the former things have passed away.”
Thursday, February 18, 2021
There will be a national data base containing the names of the official clergy who were trained and recognised by the five State authorised religions. Their loyalty to the Party is assessed periodically by awarding social credit or by sanctions which may cause the loss of the registration in the State data base.
Tuesday, February 16, 2021
Monday, February 15, 2021
A big Valentine's day party for the staff.
Because we were in shut down due to covid restrictions, we had skipped the usual Christmas/NewYears/Three Kings fiesta parties this year, but now we can party since the restrictions are limited (keep the distance, wear a mask but you can go inside, or party outside with a mask).
So we had a party.
We eat locally, and so for the party we had local food delicacies: Casava sweets, Pinoy Sphaghetti (sweet tomato sauce and hot dog slices, with Eden processed cheese instead of parmasean), roasted ducks (again from the farm: Ducks are raised there and eat the grubs etc. in the rice fields), and veggie dishes.
nIstead of the beloved "lechon" (Barbecue suckling pig) we had marinated barbecued sheep. I was going to take a picture, but it was too gruesome. But it tasted good. Kuya has helped a local farmer to raise sheep and we get ten percent of the sheep for our own use.
The reason we didn't have suckling pig is because there is a big problem locally with pork: The "African swine Flu" has been decimating the local pork industry. This pig influenza has been in Asia for a bit and really killed a lot of pigs in China. And we had a ban on Chinese pork products, but that didn't stop the illegal smugglers and the pork products from China with a label saying they came from a non infected country, so now we are losing our pork too...including neighbors who only have a couple pigs on their farms, raised for extra income or for their own use.
We ate in the meeting room, which we were preparing in the morning, so the local church that meets there instead met in the garden under the gazebo. And of course, for the party, we ate inside, and all the kids were running around having fun. But we kept our distance. And of course, as is usual in parties (or wakes for that matter), the men sneak outside and drink beer and eat snacks.
And of course we had a kareoke machine. Our maid did a lot of singing. No, she's not a good singer, but is very enthusiastic.
Kuya's pastor came, and so we started with a prayer. We are multi religion here: Kuya is Baptist, his wife is Pentecostal, and I am a normal Catholic, as is most of the staff. That means we party and thank God in our hearts. (hey, even Jesus liked a good party, and the party at Cana is traditionally seen as a foretaste of heaven's joys).
Luckily, the pastor only talked for a few minutes (I've attended some parties where the pastor kept his unwilling audience in situ to preach for half an hour... figuring he might reach some of those heathen Catholics with his rhetoric).
The dogs of course had to be kept in my part of the compound: They kept trying to sneak out and get the bones in the garbage, and bark at the intruders. Luckily, unlike our late watchdog George the Cat Killing Labrador, the present tribe of dogs don't tend to bite visitors, but they still try to kill cats. Right now, we have a feral cat hiding behind the refrigerator after being mauled by the dogs a few nights ago. He is one who comes to eat the dogfood that I put outside in the large garden we use for business meetings and is guarded by Apa, the secretary's dog. I actually hate that cat, because when I put the food down he always comes near and hisses and scratches at me when I get too close to him. Well, I guess he decided he would try eating the dog food inside our house a couple nights ago: The dogs woke me as if there was an intruder, so I left them out of my room and then when I realized it was a cat, not an intruder, I had to rescue him from them.... We thought he would die but he is now eating, including fish mixed with penicillin, and I suspect he will come out and flee in a day or two.
we also have five puppies who have reached the wandering stage and have started to eat. The good news is that usually once they eat, they go to new homes. The bad news: until then, you have to watch where you step: you might step in puppy poo, puppy pee, or even trip over a puppy trying to eat your toes. The floors are tile so easy to clean: We had to get rid of the rugs in the living room and the wicker furniture there is full of gnawed holes from earlier puppies, and one of these days we will have to fix or replace them.
A few days ago, I bought a flower arrangement and decorated Lolo's grave. His birthday and death anniversary is next month, so we will have to go and clean up the gravesite then.
The weather is overcast a bit, but soon it will become the hot and dry season that is miserable for everyone (Tag-Init). Then I'll probably stay indoors and run the aircon to stay cool. I don't need the aircon now, but often run it on dehumidify to keep the mold down, but now that Joy gave me an air cleaner, I don't have to run it all the time as a hepa filter to clean the air, so that helps the electric bill.
so life in retirement is not very interesting: Until I get the covid vaccine, I am unwilling to go to church or shop indoor. And the government is still making plans. The expected Pfizer vaccine that was arranged by the US to come in January never was sent because the government here just happened not to do the paper work. so now we are trying to get the vaccine from everyone. And yesterday we hear China will rescue us with their (crappy 50 percent efficiency) vaccine next month. Right. You should read the comments to that news story: No one here trusts China, and in the case of the vaccine, they are right. And of course, no one thinks that China might be behind some of this delay (bribery? Moi?) so they can pretend they are rescuing us and get brownie points.
But you know, several months ago, China illegally vaccinated their workers here (a lot work in the casinos, doing jobs that had been promised to locals, but never mind... and just ignore that some of them are suspected military, as are some of those here on retirement visas who are under age 40).
But you know, I wonder: there are a lot of Yanks here, both retirees who often have Pinoy spouses, and a lot of Balikbayan (Who emigrated to the US and came back to retire). So why hasn't the American embassy arranged for us to get the vaccine? Probably because it would hurt the feelings of the local officials (and of course Yanks don't bribe, alas). On the other hand, I'm not sure if I will be given the vaccine when it comes. I am high risk elderly and permanent resident, but not a citizen, so I don't know how the priorities are going to be done. Presumably Dr. Angi will let me know when I can get vaccinated. Kuya will refuse the shot because he believes in all the conspiracy theories as a back to nature green believer, but Joy, who does a lot of deliveries and liasons in higher risk areas, will probably be higher on the list to get it.
And this week: Lent starts.
I haven't been into church for a year, and still cannot go inside the church (elders have to go to mass by standing in the parking lot). So I don't know if I will get ashes this year.
update: After hissing at the cook who was giving him fish for breakfast, the cat ate the breakfast and when we came back he disappeared. No dead cat found, so presumably he ran back to his home in the storage room off the garage.
Sunday, February 14, 2021
I heard some bimbo got fired by Disney for her tweet pointing out that the Jews were demonized so badly that the locals sometime attacked them spontaneously and then helped identify them when they got rounded up. She pointed this out as a warning to the "cancel culture", and immediately the RedGuard twittersphere got her fired.
Supposedly this was bad because it equated the present day "cancel culture" to the Nazis.
It's okay to call Trumpieboy and his 74 million voters Nazis, and blame them for the violence of one riot that some suspect was encourage as a false flag operation but hey, point out that Twittermobs reminiscent of the Red Guards attacking mostly peaceful voters (not to mention the riots of BLM and Antifa that are still going on today) might not be a good thing for peace and unity.
Because hey, we love peace and unity: See we even put signs out saying so.
That someone lost her job for pointing out a slippery slope argument against hate speech is ironic.
Some people of course ignore any "slippery slope" argument, even as society goes over a cliff with immoral behavior that some Jeremiahs warned against 40 years ago, but were ridiculed by the elect who denied any validity to their slippery slope argument.
Years ago, I learned how this "slippery slope" argument (name calling, marginalization, ostracism, etc) worked:
When I worked at an ICF/MR (And the word mental retardation was still considered normal) I attended a conference on how society marginalizes certain people by name calling and ridicule, and then manipulates the media to show they are evil or useless eaters, then good people ignore how the marginalized die from policies (i.e. neglect, oversedation in nursing homes, non treatment orders), and then how it can even lead to direct killing (Nazi T4 project, or how Europe and Canada are now killing non suffering non terminal patients including without their assent).
the conference was to alert us to the (then) disturbing arguments in Medical ethics that were hinting that the mentally disabled should not be given full care because it was too expensive.
That argument was about the mentally disabled, but alas it also could apply to the disabled, minorities, the elderly and the poor of any colour.
How bad has this it become since those days? Well, Biden's health guru is an ethicist who thinks life over 75 is is not worth living, so advises people if they get sick, to just let nature take it's course.
Is there a connection between this type of thinking and the news story that there were thousands of preventable nursing home deaths from Covid, many of which were due to letting still infectious people to be readmitted to the nursing homes? Who knows.
But when Biden appoints the Pennsylvania doctor who also ordered the infectious back into their nursing homes when she moved her mom into a hotel to be safe, you can see that there is a bit of cognitive dissonance out there...follow the rules (but protect your family because you know the rules are nonsense).
And less reported are the stories how disabled people were denied full care in hospitals.
Some of these stories were known but poorly covered at a time when perhaps an expose could have saved lives. Why? Place conspiracy theory here.
There is a place for public shaming, but getting people fired and destroying lives for trivial remarks seems a bit absurd.
However the good side of the ability to accuse people is the exposure of sexual predators.
One reason is that in the 1970s and 1980s, was because, thanks to Kinsey etc, many argued that sexual exploitation of children was harmless, or even good. Those of us who said "no it is wrong" were accused of being rigid bigots.
How widespread were these ideas? I was taught them during our psychiatry rotation back in the last 1960s, but by 1980 when I was in private practice, I remember when California decided to treat their "non violent" pedophiles as outpatients, and Newsweek had an article where an expert insisted we should not report fathers/stepfathers if they committed incest because it would break up the families.
Thirty years later, the victims are now grown and getting their revenge: partly thanks to Ronan Farrow, whose stepfather sexually exploited his underage sister and defended it by saying they were not related legally and she consented.
so now, "unexpectedly" there is a story that an anti Trump political group just discovered one of their leaders used to hit on young men, including underaged boys, and gee, no one knew.
Yup. And no one knew about McCarrick (or Wuerl or Mahoney or...etc), or all those priests hitting on boys either, and Epstein didn't kill himself (and none of those VIP's who have somehow never been exposed had been taking the plane called the "Lolita express" realized he used underage girls that he had "recruited", and no one to this day knows what was hidden on Weiner's computer along with Hillary's top secret emails.
TeaAtTrianon links to an Epoch Time article about Trumpieboy's aggressive fight against human trafficking.
Canadian journalist/essay writer David Warren is recovering from surgery, Keep him in your prayers.