The Arrow #165

Hello everyone.

Greetings from Montecito.

As you can see, we’ve got a new platform today. I switched from Substack for a handful of reasons, the most important of which (to me, anyway) is to increase growth of The Arrow. I’ve been writing this newsletter for over three years now, and it has become kind of an obsession. It started really as a prompt to get me back into writing mode, so I would finish Protein Power 2.0, but it has become much more than that.

In doing research for The Arrow, I’ve ended up learning a whole lot I wouldn’t have learned had I just forged on through with PP 2.0 with what I knew three years ago. So, in its own way, The Arrow has contributed greatly to what will ultimately become PP 2.0.

I spend a lot of time and effort trying to make it easier on you, the reader, to access some of the material I post. For example, due to the spat between Elon Musk and the founder of Substack, I can’t simply post a Tweet from X. I can post only a link. Which is what virtually all of the Substack authors now do. Being the compulsive person I am, I end up using a piece of software to extract the video from X, so I can embed it on The Arrow. It takes a bit of time to do that. I have to access the software, drop the X link in, wait for it to extract the video and post it to my desktop. Then I have to upload it into Substack, which seems to take about twice as long as it does to extract the video in the first place. Only then does the video finally make its way onto the page you end up reading.

On the new platform, all I have to do is copy and paste the X link, and there it is. That alone probably saves me 10-15 minutes per video posted.

If I want to put up a particular tweet from X that doesn’t involve a video, it’s still a pain in the you know what. I have to take a screenshot of the tweet, which goes to my desktop. Then I have to get back into Substack and hit the add an image button, which takes me to all the images on my desktop. I have to select the one of the tweet, which then Substack imports onto the page I’m writing. Then—because I’m compulsive—I have to go back to X and grab the actual link to the tweet and put it under the image as SOURCE (not a link), so that people who want to go to the tweet to see responses to it or whatever can go to the source. This process also takes time to bring about.

On the new platform, all I have to do is grab the link to the tweet and copy it. The software does the rest. Takes me three seconds, and you have the actual tweet with link built in.

Another great feature that will save me much time and you, the reader, much aggravation is how the new platform deals with links. In Substack, I would click the link and it’s saved. Same here, except that now it throws the link back up in a form I can click on to immediately test it for validity. Each week, it seems, someone (or several someones) will email me that a link doesn’t work. Invariably I have screwed it up. No more since I can now easily test each one.

I could go on, but the ease of use is one reason I switched.

The other is that this new platform has a vastly more robust way to increase the number of subscribers. It takes me just as long to write The Arrow whether it’s going out to 11, 231 (the number of subscribers as I write these words) or to 100,000.

One of the things Substack promotes is helping with subscriber growth. Admittedly, they were a little better at it than the former platform I used, but they haven’t set the world on fire. If subscriber growth on the new platform meets or exceeds that from Substack, I’m still ahead of the game in terms of ease of use.

Another advantage of the new platform is that it lets me write two different newsletters that go out at the same time: One for paid subscribers and one for free subscribers. With this feature, I can write one newsletter that goes out to all, but with some sections absent from the version going out to free subscribers. I kind of hate the way Substack does it by just throwing up a notice right in the middle of the newsletter saying essentially Sorry, the rest of this is for paid subscribers only—you’ve hit a paywall.

In addition to all the above, the new platform is just simpler to write on. It has a lot more bells and whistles—much like my blogging software has—so that I can do a lot of things (underline, for example) that I can’t do with the basic writing tools of Substack.

It also allows me vastly more leeway in terms of how the newsletter looks. Substack is pretty bare bones, which is why most Substack posts look similar. It will probably take me a while to get everything how I like it, much like it did back in the No Name Newsletter days many of you were around for. Ultimately, I’ll settle on something I like, and then it will be finished. I’ll have a template, so I’ll be able to just start writing each week.

I’m aware of the grass is greener phenomenon. I may well try the new system for a month or two and say This really sucks, and head back to Substack. Only time will tell.

But I don’t know. In the end, Substack turned out to be a little like the Hotel California: I could check out, but I couldn’t leave. They were going to cancel all the paid subscriptions and refund the unused portion. All in an attempt, I’m sure, to get me to throw up my hands and say, Screw it, I’ll just stick with Substack. Instead I hired a tech firm that fixed it all. And told me to send emails to everyone to forestall any confusion. They were most helpful. I could never have escaped without them.

All of you who are paid subscribers will have been transferred over via Stripe with your subscription history intact. There shouldn’t be any problems, but if there are, just let me know and I’ll see that they’re squared away.

Having said all this, it will probably take me a few weeks to work out all the details of this pretty sophisticated software. But we’ll get there. Just be patient.

More Thinking on Excess Deaths

After writing the section on excess deaths last week, something has been bothering me. I just couldn’t quite put my finger on it, but it finally bubbled up in my brain.

The graphic I put up from the article about excess deaths didn’t look like it should have. Just to review, here is the graphic. I suggested you look at the circled part.

From the way I described the excess deaths last time, the situation was pretty bad, but upon more contemplation, I believe it is even worse. Just based on the above graphic and nothing else.

Here’s why.

The more I thought about it, the more I realized the lines on the graph above were not how they were supposed to look when representing an infectious disease outbreak. It finally dawned on me what was wrong. Why it hadn’t seemed right.

Infectious disease outbreaks follow a Gompertz curve. The above graphic does not represent a Gompertz curve. Not even close, in fact.

What’s a Gompertz curve? It’s an asymmetrical curve showing the behavior of multiple phenomena, including how a bullet falls to the ground after it is shot from a gun. And how an infectious disease spreads. Here is a perfect example of Covid in Spain.

If you take a look at the reddish curve in the graphic above, it shows a fairly rapid rise and a slower asymmetric falloff. This perfectly demonstrates what happens during an outbreak of a contagious infectious disease.

Here’s how it works.

Imagine a huge room, maybe a giant auditorium somewhere that holds 50,000 people. One person comes in who is infected with some contagious disease. The flu, Covid, whatever. It all works the same. This one person infects a couple of others. Each of those two infects two or three others. Each of those newly infected infects a few more.

You can see how quickly the number of infections would skyrocket. Almost exponentially. Ultimately, the point will be reached at which a whole bunch of people are infected. Then it starts to become more difficult to find someone who hasn’t already been infected. So the spread of the disease starts to slow down. Ultimately there will just be a few people who are still uninfected, which means the spread virtually stops.

That is what the graphic above represents. If you want to learn more about the Gompertz curve, take a look at these three YouTube videos by Michael Levitt, who is a professor at Stanford and a Nobel laureate. These are short videos (maybe 5 minutes each) showing the math leading up to and the development of the Gompertz curve. If you have any interest in math, these videos are well worth watching. I posted them years ago when Covid was just getting going.

One of the ways you’ll know Michael Levitt was accurate is that he got canceled for his efforts. Despite his Nobel prize and his 30 years as a Stanford professor, he didn’t say what the Covidistas wanted to hear.

I put together the graphic below to show how the excess deaths should appear.

As I did in the previous post, I used the green curve above—the one with the green line for males who died during Covid. This time, however I drew a Gompertz-type curve showing what should have happened with Covid deaths.

Although the Gompertz curve Michael Levitt is talking about derives from Covid infections (or any infectious disease), it’s impossible to die from Covid unless you’re first infected with Covid. What one should see is a Gompertz curve representing the cases of Covid over time with a similar, but smaller, curve for deaths from Covid shifted to the right.

Granted, the curves in the original unmodified graphic show just deaths, not infections. And people do die from other things than Covid. But the great bump in deaths starting in 2020 was due to deaths from Covid. The graphic is kind of blunted, but still it should primarily be dominated by Covid deaths.

The hashed area represents the difference in excess deaths that should have been driven by Covid and the deaths that actually occurred. You can also see in the original graphic that the increase in excess deaths started in 2019, long months before the Covid pandemic, which really didn’t get going until later in 2020. Assuming this graphic is correct—and it was created using statistics from the National Center for Health Statistics, which, one assumes, provides accurate statistics—something was killing an excess of people earlier than we thought.

Both MD and I had been on a trans-oceanic flight in mid-December of 2019 and had both come down with something a few days after we got home. We both had a weird kind of viral infection that made us both extremely fatigued without really a lot of other symptoms. We both recovered in a few days and didn’t think much more about it until Covid struck and we began hearing rumors that SARS-CoV-2 had been identified in California in late 2019.

When we heard that, we figured we had gotten it in December. But when we got tested as part of a study in Dallas later in 2020, we discovered that we had no antibodies to either the spike protein or to the nucleocapsid. So neither of us had had Covid at that time.

Maybe whatever we got a mild case of is what was killing people in 2019. Who knows?

All I know is that there have doubtless been vastly more excess deaths than there should have been. The graphic I made doesn’t show why or what from, but it does show the increase. Vaccines? Depression? Suicides? Lockdown related? Who knows? You would think the public health people would want to find out in an effort to prevent such a thing next time around.

But that’s probably too much to ask.

Protein, Protein, Protein…

As I’m sure I’ve mentioned, I get about a zillion emails each day from various medical subscription services that keep me updated with the latest in medical therapies. Most of them are worthless, but I read them all just in case one gem is hidden within all the DEI BS most are filled with.

Such was the case a couple of days ago. Not only was there one gem, there were three. All disparate, so all requiring their own heading for easier finding later. One is a real political hot potato, so I’ll leave it for last.

This first one is great. It is a reproduction of an article that appeared in the Journal of the American Medical Association (JAMA) on February 23, 1924, a few days over 100 years ago. Back before the AMA had been captured by the pharmaceutical industry.

The article, titled Food and Satiety, shows just how much science knew back then that, for some reason, it has to relearn today. Of course, this was written back in the days when people were so dumb and ill-educated that they didn’t realize meat was not a healthful food.

The idiocy of the authors shows when they write drivel such as this:

The desire to eat is a compelling feature of human experience. The antidote is found in the development of a feeling of satiety. In attempting to satisfy the desire to eat, to avert the feeling of hunger, calories, proteins, salts and vitamins vanish into the background of human concern; and yet man has learned by experience that hunger is averted longest by the ingestion of certain articles of diet. In popular parlance, we hear that one food “stays by” us better than another. Scientific investigation has demonstrated, even in the experiments of William Beaumont on Alexis St. Martin, that some foods make greater demands than others on the digestive organs. They may tarry a shorter or longer period in the stomach; they may call forth a greater or less amount of secretion. A “full” stomach tends to empty more slowly, and thus the renewal of the “hunger contractions” and the desire for food is delayed. Protein foods, as a rule, require an abundance of secretion, and their preliminary products of digestion pass through the pylorus at a rate much slower than that exhibited by food rich in carbohydrates. A meal of bread has ordinarily, for the most part, passed the pylorus within an hour and a half; the inclusion of meat prolongs the time two or three fold. The degree to which foods induce a feeling of satiety depends in large measure on the rate at which they leave the stomach. Judged by this criterion, meats, in particular, occupy a foremost position, followed by fats and such mixtures of protein and fat as cheese represents. The cereals and starchy foods stand at the other end of the list, since they do not remain long in the stomach. Obviously—and experience confirms this—cereals and chemically similar foods must be eaten frequently and liberally to equal the “staying” qualities of the products that belong to a different category, so far as satiety is concerned. [My bold]

Pretty amazing to see just how ignorant they were a hundred years ago and how smart we are today. (Sarcasm alert!)

Bones, Bones, Bones…

From the same source from a couple of days ago comes this article on bone health.

This one reports on a study that shows a keen grasp of the obvious. But still, nice to have continuing confirmation of that which everyone knows but seems to forget.

People who said that their health issues limited their ability to walk 1 km (0.6 miles) or less had a higher risk of fractures, including hip and spinal breaks, according to a study that followed up about 239 000 participants in Australia for roughly 5 years. Participants were all aged 45 years or older.

The increased risk of any type of fracture ranged between 32% and 219%. This was independent of other factors, like frailty, previous falls, and age. The relationship was also dose dependent—the more trouble participants had walking less than 1 km, the higher their 5-year risk. [Link in the original]

This study provides confirmation of what has been known forever. Bones need stress and weight bearing to maintain their density and strength. The old saying as applied to bones is true in spades. If you don’t use it, you’ll lose it.

When they’re not stressed, bones tend to dissolve. One of the few benefits of being oveweight is strong bones. Overweight people tend to put more stress on their bones during the activities of everyday life. When overweight people jokingly say, I’m big boned, they are right. They do have big, strong bones.

Doing strength training increases bone density. Almost any activity will increase bone density unless it’s something like a knitting contest. If you stress your bones, they will get stronger and denser.

In the study described above, the authors looked at ~239,000 subjects 45 years of age or older and watched them for five years. Those who couldn’t manage to walk at least one kilometer ended up having significantly more fractures than those who could. And the shorter the distance they could go, the greater the number of fractures.

It all makes sense. If you can’t walk, you probably can’t do strength training or much of anything else. And your bones will pay the price.

I’ve yammered continuously in these pages about how important protein is for building and maintaining muscle mass. Well, it’s important for bone strength, too. It’s not just calcium, so don’t make a run for the Tums.

Bone is built on a protein scaffold. It doesn’t matter how much calcium you consume, if you don’t have enough protein.

Remember the lesson from 100 years ago. Protein slows the transit from the stomach, which makes you feel full longer. Plus it builds your lean body mass. And it builds your bones. But you have to stress both your bones and your muscles—especially your bones—if you want the best results.

Everyone knows this, so it was nice that the article above simply reminded us all.

Okay, on to the hot potato.

Abortion, Abortion, Abortion…

I’ve thought long and hard about how I’m going to present this section. I finally decided that I would start with “Just the facts, ma’am, “ as Joe Friday used to say. Then I’ll sally into the politics of the whole thing in an even handed way.

So, Just the facts ma’am.

Along with the two subjects I discussed above—protein and bones—I got another summary of yet another study in the same email. This one was on rape-related pregnancies in states that prohibited abortion after the 2022 Supreme Court decision leaving it to the states. (Which I’ll discuss later.)

In this case, the article is absolutely jam packed with falsehoods. Major falsehoods. Outright lies. I don’t know who the editor was, or if there even was one. Based on all the inaccuracies it contained, it was as if the article were written as a liberal talking point. I’m not taking sides here, I’m just stating a fact. This is an opinion piece masquerading as a factual article.

Let’s take a look.

The title of the article is 65 000 Rape-Related Pregnancies Took Place in US States With Abortion Bans. If you look up the stats, you’ll find this is grossly overstated.

Here are the stats as presented in this paper.

Of the 14 US states that banned abortion after the Supreme Court overturned Roe v Wade in 2022, 5 allow exceptions for pregnancies caused by rape. But even these exceptions fail to grant the abortion access that they promise, resulting in rape-related pregnancies far outstripping the number of legal abortions, according to research published in JAMA Internal Medicine.

After the Dobbs decision, fewer than 10 abortions occurred every month in each of the 14 states, researchers estimated, using data from the US Centers for Disease Control and Prevention’s National Intimate Partner and Sexual Violence Survey. During the same time, there were nearly 65 000 rape-related pregnancies. About half were in Texas. Another 9%, or 5600, were in the 5 states with exceptions.[Link in original]

First, I tried to go to the linked article, but it was behind a paywall. Usually, I email the authors on papers behind paywalls, and they send me a copy. I went to try this, but none of the authors had contact info listed, which I thought strange. Typically one author is the corresponding author. No one in this group wanted to take credit for it, I guess.

When I looked at where they were all from, the embellishment made sense. It still wasn’t factual, but it made sense that it might be a bit overblown.

Planned Parenthood of Montana, Billings, Montana

Hunter College, City University of New York, New York

Resound Research for Reproductive Health, Austin, Texas

Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts

Department of Medicine, University of California, San Francisco

Second, I looked up how many rapes there were in the United States in 2023, which I couldn’t find. Apparently, they aren’t tabulated yet. So I looked at the forcible rape statistics for 2022, figuring they would be about the same as 2023. As it turns out, statistically, at least, forcible rape is on the decline over the past few years. The stats for forcible rape in 2022 were 133,294 nationwide.

I don’t know what fired it off in 2012, which was the start of the second term of the Obama administration. I’m not pointing fingers, I’m just putting it in the political context. I have no idea what happened then, but whatever it was was bad.

After finding the forcible rape statistics, I did multiple searches for the odds of a pregnancy given one unprotected act of intercourse anytime. Surprisingly, I couldn’t find the odds for that. I looked and looked. Maybe one of you readers knows it and can send me the reference.

I found multiple sites telling me what the odds are of getting pregnant in a given part of the female fertility cycle. But nothing on just a simple one off at a random time. I did learn that if couples went at it like minks during the most favorable time of a woman’s cycle, the odds were ~25-30 percent that they would conceive within six months.

Given those stats, I would assume a one off at any old time—I doubt rapists select their victims by their reproductive cycle—would be maybe 5 percent. At the most. Probably less. But let’s go with 5 percent.

Then 5 percent of 133,294 rapes would end up producing 6,665 pregnancies. That’s one tenth of the pregnancies due to rape stated in the above article.

When I looked at Texas in particular, a state that has pretty draconian anti-abortion laws, I discovered the state had 16,510 reported rapes last year. The state was ranked #2 in the country in terms of reported rapes, but it is the 3rd most populous state in the country, so that figure isn’t out of the ordinary.

The paper says that of the specious ~”65,000 rape-related pregnancies” in the country, “about half were in Texas.” Which would mean 32,500 rape-related pregnancies would have occurred in a state that had only 16,510 reported rapes. That would mean everyone who was raped came down pregnant with twins. Highly unlikely.

Something obviously doesn’t compute.

What I’m wondering about is their definition of rape.

In the 2012 campaign season, there was a Republican member of the House of Representatives named Todd Aiken running for the U.S. Senate seat in Missouri, the state of my birth. Aiken was way ahead in the polls, then he made a fatal error. He was a staunch conservative and a right to lifer, and on a talk radio program, he was asked about whether or not he would sanction abortion in the case of a pregnancy incurred as a consequence of rape.

In my view, he was a totally ill-prepared moron. He had to know this was coming, so he should have had his response down pat. Instead, he shot from the hip—almost always a bad thing to do in a public forum—and blew up his chance for the senate seat he was seeking.

He pondered for a bit after the question, then responded something along the lines of it depends on whether it was a “legitimate rape” or not. As you might imagine, the press ran wild with it.

The Republican establishment knew Aiken was mortally wounded, so they tried to get him to step down and let them replace him with a different candidate. The Democratic senator at that time was Claire McCaskill, who was way down in the state polls. The GOP leaders figured anyone could beat her except for Aiken after his gaffe.

Aiken did like all strongly religious people do in circumstances like this. He prayed about it. Then he told the GOP the Lord had told him to stay in the race. (Spoiler alert: The Lord obviously wanted him to lose.) The Democrats smartly laid low until the time had passed that the GOP could replace him. Once that hour came in the election calendar, they opened fire on Aiken, and he was branded with “legitimate” pregnancy. In the end, McCaskill edged him out. According to exit polls, primarily because of his ill-fated remark.

But, legitimate rape as he was speaking of it had nothing to do with whether a woman was forcibly raped. At that time, a lot of doctors and clinics wouldn’t perform abortions unless the pregnant woman was raped. So many pregnant women simply claimed rape to get an abortion. They didn’t have to file a complaint with the police, they didn’t have to go through a rape exam at the ER, they just had to claim they were raped.

What Aiken meant by legitimate rape was real, forcible rape, not rape reported to a clinic in order to get an abortion. And he tried to explain that, but the media was against him. He was doomed the minute he used the word “legitimate”

Which makes me wonder where did the authors who wrote the above article get their statistics? Were they including all the women who showed up pregnant claiming rape in order to get an abortion? They obviously were not using the same statistics I found all over the place.

Abortion is a true political hand grenade.

The big issue is that abortion was never mentioned in the Constitution, and those unmentioned things are supposed to be left to the states to decide. In the Roe v Wade decision by the Supreme court in 1973, it made abortion legal by judicial fiat. Which has caused trouble since.

It’s become a litmus test for every judge up for appointment to any court. The Democrats use it as a cudgel against Republicans by claiming the Republicans want to curtail women’s reproductive rights, and that they, the GOP, are in a war against women.

In 2008 Barack Obama was president, the House was in the control of the Democrats and the Senate was in the control of Democrats, and the Supreme Court was 6-3 liberal vs conservative. If abortion was such a huge issue for the Democrats, why didn’t they pass a law making abortion legal throughout the land? They could have done it. It would have passed the House and the Senate. Obama would have signed it into law.

I’m sure a number of pro-life groups would have sued to overturn it, but I doubt the Supreme Court would have even heard it. If it had, it would probably have passed by 8-1. I suspect even Scalia would have voted for it. He, being a Catholic and all, was pro-life himself, but he was such a Constitutional purist, he probably would have voted for it, if it was passed by Congress and signed by the president. And it wasn’t mentioned in the Constitution. I think the only nay would have been from Clarence Thomas. And with an 8-1 decision, it would have been highly unlikely any future court would undo it. It would have been the law of the land, and the whole abortion issue would have evaporated as a political issue.

So the Dems had the chance to codify it into law, but never took it. That speaks volumes. They want to keep it around to hammer Republicans with.

Here is a classic piece I came across a few weeks ago that sums it up perfectly. The article headlined At Democratic retreat, House members worry border concerns will overshadow abortion in 2024 tells the tale. The lede says it all:

With the Senate asylum and border deal firmly in the grave, some House Democrats say they are worried border security could overshadow reproductive rights as the key campaign issue in the 2024 elections.

They’re right. According to a recent Gallup poll, Americans view unlawful immigration as the most important problem facing the US. It rates right above the government itself, which was second in importance. Abortion rights didn’t even make the list.

While I’m this deep in politics, I’ll hit one more non-partisan note. Then we’re out.

Why Are People Such Rabid Partisans?

I found what appears to be the perfect answer in one of the Substacks I subscribe to. The author is Michael Huemer, who is a professor of philosophy at the University of Colorado. He is also the author of one of my favorite books Understanding Knowledge, which is kind of a hard read, but extremely rewarding for the diligent.

He also writes a Substack. His most recent one discoursed on why people are such political partisans. Something I’ve always wondered about myself.

It’s a long post titled Why People Are Irrational About Politics and is well worth reading in its entirety, but the paragraph that described it perfectly for me was this one he borrowed from economics.

According to economists, many voters have rational ignorance about political issues: they are uninformed because collecting political information would take time and effort, which is a cost, and that cost outweighs the expected benefits to them. This is partly because most individuals realize that they have close to zero chance of ever actually changing public policy; therefore, the expected benefits to them of having correct political views are close to zero.

I had never really thought of it that way, though I should have what with all the reading I’ve done in economics.

It does take effort to collect political information. Not just watching Fox News or reading the New York Times. But to really dig in and find out the score on things is a lot of effort. Especially when there is Breaking Bad or Outlander to watch.

And especially when you “realize [you] have close to zero chance of ever actually changing public policy” with your one vote. So it becomes like rooting for your favorite sports team. There is little cost to you for rooting. You can read the sports page, so there isn’t a lot of effort required to learn about your team. And, in the end, there is damn little you can do about whether they win or lose.

Okay, enough.

What Have Doctors Become These Days?

This one really pisses me off. It probably will you, too. Or you may just figure it’s how medicine works these days.

I received an article a day or two ago in one of the many medically-related emails I get. I read it, but I almost couldn’t believe it.

The article titled Why I No Longer Remove Ingrown Toenails in Primary Care is mind boggling. Here’s what the guy writes:

A former colleague once told me that there are few primary care procedures more satisfying for the patient and physician than removing part of an ingrown toenail. I disagree, but I performed this procedure quite a few times during my residency and first few years in practice. The patient would usually have been in pain for days to weeks and have tried soaking their foot or putting wisps of cotton under the ingrown nail edge, without relief. I would draw up a syringe of lidocaine with epinephrine and perform a digital block on the affected toe. After waiting 5-10 minutes for the toe to become numb, I would clean the area, use a nail elevator to push the cuticle off the nail plate, and lift up the lateral edge of the plate. I would then cut the lateral edge with a nail splitter and remove the cut nail fragment with a hemostat. Finally, after an inspection to make sure that I hadn't left any pieces behind, I or my nurse would apply petrolatum gauze and a bandage.

His former colleague is correct. There are few procedures one can do in the office that are as definitive as treating an ingrown toenail. I’ve fixed hundreds and hundreds of them.

The patient arrives in pain and leaves a short time later pretty much pain free and cured.

Ingrown toenails, as anyone who has had one knows, are intensely painful. Even crippling. You can barely walk. And they look horrendous.

As a doc, you walk into the exam room, see the toenail and know exactly what the diagnosis is. You give the patient a local anesthetic, which involves two injections with a tiny needle on each side of the involved toe. The anesthetic agent numbs the entire toe in a matter of minutes.

After reading the above, I’m wondering exactly what this guy was listening to during his training on injecting a local anesthetic. He says he uses a combo of lidocaine and epinephrine, which is a no-no on fingers, toes, tips of noses and a few other places. The lidocaine is the actual anesthetic; the epinephrine basically decreases the circulation so that the lidocaine hangs around to keep the area numb a little longer. Which is fine unless you’re injecting a finger, toe, etc. where you can cut off the circulation to the entire digit and cause some loss of tissue due to this lack of circulation. It’s okay to use the lidocaine/epi combo on arms, legs, faces, etc. where you are not cutting off the circulation to parts farther out the digit.

Anyway, you deaden the toe, remove the ingrown part of the toenail, which takes maybe ten seconds. Have the nurse wrap the toe, and the patient is cured. Even after the anesthetic wears off, the toe feels a thousand times better than it did when they walked in.

Before I go on with this story, here is what an ingrown toenail looks like:

I know, it’s gross. But ingrown toenails are like the flu. Whenever almost anyone comes down with a bad cold, they say, I’ve got the flu. The real flu, i.e., influenza, is brutal. Same with ingrown toenails. A lot of people have a little redness on the edge of their toe and say, I’ve got an ingrown toenail. So I’m showing this photo of a real ingrown toenail (some are a lot worse than this one), so people will know why I’m so miffed at this doc. As you might imagine looking at this photo, these are extremely painful.

So here is why this guy doesn’t do ingrown toenails any longer.

I don't do toenails anymore. Because this procedure was requested every several weeks at most, the offices where I worked weren't organized to make it easy to do; sometimes my medical assistants didn't know what supplies were needed or where to find them. Adding up the time it took to obtain consent, wait for the local anesthetic to take effect, and do the procedure, it was more efficient for me to see two or three patients for medication checkups and refer toenail problems to a podiatrist instead.


A patient in pain comes in to see this guy—who, other than using the wrong local anesthetic combo, has the ability to relieve the patient’s problem—and instead he gets referred to a podiatrist.

I’m assuming a nurse puts this patient in an exam room, this doc comes in, takes a look at the ingrown toenail, tells the patient it is an ingrown toenail, which the patient obviously knows, then tells the patient he’s going to refer him/her to a podiatrist. And probably charges him for an office visit.

The patient probably can’t get into a podiatrist that very same day, and even if he/she could, it involves another trip on his incredibly painful toe, another wait in a waiting room, etc. AND ONCE THE ANESTHESIA TAKES EFFECT, THE PROCEDURE TAKES TEN SECONDS? At least in my hands.

Instead of taking the few minutes required to reduce the agony of another human being, this doc refers. So the doc is saving himself a couple of minutes while allowing the patient to remain in pain for at least another hour or two, or maybe another day or two, depending upon how soon a podiatrist appointment can be set. Really unbelievable.

Maybe I’m being too harsh. Maybe the folks at the check in tell the patients the doctor doesn’t do ingrown toenails and send them limping on to a podiatrist.

But, still…

I guess I buried my rant deep in the newsletter this time instead of at the beginning.

Where Did Covid Come From?

That is the title of an opinion piece in today’s Wall Street Journal by Nicholas Wade, the same investigative reporter who wrote the magisterial article in Medium a few years ago. His was the first definitive report showing SARS-CoV-2 came from a lab leak in Wuhan. Now he has uncovered new evidence that is even more convincing.

Here are his opening two paragraphs:

In the four years since the SARS-CoV-2 virus was unleashed on the world, data have steadily accumulated supporting the hypothesis that it emerged from a laboratory. The latest information, released last month, makes a formidable case that the virus is the product of laboratory synthesis, not of nature.

This startling fact will probably take some time to sink into the national consciousness, given the mainstream media’s sustained inability to report the issue objectively. Editors have failed to think beyond the extreme politicization that requires liberals to oppose the lab-leak hypothesis. Science journalists are too beholden to their sources to suspect that virologists would lie to them about the extent of their profession’s responsibility for a catastrophic pandemic.

He goes on from there to describe what he’s discovered since writing his first article on it three years ago. It’s a tangled web, but also pretty obvious what happened when you see it laid out time-wise.

MD and I attended a talk Senator Rand Paul gave last week. He has a lot of inside knowledge, and he described many of the same things that are in the article above. The difference was that Paul never missed an opportunity to savage Fauci for his participation in the coverup and pin the blame squarely where it belongs.

Obesity, Seed Oils, and Sugar

This morning I received the latest Substack post from my friend Tucker Goodrich titled Response to Gary Taubes on Omega-6 Fats (Seed Oils) and Obesity.

The post, which is well worth a read, contrasts Gary’s take on what’s driving the obesity and diabetes epidemics (sugar) to Tucker’s (seed oils).

Gary’s contention—and I’ve discussed this with him many, many times—is that prior to being introduced to sugar, those living in non-Western societies were not obese and diabetes was unheard of. Once sugar came into the picture, people living in these societies began to develop obesity and diabetes, sometimes at alarming rates.

My copy of Gary’s book is in Dallas, so I can’t give you his estimate of how much sugar it takes per capita to bring these conditions on. But he does have a threshold figure. As he’s written, if the per capita consumption of sugar is below that threshold, obesity and diabetes are pretty much held at bay. But once a society exceeds that limit, it’s downhill from there.

When confronted with the idea that increased consumption of seed oils could also drive obesity, Gary responds by saying a) he doesn’t know much about seed oils (it’s a subject he hasn’t researched), and b) people from every non-Westernized society he’s evaluated began consuming sugar and became obese and diabetic before they had been exposed to seed oils. (I know this for a fact as I have been on the other side of these arguments with Gary many times.)

Tucker counters by providing data showing that a) seed oils have been around a lot longer than most people (myself, included) thought they had, and b) there are several societies afflicted with obesity and diabetes that consume large amounts of seed oil, yet very little sugar.

If you look at the statistics for the United States, you’ll see that obesity rates held pretty constant going back to the early 1900s (when such statistics started being kept). Then in the late 1970s the rate of obesity started moving upward and hasn’t stopped since.

At about this same time high-fructose corn syrup (HFCS) was introduced to the food supply and the amount of sugar (including HFCS) began to increase. This was also the time during which the whole cholesterol-is-bad frenzy began, so food manufacturers all switched from saturated fats to seed oils. And the increased consumption of seed oils went through the roof.

Here is a slide I put together for a talk I gave showing just how rapidly seed oil intake skyrocketed:

It’s kind of difficult to read the legend, but the blue line in the graph in the lower right is seed oils. The graph on the upper left shows that soybean oil (the red line) is the major seed oil contributor.

Both sugar and seed oils increased over the past four or five decades, so, based on this data at least, we can’t totally finger either one as the culprit.

But based on the info in Tucker’s post from this morning, I did learn that seed oils have been around in the US a lot longer than I thought they had. And up until the late 1970s, obesity held steady.

Same with sugar. Sugar has been around forever and obesity rates held steady till the late 1970s.

So, maybe there is a threshold effect for both of them. And those of us in the US hit it starting in the late 1970s. Last time I looked, the US had the greatest rate of obesity in the world. So it is a possibility.

I try to avoid both of them as much as possible. It’s easy to avoid sugar, but more difficult with seed oils, particularly if you eat out a lot. Restaurants use them in everything. Which is why I always say the best thing you can do for your health is to spend more time in your own kitchen.

And that leads me to the next section, which shows another real issue with seed oils.

Saturated Fat and the Obesity Paradox

It is a well known fact that obesity is a major risk factor for diseases ranging from myocardial infarction to cancer. It is also known that if you come down with many of these diseases, your chances of survival are better if you are obese. Thus the obesity paradox. It lays you low, then saves your rear.

Part of it, I’m sure, is a function of the extra stored energy. If you are laid low with a serious disease or injury, you lose muscle like crazy. Having an extra amount of fat available to provide the energy needed to overcome infection or healing from trauma is a real bonus.

But there is something beyond that.

A recent paper I just came across posits that the obesity paradox may well be a function not just of stored fat, but of the type of fat stored. The authors looked at geographic variations in fatty acid visceral adipose tissue storage and found that countries in which people have more polyunsaturated fat (PUFA) stored in their fat don’t survive serious illness as well as those with more saturated fat (SFA) and less PUFA packed away.

They decided to test their hypothesis on mice.

They used C57BL6 mice, which, at least in the lean, chow-fed versions don’t get severe pancreatitis, which was the researchers’ test disease.

They fed half the mice chow that was high in SFA and the other half on chow high in PUFA. Once the mice had been on their feed long enough to change the fatty acid profiles in their abdominal fat pads, they initiated pancreatitis in both groups using the caerulein (CER) model, a common way to induce acute pancreatitis in mice.

The results were pretty impressive.

I’ll start off with a kind of grisly photo, but one commonly seen in these kinds of studies. Some of the mice were sacrificed, so their abdominal fat could be examined. Which is what you see in the photo below.

As you can see, the upper two photos are of the viscera of mice with pancreatitis with a large amount of SFA in their adipose tissue. The bottom two are from mice with more PUFA. The adipose tissue of the SFA mice is pretty clean and fatty looking with minimal necrosis. The bottom two slides show a different picture entirely. You can see the dark red necrotic tissue all over the place.

And it’s not just in the fatty tissue. Below are graphics of tissue slides from the lungs and kidneys.

In this case, the mice groups are reversed. The SFA ones are on the bottom, the PUFA ones on the top. As you can clearly see, the tissues of the SFA-fed mice are pretty much normal when compared to control mice fed chow. (The control mice are identified as CON and are on the left. The ones with pancreatitis are labeled CER.)

The hypothesis is that the saturated fat is much more difficult for the pancreatic lipase—an enzyme released from the pancreas that breaks down fat—to form lipotoxic, non-esterified fatty acids (NEFA) that end up attacking other organs. The PUFA more readily converts to these lipotoxic NEFA, even though the PUFA is stored in lower quantities than the SFA.

You can see this represented in the graphic below from the article along with the description, which is small and difficult to read. You can find it in the article linked above in larger format.

There are a number of studies referenced in this article demonstrating how the adipose fatty acid composition of humans can be changed by the type of fat consumed. More SFA through the mouth, more SFA in the adipose tissue. Same with PUFA.

There is also a study I have in my files (not referenced in the above paper) showing the increase in PUFA, specifically linoleic acid (the fatty acid the above paper fingers as the most dangerous), in the US population over the past 60 years. Here is a graphic from that study.

The upper chart is of the linoleic acid increase as measured in all adipose tissue; the lower is of the linoleic acid increase in butt and belly subcutaneous fat.

Here is another graphic showing linoleic acid as a function of linoleic acid consumption.

Cleary linoleic acid in the adipose tissue increases when you eat more of it. If you go back up and look at the chart from my talk in the previous section, you can see that we all are eating a whole lot more of it.

So, basically we are setting ourselves up for the potential of being a whole lot sicker should we come down with something.

What continues to amaze me is that despite numerous papers coming out over the last several years showing saturated fat NOT to be a risk factor for heart disease, almost every article I get through the various medical subscription services I receive still recommends cutting down on saturated fat.

Not only that, the idiots who run the FDA also recommend cutting down on saturated fats. They list them as unhealthy, which is not only grammatically incorrect, it is an outright falsehood. They are proposing a new food labeling system to be attached to supermarket foods that looks like the below:

The depth of their dumbth is unfathomable.

They obviously haven’t read the terrific quote from Georgia Ede’s new book that I love so much.

if you eat more carbohydrate than you can burn right away or store as starch, your liver will turn it into saturated fat, not unsaturated fat, because saturated fat is the most compact and practical way to store energy. It stands to reason that if saturated fat were inherently bad for us, the body wouldn't be designed to do this.

Do not fear saturated fat.

Odds and Ends

Video of the Week

I can’t remember where I came across this video, but it is a great one. It is an appearance of the Blues Brothers on SNL in 1978. I remember seeing it then. I was in medical school at the time, and SNL was just about required viewing. If you didn’t watch it, you were eliminated from most non-medical chatter on Mondays. No VHS back then, so you had to watch it live.

I had forgotten how supple and good these guys were back then. Belushi’s untimely demise was a real loss to the world of performance art.

Okay, time for the poll.

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I’ve got to say, creating the poll was a lot easier on Substack. Now that I’ve figured it out (assuming I have; I’ll have to wait to see if the results show up), it should be easier next time.

That’s about it for this week. Thanks for hanging in there throughout the whole changeover process. And, remember, it might look a little different over the next few weeks as I get more familiar with the platform and figure out how to tweak it.

Keep in good cheer, and I’ll be back next Thursday.

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