Hello friends.

Greetings from Dallas, where it is starting to get hot. And windy.

There is a lot of news this week, so let’s get to it.

First, I made a major screw up last week that I have to atone for this week. When I came across the great video on how the shingles vaccine decreased the risk for dementia, I had read in the journal Nature about how taking the Shingrix vaccine reduced the risk for developing dementia. So, I assumed the video was about Shingrix, but, alas, it wasn’t. It was about another shingles vaccine, the Zostavax, which is a live attenuated Zoster vaccine, and was also written up in a Nature article about it’s ability to decrease dementia.

An easy mistake to make, I suppose. But I should have looked closer. Here is the real Nature article about the Shringrix vaccine and dementia. The other Nature article is in last week’s Arrow.

Although Zostavax does prevent development of dementia in a segment of those who take it, it’s efficacy in preventing shingles is significantly lower than that of Shingrix. And Shingrix itself prevents dementia better than does Zostavax.

Sorry for any confusion this caused. And it caused plenty because I got a few comments and a lot of emails.

Speaking of emails, I’m having trouble keeping up. When I started out, I got one or two emails per day. It has gradually grown to the point that I’m getting 50ish per day, and I’m having real difficulty keeping up. I kind of run through them and deal with the ones that are simple questions and let the others lie until I can get back to them. Which more often than I would like, I don’t.

I’ve got all kinds of stuff going on in April, but I should have more free time come May. I hope to be able to go back and respond to some of the older emails then. Fingers crossed.

Speaking of some of the emails and comments I’ve received asking about therapeutics for shingles instead of the vaccines, I figured would address those.

Therapeutics for Shingles Infections

There was some conversation in the comments section and in the emails about the various therapeutics for treating shingles outbreaks, so I figured there might be some interest there.

As I wrote about myself last week, I wouldn’t take the vaccine simply because no one in my family has ever come down with shingles. I have a built-in reluctance to take any vaccine simply because I could never become unvaccinated should the vaccine turn out to be problematic. Couple these two reasons to a third: For most people shingles isn’t all that bad.

Plus, there are effective therapeutic agents against shingles that work really well if you start them promptly. The first one—and the best, in my view—is acyclovir (Zovirax). It is one of the drugs I really love, because it works so quickly and so well. It was developed to treat genital herpes, which was a scourge when I was in medical school.

We saw so many patients in the clinic who had herpes, and there was just nothing we could really do for them other than to tell them herpes was a virus, and we had no good drugs for viruses.

I’ve got a couple of funny anecdotes about herpes in the pre-acyclovir days. I spent far too much time hanging out with a derelict non-medical student friend while I was in medical school. He was like a cat in heat, and when the cat in heat was on him, he was not particularly selective. He ended up coming down with a pretty bad case of herpes.

I was a med student at the time, and I didn’t really have a clue as to how to treat herpes, so I took my friend up to the office of another friend who was a neurosurgical resident. But this friend did a lot of moonlighting in ER’s, so I figured he might know how to treat it.

The victim drops trou and the neurosurgeon says, Wow, that’s a really bad case. There are no drugs for it. It will ultimately go away, but you want to keep the area clean so you don’t get some other kind of infection while it’s healing. He then gives my friend a handful of little packets of betadine, which is a brownish liquid antibacterial solution used in surgery suites everywhere.

In a day or so, my friend calls me up in a panic. Everything is swollen. He’s dying. I make a house call on him and realize he’s had a hellish allergic reaction to the betadine. (It can precipitate a pretty horrific response in allergic individuals.) I ended up giving him some steroids to calm the inflammation. He recovered.

A few years later, this same guy pops by our clinic and asks me if I had anything in my sample cabinet to treat (whatever I can’t remember now). I gave him some Minocin, which is a tetracycline-derived drug. The next day, he calls me outraged.

He had taken his Minocin and gone to the lake with his girlfriend. Before I tell you what happened, I’ve got to tell you that this guy is blond, blue-eyed, and probably hasn’t spent ten hours of his life in the sun. Had it been anyone but him, I would have said avoid the sun. But he was like Count Dracula, so I didn’t bother. Minocin, like all tetracycline-based drugs can cause a horrific photosensitivity reaction that makes the skin swell, discolor, hurt, and look like absolute hell. It takes a while to set in, though.

He goes home, goes to bed, gets up in the middle of the night to pee, sees himself in the mirror and goes ballistic.

Now another piece of this story you need to know to give it the full hilarity it deserves is that after his bad case of herpes and the allergic reaction we discussed earlier, he started reading everything he could get his hands on about herpes. During the course of his reading, he came across an article talking about how herpes could go systemic, which means rushing through the body in the bloodstream.

Now systemic herpes (or any other virus or bacteria, for that matter) is a serious problem—a true medical emergency. But it only happens to people who are immune suppressed, not people with normal immune function. I’ve seen countless patients with herpes, but never one with systemic herpes.

My friend flew into a blind panic and grabbed a bottle of old Stoxil he had lying around and smeared it all over his face. (Stoxil is (was) an old OTC med for herpes that was pretty much worthless.) He told me he had smeared on the Stoxil and put in an emergency call to his dermatologist. Which was the funniest part. Dermatologists don’t very often get emergency calls.

Soon after that event acyclovir hit the market, and the rest is history. My friend could rest easy. He could treat each resurgence with acyclovir before it even broke out. (When herpes activates and starts moving down the nerves to the skin, most people can sense it. All it takes is to slather on some acyclovir on the area of skin that always breaks out or take some orally, and nine times out of ten, the virus dies before it breaks the skin.

MD had a horrendomatus dental situation in which a new dental assistant glued on a temporary crown with permanent cement. When MD went in to get her crown, the dentist realized what happened, and MD had to sit in the chair for almost five hours with the dentist and everyone else tugging and chipping on her tooth and stretching dental tools across her cheek. After that experience, she developed a tingling neuralgia (nerve pain) along that side of her cheek. Occasionally a little herpes-like lesion will pop up on her lip on that side and take a few days to go away.

Now she has acyclovir with her at all times, and should she feel the tingling, she pops a pill and the tingling quickly resolves and she has never suffered a breakout.

And acyclovir orally works like a champ for shingles. It is my go to drug. It works best when it gets started quickly. The sooner you can use the acyclovir, the better.

There are a couple of other meds in the same family that work well. Valacyclovir (Valtrex and) Famciclovir (Famvir). I have had no experience with these meds as acyclovir has been my drug from the start. These drugs, like acyclovir, need to be started early for ultimate effectiveness.

All of these meds work via the same mechanism of action: they inhibit the replication of the varicella-zoster virus, reducing both the duration and severity of the outbreak. Importantly, getting started with the meds earlier rather than later lowers the risk of complications, particularly postherpetic neuralgia (PHN), a chronic pain condition that can hang around after the rash goes away.

Richard Bernstein, M.D., RIP

I just learned that Dr. Bernstein passed away on April 15, 2025 (as I was writing on The Arrow). He was a huge pioneer in the field of diabetes care and a good friend. MD and I helped him get his literary agent and his first book published. We proudly gave him his first cover blurb.

And what a book it was. Just bout everything known about diabetes is in there. We still recommend it to anyone we know with diabetes.

Dr. Bernstein had a career that was amazing in many ways. He developed type 1 diabetes mellitus (T1DM) when he was about 12 years old, or 78 years ago. I seriously doubt there has been a single person with TIDM who outlived him. Virtually no one with the disease lives to be 90.

He struggled with his disease when he was in high school and college, because there was no way at the time to even semi-accurately dose insulin correctly. You took what you thought was the correct amount, and if you started to feel sleepy, you ate carbs.

Dr. Bernstein went to engineering school and became an engineer. He married, and his wife became a doctor.

One day she came home and announced that the emergency room had obtained a machine that would spit out a glucose reading almost immediately. Prior to that, patients had to have blood drawn and wait for hours to get their labs back.

Many people end up in emergency rooms unconscious. One of the main reasons one might appear unconscious would by insulin shock in a patient with T1DM. A co-worker who brings the patient in may not know of his/her condition. So the ER folks have to sort it out.

In those days, the first thing you did when someone came in unconscious was to start an IV and give them a blast of glucose. If they woke right up, then you knew they were diabetic and in insulin shock.

If not, you checked for other things. The glucometer—even though it was a big machine at that time like an EKG machine or xerox copy machine—was a godsend as you could test blood sugar in seconds.

When Dr. Bernstein learned from his wife of this new machine, he had to have one. He ended up purchasing one for a fair sum of money. He told me how much, but I’ve forgotten.

When he got his glucometer, his life changed…literally. In typical engineer fashion, he began to measure every bite of food and drop of drink that went into his mouth and what kind of change it made in his blood sugar. He did the same with insulin, meticulously measuring his injections and reading his glucometer.

After much trial and error, he was able to calculate what he needed to do to keep his own blood sugar under perfect control.

He decided he would show the world how to do it. He wrote up several different plans and presented them to medical journals—all were rejected. He wrote a small book and tried without results to get it published.

His problem wasn’t his theory; his problem was that he wasn’t a doctor.

And the only way he could remedy that was by going to medical school in his 40s. Which he did.

Once he became a physician, he began treating people with diabetes with low-carb diets. And that’s what he did for the rest of his life, kind of dragging the academic diabetes world kicking and screaming behind him.

For those of you who haven’t seen him speak, here is a short talk from about a year ago at age 89.

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His mention of taking singing lessons at 80 years of age reminded me of an incredible experience we had with him 25+ years ago. Protein Power had just come out, and MD and I were on the speaker circuit. We had met Richard a few years before, but did not know him all that well. We all gave talks at this conference somewhere in the east, I can’t remember exactly where. When the conference was over, there was a banquet. And after the banquet, some live music.

The group playing the music started rounding up their stuff to go and everyone figured the night was over. Richard stands up on his chair—he was very short—to make some commentary about the meeting. He’s a funny guy, so he probably told a corny joke or two.

Then he says, Would you like for me to sing?

Everyone was kind of stunned, because no one had ever seen anything like that at any other medical meeting they had been to. People said, Sure.

So, and this is the God’s truth, he whips a pitch pipe out of his coat pocket and blows into it. Then he hums me me me me to get in pitch. He does it again at a different pitch. And then breaks into an operatic song. It was amazing, unusual, totally unexpected, and completely Richard Bernstein. He will be missed.

Writing about Dr. Bernstein made me think of my own glucose issues.

New Keto-Mojo and Contour New Gen

Last time I wrote about it, I had been having fits with my blood sugar and ketones. I’ve been on a totally strict ketogenic diet and my ketone and blood sugar readings have not corresponded with what I thought they should be given the strictness of my diet.

I read up on blood sugar monitors, and learned that the Contour New Generation was the best one for the money in terms of accuracy. Since it cost only 20 bucks, I bought one. At the same time, I decided to switch out my Keto-Mojo for a new unit. I got the thing at a meeting about 2.5 years ago and hadn’t taken it out of the box till I started my diet. All the strips were out of date, so I bought some new strips, which didn’t read much better than the old out-of-date ones. I was going to buy some calibration fluid and try to get it all working right, but in the end, I said screw it and just bought a new one.

What happened?

A lot. My blood sugars went down and my ketones went up. The blood sugar on the Contour virtually always runs lower than the Keto-Mojo. Once in a while, the Contour will read a little higher, maybe 5-6 gm/dl, but that’s it. Sometimes the Contour runs 20 gm/dl lower than the Keto-Mojo. Since the Contour is listed as the most accurate, I tend to believe it on the blood sugars. The Keto-Mojo is the only game I could find for ketones, but now that they have come up nicely from 0.4 to 2.4, I tend to believe it.

I want to mention a few books I think many of you might be interested in.

A Different Approach to Migraines

When I was working a lot in primary care I took care of countless patients with migraine headaches. I always kind of hated it, because I didn’t really understand the physiology behind migraines. I did then what I decry doctors doing now, which is just blindly stumbling along the path of the standard of care. SOC as every doctor knows it.

As I’ve mentioned a number of times, I’m on an email list of academic low-carb docs and a few variations of that trade. We converse, confab, and pass along patient questions, papers, and anything pertinent to low carb. One of the ladies on the list is Angela Stanton, who is a PhD and has a large patient population who have migraines.

I never learned much about her actual practice, but she always provides intelligent commentary on the questions of others. A few days ago, she put up a video of an interview she did, and it was fascinating to watch. Here it is.

I was amazed at her treatment methods and wished, as I watched it, that I had had this info back in the day. What a difference it would have made.

If you have migraines or know someone who does, send this video along to them.

Angela has also written a book on the topic titled Fighting the Migraine Epidemic. Right now it’s on Kindle Unlimited, so you can read it free if you have that service. Otherwise it’s $9.99.

The Beginnings of the Deep State

I’m reading the latest of the books written about one of my former heroes: James Jesus Angleton. He was a poet at Yale, who hung out with Ezra Pound in Italy, where his family lived. He got recruited during WWII into the Office of Strategic Services (OSS), the forerunner of the CIA. Most people don’t know that unlike other countries across the world, the United States didn’t have an intelligence service until late in WWII, when the OSS was founded.

Angleton served the OSS well, and when the CIA was created, he slid nicely into that.

Over time, he developed the counter-intelligence agency within the CIA, and arranged things so he would have many secrets unknown to anyone else in government. Before long, he became so powerful no one was willing to bring him to account. He was opening citizens’ mail—thousands of letters per month—and doing all kinds of surreptitious acts that were far from legal.

I’ve read every book I could find about him, because he is a real greater-than-life character, but once I started reading this one, written by a journalist who has followed his career for years and just came across a load of new documents, my opinion of Angleton changed. A lot of what we are dealing with today in terms of CIA control that it shouldn’t have, derived from the secret and unlawful work Angleton did. I just noticed it was selling on Amazon Kindle for $1.99.

And, finally, the book that is keeping me pissed off.

In Covid’s Wake. How Our Politics Failed Us

Another doctor who came to pretty much the same conclusions on the whole Covid fiasco as I did heartily recommended this book to me. I’ve read so many of these kinds of books now, that I could recite them. This one is different.

All the ones I can recite are written by people who felt the same way I did throughout the Covid days.

This one is from people who thought differently. Who thought the people like me were stupid. That thought mandates were good. That giving vaccines to everyone who would hold still was a terrific idea.

As that era ended, though, they slowly realized how wrong they had been. And how much politics motivated what they did. The book is a mea culpa, and it’s hard to read. I can’t imagine how hard it was to write.

Give it a read if you want to know what really happened.

RFK, Jr’s Autism Promise in September

Finally, something positive has come out of the HHS. Robert F. Kennedy, Jr. gave a news conference yesterday in which he more or less promised to provide the environmental factor(s) behind the autism epidemic.

His speech was terrific, but I know a lot of people don’t want to listen to a long video. So, I conned MD, who is one of the world’s fastest typists, to type the part up I felt was most important. Then I’ll comment after that.

Here is the entire press conference if you would like to watch it in full.

Here is MD’s transcribed bit. I’ll add my commentary after.

Those who understand are fighting a fight on two fronts here. First, we’re fighting Big Pharma, who are scared to death they’re going to get tagged as the “environmental” agent that is causing the problem. Big Pharma essentially controls Big Media because the drug ads keep Big Media afloat. Don’t think for a second that the legacy media is going to take even one quick little journalist peek into this story, because they won’t. They know which side their bread is buttered on. I don’t know how they’ll react if Bobby follows through on one of his other stated goals: Banning pharmaceutical ads in non-medical media.

The second fight we’re having is, strangely enough, from the parents and the formalized autism groups out there raising money on behalf of autism and autism research. These are people who have a totally different perspective on autism. To many of them, autism is wonderful. It’s just a different way of looking at things. Neurodivergent, they call it.

Autism obviously isn’t black and white. It is a spectrum. At one end of the spectrum you have Elon Musk, assuming he really is autistic, who is brilliant and passes as a normal person who is a little strange. His autism allows him to focus in a way most non-autistic folks can do.

We can back way down on the spectrum from Elon and find autistic kids who are really good at coding and physics and a host of other activities. They are a little strange. They may have trouble holding relationships together. They may even have difficulty learning to drive. But they are happy. They are neurodivergent. Companies want to hire them because they can focus so well on particular things.

Each little step down the spectrum, though, brings with it a lack of ability to just get by with any kind of decent life. Those are who RFK is talking about when he says “they will never pay taxes, never play baseball, they’ll never write a poem, never go out on a date. Many of them will never use a toilet unassisted.”

Those are not the kids who parents brag about the neurodivergence and their coding skills. Those other kids have parents worried about them constantly and wondering what is going to happen when they, the parents, pass on. What is going to happen to these kids?

And, to think, when they were two-year-old toddlers, they were just starting to talk, and getting into everything and being kids. Then something entered their environment and in a short time changed them for life.

We need to find out what that is.

1 in 12.5 boys in California.

We’ve got to find it fast.

But it will be a battle.

Odds and Ends

• Want to make a quick $3 million? That’s what NASA is offering to anyone who can come up with the technology to recycle feces and other human waste in space.

• Christine Grady—wife of Anthony Fauci—underwrote Zika ethics rules. Her husband broke them. Together, they cashed the checks. Her silence wasn’t neutrality—it was complicity. Now she’s banished to Alaska…if she doesn’t quit.

• Student rejected from multiple universities despite near perfect scores and a $30 application app he built over the summer. If he can’t get in, how can anyone?

• The unique items in Uber’s lost and found. I figured for sure there would be some overlap between these and unique things I’ve found doing pelvic exams in ERs. But no, not the same.

• The size of this longhouse suggests powerful rulers existed in Norway long before the Viking Age, which didn’t get going for about another 500 years.

• Study shows that flood magnitude was significantly higher before the 20th century, despite there being a negligible greenhouse gas contribution from humans.

• Is Keir Starmer on a mission to erase England? According to John Locke, it certainly appears that way.

• Hankering for a chiseled jawline? A male TikTok influencer strikes his cheekbones with a hammer—highlighting the rise of "looksmaxxing," an online trend pushing unproven and sometimes dangerous techniques to boost sexual appeal. Jesus wept.

• Finding friendship at first whiff: How scent influences our choice of friends.

• MLB Hall of Famer, now a professional photographer, Ken Griffey Jr. captured the amazing photo of Rory McIlroy's emotional masters-winning moment.

• How Covid lies destroyed kids’ lives. We were told school closures were based on evidence—and were for our own good. Five years later, millions of children are still paying the price.

• Ice age humans built sophisticated fireplaces; some of which could withstand over 1,112 degrees Fahrenheit. They had to use those big brains for something.

• A newly uncovered 1,900-year-old papyrus provides instruction as to how to evade the taxman in ancient Rome. George Harrison would be proud.

• CT scans could cause 5% of cancers, study finds; experts note uncertainty. In my view, doctors order them way too willy nilly without thinking that radiation is cumulative.

• According to former Google CEO, Eric Schmidt, former president, the vast majority of programmers will be replaced with AI programmers withIn a year.

• Salmon migration affected by drug pollution in water from anti-anxiety medications, predominantly benzodiazepines.

• Researchers in March captured the first footage of a colossal squid in its natural habitat, thousands of feet under the sea off the South Sandwich Islands. If you can bear watching the ad before it, the video at the top about the submersible is fascinating.

• Ever wonder about the difference in shopping at a Costco in France vs one in the US? I spent a lot more time on this site than I thought I would. It’s weird that in France people don’t serve Costco wines at parties, because they would be thought to be showing off due to the price. It’s just the opposite in the US. And the wine costs about the same.

• On this very day in 1964, Henry Ford II revealed the Ford Mustang at the World’s Fair in New York.

• The U.S. government spends over $160 billion annually on scientific research. The public believes these funds underwrite innovation and discovery. The truth is, much of this budget goes to questionable studies and out and out fraud. It’s time we eliminate it. There are many better ways to fund studies with better oversight.

Newsletter Recommendations

Video of the Week

Years and years ago, MD and I happened to get introduced to the CDs of a guy named Chris Smithers. We really enjoyed his music, so we bought a couple of his CDS. I think we may have seen him in person maybe three times.

Then one night we’re driving home from dinner in Little Rock and we go by this bar that I had never really noticed before. MD screams turn around.

She said she saw a sign on the front of the bar that said Chris Smithers tonight, $5 cover charge. I said, do you want to go? She said, Are you out of your mind?

So, we went.

It was a tiny venue, and we were right up front. As the concert went on, there was a table of rednecks over against the wall drinking beer, talking loud, and not paying any attention to the music. They had probably come in before the cover charge even went on and had been drinking since.

MD gets up and sweetly goes over to them and says, Guys, I know you’re just having fun, but I really like this singer, and I can barely hear him because of you. Could you keep it down or move into the next room if you don’t want to listen.

They said, Yes, ma’am, sorry.

Which I was damn glad to hear.

It ended up being a spectacular concert and the last time we ever saw Chris Smithers live.

I love these guys and gals who have a loyal following and can squeeze out a living doing what they love. This video is almost an hour long, but it was the best one in terms of quality. Just watch as much as you want. It’s just how we saw him in the bar. Wooden board on the floor under his feet to provide percussion. Just him and the microphone.

Time for the poll, so you can grade my performance this week.

That’s about it for this week. Keep in good cheer, and I’ll be back next Thursday.

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This newsletter is for informational and educational purposes only. It is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice.

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