A Retired Physician’s View of American Healthcare

In my opinion, the healthcare system in this country is currently on life support. The level of trust is lower than it’s been in at least 50 years and deservedly so. While many probably believe that the negative impact on the healthcare system’s reputation is based on the nation’s Covid response, I will endeavor to provide, from the perspective of a retired physician and patient, a roadmap that brings all of the elements of the healthcare system together to explain how the disastrous Covid response merely highlighted the rot, rather than being its cause. While I’m keenly aware of the forces outside the healthcare system that played important roles in this drama, for this article, I will stick with all things medical.

The healthcare industry can be divided into four interrelated disciplines: 1) Hands-on care providers; 2) Researchers; 3) Public health professionals; and 4) Designers and administrators of health systems infrastructure. The Prime Directive (for you Star Trek fans) for each of these disciplines is different. For the hands-on care providers, it’s: ‘First do no harm.’ For the researcher, it’s: ‘Find something/discover something.’ For the public health professional, it’s: ‘Do something’ (usually spoken in a loud shrill voice); and for the designers and administrators of health systems infrastructure, it’s a take-off on the movie, “Field of Dreams:” ‘If you build it, patients will come.’

What should be obvious is that these four Prime Directives can be in conflict with each other, so unless there is collaboration between their respective practitioners, chaos can ensue, largely dependent on the complexity of the health emergency. In the case of the nation’s Covid response, chaos reigned, at least partly because a small cadre of public health professionals and Big Pharma took over, while the hands-on practitioners and infrastructure professionals were pushed aside and given their marching orders. In the case of hands-on practitioners, threats were used, when necessary, to obtain compliance.

What’s worse, the more I’ve learned, the more I’ve come to believe that the chaos was by design, in order to distract the lay public from recognizing that the collaboration of professionals representing all four disciplines hadn’t occurred. The importance of this is that the lay public’s relationship with the healthcare system is largely through their primary care physician. Would the public have reacted differently if they were aware that the person they trusted most to help them navigate the healthcare system was beholden to someone other than them?

At this point, a legitimate question that can be asked: why should anyone listen to what I have to say? My answer is that I am part of a group that constitutes maybe 1% of the physicians in this country that have had training, knowledge, and experience in all four disciplines; and I’ve done so over a period of 50 years. Believe me when I say that I did not set out on this career track. Rather, it was the vagaries of my professional life that brought me to this point; some of it very painful and difficult. In addition, being retired provides an added advantage in that I’m no longer engaged in work where my focus favors one discipline over any of the others. I’ve come to recognize that that gives me a perspective that few in my profession have.

Specifically, I had 7 years (1973-80) of medical training (SUNY Downstate Medical School and Kings County Hospital IM Residency). While there, I saw virtually everything, from St. Vitus’ dance to uremic frost. Of note, the one thing I never saw, heard of, or read about was Type 2 diabetes in anyone under the age of 30-35, something that is epidemic in young people today. That’s because the US Department of Agriculture’s recommendations to substitute carbohydrates for fats in the American diet didn’t occur until the late 1970s. The unintended consequence of this shift was that the American diet increased, on average, by 500 calories/day, thus generating the twin epidemics of obesity and young age Type 2 diabetes.

I recall predicting in 2005 at a session covering ‘Healthy People 2010’ at the annual American Public Health Association meeting that within the next 5-10 years, life expectancy in the US would start to decline due to a critical mass of premature deaths from obesity and young-age Type 2 diabetes. In fact, 2015-2017 saw the first 3-consecutive-year decline in life expectancy since the flu pandemic of 1918-20. While this was attributed primarily to deaths of despair, I believe obesity and young-age Type 2 diabetes were at least as important. I’m providing these details, because, as I’ll show, it is relevant to the current state of the entire healthcare system.

Getting back to my medical training; while Anthony Fauci bragged about having seen HIV/AIDS as early as 1981, which was early, I saw my first case of what we later came to recognize was HIV/AIDS in September 1977. When NYC had a major Legionnaires’ outbreak in 1978, I happened to be the senior resident on the Kings County Hospital pulmonary ward where the two index cases were admitted. I did the case presentations at the Grand Rounds, which was attended by infectious disease specialists from around the country, including folks from the CDC, who were also involved while the index patients were still in the hospital. That was a high point for the CDC. How far the mighty have fallen! I also had extensive training in the care of tuberculosis patients, which was still fairly prevalent in Brooklyn. Overall, I had almost as much training in infectious disease as someone who had done an infectious disease fellowship.

My medical school and residency training was followed by almost 40 years of healthcare experience, including 19 years of direct patient care in a rural setting as a Board Certified Internist; 17 years of clinical research in the areas of substance use, HIV, and HCV at a private-not-for-profit healthcare agency, where I was lead or co-author of approximately two dozen papers published in peer-reviewed medical journals. I also had over 35 years of involvement in public health, most prominently as a 10-year member of the Quality of Care Advisory Committee of the NYS Department of Health AIDS Institute. My health systems infrastructure and administration activities were primarily in the areas of Quality Improvement and Compliance, where I was responsible for the development, implementation, and directorship of these programs at the institutions where I was affiliated or worked. 

When I retired 6 years ago, I became a member of the Institutional Review Board (IRB) at the agency where I had done clinical research. I have been IRB Chair for the past 4 years, so even though I am retired, I’m still in the arena. Based on the foregoing, I believe I am as qualified, from a healthcare perspective, as anyone to wade through the “noise” to get to the facts and data that are truly important.

My Covid journey began on Friday the 13^th of March 2020, the day that the 2-week lockdown to ‘flatten the curve’ was announced. I came down with what I suspected was peri-myocarditis, and presumed it was from Covid infection. Doctor’s offices were shut, and there were reports (which turned out to be largely false) of many deaths at the hospitals near me in Queens, NYC, so I literally decided to ride it out. My symptoms were of decreasing duration and intensity over a period of seven days, and were gone by day eight. By day 10, I was back doing my 20-mile bike rides twice weekly without incident. The significance of this will become clear later.

At the time, I accepted the ‘Flatten the curve’ strategy, since I hadn’t yet seen (because the censorship goon squads were already up and running) the papers by John Ioannidis or Jay Bhattacharya indicating that the published fatality rates were wildly exaggerated, even in the elderly. However, as soon as I saw that the 2-week period was going to be extended, and the term lockdown came into vogue, I began to smell a rat.

If people are locked down in their homes, it seemed inevitable to me that someone would introduce the virus into the home, turning it into a Petri dish. With my knowledge and experience in infection control, I was surprised that no one (other than Dr. Ben Carson) ever mentioned the size of the ‘inoculum’ as a determinant of how sick you might get. I also knew that contact tracing for an airborne infection was a fool’s errand. That’s what you get when physicians like Fauci and Deborah Birx, who have spent the bulk of their careers dealing with HIV, which is transmitted sexually or by intravenous drug use, are put in charge of dealing with an airborne infection. 

I also knew that masks were useless. I remember hearing at the time that stopping a virus by wearing a mask was about as useful as stopping mosquitoes by putting a chain link fence around your yard! That analogy has withstood the test of time quite well. I was also keenly aware of the risk of CO₂ narcosis from wearing a tightly fitted mask. This knowledge stemmed from my training days when the use of Librium or Valium to treat panic attacks was barely on the radar screen. What we did was to have the patient breathe into a brown paper bag until CO₂ narcosis calmed them down. Worked quite well, actually! I still remember a woman with frequent panic attacks who would show up in the emergency department only when her home supply of brown paper bags was exhausted.

When I finally was able to see my primary care doctor in July 2020, the diagnosis of peri-myocarditis was essentially confirmed (I had T-wave inversions on EKG that later resolved). Most important to me, I was hoping that I had made antibodies to the Covid virus. I didn’t! That was of concern since, from my perch, it was very difficult to get a good handle on whether hydroxychloroquine and azithromycin and zinc or ivermectin were effective. While I suspected that they were effective (I already knew from my practice years that the safety concerns were wildly exaggerated and/or totally false); the censorship efforts were such that I had some doubt. I did notice however, that the studies showing that these medications were ineffective were not done on the cohort for whom they were being used; namely, people who had had symptoms for less than 3-4 days. 

It was during the fall of 2020 that I first saw the definitive paper on influenza pandemic mitigation by Donald Henderson, MD, MPH published in 2006:

The guidance in this paper was diametrically opposed to the Covid response I was witnessing. Given Henderson’s experience as leader of the team that rid the planet of smallpox, and at the time of his death in 2016, he was leading teams that were on the verge of eradicating polio and measles, his credentials were impeccable. 

In addition, Sweden provided a naturally occurring control group, in that there were no lockdowns, no school closures, no mask mandates, and no social distancing requirements. Despite this, the country had no deaths in children under the age of 18. Their morbidity/mortality rates overall were no worse than countries that had locked down, and the social and economic disruptions were much less than their peer countries. 

Based on the information that I’ve described above, I decided that when the Covid jab was released, I would take it, but only after at least 10 million others had taken it without significant adverse event rates, since I still believed that for those 65 years of age or older, it had value. From the foregoing statement, you can see that at that point, I was not yet aware of the lengths to which the public health agencies had gone to hide the number of serious adverse events from the jab. Of course, before taking the jab, I planned to retest for antibodies first to see whether I had developed natural immunity.

This brings us to a corollary of the physician’s Prime Directive: ‘First do no harm.’ When the FDA approves a new pharmaceutical for patient use, even under the usual approval process, you never, ever want to be among the first group of physicians to prescribe this new product, except in very rare situations. Why is this? It’s because the number of patients that have participated in the research to complete Phase 3 trials is not very large. Therefore, when the product is released, the number of patients placed on the new pharmaceutical is usually many times the number of research participants. As a result, bad reactions, including deaths, from the new product that were not seen during the research can emerge. Just about once per year, the FDA will remove from the market a pharmaceutical it had previously approved due to bad occurrences seen after widespread use…and this has been the case for at least the past 40 years.

During my years in primary care practice, physicians were frequently surveyed as to when they would begin prescribing a new pharmaceutical product. A few percent would prescribe it as soon as it was available; a few percent would prescribe it after a few of their colleagues had used it; about 70-80% would prescribe it only after it had been used fairly extensively; and about 10-15% wouldn’t prescribe the product until it was considered the “gold standard.” When I was in practice, I was almost always in group #3. The rare situations when you would want to be first in line would be when a patient had been on every treatment regimen available and was still doing poorly. An example would be patients with seizure disorder, who, at best, were still having daily seizures despite having been on every approved regimen.

Given that the Covid jab, under Emergency Use Authorization, was released while it was still a Phase 3 research product, there should have been even greater post-marketing surveillance than usual. I had written about these oversight deficiencies previously for Brownstone: 

Everything changed for me in December 2020 when I contracted symptomatic Covid for a second time. Without getting into too much detail, I had respiratory insufficiency due to Covid-induced cytokine storm complicated by bilateral bacterial pneumonia. I was hospitalized for 11 days. If it weren’t for the increased pulmonary reserve from my years of bike riding, I surely would have died. Incidentally, I was offered Remdesivir, but by then, I knew that the only people benefiting from that drug were Fauci and Bill Gates. I took a pass. Six weeks after discharge, I was back doing my 20-mile bike rides.

At this point, I should address those who believe that the scamdemic was not caused by a virus. Based on my two episodes of illness, I totally reject that notion. It was the lethality of the virus that was wildly exaggerated, not its existence! 

In early 2021, the recommendation was that even if you had antibodies to Covid, you should receive two mRNA jabs three months after testing negative for the virus post-illness. For me, this would have been late April or early May of 2021. My plan was to test for antibodies in late April, and to refuse the jab if I made antibodies, despite the recommendations from the chief of pulmonary medicine at the hospital where I had been an inpatient. The justification given for the jab just didn’t make sense to me, and was contrary to 2,500 years of knowledge regarding immunity.

During the ensuing 3 months, good research was published clearly indicating that natural immunity was at least as effective as the jab. When I tested positive for antibodies, there was no way I was going to get jabbed. The fact that more and more evidence is emerging that some people are susceptible to severe artery clogging from the jab, and given my family history of early death from coronary artery disease, the decision not to jab may very well have saved my life. By the way, the CDC did not publicly acknowledge the value of natural immunity until late January of 2022, and even at that late date, they buried it in a graph without mention in the narrative that accompanied the graph.

The next significant event, from my perspective, was when the jab was up for consideration by the FDA for children 12-17 years of age. The same week that the FDA Advisory Committee was doing their review, a study from Israel showed that in less than 100,000 children given the jab, there were 1,200 cases of myocarditis. For a supposed vaccine, that’s a horrendously high rate of serious adverse events. The fact that no child was hospitalized was immaterial.

I saw this study within a day of its release. This study, coupled with the fact that in countries that had good records on deaths from Covid in children, the number of deaths was zero, led me to believe that there was no way that the jabs would be approved for this cohort. Boy was I mistaken! At the time, I thought that this constituted scientific misconduct that had crossed the line into criminality. If anything, subsequent events have added many exclamation points to that assessment. So much for following the science! Some European countries did not approve the jab for those under the age of 18, and still haven’t. 

To add insult to injury, I saw two interviews with Randi Weingarten done about 6-8 weeks apart. Within 7-10 days after each interview, the CDC released guidelines for handling children’s education and healthcare that I was certain came directly from those interviews. Sure enough, the email exchanges between Weingarten and Rochelle Walensky, then CDC Director, were released showing unequivocally that Weingarten was providing the CDC with their marching orders. Given that Weingarten is vicious, nasty, has no medical training, and is childless makes her the last person you’d want to have the power to determine how your children should be educated and the healthcare they should receive. It’s like having Hansel and Gretel on continuous loop, except that the wicked witch always wins!

I then came across the following study, which I thought was fairly well done:

It showed that among Medicare patients receiving the initial two-shot regimen in early 2021, there was benefit over a period of 6 months. On the basis of this study, I still maintained that the jab was of value for this cohort. However, it did not escape my notice that over the next two years, studies in other cohorts extending out for 6 months or more were not forthcoming. What was even more surprising was that there was no extension beyond 6 months in the cohort from the study referenced above. Given the poor quality of almost all studies coming from our public health agencies (the above linked study was a very rare exception), I became convinced that when they tried to extend the study beyond 6 months, the results were so poor that they couldn’t even attempt to manipulate the data, as they had done on so many other occasions (and were almost always caught). 

Of note, from September 2021 until late 2023, I regularly participated on the MedPage site, which was restricted to healthcare professionals. During my time on MedPage, I went from being an outlier, who was accused of all the usual Covid epithets to being one of the leaders of what came to be a 75% majority. It took about a year for the transition to occur. Believe me, there was a fair amount of weeping and gnashing of teeth by the Covidian goons. Whenever I would challenge the group to provide a study that was comparable to the study linked above, there was nothing but crickets, yet they continued to support giving the jab to anyone with a pulse. By the end of 2023, the Empire Struck Back with the goon squad regaining control. At that point, I unsubscribed. I subsequently found out that MedPage is a Big Pharma-controlled site. If true, I’m surprised that I was able to contribute for as long as I did.

Given the Covid debacle, it would not be unreasonable to suspect that other supposedly ‘settled’ elements of healthcare, especially with regard to pharmaceuticals, were fudged. Recently, I’ve had what I believe were very constructive interactions with Brownstone contributors, who for the most part are not healthcare professionals. I’ll characterize one of these discussions as an extrapolation of the Covid jab problems to the flu shot. A key point from that discussion was that the quality of the data supporting the utility of the flu shot appears to be even worse than for the Covid jab, which would seem inconceivable, but is probably an accurate description.

While I admit that my nearly unconditional support for giving the flu shot has been shaken, I will still continue taking it annually, as I’ve done for 42 of the past 44 flu seasons, and I would still recommend it for persons over the age of 65, and children under the age of 18. Why would I do that? It’s because my experience tells me that after 60 years of use, the flu shot has proven to be extremely safe (in sharp contrast to the Covid jab), and my clinical judgment is that good data would show that it reduces morbidity and mortality from flu, even if that reduction is modest. In other words, I believe that the risk/benefit ratio is favorable…but it would be nice to have good data to support or refute that judgment.

A second discussion was on the use of statins for hyperlipidemia. While the data supporting its use as secondary prevention for someone who has had a cardiovascular event looks to be solid, use of these medications for primary prevention appears to be on shakier ground. This is an issue, given the potential for significant side effects from long-term use of statins. An important point was that the level of lipid elevation that warrants primary prevention treatment has been lowered over the years. My own sense is that this has been pushed by Big Pharma in the quest to get everyone in the country on medication, rather than any demonstrated value for patients.

Once again, clinical judgment is key, specifically in the area of proper patient selection. Again, I’ll use myself as an example. I have a family history of early cardiac death on the male side that would choke a horse! Therefore, when I was found to have moderate hyperlipidemia about 25 years ago, along with moderate-to-severe hypertension, I was aggressively treated for both. I have now outlived all of my close male relatives, and with no cardiovascular events. I have no doubt that the use of these medications has been a significant factor in that outcome.

At this point, let me shift gears to the healthcare system in general. Within the past week, I read the following article posted on a Brownstone chat:

The paper describes the expected deleterious impact of the transition from the Flexnerian model of physician training, which is what I received, to what can be described as a diversity, equity, and inclusion (DEI)-based model. It was pointed out that Abraham Flexner, who released his seminal report in 1910, was not a physician. However, he was a hospital administrator, and his father and all of his brothers were physicians, so at the very least, there was a wealth of healthcare experience that could be drawn upon in compiling what became known as the Flexner Report. It was then pointed out that Flexner was adversely influenced by corporate interests, rather than the interest of improved physician training and competence.

Accepting these criticisms as having at least some validity, in order to put all this in proper context, it requires that events must be examined using the proper timeline. While I agree with those who believe that the quality of America’s healthcare system has been declining for at least the past 20 years, it was not because of failures of the Flexnerian model. The Flexnerian model reigned supreme from the 1910s until the early 1990s. During that period, the center of gravity of healthcare advancement worldwide shifted from Europe to the US.

That shift accelerated after WWII when Europe adopted the ‘socialized medicine’ model, and went into warp speed during the period from the late 1970s to the early 1990s. Despite this success, the dismantling of the Flexnerian model began in earnest in the mid-1990s, even though the effort to increase medical school enrollment of women and minorities started in the early 1970s, when I began my medical school education, and had achieved a certain level of success. Apparently, the powers that be were not satisfied with the diversity efforts.

My theory as to why the accelerated advancements from the late 1970s to the early 1990s happened is that when engineering as a career died during the entire decade of the 1970s (yes, that did happen), a large number of pre-engineering students went pre-med. In fact, the largest overall percentage increase in medical school applicants occurred during that decade. As a consequence of having engineering students enter the medical profession in large numbers, there was an explosion of technological and pharmaceutical advances that helped very large segments of the adult population. Examples included the adaptation for medical use or the new development of sonography, CT scans, MRI, angioplasty, flexible endoscopy, laparoscopy, beta-blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), etc., etc., etc.

All of that and more occurred during that brief 15-year period. I had the privilege of training during that period, and being able to bring those advancements to my patients. These advances extended the length and quality of adult patients’ lives in ways that had never been seen before nor, in my opinion, have occurred since.

To be fair, it was not only the intrusion of DEI-like initiatives in the mid-1990s that had negative impacts on the healthcare system. The other development was the transition of physicians from private practice (predominantly in large single-specialty or multi-specialty groups) to employees of large regional healthcare systems, insurance companies, or other mega-sized institutions. Brownstone contributors have documented the hell out of the fact that this transition intensified the damage caused by the Covid response, because physician autonomy was destroyed, computer algorithms, based on what we now know can be dubious databases (garbage in, garbage out) replaced clinical judgment, and cowardice reigned. 

Is it any wonder that we are where we are? I mentioned earlier that life expectancy declined for three years in a row beginning in 2015. The fact is, since 2017, the general trend in life expectancy has continued to trend downward. While lifestyle is certainly an important factor in this decline, we better start looking at whether our healthcare system is adding to this disaster. A major impediment, in my opinion, is that the people best positioned within the healthcare system to make the necessary changes have been rendered impotent. Potentially worse, the new system for training physicians may not provide this critical group with the skill sets needed to understand what has to be done to turn this ship around.