Journal

In this section you will find any interesting information I have come across which I think is timely and at least somewhat urgent to know.

Retirement 4/21/2022

April 21, 2022

I’ve been very busy wrapping things up and getting ready for this weekend’s 3 days of annual meetings of the Homoeopathic Pharmacopoeia Convention of the United States, which publishes the Homoeopathic Pharmacopoeia of the United States, which forms the legal basis for the use of homeopathic medicines in this country.  More about that in a future post.

This post is to urge those of you who want medical records but haven’t yet let us know to act now.  Donna will be here 3 days this coming week but in May she will be here less often.  By the end of May we expect to be finished with dealing with records.

By law, it appears that I could destroy all records still in my possession once 60 days have passed from my retirement, but  of course I will not do that.  I will keep records for at least 7 years after my last interaction with you. But requests that come in near the end of May may not be dealt with in a very timely fashion.

So please, if you want your records, please act soon and leave a message on the office phone (860 9284040) or email Donna at donna@drshevin.com

Referrals — I have two new names:
Ron Whitmont MD, in Rhinebeck NY  http://www.homeopathicmd.com.  I have known Dr. Whitmont for many years.  He is a well trained homeopathic physician who has graciously consented to be  available.  He has a well-established practice and his capacity to absorb a large number of people may be limited.

Irene Catania ND — I just spoke with her a couple of days ago.  She is a naturopathic physician who relocated to Connecticut about 8 months ago.  Her office is currently in Manchester CT.  One of my current patients found her and set up an appointment, and I then had a chance to speak with her.  She seems perceptive and caring, which are qualities that I admire in a practitioner of the healing arts.  She has had a good amount of homoeopathic training, and having relocated to CT recently her practice has room to accommodate people.  Once she learned of my intent to inform you of her availability she offered to give me some text:

My name is Irene Catania. I am a naturopathic physician who has practiced homeopathy for over 25 years. The effectiveness of this gentle, yet powerful system of medicine continues to be one of the most rewarding aspects of my practice. It offers me an opportunity to know the patient beyond their physical symptoms so healing can occur on all levels.
I invite you to a 15 minute complimentary consult: 860-645-1800. You can see my profile on Healthprofs.com

Covid 19:  Just a brief note here.  Optimism stalks the land but the BA2 Omincron variant is now on the increase in the United States.  This is also is true in Connecticut.  It has been suggested that when the case count in a given area (Windham county, for example) per 100,000 is less than 5, it is safe to congregate without masks.  About a week ago the case count was 4.6, if memory serves me well, but that only held for several days.  As of yesterday, the current count is 6.9/100,000.

Prior immunity from natural infection and/or vaccination appears to still be effective against serious illness, hospitalization, and death, but there is still a large reservoir of non-immune people so that we may see, in the coming months, a significant increase in case counts and strain on hospitals.  The current relaxation of recommendations for masking and other public health controls may not hold.  Caution is still indicated.

Retirement Notice 3/5/2022

This will not be the last notice before I retire on March 31, 2022.

Referrals:  I have not been able to find anyone to take over my practice, which is very similar to some of my colleagues around the country.  There are, however, some names that I can give you to pursue your homoeopathic care:

  • Florence McPherson ND, in Milford, CT Phone: 203 685 5795.   Doctor McPherson is well-trained, and I have met her personally.
  • Kathleen Cannon ND in Stonington, CT Phone: 860 772 6039.  Doctor Cannon, whom I have spoken to but have never met has agreed to take on my patients but has also informed me that she is making some changes in her practice and has put new patients on hold until May 2022.
  • Paul Herscu ND and Amy Rothenberg ND in Enfield, CT. phone 860 763 1225. Doctors Herscu and Rothenberg are very experienced practitioners, and I know them personally.
  • Homeopathy Help Now is a free or low-cost telehealth clinic which is staffed by current advanced students in the training program at the Academy of Homeopathy Education. I know the principals and some of the supervisors of the students and feel very good about giving you this resource.
  • Mark Brody MD in Providence RI, phone 401 861 4643. Brody, who I also know personally, is a well-trained and experienced practitioner but at present is practicing under the Rhode Island Medical Freedom Act as he objects to the Rhode Island mandate regarding COVID-19 vaccination.

In any case, please be assured that I will forward relevant records upon your request to any practitioner that you designate and am willing to speak with them regarding your case.

Medical Records:  Donna has been busy, but for those of you who have not requested records yet, I hope that you will get your requests to Donna before the end of this month.  After my retirement date, managing records transfers will gradually become increasingly slow.  Please contact Donna at the office for details.

Supplements:  The sources for the following supplements and some alternative sources are:

  • Vitamin D3 1000
    • OvitaminPro.com or,
    • Klaire Labs: 1-888-488-2488 and press “O” for more options.  To purchase directly from them you can purchase as a “guest” (your information will not be saved) or set up and account from which you can more easily order, set up recurrent shipments, etc.  In this case your information will be saved (credit cards, etc.)
  • Vitamin D3 5000
    • Metagenics: As of April 1st, 2022, their system will maintain your existing accounts in a “Friends and Family” option.  That will maintain at least some of the discount that I have been providing you with.  This arrangement will be the same with all other products besides Vitamin D.
      For those of you who have had Donna place your orders, you will need to create an eCommerce account with Metagenics.  We will be sending you instructions on how to do that.
  • Vitamin K2
  • Strontium
  • Vitamin B-12 (methylcobalamin 1 mg/dropperful) 4 oz. bottles
    • OvitaminPro.com – The Klaire Labs 1 mg per serving, 4 oz bottle can be found by searching on “methylcobalamin” and scrolling down the page. They also sell a 5 mg per serving but I do not recommend this.  Or,
    • Klaire Labs (see above)
  • Inositol Powder: The dose for those of you taking this has usually been 12 grams daily.  If you wish to purchase directly through Standard Process you will need to contact them to find a local practitioner as they do not sell directly to the public.  Inositol is available on many other online sites, and Now Foods, a widely distributed retail brand has a product, but for other than the Standard Process brand you may need to revise the number of teaspoons to maintain the dose I’d recommended.
  • Iodoral:   iherb.com
  • Phytogen OvitaminPro.com

Primary Care Status:  As is proper, I now receive copies of lab tests and X-rays from various hospitals that perform studies on my patients, even those ordered by other doctors, because the hospital or lab lists me as your “primary care provider” (PCP) in their medical records.  Once I am retired, however, I should not be receiving medical records.  I will try to inform the sources of these documents of my retiremen in advance, but I may not think of all of them, and I can’t guarantee that the medical records departments will handle this efficiently.  This is also an issue for refills of medicines that I have prescribed for you.

You can help this process along by informing the laboratories, emergency rooms, urgent care-clinics, pharmacies, etc., that I am no longer your PCP and let them know who has assumed this position on your behalf.

 

 

 

 

 

Omicron:  The pandemic lurches on.  Just when we thought that we were coming out of the woods, we are now in a 4th wave.  Case counts were dropping nationally but started to rise at the end of October, presumably as a result of the Delta variant.  Connecticut followed this trend starting in mid-November.  Here in Windham county (with the highest counts in the state) daily case counts were into the mid-20’s per 100,000 people about 5 weeks ago and are now close to 100.  As of a few days ago, Rhode Island was the national leader in case counts per 100,000.

The Omicron variant, with its unusually high number of mutations, is even more easily transmitted than the Delta variant, resulting in a doubling of cases every 2-3 days in the countries where it is better established and better studied.  The current vaccines are less effective against it, although protection against serious illness, hospitalization and death appears to still be good.  There do appear to be more symptomatic breakthrough cases, however.

Early assessments of Omicron-caused disease severity tend to suggest milder disease, but this assessment is far from certain and cannot yet be relied upon.  Given the currently over-stressed state of hospitals in areas with high case counts from the Delta variant, even a modest increase in hospitalizations due to the Omicron variant could have drastic consequences.

There is already a move to close entertainment events, limit restaurant and bar hours and it seems likely that further restrictions are coming.

If Omicron proves to cause mostly mild disease, and if it spreads widely as expected, then “herd immunity” is more likely to be achieved.  This will move us closer to an equilibrium point where, like influenza, the illness is common and usually mild and with relatively few people with long-lasting effects, hospitalizations, or death’s related to the disease.

Boosters:  As noted above, Omicron has confused the picture.  Studies conducted in the United States regarding vaccination showed significant loss of circulating antibody levels from (“humoral immunity”) at around 5-6 months (pre-Omicron) to about 55%, but with wide variations between individuals.  This was not true in studies done in the United Kingdom or in Canada, where 90% effectiveness was maintained.  The other path of immunity is “cellular immunity” mostly relating to T-cells, a type of lymphocyte which form in reaction to the vaccine (as well as in actual disease) and which are also important in the immune response.  Boosters definitely raise the levels of circulating antibodies and should therefore promote better protection.    In the end, a decision to take a booster shot follows the same logic as for the first dose.  Prior bad reactions to the vaccine would of course have to be considered.

It must be noted that for the Delta variant, and probably also for the presumably very soon-to-be dominant Omicron variant, vaccination does not prevent the transmission of the virus within a household.  In that instance, as contact is more between family members is closer and more prolonged , and with higher viral loads found in the Omicron variant, the likelihood of viral transmission is significantly increased.  If a family member is vaccinated, but brings the virus into the house, they will still initially transmit a lot of virus, but the viral load falls off more rapidly as compared to an unvaccinated person, therefore shortening the period of contagiousness.

Home Testing:  At least up until now, testing for Sars CoV-2 did not change when variants emerged, and that will probably not change with the emergence of the Omicron variant.  Home testing has the possibility of being very helpful for those of us who wish to avoid infections or at least to limit their spread.  Availability of tests seems to have improved, but demand is very high, and likely to get a lot higher.  It is possible that supplies will be diverted to hospitals, medical clinics, and large employers in order to maximize the impact of testing in the face of inadequate supply.

The “gold standard” for testing for the presence of the virus is finding viral DNA (so-called PCR testing).  That type of test requires a laboratory tes, is expensive, and the results may come after delays that make them less useful for planning family events.

Home tests detect viral proteins (“antigens”) other than DNA, and give results much more quickly and much less expensively.

The following information, (gleaned largely from an article in the October  12, 2021 issue of the Journal of the American Medical Association) should also hold true for the Omicron variant.  The information is the most specific for the Abbot BinaxNow test, but should be similar for other antigen tests now on the market.

Beside availability and cost, the two most important aspects of home testing and the accuracy of the results are:

  • Sensitivity: If I have the disease, how likely is it that the test will give me a positive result.  A test with high sensitivity correctly identifies “true positives” and minimizes “false negatives”.
  • Specificity: If the result is negative, how likely is it that I don’t have the disease?  A test with high specificity minimizes the rate of “false negatives, or people who have the disease but test negative.

Ideally, we want a test which has both high sensitivity and high specificity.  But this is somewhat unusual in the general universe of tests.

The most accurate results from testing for COVID-19 with the current tests are obtained firstly when the specimen is collected properly, and secondly that the test is done at the appropriate time (not too soon, and not too late).  It is important to distinguish between testing people who have symptoms, as opposed to those who do not (“asymptomatic”).

  • The specimen must be collected properly, which will often involve some discomfort. Detailed instructions are included in the test kit packaging, and there should be a web address given for a video which demonstrates the technique.  This is a critical step.
  • The Delta variant produced fever, flu-like symptoms, cough, headache and significant loss of smell and taste. So far, Omicron disease is not nearly as likely to produce loss of smell and taste, and fever is not as prominent.  In Omicron, runny or stuffy nose, dry cough, sore throat and fatigue are common.  If you are symptomatic   transmission has already begun, about 2 days before the onset of symptoms, and continues for about 5 days.   In other words, if you are symptomatic, you can test immediately.  The tests are highly sensitive for symptomatic persons, especially if the viral load is high.  False negatives are still possible.
  • However, even if you are infected, the viral load decreases fairly quickly, and testing after 5 days of symptoms is unreliable. A negative test at that point may then be a “false negative.”
  • If you are symptomatic, and receive a negative test, especially late in the 5 day window, or shortly afterwards, the result should either be confirmed with a PCR test if possible, especially if you know that you have been exposed. A less precise but still useful alternative is to have a 2nd rapid antigen test (which logically should be done soon after the first negative test, again being sure to collect a good sample.
  • If you are asymptomatic the earliest useful date for testing is the second or more likely the third day after exposure, but if you are destined to remain asymptomatic the viral load will decrease more quickly and a second test should also be done fairly quickly, probably a day later.
  • It is thought that asymptomatic persons tend to wait longer to be tested, and so it is possible that the window of opportunity may pass quickly. If they were infected however, the viral load would also be low and they would have been less likely to transmit the virus to others.  But there will be uncertainty remaining in this instance.

Rapid tests can be useful, but as you can see do not always give reliable information.  They are clearly better than no testing.

In conclusion, the next few weeks should see a clarification of the presentation and severity of the Omicron variant.  I will keep posting as circumstances warrant.  Please don’t give in to despair and throw caution to the winds as some have done.

 

It is now roughly 6 months since the start of mass vaccination in the United States .  I think that we can definitively say that the vaccination campaign saved the national economy and society as a whole.  Thinking back to the first wave of COVID-19 in March and April 2020, the second wave in June-August 2020, and the 3rd in November 2020 through February 2021 one has to recognize how certain weaknesses and inequities in our society were so starkly revealed.  Israel and the United Kingdom were the first countries to roll out a significantly large vaccination campaign, and they were successful in reducing case counts, serious disease, hospitalization and deaths.  The same was true in the United States despite that even now only slightly more than 50% of eligible persons have been fully vaccinated.

These successes, however, were short lived as we are now in a 4th wave, which so far is much less significant (in numbers) than the prior waves, except in those areas of the country which have low vaccination rates.

The Delta variant is the current dominant strain.  It is more contagious than the original strain, and the vaccines are somewhat less effective against becoming infected, although they are still very good against severe infection, hospitalization, and death.

The term “vaccine” has traditionally meant that infection is prevented (“immunity”), but  the current  “vaccines” were not designed for that, and since we aren’t aggressively testing the population for asymptomatic cases, we don’t really know the true incidence of Delta infections in the vaccinated population.   The CDC has stopped using the word “immunity” in favor of the term “protection”.

But it is clear that “breakthrough cases” (infections in vaccinated people) are not rare.  In terms of the numbers of people hospitalized and dying with COVID, such breakthrough cases are a small minority.

“Booster” shots may provide additional protection (Yalemedicine.org on September 24th).  The word “may” means that we don’t really know yet to the usually accepted degree dictated by science.   The booster has been approved for those over 65 years of age, and for those younger persons who are  severely immunocompromised  (solid organ transplant patients taking immunosuppressive drugs, people under treatment for solid tumor and blood malignancies, advanced or untreated HIV infections,  active treatment with high dose steroids and other strongly immunosuppressive medications, as well as a few other rare immunodeficiency syndromes).  Booster shots are now recommended for those eligible persons who have received the Pfizer “vaccine” but not yet for the Moderna or Johnson and Johnson products.

On another side of the debate about the response to the pandemic, there are prominent scientists, including a Nobel Prize winner (Luc Montaigner) and others, some of whom were instrumental in the development of mRNA vaccines, who since the beginning of the pandemic have raised concerns about the current strategy.  Among the issues that are raised is that using a “vaccine” that does not prevent infection but does promote an immune response (which we know now works very well to prevent severe infection, hospitalization, and death, even in the case of the Delta variant) will increase the “evolutionary pressure” on the virus to mutate (which happens normally in any case).    With regard to this point, the Delta variant mutation is thought to have originated in India, which at that time had an extremely low vaccination rate.  But the example of India does not invalidate the concern.

Another question has been raised about the mRNA vaccinations creating what is known as “antibody dependent enhancement”.  This has been demonstrated in other Coronavirus diseases.   In brief, the “vaccines” place a short piece of genetic code into your body which instructs your cells to create a part of the viral “spike protein”.  That spike protein subunit (S1) has the job of attaching itself to the cells.  These proteins are recognized as foreign and provoke the immune system to create an antibody to them.  The antibody combines with the spike protein subunit, changing its shape so that it is much less likely to do its job of attaching to the host’s cells.  But it is possible for the differently shaped molecule to bind to other receptors on the cell surface, and “attachment” is then accomplished anyway.  The spike protein of the coronavirus has a 2nd subunit (S2) which has the job of then fusing the outer membrane of the virus with the outer membrane of your cell, at which point the entire genetic code of the virus enters your cells and then your cells start to make more complete virus particles.  At that point, you may or may not be sick, but you can transmit the virus to others.

I lack the expertise to definitively evaluate these claims.  There are other concerns that have been raised.  But what is most disturbing is that when these dissenting voices are raised, they are either ignored or are silenced (even censored), or labeled as “anti-vaxxers”, even though some of them have worked in the field of vaccine development for decades.  The rapidity and virulence of their silencing and marginalization is not in the tradition of true science.   The silencing of debate also creates suspicion.

So what are we to do?  Ironically, I wind up in the same place as when I first started posting about the vaccines.  In the short run they are relatively safe and reduce the likelihood of severe disease, hospitalization and death.  By so doing they relieve the intolerable strain upon the health care system, and serve to protect the many among us who provide needed services to infected people (health care workers, first responders, and the many other “essential workers.”)  Social isolation and its attendant risks (domestic abuse, opioid dependence and overdoses, the lost opportunities for learning for many millions of children, etc.) are reduced.  Society almost “opened up” in the late spring but the Delta variant arose to blunt the then prevailing optimism.

As a society, we could aim for a “zero tolerance” policy which necessitates mass vaccination, severe and protracted lockdowns, strict masking and distancing, long-distance learning and working.  Or we could aim to tolerate the disease, practice masking and social distancing, targeted lockdowns, vaccinate those at the highest risk (although we can’t identify all of those individuals at this time) and eventually natural immunity would develop in sufficiently large numbers of the population that the disease would become much milder and would be considered to be “endemic” (present in the population but not out of control, and usually much milder).  Natural immunity is superior to vaccine-induced immunity.

Countries that took the zero-tolerance option (China and New Zealand, for example) were initially very successful but were still eventually vulnerable to the Delta variant.  The response in China depended on an authoritarian top-down control structure that is antithetical to democracy.  I imagine that New Zealand was able to do zero-tolerance owing to clear messaging from politicians and scientists and a more internally cohesive society that accepted the policy.

In the reality that faced us at the beginning of 2020, with the severity of the rapidly growing epidemic in Wuhan, China, the United States was not prepared.   In the last few years of the Obama administration with congressionally mandated budget cuts, and continuing straight through the Trump years our “pandemic preparedness” was not properly maintained.  Stockpiles of personal protective gear, including masks became depleted owing to expiration dates and lack of maintenance for other equipment, including ventilators.  Income inequality has been increasing for the past 40 years and has reached levels last seen before the economic collapse of 1929-30.  There is a widespread lack of trust in our institutions and rather severe polarizations in our society along class, racial, and political lines.

Another aspect of “booster shots” is the fact that while the rich, developed countries of the world are able to provide “vaccine” protection to their populations, a very large percentage of the world’s population cannot afford to do so.  Although the developed world has promised to donate vaccine to the poorer countries, the effort is so far inadequate.  In the meantime, more people can get sick and potentially recreate the chaos that other parts of the world have already experienced, as well as providing the virus with more opportunities to mutate, as has already happened with the delta variant.  The morality of booster shots in the developed world while the rest of the world does not have access to any protection has emerged as a major issue.

At least we can presently say that most of these issues are now being discussed.  Whether there is sufficient political will to address them is uncertain at this moment.  Perhaps we will be better prepared in the future.

COVID-19 7/26/2021

July 29, 2021

As I’m sure everyone knows, We are in the early stages of an uptick in cases, hospitalizations, etc.   Mask mandates are being reinstituted in many “hot spots” and continue to be resisted.

The “Delta variant” has displaced earlier variants, and appears to be more contagious, owing to it replicating at a much more vigorous rate (1000 fold!) and therefore spreading much more virus.  It is not clear at this time that the Delta variant causes more severe illness.

It was always clear that the currently available vaccines would not prevent infection (and therefore would not prevent replication and spread of the virus).  Serious disease and death declined drastically in countries where immunization was widespread (particularly in Israel and the United States).  This was predicted by the initial studies of the vaccine which gained them Emergency Use Authorization by the FDA.

But with the emergence of the Delta virus and its spread internationally, disease levels have increased.  At this time, according to the most recent figures that have been reported, 97% of patients hospitalized with COVID-19 are carrying the Delta variant, and very few of those patients were previously immunized.

While the Pfizer, Moderna, and Johnson  & Johnson vaccines are still effective against severe illness from the Delta variant (more so the Pfizer and Moderna products) there are “breakthrough” infections in the vaccinated population.  Please see https://www.npr.org/sections/health-shots/2021/07/28/1021888033/breakthrough-infections-may-cause-long-covid-symptoms-small-study-suggests  for a discussion.

From a practical point of view we don’t need to go into lockdown but please maintain caution.  Wear masks when out in public.  It is too early to go into crowds, even masked, especially if there are large numbers of unmasked individuals.

 

It is with mixed-feelings that I am announcing my intention to retire at the end of March 2022.  While it continues to be an honor to work with you towards the goal of achieving a better state of health, this is my 48th year of medical practice and the time for retirement has come.

I am sending this letter out 9 months in advance to give everyone that I’ve seen in the last 3 years enough time to make other arrangements for ongoing care. This is especially true for those of you for whom I am prescribing any kind of prescription drug on a chronic basis.   I will not be ordering refills that would extend past my retirement date.

I am making efforts to find someone that can continue your homœopathic care, should you so choose, but it does not appear likely that I will be successful.   There are vanishingly few MDs or DOs entering homœopathic practice.  The rate of new entries from the Naturopathic profession (ND) is only slightly better.  As time goes by I will inform you on my website of homœopathic practitioners in southern New England that might be open to taking on new patients.

Regarding your medical records, a very complex issue:

  • I will retain them for 7 years after your last visit, as required by law.
  • My electronic medical record (EMR) can print out a Continuity of Care Document (CCD) which summarizes your care since 2010, when I first began using the EMR. This includes demographic data, allergies, medications (past and present), dates of treatment, vital signs and some, but not all, lab reports, diagnoses, and assessments and plans.
    While the CCD does not include my detailed notes on your homœopathic case, it contains the essential data that another physician might need in order to continue your care.
    The fee for printing the CCD will be $ 0.30/page.  This report is likely to be 8-10 pages at a minimum but could go much higher if I have been seeing you for a long time.
    There may be certain consultation notes or imaging studies that also should be included, but this will need to assessed on a case-by-case basis and done manually ($0.65/page).
    The CCD (and indeed your entire EMR) can be transferred electronically, if your new physician uses the same EMR as I (PracticeFusion). Arrangements can be made to do so at no or minimal cost to you.  Physicians using other systems might be able to do so but the process is likely to be cumbersome.  Other forms of electronic transfer may be possible but might violate HIPAA regulations.  More information on this will be made available on my website should it turn out to be feasible.
  • My EMR can also print out a complete record of all visits since August of 2010 (when I first started using the system). The fee for this will be $0.30/page).  Any other information from your paper chart (pre-August 2010) will need manual selection and photocopying which will be charged at $0.65 per page plus postage costs, to be paid when you pick them up or before we mail them to you.
    In the case of a new homeopathic practitioner, they will usually want to take your case “fresh” and would likely to be overwhelmed by the amount of data in my notes. If you will not be transferring care to a physician who understands homeopathy, the vast bulk of your record will not be meaningful to them.
  • As you know from talking with me while I’m transcribing almost everything you say, my notes are long, and the page count can be high. The longer and more often that I have seen you, the more this will add up.
    My office notes also may contain information which is highly personal.  When I photocopy records for insurance companies I redact information which I consider to be too sensitive, using a thick black magic marker.  This is not going to be possible now as I am looking at transferring records for several hundred people.

As you can see, transferring and copying records will be a big job that will take a lot of time and effort for both Donna and me.  If you will not be seeing me between now and my retirement and you wish to have your records transferred in some form, I would greatly appreciate knowing that as soon as possible so that I can plan accordingly.

After this letter, all further notices and details regarding my retirement will only be available on my website (www.drshevin.com/journal).  For those few of you who are not able to utilize the internet, please let Donna know so that we can make other arrangements for you to continue to be informed.

Samuel Hahnemann MD, who systematized homoeopathic medicine in the early 19th century, wrote:

“The physician’s highest and only calling is to make the sick healthy, to cure,  as it is called.”

Thank you for giving the opportunity to work with you towards realizing that ideal.

Just a short post tonight:  Although cases nationwide are declining, COVID-19 is very much with us in the Northeast. We have been on somewhat of a plateau which may just be starting to break up, and lockdown restrictions are being lifted.  I hope that “returning towards normal” doesn’t generate another wave.

Vaccination rates are increasing, but it is likely that a substantial number of people will not be vaccinated.  That will reduce the likelihood of achieving “herd immunity.”

There are other places in the United States which are experiencing increases.  Michigan was a prominent example although it appears that things are starting to improve.

Internationally, we know that there is a very bad 3rd wave happening in India right now.  Many places in South America are also in desperate straits.

Aside from the many tragedies occurring in those places, we have to be concerned about the the development of mutated strains of Sars CoV-2 which could evade natural immunity (for those who have already had COVID-19 or evade vaccine-induced immunity.  Those strains can spread across the globe,

My basic message is that we cannot think that we are in the last stages of the pandemic.  Rather, we have to continue to be vigilant and maintain our innate immunity, whether vaccinated or not vaccinated.  We also have to use common sense. Please be careful.  If you consider eating inside a restaurant, make sure that social distancing rules are maintained, that ventilation is good, or even better eat outside wherever possible.  I would advise continuing to avoid large gatherings which include people that you don’t know.

Don’t throw away your masks.  Do use them when it is appropriate.  If you wonder if you should use one, use it.

There continues to be opinion contrary to the “conventional wisdom” out there.  Some of it is generated from the work of prominent scientists and cannot be quickly dismissed.  But when those opinions seem to deny what we see in the world, you have to question it.  Some people claim that the whole pandemic is a hoax.  But such claims are impossible to reconcile with what we have seen, now in India and South America, and recently in the United States.

We are all tired (“COVID fatigue”) but this is not the time to completely relax.

Retirement Planning

February 23, 2021

Next year will be my 48th year in clinical practice, and my 40th year of using homœopathy as my main therapeutic tool   While I have not yet set a definite date, I plan to retire in that year, most likely in the spring.  I will make every effort to finalize the date at least 90 days in advance.

I will be saying more about this in future posts and mailings. I’m beginning the process of informing you quite early as I don’t have anyone to take over the practice, and we don’t have a surplus of physicians in Eastern Connecticut.

Those of you who are on conventional medications prescribed by me will especially need to make arrangements with another physician because I will not be able to schedule refills dated for after I retire.

In April 2020 I assumed the Presidency of the Homœopathic Pharmacopoeia Convention of the United States.  I have been on the Board of Directors of that organization for about 30 years.  These are very challenging times for homœopathy in many parts of the world, and the United States is no exception.  I am already spending a good amount of time on various projects connected to this work, and expect that to continue for several years.

I have stopped taking new patients so that I can focus on those of you that I have been seeing over the years.

The issue of transfer and copying of medical records is complex and I will send information on that at a later date.

The office will continue to be open for appointments on Tuesdays from 10 am to 5 pm, and Wednesdays from 9 am to 5 pm.

Nationally, cases and deaths continue to rise, though at a lower rate than 2 weeks ago.  Connecticut ranks as the 17th state from the top of the list of cases per 100,000 persons.  In comparison, Rhode Island is at the 4th place, New York in the 9th place, and Massachusetts  is in 10th place.

In Connecticut , Windham and New London counties top that list, at 95 and 93 cases per 100,000 persons, while the other counties are in the 50’s to the 70’s.

Now that vaccination has been introduced world-wide we are starting to see more data on adverse events.   But before addressing what has recently come out in scientific and news reports, I would like to set the stage:

  • The first dictum for an individual physician is “Primum non nocere”, a Latin phrase which means “first do no harm.” An individual physician deals with individual patients, one at a time.  In the sphere of public health, however, medical science deals with populations as a whole.  Large populations can of course be divided into smaller units such children, young adults, middle-aged, the elderly, those with or without various chronic diseases like diabetes, heart disease, autoimmune disease, allergies, etc.  But still those subunits are composed of people who may differ in many other categories of health, to say nothing of their race, their stress levels, their socioeconomic status, their histories as groups, etc.  These differences, in various combinations and permutations may become significant when individuals have to make choices and seek guidance from their doctors.  When the science is not adequately settled, the situation becomes much more complicated.
  • In the present situation, the question of vaccination is clouded by all of the above factors. Those who deny the existence of the pandemic have no basis in fact for that view.  As I have previously discussed, pandemics are part of human history, and will continue to occur.  COVID-19 is the 3rd major epidemic from the family of Coronaviruses.  The first was SARS (Severe Acute Respiratory Syndrome) which began in 2003.  The second was MERS (Middle East Respiratory Syndrome)in 2012.  Those two were lethal enough that their spread was easily contained, since people got sick and died quickly.  COVID-19 is much less lethal and much more easily transmitted and as a result has spread globally.
  • I have previously noted the failures of many governments to limit the spread of the virus. I have also noted that even in countries which did well (China belatedly but then efficiently), South Korea, and New Zealand most notably, 2nd waves are occurring at higher levels than the first wave.

So here we are a few weeks after the introduction of the mRNA vaccines from Pfizer and Moderna.  Allergic reactions can be severe, although rarely, and can result in death, even more rarely.  A Florida physician in good health developed a fatal autoimmune blood disorder on day 3 after the vaccination and died.

In Norway, the government has revised its guidance to physicians who treat the elderly based on a number of deaths soon after vaccination in already frail persons aged 85 and older.  Assuming that vaccination and those deaths are related, this is obviously a “harm”.  But these people would presumably have died of COVID-19 had they been both unprotected and exposed.  How can an individual physician distinguish which of the many very elderly and frail people in nursing homes (high-risk environments) might not be able to tolerate the vaccine?  That this intolerance would exist was never in doubt, and such deaths were “expected.”

In Israel, as reported in the Jerusalem Post 13 cases of Bell’s palsy occurred after vaccination.  Most people recover completely from an acute Bell’s palsy (one-sided facial paralysis), while a few will be left with some residual paralysis.  Assuming firstly that the reported cases of paralysis are firmly linked to the vaccine, would the outcome for those particular patients have been worse if they were both unprotected and exposed?

In the development of previous coronavirus vaccines (SARS and MERS)  enhanced immune system reactivity to other infections, such as influenza, was found.  This includes enhanced reactions (stronger symptoms that might otherwise have occurred) to other coronaviruses, some of which have long been known to “cause” some common colds.  I put quotes around the word “cause” because illness is often as much or more about susceptibility to a noxious stimulus (bacteria or virus, toxins, etc.) than to the presence of that noxious stimulus.  Of course, when a virus is introduced to a population that has had no previous exposure to it, as is currently the case with COVID-19, the results can be severe, as evidence by the reaction of Native Americans to exposure to smallpox and measles when the Americas were colonized by Europeans.

The last item of news for this post is the introduction of a newer vaccine (Novavax) which is now in production.  While this is also a “spike protein” vaccine, it is formulated in an entirely different way from the Pfizer and Moderna vaccines.  The “spike protein” which is used by COVID-19 to attach to human cells (establishing the infection) is composed of 2 “subunits” named S1 and S2.  While the Pfizer and Moderna vaccines are aimed at S2, the Novavax product is aimed at S1.  Since S1 is the subunit that the spike protein uses to attach to the cells, the Novavax product may actually reduce the risk of infection, as noted in the early investigations of the vaccine conducted in monkeys.  S2 has to do with the virus’s entry into the cell after attachment so that it can multiply inside the cell.  We do not yet know if the Pfizer or Moderna vaccines actually reduce the likelihood of infection or spread.  The effectiveness of those vaccines appears to be that people don’t get sick, with an impressive protection rate of 95%.  But we know already that asymptomatic people spread the disease.  This is why recipients of those vaccines are still going to have to wear masks and practice social distancing.  Whether they will choose to do so is unknown.  Please note:  one can be infected but not sick (asymptomatic), and spread the virus to others.

While I am neither an immunologist nor a virologist, if the Novavax vaccine proves to be effective and safe, it might be a better choice than the currently available vaccines.  But the Phase III trial has just begun and early results will not be available until March 31st 2021, and the trial will not be concluded until December 30th 2022.  We also do not presently  know if the vaccine will pass scrutiny and be authorized for Emergency Use Authorization.  The Phase III trials for the Pfizer and Moderna vaccines have both reported their preliminary results and have gained Emergency Use Authorization from the FDA,  but the final reports will also not be issued until the end of 2022.  That means that these trials are still in process.

There are also many other vaccines in development.   It is more traditional for vaccines to not be licensed until Phase III trials are complete and have undergone scientific and regulatory review.   As a society however, we find ourselves in a crisis situation, which might have been avoided had world reacted more quickly or had been better prepared when this all started in the fall of 2019.

Getting back to “first do no harm”, my duty is to inform my patients to the best of my ability.   Even though we don’t yet have all the information that would make for a fully-informed choice, when vaccines are available, choice is unavoidable.  The choices:  vaccinate now; wait for more data or other vaccines; or never vaccinate. All choices contain potential risks and benefits.    We should all understand that those risks and benefits pertain both to ourselves and to our family members, to our friends and people that we come in contact with, and to society as a whole.   To not vaccinate ourselves eliminates possible risks from the vaccines (which so far have for the most part been “tolerable” from a public health standpoint) but also exposes us to infection and sickness from the virus.  This then creates the possibility of spreading the virus to other people who may then suffer a disease which can be asymptomatic (but spreadable), or result in a mild illness, or a more serious one that can later lead to significant disability or even to death.

In America, individual rights are strongly emphasized.  The pandemic has exposed us to the consequences of not sufficiently taking the collective interest into account.

Finally, as of the week ending on January 9th, the CDC reports continuing “unusually low” levels of flu activity.