The Media Is Finally Beginning to Come Clean about COVID-19

When I first learned of the Midwestern Doctor who authors The Forgotten Side of Medicine Substack, I was drawn to their deep understanding both of medical history and medical propaganda. Soon after we connected, I requested a discussion of the recent plea for COVID-19 amnesty, a request that has evolved into a series.
 As the establishment finds itself in an ever more difficult position of defending the grotesque narrative it forced upon us over the last few years, a series of attempts to appease the public and return to business as usual have been published. When these attempts are viewed collectively and in relation to the events occurring at the time, they provide invaluable lessons for each of us.
 In school we are taught that we study history so we can avoid repeating it. I in turn would argue that a future of repeating tragedies is never set in stone because there will always be courageous individuals (like those discussed in this article) who at great risk to themselves are willing to challenge the narrative. However, for the narrative to actually shift, in addition to these brave individuals speaking out, the public must collectively become aware of the historical context behind the current dysfunctional narrative.
 This article does an phenomenal job of breaking down much of what actually went wrong in the first year of COVID-19 (which set the stage for the vaccines being pushed on the public) and what those issues mean for our society which has now been left struggling to pick up the pieces from this debacle. I consider it an honor to host this article for my subscribers.

Lastly, I will note that I have recently become a big fan of Idiocracy , and it is quite depressing how close it comes to accurately portraying the almost surreal federal response to COVID-19.

 In many ways, the modern era  is a product of Sigmund Freud’s nephew, Edward Bernays , who decided to make a name for himself by using the developing science of psychology not for psychotherapy but rather for controlling the behavior of the public. Bernays’ message resonated with the ruling elite of the era, who, like Bernays, believed that the masses were inherently irrational and needed to be guided to “civil” behavior which could maintain what the elites judged to be the progress of society.

 Many debated  the wisdom of this approach (activists of the time opposed it), and arguments on the topic frequently touched upon the increasing technological complexity of society. Advocates of a propagandist based government asserted that society’s complexity had reached the point that the masses lacked the capacity to make informed decisions about the appropriate course of society, while those opposed to the propagandist model argued that the educational system needed to be reformed such that it empowered the public to address the complexities of the modern age.
 The propagandist side  eventually won , largely due to the recognition that the mass propagandizing of society was necessary to win the world wars. However, in recent times,  the utility of propaganda has changed , primarily due to the internet breaking the monopoly on propaganda previously held by the legacy media. Propaganda campaigns often cost millions to develop and disseminate throughout the society, yet many people, like myself, can now, at no cost, create counter-narratives in our free time that often suffice to upend these propaganda campaigns.
 Whenever I observe a propaganda campaign in action, I frequently wonder how far away from reality its message can go before it falls apart. In some cases, like Nazi Germany,  the collective hypnosis that bewitched the country  was so powerful that nothing could break that spell—it took a world war to end it. Within the United States, as the decades have gone by, I’ve observed an increasingly sophisticated propaganda apparatus  come into place  and reciprocally, a stronger and stronger anti-propaganda citizens’ movement to oppose it.
 In general, I’ve found the propagandist side tends to succeed, but once the lies reach a certain point of discordance with reality, they are no longer able to “win,” and a significant portion of the population begins to reject the existing narrative. Over the last 8 years, I’ve noticed a very distinctive shift with all of this, as the propaganda system which could ensnare the public has weakened, due to the machine making increasingly audacious lies as well as the internet being implemented to oppose the lies.
 This trend is best shown by a few recent political events, such as Trump’s presidency, the COVID-19 lockdowns, and the COVID-19 vaccine mandates. In all of these, the propaganda infrastructure failed to persuade the majority of the public to adopt the official narrative and instead, its over-the-top attempts to do so significantly increased the public’s distrust in the official narratives put forward by “authorities.”
 Although I am continually awed by what mass propaganda can get the public to believe. I believe  mandating  the COVID-19 vaccines was something so egregious that no amount of propaganda could overcome the widespread distrust it would create. I believe this because:

1. Many were forced to choose between prolonged economic hardship or submitting to a vaccination they did not want; being dominated in this manner is something people rarely forget.

2.  Many  either directly suffered a significant adverse effect from vaccination or saw it happen to someone they knew (I believe this now applies to over half of the USA’s adult population). Since many of those events  were sudden deaths , the link to vaccination is both unambiguous and difficult to forget.

3. The  ever-shifting promises  from our healthcare authorities about the vaccines have over and over again been proven to be lies. Because of the two previous points, the public remembers exactly what was said and no amount of propaganda can rewrite the history of what happened.
 All of this has led to the situation where we are continually watching the narrative implode in real time, as those in charge realize what they had previously hoped for is untenable (e.g., the public compliantly vaccinating every 4 months indefinitely). Instead, major concessions will need to be made to regain the public’s trust and something (e.g., long COVID or climate change) will need to be offered up as an explanation for the epidemic of sudden deaths and permanent disability we are now facing.

 Note: Ed Dowd, whom I consider to be a reliable source, has stated  he has been told  what was described in the previous paragraph by contacts within the Biden administration.
 The Forgotten Side of Medicine Here I do my best to expose both the light and dark within medicine that has remained hidden. My hope is that knowledge can improve your health and the health of those around us.
 By A Midwestern Doctor

 Pleas for Amnesty
 One interesting snapshot of the collapsing narrative is provided by a series of articles written by mainstream publications.

The first,  published in The Atlantic on 3/22/21  acknowledged that so-called “experts” had made some minor mistakes but simultaneously had the audacity to state that we nonetheless must trust them rather than our own instincts:

 Note: Many people I know who have been severely injured by a pharmaceutical have told me that they did not want to take it (or continue taking it), and that their biggest regret was ignoring their intuition, which told them to avoid it, because of the pressure that the authority figure (e.g., the prescribing doctor) imposed upon them to take the pharmaceutical.

 The Atlantic essentially argued that we depend on experts for the world to go round, and that the tasks delegated to them are complex enough that we can’t always expect them to perform perfectly:
 The rest of us, however, can do better. We are capable of being serious adults who understand, if we choose to try, and accept that in every crisis, risks and imperfect solutions exist, while still maintaining our faith in expertise and its achievements.
 I get a little shaky thinking about being alone on a boat hundreds of miles from land, just as I do about getting a shot in my arm to protect me from something no one knew existed a year ago. But I know that dedicated and decent people created such miracles. They have done their part, and I will do mine.
 Given the fact that we now know the experts (e.g., Anthony Fauci) deliberately lied throughout the pandemic, and provided extremely harmful advice (while deliberately suppressing helpful advice), I am not the most inclined to believe these arguments. Fortunately, this attempt by The Atlantic never caught on, and I only learned about it long after it had been published.
 The next attempt  on 10/30/22  built upon the  3/22/21 article’ s message and instead of commanding us to continue trusting experts, simply made a plea for amnesty so that we could all move on and forget what happened.

 This plea (which I discussed  here ) was justified by the argument that the complexity of handling COVID-19 and the uncertainty of available information at the time made it impossible to make the correct decisions for handling the pandemic. I did not believe this held water because:

•The available information showed that what the experts were doing was wrong; the experts  just deliberately suppressed it  to protect their narrative.

•Uncertain information does not justify poor decision making—every leader throughout history has had to navigate uncertainty and has been judged by their success or failure in handling the situation with which they were presented.
 One of the key challenges for those who advanced the narrative is how to reconcile how they got things so wrong (as their tribe typically prides itself on being the “smart” ones). This is why excuses that absolve them from responsibility for their severe errors of judgment, such as “ we had no way of knowing ” are so well received in this tribe. Similarly, to them, the only conceivable reason why those with differing beliefs could have actually been correct was, to quote Oster:
 In the face of so much uncertainty, getting something right had a hefty element of luck . And, similarly, getting something wrong wasn’t a moral failing.
 Note: When Scott Adams on  1/21/23  admitted his errors in supporting the COVID narrative, he, like Oster, also argued that those who got things right by opposing it succeeded purely due to their luck in picking the correct side. I mention this because throughout my life I have observed that unsuccessful people tend to blame their mistakes on bad “luck,” while successful people are dramatically more honest with themselves when they make mistakes.
 Unlike the first plea, Oster’s plea attracted significantly more attention due to widespread outrage triggered by her disingenuous and condescending attitude (e.g., she asked for forgiveness without admitting she did anything wrong, continued the demonization of those opposed to the narrative, and repeatedly made false claims throughout the article). My favorite response to the article was someone paying to fly this over her house:

 Since Oster’s message was not effective at restoring the public’s trust in the health care system, something else needed to be done to solve the pickle the medical industrial complex had created for itself (such as the overall vaccination rate  significantly dropping due to   COVID-19 ).

 Newsweek , another establishment publication, took over for The Atlantic and published this editorial authored by a medical student (which I discussed  here ):

 Note: many of us suspected that the Bass article  was ghost written by a  public relations firm  (as its well- crafted language differed significantly from Bass’s past writings and recent interviews).

What was interesting about Bass’s editorial was that on the surface it appeared to be exactly what we had asked for after Oster’s piece—a direct admission of fault for each aspect of the COVID-19 response, which did not attempt to make excuses like claiming it was impossible to know what to do at the time. However, when I read deeper into it, I noticed that:

•He labeled those on front lines trying to stop all of this as “conspiracy theorists and a cottage industry of scientific contortionists,” and in a later tweet stated that many leading figures in this movement were not real or serious scientists.

•He deliberately avoided touching on the topic of COVID-19 vaccine injury (which for many is the most concerning issue).

•He deliberately avoided addressing the topic of the unprecedented spike in deaths in the working class following Biden’s illegal vaccine mandates for them.
 As such, I interpreted this piece to be a forced apology that the medical industrial complex really did not want to have to provide (e.g., Bass also mentioned the  tragedy  of declining vaccination rates but did not discuss the severe consequences of the COVID-19 vaccines which the American public is now alarmed about ). Nonetheless, I also viewed it as immense progress, since it demonstrated that the medical system is feeling enough pressure from the blowback of its COVID-19 policies that it is willing to bring quite a bit to the table to regain the public’s trust.

Fortunately, we were able to prevent Bass’s apology from gaining traction. I was thus, quite eager to see what would be presented next since we had made it clear that the previous insincere attempts would not suffice. On March 6,  Newsweek delivered :

 Scott Atlas
 While the previous pleas for amnesty were written by people who simply supported the narrative and did not have much to offer (beyond a decent online following), Scott Atlas is the real deal.

 Scott Atlas  is a renowned physician (e.g., he was chief of neuroradiology at Stanford for 14 years and authored a fundamental textbook in his field), who transitioned to becoming health policy analyst for the Hoover Institution. Atlas was frequently consulted for advice by leading political figures, and came to prominence during COVID-19 by dissenting against the lockdown policies when the hysteria behind them made it quite dangerous to disagree with the narrative. Because he chose to speak out publicly on the issue, the Trump Administration requested for him to join the White House Coronavirus Task Force.

What I find fascinating about Atlas is that by the standards of the not-too-distant past, he was clearly a moderate, and held mainstream positions endorsed by the scientific community. Unfortunately, because of the hysteria which overtook the medical field Atlas was instead painted as an extremist and mass murderer.
[ Note from Pierre Kory: Atlas was not the only moderate who was targeted. I also learned of the sad story of a highly regarded public health official in Hawaii who was sanctioned and defamed for daring to suggest using ivermectin to treat COVID-19.]

Atlas later published  a memoir  about his time there, which I believe provides the best available summary of what went wrong during COVID-19 (discussed further  here ) that I would highly recommend reading. Since that time, he has spoken out publicly about the dangers that scientific censorship poses to our democracy, and the profound mistakes made throughout the COVID-19 response due to the extreme suppression of free speech and open scientific discussion.
 Note: Peter Navarro, another skeptic of the narrative at the White House, like Atlas, could see that something was greatly amiss with the existing pandemic narrative. From the very start (as discussed in  his memoir ), Navarro tried to implement policies which could have averted the disaster we experienced, but like Atlas, was sidelined by forces within the White House. Based on what I’ve read from both their accounts, I hold the opinion that the Trump Administration had a shortage of personnel to advance Trump’s populist agenda, and as a result, many policies I felt needed to be enacted never could be implemented.
 The White House Coronavirus Task Force
 Much of what happened behind the scenes on the Coronavirus Task Force was quite surreal, and Atlas compared it to being at the  Mad Hatter’s  tea party from Alice and Wonderland. Although I understand his rationale for this analogy, I personally believe that the events he chronicled are more accurately encapsulated by the movie  Idiocracy —many of the events Atlas recounted resembled scenes straight from the movie like this one:

 The essential problem with the Coronavirus Task Force was that very few members of the Trump Administration had a good grasp of the science behind COVID-19, and instead deferred to the expertise of the doctors within the White House.
 Then reality hit me. The vice president had some papers in his hands. With great pride, he excitedly showed me a printout that had just been handed to him. It was a very simple, frankly crude, chart documenting the increasing number of PCR tests administered by the day in the United States. “Congratulations!” I replied, feigning excitement. But inside, I realized something far more significant was being revealed.
 The White House was looking at the simplest indicators—rudimentary numbers without detail, without context, without any concept of what actually mattered. The total number of tests was far from the critical part of the situation. We were already more than six months into the pandemic. What should have mattered was who was tested, when they were tested, what the testing revealed about contagiousness, and what positive testing meant in terms of action. That was my first “OMG” moment.
 Note: During the pandemic, the media regularly catastrophized not having enough ventilators, which led to a national drive to produce as many ventilators as possible (despite their excessive use being a key cause of death during the pandemic), and did something similar with the vaccines (whose increased administration likewise caused harm). Likewise, the media (and celebrities) continually admonished the Trump Administration for not offering an ever- increasing number of COVID-19 tests to the public, which led the administration to keep on increasing their deployment, despite no tangible benefits (and only harms) resulting from their mass implementation.
 The three most vocal doctors on the task force, Anthony Fauci, Deborah Birx, and Robert Redfield (the CDC director) were all career bureaucrats with deep ties to the Department of Defense, whose experience with handling infectious diseases primarily came from HIV, a virus which behaves completely differently from SARS-CoV-2.
 What was less understood was how closely connected  they were to each other  and their previous mutual involvement in questionable research studies (such as  this one  by Redfield and Birx discussed in  Vaccine A  or Fauci’s long history of atrocious human experimentation throughout the HIV era detailed within  The Real Anthony Fauc i ). Because of their longstanding ties, they consistently echoed identical (and often nonsensical) policy positions on the task force, and it was later revealed that they  had formed a pact  that they would all resign in unison if Trump dismissed a single one of them from the task force.
 Prior to Atlas’s involvement, for the prior six months, the Coronavirus Task Force had committed itself to handling COVID-19 through doing the following:

•Encouraging as much mask wearing, social distancing and hand washing as possible.

•Performing as much COVID-19 testing as possible.

•Using the positive results from the COVID-19 tests to justify as many lockdowns as possible for all segments of the population.

This approach had a few major issues:

•Everyone already knew the COVID mitigation approaches (e.g., washing your hands) within a month of COVID-19 beginning in the United States, so there was no point in continuing to belabor the point (governors eventually got so frustrated with Birx spreading this message but doing nothing more, that they stopped accepting her solicitations to visit).

•They were abjectly failing to prevent those most vulnerable from dying from COVID-19 (e.g., the elderly).

•They were devastating the American economy and creating significantly greater health consequences than those caused by COVID. These consequences primarily arose from the poverty they created, the severe mental health issues resulting from social isolation (particularly for adolescents), and the harms from individuals having to forego routine necessary care.
 Note: many other issues also arose due to the lockdowns  such as significant increases in domestic abuse .
 Atlas instead advocated for the following:

1) Continue the basic COVID-19 mitigation measures (e.g., washing hands).

2) Prioritize the available resources for protecting those at high risk of dying (e.g., at the nursing homes).

3) Allow everyone not at a high risk of dying to live their lives as normal without a large number of harsh mandates placed upon them. This was especially true for allowing children to return to schools.
 Unfortunately for Atlas, while these three approaches were both absolutely critical and clearly logical, many entrenched interests strongly opposed doing them. In turn, many of the pleas for amnesty we are now witnessing are seeking forgiveness for blocking the policies Atlas (and many other prominent academics) advocated for.
 The Mad Hatter’s Tea Party
 One of Atlas’s most disturbing discoveries on the COVID-19 Task Force was the extreme lack of medical knowledge presented by the de facto leaders of the COVID-19 Task Force, Birx, Fauci and Redfield (e.g., they did not appear to understand that most of the population were at very low risk from a fatal infection, or that different risk factors entailed very different risks of a severe COVID-19 infection). Since these three individuals were effectively able to dictate the national COVID-19 policy we suffered through for years, I will share some of Atlas’s observations.
 Evident from my first encounter was what appeared to be a functioning troika of “medical experts” composed of Drs. Birx, Fauci, and Redfield. They shared thought processes and views to an uncanny level. One depressing commonality was that none of them showed detailed knowledge of ongoing scientific literature on the pandemic. As opposed to what I had experienced with my colleagues in academic research centers, I never witnessed any of them provide any detailed critique of any journal publication. Unlike scientists with whom I had worked for decades, I never saw them voice any critical assessment, methodological or otherwise, of the pitfalls of any published studies. That analytical process is an extremely important part of evaluating medical research. Likewise, none of the three ever brought scientific publications into the meetings that I attended. And unlike other doctors I had worked with, none showed familiarity with clinical medicine or had any clinical perspective on medical journal publications or any facility with clinical terminology in meetings I attended during my time in Washington.
 Atlas thus found himself in the curious position where he (with the assistance of anonymous academics around the world—some of whom I suspect migrated to Substack) had to compile and critique the existing data on COVID-19 and make it available to the Coronavirus Task Force as no one within the federal government was fulfilling this  critical  role.
 Even though I handed out a number of these published studies to everyone at the table, no one ever mentioned them in the Situation Room. My guess was that no one in the Fauci-Redfield-Birx troika ever opened them.
 I will now share some of Atlas’s most salient observations on these three individuals.
 Anthony Fauci
 First, in Fauci’s case, although he continually spoke to the media (to the point that many in the White House questioned how he had the time to do it), Fauci was rarely present at the task force meetings. In the cases where he was present, his primary focus was on how to further terrorize the (already terrorized) public about COVID-19. I could not help but notice that this was almost identical to the playbook he developed during the AIDS epidemic (detailed within the  Real Anthony Fauci ), which allowed him to become one of the most successful bureaucrats in history.

 Because of Fauci’s narrow focus on all the potential, but unknown harms of COVID-19, Fauci rarely contributed anything to the task force, nor appeared to be able to grasp the merits of approaches less fearful than the ones he relentlessly promoted to the public.
 I described data verifying the absence of unusually high risk to teachers. I was doing almost all of the talking. Fauci listened. He offered no other studies, no other data, and nothing in dispute, other than commenting, “Well, what if we aren’t totally sure?” I was taken aback, because this was not the sort of thought process I anticipated in a data-driven scientist or public health expert.
 Interestingly, there was only one time during Atlas’s time on the task force where Fauci discussed a research paper he had reviewed with them. In this instance, Fauci excitedly shared a study (which Atlas had already reviewed) suggesting an association between COVID-19 and myocarditis. What was noteworthy about this instance was that Fauci demonstrated not only that he failed to understand the study (it did not support what Fauci was claiming it did), but also to Atlas’s great surprise, that Fauci did not even understand how to pronounce standard medical terminology contained within the paper.

 Note: One of Fauci’s claims to fame is that he is a chief editor of the foundational textbook for internal medicine. I  checked the version  which was published shortly before COVID-19 and found the mispronounced term, encephalomyelitis, was used 33 times within “his” textbook.
 Since Fauci appeared to be unable to logically defend his policies, he would often use the media to attack Atlas from afar. False statements about Atlas were frequently provided to the media and in certain cases, Fauci directly attacked Atlas on national television.
 Robert Redfield
 Redfield, the CDC director, appeared to be the most reasonable of the three (however he almost always ended up 100% agreeing with Fauci and Birx). Nonetheless, like the other two, he failed to grasp the lack of evidence supporting the value of masking, cited nonsensical data to justify his policies, and frequently helped enable the misdeeds of the other two.

In one instance, after a great deal of work, Atlas was able to convince the task force to dial back the CDC’s testing recommendations into something much more reasonable (e.g., in many instances, it was left to a physician’s discretion to perform testing rather than it simply being indefinitely required irrespective of a physician’s judgement). Redfield nonetheless silently redacted that recommendation from the final summary of the meeting. Atlas later caught Redfield’s redaction and was ultimately able to make sure the agreed upon change, against Redfield’s wishes, did enter the official guidelines.
 Once the guidelines were published, a media firestorm erupted against this guideline change, full of salacious and false accusations from anonymous sources against the Trump Administration. Much of this was so over the top (and echoed by leading Democrats), that many friends of Atlas from abroad—Switzerland, France, even Brazil—emailed him, saying, “What the hell is wrong with the United States?” After, two weeks of this (without Redfield consulting the task force), the CDC’s guidelines were then retracted.

 Note: Redfield  recently testified before Congress  that SARS-CoV-2 came from a lab, directly contradicting Fauci’s statements throughout the pandemic. As many of you know, FOIA emails have shown early in the pandemic that  Fauci coerced  leading academics to bury the lab leak theory. Similarly, Fauci,  in  private communications  spoke out against the masks he pushed on Americans. Additionally, in a July 2020 interview ( go to 04:20 ), Fauci directly admitted that the cycle thresholds for the PCR testing he had  forced on Americans were unlikely to correlate to someone having a COVID-19 infection.
 Deborah Birx
 Although Fauci was thought to have the greatest influence over the COVID-19 task force, Deborah Birx actually assumed that role, and did everything she possibly could to encourage lockdowns and testing across the nation. Interestingly, when Atlas tried to determine how she had obtained her critical role on the task force, he discovered that no one actually knew how she had gotten onto it in the first place.

Like Fauci and Redfield, Birx had an atrocious understanding of the data underlying her policies (based on Atlas’s account, she appeared to be the worst of the three), and seemed to continually pick and choose whatever correlation she could find to support her policies, regardless of how absurd it was. This frequently led to moments that left Atlas dumbfounded as he came to appreciate how scientifically illiterate the entire task force was, something extremely concerning given that they were depending on Birx for their data.

For example, Birx used the catastrophic ( and clearly disproven ) models used throughout the pandemic to promote the lockdowns in order to support her policies. This was accomplished by showing that the deaths which the models had predicted failed to occur in areas that adopted mask mandates and lockdowns, and then attributing the adoption of these policies as the reason why the model’s predicted deaths had not occurred. Since the deaths predicted by these models also failed to occur in areas which did not implement any of Birx’s policies, this suggested that the models were simply wrong, but as you would expect, Birx was never willing to consider this possibility.

Birx also always used highly inaccurate datasets pulled from Google (e.g.,  this one ), to support her policies, which researchers around the world knew were highly inaccurate. Birx also repeatedly failed to recognize strong confounders to causative correlations that she identified (e.g., if COVID-19 cases in an area were already dropping before mask mandates or lockdowns were implemented, you cannot argue those policies caused the decline which happened—especially if an identical decline was observed in nearby areas which did not impose those policies).
 Birx would also frequently identified essentially meaningless trends within the data available to her, and then directed everyone’s focus to the importance of that figure (e.g., the test positivity ratio or college students having symptoms too minor for them to recognize that they had SARS-CoV-2).

One of the saddest examples was Birx becoming alarmed that a ratio she had discovered (positive COVID-19 tests relative to COVID-19 hospitalizations) was increasing, despite there being no actual increase in total COVID-19 hospitalizations. Birx, in turn, proposed solving this issue by increasing the number of COVID-19 tests of asymptomatic individuals (these individuals are unlikely to get hospitalized even if they test positive), so that the ratio would be lowered.

Like many of the previous examples, the entire task force (including Fauci) failed to recognize the absurdity of this approach (it only served to artificially alter a theoretical ratio with no real life significance). Atlas then clearly explained the logical issues with this approach, but despite this, the task force could not process what he was saying and ultimately chose to adopt Birx’s recommendation for more testing.

Birx frequently pulled many other things out thin air. These included arbitrarily decreeing specific times that bars must close to slow the spread of COVID-19 (which, without any evidence to support it, changed from 11:00 PM to 8:00 PM as time moved forward) and coming up with increasingly sophisticated (but entirely meaningless) color codes for the graphs of data she had obtained from Google. Further compounding this behavior, she appeared to be highly emotionally unstable, was regularly prone to outbursts or passive-aggressive behaviors when she did not get her way, and would double down on her incorrect interpretations of the data when evidence undermining her conclusions were provided to her by Atlas.

Although she held significant sway in the White House (largely due to the national media adoring her), near the end of Trump’s presidency, many besides Atlas finally began to lose their patience with her:
 “We absolutely need to get rid of Birx.” I [Atlas] replied with a noncommittal, “Really?” Giroir [the Assistant Secretary for Health] went on. “She cannot work with anyone. She just goes full speed ahead without consulting anyone. She’s extremely difficult, she flies off the handle at any criticism, and she doesn’t understand the data. The president needs to get rid of her.”
 Normally, I would not want to devote this much time to critiquing a clearly dysfunctional human being. However, given that her whims became national policy and grievously harmed millions, I felt what actually happened behind the scenes needed to be covered here.

Unlike Atlas, I do not whatsoever consider myself an expert in most of the disciplines necessary to develop a national COVID-response. However, I am relatively certain based on what Atlas shared, that in my free time, I could have easily produced dramatically better evidence-based guidelines than what the “most respected” doctors in America were able to devise over nearly a year on the task force. That’s quite scary when you think about it.
 She [Birx] strongly tried to reject my point [to prioritize targeted protection of the elderly], leaning across the table and emphatically telling me, “Nothing more could be done; we are already doing everything!” But stating something aggressively did not change the facts. Their efforts were failing to stop the deaths, and more could be done.
 Don’t Make Deals With The Devil
 When my team contacted the Trump Administration about early treatment options for COVID-19, we were told that our data was promising, and that they at least heard our argument that anything besides an effective treatment for COVID-19 being widely available a few months prior to the election would likely cost them the presidency. Nonetheless, we were told they could not work with us because they knew the administration would be crucified in the media for advocating for anything even slightly unorthodox (which we repeatedly saw  happen throughout 2020 ).
 As you all know now, despite the Trump Administration’s commitment to coddling Birx in order to not rock the boat ahead of the election (e.g., by permitting her to spread a message of fear on behalf of the administration across the country), Trump nonetheless lost. Similarly, Pfizer, who had the red carpet rolled out to them by the Trump Administration to facilitate the accelerated production of their vaccine, at the last minute chose to delay the finalization of their vaccine until right after the election. In effective, Pfizer stabbed Trump in the back to prevent him from getting the positive press he had been promised from getting a vaccine to market in record time.
 What all these examples show is that because the Trump Administration gave in to catering its actions to the media’s expectations of what it needed to do (e.g., vaccines can never be wrong) rather than common sense like Atlas’s advice or Trump’s desire to reopen the country, they simply got burned and had nothing to show for it.

Near the end of Atlas’s appointment, he flew home and had a final conversation on the phone with Trump, and he knew he was on speaker and Trump’s staffers could overhear:
 “You were right about everything, all along the way. And you know what? You were also right about something else [Birx]. Fauci wasn’t the biggest problem of all of them. It really wasn’t him. You were right about that.”
 “Well, Mr. President, I will say this. You have balls. I have balls. But the closest people around you—they didn’t. They had no balls. They let you down.” I expected but didn’t receive any pushback. Instead, he replied quickly, with a slight tone of resignation and acknowledgment in his voice, rather than with any anger. “Well … they didn’t know, they just didn’t know…” and his voice trailed off.
 Note: Another point Atlas made was that Ron DeSantis periodically consulted him on COVID-19. DeSantis was fairly unique because rather than trusting the experts, DeSantis took the time to try to understand all of the data on COVID-19, determine what appeared to be the most sensible policy to enact, and only contacted Atlas after he had done so in order to ask what part of his analysis was incorrect.

DeSantis, despite not being a medical “expert,” from looking at the data came to a relatively similar conclusion to Atlas. DeSantis only briefly locked down Florida (e.g., compare Florida’s response to California’s ), something he was widely condemned in the media for doing so. His not only protected Florida from the hardships of the COVID-19 lockdowns, but also saved lives ( Florida outperformed the nation ) and as a result of his policies, he became one of the most popular governors in the country. In total during 2020, only seven states did not enact stay at home orders, and of those, only South Dakota (due to their governor wishing to respect the liberties of her constituents), avoided ordering businesses in the state to temporarily close.
 The Media’s Complicity
 When Atlas first came to the Whitehouse, Trump told him:
 “I’m sure you will teach me many things while you’re here. But there is only one thing you’ll learn from me. Only one. You will learn how vicious, how biased, how unfair the media is. You already know they are the fake news. But you have no idea how badly. That is the one thing that you will learn from me here.”
 Although it could be argued that Trump’s confrontational demeanor provoked the media’s hostility towards him,  the same could not be said for Atlas . Despite this, the moment Atlas threatened the narrative (indefinite lockdowns and testing alongside doing nothing which saved lives), the media did everything they could to defame him and neutralize his influence.

As discussed above, Atlas advocated for a very reasonable policy of focusing our resources to protect groups vulnerable to COVID-19, while allowing everyone else to live their lives (rather than suffer the horrendous costs of the lockdowns). To counter this, the media collectively reframed this approach as Atlas advocating for a merciless (natural) “herd immunity” strategy where the virus was encouraged to rip through society, and countless American lives would be immorally sacrificed to reopen the economy (thereby putting profit over lives). Although this was completely different from Atlas’s much more conservative position, a significant portion of the public believed it, to the point that Atlas was repeatedly confronted in public for being a murderer (Atlas also received death threats and was publicly condemned by 98 of his colleagues at Stanford).

 Note: It might not come as a surprise that many of the accusations against Atlas aired by the mainstream media were attributed to “anonymous sources” present at the task force meetings who somehow overheard Atlas stating things he never actually said.
 One of the most interesting aspects of Atlas’s experience was that each time he appeared to gain traction on the task force for shifting the national COVID-19 policy to something sensible, the entire media would catastrophize the policy Atlas was pushing for. This, in turn, created sufficient public pressure to force the task force to regress to its failed policies, which only served to hurt the American public.

In many cases, the events that transpired appeared to suggest that Fauci and Birx were working hand in hand with the national media to neutralize the Atlas presented that refuted their narrative. This suspected collusion was also suggested by the continuous lavish praise Fauci and Birx both received from the media in spite of their complete failure to do anything whatsoever to address the pandemic.
 Similarly, throughout the pandemic, like Fauci and Birx, the media refused to report any reassuring data to the public, and instead was only interested in portraying COVID-19 as negatively as possible to terrify the public. This is particularly ironic, as until COVID-19 broke out in the United States,  the media  (and  many politicians ) actively condemned anyone who suggested it was any more dangerous than a flu.
 To this same point, in every White House press briefing, countless members of the press (who did not appear to understand any of the existing science on COVID-19) would only focus on aggressively accusing Trump of being a mass murderer, since his actions had allegedly resulted in the needless deaths of hundreds of thousands of people (I’m sure you all remember CNN’s daily COVID-19 death count that mysteriously vanished after the election)

 The same has never been said for Biden, which I believe illustrates how little the national media actually cares about American lives. Deaths are sensationalized when convenient and swept under the rug when they challenge a narrative. Sadly, this is by no means unique to this instance; consider for example how little attention has been paid to the massive number of deaths following forced vaccination of the American workforce.

 I am not aware of anyone besides Tucker Carlson who has covered the above data.
 To quote Atlas:
 Scientists and the media shared the same strategy: seek out and destroy all who dared dissent from the accepted narrative, and delegitimize everything uttered by President Trump and all who agreed with him. Instead of rethinking failed policies and admitting their errors, these scientists chose to employ smears and organized rebukes against those of us who disagreed with what was implemented and who dared to help the president they despised.
 The Institutional Decline of Science
 Even though they [Fauci and Birx] constantly invoked “the science” in their interviews, they grasped at straws to prove the value of their recommendations.
 Many have observed that modern science is more akin to a malignant religion (frequently termed “ scientism ”) than something which follows the scientific process. In other words, rather than determining truth through assembling evidence that proves or disproves competing hypotheses, science has become an institution where scientific authorities (like many religious figures of the past) simply make pronouncements which everyone else is expected to follow.

Given how much money depends upon a commercial interest holding a monopoly on scientific truth, it should come as no surprise that more and more of science has shifted to becoming scientism that only serves to sustain the vested interests which fund it. My favorite authors have utilized a variety of terms to describe this phenomena (e.g., Malcom Kendrick  terms it  Zombie Science, Pierre Kory  often references  the Disinformation Playbook).
 Many outside commentators have noted that COVID-19 accelerated many of the long-standing issues in our society:
 •As Atlas’s experience (along with that of many others) showed, any veneer of considering the evidence within the scientific process was thrown out the window to support the narrative, and it is profoundly sad that the scientific core our nation depends upon was slandered and censored. Similarly, it is almost comical instead that people as unqualified as Birx or Fauci were elevated to scientific sainthood for supporting the narrative. This, in turn, is creating a widespread loss of trust in the institution of science, which to a large extent the cohesion of our society has revolved around for decades.

•Friends who are therapists have shared with me that since COVID-19 started, many healthcare workers have lost faith in the system and are having difficulty continuing their jobs. Some, as you know, have shared concerns over the suppression of treatments for COVID-19, and unsafe vaccinations being forced upon the public. Many have also shared that they are burned out from the additional demands placed on them during the pandemic (extra work or  their own vaccine injuries ), that staffing shortages are making it impossible for them to provide the bedside care they feel is necessary for their patients, and that it is becoming impossible to ignore how many medical decisions they are forced to follow are driven by profit-seeking rather than serving the best interests of the patients.
 Throughout history, a common observation has been that institutions, societies (e.g., empires) build up, plateau, break down, and then either build themselves up again or break apart. This cycle also often coincides with the amount of corruption in society—the periods of decline are mirrored by increasing corruption and debasement of every institution which the society relies upon.
 Presently, the United States appears to be in state of institutional decline, and I believe the transformation of our scientific system by the media into a system of blind trust in anointed scientific authorities (whom, as this article has shown, were clearly unqualified for that role) is a perfect illustration of that decline. My fear is that if this trend is not addressed, like many other empires throughout history, the United States will lose its place as the leading superpower, and that the empire that replaces it will most likely be far worse for the citizens of the world.
 When you think about that, it’s quite scary what these three [Fauci, Birx and Redfield] decreed became the “science” no one was allowed to question.
 Atlas’s OP-Ed
 It was baffling to me, an incomprehensible error of whoever assembled the Task Force, that there were zero public health policy experts and no experts with medical knowledge who also analyzed economic, social, and other broad public health impacts other than the infection itself. Shockingly, the broad public health perspective was never part of the discussion among the Task Force health advisors other than when I brought it up. Even more bizarre was that no one seemed to notice.
 Because of  the hatred Atlas received from the media  for espousing the need to protect the general public, I believe Newsweek choosing to  publish an op-ed  by Atlas illustrates a turning point in the current narrative. Atlas, in turn, got straight to the point:
 In a democracy, indeed in any ethical and free society, the truth is essential. The American people need to hear the truth—the facts, free from the political distortions, misrepresentations, and censorship. The first step is to clearly state the harsh truth in the starkest possible terms. Lies were told. Those lies harmed the public. Those lies were directly contrary to the evidence, to decades of knowledge on viral pandemics, and to long-established fundamental biology.
 None of us are so naïve as to expect a direct apology from critics at my employer, Stanford University , or in government, academic public health, and the media. But to ensure that this never happens again, government leaders, power-driven officials, and influential academics and advisors often harboring conflicts of interest must be held accountable. Personally, I remain highly skeptical that any government investigation or commission can avoid politicization. Regardless of their intention, all such government-run inquiries will at least be perceived as politically motivated and their conclusions will be rejected outright by many. Those investigations must proceed, though, if only to seek the truth, to teach our children that truth matters, and to remember G.K. Chesterton's critical lesson that " Right is right, even if nobody does it. Wrong is wrong, even if everybody is wrong about it ."
 Scott Atlas has been remarkably consistent in his message, and for those interested, a year ago he gave an excellent talk on this same subject for  The Academy for Science and Freedom :

 Note: a shorter presentation encapsulating the key points of this talk can be viewed here .
 Conclusion
 Many of you are probably familiar with this meme (tweeted by Elon Musk):

 One of the most remarkable aspects of COVID-19 is how the rapid institutional decline we’ve witnessed in science and medicine has caused many with previously respectable professional positions to now be viewed as extremists (and frequently linked to the “far-right” ).

 A few years ago, I would never have expected to write an article detailing the work of an establishment moderate like Scott Atlas, yet, here I am doing just that because of how far and how fast our society has drifted away from his (previously) extremely reasonable positions.
 I personally believe that it is critical to prioritize allowing patients and physicians the freedom to utilize the treatments they believe to be effective, regardless of what commercial interests those treatments threaten. This, I would argue, is because the systemic issues within our healthcare system will persist until therapies that can compete with the present medical monopoly are made available to the public.

However, while I hope the events of the last few years will support increased medical freedom within the United States, I believe Atlas’s much more moderate message (allowing open scientific debate, accurately examining the existing data, and not mandating questionable health policies on the public) is something most of the public can get behind as we move towards holding those responsible for the past three years accountable for their actions.
 If you enjoyed this article, please consider Subscribing to a Midwestern Doctor’s Substack here . The content is excellent and I make a point to find the time to read all of it.
 The Forgotten Side of Medicine Here I do my best to expose both the light and dark within medicine that has remained hidden. My hope is that knowledge can improve your health and the health of those around us.
 By A Midwestern Doctor

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Summary: Scott Atlas provides an insider’s account of the horrendous mistakes made throughout the first year of the pandemic


The Hillington Hospital Nightmare of Dr. Paul Marik

Years ago, Dr. Paul Marik got suddenly and severely ill when he was attending a medical conference in London. He was brought to Hillington Hospital within UK’s National Health Service (NHS). What happened next is a comedy of hospital mis-steps that is almost unimaginable. To describe Paul’s marathon stay in the emergency department as a dystopian nightmare would be a completely fair description.
 When Paul told me this story for the first time, I was laugh-crying so hard because the way he told it was hilarious (if any of you know or have met Paul, he has an amazing sense of humor). But it wasn’t funny back then because he suffered a great deal. When he got back to the U.S, he decided to write a letter to the head of the NHS. Both the written letter and the audio version are included below (I got him to read the letter below word-for-word, but he had to do it in a serious tone given he was reading a professionally written letter). You have to hang out with him to get him to tell it in his more typical, spontaneous, comedic delivery. Enjoy.

 The Failure of NHS: A Personal Experience.
 Paul E Marik, MD, FCCM, FCCP
 This paper describes my unfortunate encounter with the National Health System (NHS) in Central London on a cold and dreary winter day in February of 2018.  I had flown to London from the USA spending over 12 hours travelling to attend a meeting.
 While sitting at the conference table, I remember turning my head to better visualize the screen, suddenly developing intense vertigo with the room turning, rotating and whirling about me. This was accompanied by a feeling of intense nausea and disorientation. Although unsteady on my feet, I left the room thinking that I was having a vasovagal attack and needed to sit down on the floor. I had difficulty sitting and so decided to lay down. The symptoms did not improve.  I had broken into a cold sweat, developed projectile vomiting and had a sense of “impending doom” (I thought I was about to die). I had no chest pain or shortness of breath.
 My colleagues, recognizing that something bad was happening called 999 (London’s emergency phone number). The operator informed them that it would take “ at least 4 hours for an ambulance to arrive and that was no guarantee. ” This should have been a warning that I was in great trouble. With no other option, my colleagues wheeled me to a car, placed me in the back seat, and drove me to the nearest hospital. The car journey, which took about 10 minutes, intensified my vertigo and I developed severe and uncontrollable projectile vomiting; I probably aspirated at that time.
 We pulled up to the emergency entrance of the Accident and Emergency (A&E) Department of the hospital (a teaching hospital affiliated with the Imperial College of London). With no response from the A&E staff, my colleagues found a wheel chair and wheeled me into the A&E department. After much discussion, I was placed on a gurney and wheeled into the emergency section of A&E where I was seen by the A&E doctor. I was disorientated for time and place and had difficulty remembering my home address. I was placed on a cardiac monitor; my blood pressure was 140/90 mmHg, my pulse was in the low 50’s, and my arterial oxygen saturation fluctuated between 86 and 88%.
             After taking a brief history and performing a cursory examination (H&P) that consisted only of asking me to show my teeth, clench my fists and shrug my shoulders despite my complaints of vertigo, confusion and disorientation, the A&E doctor decided that I had Meniere’s disease.  I was treated with ondansetron with some improvement in my symptoms.  A normal electrocardiogram and troponins excluded an acute myocardial infarction. Due to hypoxemia, he told me he was going to do a blood gas analysis. He attempted with much difficulty to get a left radial arterial blood sample. Despite much poking and prodding, and knowing that this was a painful procedure, I was surprised that I did not feel a thing.
 Due to the persistent hypoxemia, my colleague suggested that I might have had a pulmonary embolus (PE). The A&E doctor seemed puzzled by this suggestion and argued that I had no risk factors or features of a PE. After much discussion, he agreed to perform a d-Dimer test. This came back markedly elevated (1305 ug/L- ULN 275 ug/L). After a discussion with someone on the medicine team the A&E doctor told me that computerized tomographic pulmonary angiograms (CTPA) could not be performed at night and that I would need to be admitted to the medicine team to have a CTPA performed.
 At this time, I was moved to another room at the back of the A&E department. After about 4 hours, my disorientation and confusion began to clear and I began to appreciate the gravity of my situation. I asked the nursing staff when the medicine team would see me; she responded that she had not seen the team for hours and that I should be patient.
 After waiting several more hours, I again enquired as to the status of the medicine team and was told that they had arrived in the A&E but there were many patients ahead of me. After waiting for about 10 hours, the medical registrar finally arrived. He did a very quick H&P (no neurological examination) and told me I would have to wait to be seen by his attending.
 About two hours later the attending arrived, and she too did a very brief H&P. She told me she was unable to order a CTPA and that I needed to be seen by a pulmonary doctor. Sometime later, the pulmonary doctor arrived. She auscultated my lungs and told me she could order the CTPA but there was no guarantee that it would be done that day. I explained my situation and pleaded with her to get the test done as soon as possible.
 After waiting for about 3 more hours the CTPA was completed and I was told that the result would be available within one hour.  I was wheeled back to the A&E and placed in different room; I was moved twice again eventually being deposited in the plaster (casting) room with broken plumbing and lighting. I was once again totally ignored by the nursing staff.
 After waiting for about 4 hours, I asked the nurse when I could expect the results. I was told that only the medicine team could give me the results, that they were busy, and that they would get to me sometime that day or the next.  The nursing staff was extremely harsh and unwilling to help. After being held captive in the A&E department for close to 20 hours and having received very little to eat or drink I realized that I was in big trouble.
 I wanted to sign myself out of the hospital but was reluctant to fly home without knowing if I had had a PE.  At this time, I went to the central station in the A&E. I introduced myself to two doctors and explained my situation pleading with them to get my results. I was told that only my medicine team could do that but they would see what they could do. So, I went back to room 23 (the plaster room) and waited; no response. I tried to get the attention of some of the nurses and other doctors who were in the passageway, but was ignored.
 Eventually, I was able to get the attention of a young doctor who was the first healthcare provider to listen to me and show compassion and concern. She tried to contact my team but they were “unavailable” and could not be reached; apparently they were no longer on call, were not in the hospital and would only return the next day.  She was kind enough to print out all my records (which included my CTPA report indicating I had not had a major PE) and advised me to “get the hell out this hospital and sign myself out.”
 This is exactly what I did… I  got dressed and walked out the hospital without signing a thing. When I landed at John F Kennedy (JFK) airport in New York, I kissed the ground, happy to be home (and alive). After undergoing a number of screening tests at home, the most likely diagnosis was benign paroxysmal positional vertigo. The cause of my hypoxia was likely due to aspiration pneumonitis (the CTPA was negative but did demonstrate patchy basal infiltrates).
 There are a number of reasons for recounting my experience, which is unlikely to be an isolated event in the United Kingdom. Furthermore, having practiced medicine for over 35 years in various settings and countries gives me the unique insight as to what a patient should expect in a situation similar to mine. Clearly, the system failed. While I recognize that A & E departments tend to be chaotic, they provide a point of entry into the health system and need to provide both safe and efficient care.
 With cuts in National Health System (NHS) funding, a recent report demonstrated clear evidence of health systems failures, which included “ambulance call-out times and waiting times in A&E”.[1,2]  The hospital experience can be a terrifying one, however, we clinicians may have underestimated just how terrifying it can actually be. Health care providers need to engage with patients, act in a professional manner and be caring and compassionate. I felt dehumanized, helpless and abandoned.

 Notice this occurred a few years before the pandemic. Reading Paul’s letter in the wake of my recent posts on the proximate cause of the catastrophic non-care delivered to the UK care home residents in Spring of 2020 is unsettling. I might have to re-think the idea that spontaneous mass euthanasia by U.K care providers is inconceivable. Whoa.
 References
 1.   Hiam L, Dorling D, Harrison D et al. Why has mortality in England and Wales been increasing? An iterative demographic analysis. J R Soc Med 2017; 110:153-62.
    2.   O'Dowd A. NHS cuts have played part in rise in excess deaths, study claims. BMJ 2017; 456:j875.
 P.S I just want to say thanks to all my subscribers, especially the paid ones! Your support is greatly appreciated as it allows me to devote what is often large amount of time I spend researching and writing my posts, so again, thanks .
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 P.P.S. I opened a tele-health clinic with a specialized focus on the treatment of both Post-Vaccination injury and Long-Haul Covid syndromes. If anyone needs our help, feel free to visit our website at  www.drpierrekory.com.
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Summary: I laugh so hard when Paul tells this London hospital story. But it wasn't so funny for him. Enjoy his powerful complaint letter to the UK's National Health Service. Audio version by Paul Marik!


More Thoughts On The Increase In Morphine and Midazolam Use in UK Care Homes in Early 2020.

I made an error in my post by not exploring the root cause of the deaths as I was simply trying to rebut the idea that providers suddenly decided to use medicines to euthanize patients.
 My hypothesis as to the “root cause” of the excess deaths is that as the chaos of the first wave of the Wuhan variant unfolded, policy makers made an assessment that they were in a “mass casualty” scenario. Policies were hastily created which removed care opportunities to care home patients. The seemingly blanket DNR policies and “do not hospitalize” policies in the homes they were following for a time is what I suspect was the proximate cause of the excessive dying (not the medicines), as sick residents were forced to stay in the homes and proper Covid care could not be provided there.
 In that first wave in New York (I was not in the UK), I saw a lot of ethically troubling ideas and even actions borne of fear as well as ignorance as to how much capacity they had or would be able to be created or even how many patients would need to be cared for. Could we handle a 1,000 admissions a day at my hospital? No way.
 Again, my hypothesis is that the hasty attempt at creating "rationing" policies in the UK was catastrophic. It seems they were trying to "ration" or "prioritize" care for certain classes of citizens with a priority for the non-elderly, non-disabled(?) as if they were in a mass casualty event . Although I am not an expert in the management of mass casualties, I do know that in mass casualty events one of the first steps is to triage care (triage=ration?) to those most likely to survive or benefit from medical intervention. If you read the below, I think it supports my hypothesis that those extremely destructive policies were informed by “ mass casualty ” thinking.

 From the Mayo Clinic: According to a 2016 issue of World Journal of Emergency Surgery, a mass casualty incident refers to an event that overwhelms the local healthcare system, with number of casualties that vastly exceeds the local resources and capabilities in a short period of time."
 Sort, Assess, Lifesaving Interventions, Treatment/Transport (SALT) applies in incidents with five or more patients, such as a large motor vehicle crash. In this circumstance, first responders need to assess people quickly to determine who needs treatment in what order and then alert the receiving hospital so that medical staff can prepare for them.
 In both SALT and START, responders classify each victim involved in a mass casualty incident into the following categories for treatment needs:
 Green (minimal)

 Yellow (delayed)

 Red (immediate)

 Black (dead)

 SALT also includes a new category, Gray status, meaning that responders expect the victim to die. This eliminates previous consternation when a patient was dying, but not yet deceased .
 "If you label someone black and someone else walks by and sees the victim breathing, that's confusing," says Juntunen. "A Gray tag means there's not any hope and that responders need to concentrate efforts elsewhere. I have encountered a victim in this status personally, and I had to move to another patient for whom we had resources."

 It seems that UK policy makers, for a time, assigned a “grey status”.. to all the UK care home patients? I have not done a deep dive into what the actual hospital capacity for care was to even remotely justify such a policy, but from what I have read, these policies were not justified by a catastrophic lack of capacity. Given that reality, the policies , in hindsight(?) were outright violations of proper medical care but I still have trouble ascribing them with a primary intent to cause death, although those erroneous policies did cause excess death for sure.
 My personal experience in that first wave was that there was outright chaos in some places, it truly was disorienting and scary and that is where policies come from - to bring order out of chaos (and presumably to ensure the right thing happens for the most people like in a mass casualty event).
 However, even if the situation approximated a “mass casualty”, a blanket assigning of “grey status” to all care home residents is extremely disturbing versus trying to do so on an individual basis.
 The reason why I am reluctant to accept there was a primary intent to cause death is that I just can’t. I have been exposed to so much fraud and corruption and ignorance within the medical system through Covid, with what now seems like systematic depravity around the vaccines, but I can’t believe any suggestion that health care providers systematically began to practice euthanasia or homicide in the early pandemic. Or that the policies were formed with a primary intent to cause excess death in care homes. I just can’t do it. And won’t, because if I do, then the world is lost to me.
 The seeming perception of policy makers that they were in a mass casualty when it appears they were not led the care home residents to die of Covid at needlessly excessive rates due to lack of access to hospital support devices. Which then led to many developing severe breathlessness in the home with the only available care options to be those of "comfort meds." It seems the reason why they put in a medication protocol as part of their policies, is that they knew they would be needed as a result of insufficient hospital capacity with inability to make available the use of non-invasive and invasive ventilators and high-flow oxygen devices.
 Again, my hypothesis is that UK policy makers had come to the conclusion that there was not enough hospital resources for everyone. My point is that my prior post did not address this as what I think was the "real" problem - the blanket issuing of DNR and do-not-hospitalize policies which created a situation where large increases in the use of comfort meds was observed.
 Further, these policies likely explain so many of the troubling reports by patients and their families of being denied care and thus causing the premature death of patients. But again, I believe (although I was not there, I have read some of the investigations into what happened) that it was the policies that caused the excess deaths, not the meds (although I suppose one could argue there is little difference given that the meds were part of the policy, but I personally do see a distinction - the meds were secondary, albeit an unfortunate and ugly part of the whole mess in that early wave).
 A second “correction” to my post is that my skills and approach to end-of-life care, prognosticating, and following ethical principles are mine and were formed from a decade and a half of practice in busy, urban ICU's as well as my study of medical ethics and the tutoring by some incredible mentors. I have to acknowledge the wide variability amongst providers in this knowledge and skill set as I have heard too many horror stories of improper actions of doctors to think we all have the same understanding and application of the principles of medical ethics.
 But again, although terrible actions were taken by some providers out of fear and confusion as to what the "right" thing to do was, I cannot ascribe the intent of murder or euthanasia systematically to a population of health care providers. Although I, like many others, recognize that individual providers in certain situations may have "lost their minds”,, a.k.a “ethical bearings" and thus may have actually committed those acts out of some combination of ethical ignorance and fear but I refuse to accept they did it out of malice.
 P.S. I also want to apologize for my “stay in your lane” comment - egregious and arrogant, not sure what I was thinking. I removed it.

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Summary: I made a grievous error in my last post. I did not explore the root cause of all the excess deaths which I think was from the blanket issuing of policies intended for use in mass casualty situations.


A Contrarian Opinion Regarding The Massive Increase In The Use of Sedatives And Opiates In UK Nursing Homes In Early 2020

I am not disturbed by the data or reports of massive increases in the use of sedatives and opiates in the UK and elsewhere in early 2020. I believe people are interpreting these data malevolently, which is uncalled for and frankly, in my opinion, this shows an astounding amount of ignorance as to how those medicines are used in real life situations.
 Before we get to the issue of increased use of these agents in the UK “care homes” (i.e not ICU), I think it is instructive to review what I observed in regards to their use in New York ICU’s in the Spring of 2020.
 When I left the University of Wisconsin (which, like many places, was not terribly overwhelmed with Covid in Spring 2020), I did so on what I called a “humanitarian leave.” I took a leave of absence of my leadership position at UW to take over my old ICU at Beth Israel Medical Center in lower Manhattan (as a New Yorker I couldn’t stand not being on the “front lines” of my hometown during their massive “surge”). I arrived to find my old colleagues over-worked and exhausted. The hospital was running six full ICU's (there were three just prior to the surge) with four or five of them full of Covid patients on ventilators.
 Now is probably a good time to address the “controversial” issue of whether hospitals were really “overwhelmed” in Spring 2020 or whether it was all just media “fear porn.” In talking to so many people throughout the pandemic, it is my belief that Covid surges were extremely variable - many places experienced only a slight uptick in admissions and ICU needs, others had empty hospitals due to people’s fear of going to the hospital or because they stayed severely locked down etc. But in New York City it was literally like a wartime catastrophe in the ICU’s. Perhaps you had to see it to believe it. But, I will agree with the naysayers that the media never showed videos and pictures of quiet ER’s and ICU’s to balance out the “chaos” the media was constantly blaring from hard-hit areas like Seattle, NYC, Detroit and New Orleans (and other densely populated urban areas). “If it bleeds it leads” but for sure it wasn’t “bleeding” everywhere. But In NYC it was hemorrhaging. Another data point that people don’t realize when they look at admission and hospital capacity data is that almost all hospitals shut down “elective surgeries” for weeks to months which are the bread and butter of a hospital’s bottom line. Thus a huge cohort of patients no longer were in the hospital because it was filled with Covid patients. So even if it “looked” like a hospital was not at capacity, this overlooks the fact that the patient population in the hospital was suddenly inverted with a massive increase in the need for ICU beds, ventilators and ICU experts. That is why I went to New York.

 The patients I took over the care of when I arrived, were, as you know, not being effectively treated (because nothing was “proven” to work yet at that time, so everyone was afraid to try therapies, ugh). Further, I saw something I had never seen before outside of an ICU at Beth Israel- a separate, “regular” hospital ward full of patients on heated high-flow nasal cannulas and/or non-invasive ventilators, two devices which were, prior to Covid, almost never used outside of ICU’s for prolonged periods. The degree of respiratory distress I saw in patients outside of an ICU was unprecedented. (Remember this sentence when we get to the care home discussion).
 Many of those patients were on those devices for days, on the precipice of end-stage respiratory failure. I called that floor the “Wild West.” Every shift, emergency calls to my ICU team would go out from that floor because one or more patients needed emergent intubation so they could be placed on a ventilator. Then we had to find them (or rapidly “create”) an open ICU bed to transfer them there.
 In the ICU I took over, many were in late phase disease, in a condition called Acute Respiratory Distress Syndrome (ARDS) and their lung mechanics on the ventilator were severely disturbed with many in a state of what we pulmonologists call “patient-ventilator asynchrony.” Plus they had severe encephalopathy and delirium. In order to sedate them so we could synchronize them with the ventilator (i.e help them to not “fight” the ventilator, this required, for whatever physiologic reason in that first Wuhan variant, much higher doses of sedatives than what we typically used in vented patients). Unprecedented doses in fact.
 I can recall one patient who needed three different high dose sedative infusions to keep them comfortable and their lungs safe/protected (and to keep them unconscious because they were also on a paralytic agent - you never want a patient conscious who is being paralyzed as it would be as distressing an acute condition as you can imagine). I had never seen a patient who required such levels of sedation to achieve this state.
 We weren't trying to “kill” them using such doses, we were trying to save them . In my opinion, the massive doses of sedatives required during that time simply resulted from the widespread insufficient or non-treatment of the underlying lung disease with corticosteroids and anti-coagulants (foreshadowing - it was not from a deficiency of antibiotics).
 In the below charts showing the overlapping of the excess death spikes with spikes of sedative use in the UK care homes is, to me, completely unsurprising. The main question to answer is, was it the chicken or the egg? I am making the argument that it was the increased rates of respiratory distress from Covid that led to a need for increased use of medicines to keep patients comfortable. Many/most seem to be arguing that increased use of these medicines caused all the deaths. I find this notion absolutely preposterous and trust you will too by the end of this post (if we ever get there).

 Now, although I realize that the above charts reflect care home use only, just stick with me for a bit.
 In the ICU, patients with end-stage Covid ARDS on ventilators were wickedly difficult to sedate. When patients are deeply sedated, the ventilator does the work of breathing for them. So you can’t “kill” (ugh) someone on a ventilator with sedatives because the ventilator always has a back-up rate, so even if their breathing is completely suppressed, which, in those patients, we often had to do with paralyzing agent infusions but they do not die. In fact, they become much more synchronized with the ventilator and thus more comfortable and less distressed. The “synchrony” that results between the patient and ventilator helps avoid a condition called “Ventilator Induced Lung Injury.”
 Life support devices like ventilators, acute dialysis, and ECMO (heart-lung support machine) are “double-edged swords” in that, yes, those interventions can and do save lives by affording patients time for their failing organs to recover. Many patients in such states will respond to treatment and their organs recover in time. But sometimes those devices simply serve to prolong dying. Thus my use of the term “double edged sword.”
 Overall, depending on the ICU, despite use of these tools, an average of about 10%-20% of ICU patients will die. People die. It’s life. The machines do not make us immortal. These machines cannot “save” everyone. In those that continue to deteriorate or enter multi-organ failure, the patient becomes “irrecoverable” and enters into what I call the “actively dying” phase. Prolong the actively dying phase with life support machines means you are actually prolonging suffering. This happened a lot and was one of the reasons why I myself had a career-long “love-hate” relationship with ICU work.
 Further, in patients at the end-of-life who are being removed from a ventilator to allow them to die more peacefully, it is absolutely required to sometimes use high doses of opiates and sedatives so that they experience no significant respiratory distress. Opiates are particularly well-suited for such situations since one effect of opiates is that they blunt or relieve the feeling of “dyspnea.” The definition of dyspnea is a “sensation of difficulty breathing.” In patients dying of respiratory failure, it is perfectly appropriate to use such medicines when removing them from the ventilator so they can pass comfortably without experiencing severe dyspnea, a procedure called “terminal weaning.”
 My experience in the ICU I was running in Spring 2020 was that many patients were dying from irrecoverable lung injury (they hadn’t been treated!) such that they had to be terminally weaned which required even more sedation. This is actually something that I would even call “best practice.” But medicine is complex and some patients, even in advanced Covid, could stay in an advanced state of respiratory failure for prolonged periods without further deteriorating and they instead benefited from a tracheostomy (a stable and more permanent airway) with prolonged weaning at a ventilator facility. So, I am not saying that every patient on a ventilator died, but a very high proportion did while others required prolonged weaning over weeks to months in ventilator facilities.
 However, once the decision has been made with the family that life support and critical care should be discontinued due to a collaborative assessment that such interventions were “prolonging suffering,” rather than providing a reasonable “opportunity for recovery”, terminal weaning is completely ethical. Our core responsibility as a physician is to relieve suffering of our patients and not to prolong their suffering and dying. The latter is what happens when life support interventions are used in inappropriate situations.
 In my entire career, I was almost always physically present in the patients room during “terminal weans” to support not only the family but also the nurses in giving enough sedation (some young nurses were sometimes too timid with dosing and the patients would experience distress). Again, the goal was to allow the patient to pass comfortably without respiratory distress. This is NOT euthanasia, this is humane care of a patient at the end of their life who is suffering terminal breathlessness. We are not “killing” them, we are simply stopping a medical intervention that is failing at its purpose and doing it in as humane and comforting way possible. Everyone has the right to refuse medical care (or did before the vaccine mania, ugh) and the families were asking us to stop life support. Removing someone from life support in this way is a core skill of a palliative medicine specialist (and palliation is a core skill of an intensivist).
 Okay, I am going on a tangent here, but know that NYC is a place with one of the most diverse populations in terms of cultural, ethnic, and religious backgrounds. Many different ethnicities in New York had either personal, cultural or religious beliefs which left them either unable to discontinue life support in their loved one, or their religion supposedly forbade it (I say supposedly because no religion has a precept regarding the absolute need for always providing life support in all situations, but many adherents of certain religions interpret their religious precepts in such a way).
 Often, despite the extensive amounts of time I spent with families in what we called “end-of-life” discussions, the family decision maker would disagree with or simply not accept my assessment and recommendations. They would instead insist that we keep “trying.” So, in many dying patients, they would remain on life-support for days to weeks in a state of single or multi-organ failure with their heart still beating as a result of the devices. That is, until, despite all the organ support, the heart would finally somehow stop on its own. To make matters worse, in such situations, due to New York State (and many other states) laws, we were forced to do CPR unless the family agreed that it was not indicated. CPR, so you know, is indicated for acute, reversible causes of cardiac arrest and was never intended to be used in... dead people or people who are dying after weeks of what is essentially CPR (life support).. But we often were legally forced to do CPR in dead people despite our professional opinion that is was clearly not indicated. The issue of CPR laws is an ugly one to me but let’s not go there right now.
 It would take an entire separate post to explore the obvious “grey areas” I am not addressing, like.. “how do you know they are irrecoverable?” Have you ever made a “mistake” in your assessment of their prognosis? The answer is that I can recall one or two cases where my assessments were proved somewhat incorrect. Why do I say somewhat? Because, in those cases, although the patients ended up recovering function to a degree that was unexpected, they still remained gravely and chronically ill. If you want to argue that had I kept all the dying patients alive for longer, I may have seen more recoveries, that is certainly a possibility and is one I struggled with emotionally throughout my career.
 However, as a NY ICU doctor, I gained extensive experience providing life support to dying patients because families often insisted on it “to give them every possible chance” (I completely empathize with this sentiment). Thus, I was being forced to do exactly that due to the “families wishes.” My experience caring for hundreds and of patients in critical illness states that were beyond saving made me an expert at “pattern recognition” and thus I could get highly accurate at prognosticating. But to say we could claim 100% accuracy is delusional. However, based on these experiences, ICU physicians, especially if you practice in NYC, develop a keen sense of “futility” because, again, I provided way more futile care than I could emotionally handle at times. But keep in mind, if I had any “grey area” or uncertainty in a patient’s prognosis.. I either did not initiate an end-of-life discussion or I communicated that uncertainty to families. Period.
 Weird fact: I will never forget a discussion I had with my early mentor Dr. Paul Mayo right before I left New York to start my new position at the University of Wisconsin. He told me that my life as an ICU doctor would be transformed in the Midwest because I would no longer be constantly forced by families to continue life support in the dying to the degree this occurred in New York.
 He was 100% correct. I quickly discovered that end-of-life conversations were much “easier” in Wisconsin as I found that families more readily accepted my assessment that their loved one was dying. When I would explain to them the medical situation in great detail, they generally agreed and accepted my assessment and guidance. In New York, this occurred a minority of the time whereas in Wisconsin this described the majority of my end-of-life discussions.
 Why is that? To be honest, I don’t really know but my two theories are that, in the Midwest, people seemed to be much more deferential and respectful of my expertise and guidance as a physician whereas in New York, many patients families challenged me and seemingly discounted (disrespected?) my experience, knowledge, and expertise. It seemed like they “knew better” than me, which certainly may have been the case in certain situations, but most of the time it was not. Another reason is that they didn’t “trust me.” Who wouldn’t trust a doctor? (I know, I know, it is a terrible joke, so sorry).
 So, end-of-life discussions in New York were challenging, leading to more situations than I can count where families accused me of wanting “to kill their grandmother” or “to save the hospital money” etc. Another theory explaining the cultural difference towards death between NY and Wisconsin is that Wisconsin is more rural and more people have experiences on farms and caring for animals. Thus, they are much more attuned and knowledgeable about the “cycle of life” and thus understand that all animals, no matter how we/they have lived, will come to the end eventually, and that at some point, “it’s time.” In New York, death was a four letter word and families often wanted to fight off death, no matter how futile the medical situation was (I can tell you stories my gosh). Now you know why I said I had a “love/hate” relationship with my specialty.
 Now, lets get back to “terminal weans.” One of my mentors said to me early in my career that he felt that ICU’s were the “best place to die.” One of the reasons why I came to completely agree with him is that I have had friends with parents with terminal illnesses on home hospice, with sublingual morphine and sedatives in the fridge, and even an emergency hospice nurse on site to administer the medicines during their final minutes/hours.. yet the descriptions of those deaths were quite distressing and traumatic to the family (and the patient). That is why, although we think we want to die at home peacefully, home deaths are not always so “peaceful” depending on what the patient is dying from - respiratory failure is not a pleasant way to die at home. Thus, ICU’s can, for some, be the best place to die in that we have so many resources and meds and IV’s etc. It can be accomplished in a highly organized, controlled, and even peaceful fashion whereby the patients (and the family) experience no such distress or trauma.
 Now, lets get to the issue of what was happening in the UK care homes. One Substack author interpreted the problem as follows:
 It seems that starting in April 2020, 10,000s of elderly were designated as “at the end of life” and euthanized with an opioid (Morphine) and benzodiazepine (Midazolam) combination.
 The evidence of United Kingdom’s “Midazolam murders” in Long Term Care homes is damning. Overall, it paints a very dark picture: in the UK, it appears the elderly in Long Term Care homes were euthanized by the 10,000s in order to drive up the COVID-19 death toll in 2020.
 We need whistleblowers to tell us.
 Notice the interpretation that “murder” and “euthanasia” must have been committed to explain this. This is their reasoning: since lots of sedatives were used and lots of deaths were recorded this meant that health care providers must have been murdering or euthanizing people.
 Whoa.
 How about this reasoning instead: People in care homes/nursing homes often have what are called “advance directives” which stipulate that they do not want to be intubated and placed on a ventilator to die a slow death in an ICU at the end of their life. They stipulate this because they understand that life support interventions are not only unable to return them to some previous state of health, but mostly because ICU care in frail, elderly patients with significant co-morbidities very rarely leads to even the possibility that they can be returned to even their present diminished health status. Thus, such patients often have orders stipulating things like “do not hospitalize,” “do not intubate,” (no vent), and “do not resuscitate” (no CPR). Their own (or their families) assessment is that they are at the end of their life and instead of seeking “extraordinary measures” which will not achieve what they desire, they instead elect to die peacefully.
 So, I maintain that another explanation for the increased need for opiates and sedatives is that patients were falling ill with Covid, then entering the pulmonary phase, were not being treated with corticosteroids or anti-coagulation, and thus becoming increasingly breathless with falling oxygen levels. Focusing on symptom control in these patients by using medicines to blunt what is often severe dyspnea is entirely appropriate in such situations.
 Now, lets review some definitions:
 Murder - The killing of another person without justification or excuse, especially the crime of killing a person with malice aforethought or with recklessness manifesting extreme indifference to the value of human life.

 Euthanasia, also called mercy killing, is the act or practice of painlessly putting to death persons suffering from painful and incurable disease or incapacitating physical disorder or allowing them to die by withholding treatment or withdrawing artificial life-support measures.

 Palliative care at the end-of-life : actions taken to provide comfort and support to patients who are facing the end of their life.

 Let’s address murder first. I realize that the medical system has lost its way over almost all aspects of diagnosing, preventing, and treating Covid. The fraud and corruption by those in power who have used propaganda and censorship to manipulate doctor’s thoughts and actions does smack of depravity given the consequences that those actions caused. But to argue that, early in the pandemic, before the propaganda and censorship reached the heights they would eventually reach, suddenly health care providers in those homes just started to arbitrarily murder residents under their care is just not credible.
 Now, what is the difference between administering medicines to euthanize someone versus administering medicines to make patients more comfortable, given that in both situations, you are using medicines which suppress the respiratory drive?
 Answer: intent.
 When you euthanize someone, the dosing and administration of the medicine is done with the sole purpose of ending their life. Quickly I assume (I don’t know, I have never euthanized someone).
 When someone is suffering from terminal breathlessness (i.e they are approaching the end of their life) the primary intent of the medicine is to make them more comfortable, it is not to end their life . Their life is ending already, and you are trying to make that transition from life to death a more peaceful and less distressing one.
 Where people get confused is that, in both cases, the opiate will suppress their breathing, so people think that, even in the latter case of providing comfort, that doctors are “hastening” death. Not true. The dose of the medicine used is titrated to the patients appearance, not their breathing or their pulse like in euthanasia. In comfort care, the doses are repeated or increased as needed until the patient is not gasping, rapidly breathing, or showing any other signs of distress like tightening of the facial muscles that suggest pain or discomfort. Typically, by the time your medicine doses achieve a state where the patient “looks comfortable”, the patient is unconscious, and yes, their respiratory rate has slowed. But they appear comfortable. Your therapeutic goal has been reached.
 Question: do patients die faster in this situation? Answer: it depends. I will admit that yes, the time until the heart stops can be shorter in many cases, but again, that was NOT the intent, it is instead a secondary effect of the medicines, the primary effect was to relieve respiratory distress and make them more comfortable. Now, can it happen for instance that a nurse, after giving a few IV pushes of a medicine, does not achieve the state of comfort she is trying to, and then maybe gives a double dose as the patient is still struggling and she is trying to further relieve their continued distress. And lets say, for whatever reason, that that dose suddenly leads to a severe decrease in the patients respiratory rate, their oxygen drops, and then they die. This can happen, but it is NOT murder or euthanasia as that was NOT the intent. The nurse was trying to help someone get more comfortable at the end of their life! No nurse or doctor I have ever met (save a few serial killer documentaries I have seen), want to KNOWINGLY kill patients! Jesus man, come on!
 Weird fact: I have seen a fair amount of cases where, after the morphine and sedatives are given and the patient appears more comfortable with breathing slowed… their oxygenation status actually improves.. and the dying process paradoxically lasts longer. Weird right? Why is that? Well, when patients are struggling with an increased work of breathing, this creates an oxygen demand. Once that demand is lessened from being made comfortable and their work of breathing lessens, the oxygen status improves. It takes longer for them to die, but they die comfortably. Similar with my nurse example above, you could accuse me of violating a core precept of a physician which is not to prolong dying unnecessarily. In this situation, in order to get the patient more comfortable, I used medicines which paradoxically prolonged the dying process. But they died comfortably, and the prolonged dying was a secondary effect, not a primary intent.
 So, lets finish with the care home business. The other rationale for why people are suggesting murder or euthanasia was occurring is because apparently family members have reported that they “feel” that the medicines being used hastened their family members death. I am unsurprised that certain family members felt this way. Why? Because to explain all that I have explained above, is well beyond the capacity of providers in a crisis. Even in normal times, many physicians are poor communicators as they are overworked, poorly trained in communication, pressed for time, and thus often cannot explain the nuances of incredibly complex topics like care approaches at the end of life.
 I promise you that if a doctor or nurse started giving doses of medications that were inappropriate or not indicated and patients started dying under their care as a result.. they would be immediately be reported by a colleague, lose their license, or even go to jail (maybe not too).. But, you cannot tell me that suddenly the whole staff of a care home collectively and simultaneously started euthanizing or murdering the residents. Not so fun fact: Although I dont know the reimbursement sources of care homes in the UK, if this happened in the U.S, all those workers would soon be out of a job. Why? An empty bed in a nursing/care home.. brings in no money. Last point - do you think providers at care homes have any experience or training in the care of the dying? They absolutely do.
 Thus, I believe, on no granular direct evidence (find me a whistleblower that will change my mind), that they were doing the best they could, in a difficult situation of rapidly spreading Covid in those care homes, in frail, elderly patients that had advance directives that they were not to be hospitalized or ventilated, and, due to their age and frailty and the fact the first Wuhan variant was such a beast, were rapidly succumbing to various degrees of respiratory failure and the providers were trying to keep them comfortable in the only way they could which was to treat symptoms (no effective anti-viral or anti-inflammatory treatments were “approved” remember?).
 Two more issues to address, this “vial” issue where the sedative vials only came in 5mg or 10 mg strengths or something. Who cares? Nurses and doctors know how to dilute any vial, yeesh. You draw up the vial into a syringe, then draw in saline to dilute, and you can carefully titrate to any dose you want. You are not “forced” to only give 10mg or whatever. Absurd.
 The drop in antibiotic use. Yes, I am sure it is because they wanted all their residents to die of secondary bacterial pneumonia. Nonsense. It was a viral induced pneumonia, no antibacterials were indicated in the majority, and so many in care homes died from a viral pneumonia quickly, that I don’t find it that weird that total antibiotic use dropped. “Secondary bacterial pneumonia” certainly occurred, but it was relatively rare, even in the ICU! To suggest that everyone was dying of a secondary bacterial pneumonia (like in 1918 Spanish Flu where a bacterial pneumonia actually was the proximate cause of most deaths) is absurd. I would start antibiotics in the ICU any time I felt something “new” was going on, or they were getting “worse” and I couldn’t rule out a bacterial pneumonia, so I empirically treated them with antibiotics.. Didn’t matter.
 Please everyone, stop interpreting these data as evidence of mass murder or mass euthanasia on the part of committed health care professionals trained in the care of the frail elderly, who were experiencing an unprecedented catastrophic situation in some places, particularly care homes. Although I have been exposed to increasing levels of depravity and absurdity in the actions of authorities in many fields and countries throughout the pandemic, the time period we are talking about is Spring 2020. Not everyone in Medicine had lost their minds… yet.
 See Part 2 here for my hypothesis as to the more proximate root cause of all the deaths.

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Summary: Some Covid experts think that over-use of sedatives and opiates caused the increased deaths in early Covid. They even go as far as suggesting euthanasia was committed. I strongly disagree.