Advanced Mediterranean Diet

On Dec 23, 2021, FDA gave Emergency Use Authorization to molnupiravir as outpatient treatment for COVID-19 in high-risk patients 18 and older. “High risk” means high risk for hospitalization or death from COVID-19. Users need a positive COVID-19 test and should start treatment as early as possible, within five days of symptom onset.

The drug reduced hospitalization and death by 30%. FDA approval was based on a clinical study that included only ~700 patients who got the pill. I assume there were 700 others who got a placebo.

By comparison, Pfizer’s Paxlovid reduced hospitalization and death by 90%.

The dose is 800 mg by mouth every 12 hours for five days. Available capsules contain 200 mg.

Notes:

• The drug is well-tolerated. Most common side effects are diarrhea, nausea, and dizziness.
• No known drug interactions. This is an advantage over Pfizer’s Paxlovid pill.
• No dose adjustment needed for kidney disease, liver disease, or old age. Another advantage over Paxlovid.
• The drug could be dangerous to embryos/fetuses. Don’t get pregnant while taking this! Male users need to use reliable birth control for the three months after use.

Click for FDA’s prescribing information.

Don’t ask me for the drug’s brand name or cost. I couldn’t find those. CNET says the U.S. Fedgov will provides some doses for “free.” I.e., the taxpayers are paying for it. More than 100 million U.S. households, or 61% of all taxpayers, paid no federal income taxes in 2020.

Steve Parker, M.D.

Acetaminophen is a very common drug used to relieve pain and reduce fever. A few of its advantages over non-steroidal anti-inflammatory drugs are that it rarely causes bleeding, upset stomach, or kidney impairment. In excessive doses, acetaminophen causes liver toxicity. The most common brand name is Tylenol.

Last year I watched a video of ZDoggMD and Dr Marty Makarey wherein the latter mentioned offhand that acetaminophen (aka paracetamol) worsens the effect of cytokine storm in COVID-19. That was news to me.

See “Paracetamol-Induced Glutathione Consumption: Is There a Link With Severe COVID-19 Illness?” in Frontiers of Pharmacology, October 2020.

First, note that antioxidant activity is considered an important defense against inflammation, including that which might be due to infection. An important player in antioxidant activity is glutathione. Acetaminophen apparently and commonly reduces blood and cellular glutathione levels. Hence, less antioxidant activity leading to worse infection outcomes. That’s the theory anyway. This is one article that supports Makarey’s remark.

You may have heard about NAC (N-acetylcysteine) being used as a treatment for COVID-19. NAC is a precursor to glutathione.

Guess what the antidote for acetaminophen poisoning is…NAC

From the article linked above:

GSH [glutathione], an abundant tripeptidyl molecule, contributes to the body and lung health status (Cantin and Begin, 1991) and plays pivotal roles in protecting cells against oxidative stress-induced cellular damage, in detoxifying xenobiotics and drug metabolism (Cantoni et al., 1996); decreased GSH levels are associated with the common features of aging as well as of a wide range of pathological conditions (Homma and Fujii, 2015), comorbidities, smoking habit which, intriguingly, represent the major risk factors for COVID-19.

Resistance to viral diseases positively correlates with the extent of GSH stores (Khomich et al., 2018). Higher levels of GSH have been associated with better individual’s responsiveness to viral infections (De Flora et al., 1997; Lee, 2018): in particular, GSH is known to protect host immune cells operating in oxidative stressing environments and contributes to their optimal functioning. Reactive oxygen species (ROS)-induced alterations of the immune response has been proposed as a key player in COVID-19 pathogenesis and antioxidant intervention with NAC recommended as a preventive and therapeutic strategy (De Flora et al., 2020; Schönrich et al., 2020).

Interestingly, preventive supplementation of NAC significantly reduced the incidence of clinically apparent influenza, especially in higher risk elderly population (De Flora et al., 1997). This effect may also depend on the GSH-induced inhibition of various respiratory viruses’ replication, an effect which is thought to prevent increased viral loads and the subsequent massive release of inflammatory cells into the lung. i.e. cytokine storm (Palamara et al., 1996; Nencioni et al., 2003). To this regard, GSH may also have direct anti-SARS-CoV-2 potential: indeed a computational study indicates that the binding of spike protein to ACE2 is maximal when ACE2-sulfur groups are in the form of disulfides and impaired when fully reduced to thiols: hence a prooxidant environment with low levels of GSH would favor viruses cellular entry (Hati and Bhattacharyya, 2020).

One of the authors’ conclusions is:

The routinary use of PAC [paracetamol, aka acetaminophen] in at risk categories, along with their intrinsically frail conditions, may have further worsen the scarcity of GSH, especially in western countries where PAC consumption is particularly high. Such a situation may have rendered this group of population even more susceptible to SARS-CoV2 at the time of its spreading. To this end a merely speculative but intriguing hypothesis is that PAC adoption might have contributed to the high virulence of COVID-19 observed in many EU countries and USA. Notably, in most countries PAC is freely sold as an OTC [over the counter] drug, raising the risk of unintentional abuse and increased adverse effects (Sansgiry et al., 2017).

Interesting stuff. But at this point there is no medical consensus on this issue.

Steve Parker, M.D.

Are you ready to give up on the vaccines? Despite brisk uptake of the Pfizer and Moderna vaccines starting in early 2021, there were more U.S. COVID-19 deaths in 2021 than in the first year of the pandemic, 2020. Are you gonna blame the un-vax’d, like Biden, Fauci, and CNN? Right now we’re seeing the highest “case rates” we’ve ever seen, despite 62% of the population being fully vaccinated.

We just need a more people vax’d, right? We’ll have herd immunity when 75% of us are vax’d, right?

Vermont is 78% vax’d. Look at their cases:

But that’s only one example. In Ontario, Canada, over 90 per cent of Ontarians aged 12 years and older have received one dose of a COVID-19 vaccine and 88.2 per cent have received two doses. Yet here are their cases:

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Pfizer and Moderna Vaccines Less Effective Against Omicron Compared to Delta Variant, and Effectiveness Wanes Quickly. So Vax More Often…!

Vaccine effectiveness against SARS-CoV-2 infection with the Omicron or Delta variants following a two-dose or booster BNT162b2 or mRNA-1273 vaccination series: A Danish cohort study

This study found negative vaccine effectiveness four months after vaccination. So they increase your odds of getting sick?!

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Mississippi hospital fires doctor, anti-vaccine leader for treating COVID patients with ivermectin.

The founder of an anti-vaccine mandate group of Mississippi physicians said he was fired from his job at Yazoo City hospital emergency room on Friday. Dr. John Witcher, an emergency physician working at Baptist Memorial Hospital in Yazoo City, said in a video his firing came after taking three patients off FDA-approved COVID-19 medication and replacing it with ivermectin. Baptist Memorial says he was working as an independent physician and was not a hospital employee.

Here’s the coverage at MedPage Today.

They say Dr Witcher was working as an emergency physician in the emergency room. In my part of the world, it would be highly unusual for an ER physician to stop an active order for remdesivir ordered by another physician. Once the decision is made to admit the patient to the hospital, care is turned over to another physician and the emergency doc is out of the picture. I don’t think we have the full story here.

Remdesivir is a Gilead drug. Pfizer makes it for them.

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Opinion: How have we gotten here? Mass Formation Psychosis, explained

I received the following comment recently from a reader in Africa, on a column I wrote a while back regarding natural immunity. It captures the essence of my daily inner dialogue.  

“Arguments from privileged countries. We in Africa have little access to vaccines, boosters, etc. The question we should be asking is, how is Africa managing? You people have already caused mayhem over Omicron. Our good doctors from South Africa have told us not to panic, but the rest of the world is in the highest panic mode yet … your countries’ have over 70% vaccinated, boosted etc. You should be at peace … you will die of fear.” 

* * *

There are four basic conditions which need to be met in order for a society to be vulnerable to mass hypnosis. The first of which is a lack of societal bonding. It is easily argued that members of Western society struggled with loneliness long before the pandemic, and then with the ongoing lockdowns, isolation, and general fear of one another, this lack of community has continued to a dangerous degree.  

The second condition is met when the majority of people view their lives as being without purpose or meaning. A recent poll of young people in the UK revealed that 89 percent of those aged 16-29, “believe that their lives have no meaning or purpose.” Desmet also cites studies showing that half of all adults believe that their jobs are completely meaningless and are basically “sleepwalking” through their day.  

Free floating anxiety is the third condition for the rise of mass formation. A quick count of the number of anxiety/depression medications prescribed each year, confirms that there is no arguing the crushing levels of anxiety prevalent in our communities. 

And the fourth condition is high levels of frustration and aggression, with no discernible cause. If you spend any time driving or on social media these days, you will experience the open hostility present in the world today. 

An alternate opinion at Forbes:

What Is Mass Formation Psychosis? Robert Malone Makes Unfounded Covid-19 Vaccine Claims On Joe Rogan Show

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Steve Parker, M.D.

If you believe the current political/media/globalist propaganda on COVID-19, this three-hour interview may change your mind. I don’t know how you can see the interview without opening a Spotify account and downloading their app. After that, search for The Joe Rogan Experience podcast then search for Dr Robert Malone. The interview was in Dec 2021. You can speed up the interview so it doesn’t take three hours. I listened at 1.5 x speed.

Herein, Dr Malone recommends against vaccination if you’ve already had COVID-19 because that that would increase your risk of an adverse effect from the vaccine. Which you don’t need anyway because the immunity you develop from being sick with COVID is better than the immune response to the vaccine.

Steve Parker, M.D.

Oral preventatives during disease surges:

• Vitamin D (cholecalciferol)1,000-2,000 IU/day. (Gruff Davies and Linda Benskin recommend, in general, 4,000 IU daily, perhaps year-round, or whatever combination of food, supplementation, and sunlight gets your blood level of 25-hydroxy vitamin D to to 50 ng/mL.)
• Aspirin 81-325 mg/day
• Vitamin C 500 mg/day
• Elemental zinc 10-50 mg/day
• Melatonin 1.5-6 mg/day at night or bedtime

The doses vary, depending on body weight, age, tolerance to the drug. Generally, the higher doses are for younger and heavier folks. If one gets plentiful sunlight exposure, the oral vitamin D may not be needed.

Other strategies during disease surges (or always?):

• Regular exercise
• Lose excess weight, especially if obese (BMI over 30)
• Maintain normal blood sugars (if diabetic, keep HgbA1c under 6.5%)
• Avoid close, prolonged contact with coughing and sneezing people, especially in enclosed spaces
• Frequent hand-washing if exposed to public doorknobs, elevator buttons, or other potentially contaminated surfaces, or if around sick (coughing and/or sneezing) people
• Avoid sick people who are coughing and sneezing
• Eat healthful food

Did you notice I haven’t mentioned masks? I’m not a big believer. Do I wear an N-95 mask when I’m seeing a COVID-19 patient at the hospital? You bet. And the mask was fit-tested. Is that testing available to the general public? Not that I’m aware.

Do I have great data to support all these strategies? No, but some. Are they recommended by the CDC or NIH (Nat’l Institutes of Health)? I don’t know or care. I’ve lost faith in them. I’m afraid they’ve been bought and paid for by Big Pharma (and others?).

I don’t know about your personal health and medical history. I’m not your doctor. If you’re considering any of these recommendations, consult your personal physician before implementation.

I was motivated to write this post by the failures and risks of the rushed vaccines. Vaccination might be helpful if you are sickly, over 65, or have underlying conditions such as diabetes, active cancer, a poor immune system, obesity (especially BMI over 35), or some other co-morbidities. I see both very healthy, vigorous 65-year-olds, and sickly 65-year-olds. Which one are you? If you’re over 80, you may have nothing to lose by vaccinating. Average U.S. life expectancy is 79 years, less for men, longer for women.

Steve Parker, M.D.

Update on Jan 9, 2022:

From Dr Robert Malone in his substack Dec 31, 2021:

“So, yes back to my thoughts on Omicron – please keep taking that vitamin D3 and get your levels tested, if you haven’t already.  Use a formulation that combines the D3 with Vitamins A and K. Please keep up with the zinc, vitamin C and magnesium.  Work on weight control, glycemic control and please exercise!  All are important.”

No scientific references provided. He’s smarter than me.

I can’t say I’d heard about it until recently. AAPS in November published an inflammatory article about the CARES act. Some excerpts:

Creating a “National Pandemic Emergency” provided justification for such sweeping actions that override individual physician medical decision-making and patients’ rights. The CARES Act provides incentives for hospitals to use treatments dictated solely by the federal government under the auspices of the NIH. These “bounties” must paid back if not “earned” by making the COVID-19 diagnosis and following the COVID-19 protocol.

The hospital payments include:

• A “free” required PCR test in the Emergency Room or upon admission for every patient, with government-paid fee to hospital.
• Added bonus payment for each positive COVID-19 diagnosis.
• Another bonus for a COVID-19 admission to the hospital.
• A 20 percent “boost” bonus payment from Medicare on the entire hospital bill for use of remdesivir instead of medicines such as Ivermectin.
• Another and larger bonus payment to the hospital if a COVID-19 patient is mechanically ventilated.
• More money to the hospital if cause of death is listed as COVID-19, even if patient did not die directly of COVID-19.
• A COVID-19 diagnosis also provides extra payments to coroners.

CMS implemented “value-based” payment programs that track data such as how many workers at a healthcare facility receive a COVID-19 vaccine. Now we see why many hospitals implemented COVID-19 vaccine mandates. They are paid more.

Because of obfuscation with medical coding and legal jargon, we cannot be certain of the actual amount each hospital receives per COVID-19 patient. But Attorney Thomas Renz and CMS whistleblowers have calculated a total payment of at least $100,000 per patient.

You can read the CARES act for yourself.

For more scintillating reading, see Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency.

By no means do I agree with everything written and implied in the AAPS article. For instance, at my hospital we do everything we can to avoid intubation, and do it only if we think the patient is about to die in the next few minutes or couple hours if not intubated. If we thought intubation was futile, we wouldn’t do it.

From one source:

The in-hospital mortality rate of intubated COVID-19 patients worldwide ranges from approximately 8% to 67%, but in the US, it is between 23 and 67%. There is substantial variability in the disease process, such that some patients rapidly deteriorate and die of severe respiratory failure or multiple organ failure within 1 to 2 weeks after intubation, while others recover, despite requiring mechanical ventilation.

The same source found the mortality rate of intubated COVID-19 patients within the two weeks after intubation at their hospitals was 45%. Unfortunately, the report doesn’t say what percentage of the initial survivors eventually died of COVID-19 anyway. That’s important information. The study at hand was done in New York early in the pandemic in 2020. I’d like to think we’re better at treating the disease now, 21 months later.

An Italian study, also done early in the pandemic in 2020, found that 43% of ICU (intensive care unit) COVID-19 intubated patients died in the hospital. If 57% survived intubation, that’s far from futile care.

If you find significantly different death rates in published studies, please share with a link in the Comments. I didn’t do an extensive search.

As far as I know, none of my hospitalist colleagues have ever been pressured to list COVID-19 as the cause of death when that was not actually the cause of death. Our death certificates are filed by us directly online with the State of Arizona.

What is very fishy about this illness is the degree to which hospital administrators, politicians, bureaucrats, and others have dictated how most physicians have to treat the illness and muzzled or attempted to muzzle dissident voices, disregarding the underlying science. In forty years of medical practice, I’ve never seen anything else like it.

Highly suspicious.

Steve Parker, M.D.