Author Archives: gonzo66

Some notes on Anti-Vaccination

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David Crippen, MD

Antivax- An argument sort of like the war cry of the Appalachian Wing Nut: “Ain’t no gov’ment gonna tell me what to do”, but in fact, it’s an empty argument since the Gov’ment tells all of us what to do all the time and if we don’t do it, there are unpleasant consequences. We must prove we have liability insurance for our cars. We must wear seat belts. We must have “approved” child seats for kids ion our vehicles.  We have speed limits. States with a half a grain of sense have mandatory DOT approved helmets for motorcyclists. We must pay income tax. There are rules pertaining to possession and use of firearms. If there are minor children involved, you must pay child support in the advent of divorce. The list goes on and on, 

And by the way, by law your child must have several vaccinations before they can enter public school. All these vaccinations are considered extremely safe and the very few adverse reactions that might occur are inconsequential compared to the disaster if any kid gets the childhood diseases they would be protected from. So-called “anti-vaxxers” are a blight on the planet. When they get away with avoiding vaccines for childhood diseases, those diseases (measles) explode in those areas.

The number of vaccinations in the USA have stalled now at under 50% for all the population last I looked, not enough for “herd immunity”, which means that the resistant forms of COVID in the un-vaccinated now have fresh meat. As a result the number of hospital admissions for COVID related issues are exploding. CDC reports that from one year (August 01, 2020 – July 30, 2021) there were two and a half million hospital admissions for COVID and over six hundred thousand deaths. All increasing now since the advent of the delta variation.

The number of vaccinations are stalled because we’ve reached the population that understand the importance of the shots and go out of their way to get them. We’re now looking at the population that actively reject the shots for whatever reason. Some distrustful of them, some political, some rabid anti-vaxxers, some lazy and don’t care. Some states have tried to generate interest by offering money and other incentives. If you watch Fareed Zakeria’s show this Sunday morning, one of his guests went into detail on why that won’t work. His book “Nudges” is quite interesting, 

Nobel winner Richard Thaler suggests that the way to get all those recalcitrants in gear is to create the same kinds of irritating adverse consequences we all suffer if we get crosswise with all the irritating laws currently in place (by the gov’ment). Sorry- no mask, no service. Sorry, no vaccination card, no seat on an aircraft. Sorry, no vaccination card, go eat or work somewhere else. Your kid didn’t get his vaccinations?  Home school. Those are the incentives that get people to comply with things like vaccinations.

If there are no adverse consequences to that population who for whatever reason don’t get the shots (and that’s where we’re stalled), then that population will inevitably land in hospitals and many will die from the virus. The personal and economic consequences of this mandate the same kind of laws that exist to protect the population.  It isn’t a personal choice issue. It’s my personal choice if I choose to drive my Ferrari at 120 miles per hour on Rt 28 near my home. But if I choose to do so, there are unpleasant consequences if I get caught, which is likely as a yellow Ferrari passing other cars like they’re standing still sort of stands out. 

There is no convincing data that there are any untoward reactions to any of the vaccinations more than would be expected by luck of the draw. There is convincing evidence that the vaccinations are at least as safe and effective as childhood disease vaccinations. The consequences of COVID are positively scary and are getting worse by the month. If we don’t achieve something like “herd immunity” (the virus is stamped out for want of a susceptible population), this scourge has the potential to keep killing people indefinitely. If there are no consequences for those refusing the immunization, the won’t do it, and that action will have it’s own consequences.

Unclear to me exactly what your argument against demonstrably effective vaccinations for viral illness is. The Government tells all of us what to do all the time and if we don’t do it, there are unpleasant consequences. We must prove we have liability insurance for our cars. We must wear seat belts. We must have “approved” child seats for kids in our vehicles.  We have speed limits. States with a half a grain of sense have mandatory DOT approved helmets for motorcyclists. We must pay income tax. There are rules pertaining to possession and use of firearms. If there are minor children involved, you must pay child support in the advent of divorce. The list goes on and on,

And as it pertains to children, by law, a school age child must have several vaccinations before they can enter public school. All these vaccinations are considered extremely safe and the very few adverse reactions that might occur are inconsequential compared to the disaster if any kid gets the childhood diseases they would be protected from. Polio and Smallpox were wiped out by vaccinations. So-called “anti-vaxxers” are blight on the planet. When they get away with avoiding vaccines for childhood diseases, those diseases (measles) explode in those areas. Nut cases like Jenny McCarthy know nothing about the science and are using completely obsolete evidence.

The number of vaccinations in the USA have stalled now at around 60% for all the population last I looked, not enough for “herd immunity”, which means that the resistant forms of COVID in the un-vaccinated now have fresh meat. As a result the number of hospital admissions for COVID related issues are exploding. Current numbers from the New York Times show to date in Pennsylvania there are 2.62 million COVID cases and 40,257 deaths. 

Way back when dinosaurs roamed the earth, I was a medical microbiology major in college. At some point, I had a virology course, taught by a full professor. The question of whether viruses were alive inevitably came up. Best of my recollection, the professor said there were two basic criteria that defined “life”:

  1. The ability to replicate.
  2. The ability to adapt to (survive) injurious environments.

If such an entity could not replicate or couldn’t adapt, the line would also stop right there.  The question of whether “personality” was necessary for life was undefined. Probably not, but then do we know whether viruses have personality?

Viruses most likely originated from early RNA-containing cells that for unknown reasons made an evolutionary leap away from the cellular form, casting off weighty metabolic shackles to opt for a more streamlined existence. While a virion is biologically inert in and of itself, once it enters a hospitable environment, it most assuredly can replicate and adapt. It is therefore “alive” (and smart) in a satisfactory sense.

The nature of a virus is to change its form to survive any environment. When one environment gets hostile, maybe from a creation of antibodies, it morphs to become resistant to those threats. Started with the original virus, then morphed to Delta and now Omicron. Pretty good chance it will continue to do so, maybe indefinitely, but each iteration becomes less virulent. There doesn’t seem to be much evidence that this virus will die off any time soon, even if we reach huge levels of vaccinated humans. We don’t seem to be on a rapid course for that. We’ll probably end up with yearly shots for it just like the usual Flu.

The numbers of vaccinations are stalled because we’ve reached the population that understand the importance of the shots and go out of their way to get them. We’re now looking at the population that actively reject the shots for whatever reason. Some distrustful of them, some political, some rabid anti-vaxxers, some lazy and don’t care. Some states have tried to generate interest by offering money and other incentives. If you watch Fareed Zakeria’s show a few Sundays ago, one of his guests went into detail on why that won’t work. 

Nobel winner Richard Thaler suggests that the way to get all those recalcitrants in gear is to create the same kinds of irritating adverse consequences we all suffer if we get crosswise with all the irritating laws currently in place (by the government). Sorry- no mask, no service. Sorry, no vaccination card, no seat on an aircraft. Sorry, no vaccination card, go eat or work somewhere else. Your kid didn’t get his vaccinations?  Home school. Those are the incentives that get people to comply with things like vaccinations. 

If there are no adverse consequences to that population who for whatever reason don’t get the shots (and that’s where we’re stalled), then that population will inevitably land in hospitals and many will die from the virus. The personal and economic consequences of this mandate the same kind of laws that exist to protect the population.  It isn’t a personal choice issue. It’s my personal choice if I choose to drive my Ferrari at 120 miles per hour on Rt 28 near my home. But if I choose to do so, there are unpleasant consequences if I get caught, which is likely as a yellow Ferrari passing other cars like they’re standing still sort of stands out. 

There is no convincing data that there are any untoward reactions to any of the vaccinations more than would be expected by luck of the draw. There is convincing evidence that the vaccinations are at least as safe and effective as childhood disease vaccinations. The consequences of COVID are positively scary and are getting worse by the month. If we don’t achieve something like “herd immunity” (the virus is stamped out for want of a susceptible population), this scourge has the potential to keep killing people indefinitely. If there are no consequences for those refusing the immunization, they won’t do it, and that action will have it’s own consequences.

I and everyone I know got the booster because it’s the lesser evil and the numbers are definitely on our side. The statistics clearly show that over 90% of those hospitalized and dying didn’t get the shots. Those that did had very mild courses if they got the bug. Two of my clinical colleagues that took a stand against the shots BOTH ended up in an ICU, one almost died. Don’t get fired over this. Your career is worth infinitely more than making a stand for a lost cause.

A simple, desultory philippic…….2/20/22

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We’ve explored politics now for a while. Just for grins, let’s take some time to explore the “times that stir men’s souls”- Rock music, a dying art form. I do this a great length in my two Pitt Osher Lifelong Learning Institute classes on Rock Music Appreciations (60s and 70s). I’m told there is some interest among academic Pitt students for a 3-credit class by me on these subjects and I’m looking into it for next Fall. Even if you have no clue who Led Zeppelin is, it’s a good general education subject you can amaze your otherwise unknowledgeable friends with.

Let me give you a little history and philosophy of this captivating art.  

Among other things, the revolutionary 60’s changed everything in music. Strains of “Are you experienced” by Hendrix and “The End” from the Doors wafted out of dorm room doors in the mid-60s replacing girl groups and do-wop. No one had ever heard anything like this before and it changed lives, putting young adults in tune with what was going on in society and government. Then the age of 60s “collectivism” and communalism died under its own weight, morphing to the “Me Generation” of the early 70s. Convoluted “Bands” morphed to “singer-songwriters”; Sweet Baby James, Paul Simon, Don Mclean and getting in touch with one’s inner self. 

The 70s, evolved to a rich tapestry of music embodying some of the most talent musicians in history, an alternate universe of unconventional social mores passing through optimistic iterations to ultimately to end in a fatal mutation. An exploration of “no limits”, the price of admission for which a number of very talented players paid with their lives.

The medium of Rock has always been one of rebellion against conformity and conventionality. A high risk-high gain medium selecting for those actively living the dream, selecting strains and chords to pull resonant strings of the human brain, abandoning order. The stuff of existential anti-heroism, inviting those seeking salvation by immersing their souls in cathartic rock media masquerading as social profundity.

Those selected as the cast in this living theater had no safety net and were drawn in at their peril. Normally composed hominids become temporarily irrational at a Jerry Lee Lewis concert and ripped out seats. Jerry Lee lights a piano on fire and is carried out still playing by firemen. Duane Allman thought he was immune to laws of traffic. Bonzo and Moonie thought they were immune to the dangers of ethanol. Hendrix couldn’t sleep without escalating soporifics that ultimately put him to sleep forever. Cobain chose the brief pain of a shotgun blast to end the constant pain of his life. Jim Morrison died alone in a bathtub.

The early 70s were also a straight up revolution, preceded by the assassinations of Robert F. Kennedy and Martin Luther King in 1968 and nurtured by the violent Democratic National Convention also of 1968. An age of violent protest. Nixon Agonistes, the Students for a Democratic Society and the Weather Faction, Kent State, Vietnam Veterans Against the War (it’s head- John Kerry), Angela Davis and Black Power.

MLK was assassinated on April 4, 1968, the day before I left for Vietnam. The country exploded and, as you can imagine, the Brothers in my unit finishing jungle training at Ft. Bragg, NC were upset beyond belief. But we all understood that we were all responsible for each other once we arrived in-country, if for no other reason than no one else would be. So, I ran into one of the Brothers crying in the bathroom and touched his shoulder (in retrospect, maybe a dangerous move under the circumstances). I told him how painful this was for me as well and he accepted that. We never had a problem from that moment on. The candidate for President Robert Kennedy tearfully announced the death of MLK to the country from the back of a truck platform in Indianapolis.

Much but not all of the 70s related to an intensely polarizing President and the unpopular Vietnam conflict that remained in full swing. The current perception of popular unrest in the 2000s is jejune in comparison. In the early 70s, virtually every city in the country brimmed with firebombs, looting and the crackle of small arms fire. Business owners sat in shifts with shotguns propped on their toes outside their storefronts nightly.  

But I digress.

Something very important was happening to American music in the 70s. Dave Grohl believes that virtually all Rock music can eventually be traced to a central origin, nurtured and modulated in the turn of the 60s into the 70s. The best way to explain that concept is to postulate the repository of Rock music as an unstable white dwarf star in the universe, undulating and straining but not ready to explode into a supernova just yet, waiting for the right stimulus. Back in the 40s, big band music was simple and staid, feeding upon itself. In the 50s, a fundamental instability began with skiffle in England that created the Beatles. In the USA, be-bop and rhythm & blues, Gene Vincent and the Blue Caps, Little Richard, Jerry Lee Lewis and of course, Elvis. 

All of this boiled to the surface to bring the star to an explosive point in the 60s and 70s, setting the stage for the cataclysm it all literally and metaphorically went electric. A musical revolution never before dreamed of and will probably never be seen again. The star erupted sending chunks of musical expression out into the abyss to change the fundamental nature of music.

To name a few off the top- Hendrix, The Animals, the Zombies, The Kinks, Cream, the Doors, Pink Floyd, The Rolling Stones, Frank Zappa, Otis Redding, Credence Clearwater, The Byrds, Janis Joplin, James Brown, Miles Davis, The Who, Sly & the Family Stone, Paul Butterfield Blues Band, Buffalo Springfield, Procol Harum, Paul Revere & Raiders, Hollies, Dave Clark Five, Neil Young, Steve Miller Band, The Guess Who, Steppenwolf, Blood, Sweat & Tears, Jefferson Airplane all at once.

Each of these chunks shone brightly and autonomously, but in the end, like real stars, gravity must eventually rule and all the chunks were slowly drawn back into the star’s mass, stabilizing them into a heterologous mass of eclectic sound and tone. The metamorphosed star then launched a kind of solar wind from its surface, fabricating swells of unfiltered music that waxed & waned in time, creating vacuous slabs- Disco, Britney Spears, Justin Bieber, “American Idol”,’ The Voice”, Rap, Hip-Hop, Snoop Dog and many more dead or in jail. Survivors all wafting around out there at the whims of aimless, desultory mini-eruptions.

But the solar wind occasionally allows some bright spots, some incredible music out there but it’s dying out as the original artists age.  If you seek it, there is one rule. Don’t follow the money. The money will lead you to hype, glitz and an empty box with “Kardashian” somewhere on it. The performers that we’re still listening to pushing 50 years ago wandered into Nashville or San Francisco on foot, broke with a Taylor or Telecaster strung over their back and played for five drunks in a dark bistro. 

They all shared one commitment- absolutely no compromise. The music was what it was and would not be altered for any commercial advantage. It was all about the music. They didn’t care if they starved as long as someone was listening. The further you get away from money, the better it gets.

The one big paradox in American music is the ascension of mediocre talent to big money. Few performers illustrate mediocre voice talent more than Taylor Swift or her interchangeable monozygote Katie Perry. I’ve heard equal voice talent in local bar band singers. As it pertains to the nuts and bolts of voicing, tone and ear worthiness, neither can stand on the same stage as Sharleen Spiteri of the Glasgow band “Texas”, who in 25 years continues to enjoy only local UK exposure.

Ms. Swift’s albums of sophomoric personal narratives, “1989” sold 1.287 million copies in its first week, debuting at number one on the Billboard 200 and making Swift the first singer to have three albums sell more than one million copies in a week. It’s difficult to explain how this can be.  The unfortunate reality is that lack of talent does not necessarily equal failure once creative marketing becomes involved. 

Taylor Swift started out in Nashville spending at least half her career learning creative marketing techniques applied to performance art for the specific goal of moneymaking while delivering a serviceable vocal product. For years her mentors gently nurtured her into a product that would fill a bill encapsulated with money. It was about leaping onto stage from spring loaded boxes dressed to show her figure as provocatively as possible and warbling to the flashing lights and swells of electrified instruments.

Recently, Charlie Rose interviewed actor Jake Gyllenhaal regarding his film “Nightcrawler”. The conversation described a sociopath that creeps around Los Angeles at night photographing violent, salacious activities and selling them to local TV stations. The question of who could possibly be interested in such things arose. The answer was interesting. 

Back in the 60s, television news was immune from TV station merchandizing. This changed somewhere along the way, demanding that the news section generate a profit. This quickly produced what we see now on every local TV station in the country. Roving reporters searching for anything that might possibly be interesting to a population of jaded viewers otherwise bored with life in general. Weepy mothers decrying their kid shot dead just minding his business in the middle of a high drug exchange area at 3am. Vivid car accidents. High visibility court cases. 

This is news? No, it’s entertainment and it draws viewers, which draws sponsors generating money by lying straight faced about their products. It is an inalterable fact of our life, as are blatantly deceptive TV commercials for products that don’t work, even for Shaq.

Unclear where this will end if it ever does. But where they shone, they shone oh so brightly.

“Lies and the lying liars that tell them” (Al Franken)

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I continue to notice some things about TV commercials over the past few months. I wonder if anyone else has as well.

1.  I’d hazard a guess that at least two thirds of all network TV advertisements, maybe more, involve Big Pharma drugs hawked to would-be patients. Many hawk incredibly esoteric drugs to treat extremely unusual and relatively rare diseases. Once approved and marketed, several companies have shown that huge profits can be made on orphan drugs despite small numbers of potentially treatable patients. Gross profit margins of over 80% are reported in the rare disease industry, whereas the pharmaceutical industry average is 16%. Those ads exhort watchers to “ask your doctor if these drugs might be right for you”. Any of those specialists dealing with those diseases would intimately know these drugs well and would certainly not need reminding from potential patients watching TV ads. Big Pharma must be making a bundle off these expensive TV ads, or they wouldn’t be promoting them.

3.  Over-the-counter commercials are taking a lot more liberty with the truth than even a few years ago.  Best of all is a memory aid promoted by new “Jeopardy” host Mayim Bialik- “Neuriva Plus” as the brain supplement that “thinks bigger” so you can too”.  Mayim says, “I’m a real neuroscientist and I like the science behind Neuriva”. But because these supplements are OTC, they not required to undergo testing to show exactly how they work in the body.

So, the issue of Dr. Bialik being a “real neuroscientist” bears some examination. Yes, she has a PhD in “neuroscience” but it’s unclear exactly what that is. She’s not a physician, nor is she an accredited researcher. She’s an actress and has done nothing detectable with her PhD. Zero publications, no teaching at any college level and no lab work. Her esoteric dissertation has nothing to do with memory and she has no peer reviewed references in her dissertation. She’s written a Vegan cookbook. Recently, the manufacturer was forced to withdraw claims that Neuriva is science and clinically proven. In her research, she might have overlooked a March 27, 2020, article in Psychology Today by Gary L. Wenk, Ph.D. Author of Your Brain on Food. He called it snake oil.

3.  Three older guys in white coats sitting around surmising what the best analgesics for their patients in pain might be. On the nearest one, you can see “MD” on his name tag, but his actual Christian name is obscured. They all agree that their pained patients should all be using “Salonpas gel analgesic” (OTC).  The active ingredient is diclofenac sodium 1% gel, absorbed through the skin. Brand name Voltaren. It’s been around in one form or another since the 60s. 

Diclofenac is a NSAID like all the rest. There is no convincing evidence that absorbable diclofenac is any more effective in that route than any other NSAID taken orally. The same risks apply, none of which are mentioned by our three would-be physicians concerned with their patient’s pain issues.  A similar drug, rofecoxib (Vioxx), in the same non-steroidal anti-inflammatory drug family as diclofenac, was voluntarily taken off the market by its manufacturer in 2004 amid concerns over associated heart risks. There is an ongoing Europe-wide review of diclofenac’s safety. Evidence is lacking to determine the effectiveness of topical NSAIDs compared with oral NSAIDs.

4.  The worst. Endless, run-on ads exhorting social security recipients to call a number seeking to determine if they aren’t getting SS benefits, they deserve because the Medicare agency is intentionally withholding that information. Such has-been stars as Broadway Joe Namath and the former “Good Times” actor Jimmy Walker gleefully hyping the 800 number. Several things about this intensely misleading ad. First, if you watch closely, you’ll see that all these extra pie-in-the-sky SS benefits are never added on to Part A and B of Medicare benefits for free. They’re “available” for extra cash outlay, sometimes a lot of it. The ad doesn’t say you’ll get any of these extra benefits, dental, optical, free rides to doctors’ offices and such.  It says that the phone call to find out if any of these things are “available” is free.  The talking heads (fully compensated, BTW) don’t say they got anything. They say they’re glad they made the call. Down in the fine print, it states that callers will be put through to a licensed insurance salesperson (to sell the caller extra benefits.)

A compensated talking head- “I Called the 800 Number to See What Extra Medicare Benefits I Could Get – An Actual Person Answered Looked Up My Zip Code”. That talking head neglects to say any other benefits were accessed. There are a lot of government regulations associated with Medicare and looking up a zip code does not necessarily mean extra benefits are in the works. “The 2021 Medicare Helpline is not affiliated with or acting on behalf of any government agency or program”. A “licensed sales agent” will sadly let you know you’re not eligible for any of this, but they’ll be happy to sell them you.

4.  Over-the-counter back pain aids are in a class by themselves. The one that floats quickly to the top is “Salonpas” pain patch, a masterpiece of the effectiveness of placebo effect. This is a patch of 5% lidocaine placed on the lower back, said to decrease low back pain. Many sing its praises. In fact, the skin is a very effective barrier to things just like lidocaine, which never gets deeper than a few millimeters, nowhere near the strained muscles. If there were enough real lidocaine soaking into the muscles of the back, the patient would be seizing from toxicity. In fact, low back pain has a very potent psychological angle to it. An article a while back in one of the journals looked at the long-term effectiveness of Physical Therapy, Chiropractic, Orthopedics and good ole family doctor treatment. The results were identical if enough time went by. 

Photo journalism in Vietnam (1963 – 1975)

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Journalists covering action in Vietnam (or elsewhere) try to paint a word picture in the minds of readers describing what they see. Some more successfully than others as those words are amenable to social or political bias. Joe Galloway was successful describing the horror in the Ia drang valley in 1965, but only in prosaic terms requiring the reader to create form and function from that void.

Studies in sadness

Compiled by David Crippen, MD

135 photographers from either sides of the Vietnam conflict killed or missing presumed dead. 

This collection is a memorial to them and their photographs, a VERY important piece of history that I need to dwell on for many reasons. Those of us that were involved in Vietnam are now in our 70s and we’re dying out. Soon, no one will remember Vietnam, a fate that awaited a similar political mistake, Korea in the 50s. The mistakes that led to Vietnam still being made today, events that are important and need to be accurately recorded vividly.

Today’s young people now largely forget the amazing decade that set the stage for much that’s happening in our culture. I frequently toss out some 60s icons to my young doctors on rounds just to see the reaction. Ha! Usually greeted by blank looks. None of them have a clue of the location of Alice’s Restaurant, visualize that deaf, dumb & blind kid Tommy, recall Timothy Leary, how the Jefferson Airplane, Strawberry Alarm Clock, Moby Grape, Foghat, Creedence Clearwater Revival, The Zombies, The Byrds, Country Joe & the Fish and The Mothers of Invention shaped the culture of the era. 

They will possibly read word accounts of what happened in that era that profoundly shaped our world. The assassination of Jack Kennedy, Robert Kennedy, Civil rights, Medicare and Medicaid, Freedom riders, the assassination of Dr. Martin Luther King, the Berkeley Free Speech Movement, a man on the moon, the Weather Underground and the Days of Rage. These things can be testified by TV talking heads, but photographs detail the passion involved, not just the dry details. It’s IMPORTANT to understand the passion behind the words because if they aren’t collected, young people today will never know them. A tragedy, as they are so important to history.

I returned to Hanoi in 2012, visiting one of the museums and I noted a display of the photographer Robert J. Ellison (1944-1967), killed in action at Da Nang after less than a year in Vietnam. One of the few known personal photos of Eliison in Da Nang was displayed alone on a wall. Look at that face for a long time and you’ll see the pain and passion showing the reality he saw through those eyes. It brought me to tears. 

I was absolutely devastated by this display and it prompted me to assemble this collection photos by Vietnam photo journalists, some killed in action. I tacked on some of the photos I took in 1968-69 as an aside.

Rob Ellison landed in Vietnam in early 1967 with no credentials, one duffel and three cameras. He finessed his way out to Khe Sanh on a supply helicopter with a case of beer and box of cigars. On arriving at the violence-infested area, Rob insinuated himself into the full fury of the action, cheek by jowl with the Marine grunts, photographing the action as it happened in the unimaginable fiery Hell that was Khe Sanh in the early months of 1967.  Rob was killed when, as a passenger, the C-130 took rocket fire and crashed killing everyone on board. The bodies were not identifiable and are all buried in a mass grave in Missouri. Rob Ellison was 23 years old.

The genius of Van Gogh translated to a photographic vision. I stood heartbroken, feeling the vibrations of his urgent passion and what I knew he had to do to seek it out. I had to know him. I went on to collect many of his photos and they spoke to me, as they will for you.

Posthumously, Ellison has been rated as one of the top young photographers in the world. The Newsweek edition of March 18, 1968 carried eight pages of photos by him of the battle for Khe Sahn. His photographs were graphic illustrations what the Vietnam conflict was like in real life, not watered down media depictions.

Rare female photographer in hot zones, Dickey Chapelle was killed after the lieutenant in front of her kicked a tripwire mortar shell booby trap. Chapelle was hit in the neck by a piece of shrapnel which severed her carotid artery.  Clip shows Marine Chaplain giving photographer Dickey Chapelle last rites.

Larry Burrows covered the war in Vietnam from 1962 until his death in 1971. His work is cited as the most visually caustic photography from the war.  One of his most famous collections was published in LIFE Magazine on 16 April 1965. Burrows died in a helicopter shot down over Laos in 1971.  The scant remains of Burrows and fellow photographers Huet, Potter and Shimamoto were honored and interred at the Newseum in Washington, D.C.

Robert Capa accompanied a French regiment at the ill-fated battle for Dien Bien Phu in 1954 that should have been a massive red flag for further military adventure in Viet Nam. His photos graphically captured the agony of the futile holdout. On May 25, 1954 Capra passed through a dangerous area under fire and stepped on a land mine. He is buried in Westchester County, New York.  The Overseas Press Club created the Robert Capa Gold Medal in the photographer’s honor.

It is impossible to understand Vietnam without reading “Hell in a very small place” (The siege of Dien Beien Phu,1954) and “Street without joy” (a clear warning about what American forces would face in the jungles of Southeast Asia).  While accompanying a company of the 1st Battalion 9th Marines on Operation Chinook II in the “Street Without Joy” (Thừa Thiên Province) in 1967, Fall was killed after stepping on a Bouncing Betty land mine.

There are many others in “Requiem”, many heartbreaking.

I have collected some of these photographs in a Power Point presentation for you to peruse and etch into your general education memory. I would ask you to take a few minutes and view them, as they are really important history. Also included are some photos I took between 1968 and early 1970 if anyone has any interest. (see enclosures).  It was necessary to keep these Power Points under 10 MB each or they’ll hang up on the server so I had to reduce the size of some, reducing their resolution. 

Film Review: “Roadrunner (2021)

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The movies are making a comeback now that the Pandemic seems to be receding. They’re slowly showing up in theaters now, but I was surprised that we were the only couple in the theater module showing this interesting saga of the late Anthony Bourdain. I’m a bit surprised that the theater survived for a year and a half sitting fal

Anthony Bourdain is a fascinating man who tried and failed to traverse the path between success and happiness. He opined right from the beginning that he had no particular talent for anything, yet progressed to a globally revered mega-personality propelled by dumb luck and kismet. He progressed from a line cook to a chef because of his writing skill he never recognized. Then, on the basis of his New York Times best seller “Kitchen Confidential”, producers liked his style and took a shot at trying him for a TV travel series featuring menus from the places he visited. After some gyrations, his Peabody winning CNN show (Parts Unknown) ran 11 seasons and was still in progress at his death in 1018 at the age of 61.

Not commonly made public but Anthony had seriously personality disorders including long time heroin addiction and cocaine dependence. “You know, something was missing in me, some part of me wanted to be a dope fiend,” he confesses in one scene. He very much didn’t understand how to make sense of his ascendency to what he considered undeserved celebrity. He had an open-ended passion for life that manifested in his overwhelming need to experience new places, looking for answers that remained camouflaged. His first wife of 30 years divorced him due to his impossible travel schedule. He married again and sired a beautiful daughter but this relationship also faltered due prolonged absence. At the time of his death he was involved with a younger Italian girl.

The film eloquently captures Anthony’s passions and then sadly explores his descent into a kind of madness that ultimately drove him to depend on the journey as a destination. He was a man with no boundaries but the exploration of them was always destined to fail. The food was only a small part of the aura. The thrust was how he injected his unique personality into his visits to 93 countries. He’s said to have circled the globe over 20 times in his TV career, but in the end, it wasn’t where he went in life, the substance was what he left behind, this very deftly explored in this excellent documentary.

Anthony’s quest for happiness seemed doomed from the beginning, as the journey thereof never stayed on the tracks. He had an unfortunate “imposter syndrome”, that he didn’t deserve any of it and it could all vanish in a heartbeat for no particular reason. His quest for fulfillment continued to scour the globe looking for the next commodity that would make him happy or answer his existential questions. Numerous friends and colleagues offered their assessment of Anthony’s slow descent into suicidal madness and detailed their powerlessness to interdict it.

One of the saddest and most poignant of his film appearances near the end was of him sitting at the head of a table full of jubilant partygoers, all eating and toasting, Anthony looking alone and forlorn. It was very clear at this point that this wasn’t going to end well.

The subject of suicide in the face of success was handled delicately in the film. I think, in the end that success is a fragile thing and if built on iterations of insecurity, will eventually collapse. Anthony built a fragile empire built on a house of cards. He suspected his talent and his pain were inextricably linked. The crash was inevitable but lasted longer than it might have on a platform of sheer force of personality before it began to crumble.

Roadrunner is a sad exploration of inevitable ruination the likes of which began many years before the fact. Like Anthony opines, had it not been for dumb luck and being in the right place at the right time, it could have, maybe should have happened much earlier, or maybe it could have all been a vaporous dream. It’s a very good film, recommended by me. I give it four of five Saigon sidewalk lunches (Photo 1)

By the way, the film details a number of cities Anthony visited, each of which I have set foot on at one time or another. An oil painting that I purchased from a sidewalk artist in Kowloon, two sailing Junks in the harbor between Kowloon and Hong Kong hangs in my living room. It’s picking up dust now, losing some of its luster so I guess I’ll have to have it cleaned (Photo 2).

David Crippen, MD, FCCM

A passing: Jim Steinman (1947-2021)

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Jim Steinman dead at age 73 of stroke complications. Jim wrote all the songs in the awesome album “Bat out of Hell” all sung by “Meat Loaf” born Marvin Lee Aday, overweight rocker since high school. Meat Loaf’s interpretations of Jim’s songs became one of the biggest-selling albums of all time in 1977, after being initially turned downed down by virtually every record label.

According to Meat Loaf’s autobiography, the band spent most of 1975, and two-and-a-half years, auditioning “Bat out of Hell” and being rejected.His works tended to be vivid in their imagery and heavy on drama. The album contained only seven dramatic, operatic songs filled with teen-angst. Jim wrote several other songs for other artists but “Bat” was his magnum opus. Jim was to Meat loaf as Bernie Taupin was to Elton John for 50 years, neither survivable without the other.

The lead song details a motorcycle crash, a mini-opera in itself. “Paradise by the dashboard light” is almost eight minutes long narrating a sexual tug of war in the front seat between a teen guy and a resistant female the play-by-play narrated by Yankee broadcaster Phil Rizzuto.

Jim attended Amherst College in Massachusetts where he was such a mediocre student that he was unlikely to graduate. He did graduate and later in life accepted an honorary doctorate in music and a standing ovation from Amherst. Upon Steinman’s death, rock writer Paul Stenning wrote that Jim left a “tremendous legacy”, referring to him as a great composer of symphonic rock and citing him as an influence on a variety of bands across many genres.

Below is an early photo of both artists (1978) and a clip of the classic album coverBelow is a brief YouTube clip from “Bat outta Hell” featuring Meat Loaf in fine form.

Start at 4;40 https://www.youtube.com/watch?v=3QGMCSCFoKA

A forgotten CODEs gig at an SCCM meeting resurrected

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Hello again, the 50th Anniversary of the Society for Critical Care Medicine (SCCM) is coming up and they were wondering if the CODES were available to play for the meeting again as we did several years ago. Not likely as we haven’t played together for a couple of years but it was a good run as our first gig was in 2006.

So I suggested maybe I edit a song from our last SCCM gig, which was several years ago. I rummaged through the high-resolution videos of that gig, selected a song that featured all of us playing and cut it back to a minute and a half. Don’t know if they’ll play this in their repertoire of ZOOM selections but I gave it to them. Maybe they’ll play it. Maybe not, but here it is for whatever interest anyone has.

The song is “Twilight Zone” originally done by a Dutch group Golden Earring (1982). It’s a great song and part of our set list for years. I chopped it after the meat & potatoes just before the extended lead break for brevity. You’ll get the idea. Listen for Gary’s scrape of the low E string from top to bottom. EEEEEOOOOOWWWWW. Not very loud. You have to listen for it.

Enjoy if you have an interest. As always, turn up the volume.

Percussion: Mike DeGeorgia, MD, FCNS
Professor
Chair, Neurology and Neurocritical care
Case-Western University, Cleveland

Rhythm guitar and backup vocals: David Crippen, MD, FCCM
Professor Emeritus (ret)
Department of Critical Care, Neurovascular ICU
UPMC, Pittsburgh

Lead Singer and base guitar: Stephan Mayer, MD, FCNS
Professor
Director of Neurocritical Care and Emergency Neurology Services, Westchester Medical Center, Valhalla, New York

Lead guitar and vocals: Gary Bernardini, MD, PhD, FCNS
Professor
Chair, Neurology and Neurocritical care
Cornell Medical Center, New York City

A passing: Eddie Van Halen (1955-2020)

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The death of Eddie Van Halen is a big enough deal as to require some comment by me.

Van Halen’s efforts in 1978 produced a seemingly odd instrumental named “Eruption” that radically changed the entire spectrum of guitar music. It introduced the concept of “tapping”, that is- tapping with the finger on the string 12 frets away from its insertion. This can be moved around the fret board and produces a very unusual tone compared to simply plucking a string.

Eddie was not the first to produce sounds from tapping strings.  Steve Hackett of Genesis did it in 1975. Canned Heat guitarist Harvey Mandel was doing it in as early as 1968 at the Whisky in LA.  But no one did it like Eddie Van, who originally only did it in clubs and as a warm up exercise. But when it surfaced on Van Halen’s first album in 1978, the 1.4 minute instrumental explosion changed everything from the ground up.

Every player, including me, had to learn it but few could really do it justice. I could do about ten seconds of it before every finger cramped. Otherwise, “tapping” became the order of the day and every guitar shop had at least two or three acolytes trying it out on instruments sporting fast fret boards and lots of amplifier distortion effects. It’s said that Eddie plugged in an electronic gadget to increase the voltage to his Marshall amp, blowing them up pretty routinely.

The fact, however, is that most players couldn’t play it and even if they could, the amount of technical ability didn’t translate into listenability. You really can’t take it for too long before your ears start to ring. That said, Eddie did a lot more for guitar music than Eruption. His creativity and imagination was unparalleled. I learned to play some of his slower songs and very much enjoyed them. In their prime (late 70s and 80s), Van Halen with Diamond Dave Roth was a great band.

So one of the guitar magazine guys once asked Eddie how he came to be such a facile player. The story is interesting. When in high school, Eddie discovered that his life was guitar and nothing else mattered. He routinely skipped school, got up early in the morning, sat on the edge of his bed and practiced. Continuously, then had a sandwich for lunch and practiced again all afternoon, then supper after which his brother went out to socialize and Eddie say on the edge to practice until bedtime- every day for days on end.

So my response to that is that if I had that kind of passion for playing, I could probably play like Eddie too but I had a day job and I didn’t live for music. I had other passions that I lived for. Music was a side issue.  And BTW, if you read very erudite criticism of Eddie’s playing, they are all the same. It sounds “practiced”, practiced music lacks soul and soul is what the ear likes to hear.

If you dial into watch Neil Young play “The needle and the damage done”, he doesn’t have much of a singing voice and his guitar chords are rudimentary but trust me, you can’t take your eye off him.  Similarly, BB King always on the same area of the fret board and he rarely looks to see where he’s playing. He doesn’t have to. His fingers know where to go intuitively.

Sadly, the musical heros of my youth are sinking quickly. Some from old age. Some from suicide as they are unable to make the transition from the 60s and 70s to the new world. Eddie and the Band “Van Halen” were absolute masters of their trade in the 80s and now, having flashed across the sky in a blinding burst, have descended into history.

Rest in Peace Eddie Van. A life well lived.

Protests v. Violence: Forward to the past

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Last night, 5/30/2020, my daughter the cop was called out emergently with a bunch more cops, to join the National Guard in protecting the city (Pittsburgh) from roving bands of vicious destructors. Cars overturned and set on fire. Store window glass destroyed and stores looted. Four cops hospitalized, dozens of others treated at various sites. Traffic backed up for miles. All seemingly to raise the public’s consciousness about what amounts to 100 years of racial inequality and abuse. The first Amendment allows for peaceful demonstrations to complain about various kinds of abuse and one rarely hears much complaint about it. City dignitaries and various professional sports figures (here) frequently join such demonstrations.

Some history:  Back in the 60s Dr. King’s strategy was strictly non-violent demonstration to point out inequities in how the races were treated. There were good reasons for this. If protesters fought back in kind when physically abused by police, it might be construed that the protesters were assaulting the police, giving them a legal reason to beat them to a pulp in self-defense. These were the days before pocket size video that everyone now carries. In the 60s, creative photography made it difficult to prove one way or the other who was assaulting who.

This strategy lasted from the 50s into the late 60s when it was finally figured out that non-violent demonstrations were ineffective, if for no other reason than few cared and they were not carried to large audiences via what was then rudimentary TV. About the time Dr. King was assassinated, it was becoming clear to would-be protesters that getting routinely beat up wasn’t very effective in proffering their points. About this time, younger black leaders, Rap Brown, Malcolm X, Eldridge Cleaver, JoAnne Byron, the, The Black Liberation Army, (BLA), Black Panthers and many others began various “push-back” strategies of getting their agenda more noticed by becoming more noticed. BLA goons assassinated white police officers walking beats.

So, somewhere in this time period, protesters figured out they get a lot more attention if they started inconveniencing those who really don’t care much about their activities, aided by the visual media (CNN) whose advertisers love anything that draws viewers to their plethora of commercials. So drawing viewer’s attention to social inequities moved from visual to violent.

It should also be noted that none of this is anything new. The white population in virtually any city traditionally had a heap of contempt for former slaves who had been legally liberated but remained their previous underdog social status. White lawmakers, administrators and politicians greatly feared that if blacks gained any amount of political power (voting), this would diminish the dominion of those ensconced in power. Various very creative schemes were created to insure “minorities” stayed minor.

For want of a better term, “Whites” as a group have never liked the black population very much and that dates all the way back to Reconstruction. They are legally mandated to legally treat them as equals but that changes nothing about their emotional feelings about them. It must also be remembered that blacks are no longer “minorities” anywhere. They’re majorities or near majority in virtually any major city except in the deepest Western States. In many cities with ingrained racial problems, the local TV stations gleefully portray them on-screen after they’re picked up for various law-breaking, subjectively suggesting that most of the ills of the city are caused by roving bands of grimacing black criminals festooned with facial metal, tattoos and bulky hair braids. Aliens. Aliens caught doing damage.

So here we are.  One would think that police officers would have enough sense to do whatever it takes to stop killing those black guys, especially the ones obviously unarmed. They’ve been doing it now pretty reliably since Fred Hampton in 1968. Killing them over and over, sometimes for the thinnest excuse, nowadays each episode filmed from multiple vantages by ubiquitous cell phone video cameras. Whenever a cop appears almost anywhere, fifty cameras appear starting with Rodney King in 1991. You would think they’d learn that every time it happens it gets videoed in high resolution, followed by multi-city riots.

Why does this keep happening?

I think it keeps happening because the experience of many police officers with black citizens is pathologic and not much is being done to rectify it. A relatively few bad interactions goes a long way. After a cop gets shot at a few times, and forced to follow would-be armed criminals up dark, dangerous alleys, they start considering them not much more than vermin and stomping them out isn’t much different than eliminating cornered rats. Videos of many of these murders don’t show much emotion on the faces of cops killing other humans.

Similarly, anyone that’s viewed the killing of Mr. Floyd will not be reminded by protests. They’re quite aware of the atrocity and it’s as unclear how to solve it as it was in 1968. Mass peaceful protests usually fall on bored motorists that avoid the traffic jams shown up on WAZE. However, once protesters start burning cars and businesses, beating up cops and doing as much damage as possible, everything changes. CNN, MSNBC, Fox News and all the local stations stop everything and photograph as much as the violence as they can- close up from helicopters. Already Beleaguered downtown business owners (from COVID shutdown) pleading with looters carrying out flat screen TVs. Protesters throwing Molotov Cocktails through broken glass windows to start damaging fires in their own community.

At this point, no one remembers the original point of the “protest”. Now it’s become a Netflix special action series, cops against the bad guys. If TV viewers glued to the tube didn’t care much about the root cause of the protest anyway, they now loathe them and the entire thrust of the protest vanishes as the police and National Guard prevail because they’re more of them and they’re better armed.

So, in essence, the events of the 60s that evolved to the violent 70s is coming around again.

Editorial comment by me 5/14/2020

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What I’m seeing here in Pittsburgh is similar to what’s happening elsewhere in the mid-west, lots of people believing that rituals will save them from doom and gloom. That wiping down things with alcohol, wearing essentially ineffective surgical masks and bandanas that demonstrate they’re “doing something” and playing out the opera as dictated by experts who have never seen anything like this before and are all guessing.

Sunday, on Fareed Zakaria’s show, expressed the idea that the virus most probably did start from a wet market in China where a large number of previously “wild” animals were herded together (as food stuffs) in proximity to lots of humans, some probably sick or with immune deficiency for whatever reason. It’s easy for any virus to follow these pathways from sick animals to sick humans. And as more and more of the natural habitat of these animals is destroyed to build Hiltons and parking lots or simply to slash and burn, the pathway from animal to human becomes smoother. I think that’s a very viable theory and what it means as a practical matter is that this virus made a very smooth transition to the globe and for all those reasons we can expect more of the same.

In Pittsburgh, we are now in the “Yellow Zone” of social activity, which means “some” businesses are now open in a limited sense, with nods to social distancing and crowd control, lots of wiping things down and some kind of mask for all. But Americans always find creative ways around anything that inconveniences them. Two businesses that are STILL shut down in the Yellow Zone are gyms and hair salons. I have no idea why, but I have an appointment at a local Gym tomorrow to start building my functional ability back again. I also have an appointment next week for a haircut after two months. If I look around, I can find a place to go out to eat. So, I would hazard a guess that all over the country, most of these admonitions for the viral infestation are simply ignored or things like surgical masks are being touted as “real” prevention. What that means is that the virus will persist for a LONG time and lots of things will become the “new normal”.

What will be the new Normal? Last night on the news, they explored the probability that we will become a “Virtual” nation. That means computer visualization of meetings, education and everything else formerly requiring face-to-face discourse. It’s already happening. Schools and universities have already served notice that they are most assuredly transitioning to computer classes, students participating by laptops from home. Harvard School of Medicine has served notice that they are rapidly gearing up for visualized classes from home. The dehumanizing effect of this kind of faux social interaction is truly scary.

Everyone accesses their daily items and desires from Amazon, Craig’s List and eBay, with more added every month.  It’s simply more convenient and those on-line businesses have EVERYTHING for sale, cheaper than the increased cost of the necessary middle-man in structural stores. Brick & Mortar businesses are closing right and left. The last one yesterday was GNC food supplements, a huge office building and shops all over the country. They’re going to go the way of Radio Shack, with thousands of jobs going with them.

The concerts that normally fill stadiums have all been cancelled with no hint of when, if ever, they will return. That means the Kenny Chesney concert scheduled for next week is out and all the football games that normally number over 50,000+ rabid fans that come from all over the country to see the Steelers in Heinz Field are cancelled till further notice. Similar actions for hockey and baseball. What they didn’t mention is what’s happening right now. All those 50,000 rabid fans eat food, drink beer and park their cars in Pittsburgh, bringing in a ton of money and literally supporting industries. All gone, and with it those industries and jobs.

The major grocery in Pittsburgh is the Giant Eagle and going for food is a very interesting trip. The entrance to the store is about 30 or so yards along the side of the store from the entrance and the only way out is the designated exit. No entry without a mask of some variety. 6 feet spacing on the sidewalk and store personnel walking around to enforce social distancing. Large chunks of foodstuffs missing off the shelves due to panic buying, including water bottles. Prices of everything are up at least 30% so far. As there is more and more unemployment and providers of meat slow down production, this will continue and get worse. As demand from kids school meals vanishes, Farmers are dumping milk into their fields as the cows need milking whether the product is sold or not. The income from milk is now less than the cost of producing it. This has the potential to destroy farming.

The CEO of Boeing Aircraft was interviewed yesterday and he opined that at least one, possibly two airlines were poised to enter Chapter 11 due to decreased number of passengers and increasing cost of fuel and airport costs. Delta is burning through fifty million dollars a day. There are several photos of passenger planes lined up, filling the entire runway at Pittsburgh International. The planes that are still flying are doing so with only a few passengers. They won’t do that for long at the current cost of fuel. So, not only are people not traveling anymore, the potential for carriers is progressively crashing. I was thinking I might want to go one more interesting place before I died. Delta told me to forget it unless I was prepared to pay an astronomical price for a seat 6 feet from the next guy.

The Washington Post detailed American workers filing 3 million new unemployment claims last week, bringing the eight-week total of coronavirus-induced layoffs to 36.5 million. This number will progressively increase as more and more businesses go under. The money men in government are sending out trillions of dollars here and there. No one knows where it’s coming from or exactly where it goes. The effective long range planning by central government officials can best be described as loose cannons rolling around the deck firing the odd shot here and there. The unemployed will start protesting their plight in larger and larger numbers resulting in ????  This is said to return when “things get better”.  I think there is some evidence that once many of these industries die, the cost of resurrecting them would be prohibitive and they’ll stay dead. Society will then learn to live without them and that will be a very interesting life, indeed.

I’ve made it to nearly 77 years of age and I now count myself as exceptionally lucky to have lived in an era where I could do pretty much anything I wanted, go where I wanted and work in a career that worked very well for helping sick persons. I’m very glad I won’t have to live in the world being created right now as I sit here. I feel very sorry for those much younger than me that will have to figure out how to survive in it.

 

“The Edge… There is no honest way to explain it because

the only people who really know where it is are the ones

who have gone over it.”

 

―Hunter S. Thompson, “Hell’s Angels: A Strange and Terrible Saga”