Physicians publish open letter critical about Louisiana Senator Dr. Bill Cassidy for undermining his Hippocratic Oath

Physician Senators, What Have You Done?
— They betrayed the Hippocratic Oath in voting to confirm RFK Jr.
Echo opinion published in MedPage Today  by Joseph V. Sakran, MD, MPH, MPA, and Samuel Okum

When Senator Bill Cassidy, MD (R-La.) -- a physician, longtime advocate for healthcare policy, and potential swing vote on the Finance Committee -- voted to advance Robert F. Kennedy Jr.* as secretary of HHS, he didn't just make a political choice. 

He made a choice that undermines science, public health, and the very Hippocratic Oath he once swore to uphold.

While Cassidy claims to have taken this decision "very seriously," he must know it is wrong. As a legislator, he understands that the HHS secretary oversees critical health institutions like the CDC, FDA, and CMS. As a doctor, he has firsthand knowledge of how these agencies impact patient care, from ensuring access to safe medications to shaping life-saving public health policies. Entrusting this role to Kennedy -- a man with no qualifications beyond his fame as a purveyor of medical disinformation -- isn't just reckless. It endangers us all.

Kennedy's Dangerous Track Record:  Kennedy's record must not be mistaken for misunderstood skepticism. He is one of the most prolific and, seemingly, deliberate spreaders of medical misinformation online.

Through his organization, Children's Health Defense, Kennedy has falsely linked vaccines to autism, opposed COVID-19 safety measures, and promoted debunked medical treatments. In 2021, the Center for Countering Digital Hate identified him as one of the "Disinformation Dozen" -- a small group responsible for nearly two-thirds of anti-vaccine content circulating online. All of this suggests this promotion of falsehoods has eroded public trust in vaccines, contributing to preventable disease outbreaks and declining immunization rates.

The consequences of his rhetoric have been deadly. In 2019, Kennedy traveled to Samoa to support an investigation into routine childhood vaccinations. His visit coincided with a devastating measles outbreak that infected thousands and killed dozens of unvaccinated children. 

When confronted by the country's prime minister, Kennedy expressed no remorse. Instead, he baselessly suggested that the measles, mumps, and rubella (MMR) vaccine itself may have been responsible for the deaths.

While angling for HHS secretary confirmation, Kennedy tried to sanitize his record. During his Senate hearing, he framed himself not as an anti-vaccine crusader, but as a principled advocate for "good science" and "safety." This appears to be a blatant lie. The scientific consensus on vaccine safety is long established. It's widely recognized that serious adverse effects from vaccinations are incredibly rare. The only published study to ever suggest a significant association between vaccination and lifelong disability -- the infamous 1999, Wakefield paper in the Lancet -- was exposed as fraudulent and later retracted.

By dismissing this established science in search of something superior, Kennedy appears to demonstrate complete disinterest in evidence that refutes his worldview. As HHS secretary, he will only have a larger platform to erode public confidence in vaccines under the guise of pursuing "gold standard science" that will never be good enough for him.

A Physician's Vote Should Reflect Medical Ethics

Almost no senator is better positioned to recognize this deception than Cassidy.

Cassidy is not just another politician. He is one of only four trained physicians in the Senate and is bound by an ethical obligation to champion science, evidence-based medicine, and policies that save lives.

He has long cultivated a reputation as a rational, science-driven conservative, supporting funding for medical research and speaking out on vaccine importance. Moreover, Cassidy was reticent to quickly line up to disregard his professional oath and announce support for Kennedy ahead of the first Senate vote. Cassidy's public displays of discomfort with the nomination sent a clear message: he seems to know exactly who Kennedy is and what his leadership would mean. Some observers predicted Cassidy's vote would be difficult, if not impossible, for Kennedy to win over.

So why did Cassidy change course❓

On the Senate floor, Cassidy justified his vote by parroting Kennedy's revisionist rhetoric -- reiterating that Kennedy said he "just wants good science and to ensure safety." 

But, Cassidy should know this is nonsense. He watched Kennedy refuse to disavow his past vaccine-autism claims during his confirmation hearing. It also appears Cassidy doesn't trust Kennedy to govern responsibly -- otherwise, he wouldn't have extracted preemptive concessions, including mandatory meetings and commitments to maintain existing vaccine safety protocols. If Cassidy truly believed in Kennedy's fitness for the role, why would these conditions be necessary?

The answer is simple: We believe Cassidy prioritized political expediency over medical integrity. He arguably chose to align himself with President Donald Trump and conspiracy rather than the national interest and public health.

Meanwhile, Cassidy set the stage for his physician colleagues -- Republican senators Roger Marshall, MD (Kan.), John Barrasso, MD (Wyo.), and Rand Paul, MD (Ky.) -- to follow suit. They have all betrayed their oath as doctors.

What's at Stake: A Nation's Health and Safety:  After securing Cassidy's support, Kennedy was all but assured to be confirmed by the Senate. And in the end he was confirmed by a 52-48 vote. The potential consequences of Kennedy's elevation to HHS secretary will be profound:Vaccine programs could be dismantled or defunded, leaving millions vulnerable to preventable disease.
Funding for infectious disease research could be slashed, slowing vaccine development and antimicrobial innovations.
Gun violence research -- long recognized as a public health issue -- could be deprioritized or defunded. Medicare and Medicaid policy could be shaped by someone with no expertise in healthcare systems.

This list is just the beginning: More fundamentally, we should expect the deadly crisis of medical misinformation to be exacerbated under Kennedy's tenure as HHS secretary. Confirming a science denier for such a crucial role poses an existential threat to evidence-based medical practice and could irreparably damage the integrity of our public health institutions.

We already see how misinformation harms patients -- from surging interest in dangerous, unproven therapies during the COVID-19 pandemic to vaccine refusal begetting a resurgence in measles. With Kennedy leading HHS, conspiracy theories may soon have a sounding board at the highest levels of the American medical establishment. Abandoning empiricism and the highest scientific standards will leave us far sicker as a nation.

Senator Cassidy's Legacy: Cassidy's choice to send Kennedy's nomination to the floor for approval will forever be remembered as crucial in assuring Kennedy's confirmation.

Under unrelenting pressure from his party, Cassidy betrayed his solemn oath as a physician to elevate a dangerous ideologue to the highest halls of power. At this critical moment, he lacked the courage to put our nation's health before his personal political fortunes.

It is the choices our public officials make in the most difficult situations that defines their character. By supporting Kennedy's nomination, Cassidy, Marshall, Barrasso, and Paul have shown us theirs.

We fear that history will not be kind.

Joseph V. Sakran, MD, MPH, MPA, is a survivor of gun violence, a trauma surgeon, and executive vice chair of surgery at Johns Hopkins Hospital in Baltimore. He also serves as chair of the Board and Chief Medical Officer at Brady United. 

Samuel Okum is a medical student at Johns Hopkins University School of Medicine.

*I am old enough to remember the heroism of his father everytime is see RFKjr's name in print. Shame on his son's ignorance.  In fact, RFKjr has desecrated his father's compassionate legacy.  

Oppostion to incompetent Robert F. Kennedy jr from the Public Health Association of America

One of the leading public health associations came out against President-elect Trump's incompetent nomination of vaccine skeptic and conspiracy theorist Robert F. Kennedy Jr. for HHS secretary

Published in MedPage Today by Joyce Frieden 

Kennedy's selection, which would have to be either confirmed by the Senate or finalized temporarily in a recess appointment, "raises serious concerns for the health of the American people," Georges Benjamin, MD, executive director of the American Public Health Association (APHA), said in a press releaseopens in a new tab or window headlined, "America deserves better than RFK Jr."

"To effectively lead our nation's top health agency, a candidate should have the proper training, management skills, temperament, and the trust of the public," he wrote. 

"Unfortunately, Mr. Kennedy fails on all fronts."

"Kennedy's past statements and views on vaccines alone should disqualify him from consideration," Benjamin continued. "He has stated that 'there's no vaccine that is safe and effective' and touted misinformation claiming that vaccines cause autism. A serious candidate for this position would follow the decades of real-world evidence that shows that vaccines are safe and prevent as many as 5 million deaths each year."

"The American people deserve better than Mr. Kennedy," he noted. "We need an HHS secretary under the Trump administration who will listen to science, not discredit it ... We urge President-elect Trump to select a qualified health leader that is properly trained and has the management skills to be the nation's top health official. We look forward to working with the incoming administration to advance effective, evidence-based approaches to improve the health of the nation."

Kennedy's selection has been a controversial one largely because of his skepticism on the safety and value of vaccines. He also said he supports getting rid of fluoride in the drinking water.

The APHA's (American Public Health Association's) statement is in sharp contrast to the response from physician associations, which have remained mostly quiet probably because, if confirmed, Kennedy will hold enormous sway over issues that physician groups care about. Several major physician organizations have not put out a statement at all, while others, such as the American Academy of Pediatrics (AAP), have put out statements in support of vaccination but mentioned the nomination obliquely or omitted it entirely.

"[This] nomination ... offers an important opportunity to share the settled science on vaccines with government leaders, policymakers, and the American public," AAP President Benjamin Hoffman, MD, said in that group's statement. "This is a conversation pediatricians have every day with families, and we welcome the chance to do the same with national leaders."

"Vaccines are the safest and most cost-effective way to protect children, families, and communities from disease, disability, and death," he continued. "Continuing national investment in vaccine access is absolutely essential to support healthy communities ... As pediatricians, we firmly believe the most effective way for HHS to ensure the future health of our nation is to protect and support the health of our children: by ensuring that science continues to underpin all decision-making, policies, and programs."

The American College of Physicians (ACP) did not comment directly on the nomination at all in its statement. "Vaccines are vital to our ability to prevent diseases that threaten public health," said ACP President Isaac Opole, MBChB, PhD. "The ACP remains concerned about the spread of disinformation and misinformation regarding vaccination ... It is critical that policymakers and government officials understand the importance of vaccines, evidence-based medicine, and other ways that our public health infrastructure protects all of us."

Doctors for America did not put out a statement, but did post an "advocacy alert asking members to write to their senators to urge them to oppose Kennedy's nomination. The group's mission statement says it "mobilizes doctors and medical students to be leaders in putting patients over politics on the pressing issues of the day to improve the health of our patients, communities, and nation."

"We oppose the nomination of Robert F. Kennedy Jr. as Secretary of Health and Human Services because he is unqualified and has a dangerous track record of spreading false information about health," the alert noted. "Our nation's health and healthcare system are in need of reform and improvement. The American public deserves to have full, unbiased information on how to protect their health. But the nomination of RFK Jr. leaves us deeply concerned that he will harm the nation's health by continuing to spread false health information."

A Robert F. Kennedy Jr. influence in American public health is harbinger of danger to medical science

Opinion:  Jeremy Faust is editor-in-chief of MedPage Today, an emergency medicine physician at Brigham and Women's Hospital in Boston, and a public health researcher. He is author of the Substack column Inside Medicine. Follow
Well, the next 4 years are going to be challenging ones for public health.

Let's talk it through for a moment.

In 2016, I wrote in Slate that I was very concerned opens in a new tab or window about the Republican party's embrace of pseudoscience during its wacky summer convention. 

But when it came down to filling positions at the highest levels of the federal government's public health infrastructure, Donald Trump's choices as President often turned out to be more or less mainstream. Even if you didn't agree with many of the particular views, these were frequently people who had long and serious prior involvement in healthcare and public health. Maybe they were a little on the crony side and had a few more scandals in their rearview mirror than one would have liked, but they nevertheless generally recognized important truths -- little things like, oh, I don't know, vaccines work.

Last Time Could Have Been Worse: At the time of the COVID-19 pandemic, the CDC was run by Robert Redfield, MD, a physician with substantial government experience. HHS was run by Alex Azar, a lawyer with relevant experience in the healthcare sector. And when COVID-19 hit, it was Deborah Birx, MD -- a physician and long-time public servant -- who ran the White House response, and whom we can thank for getting President Trump to sign on to a social distancing plan that literally saved hundreds of thousands of lives in the early months of the crisis. Remember, Trump never fired Anthony Fauci.

This Time Might Be Much Worse: Well, now we are facing round two, and while I would like to think that things won't be much worse this time, I worry they might be. In recent days, Trump signaled dangerous ideas held by Robert F. Kennedy Jr. would be considered. There's talk of taking some vaccines off the market. There's talk of removing fluoride from the water supply. These are genuinely bad ideas that could cause a lot of suffering and death.

Turning away from science should be seen as anti-American, since so much of the progress that humanity has made in medicine and health came from work done right here in the U.S. Apparently, that's not the way a lot of people see it. I would like to understand why that is, because I do not.

Brain Drain:  To me, one of the sadder parts of this is the number of highly talented public health experts who won't be working in government on our behalf over the next 4 years. 

Do I think that the FDA and the CDC are performing at their best on some key issues? Not particularly, no. Both of those agencies have gotten some important things wrong over the years, and yes, including under President Joe Biden's watch. However, my sense is that the kinds of people Vice President Kamala Harris might have brought on board had a real chance to improve things. (I say this because I know and admire many of them.) Meanwhile, Trump seems to be suggesting that he wants to burn it all down.

International Implications:  Then there's the international implications. Will the U.S. withdraw support for the World Health Organization (WHO)? That was slated to happen under Trump right until Biden won the 2020 election, at which point we reversed course. If that happens now, what will that mean for public health around the world? If we pull out of the WHO, it's likely that people will literally die for lack of medical care. That's on our hands, I'm sorry to report.

Fighting Misinformation:  Lastly, there's misinformation to consider. I suppose people like me will have a lot of work to do in the coming years, depending on who is installed into what governmental positions. It won't be easy. My colleagues and I are really going to need your support. If we can't work on these issues from the inside (or with a sympathetic audience there), we'll keep doing our best from out here, laying the groundwork to take back lost ground later.

We Can Make a Difference: This is my commitment to you: No matter what, I'll keep speaking up for medicine, science, health, and data. And...

You can help: How? Join me in speaking up for facts -- for the truth. Shout it from the rooftops. Don't delete your social media profiles. Stick around and make those places better. Spread facts and promote reasonable discourse. Try to move minds. We can do that. I know we can. But we'll need to work together. We'll need to amplify each other now more than ever. That is our task. We aren't alone -- this community is just one of many. Let's lead by example.

What other option do we have? Our health and our lives depend on it.

This post originally appeared in Inside Medicine opens in a new tab or window.

Physicians and nurses sign petition calling on Donald Trump to release his medical records!

 Echo report published in Medpage Today News

More than 230 doctors, nurses and health care professionals, most of whom are backing Vice President Kamala Harris, are calling on former President Donald Trump to release his medical records, arguing that he should be transparent about his health "given his advancing age."

"Trump is falling concerningly short of any standard of fitness for office and displaying alarming characteristics of declining acuity," the 238 signatories wrote in a letter dated Oct. 13 and first obtained by CBS News. "In the limited opportunities we can examine his behavior, he's providing a deeply concerning snapshot."

The letter was organized by the group "Doctors for Harris," which is unaffiliated with Harris' campaign. The doctors and nurses note that presidential candidates have traditionally disclosed their medical records, including Arizona Sen. John McCain, who did so during his 2008 presidential campaign. In his 2020 race against President Biden, Trump released results of his physical in the June before Election Day.


The letter noted that absent detailed health records, "we are left to extrapolate from public appearances."

"As we all age, we lose sharpness and revert to base instincts. We are seeing that from Trump, as he uses his rallies and appearances to ramble, meander, and crudely lash out at his many perceived grievances," the doctors wrote.

The letter comes as Harris has been putting pressure on Trump to release his medical records, with her campaign viewing their contrast in age as a salient argument. Trump is 78, and Harris turns 60 on Sunday.

On Saturday,Harris released a letter from the physician to the vice president that said she "possesses the physical and mental resiliency" to serve as president. It also detailed specifics about her medical history and vitals, and said her most recent physical was "unremarkable."

Harris again called on Trump to release details about his health in an interview released on Monday.

"I put out my medical records. He won't put out his medical records. And you have to ask, why is this staff doing that? And it may be because they think he's just not ready, and [is] unfit and unstable and should not have that level of transparency for the American people," Harris told journalist Roland Martin in an interview for his Black Star Network.

Trump's campaign responded to Harris' release with letters from his personal physician Dr. Ronny Jackson, including one after the assassination attempt at a rally in Butler, Pennsylvania, that said he is in "perfect and excellent health to be Commander in Chief." The letters do not contain specifics about his health.

If elected, Trump would be the oldest president in history by the end of his term.

Mark Lopatin, a retired rheumatologist in Pennsylvania who signed the letter and has donated to Harris' campaign, said that he sees Trump as a man "who rambles" and "gets off track."

"You're talking about the most powerful man, or female, in the world. You're talking about a job which is probably more stressful than any other job that I can imagine. The question is, does the person who takes that job have the resources — healthwise, physically, mentally, emotionally — to deal with that?" said Lopatin. "It boils down to transparency and intent and these kinds of things that I see from one candidate and not from another."

On Monday, Trump called Harris' mental acuity into question and said she should submit to a cognitive test. "Her actions have led many to believe there could be something very wrong with her," he wrote in a post on Truth Social. The letter from the vice president's physician said Harris "remains in excellent health."

Trump had told CBS News in an August interview that he would "gladly" release his medical records to the public and that he "aced" two cognitive tests. Asked Monday if details on those cognitive tests and more recent medical results would be released, Trump's campaign pointed to its statement over the weekend.

Before Mr. Biden dropped out of the race, polls showed doubts from voters about Mr. Biden's mental and cognitive health. That has flipped since Harris became the nominee.

Anti-vaxxers are now stalking physicians: Are restraining orders needed?

Echo essay published in MedPage Today, news by Vineet Arora, M.D., Tricia Pendergrast, MD and Regina Royan, MD:

While the nation has declared the COVID-19 public health emergency over, the politicization of healthcare and medicine continues to result in harassment of doctors and scientists.

Just this past weekend, vaccine scientist Peter Hotez, MD, PhD, became the target of significant online harassment after criticizing a Joe Rogan podcast episode featuring Presidential candidate and vaccine skeptic Robert F. Kennedy Jr. and debunking many of Kennedy's claims as misinformation. After being challenged to debate Kennedy, Hotez was approached unannounced outside his homeby a couple of anti-vax activis ts demanding answers. Whether it is about vaccination, reproductive rights, LGBTQ+ health, or advancing diversity, equity, and inclusion, doctors and scientists continue to face attacks online and off.

Among a sample of over 350 physicians and scientists online, over two-thirds reported being harassed on social media. The most commonly reported reason for harassment was advocacy, with those who advocated for public health issues more commonly facing harassment. While no one is "safe" from harassment, personal attacks on social media were not equally distributed. Those who identified as women, nonbinary, Black or Hispanic, LGBTQ+ or disabled were significantly more likely to report harassment due to their identity.

While "online harassment" may sound like annoying trolling, our study paints a much more nefarious picture of online harassment of physicians and scientists. In open-ended comments, many participants described detailed and targeted incidents of harassment for the expressed purpose of harming a professional's career (i.e. negative online reviews, reports to an employer) all the way to threatening violent bodily injury, including rape, against the professional or their family members. 

In a few cases, the harassers eventually moved offline and went so far as to physically appear at the professional's place of work, and in one case, even physically assaulted the victim. Our findings are strikingly similar to the escalation in the Hotez incident over the weekend.

Despite the harrowing nature of these incidents, physicians and scientists disclosed that when they did report these online threats to either law enforcement or their employer, it was to no avail. 

As a result, several stated they have started posting online less regularly or have stayed stay away from controversial topics due to fear of harassment. As one subject reported, "I've had to take a step back from a lot of health discourse. This constant battle is taking a lot out of me. Unfortunately, I tend to now stay out of it."

In light of these findings, it's important to consider the consequences of such online attacks on physicians and scientists.

First and foremost, online threats are not and should not be seen as harmless. As evidenced by the bomb threats to Boston Children's Hospital and children's hospitals around the country due to provision of life-saving gender affirming care, online threats can incite actual threats of physical violence that jeopardize the safety of both medical professionals and the communities they serve. 

Robert Kennedy Jr. is a politician, and writer who has promoted anti-vaccine propaganda and public health-related conspiracy theories.

Moreover, online attacks of medical and science professionals take an emotional toll on a workforce that is already facing a high degree of burnout and depression. 

Given that recent data suggest that 1 in 5 physicians already plan to leave the workforce, online attacks for those who continue to work will only exacerbate the problem. A telling example comes from a study of public health officials from last year. Of the more than 200 public health officials who had recently left their post, over one third had experienced some form of harassment.

Furthermore, these online attacks appear to be effective in silencing the voices of physicians and scientists. This is especially concerning given that those with minoritized identities are at greater risk of being silenced, at the time when we should be elevating and supporting their voices. Given the large health equity gaps and continued health challenges faced by women and minority populations, it is particularly important that physicians and scientists from these groups are supported. 

Retaining these individuals in our workforce is even more critical given the continued underrepresentation of women and minorities in STEM and the already high rates of attrition these groups face. Lastly, silencing the voices of medical and scientific professionals can also facilitate the unchecked proliferation of misinformation online. At a time when trust in scientific institutions is already low, it is essential to retain these trusted messengers within minority communities.

For these reasons, addressing the online harassment of physicians and scientists is paramount. Supporting physicians and scientists who are victims of online harassment is key.

Professional societies and employers can also facilitate support through rapid response mental health support for those experiencing online harassment, akin to the online harassment that has been produced by Pen America for journalists. 

Recently, the University of Chicago published a guide to managing online harassment, which includes steps you can take to report the incident as well as steps the university can take to mitigate the consequences. Leaders of professional societies can also lobby for stricter regulations of social media companies given the toll online harassment puts on their constituents. Social media companies should also be held responsible for the deliberate misuse of their platforms to harm individuals. While disheartening to see that Twitter disbanded its unit that previously tackled online harassment and misinformation, we are encouraged that YouTube is proactively labeling credible health information. Lastly, policymakers can intervene. For example, Colorado has recently criminalized doxxing of personal information of public health workers or their families. Similar legislation can easily cover a broader population of workers, including doctors and scientists.

As long as doctors and scientists continue to face death threats, doxxing (publishing private or identifying information), sexual harassment, and other forms of harassment online, we risk silencing their voices at a time they are needed most. It is time to condemn online attacks against physicians and scientists to ensure the health and longevity of our workforce, and to promote sharing of scientific knowledge freely and constructively. This will ensure we can ultimately reap the benefit of scientific progress in an equitable and just way.

Vineet Arora, MD, MAPP, is dean for medical education at The University of Chicago Pritzker School of Medicine. Tricia Pendergrast, MD, is a PGY1 anesthesiology resident at the University of Michigan Hospitals. Regina Royan, MD, MPH is an assistant professor of emergency medicine at the University of Michigan.

As a nurse always something new - if sad- to learn BRI (bullet related injury)

The Viral Illness of 'Gun Violence'
— The most virulent feature is polarization\

by by LJ Punch, M.D. published in MedPage Today.

In March, another mass shooting took the lives of three children. Three adults were killed in the shooting.
A fourth adult died as well.
A classroom became a crime scene.
A workplace became a morgue.
A schoolyard transformed into an emergency waiting room.
A small community hosted the national press.
And fame that was never sought was shared across the globe.
Then just as fast as the collective media cameras zoomed in for the close up, they panned to another shot.
Because it was over.
But you and I both know it's not.
You felt it when you looked at your child's book bag.
You thought about it when you checked on your Glock.
You thought about it when that nightmare came back with you crouched under your school desk.
You thought about the sound, the pop pop.
You had questions.
You had answers.
You made sure your supply of bullets was stocked.
You checked on your friends.
You questioned your neighbors.
You wrote letters and posts and emails.
You made sure the door was locked.

And then you checked it again.
Lock lock.

You couldn't eat.
You couldn't sleep.
Your back and head and feet were hurting.
Your stomach was rancid.
Your neck was hot.
Your fingers felt cold.
You imagined you were dead.

All of these feelings. All of this commotion. All of this anger and rage. All of this terror. All of this horror.

Because it was over.

But you and I both know it's not.

You felt it when you looked at your child's book bag.

You thought about it when you checked on your Glock.

You thought about it when that nightmare came back with you crouched under your school desk.

You thought about the sound, the pop pop.

You had questions.

You had answers.

You made sure your supply of bullets was stocked.

You checked on your friends.

You questioned your neighbors.

You wrote letters and posts and emails.

You made sure the door was locked.

And then you checked it again.

Lock lock.

You couldn't eat.
You couldn't sleep.
Your back and head and feet were hurting.
Your stomach was rancid.
Your neck was hot.
Your fingers felt cold.
You imagined you were dead.

All of these feelings. All of this commotion. All of this anger and rage. All of this terror. All of this horror.

You felt it whether you chose to or not.
This is
Bullet
Related
Injury

BRI

The physical, emotional, mental, and spiritual impact of being injured by a bullet or threatened by one.

It is the whole person experience of having your life threatened by powder-powered metal.

It impacts families, communities, homes, and nations.

For some it is the foundation of why it is so important to own a gun.

For others it is the precise reason to not.

And for me as a trauma surgeon and community health advocate, it is the most significant unrecognized health concern in America, a "viral" illness whose most virulent feature is polarization.

This piece is part one in a two-part series on gun violence. Part two will focus on the history of gun violence and potential solutions.

LJ Punch, MD,opens in a new tab or window is a "trauma surgeon in recovery," who serves as executive and medical director of Power4STL and The Bullet Related Injury Clinic, known as "The BRIC."

LJ Punch is an American critical care surgeon, an associate professor of surgery, and a scholar within the Institute for Public Health at Washington University School of Medicine in St. Louis, Missouri. Punch is also an activist in the fight against gun violence and directs StopTheBleedSTL, located at "The T" anti-violence center in St. Louis, which runs programs to educate the community on how to reduce the impact of trauma, injury, and violence in St. Louis. 

As a physician, educator, and activist, Punch aims to propagate the idea of “Radical Generosity” as means to better his community and the lives of those around him.

Do not drink bleach. Full Stop! A medical opinion

Health officials: Man drank toxic cleaning product after Donald Trump’s stupid comments on disinfectants

https://whdh.com/news/health-officials-man-drank-toxic-cleaning-product-after-trumps-comments-on-disinfectants/

Stupid Donald Trump, "wondered aloud if couldisinfectants could be injected into people, the Kansas Poison Control Center has reported a 40 percent increase in cases involving cleaning solutions, the Wichita Eagle reported."

Alcohol and bleach are surface disinfectants. They don't disinfect inside the body. They only cause harm, without any benefit at all.

Physician "Dr. Bernard"reported in MedPage Today:

CB is a 35-year-old man presenting to the emergency room unconscious. His mom tells the admitting nurse that she found him on the floor with an empty bottle of rubbing alcohol in his hand. CB had read on the Internet that alcohol disinfects the SARS-CoV-2 virus. Afraid that he had been infected after touching his face at the grocery store, CB found a bottle of 91% rubbing alcohol and started drinking it.

Immediately after drinking the entire bottle, CB felt confident. He wasn't going to be infected this time. Someone on the Internet said it'll burn a little on the way down, but in his mind the benefits of disinfecting himself outweighed that burn. As the minutes passed, CB started feeling dizzy. The floor started spinning. He collapsed. His mom heard the noise and found him unconscious on the floor. She called for 911 as he's brought to the emergency room where we are now.

Rubbing alcohol's real name is isopropyl alcohol. Iso- meaning equal, propan-, which is a prefix, denoting the quantity of 3 and referring to the number of carbons, and alcohol meaning a chemical moiety of 1 oxygen bound to 1 hydrogen.

Long chains of carbon are oil. Oil doesn't mix with water at all, but alcohol groups interact with water because water is also made of hydrogen and oxygen. Both the name isopropyl alcohol and its structure not only tells us everything that we need to know about what's happening to CB, but it also tells us why drinking disinfectant isn't going to cure anyone of the virus.

How do alcohols disinfect? Well, they disturb proteins. On the surface of the SARS-2 virus are crown-shaped spikes. The word corona means crown, crown virus. These spikes are how SARS-2 virus infects people, and they're made of protein. If alcohols interfere with proteins and SARS-2 infects people using a protein, then rubbing alcohol should disinfect SARS-2 virus.

Seventy percent rubbing alcohol is a better disinfectant on surfaces than 91%. More doesn't appear to be better here. If 70% is alcohol, then the other 30% is water. Extra water helps to target these proteins. But while 70% isopropanol disinfects viruses on surfaces, it's not going to disinfect viruses inside the body, and here's why.

Anything that you swallow goes into your stomach and then absorbs into your liver. The liver breaks things down into forms that the body can handle. This is called metabolism. Humans evolved a very specific way of metabolizing alcohols. In the liver, there's something called alcohol dehydrogenase, de- meaning the removal of hydrogen, and -ase describing an enzyme, which is a protein that does chemical reactions (-ase is like lactase, which is an enzyme that breaks down milk sugar).

The body has no use for rubbing alcohol. It wants to get rid of it. 

To do that, it needs to make it easier to react with, in the hopes that a final product easily dissolves in water and can be collected by the kidneys to be urinated out. When alcohol dehydrogenase processes isopropanol it becomes acetone, which is the chemical name for nail polish remover.

Okay. If someone is exposed to SARS-2 virus and they get infected, it ends up in both of their lungs. We've already established that drinking rubbing alcohol is going to pass it into the liver where it's broken down to acetone. Acetone is a disinfectant too, so why wouldn't it end up in the lungs to fight the virus?

Well, this brings us to a concept called distribution. Once something is broken down by the liver, it enters the circulation. Human body has a large volume of water and blood, so that acetone is going to get diluted in that huge volume. Drinking a bottle of 91% rubbing alcohol will overload alcohol dehydrogenase in the liver. The acetone floating around will cause temporary brain problems, but it won't be concentrated enough to hit any virus in the lungs. Okay, so that's rubbing alcohol.

How about 60% liquor, like vodka or rum? Well, the alcohol that humans drink for fun is different. It's named ethanol. Ethan- means two. The CDC says that 120 proof, or 60% alcohol, can disinfect SARS-2 virus. But that disinfection happens outside the body, not inside.

Ethanol's broken down by alcohol dehydrogenase in the liver. Anything with an alcohol group gets processed by this enzyme. The result is acetaldehyde. This is what causes someone to become red when they drink and it also causes hangovers.

Acetaldehyde isn't a disinfectant and the body wants to get rid of it, so acetaldehyde is broken down again into acetate, which is a very weak vinegar and also not a disinfectant. Vinegar can be a disinfectant, but when it's weakened like this it isn't.

Drinking 60% liquor won't cure anyone of COVID-19 if SARS-2 virus is already in the body. Inhaling it won't cure the disease either. It would bypass the liver. It would bring a first pass of alcohol right to the brain. We don't have good data on this. But at 60%, that's going to negatively impact your brain, provided it doesn't damage the mucous membranes and lungs in the first place.

Alcohol inhalation misuse can cause acute respiratory distress syndrome, which is what happens in severe COVID-19 disease. The only analogy I have for inhaling really concentrated ethanol in hopes of disinfecting SARS-2 virus in your lungs is that it's like lopping off your leg to clip a toenail. No benefit at all and all risk, so don't do it.

The final, alcohol. There were news reports of people in Iran drinking industrial-strength alcohol, a prominent one being methanol, methan- being the prefix meaning one. In the body, alcohol dehydrogenase turns methanol into formaldehyde. This chemical was used to embalm mummies.

Formaldehyde is a disinfectant, but it's also a poison. Instead of weak vinegar, formaldehyde gets broken down a second time to become methanoic acid, which causes blindness. The acid part spills into the blood, causing acidemia, acid presence in blood. In high enough amounts in blood, acids can cause the heart to stop beating, meaning that no alcohols are good enough for curing COVID-19 inside humans. They should be good enough to disinfect surfaces outside the body in the right concentrations, which brings us back to CB.

Acetone -- nail polish remover -- causes mild nervous system effects. The body can't break it down any further because of the balance part from the word iso-. The chemistry says that these bonds are too hard to break in humans, so it's a matter of time for CB's body to work to eliminate it in his urine.

With supportive care, he came out of his coma and was sent home a day later. It's good that he ended up being okay, but it's not good that the hospital had to use those resources during this pandemic. There are other patients who come in critically ill, and then there's CB because he drank rubbing alcohol. Don't be like CB.

How about another disinfectant? AC is a 40-year-old man presenting to the emergency room with drooling and vomiting. He tried to speak, but he couldn't. An exam of his mouth and throat found swelling, redness, and ulcers inside. In the emergency room, doctors immediately stick a tube with a camera down his throat. Swelling and inflammation were so bad that they couldn't find his vocal cords.

A longer tube was stuck down his throat to look at his stomach. Burns and dead tissue were found in the inner lining of his esophagus, confirming that AC is suffering from caustic burn injury because he accidentally swallowed industrial-strength bleach, thinking that it would cure him of the virus.

He later claimed that he thought it was dilute and watered down before drinking it, which is plausible, and here's why. Bleach is a really good disinfectant. Household bleach is sodium hypochlorite. If you take away the hypo-, sodium chlorite is industrial-strength bleach.

This brings us to a concept called equilibrium. Household bleach is around 6% sodium hypochlorite. The rest is mostly water. In this mixture, water interacts with the sodium and the hypochlorite. If we break it down, bleach is multiple chemicals living together in a balanced state called equilibrium.

These chemicals are sodium hydroxide, which is a base. A base is something that takes hydrogens. This is opposite to an acid, which is something that gives hydrogens, and this balance is complete because bleach produces hypochlorous acid in solution. These quickly kill bacteria and viruses, but they're not the only thing that bleach kills.

Human cells are enclosed by a layer of molecules that have long chains of fats. Sodium hydroxide from the bleach doesn't just take a hydrogen from these fats, it strips off long chains of it. Doing this actually ends up making soap. Immediately on contact, bleach rips open cells, spilling their contents out, but it's not done here.

Proteins live on the surface of cells, meaning that they're freed once that fat layer is stripped off. Sodium hydroxide and hypochlorous acid from bleach neutralize these proteins, all of this immediately consuming the bleach solution. By the time it gets to the stomach it's not really bleach anymore.

It's a mix of soap, salt, and dead liquefied tissue. This is why it doesn't cure COVID-19. It consumes itself on the way down because it reacts with everything that it touches. It never gets to the lungs, but if someone somehow did inhale it, it would strip off all the cells of the windpipe and the lungs, causing burns there too. Again, lopping off your leg to clip a toenail.

AC developed narrowing in his esophagus because scar tissue grew over time. He had to undergo multiple procedures where a balloon was put in his esophagus and inflated to keep it open, and he was maintained on a liquid diet because there were permanent scars.

Alcohol and bleach are surface disinfectants. They don't disinfect inside the body. They only cause harm, without any benefit at all.

How about other things? Some people say eating garlic is going to help fight SARS-2 virus. Well, it's probably not going to. Garlic has some antimicrobial properties and this could be because of a chemical named allicin. There could be more chemicals, and that's fine. When you see something like this in a chemical, you can assume that it's going to interact with sulfur in the body. Where's sulfur? It's in proteins, just like the SARS-2 virus spike. But inside the body, it's going to get broken down when you eat it.

You might say that garlic can boost the immune system. Okay, suppose that's real, and maybe it is. How are you going to measure that? And there's no role in treating a critically ill patient today with that. "I don't need to wash my hands because I ate garlic today." No, stop.

The only documented case of garlic doing anything for COVID-19 is a report from China in Zhejiang province, where a woman ate 3 lbs. of garlic. This is what happened to her throat. She couldn't speak because it was inflamed. That's it

Don't get me wrong, I like my garlic. But if I have fever and I'm starting to become short of breath right now in March 2020, I'm not going to be eating more garlic hoping that it all goes away and neither should you.

There's also more talk about ginger. Look, SARS-2 virus broke out in China. Chinese people today still practice traditional Chinese medicine, mixed with variations on Western standards of care. If ginger worked, they would have used it and SARS-2 virus wouldn't have spread like this. But it did spread like this.

Finally, essential oils. These have kind of become the butt of jokes -- and I know people probably want me to rag on them -- but they do actually have compounds that have demonstrated some antimicrobial activity, but the game changes once these things are inside the body. That's the overarching theme for everything involving disinfecting this virus. The scientific phrase for this is in vivo, from Latin meaning "inside life."

These things are broken down into things that don't disinfect, and if they do, they're not in the right amounts to disinfect. They end up causing more harm than good in the body. For essential oils, the reality is that the manufacturers of these oils have a wide variability in how much of the active chemicals are in their formulation. One manufacturer might have more of one thing than the other. One may have less than the other. It's not reliable and it's not enough to cure COVID-19 disease, and it could do harm in falsely elevating your confidence that it has eliminated a virus when it actually hasn't.

Anything that you swallow goes into your stomach and then absorbs into your liver. The liver breaks things down into forms that the body can handle. This is called metabolism. Humans evolved a very specific way of metabolizing alcohols. In the liver, there's something called alcohol dehydrogenase, de- meaning the removal of hydrogen, and -ase describing an enzyme, which is a protein that does chemical reactions (-ase is like lactase, which is an enzyme that breaks down milk sugar).

The body has no use for rubbing alcohol. It wants to get rid of it. To do that, it needs to make it easier to react with, in the hopes that a final product easily dissolves in water and can be collected by the kidneys to be urinated out. When alcohol dehydrogenase processes isopropanol it becomes acetone, which is the chemical name for nail polish remover.

Okay. If someone is exposed to SARS-2 virus and they get infected, it ends up in both of their lungs. We've already established that drinking rubbing alcohol is going to pass it into the liver where it's broken down to acetone. Acetone is a disinfectant too, so why wouldn't it end up in the lungs to fight the virus?

Well, this brings us to a concept called distribution. Once something is broken down by the liver, it enters the circulation. Human body has a large volume of water and blood, so that acetone is going to get diluted in that huge volume. Drinking a bottle of 91% rubbing alcohol will overload alcohol dehydrogenase in the liver. The acetone floating around will cause temporary brain problems, but it won't be concentrated enough to hit any virus in the lungs. Okay, so that's rubbing alcohol.

How about 60% liquor, like vodka or rum? Well, the alcohol that humans drink for fun is different. It's named ethanol. Ethan- means two. The CDC says that 120 proof, or 60% alcohol, can disinfect SARS-2 virus. But that disinfection happens outside the body, not inside.

Ethanol's broken down by alcohol dehydrogenase in the liver. Anything with an alcohol group gets processed by this enzyme. The result is acetaldehyde. This is what causes someone to become red when they drink and it also causes hangovers.

Acetaldehyde isn't a disinfectant and the body wants to get rid of it, so acetaldehyde is broken down again into acetate, which is a very weak vinegar and also not a disinfectant. Vinegar can be a disinfectant, but when it's weakened like this it isn't.

Drinking 60% liquor won't cure anyone of COVID-19 if SARS-2 virus is already in the body. Inhaling it won't cure the disease either. It would bypass the liver. It would bring a first pass of alcohol right to the brain. We don't have good data on this. But at 60%, that's going to negatively impact your brain, provided it doesn't damage the mucous membranes and lungs in the first place.

Alcohol inhalation misuse can cause acute respiratory distress syndrome, which is what happens in severe COVID-19 disease. The only analogy I have for inhaling really concentrated ethanol in hopes of disinfecting SARS-2 virus in your lungs is that it's like lopping off your leg to clip a toenail. No benefit at all and all risk, so don't do it.

The final, alcohol. There were news reports of people in Iran drinking industrial-strength alcohol, a prominent one being methanol, methan- being the prefix meaning one. In the body, alcohol dehydrogenase turns methanol into formaldehyde. This chemical was used to embalm mummies.

Formaldehyde is a disinfectant, but it's also a poison. Instead of weak vinegar, formaldehyde gets broken down a second time to become methanoic acid, which causes blindness. The acid part spills into the blood, causing acidemia, acid presence in blood. In high enough amounts in blood, acids can cause the heart to stop beating, meaning that no alcohols are good enough for curing COVID-19 inside humans. They should be good enough to disinfect surfaces outside the body in the right concentrations, which brings us back to CB.

Acetone -- nail polish remover -- causes mild nervous system effects. The body can't break it down any further because of the balance part from the word iso-. The chemistry says that these bonds are too hard to break in humans, so it's a matter of time for CB's body to work to eliminate it in his urine.

With supportive care, he came out of his coma and was sent home a day later. It's good that he ended up being okay, but it's not good that the hospital had to use those resources during this pandemic. There are other patients who come in critically ill, and then there's CB because he drank rubbing alcohol. Don't be like CB.Human cells are enclosed by a layer of molecules that have long chains of fats. Sodium hydroxide from the bleach doesn't just take a hydrogen from these fats, it strips off long chains of it. Doing this actually ends up making soap. Immediately on contact, bleach rips open cells, spilling their contents out, but it's not done here.

Proteins live on the surface of cells, meaning that they're freed once that fat layer is stripped off. Sodium hydroxide and hypochlorous acid from bleach neutralize these proteins, all of this immediately consuming the bleach solution. By the time it gets to the stomach it's not really bleach anymore.

It's a mix of soap, salt, and dead liquefied tissue. This is why it doesn't cure COVID-19. It consumes itself on the way down because it reacts with everything that it touches. It never gets to the lungs, but if someone somehow did inhale it, it would strip off all the cells of the windpipe and the lungs, causing burns there too. Again, lopping off your leg to clip a toenail.

AC developed narrowing in his esophagus because scar tissue grew over time. He had to undergo multiple procedures where a balloon was put in his esophagus and inflated to keep it open, and he was maintained on a liquid diet because there were permanent scars.

Alcohol and bleach are surface disinfectants. They don't disinfect inside the body. They only cause harm, without any benefit at all.

How about other things? Some people say eating garlic is going to help fight SARS-2 virus. Well, it's probably not going to. Garlic has some antimicrobial properties and this could be because of a chemical named allicin. There could be more chemicals, and that's fine. When you see something like this in a chemical, you can assume that it's going to interact with sulfur in the body. Where's sulfur? It's in proteins, just like the SARS-2 virus spike. But inside the body, it's going to get broken down when you eat it.

You might say that garlic can boost the immune system. Okay, suppose that's real, and maybe it is. How are you going to measure that? And there's no role in treating a critically ill patient today with that. "I don't need to wash my hands because I ate garlic today." No, stop.

The only documented case of garlic doing anything for COVID-19 is a report from China in Zhejiang province, where a woman ate 3 lbs. of garlic. This is what happened to her throat. She couldn't speak because it was inflamed. That's it

Don't get me wrong, I like my garlic. But if I have fever and I'm starting to become short of breath right now in March 2020, I'm not going to be eating more garlic hoping that it all goes away and neither should you.

There's also more talk about ginger. Look, SARS-2 virus broke out in China. Chinese people today still practice traditional Chinese medicine, mixed with variations on Western standards of care. If ginger worked, they would have used it and SARS-2 virus wouldn't have spread like this. But it did spread like this.

Finally, essential oils. These have kind of become the butt of jokes -- and I know people probably want me to rag on them -- but they do actually have compounds that have demonstrated some antimicrobial activity, but the game changes once these things are inside the body. That's the overarching theme for everything involving disinfecting this virus. The scientific phrase for this is in vivo, from Latin meaning "inside life."

These things are broken down into things that don't disinfect, and if they do, they're not in the right amounts to disinfect. They end up causing more harm than good in the body. For essential oils, the reality is that the manufacturers of these oils have a wide variability in how much of the active chemicals are in their formulation. One manufacturer might have more of one thing than the other. One may have less than the other. It's not reliable and it's not enough to cure COVID-19 disease, and it could do harm in falsely elevating your confidence that it has eliminated a virus when it actually hasn't.

Vitamin C*. There isn't great evidence for it on cold and flu, which are different illnesses than COVID-19. If you're going to take it, follow the directions on the label. Don't double it up. The general consensus is this. Lots of things can kill SARS-2 virus outside of the body. They don't kill the virus inside the body because the game changes in vivo. At best, they don't mess with COVID-19 disease like garlic and ginger, and at worst, they cause somebody to go blind, and someone's heart to stop beating like methanol. At worst, it liquefies and strips off the inner lining of your throat and stomach, like bleach. (Dr. Bernard received push back about this use of Vitamin C opinion.  See link to see the responses.)

Or at worst, it does nothing and gives someone self-confidence that they're clear of the infection, when they're actually not. Then they go out and spread it around the community because they think they're virus-free. Don't be that person.

Wash your hands after you come back home. Wash them after you touch anything that came from outside of your house. When you wash, keep the soap on your hands for 20 seconds while rubbing them together thoroughly. It's even better if you wash them a second time again for another 20 seconds right after, and then dry your hands with a clean towel.

That's all benefit for prevention with little risk. But if you do feel fever and cough and body aches, then get that checked out. Don't pretend nothing is wrong if you feel sick. It doesn't matter what age you are. This is very important. #alert_notanxious. Check out Heme Review. Take care of yourself and be well.

"Dr. Bernard" is a licensed physician and clinical adjunct professor at the University of Illinois.

*https://www.clinicaltrials.gov/ct2/show/NCT04323514
...and this one from China:
https://clinicaltrials.gov/ct2/show/NCT04264533