Bob Schwartz

Category: Medicine

March 22, 2020

If You Pray, Pray for Dr. Fauci

In her New York Times column today, Maureen Dowd interviews Dr. Anthony Fauci.

If you have been paying attention, you know that 79-year-old Dr. Fauci has been the trusted national voice of fact and reason in response to the pandemic. He is currently director of the National Institute of Allergy and Infectious Diseases, and has served six presidents.

In the interview, we learn that Dr. Fauci has been working 18-hour days, and at one point worked four or five days on three hours sleep each day. Because as a doctor, scientist and public servant he wants us to understand, wants us to behave appropriately, and wants as few Americans as possible to suffer and maybe die.

Part of that interview:

Thank God the Doctor Is In

By Maureen Dowd

March 21, 2020

WASHINGTON — It’s not easy being a national treasure.

“I’m exhausted,” confessed Tony Fauci when I reached him Thursday evening in the middle of another 18-hour workday.

“I have changed my tune a bit, probably thanks to my wife,” said the 79-year-old director of the National Institute of Allergy and Infectious Diseases. “About a week ago, I was going about four or five days in a row on about three hours of sleep, which is completely crazy, ’cause then I’ll be going on fumes. The last couple of nights, I’ve gotten five hours’ sleep, so I feel much better.”

He said he misses the endorphins of power walking, and he is wracked when he gets home at midnight and it’s too late to answer calls and emails.

“I gotta get rid of this guilt feeling,” he murmured about that moment’s 727 emails.

He said he has not been tested for the coronavirus but takes his temperature every day and usually has it taken another couple times before White House press conferences and meetings in the Oval.

When I spoke with him, he had been missing from the White House briefing for two days and Twitter blew a gasket, with everyone from Susan Rice to Laurence Tribe seeking an answer to the urgent query, “Where is Dr. Fauci?”

Donald Trump, the ultimate “me” guy, is in a “we” crisis and it isn’t pretty. The president is so consumed by his desire to get back his binky, a soaring stock market, that he continues to taffy-twist the facts, leaving us to look elsewhere — to Dr. Fauci and governors like Andrew Cuomo and Gavin Newsom — for leadership during this grim odyssey.

Dr. Fauci chuckled at speculation that he was banished due to his habit of pushing back on Trump’s hyperbolic and self-serving ad-libbing.

“That’s kind of funny but understandable that people said, ‘What the hell’s the matter with Fauci?’ because I had been walking a fine line; I’ve been telling the president things he doesn’t want to hear,” he said. “I have publicly had to say something different with what he states.

“It’s a risky business. But that’s my style, Maureen. You know me for many years. I say it the way it is, and if he’s gonna get pissed off, he’s gonna get pissed off. Thankfully, he is not. Interestingly.”

The first time I talked to Dr. Fauci was during a panic in the mid-80s about stopping another virus, the cause of the heartbreaking AIDs crisis. Then, as now, he was honest, brave and innovative. He told me that he tries to be diplomatic when he has to contradict the president about what “game-changer” cures might be on the horizon and whether everyone who wants to be tested can get tested.

“I don’t want to embarrass him,” the immunologist says, in his gravelly Brooklyn accent. “I don’t want to act like a tough guy, like I stood up to the president. I just want to get the facts out. And instead of saying, ‘You’re wrong,’ all you need to do is continually talk about what the data are and what the evidence is.

“And he gets that. He’s a smart guy. He’s not a dummy. So he doesn’t take it — certainly up to now — he doesn’t take it in a way that I’m confronting him in any way. He takes it in a good way.”

On Friday, a trigger-happy Trump was so quick to talk up the fabulous possibilities of an antimalarial drug in combating the virus that Dr. Fauci had to pump the brakes, taking the microphone to explain that we do not know yet because controlled testing is needed.

The president returned to the lectern to press his unscientific case and compliment himself: “I’m a smart guy,” he said. “I feel good about it. And we’re going to see. You’re going to see soon enough.”

Probably thinking about all his government staffers working round-the-clock, Dr. Fauci could not help rubbing his forehead and cheek — going against his own advice to the public — when Trump cracked a joke about the “Deep State Department.”

Though the scientist listens respectfully when the president and the vice president are talking, he somehow manages to emit an “Oh my God, please don’t say that” vibe when the two men scamper over the line. When Mike Pence went into false-hope overdrive, saying, “I just can’t emphasize enough about the incredible progress that we have made on testing,” Dr. Fauci and Dr. Deborah Birx, the administration’s virus response coordinator, exchanged a whispered aside that sent the internet into a frenzy.

Dr. Fauci assured me that, despite their crosscurrents and an early overconfidence about how easy it would be to control the path of the virus, the president “absolutely” now gets the threat of “the invisible enemy,” as Trump calls the virus.

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March 20, 2019

DSM-5: Antagonism and Narcissistic Personality Disorder

 

DSM-5

This post was first published more than two years ago. It refers to no individual by name, but since it is regularly viewed by dozens of people each week, I am confident the message got through. Now that the issue of this personality disorder is finally at the top of the news, here it is again for those who may have missed it. Still no name mentioned, but there is no doubt what it suggests.

Mental health is a serious matter and mental health practitioners are serious professionals. These are not to be treated lightly and off-handedly.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the “bible” of the mental health profession: “a classification of mental disorders with associated criteria designed to facilitate more reliable diagnoses of these disorders.” It is not a reference to be thrown around and used casually by non-professionals.

The DSM can nonetheless be fascinating, especially when certain strong behavioral traits observed in others seem to closely match the traits and possible related disorders referenced in the DSM.

With the above caution and caveat, here are selections from DSM-5 about the Personality Trait Domain of Antagonism. More from the DSM about the way this may or may not relate to Narcissistic Personality Disorder will follow in a subsequent post.

Personality trait: A tendency to behave, feel, perceive, and think in relatively consistent ways across time and across situations in which the trait may be manifest.

Personality trait facets: Specific personality components that make up the five broad personality trait domains in the dimensional taxonomy of Section III “Alternative DSM-5 Model for Personality Disorders.” For example, the broad domain Antagonism has the following component facets: Manipulativeness, Deceitfulness, Grandiosity, Attention Seeking, Callousness, and Hostility.

Antagonism: Behaviors that put an individual at odds with other people, such as an exaggerated sense of self-importance with a concomitant expectation of special treatment, as well as a callous antipathy toward others, encompassing both unawareness of others’ needs and feelings, and a readiness to use others in the service of self-enhancement. Antagonism is one of the five broad personality trait domains defined in Section III “Alternative DSM-5 Model for Personality Disorders.”

Manipulativeness: Use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one’s ends. Manipulativeness is a facet of the broad personality trait domain Antagonism.

Grandiosity: Believing that one is superior to others and deserves special treatment; self-centeredness; feelings of entitlement; condescension toward others. Grandiosity is a facet of the broad personality trait domain Antagonism.

Deceitfulness: Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events. Deceitfulness is a facet of the broad personality trait domain Antagonism.

Attention seeking: Engaging in behavior designed to attract notice and to make oneself the focus of others’ attention and admiration. Attention seeking is a facet of the broad personality trait domain Antagonism.

Callousness: Lack of concern for the feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one’s actions on others. Callousness is a facet of the broad personality trait domain Antagonism.

Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behavior. Hostility is a facet of the broad personality trait domain Antagonism.

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May 1, 2018

Trump’s Shtarkers

There is news that the offices of Trump’s long-time New York doctor were raided in February 2017 by Trump associates. A great Yiddish word comes immediately to mind: shtarker.

The Hill reports:

President Trump’s longtime personal doctor in New York said a trio of Trump associates raided his office in February 2017, seizing the president’s medical records.

Dr. Harold Bornstein told NBC News that Trump’s bodyguard, Keith Schiller, a lawyer with the Trump Organization and a third man came to his office the morning of Feb. 3, 2017. They took lab reports and Trump’s medical charts, he said.

“They must have been here for 25 minutes or 30 minutes. It created a lot of chaos,” Bornstein said, adding that he felt “raped, frightened and sad.”

Stark in Yiddish means strong, and so one of the usages of shtarker is to mean “strong man” or “tough guy.” But it acquired another, more sinister meaning in the lexicon of crime. A shtarker is a strong-arm man, an enforcer, a thug.

It is a word definitely well-known to the Russian and Eastern European Jews who surrounded Michael Cohen in his family and business (see A Brief History of Michael Cohen’s Criminal Ties . It is a word that may not be known to all of Trump’s people,  but it is a concept that some of them understand, endorse and are not afraid to use.

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March 17, 2017

Brain Fiction: Self-Deception and the Riddle of Confabulation

What if someone lies in the face of overwhelming contrary evidence? What if that person really believes what he is saying?

Confabulation is the construction of false answers to a question while genuinely believing that you are telling the truth.

This mysterious phenomenon usually accompanies neurological or cognitive disorders, and the puzzle of it has been the subject of some study among researchers. In his book Brain Fiction: Self-Deception and the Riddle of Confabulation, William Hirstein takes this study further than it has gone before:

“Both a neuroscientist and a philosopher, William Hirstein writes from his unique vantage point with great scholarship, precision, and clarity to tackle some of the deeper mysteries of the human mind. Brain Fiction is full of profound insights, and I recommend it to all who wish to better understand our human nature.”

—Fredric Schiffer, M.D., Harvard Medical School, author of Of Two Minds

Here is a description of the book:

Some neurological patients exhibit a striking tendency to confabulate—to construct false answers to a question while genuinely believing that they are telling the truth. A stroke victim, for example, will describe in detail a conference he attended over the weekend when in fact he has not left the hospital. Normal people, too, sometimes have a tendency to confabulate; rather than admitting “I don’t know,” some people will make up an answer or an explanation and express it with complete conviction. In Brain Fiction, William Hirstein examines confabulation and argues that its causes are not merely technical issues in neurology or cognitive science but deeply revealing about the structure of the human intellect.

Hirstein describes confabulation as the failure of a normal checking or censoring process in the brain—the failure to recognize that a false answer is fantasy, not reality. Thus, he argues, the creative ability to construct a plausible-sounding response and some ability to check that response are separate in the human brain. Hirstein sees the dialectic between the creative and checking processes—”the inner dialogue”—as an important part of our mental life. In constructing a theory of confabulation, Hirstein integrates perspectives from different fields, including philosophy, neuroscience, and psychology to achieve a natural mix of conceptual issues usually treated by philosophers with purely empirical issues; information about the distribution of certain blood vessels in the prefrontal lobes of the brain, for example, or the behavior of split-brain patients can shed light on the classic questions of philosophy of mind, including questions about the function of consciousness. This first book-length study of confabulation breaks ground in both philosophy and cognitive science.

A sample chapter can be read here. A couple of brief excerpts:

Why then does confabulation happen? Confabulation seems to involve two sorts of errors. First, a false response is created. Second, having thought of or spoken the false response, the patient fails to check, examine it and recognize its falsity. A normal person, we want to say, would notice the falsity or absurdity of such claims. The patient should have either not created the false response or, having created it, should have censored or corrected it. We do this sort of censoring in our normal lives. If I ask you whether you have ever been to Siberia, for instance, an image might appear in your mind of you wearing a thick fur coat and hat and braving a snowy storm, but you know that this is fantasy, not reality. In very general terms, the confabulating patient lacks the ability to assess his or her situation, and to either answer correctly, or respond that he or she does not know. Apparently, admitting ignorance in response to a question, rather than being an indication of glibness and a low level of function, is a high-level cognitive ability, one that confabulators have lost. ‘‘I don’t know,’’ can be an intelligent answer to a question, or at least an answer indicative of good cognitive health….

Young children sometimes confabulate when asked to recall events. Ackil and Zaragoza (1998) showed first-graders a segment of a film depicting a boy and his experiences at summer camp. Afterward the children were asked questions about it, including questions about events that did not happen in the film. One such question was, ‘‘What did the boy say Sullivan had stolen?’’ when in fact no thefts had taken place in the film. The children were pressed to give some sort of answer, and the experimenters often suggested an answer. When the children were interviewed a week later, the false events as well as the suggested answers had been incorporated into their recollections of the movie.

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March 4, 2017

DSM-5: Paranoia

DSM-5

I did not think that I would be returning to the DSM quite so soon after my recent post.

The caveat in my last post about the DSM bears repeating. Mental health is a serious issue. Using diagnostic tools and terminology merely for entertainment and “pop psychology” can be careless. On the other hand, these tools can help provide insights that may be useful, particularly when the subject and the subject matter are very important or even critical.

Non-professionals talk loosely and colloquially about paranoia. The DSM approaches this clinically and scientifically:

Paranoid Personality Disorder

Diagnostic Criteria

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

  1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
  2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
  3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
  4. Reads hidden demeaning or threatening meanings into benign remarks or events.
  5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
  6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
  7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

Diagnostic Features [selected]

They suspect on the basis of little or no evidence that others are plotting against them and may attack them suddenly, at any time and without reason.

They are preoccupied with unjustified doubts about the loyalty or trustworthiness of their friends and associates, whose actions are minutely scrutinized for evidence of hostile intentions.

They may refuse to answer personal questions, saying that the information is “nobody’s business.”

They read hidden meanings that are demeaning and threatening into benign remarks or events. For example, an individual with this disorder may misinterpret an honest mistake by a store clerk as a deliberate attempt to shortchange, or view a casual humorous remark by a co-worker as a serious character attack.

They may view an offer of help as a criticism that they are not doing well enough on their own.

Individuals with this disorder persistently bear grudges and are unwilling to forgive the insults, injuries, or slights that they think they have received.

Minor slights arouse major hostility, and the hostile feelings persist for a long time.

Because they are constantly vigilant to the harmful intentions of others, they very often feel that their character or reputation has been attacked or that they have been slighted in some other way.

They are quick to counterattack and react with anger to perceived insults.

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March 2, 2017

DSM-5: Antagonism and Narcissistic Personality Disorder

 

DSM-5

Mental health is a serious matter and mental health practitioners are serious professionals. These are not to be treated lightly and off-handedly.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the “bible” of the mental health profession: “a classification of mental disorders with associated criteria designed to facilitate more reliable diagnoses of these disorders.” It is not a reference to be thrown around and used casually by non-professionals.

The DSM can nonetheless be fascinating, especially when certain strong behavioral traits observed in others seem to closely match the traits and possible related disorders referenced in the DSM.

With the above caution and caveat, here are selections from DSM-5 about the Personality Trait Domain of Antagonism. More from the DSM about the way this may or may not relate to Narcissistic Personality Disorder will follow in a subsequent post.

Personality trait: A tendency to behave, feel, perceive, and think in relatively consistent ways across time and across situations in which the trait may be manifest.

Personality trait facets: Specific personality components that make up the five broad personality trait domains in the dimensional taxonomy of Section III “Alternative DSM-5 Model for Personality Disorders.” For example, the broad domain Antagonism has the following component facets: Manipulativeness, Deceitfulness, Grandiosity, Attention Seeking, Callousness, and Hostility.

Antagonism: Behaviors that put an individual at odds with other people, such as an exaggerated sense of self-importance with a concomitant expectation of special treatment, as well as a callous antipathy toward others, encompassing both unawareness of others’ needs and feelings, and a readiness to use others in the service of self-enhancement. Antagonism is one of the five broad personality trait domains defined in Section III “Alternative DSM-5 Model for Personality Disorders.”

Manipulativeness: Use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one’s ends. Manipulativeness is a facet of the broad personality trait domain Antagonism.

Grandiosity: Believing that one is superior to others and deserves special treatment; self-centeredness; feelings of entitlement; condescension toward others. Grandiosity is a facet of the broad personality trait domain Antagonism.

Deceitfulness: Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events. Deceitfulness is a facet of the broad personality trait domain Antagonism.

Attention seeking: Engaging in behavior designed to attract notice and to make oneself the focus of others’ attention and admiration. Attention seeking is a facet of the broad personality trait domain Antagonism.

Callousness: Lack of concern for the feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one’s actions on others. Callousness is a facet of the broad personality trait domain Antagonism.

Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behavior. Hostility is a facet of the broad personality trait domain Antagonism.

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October 5, 2015

Collateral Damage in Afghanistan

In the vocabulary of war, no term is darker or more chilling than “collateral damage.”

There was last week collateral damage in our war in Afghanistan, where a Doctors Without Borders hospital was the target of aggressive American airstrikes. A number were killed and injured, including children, and the hospital was destroyed.

The few facts, besides the destruction, are these.

Collateral damage is unavoidable, though it can and should be minimized.

The Taliban has overtaken the area, though not the hospital.

We are engaged in supporting the Afghan fight against the Taliban, by, for example, air strikes.

Hospital personnel contacted the U.S. military after the barrage began, but it continued anyway.

Now for the rest of the story, which the Pentagon tried to correct this morning.

Early reports were that the U.S. itself called for the air strikes.

Not so, says the Pentagon. It was the Afghans who identified the target as a Taliban position, and then we conducted the airstrikes.

Don’t you see the difference? The difference, of course, being some sort of operational and moral distinction, being entirely responsible for a tragic and avoidable error versus being only mostly responsible for a tragic and avoidable error. Now we see.

It isn’t really about the particulars anyway. It’s about the need for unceasing realization that if you choose war, you choose its worst impacts. The calculus can’t just include the big win and big benefits—assuming there are any—so that those cancel out the ill you do. It doesn’t work that way. So when and if we choose war, it is never illegitimate to keep the costs constantly in mind. In fact, it is always immoral and ill-advised not to.

Otherwise, you might end up with millions of underserved and nearly abandoned veterans. Or a badly damaged economy. Or a dispirited and skeptical nation. Or some of the world’s most selfless health workers in one of the world’s most needy countries watching as their patients and their hospital die and burn.

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October 23, 2014

Coming Out: How Cosmetic Surgery Is Like Being Gay

South Park - Tom Cruise

In case you haven’t noticed, the noise surrounding Renee Zellweger’s about face sounds just like the conversations we have about celebrities being gay: did she or didn’t she, is he or isn’t he?

There are three kinds of cosmetic surgery: the public kind that can be explained as the result of exercise and nutrition (body shaping and toning), the public kind that is hard to explain that way (obviously enhanced breasts), and the private kind that is (sort of) meant to be private (vagina rejuvenation, penis enhancement).

Questions about the public kinds can be met with a variety of replies, all of them valid:

Yes.
No.
No comment.
It’s none of your business.

This remarkably parallels the situation of those who are “suspected” of being gay. Sometimes it is made public, sometimes it is kept private, sometimes it is treated matter-of-factly: it is what it is, it’s my life, take it or leave it, so what?

Admitting to plastic surgery is in many contexts (including and especially entertainment) as delicate as admitting to being gay—even if the fact is relatively obvious. One of the many reasons the late Joan Rivers was so beloved, why what was obnoxious in others was endearing in her, is that the fact of her many plastic surgeries was a prime subject of her own bits. As with other topics, she just gave you the finger, laughed, and had you laughing too.

In the scheme of all but the tiniest matters, Renee Zellweger’s face is inconsequential. But as with all the tongue wagging about the sexual preferences of some celebrity, it exposes unanswered and mostly unspoken questions about how people feel about certain things. Many people still don’t know exactly what they think about major or minor voluntary body mod, any more than they may have totally resolved their deepest puzzlement about homosexuality, no matter how genuinely progressive and tolerant they are.

For better or worse, we are actually seeing a bit of that in the Renee Zellweger situation: along with an avalanche of typically mindless chatter, there has been some useful discussion about the nature of celebrity, privacy, aging, feminism, and health. It is unfortunate that this has to fall on a single individual’s shoulders, with so much collateral and gratuitous hurt. But if we are careful, we might just learn something, mostly about ourselves. How rare and valuable an opportunity is that?

Illustration: The obvious illustration for this post would be yet another photo of Renee Zellweger, which neither the world nor she need. Instead, above is a frame from South Park, the 2005 episode called Trapped in the Closet. It is widely considered the show’s most controversial episode, which is saying something. In it, the fearless and brilliant and culturally incorrect Parker and Stone managed to skewer (eviscerate?) both Scientology and the rumored homosexuality of Hollywood stars. In this scene, Tom Cruise won’t come out of the closet (where he will ultimately be joined by John Travolta). Nicole Kidman, his then-wife, is trying to talk him out. As I said, culturally incorrect, and probably intolerant and spiteful in light of all that’s written above. But it is funny, and not surprisingly, it is the equally fearless and funny Joan Rivers who also took on the very same subject. Laughing and thinking. What a combo.

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March 21, 2014

Thor Gives Birth to Twins

Thor
Nobody wants to hear from word nerds. They just stifle creativity and block linguistic evolution with their definitions and rules. Humpty Dumpty from Alice in Wonderland is the man (or eggman): words mean exactly what anybody says they mean.

Except they don’t, or they can’t or shouldn’t. If you tell a doctor you have a pain in your leg, and she examines and treats your arm, because leg now means arm, everybody has a problem.

Here’s the TMZ story that’s been widely picked up:

Chris Hemsworth and Elsa Pataky — Give Birth to Twins
Thor’s Got Twins Now!

3/20/2014 4:14 PM PDT BY TMZ STAFF
EXCLUSIVE

Chris Hemsworth and his wife are at Cedars Sinai Medical Center right now giving birth to twins … TMZ has learned.

It’s ultra-high security in their hospital suite … we’re told 2 security guards are standing at the door.  Chris is strolling the hallway and is being escorted with a guard.

Chris and his wife Elsa Pataky already have one baby — India Rose Hemsworth who is now 22 months old.  She’s about to have a couple new siblings.

Chris and Elsa were married in 2010.

This led to headlines like this one in the New York Daily News:

Chris Hemsworth, wife Elsa Pataky giving birth to twins

Nobody may care, except for mothers, doctors, and Mrs. Chris Hemsworth, but “giving birth” is not the same as parents having a baby. “Birth” is variously defined as “The emergence and separation of offspring from the body of the mother” or “The event of being born, the entry of a new person out of its mother into the world.”

Chris Hemsworth can be a proud and involved daddy. So can Thor. But neither of them can give birth, no matter what TMZ or the Daily News say.

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October 9, 2013

League of Denial: The NFL’s Concussion Crisis

league-of-denial-raster-br10-8
You may not think that you want to watch the new PBS Frontline documentary League of Denial: The NFL’s Concussion Crisis.

You may not want to spend almost two hours on a documentary, even a superb one. You may not like football, may not know anybody who plays football at any level, may not care about the business of sports. Then again, some or all of those may apply to you.

It doesn’t matter. You can watch League of Denial online. Please watch it.

One of the many lessons you will learn, if you didn’t already know, is that we pay a price for everything. Or at least somebody does. The price is sometimes advertised and obvious, but sometimes hard to find or even hidden. The point is not that something is good or bad, right or wrong, but that we can only make informed and enlightened decisions when everything is known. No more or less.

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