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Marine General James Mattis Denounces Trump

No sorry here, I refuse to call Trump President. It is time for this bum to leave.

Breaking his silence  .   .   .

General Mattis denounces the president for dividing the nation, and accused him of ordering the U.S. military to violate the constitutional rights of American citizens.

General Mattis: “I have watched this week’s unfolding events, angry and appalled The words ‘Equal Justice Under Law’ are carved in the pediment of the United States Supreme Court. This is precisely what protesters are rightly demanding. It is a wholesome and unifying demand – one that all of us should be able to get behind. We must not be distracted by a small number of lawbreakers. The protests are defined by tens of thousands of people of conscience who are insisting that we live up to our values – our values as people and our values as a nation.  We must reject and hold accountable those in office who would make a mockery of our Constitution.’”

James Mattis Denounces President Trump, Describes Him as a Threat to the Constitution The Atlantic

Retired Admiral Mike Mullen (Chairman Joint Chief of Staff).

“It sickened me yesterday to see security personnel—including members of the National Guard—forcibly and violently clear a path through Lafayette Square to accommodate the president’s visit outside St. John’s Church. I have to date been reticent to speak out on issues surrounding President Trump’s leadership, but we are at an inflection point, and the events of the past few weeks have made it impossible to remain silent.

Whatever Trump’s goal in conducting his visit, he laid bare his disdain for the rights of peaceful protest in this country, gave succor to the leaders of other countries who take comfort in our domestic strife, and risked further politicizing the men and women of our armed forces.

There was little good in the stunt.”

I Can Not Remain Silent, The Atlantic

There is more to their statements which I am not going to include here. Follow the links.

I have never experienced a General denouncing a President during my cognizant lifetime. I have read about MacArthur and his battle with Truman. I do not believe this type of commentary ever went to the open level. Both of these commentaries are beyond the norm for flag officers

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More On “Obamagate!”

More On “Obamagate!”

Just three items.

1) Today (or yesterday late?) AG William Barr appointed yet another Special Counsel to investigate “Obamagate!” John Bash of the Texas Western District of the DOJ. He has been assigned to investigate the various unmaskings of Michael Flynn that happened between the election of 2016 and Flynn’s interrogation by the FBI after Trump became president in January, 2017. The full absurdity of this is that even Barr in making this assignment recognized that there is nothing illegal about unmasking, not even anything improper.  Nevertheless, he thinks this particular set of unmaskings needs further investigation by the Department of Justice.

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Meanwhile the US Supreme Court is still working

Via Truthout is a reminder the US Supreme Court has rulings to make:

On May 12, the Supreme Court will have an opportunity to rebuke or endorse Trump’s pretensions to monarchical grandeur when it hears oral arguments in three cases that have the potential to redefine the nature and scope of presidential power.

The cases before the court are Trump v. Mazars USA, LLPTrump v. Deutsche Bank AG; and Trump v. Vance. In the first two, the president is trying to block congressional subpoenas seeking access to his personal financial records. In the third, he’s asking the court to block a subpoena issued by a New York City grand jury, and to accord him unprecedented “absolute immunity” from state criminal investigations.

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Are capitalism and democracy compatible?

by Ken Melvin

Are capitalism and democracy compatible?

 Both Capitalism and Democracy are complicated, complex concepts with varying interpretations.

Beginning with a working definition of democracy:

Democracy — A government formed of representatives popularly elected by the enfranchised citizenry of the governed entity.

    • Webster’s a government in which the supreme power is vested in the people and exercised by them directly or indirectly through a system of representation usually involving periodically held free elections.

In a true democracy, with as few exceptions as possible, every citizen over a certain age would be eligible to vote, all eligible would vote, and all of their votes would be equal. In the 2016 election only 61.4% of adult U.S. citizens (137.5 million) cast ballots, Trump won the electoral college vote 304 (57%) to 227 (43%) even though he received slightly less than half (46% to 48% for Clinton) of the votes cast. So, by any measure, it wasn’t even close to being a democratic result. This wasn’t by accident.

Putting aside for a while: all the unscrupulous things done in the 2016 election to sway opinion, all efforts to make voting inordinately difficult for some, all the hacking into computers by Russia, all the involvement of the likes of Wikileaks and Cambridge Analytica, the nefarious role of Facebook and other social media, the tons of dark and not so dark money, … ; it was the extremely skewed electoral college vote that determined the winner. How can you have a democratic outcome when South Dakota with less than one-million citizens has 3 electoral votes and California with almost forty-million (40 times SD’s population) has 55 (only 18 times as many electoral votes)? SD residents have one electoral vote per 300,000 resident and CA one vote per 727,000; a 2.2 to 1 ratio of inequality. Essentially the same could be said of ND, ID, WY, MT, AK, NM, KS, NB, NV, AR, MS, NH, VT, ME, and WV; their votes for president are worth more than the votes of voters in populous states and twice as much as the votes of the voters in the more populous states. States electors are allotted per Article II, Section 1, Clause 2 of the US constitution.

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Judges, Ideologues, Dogmatics, and Bad Decisions

by Ken Melvin

Judges, Ideologues, Dogmatics, and Bad Decisions

A judge should be wise enough to look to the possible consequences of his or her decisions. A judge should be wise enough to change his or her mind.  A judge should generally accord these qualities to the decisions of his or her predecessors. And, given that judges pass judgment on others, a judge should be law-abiding, of good moral character, … above reproach.

At the present time we have three, maybe four or five, supreme court justices: Alito, Thomas, Gorsuch*, and perhaps Kavanaugh*, and Roberts, who feel that they, more than anyone before them or now on the court, know how the constitution should be interpreted; would impose their interpretation on the nation no matter the consequences.  Some consequences of this sort of thinking of late include:  District of Columbia v. Heller, McDonald v. City of Chicago, Shelby County v. Holder, Citizens United v. Federal Election Commission, and, most recently, Rucho v. Common Cause; all decisions with horrendous consequences.

Columbia v. Heller:

The Second Amendment to the Constitution:

A well regulated Militia, being necessary to the security of a free State,

the right of the people to keep and bear Arms, shall not be infringed.

In 2008, in the Heller decision, the Supreme Court, by a 5 to 4 margin, affirmed a Court of Appeals ruling that a citizen had the constitutional right to possess a firearm separate the militia clause.

The Supreme Court held:

(a) The Amendment’s prefatory clause announces a purpose, but does not limit or expand the scope of the second part, the operative clause. The operative clause’s text and history demonstrate that it connotes an individual right to keep and bear arms.  

(1) The Second Amendment protects an individual right to possess a firearm unconnected with service in a militia, and to use that arm for traditionally lawful purposes, such as self-defense within the home.

In writing the majority decision, Justice Scalia invoked his theory of original intent based on his review of colonial history and the early years of the republic and concluded that the Constitution’s Second Amendment meant, not what others before had said it meant, but whatever he said it meant some 230 years later. Scalia said that the second part, not the first part, was the operative clause. Scalia, not the second amendment, said, “ … to use that arm for traditionally lawful purposes, such as self-defense within the home.” Scalia was joined in the majority by Justices Roberts, Kennedy, Thomas and Alito.  Justice Stevens, who wrote the dissent, recently called Heller, “… the worst decision of my tenure.”

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Meanwhile, another DOJ move from Barr

Meanwhile while we are pre-occupied with corvid-19 comes this news from  Rolling Stone:

The Trump Department of Justice has asked Congress to craft legislation allowing chief judges to indefinitely hold people without trial and suspend other constitutionally-protected rights during coronavirus and other emergencies, according to a report by Politico’s Betsy Woodruff Swan.

The DOJ has requested Congress allow any chief judge of a district court to pause court proceedings “whenever the district court is fully or partially closed by virtue of any natural disaster, civil disobedience, or other emergency situation,” according to draft language obtained by Politico. This would be applicable to “any statutes or rules of procedure otherwise affecting pre-arrest, post-arrest, pre-trial, trial, and post-trial procedures in criminal and juvenile proceedings and all civil processes and proceedings.” They justify this by saying currently judges can pause judicial proceedings in an emergency but that new legislation would allow them to apply it “in a consistent manner.”

Norman L. Reimer, executive director of the National Association of Criminal Defense Lawyers, told Politico the measure was “terrifying,” saying, “Not only would it be a violation of [habeas corpus], but it says ‘affecting pre-arrest.’ So that means you could be arrested and never brought before a judge until they decide that the emergency or the civil disobedience is over. I find it absolutely terrifying. Especially in a time of emergency, we should be very careful about granting new powers to the government.”

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Not Just Covid 19, Cancer Too

Chloroquine and Hydroxychloroquine are being tested as components of multi-drug cancer chemotherapy. I have noticed that when I tweet this, people conclude that I am insane.

However this is not a tiny literature. \

Repurposing Drugs in Oncology (ReDO)—chloroquine and hydroxychloroquine as anti-cancer agents
is a long review article and meta analysis. It cites seven peer reviewed article which report the results of clinical trials and dozens of ongoing trials.

This is why I became interested in chloroquine and hydroxychloroquine. My family was very amused to find those drugs appearing in the news on Covid. I learned about Donald Trump playing doctor on TV, because my father immediately e-mailed me that now Trump is saying that stuff too (he I note does not think I am crazy — but he wouldn’t would he).

It is very easy to keep up with clinical trials, because there is a Clinical Trials Registry. To prevent publication bias and cherry picking, studies must be posted there, and a principal outcome measure must be chosen in advance. Otherwise the FDA considers any data to be irrelevant.

So see there are 21 Studies found for: chloroquine | cancer (at least one terminated because there was no sign the Chloroquine was helping — others with promising results — many others ongoing)

There are 74 studies of hydroxychloroqine & cancer

There are currently 5 Studies found for: hydroxychloroquine | Coronavirus

There is a (very overlapping) set of 6 studies of covid 19 & hydroxychloroquine

MY mania was triggered months ago while I was searching the Clinical Trials Registy.
https://clinicaltrials.gove is addictive

Hmm only 2,236 studies of addiction, one is
“Smartphone Addiction and Physical Activity” now I do have to look at that one on my phone (having neither the inclination nor the Prime Minister’s permission to engage in physical activity

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It is Clear that Hydroxychloroquine and Chloroquine are Currently Used to Treat Covid 19 in the USA

Patient privacy prevents precise calculation of the fraction of Covid 19 patients in the USA being treated with Hydroxychloroquine or Chloroquine. However, Hospitals are purchasing hugely increased amounts

Christopher Rowland reports.

Data gathered in the first 17 days of March by Premier Inc., a large group purchasing organization for 4,000 U.S. hospitals, showed a 300 percent week-over-week increase in orders of chloroquine and a 70 percent week-over-week boost in orders of hydroxychloroquine.

I think that, because of the association with Trump, this is presented as a bad thing. Certainly there is a problem of short supplies. Hydroxychloroquine is used to treat Lupus Erythematosus and Rhumatoid Arthritis and those people have trouble making sure they get their medicine, because of the sudden new demand.

The article begins with the odd reference to the FDA as if the FDA regulated off label prescription of drugs. The only legal effect of an FDA finding that the drugs work when treating Covid 19 is that manufacturers would then be allowed to claim this in advertisements. This is extremely irrelevant. The drugs are off patent and produced by many firms — there are no huge profit margins there. Also the free publicity dwarfs any possible ad campaign. The FDA has no relevant authority here.

It seems that there is an idea among many people that doctors shouldn’t do anything unless it is proven to work in a clinical trial. I recall (but can’t find) and article in which Dr Arnold Relman (editor of the New England Journal of Medicine and pretty much head of the medical establishment) denounced this. Waiting for clinical trials is a decision. It is a decision which has caused deaths. There is no option to stop the clock while the trial progresses. Patients who could benefit from or be harmed by novel treatments exist.

The idea that the practice of medicine should be vaguely like the approval of pharmaceuticals is definitely new. I am 100% sure that the main driver is fear of malpractice suits. It is very necessary to have an official published standard of care — following this standard is the only protection against malpractice suits when outcomes are bad &, you know, we all end up dead in the end.

But doctors must practice also when there is no standard (that is no committee of respected doctors is willing to take the moral not legal responsibility of drafting one). Obviously there is no standard of care for Covid 19. Also obviously many doctors are sensible enough to look at the balance of evidence in the absense of proof and make decisions which they believe are best for the patient in the absence of certain knowledge and knowing that they might regret the decision with the benefit of hindsight.

I don’t understand why official talk about medical care is so different from the current actual practice. I think it is partly about practical action vs scientific research. In scientific research it is perfectly fine to have open questions. If there is a patient on the edge of death, it is necessary to decide now.

But I am more confident than I was that small c conservatism is not killing as many people in the USA as it might.

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What do we want ? Hydroxychloroquine (update without Azithromycin) and Remdesivir. When do we want it ? Now

I will never forgive Donald Trump for saying something exceedingly controversial with which I agree. I hate to say this but I agree with Trump and disagree with Fauci on hydroxychloroquine and Remdesivir.

Update: But don’t mix the Hydroxychloroquine with Azithromycin
“Azithromycin: (Major) Avoid coadministration of hydroxychloroquine and azithromycin.”

Thanks Ted Lieu

I will discuss hydroxychloroquine here because there is no legal issue. It can be prescribed for Covid 19 under current law and regulation. As noted here, the FDA has no say in the matter — they regulate food, drugs, and advertising and do not regulate the practice of medicine.

Consider the different treatment of Remdesivir, Hydoxychloroquine, and sever control measures. Because it is not proven that hydroxychloroqine works, it is considered a Trump average level outrage to say it should be tried. The side effects have been known for decades (and are acceptable given the circumstances). It inhibits SARS Cov2 replication in vitro https://www.nature.com/articles/s41421-020-0156-0 . There is anecdotal evidence that it has saved lives.

This does not amount to proof. Therefore, it is argued (by many people I respect) that it is irresponsible to type the following: all Covid 19 patients should be given hydroxychloroqine now. There is no morally acceptable alternative to doing this now. Now.

In contrast, there is extremely limited evidence on extreme control measures. There is no control group. The sample size is maybe one or two. And yet, it is perfectly responsible to advocate extreme control measures. Indeed it is perfectly responsible to impose them by decree (I am in Rome and have been ordered by prime minister Conte not to leave this apartment without a good reason).

Note the contrast here
The NYTimes.com presents a model graphically on page 1. It shows estiamtes. It is, in fact, theory, forecast not fact. The effectiveness of “severe control measures” is assumed. The data on which the estimate is based isn’t presented (on page 1)

Consider this published the same day (no longer on page 1)

“Trump’s Embrace of Unproven Drugs to Treat Coronavirus Defies Science”

Notice there is no headline about how Cuomo’s, Newsome’s and Conte’s embrace of unproven public health measures defies science (and I absolutely don’t assert that — I think they are making reasonable policy choices given necessarily incomplete knowledge)

It is absolutely clear that there is no general rule for acting without proof or solid knowledge. Sometimes, the rule is to not do something new until there is proof that it works. Usually, the rule is entirely different.

I do not think that anyone can justify the current dichotomy. I don’t think anyone tries. It is just assumed that the FDA rules are laws of nature and must be accepted.

I am trying to understand why this is. There are many possible good explanations which I will try to consider over after the jump

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Remdesivir II

This is, in fact, another post on Coronavirus, but it will take me a while to get to the point. To put the conclusion here, I think that it is important to get the FDA out of the way (by executive order if necessary).

The Food and Drug Act, as currently interpreted, requires the assumption that people should (generally) not be treated with pharmaceuticals which haven’t been proven to be safe and effective. The rule is first do no harm, second do no harm. This only makes sense if results with current standard of care are acceptable. In this case, they aren’t. I think there should be mass production and use of Remdesivir starting on the 5th of March, based on one case where it seems to have cured a patient overnight.

To be honest, I think it should have been approved based on evidence that it is safe (from failed efforts to treat Ebola) and evidence that it inhibits the RNA dependent RNA polymerase of the MERS Coronavirus

Obviously one case is not proof. Still more obviously a pre-clinical study of a related organism isn’t strong evidence about the novel coronavirus.

So ?

It isn’t as if the current approach is working so well, that we should stick with it until there is proof that a new approach works better.

I think the trace of information is enough that, given almost no knowledge and a very diffuse posterior, one can conclude that the expected welfare of a patient treated with Remdesivir is higher than of one not treated with Remdesivir.

At this point, the standard ethical rule that decisions should be made in the patients’ intererests would mandate use of Remdesivir
(I personally do not accept that rule)

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