Inside the Virus-Hunting Nonprofit at the Center of the Lab-Leak Controversy This gun isn’t smoking, it’s on fire 📰

Putin’s useful German idiots 📰

This is not limited to Putin. Germany has a rich history of enabling petty autocrats world wide, including the Balkans.

Invasion of the Fact-Checkers 📰

An uneducated populace with little capacity for critical thought does need a Ministry of Truth to tell them what to think. But that’s just Orwell’s 1984. Couldn’t possibly happen in the here and now.

“We are still talking about the original Wuhan strain coronavirus vaccine. Sad!” Attempted Trumpism aside, VP makes a good point. The short time it took from sequencing to mRNA vaccines made headlines. FDA then made provisions for quick review of sequence changes. What happened? 📰

Good morning 📰

A brief experiment with Drummer reminded me how fun it was to write short, untitled, tweet-like posts throughout the day without having to be exposed to social networks. Drummer itself was too high-maintenance for the 2020s me, but Micro.blog is a (paid) service whose focus is — and the name does give it away — short, untitled, tweet-like posts with a light layer of social networking.

Which is to say, my old domain is now resurrected as a micro blog with a snazy Edward Tufte-inspired design. The RSS you get there should include updates from this blog, so subscribe to either but not both.

Infinite Regress HQ wishes a Happy New 2022 to all those who celebrate. ⊕ By the time this gets published, it will be January 1, 2022 in all time zones. The earliest someone has wished me a Happy New Year this season was mid-December (!?). Yes, yes, we won’t see each other until the next year, but let’s see the old year out the door before celebrating the new one. I’m superstitious like that.

• 1994: Fifth grade; I am charged with editing the school newspaper. There is an Intel 386 PC at home that is about to be upgraded to a 486 and do something more than run Lands of Lore.
• 1996: Seventh grade; I typeset a book of poems¹. The school newspaper becomes the school magazine — in layout only; the publishing schedule remains haphazard — as I upgrade from Word 6.0 to QuarkXPress
• 2000: High school starts again after a freshman year interrupted by NATO bombing. I make the town library’s official website. It is a php hack job laid out in tables instead of the newfangled and to me unknown CSS; it still wins an award.
• 2002-2008: Med school; I typeset a book here and there and occasionally help out with the library website.
• 2009: Teaching assistant, Institute for histology and embryology, Belgrade School of Medicine.
• 2010: Resident, Internal medicine, JHU/Sinai, Baltimore MD.
• 2013: Chief resident, Internal medicine, as above; I understand the benefits of not being invited to a meeting.
• 2014: Clinical fellow, hematology/oncology, National Cancer Institute, Bethesda MD.
• 2016: As above, but also Chief fellow ex tempore for the joint NCI/NHLBI fellowship; my hatred of poorly-run meetings intensifies.
• 2017: Staff clinician, later to be renamed Assistant research physician, Clinical Trials Team, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda MD; the 1994 me marvels at the word salad trailing the title.
• 2021: Chief Medical Officer, Cartesian Therapeutics.

• A few hours before I developed symptoms I had a negative screening nasal swab. By the time I got a positive test three days later the symptoms were well on their way to resolving. Good thing I didn’t believe that first result.
• What helped my not believing was that I had textbook Covid-19 which was moderate bordering on severe: fever 39.5°C (~103°F), chills, body aches, nasal congestion, rhinorhea, and a dry cough that was mild enough for me not to worry. But thankfully no anosmia.
• Read the preceding paragraph again. The nasal swab done just before I developed all those symptoms (and arguably while having chills - though I didn’t know they were chills at the time) was negative. Covid-19 testing is no better or worse than any other clinical test we have, which is to say caveat medicus.
• Considering our family’s practices I was surprised that it managed to get in and suspected it was one of the new strains. Lo and behold not 7 days later the UK strain was found in Maryland. I won’t know the sequence of the one that got me for a few more months, but I’d say it’s likely.
• Said practices did contribute to containment, as there seemed to be no spread outside of the household (there is a small asterisk there which I will leave for another time).
• The new strains being so much easier to get makes any delays in administering the vaccine that more deadly. This is hard to overstate: shots in arms now, doesn’t matter how and to whom.
• Speaking of shots, I did get my first dose a few days before the likely exposure, and plan on getting the second one as scheduled if available.
• Masks aren’t 100% effective, particularly in areas of high prevalence which is right now most of the world. The new strains shift the equilibrium even more. Holier-that-though memes about things being OK again if only people did what’s good for them (i.e. wore a mask) are misguided at best and quite likely counterproductive.
• Another misguided effort: a DC health professional telling the sole member of a large family without a fever to use a separate bathroom, wear a mask at all times and open all the (quite tall) windows of their 1200 sq ft 7th floor apartment. Hard to tell if this was more comical or dangerous.
• DC health professional’s misguided advice #2: to get everyone in the household tested. If mine was positive and four more people also have fevers do we really think they have something else? Why risk the tester’s exposure and waste reagents: count these people as positive and move on.
• But as things stand right now, if these household members don’t get tested they don’t count as positive. How prevalent is this situation, I wonder? Even with test availability not being a bottleneck I’d multiply the current counts by at least 2, probably 3 to get the real number (and I’m sure there are epidemiologists who have a more scientific explanation for why we should be doing that anyway).
• Symptoms in children seem to be no different than any other febrile viremia of childhood (and in fact may be slightly better as they didn’t seem to sap any of their energy, for better or worse). Does this make in-person school more or less safe? I can see both sides of the argument but if you thought children as asymptomatic carriers would be a big risk that risk is probably overblown as they do in fact get symptoms — they just won’t telegraph them.
• And if you are worried about long-term effects of Covid-19 in children, well, sure, but how is that different from long-term effects of any febrile viremia of childhood? I’m sure our parenting style will ruin their prospects enough that Covid-19 will be just a drop in the bucket.
• I have been getting lists of home remedies from people who should know better. This includes aspirin (as an anti-platelet agent, not an antipyretic), azithromycin (still!) zinc, turmeric, propolis. What I took: a little bit of APAP and a lot of H2O.
• I have a new appreciation for the gig workers, who are the unsung heroes of the pandemic. Tip your Dasher.
• 2021 is certainly off to an interesting start.

Residency application season has just started. Many of the applicants, a few of whom I know in person, will be foreign medical graduates, or FMGs, meaning that they are doctors who want to work in the US but are not US citizens. Most FMGs, but not all, will also be international medical graduates — IMGs — meaning that they have graduated from a non-US medical schools. Something called the Education Commision for Foreign Medical Graduates, or ECFMG, acts as their medical school when interacting with most of the sprawling US bureaucracy. These are our personae dramatis, if you will.

Disclosure: I am both an FMG and an IMG, and first began working in the US on an ECFMG-sponsored J1 visa.

America is a net importer of physicians, that much should obvious to anyone who’s ever been in an American hospital. The country depends on FMGs to keep the system running, get the less lucrative specialties, work in underserved areas, etc. Not so obvious is that most FMGs get to America by lying; ICE-approved, foreign-government sponsored lying for sure, but lying nonetheless.

Here are the lies FMGs tell when they come in: that their country has a need for doctors of such-and-such specialty, and/or that their government is sending them to the US for training in the said specialty, and/or that at the end of training they will go back to their country of origin to work in the (sub)specialty they came in to obtain. Those are the three postulates of the J1 physician exchange visa, the very name of which is also a lie as there is no exchange taking place: foreign doctors do come in, but no American doctors come out.

The postulates are incompatible with reality, and imply foreign government competence that just isn’t there in second and third-world countries. ⊕ The transitioning and developing world, if you will. Because over there, no one is keeping statistics on specialist needs, and if they are there is actually a surplus, and if there isn’t they wouldn’t be able to afford the (sub)specialists once they come back, and if they could then they would be chosen by party or family lines, and you wouldn’t want them in your hospitals anyway.

So to get a J1 visa FMGs need to obtain a letter from their Ministry of Health or equivalent stating the above (the postulates, not the actual truth; I’m sure that in some of those countries people have gone to prison for saying the truth). But is there a functioning Ministry of Health? Does anyone there know that the letter they are supposed to provide about lending a medical graduate and wanting them back is a piece of kabuki theater, and not a commitment to employ that person if and when they come back? And because this letter is supposed to come in a sealed envelope directly from the Ministry to ECFMG: does anyone there speak English? So here are all those FMGs whose main reason to emigrate to America may have been to escape their kleptocratic governments, being dragged into a game of Whom do I bribe next? and Which newspaper do I threaten them with? ⊕ In 2019 the correct answer is, for most countries of this sort, None. by the rules of the country they were hoping was less crooked than their own.

Which is fine for America, because it doesn’t care as long as it gets its steady stream of MDs one way or another. Only it should care because 1) the amount of person-hours wasted is on par with if not greater than the amount spent writing grants, and that one’s a whopper, 2) it relinquishes control over a part of its healthcare to foreign governments, and 3) it introduces an air of subterfuge and deceit at the very beginning of the FMG-USA relationship. I would like to think this is an aberration to be fixed, and not a preview of things to come in other areas of governance.

The process was probably fine 50 years ago, when both demands of the medical system and the influx of foreign doctors were but a fraction of the current monstrosity, when USMLE was taken on paper if you had to take it at all, when it wasn’t so obvious to a non-aligned physician whether they should go to the US or USSR (or Yugoslavia, for that matter) to get more training. But healthcare has changed and so has the world: it’s time do drop the pretense of an exchange, America, and be honest about what’s going on here.