Sunday, May 15, 2022

Alabama Politics Trumps Transgender Health

This is my first letter to an Alabama politician since we moved to Opelika in November: 

Governor Ivey,

I am distraught by your support of the so-called Alabama Vulnerable Child Compassion and Protection Act, which does not provide compassion or protection. Thankfully, Judge Liles Burke’s ruling stopped your misguided and harmful plan to ban puberty blockers and hormones for minors with gender dysphoria. His injunction provided ample justification for the ruling:
”the uncontradicted record evidence is that at least twenty-two major medical associations in the United States endorse transitioning medications as well-established, evidence-based treatments for gender dysphoria in minors.”
Further, your Tweet claiming knowledge of God’s intentions reveals hubris, a lack of knowledge of gender dysphoria, callous indifference for the mental health challenges faced by children with gender dysphoria, and disregard for parental rights — which I thought was a bedrock principle of Republicans. It’s really not simple.
"we’re going to go by how God made us: if the Good Lord made you a boy, you’re a boy, and if he made you a girl, you’re a girl. It’s simple."
For the health of the transgender youth of Alabama, I urge you to get to know several families with transgender youth and meet with the medical community to become more informed. It may not make for great election year politics, but it’s the principled step to take.


Saturday, March 06, 2021

Masks and Personal Freedom

This week Governor Greg Abbott of Texas announced the state's mask mandate will end March 10, saying citizens "no longer need government running our lives." Yet, in a subsequent interview with KTRK TV in Houston, he said, "We are still urging people to continue to wear the mask."

I've been surprised that masks became and remain such a lightning rod in the country's response to COVID-19. More precisely, the issue is whether the government has the authority to require wearing masks in a public space.

The argument for wearing masks is they reduce the risk of transmission of the SARS-CoV-2 virus, which has led to the deaths of some 525,000 Americans (and counting). As part of its responsibility for public safety and health, governments have the authority to require wearing masks, at least in public spaces, to reduce the risk of infection, hospitalization, and death.

Those opposed to mandates argue governments are infringing on an individual's freedom and liberty, adding people will act responsibly if presented with the evidence, presumably then choosing to wear a mask.

I side with a government mandate for these reasons:

1) The government has a responsibility for public safety and health, with the authority to impose regulations to ensure appropriate standards.

The history of the country has been a progression of government regulation to improve safety and health, either as society gains more knowledge or to address violations. Perhaps stop signs and red lights were controversial when first proposed, yet today we accept them, trading the expectation to safely drive to the grocery store for the loss of time and personal freedom.

2) Behavioral and cultural change takes time, while a pandemic grows exponentially.

When COVID-19 first exploded in New York City, then spread across the country, we didn't have much time to socialize wearing masks and overcome the inconvenience, discomfort, and self-consciousness doing so. If I'm the only one in a store wearing a mask, I'll take it off so I won't stand out and be embarrassed — particularly since wearing masks quickly became polarized, an unfortunate symbol of a different argument.

Intuitively, wearing a mask reduces the transmission of particles to and from the lungs, and much experimental data confirms their effectiveness. Their use is accepted in other countries: I've seen many people wearing masks in China, whether to prevent disease or reduce breathing pollutants from the air.

I doubt my reasoning will convince those who see this as a violation of personal freedom. I suspect the issue is not COVID-19, it's the relationship between the individual and society. COVID-19 is simply a battle in a much more expansive philosophical war.

Also posted at my Hey World blog.

Saturday, January 16, 2021

Politics or the Constitution?

Ten of the 211 Republicans in the House of Representatives voted to impeach President Trump on January 13, just one week after a mob of angry partisans stormed the Capitol, following a speech where the President told his followers, “We must stop the steal and then we must ensure that such outrageous election fraud never happens again, can never be allowed to happen again.”

Of course, there was no election fraud.

Peter Meijer, a newly elected representative from Michigan, was one of the 10 who voted to impeach the president. Michael Barbaro, host of The Daily podcast, interviewed Meijer yesterday to understand Meijer’s hopes entering Congress, his response to the claims of election fraud, and what led him to vote for impeachment and place himself in a small cohort of unpopular, endangered — electorally and possible physically — Republicans.

In a world of political spin, I found Meijer open, honest, and vulnerable. I sent him the following feedback:

Representative Meijer,

I listened to your interview with Michael Barbaro on The Daily and want to thank you for being so thoughtful and open, describing your hopes as a newly elected representative, assessment of the claims of election fraud, and decision to vote to impeach President Trump following the attack on the Capitol.

I have been disheartened by the tone of political discourse, particularly about the election, and respect your principled decision to choose our democracy over the Republican party’s allegiance to President Trump. May your leadership be an example to the party.

May you be safe and have a successful term, building bridges with your colleagues on both sides of the aisle.


House of Representatives vote to impeach Donald John Trump, President of the United States, for high crimes and misdemeanors. Roll Call 17 | Bill Number: H. Res. 24

Sunday, January 10, 2021

Impeach Him Again? Yes.

I sent the following to Representative Annie Kuster today.

I am writing to support the impeachment of President Trump in response to Wednesday’s violent mob attack on the Capitol, which interrupted Congress’ acceptance of the votes from the Electoral College and, more profoundly, threatened the safety of government officials, led to the death of Brian Sicknick, and desecrated our democracy.

As you know, the Constitution provides a process for removing a President from office for “treason, bribery, or other high crimes and misdemeanors.” In my view, President Trump’s false, absurd, and continued gaslighting that the election was fraudulent, culminating in his rally on Wednesday, where he instructed attendees to go to the Capitol to “stop the steal,” is sedition — which certainly qualifies for impeachment.

President Trump’s subsequent video telling supporters to go home, that he loved them and knows how they feel, did not condemn the violence and lawlessness, and he continued to falsely claim a fraudulent election. Only the following day did he release a video addressing the “heinous attack on the United States Capitol” and, for the first time, conceding the election — perhaps because Congress had, indeed, certified the election.

Although President Trump has now acknowledged he will leave office on January 20, impeachment is warranted: to warn those extremists who flagrantly attacked our democracy and to provide a coda to this travesty of governance, that the House of Representatives held a delusional and despotic President accountable.


Transcript of President Trump's Save America rally speech on January 6.

Transcript of President Trump's video telling protestors "So go home. We love you. You’re very special."

Transcript of President Trump's video acknowledging "a new administration will be inaugurated on January 20th."

Thursday, December 31, 2020

President Pence?

Just over a year ago, on December 18, the House of Representatives approved two articles of impeachment against President Donald Trump, for abuse of power and obstruction of Congress.

The articles were submitted to the Senate on January 16, 2020, which voted to acquit the president of both charges on February 5.

Suppose, however, at least 67 Senators had voted to convict the president on one or both of the articles. Donald Trump would have been removed from office and Vice President Mike Pence would have assumed the role.

A more emotionally stable President Pence would have been less divisive and may well have handled the pandemic more responsibly than the man he replaced.

Pence would logically have been the Republican candidate for president in the 2020 election. With the anti-Trump fervor gone, the nation could have rallied around Pence, supporting his efforts to develop a more coherent strategy to combat COVID-19.

The Republican party would be in a far better place inaugurating a President Pence on January 20. Its fealty to President Trump led it down a blind alley promoting false claims of a fraudulent election, claims that undermine our democracy and relegate the party to infamy.

Audio Version

Wednesday, December 30, 2020

The Pandemic Paradox

As we end this tumultuous year, 2020, which has been defined by the coronavirus, deaths in the U.S. from COVID-19 are approaching 330,000 from over 19 million confirmed cases. These numbers understate reality because not all cases and deaths have been diagnosed.

Why did it turn out so, the infections accelerating this fall as the weather turned colder and the U.S. responded with que serĂ¡, serĂ¡ and a shrug?

The Paradox

The pandemic is a paradox which the country has not been able to solve.

Many who are infected with COVID-19 have no symptoms, many have mild symptoms, most recover — yet the virus is the third leading cause of death in the U.S., the cumulative death toll the same as the population of Salt Lake City or Birmingham, according to Scientific American.

The highly contagious disease spreads largely by close contact among people and, in some cases, transmission across longer distances. Limiting gatherings with others avoids exposure, by definition. When that is not possible, wearing a mask to reduce the probability of either inhaling the virus or expelling reduces the risk of infection. Yet government and business policies implementing these steps, either as regulations or simply recommendations, have been decried by some as unconstitutional infringements on personal liberty.

The life of an infection is relatively short — weeks — yet the U.S. has not been able to contain it after 11 months. It has consistently spread across the country, infecting all regions, even those knowing for months it was coming. December — not yet history — has been the worst month for deaths since the first peak in April.

Confirmed COVID-19 infections in the U.S. Source: Johns Hopkins University, 12/30/20.

Why is this pandemic such a paradox, when the U.S. has the medical expertise, the infrastructure, and financial resources to counter it? Why is it so difficult to manage, when other countries have demonstrated strategies that work?

I’ve concluded we lack government leadership, a coordinated and unified response, and both community and individual resolve. These interconnected deficits, amplified by a vocal minority of naysayers, have created a controversy about wearing masks and a false either/or choice between reducing infections or sustaining the economy.

What Can We Do?

Eleven months in, can we do anything to mitigate this tragedy or must we await the country being vaccinated, accepting the collateral infections and deaths while hoping they don’t affect us personally?

I think the following steps would yield measurable improvement, reducing infections and death until enough of us are vaccinated for the country to reach herd immunity. These steps must be implemented consistently across the nation, a “united we stand, divided we fall” strategy.

1. Stay in place for 14–21 days to minimize new infections.

The idea is for everyone to stay in place to let the current infections play out without causing new infections.

The incubation period for COVID-19 infection is 5–6 days average and up to 14 days, according to the World Health Organization. The BMJ reports data from culture studies indicates people can become infectious 1–2 days before feeling symptoms and will remain infectious for up to seven days. CDC guidance is a person with a mild case of COVID-19 remains infectious for “no longer” than 10 days after symptoms appear, while a person with a more severe or critical illness will “likely” be infectious for no more than 20 days.

The life of the infection defines the time we need to stay in place. While some exceptions will be required — seeking medical care, getting groceries — wearing masks and reducing the number of people in stores will reduce the probability of infection.

Everyone staying in place must be done nationally at the same time; otherwise the virus will cross borders and spread from areas with high infection to those with low infection — just as we’ve seen it cross the country this year.

2. Quarantine international travelers entering the U.S.

As other countries and some U.S. states have done, incoming travelers must quarantine for an appropriate time to minimize the risk of bringing in the virus and spreading infection.

A 14-day quarantine has been the norm, based on the incubation period for infection, although this time could be reduced if the quarantine is combined with testing.

Our near-empty hotels can provide the rooms, meals, and testing centers for travelers.

3. Implement a multi-layer testing strategy.

The foundation of a multi-layer testing strategy is in-home antigen tests with near real-time results, with a protocol of one or two tests per week per person following the national stay-in-place period. This policy would apply nationwide, for anyone going to public places (e.g., offices, stores, churches).

If a test is positive, the person quarantines while confirming the infection with either additional in-home antigen or local PCR tests.

Although the antigen tests may not be as accurate as PCR tests, they can be widely accessible, and the near real-time results will enable anyone infected — especially if they are asymptomatic — to protect others from becoming infected. See

Ideally, the test results would be reported to public health officials to provide community data on the positivity rate. To balance individual privacy with public health, the data — even from a positive test — could be reported anonymously (by zip code, perhaps). Someone with a positive test could be asked to contact local health officials. Anyone becoming seriously ill will presumably show up at a hospital.

4. Provide additional economic relief.

Given the economic impact of staying in place, adding to the year-long effects, it’s reasonable for the federal government to provide additional economic relief: unemployment, rent and mortgage assistance, and business support. Considering this national disaster, the “cost” to the federal deficit is an investment in the economy, particularly with interest rates so low.

I believe if this strategy had been employed in the spring, when the coronavirus was first spreading in the U.S., the number of infections, deaths, and attendant economic devastation would be considerably less than what we’re living through. Had we been united around a nationwide response, the virus would not have been able to dance through our patchwork of local and state plans and political divisiveness.

While Operation Warp Speed’s development of vaccines is heartening and will, hopefully, enable us to return to a more normal life by the end of 2021, we have a long winter and spring to endure. A strategy built around these principles will alleviate the nation’s suffering near-term.

SARS-CoV-2 won’t be the last pandemic to threaten the globe. Developing such a strategy will help us better prepare for the next time.

Caveat: I claim no medical expertise. Nonetheless, I think the framework is a sound approach and should be appropriately tweaked to reflect the latest medical knowledge of the virus.

This post also published on Medium.

Monday, December 14, 2020


On this day, Monday, December 14, I note several milestones worth remembering:

Joe Biden was officially elected president and Kamala Harris vice president with the vote of the Electoral College — actually 50 separate tallies, one in each state. The totals were 306 to 232, coincidentally the same split as in 2016, when Donald Trump was elected.

The first SARS-CoV-2 vaccinations, developed by Pfizer, were given across the U.S. after the FDA approved use of the vaccine late Friday. The U.S. has ordered some 100 million doses, enough to cover 50 million people, each requiring two shots 21 days apart. Vaccines being developed by several other companies are being tested, with Moderna’s version set to be reviewed by an independent panel of the FDA this Thursday.

That is a hopeful sign in the face of the grim milestones that more than 300,000 Americans have died of COVID-19, over 110,549 are now in the hospital, and 1,358 died so far today, according to data on The COVID Tracking Project website.

Another positive milestone would have been President Trump conceding the election and graciously congratulating the new president and vice president. He didn’t. Even before the election, he was claiming voter fraud and a stolen election, offering no proof to support his wild claims. Is Donald Trump delusional or just a massively sore loser, intent on destroying as much of the government as he can on his way out of Washington?