HJNO Nov/Dec 2024

A PHYSICIAN’S RESPONSE 34 NOV / DEC 2024 I  HEALTHCARE JOURNAL OF NEW ORLEANS came out that he was in the top some per- centage of opioid prescribers in the country. CMS released that data, and he was listed as a top prescriber. Honestly, I think this is a gentleman who runs a rural clinic. I think he probably does what he thinks is his best for his patients. His patients probably appreci- ate that very much, but he’s got a real chip on his shoulder from other people in the medical community suggesting that per- haps what he’s doing is not the best care. Editor This session made me pull up how Trump was treated when he had COVID and was president, and he was not treated with ivermectin. Physician Absolutely not. But, even if he was, so what? The way medicine works is we learn more every single day, and that comes in the form of studies, ideally placebo-controlled, randomized trials, where sometimes you don’t get that, but ideally you get that. Those studies get peer reviewed, and they get published, and we adjust our practice accordingly. The more we know, the more we adjust our practice every day. Any disease, and treatment has evolved as we learn more. That is the method by which we learn more. So, with drugs like hydroxychloroquine and ivermectin, vitamin D and stuff, we all had a lot of hope. Wouldn’t it be great if there was a silver bullet? But you can’t stop there and ignore the resource that comes after that. You’ve got to incorporate that. I think at the end of the day, docs that fall into this one particular camp were either offended that, “How dare someone suggest that they weren’t doing what’s supported by current evidence,” or they’re profit- ing off of it. People have talked about this group, Front Line COVID-19 Critical Care Alliance docs or FLCCC. It’s one of these groups that pushes ivermectin hard. You go to their website, it’s all grift. They’ll sell you telemedicine sessions for $500. It’s all grift. It’s really, really disparaging. Editor You just had COVID. How were you, and how was your family treated? Physician We treated ourselves like the com- mon cold. None of us are elderly. None of us have significant underlying medical condi- tions that put us at particularly high risk for disease. None of us have a real indication to take an antiviral like Paxlovid because we don’t fall into those categories. So, we stayed home, we kept away from other people, a lot of rest, a lot of fluids, some orange juice, treated it just like we would a cold. If my folks got it, I would suggest that they go on Paxlovid because they are older and have a much higher risk of developing severe dis- ease. I’m still seeing people who die from COVID. I’m still seeing them in hospitals — not anything close to the number we saw, thankfully, but still something not to be taken lightly, particularly if you have par- ticular vulnerabilities by virtue of age or underlying conditions. But if you’re old, if you have vulnerabili- ties, COVID remains more fatal in numbers than the flu. It’s certainly coming down, and at some point in the future, we presume it’ll be just like the flu. It’s still a little bit more fatal than flu. But even with the flu in Loui- siana, on an average flu season, somewhere between 500 and 1,500 people die from the flu. That is far from trivial. And the fact of the matter is a lot of those people, not all of them, would have had far less chance of dying if they had gotten the flu vaccine that year. Simple interventions. We do a pretty crappy job with the flu vaccine in Louisiana anyway, and it’s going to get even worse now that the state health department doesn’t believe in vaccines. A lot of this is not 100% preventable, but a big share of it is preventable. There are simple things that we can do. Just like putting your seatbelt on doesn’t mean it doesn’t decrease your chances of getting into a wreck, but it certainly decreases the chances you’re going to get hurt when get into a wreck. That’s the same thing with these vaccines. I remember very well treat- ing some patients in the peak of COVID where the loved one got really sick and was on the verge of being put on a ventila- tor, and the family asked if it was too late to get the vaccine. It’s really heartbreaking. I really feel for families that fall victim to these types of myths and misinformation. It’s just so much more heartbreaking when those myths or misinformation are put out deliberately for political reasons. That’s a hard pill to swallow. Editor Do you think elderly people should get the COVID, the flu, and the RSV vac- cination at the same time? Physician I think it’s a good idea to, but I think the better answer is everyone should talk to their doctor about it. Editor I just wonder if they should be spaced. Physician It doesn’t have to be. Some peo- ple would prefer it, but there’s no wrong answer. If you want to space, space it. If you don’t, don’t. But I think everyone in that age bracket should go to their doctor and have a conversation about it. Editor Hey, thank you for what you’ve done through the pandemic, and thank you for your input on this. We’re going to get this transcribed, too. We think it’s very important. Physician I think you’re right. I’m happy you’re doing it. I’m happy to put this down for posterity, and maybe it’ll affect some- thing. I’m glad you’re doing it, Dianne. Thanks so much for talking. n