Heme Doc

Oh and post surgery there might be a role for immunotherapy (Checkmate 577 trial). Disclaimer: I’m not a GI oncologist but watch a lot of TV doctor shows

sorry to hear about this. I assume this is adenocarcinoma of the GE junction. I’m Assuming you have only locally advanced disease and hopefully not distant disease. At MD Anderson, for something along those lines, you’d probably get concurrent chemo (likely FOLFOX) and radiation (likely protons, although I have no idea how they get insurance to agree to pay for that). Assuming a good response on follow up PET scan, you’d then look at potentially surgery (esophagectomy). But I’m just some dope who slept at Holiday Inn last night. I mostly know about blood stuff.

At least you guys don’t have monkeypox (yet)!

I just found out there’s no peach ice cream sandwiches this year due to supply chain issues….

I’ll be there Tuesday, Wednesday, and Thursday. Forecast sucks for tomorrow. I’ll take lots of pictures with my phone for you guys.

Maybe the idea of “original antigenic sin”? But I doubt he’s smart enough for that. I don’t have time to explain it to you peons. Google it if you like. But it’s been shown to not be a concern with SARS-CoV-2

I agree his take there on the transplant issue is pretty bad.

I agree about it being a gray area. I don’t pretend to have all the right answers. I hope you don’t feel like I’m throwing a tantrum. Just trying to have respectful dialogue. I’d lean more towards the carrot/stick approach above. Companies can give reduced insurance rates or other perks for employees to get vaccinated. I’m fine with healthcare workers being mandated to get the vaccine. I do wish there were carve outs for exceptions for those previously infected (although I’d still advise them to get vaccinated).

Physicians are good at taking multiple choice standardized tests. It’s how many of us think. “Here’s a problem. Pick the one best solution”. COVID, unfortunately, is not like that. COVID reminds me of a test question in medical school… After the test, friends and classmates all gathered to discuss how we thought we did. “What did you answer on question 7?” Everyone had a different answer. Each person convinced their answer was correct… But it turns out they screwed up the test and left off the correct answer choice. We ALL answered wrong but were convinced we were right. There’s some deeper meaning there, probably.

Yes, it probably would. In a case where vaccine confers sterilizing immunity, much less risk of transmitting to others and harming them. GREAT question about new vaccine development. I don’t know what the deal is.

VERY well said. Full agreement here

I agree with you that the unvaccinated disproportionately utilize resources and this results in indirect harm to others. But I disagree that mandates are an ethical solution to the problem. We do not mandate other behaviors which disproportionately utilize healthcare resources (weight loss for obesity, smoking/alcohol cessation, flu vaccinations, etc).

Thank you for the thoughtful reply. I wasn’t relying on the article for my feelings on usefulness of mandates. I just used it as a jumping off point for discussion around certain aspects of vaccine mandates. I stand by my previous post that mandates of current vaccine formulations against the current circulating variant (and likely future variants) have little value. To me, the ethical case for vaccine mandates requires that vaccines significantly reduce harm to others. I think we both agree that current vaccines do a relatively poor job at stopping transmission to others with Omicron and also with waning immunity. I agree that vaccines do slow transmission some (especially if boosted), but not enough to mandate them (in my opinion). Preventing indirect harm to others is another way mandates might be beneficial, by improving hospital capacity. I have previously laid out some problems with this reasoning. I think we would both agree that the main benefits of vaccination are primarily protection for the individual, particularly against severe outcomes. We do compel other activities for individual safety (seatbelts being an example you mentioned). But there are important differences between seatbelts and vaccinations. Further, we do not compel other interventions which would be of benefit to the individual or society (weight loss, restrictions on food/alcohol, or yearly flu vaccines to name a few). The primary goal of a mandate with current circumstances, to me, is to compel as many people as possible to get vaccinated. I fear we have reached the end of that usefulness. If you ain’t been vaxxed yet, you’re probably not going to. I can’t speak as much to the legalities of mandates. I know there’s been stuff in the Supreme Court, but I’m no lawyer. In an unrelated note — on the topic of the power of these vaccines…my wife went in today for her very last cycle of pretty potent immune suppressive adjuvant chemo. She has been on chemo since late Sep and got her COVID booster just before starting chemo. SARS Ab level is STILL off the charts > 2500 as of last week. Still not had COVID throughout the surge and being on chemo the whole time.

I’ll drink to that!

It sucks to have so many people still dying. Omicron is infecting almost everyone who hasn’t been vaxxed/boosted or previously infected. And the unvaccinated are the ones dying, almost exclusively. So I think you’ve got a lot of people who are vaccinated saying “fuck those folks who are dying, they could have protected themselves and prevented this, but they didn’t. Why should I have to limit my activities to protect those assholes who wouldn’t protect themselves”?

See my post above replying to PW. Did you read the article posted by Immaculate Vibes? Were there specific things in the article you felt were incorrect?

And I love your posts about NYC. Makes me want to hop on a plane almost every time

What do you mean by “work”? Do you mean “increase vaccine uptake with the end goal of decreasing death/hospital burden”? I suppose I’d agree with this. Although losing some hospital staff due to the mandates exacerbates hospital burden. But those people who want vaccinations have already gotten it. Mandates, at this point, I fear, only serve to harden resolve of those who refuse the vaccine. I do not believe mandating injections of current vaccine formulations to enter certain venues, school, or participate in society substantially decreases transmission with our currently circulating variant. Boosters probably do help with this issue somewhat. To me, there’s 2 ethical reasons to mandate a vaccine. 1. The vaccine protects the individual from falling ill and prevents that person transmitting the disease to those at risk. Current vaccinations absolutely prevent most death and hospitalizations but clearly do not do a great job of providing sterilizing immunity and protecting those around us from getting COVID. In short, this argument says, “my vaccine protects you”…this is not the case (unfortunately). Your vaccine protects you from severe illness/death. Maybe not a lot more than that. 2. Mandating vaccination prevent hospital overload and allows for continuation of normal healthcare delivery (delays in surgery or care due to overburdened hospitals are bad for everyone). While on the surface, this seems reasonable enough, Ethically, I find this problematic as well. We do not mandate other medical treatments for this reason (flu or pneumonia vaccinations, for example). We do not compel people to significantly change behavior when hospitals are at capacity (as often happened in winters even pre-COVID). We don’t shut down liquor stores, limit driving, or stop other activities that add to hospital burden when they’re already full. I hope I’ve been clear in the above. I always aim for respectful discourse/discussion. I don’t pretend to have all the answers. I find COVID to be much like many cancer problems I deal with. Complex, often without simple solutions, where intelligent, caring people with the best of intentions can sometimes disagree on the best course of action.

I completely agree with this. I’m as pro vaccine as you’ll find. But anti vaccine mandates due to many reasons

You nailed it. I think of it like a fortress. Your antibodies are like the castle walls. But you’ve got T cells behind the walls ready to blast anything that gets through. Before getting the vax, you’re completely vulnerable. The enemy gets in and it takes a while to rally and overtake them (if you can). Getting the vax is like training your knights behind the wall (T-cells) and building your wall (antibodies) so the enemy can’t get in. But the enemy might still sneak in, but your knights are there ready to fuck shit up. Getting boosted is like fortifying the wall and also like giving the knights machine guns instead of swords

You have AIDS

Who wasn’t there to let the dogs out? Who? Who? Who? Who?

Get a booster. I’ve never even heard of this weird med you’re on, and I love me some weird drugs. I had to look it up.

That’s good.

Completely agree. Badly need cluster RCT of cloth masking in schools. I’d eat my house there’s zero benefit