It Defies Explanation

It Defies Explanation

            Robert A. Levine 8-4-23

We live in a nation whose prime institutions are denigrated by large majorities of the population. Gallop surveys have shown a steady drop in Americans’ confidence in virtually all important public institutions, including the military. Small businesses are the most trusted bodies, with 65 percent of the population having faith in them. However, even this is lower than it was 3 years ago at 70 percent. Only 60 percent of Americans have confidence in military and only 43 percent in the police. And just 34 percent trust our medical system whom people rely on constantly. Organized religion and the church have a 32 percent approval, the Supreme Court 27 percent, banks, the public schools and the presidency 26 percent, newspapers 18 percent, the criminal justice system 17 percent, big business 14 percent, and Congress 8 percent. Given these numbers, with such low levels of institutional trust, it is amazing that America is a functioning state, though there are some who might dispute that description.

However, what is more amazing is the number of people who accept Donald Trump’s lies and believe that the 2020 election was stolen from him. According to a recent Monmouth poll, 30 percent of respondents believe that Trump won the election and Biden used fraudulent methods to steal it from him. Only 59 percent of Americans believe that Biden won the election without any chicanery, 93 percent of Democrats and 58 percent of independents. 21 percent of Republicans agree that Biden actually won fairly, while 68 percent he won because of voter fraud. These numbers are nearly unchanged from a Monmouth poll shortly after the election itself. The unwillingness of so many Americans to acknowledge that Biden won the election fairly is in spite of the dozens of court cases that Trump brought to challenge the election that were all dismissed for lack of evidence.

In Monmouth’s poll, about half of Republicans call the events of January 6, 2021 that breached the Capitol a legitimate protest. How can so many Republicans still support Trump so avidly when his behavior is so malign and he engineered an obvious attempt to overturn the election and thwart the will of the American people? He tried to mount a coup and directed an insurrection against the government. Can people just ignore these actions? Are his supporters insurrectionists or criminals themselves? What is even more surprising is that many Republicans believe that Trump committed serious federal crimes and they still support him in his 2024 run for president.

All the indictments against Trump for trying to overturn the election by fraudulent means have not appeared to sway Trump’s acolytes to abandon him. There are currently 72 charges pending. In fact, he has been able to raise more money on the basis of these indictments. Perhaps many of his supporters are just naïve and do not understand the seriousness of Trump’s actions and what they meant in terms of our democracy and our constitution. But it defies belief that Americans do not trust the nation’s institutions and so many still have confidence in Trump as a leader.

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Dealing with Our Debt

 Dealing with Our Debt

                    Robert A. Levine  May 23, 2023

America’s entire debt situation is insane. First of all, there should be no debt ceiling. When Congress appropriates money for any government acquisition or activity, that should be deemed as obligating the government to spend the money to pay the bill. There is no reason to have a separate vote to allocate money to pay off debt that Congress already agreed was necessary. This vote to raise the debt ceiling to pay bills that Congress has already authorized allows a minority party to hold the nation hostage. And extremists on both the right and left are only too willing to raise questions and gain publicity by opposing or delaying the increase in the debt ceiling for money that Congress has already spent.

It is time for a separate vote on the debt ceiling to be eliminated. When Congress passes a bill that entails government spending, that bill should ensure that government funds will be used to pay that debt. Almost no other nation in the world has separate votes on spending bills and raising the debt ceiling to pay these bills. The uncertainty associated with approving the debt ceiling roils all the financial markets, damages the sanctity of the dollar and hurts the American economy, even if raising the debt ceiling is passed. Thus far, the United States has never defaulted on its debts and it is hoped that this will never happen.

Having the dollar as the currency used in international trade is beneficial for the United States. There are currencies waiting in the wings, like the Chinese yuan or the European euro that would be glad to take the place of the dollar in international trade.  This is much more likely to happen if the U.S. defaults on its debt. Dollar denominated debt is also considered as a safe haven for the rest of the world. When there is an economic crisis anywhere, people all over the world want to park their money in American government obligated debt. This strengthens the dollar and also America and we should be loath to do anything that would damage the standing of the dollar.

That is why it is crazy for the Republicans in Congress to make demands regarding future spending when the debt ceiling is for money that had been already spent. There should be no question about

payment of this debt and no question about raising the debt ceiling when the payment comes due. As I said, the proper way to handle this is to get rid of the debt ceiling completely, allocating funding whenever Congress and the president pass a bill. No more games involving the dollar and America’s debt.

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What's Going On With

What’s Going On With Putin?

                        Robert A. Levine, M.D.  March 8, 2023

I am a retired neurologist. Last week, I watched a five to ten second video of President Putin’s meeting with Lukashenko in a villa outside of Moscow online. Instead of being seated behind a table which would hide his lower body, he was in a chair with nothing blocking his legs. During the period he was visible, constant movements of both legs were noted in an asynchronous fashion. One might call these “restless legs,” but medically they looked like a syndrome called akathisia or psychomotor restlessness. Minimal movements of the hands and fingers were also noted.

Akathisia is most often caused by an adverse reaction to drugs, particularly with anti-psychotic medications. However, other drugs can also be responsible less often, including antidepressants such as tricyclic medications (nortriptyline and amitriptyline) and (SSRIs) selective serotonin uptake inhibitors (Prozac, Zoloft, Paxil, Celexa, Lexapro). In addition, calcium channel blockers (Cardizem), which are utilized for high blood pressure can rarely produce akathisia. Even if Putin is taking anti-psychotic medications, it does not indicate he is psychotic as some physicians may also prescribe these drugs for anxiety. And he may be taking anti-depressants or calcium channel blockers and having an adverse response, though akathisia is seen uncommonly with these compounds.

The National Library of Medicine of the NIH also mentions that akathisia can be seen with anti-emetic drugs (Compazine), drugs for vertigo, sedatives used for anesthesia, and abuse of cocaine.

Other considerations besides akathisia for Putin’s leg movements include the possibility of a tardive dyskinesia which can also occur with the above medications, or when they are withdrawn. However, movements of the arms and facial tics are present more often with tardive dyskinesia than mainly leg movements.

Less likely possibilities are that Putin has a neurodegenerative disorder or a movement disorder such as Parkinson’s or one of its associated syndromes. There are medications that can treat akathisia, but Putin may not even be aware of his problem or may not want any additional medications. And the treatments are not always successful. Those used include mirtazapine, beta blockers and anticholinergic compounds. The mechanism in the brain that produces akathisia is uncertain, but may have to do with dopamine or other neurotransmitters, and an imbalance between neurotransmitter systems, such as dopamine and acetylcholine. A blockage of dopamine type 2 receptors is also a consideration. There are no specific laboratory tests that can help with the diagnosis of akathisia. It is merely a diagnosis made by observation.

Patients with akathisia usually feel restless with a need to move. They may also feel subjectively uncomfortable. The akathisia may be short lasting or may persist indefinitely, even after the precipitating medications are withdrawn and treatment is initiated. We don’t know how long Putin has had these movements as there have not been videos of him with his legs exposed. Usually, he has been seen sitting at a long table, with his advisors or guests at the far end. There have been suggestions that this was a manifestation of paranoia, as Putin was afraid of catching Covid or of being assassinated. But perhaps this was related to his akathisia.

As far as we know, Putin is cognitively intact, but it would be helpful if his physicians told the world what is going on since he is the leader of a powerful nation with nuclear weapons. However, Putin wants to project an aura of strength and determination to the world and certainly does not want it known that he has an illness of any sort or is taking medications on a regular basis. In an autocratic state, the leader controls the release of all information, particularly those of a personal nature.

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Where Did Trump Go?

Where Did Trump Go?

            Robert A. Levine   12-12-2022

Since Donald Trump announced his candidacy for president in 2024 election, he has been mostly out of sight. Unlike his usual parade of public appearances and rallies, he has been keeping a low profile, with few pronouncements other than his recurrent lament of the 2020 presidential election being stolen from him. Instead of pushing his candidacy, as would be expected, he has had little to say. What had happened to the usually ebullient, narcissistic and loud mouthed Donald?

There are a number of possibilities for his public reticence. One is that he is sick or simply tired. The Donald is not a young man, is obese and has risk factors for cardio-vascular disease. However, for someone who has been almost continuously in the public spotlight for the last eight years, one would have anticipated that some word would have leaked if he were ill in any way. Political fatigue is also an unlikely factor. Trump is a man who always likes to be in the public arena and has been a very energetic figure in the political world. It would be very unusual for him to recede into the background because he is too fatigued to get out there and spout off with his normal bravado, to elicit support from his base and antagonist responses from his adversaries.

Another consideration is that The Donald and his team are reassessing their political approach, particularly after the poor showing of Trump endorsed candidates in the recent elections. The loss in Georgia by Trump supported Hershel Walker in the Senate race was also a tough blow for him. The only prominent Trump acolyte who won was J.D. Vance as Senator in the Ohio election. Not only did most Trump endorsed candidates lose, but many of them asked him to stay away from their campaigns, and many barely mentioned his endorsement as they felt it might hurt rather than help them. His constant moaning about the 2020 election being stolen from him even though it has been thoroughly disproved, is old news. Many Republicans want to project a forward looking image and are reluctant to be weighed down by Trump’s baggage.

Yet another possibility is that The Donald is aggravated by the number of Republicans who seem willing to challenge him to be the next GOP candidate for president in 2024. The front-runner of course is Governor Ron DeSantis of Florida, for whom Trump has already devised a derogatory nickname- Ron DeSanctimonious. This early attack by The Donald shows that he is taking deSantis seriously and sees him as a serious opponent. Other possible contenders who seem willing to throw their hats into the ring are Governor Glenn Youngkin of Virginia and former Governor Larry Hogan of Maryland. Former Congresswoman Liz Cheney is another possibility, but it is unclear whether she would run as a Republican or as an independent. This is not a complete list as others have also mentioned consideration of becoming candidates.

Actually, the more candidates there are in Republican primaries, the better the chances of Trump receiving the nomination. Much of Trump’s base is extremely loyal to him and would vote for him in a primary, while the other candidates would split the remaining vote. In this way, Trump might win even with a small percentage of the total Republican primary vote.

But aside from the next election which is two years off, The Donald may be upset by being blamed by many conservative pundits for the poor showing of his handpicked Republican candidates in the 2022 elections. In addition, some recent polls have showed Ron DeSanctimonious ahead of Trump as the desired Republican candidate for president. Trump may also be bothered by all the legal actions to which he is being subjected, his New York company already having been found guilty of fraud. And he has barely started running through his legal gauntlet.

The 2024 is still two years off and many things may change. But the question now remains- where did the usual Donald Trump go?

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