July 11, 2025

Exactly eleven years ago, at this hour, Tommy and I stood before a judge in the King County Washington Criminal Court (right after the Grand Theft Auto Case that had dragged on a bit longer than anyone had expected) and said our ‘I Dos’. Tommy, who always hated ceremony of any kind, wasn’t too thrilled with it but it meant something to me as I never expected that a legally binding marriage contract would be available to me within my lifetime and yet, there we were – signed, sealed, and delivered. It wasn’t a wedding with the usuall fripperies and the only people in attendance were my father and my cousin Jenny as witnesses. It was followed by a dinner in the backyard of my sister’s house with the rest of the family and a few friends. We had been together for over a decade at the time and didn’t want a fuss made. Later that evening, in bed, we both changed our Facebook statuses to married and were highly amused at the rapid appearance of exclamations of surprise and good will as we had told no one in Alabama of our plans.

Our marriage didn’t last. Tommy’s death four years later saw to that. But I did have a marriage and it’s recorded in various legal databanks for posterity. That means something. As I sit here and watch the current administration industriously trying to rewrite history, weaponize politics against individuals with whom they disagree, and blithely erase data which might contradict their belief system, I sometimes wonder if the record of my marriage will survive? It really won’t make any difference in the history of the world one way or another but as a member of a suspect class in a time when conservative forces are trying to eliminate the rights of members of suspect classes, I feel it’s important that my marriage, and all of the other legal same sex marriages that have come into being over the course of the last couple of decades continue to stand as evidence of lives and achievements.

The various DC meltdowns over the Epstein files and their Schroedinger’s cat like existence and the finger pointing regarding the tragedy of the flooding in Texas have knocked most other stories out of the headlines over the last week or so. I don’t care who or what is in the Epstein files. If there’s evidence of criminal wrong doing, let justice take its course. I don’t believe in the bizarre conspiracy theories that are being swapped around on the seamier side of social media. The number of people who would have had to have been complicit and never talked makes it unlikely that it’s anything other than garden variety sleazebag behavior among the class with more money than sense. If there’s one thing that forty years in medicine has taught me it’s that human beings are terrible at keeping secrets. Someone always spills the tea. This is why these exotic and far reaching conspiracies are just not possible. There’s always a repair guy or a maid or a low level functionary who sees or reads something and they don’t keep quiet. Just like the nonsense about chemtrails. The number of pilots, airline ground crew, chemists, transportation workers, and manufacturing plant employees that would have to be in on it and then keep quiet for decades is impossible.

I don’t have much to say about the flooding. One of the girls killed at Camp Mystic was the daughter of a colleague here at UAB and my heart aches. Murphy’s law was in full force that night regarding weather, official reactions, federal responses, and all the rest and sometimes tragedies occur. We have two choices. Sitting around finger pointing and shifting the blame or learning form what happened and making changes in our behavior to lessen the chances of this tragedy recurring. Given that a nearly identical tragedy happened back in 1987, I can bet as to which one is likely to take place. The average American, and their governmental representatives have decided since about World War I that development and building is about profit and natural forces are immaterial. Just because you build does not mean the flood plain vanishes, the storms don’t form, the fires don’t race up the hillside and the earth won’t shake.

What has been driven off of the front pages, and even the middle pages, is what’s happening in public health. Measles, a disease that had more or less been eradicated, has come roaring back with a vengeance fueled by vaccine politics and misinformation that has infected the entire body politic. Measles is so contagious that it’s the canary in the coalmine. It’s always going to be the first one back if public health fences start to fall. Other previously eradicated or controlled diseases are likely to follow. And the building of unsanitary concentration camps in swamps may accelerate this. DHS has decided to cease all reporting on H5N1 bird flu so there is no way of knowing where it is, whether it’s increasing, if it’s showing more signs of human to human transmission, or anything else that might be useful. Keep in mind that it’s mortality rate in humans is approaching 50% so it might be a good thing to know what’s going on with it. Out of sight, out of mind is not a useful public health strategy. Covid-19 numbers remain relatively low in terms of hospitalization and mortality but it’s still out there. About one in two hundred Americans is infected at any given time and the biggest issue currently is multiple subclinical infections which can still lead to long covid. I have found that I am requiring a good deal more sleep this last month or so than usual and am having to budget in time for naps. This is new for me. I don’t think it’s just my advanced age. I truly wonder if one of my endless series of respiratory infections this past winter was subclinical covid that didn’t show up on testing and this is my version of long covid. Covid shots should still be available this fall for those who want them. I am still going to get mine. Chance of severe complication from covid vaccine = 1/1000000. Chance of severe complication from covid 1/50.

Our illustrious head of DHS, RFK Jr. has cancelled the next meeting of the US Preventive Services Task Force. When he did this for the advisory committee on immunization practices this past spring, it was in preparation for firing all of the vaccine scientists on the board and replacing them with, from what I can tell, a lot of anti-vaccine cranks. I don’t know if he’s going to do the same with USPSTF but I won’t be surprised. Why should you care? USPSTF is an impartial group of experts in public health who go over all of the evidence regarding health screenings and rating them as to their effectiveness and whether they should be pursued in the population at large. Language in the PPACA requires health insurance plans to cover any screening that USPSTF rates at an A or B level (it’s a cost effective measure that saves lives). If USPSTF falls, then insurers will have no mandate to cover screening tests for cancer or other diseases. You’ll still be able to get them, but they’ll cost you a lot more.

I’m still hearing about fallout from the Big Beautiful Bill signed last week. Now people are actually starting to read those thousand pages and project out what they mean. In regards to the Medicaid cuts, and yes they actually exist, they won’t hit Alabama as hard as a lot of other states. We never took the Medicaid expansion and we have always had one of the stingiest of plans so there’s almost no fat to cut. There are no able bodied guys eating Cheetohs and playing video games on mama’s couch receiving Medicaid in this state. Able bodied men are essentially ineligible. Nor does Alabama Medicaid enroll undocumented adults. The very narrow margins that exist in rural healthcare in this state will almost certainly be upended and we will lose rural hospitals and clinics. UAB is going to be heavily impacted between Medicaid cuts, grant cuts and reduction of indirects. In 2023 (the last year for which I can find numbers), UAB was the state’s largest employer and provided just over 5% of the state’s total GDP. Major cuts there will have ripple effects absolutely everywhere. I’m still trying to hang in there for another couple of years but if all hell breaks lose after next year’s budgets come out, I may need to gracefully exit stage left, pursued by bear.