Democrats ‘Charity’ Voter-Registration Scheme

 Senate Democrats plan to pass the Disclose Act, a bill they claim would force “dark money” groups into the light. Never mind the darkness that envelops their own epic voter-registration scam.

A New York Times article this week confirmed a political reality that Republicans have been slow to publicize: Democrats are openly abusing charities to stack voter rolls in their favor. The Times story was ostensibly about “voter registration” groups worried that donors weren’t giving enough to “democracy-related” programs this midterm cycle. Read closely and you notice the story is entirely about Democrats, confirming a longstanding scheme by which foundations and private donors funnel tax-exempt dollars into “charities” that microtarget and register Democratic voters.

Among those quoted was Nsé Ufot, head of the New Georgia Project, which the Times credits with helping “turn Georgia into a blue state” by “registering tens of thousands of voters of color.” Ms. Ufot bemoaned “an overall dip in fundraising” from the likes of George Soros’s Open Society Foundations and the Democracy Fund: “Folks who think Georgia is competitive do not understand what made Georgia competitive.”

The Ufot comments are stunning, given the New Georgia Project is a organized as a charity, donations to which are tax-exempt under Section 501(c)(3) of the tax code. Such groups, as the Internal Revenue Service notes, are prohibited from engaging in “voter education or registration activities with evidence of bias that (a) would favor one candidate over another; (b) oppose a candidate in some manner; or (c) have the effect of favoring a candidate or group of candidates.” Yet here is Ms. Ufot openly fretting that without more Democracy Fund cash, she won’t be able to elect more Democrats.

The left has been growing this “philanthropy” racket for decades, and as a seven-page internal 2019 memo, leaked in 2020, reveals, it is now a giant operation. The memo was from Mind the Gap, a liberal super PAC that pushes donors to give to Democratic campaigns and nonprofits. It explained that in 2020 “the single most effective tactic for ensuring Democratic victories” would be “501(c)(3) voter registration focused on underrepresented groups in the electorate.”

Mind the Gap was brazen about its partisanship: “Provided that such efforts are well-designed and executed, on a pre-tax basis they are 2 to 5 times more cost-effective at netting additional Democratic votes” than advertising. Even better, because these groups are “tax deductible, on an after-tax basis such programs are closer to 4 to 10 times more cost-effective than the next best alternative.” The group said that 90% of the donations it was recommending for voter-registration and get-out-the-vote groups would go to 501(c)(3) nonprofits.

Don’t think these are innocent charities getting “used” by cagey Democratic operatives. Among the groups the memo recommends is the Voter Participation Center, which says it’s creating “a new American majority” by targeting “young people, people of color, and unmarried women” for registration. In 2018, the most recent year for which IRS records are available, it spent 64% of its vendor money on two groups that specialize in microtargeting reliable Democratic votes: Pivot Group ($10.5 million), which says it is “committed to electing Democrats up and down the ballot,” and Mission Control ($3.9 million), which calls itself “the most successful direct mail firm working in Democratic politics today.”

This would be the equivalent of Republicans using “charities” to microtarget and register only blue-collar gun owners, white evangelicals, and adamant pro-lifers. Totally nonpartisan, right? Only it’s hard to find a conservative foundation engaged in such activity, given a fear of IRS consequences. Democrats, by contrast, are so confident the IRS won’t question their “democracy” projects that they are pouring ever more money into this political operation and talking about the game openly.

As liberal writer Sasha Issenberg made clear in a 2012 book, “The Victory Lab,” liberal foundations and charities have been engaged in this scam for ages, describing the Carnegie Foundation’s registration drives even back then as “a backdoor approach to ginning up Democratic votes outside the campaign finance laws.” It’s a particular win for liberal foundations like Mr. Soros’s, which can fully write off partisan vote-getting as “charitable” activity. And luckily for Democrats, charitable nonprofits don’t have to disclose their donors, and the Disclose Act—surprise!—wouldn’t change that.

America’s charitable giving laws have been an enormous force for good, but Democrats are cynically abusing the system for partisan gain. If Congress wants to keep dollars and politicking in the political sphere—and under the remit of the Federal Election Commission—it needs to change tax law to prohibit “charities” outright from taking part in voter-registration or get-out-the-vote drives. The problem isn’t “dark money”—it’s the sham “philanthropy” voter-registration racket, taking place in broad daylight.

https://www.wsj.com/articles/democrats-charity-voter-registration-scheme-tax-exemption-soros-democracy-philanthropy-501c3-georgia-11663883529

Are Fake Sugars Causing Real Disease?

 So much of medicine is practiced within a shroud of mystery. When it comes to artificial sweeteners, an enigma that long has confounded me is: Why would anyone want to drink a Diet Coke? I’ve learned to allow my patients to have strange tastes in beverages. Should I be tolerant towards their drive to consume artificially sweetened foods and drinks, though? A new study joins a mixed bag of older research which suggests that I should not. I don’t think my Splenda-swilling patients have cause for alarm, however.

The work, published in the British Medical Journal, tracked over 100,000 French adults prospectively for more than a decade. Dietary consumption of several artificial sweeteners, primarily aspartame (Equal/Nutrasweet), acesulfame potassium (Sunett/Sweet One) and sucralose (Splenda), was determined via questionnaire, and then health outcomes in regard to heart events like anginal pain, stent, or heart attack, or brain events like TIA or stroke were followed both through participant report (with physician confirmation) and national health records.

A rather nice study design, and ample size over a long enough study period to accumulate a significant number of events. True, as with any observational trial, there is risk of missed or mis-labeled events, mis-classified participants, statistical massage with multiple end points, and, of course, the potential for confounding: people who choose to reach for Splenda packets in lieu of the honey jar might just be inherently more or less healthy than their peers in ways that are hard to control for even when demographics and lifestyle differences are taken into account.

What they found was a rather modest increase in cardiovascular events among those who consumed artificial sweeteners. Indeed, it barely reached statistical significance for the composite measure:

The results are hardly surprising. Earlier meta-analyses have found mixed results for artificial sweeteners in metabolic health; among the small randomized controlled trials for artificial sweeteners — often run by industry — there is a slight positive trend, while larger observational studies trend towards worse outcomes.

What might be the mechanism for this? It runs counter to the indoctrination of the American public since the 1960s that sugar-free treats are a fine part of a weight-loss diet. However, most things in the world that seem too good to be true turn out to truly not be that good. Whatever you think of their taste (I find them all abominable, personally), from a health perspective, artificial sweeteners have their fair share of flaws.

A theory often postulated is that artificial sweeteners deleteriously alter the gut biome. A randomized controlled human study found that four non-nutritive sweeteners (saccharin, sucralose, aspartame and stevia) indeed altered bacterial composition in the gut, and sucralose and saccharin caused worsening response to actual sugar loads. Please note the inclusion of stevia in that study – “natural” non-nutritive sweeteners are not exempt from these concerns.

It’s also been hypothesized that fooling our brain and bodies with false sweetness could lead to problems. Sweet taste receptors in our endocrine system might be fooled by artificial sweeteners, leading to disruptions in the release of critical metabolic hormones like insulin and incretins. Our behaviors centered around seeking out other carbohydrates might be altered, too; directly, if our brain does not give us “reward” feedback that it’s time to rest and stop seeking more food when we are not consuming actual calories, or indirectly, if we develop a worsening sweet tooth by accustoming ourselves to sweetness at every meal.

So, what’s a doctor to do? Well, the simplest advice is to avoid sweetened foods. I am now aware that this makes me a food-shaming monster, but let’s be real: I want people to live long and healthy lives, and high-sugar foods simply are not part of that plan. Fruit? Not in excess, and make sure it’s whole fruit (fiber-rich skin and all); we worry about high amounts of fructose gumming up the liver and perturbing metabolic health, too. Honey? It’s almost half fructose, so not as healthy as you might think. Good old table sugar, sucrose? It’s a mixture of fructose and glucose; the latter leans heavily on insulin to control blood glucose after a sugar load, and I don’t believe anyone thinks this is fine for your health.

The best approach for most people is to eat a predominantly savory diet. A motivated soul stuck on highly sweetened foods can slowly wean themself down if they’re patient. Two packets of Equal or teaspoons of sugar can become one, can become half, can become zero, over enough time, and — lo and behold — coffee is still delicious.

I know, I know: this stuff is hard. Some people don’t have the time or the bandwidth in their over-booked lives to add another challenge. Consider this advice aspirational, then.

Along those lines, back to the study. It’s worth noting that the absolute increase in risk of consuming artificial sweeteners was quite low, even if the relative risks hold statistical water and can be generalized outside of French 40-somethings . In their middle aged cohort, high consumers — who averaged about 2 packets of sweetener per day — had about 1 cardiovascular event every 290 person-years, while non-consumers spaced out their events only to about every 320 years. The average middle aged person would need to live over 3000 years to reap the benefits of that responsible choice to forego Nutrasweet. Put from a physician’s or nutritionist’s perspective, we’d have to counsel 60 patients each with 50 years of tread on their tires to avoid artificial sweeteners in order to prevent one cardiovascular event.

We’ve got bigger fish to fry. Hold the honey glaze on mine, please.

https://doctorbuzz.substack.com/p/are-fake-sugars-causing-real-disease

Antidepressants, Empathy, and Democracy

 You can learn much about what a civilization lacks by observing what sentiments it elevates as an ideal. The ancient Greeks, who invented the concept of the “golden mean” between extremes, were, on the basis of Greek tragedy and historical accounts, given to wild eruptions of rage. For years now, Americans have exalted empathy as our king of sentiments, but on the evidence of everyday life, empathy is in short supply.

We’re surrounded by polls, studies, memes, and viral events said to reveal or shape our national existence. It could be, though, that the social forces that most determine our collective destiny are barely talked about because they are impossible to quantify. To take one profoundly consequential trend: nearly one in four American adults is taking psychiatric medication, and a substantial portion of these people report experiencing “emotional blunting”—an inability to feel their own and other people’s emotions.

Over the last few years, I lost two close friends to the effects of psychiatric medication. Both had been taking antidepressants for many years. One was on Trazodone, which, along with stunting empathy, causes reckless behavior and problems with impulse control. I watched as he blew up his marriage and in one instance publicly humiliated his wife and teenaged children. I’ll never forget the strange, dislocated grin he wore the last time I saw him. He had come with his children for lunch and began showing my wife and me pictures of his third child, whom he had just had with his new wife, as the two children he had raised with his first wife stood there, stricken and speechless. And yet he grinned as if we were all having the time of our lives.

I had been very fond of him, but the second friend, whom I knew for 20 years, I had loved. He was a kind, deep-feeling, brilliant, funny, creative prince of a man. But he began to act irrationally, missing basic emotional cues, finally emotionally hurting my son, whom my wife and I had, out of trustfulness, allowed him to sponsor in some way. I gently asked him to be a little more conscientious with our son and he said that he would—then gave me that same dislocated, jack-o’-lantern grin I had seen from my other friend. When he never did change his heedless behavior toward our son and I reproached him in an email, he exploded and tried to retaliate against me professionally.

I cannot make any significant connection between the behavior of my two old friends and what I knew to be their characters. Sure, what they became might have been lying deep within them all along. But considering the widely studied and reported side effects of emotional blunting, it seems almost certain that their empathy was broken by the psychiatric medication, the way any powerful drug can turn an inactive physical condition into an emergency.

We all hear sophisticated explanations for the divisions in America now: political, cultural, social, historical. They are all legitimate, in one degree or another. But it seems to me that the widespread use of drugs that can abolish our ability to empathize with what another person is feeling risks creating a collective hell—even if it is a living, functional, and sometimes even pleasurable and gratifying one.

As what one might call a celebrity emotion, empathy is often simplified and caricatured. It’s hardly an entirely positive attribute. Being able to feel what another person is feeling can also allow someone to manipulate or injure another person. Sadists can be as empathetic as therapists. Iago is the most empathetic figure in literature—he feels every nuance and degree of Othello’s insecurity and plays on them to destroy him.

Yet in a democratic society, where individual freedom abounds at historically unique levels, empathy is indispensable. In a dictatorship, it doesn’t matter if you’re aware of another person’s inner state; the regime regulates relations between people. In a democracy, however, the people themselves regulate the relations between them. In order for that arrangement to proceed harmoniously, people must grasp what others are feeling.

Tocqueville knew this. After discussing how, in an aristocratic society, people understand only the feelings of members of their own class, he describes life in a capitalist democracy, in which even class and region are far more porous than birthright and pedigree. In a democracy, he writes,

each [man] may judge in a moment of the sensations of all the others; he casts a rapid glance upon himself, and that is enough. There is no wretchedness into which he cannot readily enter, and a secret instinct reveals to him its extent. It signifies not that strangers or foes be the sufferers; imagination puts him in their place; something like a personal feeling is mingled with his pity, and makes himself suffer whilst the body of his fellow-creature is in torture. In democratic ages men rarely sacrifice themselves for one another; but they display general compassion for the members of the human race. They inflict no useless ills; and they are happy to relieve the griefs of others, when they can do so without much hurting themselves; they are not disinterested, but they are humane.

“He casts a rapid glance upon himself, and that is enough.” That is to say, the condition for feeling what others are feeling is to find that emotion in oneself. This is the basic precept of Method acting, perhaps the truest expression of the complexity of the democratic personality ever produced—for all its Russian origins—by American culture. Method acting’s central principle is simple: find an experience and emotion in yourself similar to what the character is experiencing and feeling, and then you can make that character come alive. Delicately balanced against the Method actor’s radical submersion in himself is a radical submerging of himself in another. The Method actor’s experience embodies the drama of American individualism. To put it more concretely: when Philip Seymour Hoffman’s inner torments became public after his death from a drug overdose, I understood why his portrayal of the tormented Willy Loman in Death of a Salesman had reduced me and other people in the audience to tears.

If it is true that the essence of a functioning democracy is the ability of its people to feel empathy for one another, then the widespread reliance on antidepressants—and I lament not their necessary use, but their unnecessary overuse—is like some cruel joke. Add to the pharmacological cultivation of emotional blunting the emotionally blunting effect of lives lived increasingly online, and you have a democracy resting on a fundamentally anti-democratic way of life. The Cassandras who see democracy about to collapse at every turn might want to look in their own medicine cabinets.

Lee Siegel is a City Journal contributing editor and the author of seven books, including, most recently, Why Argument Matters.

https://www.city-journal.org/antidepressants-empathy-and-democracy

Florida school system studies Tom Brady fitness plan in pilot program

 A school district in Florida is implementing a pilot fitness program created by NFL quarterback Tom Brady to promote healthy practices among students. 

The program is being implemented in six middle schools and four high schools in Pinellas County Schools, which is located on the western side of the state and includes the city of St. Petersburg. It was started as a result of a partnership among the Pinellas Education Foundation, a coalition of community members that work to improve public education, Brady’s nonprofit TB12 Foundation and the school system. 

The program is comprised of five pillars: pliability, nutrition, hydration, movement and mental fitness. Pliability is the most crucial part of the TB12 method as it allows muscles to be “resilient” and better at absorbing force, according to the website for the method. 

The Washington Post reported that the idea for implementing the program came from Ben Wieder, a Pinellas Education Foundation board member. Wieder heard Brady speaking on a podcast about the method that the NFL star and his body coach created and was so eager about it that he pitched the TB12 Foundation to adapt it for schools. 

The Post reported that supporters of the program believe it will get students enthusiastic about fitness, and dozens of other school districts have called Pinellas to ask questions about it. 

But Brady’s method has received criticism in the years since he created it in 2017. 

A New York Times review of the book in which Brady outlined the method said the concept does not have strong scientific backing and that pliability is not a concept in exercise science. Experts have cast doubts on the effectiveness of his method, but Brady has defended his approach. 

Pinellas County Schools, the Pinellas Education Foundation and the TB12 Foundation did not immediately return requests from The Hill for comment.

https://thehill.com/blogs/in-the-know/3658806-florida-school-system-studies-tom-brady-fitness-plan-in-pilot-program/

NFL season sees Pfizer kick off major Comirnaty COVID vax ads for teens, boosters

 Pfizer has been using a softly, softly approach when it comes to promoting its COVID-19 vaccine Comirnaty. But as the NFL season kicked off this month, the Big Pharma’s marketing strategy is going the extra yard.

That’s according to data and analysis shared with Fierce Pharma Marketing by real-time ad tracker iSpot.tv. These data find that since Aug. 22, ads for Comirnaty have aired 749 times on national linear TV, with a particular emphasis on NFL games, which started Sept. 9.

In fact, almost 30% of Comirnaty TV ad impressions appeared during NFL games, and more than 63% of national TV ad spend for the brand was allocated toward the NFL, according to iSpot's analysis.

“On the NFL end, Comirnaty is also pretty visible, as one of the 30 most-seen advertisers over the first two weeks of the regular season,” an analyst from iSpot told Fierce Pharma Marketing. “It’s by far the most-seen pharma spot during NFL games.”

There are only four prescription medicine brands appearing during NFL games so far this season. Besides Comirnaty, the other three are Bristol Myers Squibb’s blockbuster cancer drug Opdivo and its autoimmune med Zeposia as well as AstraZeneca’s diabetes drug Farxiga.

But iSpot’s data show that Comirnaty as a brand is “significantly higher than the rest by both spend and impressions” during NFL games. Its estimated spend is $9.5 million with 31 airings, nearly double its nearest rival in Opdivo, which had an estimated TV spend of just over $5.1 million with 10 airings.

This comes as sales of Pfizer’s vaccine, which soared to a major $36 billion last year, are expected to slow down in 2022 and beyond, given that the immediate threat of pandemic COVID is, according to U.S. President Joe Biden, now “over” and fewer people are getting a vaccine.

Pfizer is, however, now gearing up for COVID booster season alongside rival Moderna. Both nabbed FDA authorizations for their respective variant-specific shots last month.

The new Comirnaty ads and the ramping up of its marketing spend for the NFL season mark a notable change for Pfizer.

The DTC ad work for the vaccine began last December, well after Pfizer won its first Comirnaty full approval in August 2021. Companies aren't allowed to do any DTC marketing for products under emergency authorization, but that all changes with full approval. 

Nonetheless, Pfizer's first TV spot, called “Remarkable,” did not mention Comirnaty by name nor did it talk about vaccinations broadly or even the COVID-19 pandemic specifically. Instead, the campaign focused on how society was yearning to get back to normal and how that drove Pfizer's mission.

The second ad, “Don’t miss your shot,” was a little more direct but not by much. It came shortly after "Remarkable" in December 2021 and once again did not showcase Comirnaty nor mention COVID. It did, however, talk up the availability of vaccines and portray the importance of not missing your opportunity to get your shot.

But the branding strategy has changed over Pfizer's two latest TV ads. Launched a month ago, on Aug. 22, and called “Hard on everyone,” the 60-second spot followed Pfizer's July full approval for Comirnaty in teens. For the first time, the Big Pharma takes a directly branded approach that it didn’t in earlier commercials.

Pfizer talks up how the last two years of COVID have been tough and has a specific focus on teens. It directly says in the ad that there is a vaccine for 12- to 15-years-olds and mentions Comirnaty by name at the end of the spot.  

And, in the main ad used for the NFL spots, “More,” launched Sept. 8, a narrator tells the story, in rhyme, about the “normal” things that happen in everyday life with the tagline, “the more you want to do, the more we want to do.”

This is a specific plug for Pfizer’s new COVID boosters. The Comirnaty name isn’t used in the ad itself, but logos for Pfizer and its partner BioNTech are shown at the end of the spot, and there's a clear message for people to get their COVID booster shots this fall and winter.

There is a slight marketing issue for Pfizer when it comes to the Comirnaty name and its new booster. This bivalent booster has an emergency use authorization but not full FDA approval and therefore has limits on how it can be marketed. Also, its official title is Pfizer-BioNTech omicron BA.4/BA.5 COVID-19 bivalent vaccine.

That may explain why it is not using Comirnaty in its booster DTCs, but it is cropping up in another ad.

https://www.fiercepharma.com/marketing/nfl-season-sees-pfizer-kick-major-comirnaty-covid-vaccine-ad-offensive-teens-boosters

Toxicologist From 'The Good Nurse' on Catching a Killer

 This fall brings the release of two films on Netflix about Charles Cullen, the New Jersey nurse who admitted to murdering up to 40 patients but is suspected of having killed hundreds over his 16-year career.

One film, "The Good Nurse," is a dramatized version of events starring Eddie Redmayne and Jessica Chastain, while the other is a documentary called "Capturing the Killer Nurse." Both are largely based on Charles Graeber's 2012 book with the same name as the Hollywood movie.

edical toxicologist Steven Marcus, MD, was the director of New Jersey's poison control center when his organization received two unusual calls about digoxin toxicity in two different patients at Somerset Medical Center within 2 weeks of each other in June 2003.

Marcus' suspicions and persistence set the wheels in motion on the investigation that eventually resulted in Cullen's arrest in December 2003.

Marcus, who hasn't yet seen either film, spoke with MedPage Today about his role in the case and the flaws in a system that allowed Cullen to work for 16 years without any repercussions.

The conversation has been edited for clarity and brevity.

MedPage: When did you first suspect that someone at Somerset Medical Center was intentionally harming patients?

Marcus: I'm always a cynic and I'm always questioning things. The first call didn't make sense. A woman was found to have digoxin in toxic levels and the only thing that they could blame it on was drinking this Korean tea. So that didn't make sense, but it's the kind of thing you put in the back of your mind.

Two weeks later, I overheard Bruce [Ruck, head pharmacist at the poison control center at the time] talking to somebody on the phone about it. I said I already spoke to them about unexplained digoxin toxicity. He said to them, 'Have you already spoken to my director?' As soon as they said "no," the bells went off in my head.

When we asked about any other strange occurrences, they had these two cases with insulin overdoses.

This was either just wholesale bad medicine, or there was somebody attempting to kill people.

MedPage: What were your next steps? How did you try to sound the alarm?

Marcus: The first thing we did was say that we need to have a discussion with the [hospital's] chief medical officer, risk management, the pharmacist, and the head of nursing to see if we can come up with a logical explanation.

We wanted to be sure that these four events were real and were documented. Then we would work together to try to come up with an approach to see if, in fact, there is somebody there that's attempting to kill people -- or is there a breakdown in their system someplace that allows for really severe medical errors to recur?

We did get into a telephone call, but there was a complete denial by the hospital. [They said] there was no way that this could be happening, and that there are obvious other reasons that it could occur. They were not willing to get involved, as far as we could tell, with any investigation.

MedPage: So what did you do next, given there was likely someone out there killing people?

Marcus: I had no clue who to call, so knowing that there was an outbreak in a hospital, I figured it has to be reported to the state.

Our grants were all administered through the Emergency Medical Services Branch of the Department of Health, so it made sense to call that group first. At the head of that group was the state epidemiologist.

After a second call with the hospital, I said it would work out a lot better if you call, rather than me. They said they absolutely won't. I said I felt obligated. The chief medical officer said, "If you feel that way, go ahead."

The epidemiologist ... his comment was they were not going to study it epidemiologically but that it sounds severe enough that it probably ought to be investigated by the hospital licensing group, which was another part of the Department of Health.

So he gave me a name there, and I called them. I said, if you don't find a logical explanation, you probably need to reach out to the Attorney General's office and figure out where to go from there. And she assured me that would happen.

Then I became a little bit of a pest, reaching out there saying, "Where are we?"

That was in the second week of July 2003. It wasn't until October that a call came in to the poison center from the Somerset County Prosecutor's office, asking about digoxin. Bruce [Ruck] took the call and said, "Are you talking about the case at Somerset Medical Center?"

They asked what we knew and Bruce told them I had a thick binder of correspondence about it. They asked if we could talk.

I said, "Let's get the attorneys to make sure that we dot every 'i' and cross every 't' before we get ourselves too much further into this." The [attorneys] said, "Of course, we will cooperate, but you need to get a subpoena." We called them [the detectives] back and within a half an hour, they were at our doorstep with a subpoena.

MedPage: Had you been involved in a murder case before?

Marcus: No. I was aware of the outbreaks that had been reported previously. In 1982, the Tylenol case struck all of us in the business. Somebody put the cyanide into the capsules. I had a particular interest in [healthcare murders] before, but the Tylenol episode certainly crystallized my interest in the field.

MedPage: You met face-to-face with Cullen. What was that like?

Marcus: That was part of the plea bargain to take execution off the table. He would clear the minds of the people who thought their loved ones were killed by him. He would admit to the murders if he thought he had [committed them]. They asked me to sit with him and hash out which cases he was willing to admit to.

It was a bizarre experience. We met in a conference room in the Somerset County Courthouse. It was, I think, in February, so it was cold. And I don't know whether the fact that I was freezing was because it was so cold or because it was just such an emotional experience.

We spent probably the better part of a day in that room discussing the cases. I would explain to him why there was evidence that he was probably involved. There were a couple that I couldn't convince him that he was involved. And that was how the day was spent.

At the end I just sat there kind of wiped out. The detectives said, you know, doc, you look a little shocked. And I said, "Well, this was a strange experience." They said to me, "You mean, you've never met a serial killer before?" I looked at them and said, "Have you?"

I tell people that, if you sat next to him on a bus or train, he would not have stuck out as someone unusual. There was nothing about his demeanor, nothing about his look, nothing that would have raised any suspicion.

MedPage: What do you think drove him?

Marcus: He was not an "angel of mercy," that is for sure. These were not people who were in intense pain that were asking to be put out of their misery.

Some of the people were on the mend. One was leaving the hospital when he administered that digoxin to her and killed her. One was a 20-something kid. Some were directed at individual patients, but sometimes he would just go into the clean utility closet and grab an IV bag and put poison into it so that it would go to somebody random. I have no explanation as to why he committed such heinous crimes.

MedPage: Do you think that over his 16 years as a nurse, other colleagues had suspicions about him?

Marcus: There were attempts at other hospitals to report him. There was one place where the nurses went on record, saying he was not a good nurse and he was doing bad things. And the hospital just didn't do anything.

Not only did they not do anything, but the next hospital came along asking them for a recommendation, and they didn't tell the hospital "Don't hire him."

Part of the thought process is that the hospital could be sued if they gave a bad recommendation.

I mean, it is a business. Without bringing in revenue, the hospital can't operate. So to some extent, you can understand that. The chief medical officer in Somerset, at one point said the reason they didn't act faster is they didn't want to have a total disturbance in the community, because everybody depended on the hospital.

MedPage: Was the hospital ever held accountable?

Marcus: There were no repercussions for Somerset. To my knowledge, they were fined for some minor problem as part of the licensing investigation. Something was found that would not have accounted for the overdoses. But it was a slap on the wrist.

MedPage: What changes are needed in the current system to prevent the next Charles Cullen?

Marcus: I don't have the answer, but one thing needs to be education. People need to know that if they see something that doesn't look right, they need to report it.

We have to educate people on who to report it to. And then you also have to educate the people that you are reporting to, on what to take seriously. Everybody has to be on the same page.

I think the COVID experience shows pretty well that we're not very good at surveillance, and we're not very good at doing public health. In my experience, it's usually the compulsive, astute clinician who picks up, if not the first case, then other cases and makes some effort to intervene. That's not a great way to run a system.

In our case, just think about the serendipity involved. Had we not had two calls -- one from a nurse, one from a pharmacist -- to the poison center within a couple of weeks; had I not been consulted on the first case; had I not walked by Bruce on the second case, Cullen might never have been stopped.

There are probably murderers out there killing people as we speak.

https://www.medpagetoday.com/special-reports/exclusives/100876