Gentle Readers,

Dr. J.’s been horrifically busy of late, so he hasn’t been able to write much of substance and you’ve had to suffer the slings and arrows of My Little Pony jokes and puppy pictures, and not much Gormotastic commentary on the goings on in the world of late.

Rather than speak exhaustively to each and every subject he’s going to cover a bunch of his musings ‘Larry King Style.’ with a bunch of unrelated bullet points for which the deep substance is out there somewhere in teh interwebz…the last one of these was almost six months ago, so it’s quite OK for Dr. J. to go to the well again.

• Bill Clinton’s going after President Obama on his broken “You can keep your plan…” promise is no coincidence. Hillary is running in 2016, and in light of Bengazi and a dozen other White House disasters, she can only be running against the White House. Bill is firing the first of many polite subliminal compare and contrast salvos. He’s really good at this sort of thing.
• This makes sense, President Obama leads as an outsider (the Limbaugh Theorem), so Hillary distancing herself from the current administration (especially as Republicans can do no more than run the four corners defense for now) and running ‘against Washington NOS*’ is her best shot, even though she’s about as inside a player as it gets as a former First Lady, Senator and Secretary of State.
• The 7 minute prologue for the Doctor Who 50th Anniversary Special was pretty amazing, taking Paul McGann out of mothballs to reprise his role as the 8th doctor was some nicely done fan service.
• Regarding the budget talks, it appears that the best case scenario for the Republicans, and the American people is to keep on the current path for now. That’s still lousy policy, but anything else will probably blow up in their faces. Dr. J. thinks that Paul Ryan and the GOP are making short term decisions on what is best for them in 2014 and for him in 2016.
• Doctors are not on every Obamacare plan (or every insurance plan for that matter). Furthermore they’re not being reimbursed at the same rates for those Obamacare plans. As a consequence, with Obamacare, you will get less doctor per visit. You get what you pay for, or in this case, others get what you pay for and you get what they voted for.
• There’s a new blood thinner on the horizon. It’s name is Edoxaban. It was studied as an alternative to warfarin for stroke prevention in patients with atrial fibrillation. On the continuum of efficacy (which we shouldn’t really do as there are no head to head trials, but only trials compared against warfarin), it probably shakes out that with regard to stroke prevention, dabigatran is number 1 (number needed to treat (NNT) to prevent 1 stroke per year ~160), apixaban (NNT ~300), Edoxaban (NNT ~312, not statistically significant), Rivaroxaban (neutral against warfarin). With regard to safety (major bleeding risk) Apixaban (NNT ~100 to prevent one bleed/year vs. warfarin), Edoxaban (NNT ~ 147), Dabigatran (NNT ~ 300, not statistically significant), warfarin (reference), rivaroxaban (number needed to harm ~ 400, not statistically significant). Apixiban and dabigatran still are the players to beat with regard to net clinical benefit over warfarin. The game gets interesting this spring as apixaban and dabigatran will likely get FDA approval for deep venous thrombosis/pulmonary embolus treatment indications. 
• Recently, Team Obamacare has started calling plans that do not pass muster, substandard, inferior and inadequate? Dr. J. has long held that minimum coverage should be just that, minimum, and not cover elective items. Obamacare wants everyone to have a three course meal. Soup and salad are substandard. A burger and fries is junk. A five course meal is unequitable and unfair and should be taxed. Everyone should get a three course meal, even if you don’t want that big a meal. Furthermore, instead paying an equal, or risk based rate, everyone should pay proportionally based on their means. You pay $50 for a meal, someone else $25, and Dr. J. $100. Fair? Not fair.
• Dr. J.’s never understood what he calls the Republican paradox. Democrat policies are clearly bad for the country. Some of these policies, including Obamacare, are also extremely unpopular. Yet when Republicans try to tackle them, they get cold feet when a small minority starts screaming at the top of their lungs and the numbers shift a little. The left hates them no matter what they do, so why not go all in. At least the Democrat leadership, wrong as they are, believe what they believe and they’re ruthless enough do what needs to get done done. Dr. J.’s not advocating lying, as the truth is on the side of the conservatives, but the Republicans need to grow a pair. 
• Dr. J. likes Marvel’s Agents of S.H.I.E.L.D. He agrees that the characters and the long game are not quite there, but that will right itself when new episodes come out. Buffy’s first (short) season involved figuring itself out, but it hit its stride pretty quick. 
• Lee Harvey Oswald was, if anything, a communist sympathizer.
• Senator Reid and the Democrats have killed the filibuster for executive and court nominees other than the Supreme Court, one could call it a tactical nuke. Dr. J. looks forward to President Cruz nominating Sarah ‘The Secretary shall…’ Palin to HHS, just to make heads explode. Sens. Levin (MI), Manchin (WV), and Pryor (AR) get kudos for voting no, even if it was for cover. 
• Kids are less fit than their peers thirty years ago, running the mile on average 90 seconds slower. The decline in fitness is 30-60% attributable to increases in fat mass. This is no surprise to Dr. J. 
• A colleague went to an ethics and research conference last week. One of the strange notions that a Yale ethicist put forward is as technology advances, greater inequity of opportunity for care exist between rich and poor, thus new innovations should be vetted by Institutional Review Boards. For example, NAITMC has an online patient portal where patients can check labs and securely contact their doctors with questions. They argue that not everyone has internet access, so that technology should not be available because it creates inequity. Dr. J. took their bat-shit crazy notion further saying that a homeless guy comes into the ER with (stable) chest pain. He has a stress test, and it’s positive for a blockage. His heart cath shows a 90% blockage in the right coronary artery. Given his circumstances, the doctors deem him not a good candidate for a stent (as he probably can’t faithfully take Plavix for a year as required for the drug eluting stent, as it’s a long complex lesion). But extension, this ethicist would put forward that if he can’t get a DES and one year of Plavix, the ‘haves’ should not have access to that care. 
• If you think that craziness can’t happen, think again. We’re seeing the ramifications of letting the Faculty Lounge™ run the country right now. Victor David Hanson covers this nicely on NRO. He writes, “The Left, which cares for humanity and strives for fairness and equality, has earned the moral right of exemption from one-dimensional truth. The Right, which focuses on the liberty of the selfish individual to do what he pleases against the collective interest, has not.” He also picked up the ball from Dr. J., earlier in the article when he writes.  
• Regarding the nuclear option, President Obama today says, “the pattern of obstruction is not normal.” Ever notice every extreme measure the Democrats have taken over the last five years has been a response to ‘extreme’ situations. Dr. J. would like to run the numbers on Obama’s nominees compared to W.’s or any of their predecessors. Dr. J. suspects the only thing that’s extreme is the politics of President Obama’s nominees.

Dr. J.