Mary Trump's Book: Too Much And Never Enough

 

 

I.

It is just so sad. That's my reaction to reading Mary's book. My God, the anguish that everyone in this super-dyfunctional family has had to live with! No one escaped. Mary's father, Fred Jr., “Freddie,” tried to escape and failed. He succumbed to a heart condition and alcoholism, divorced, solitary, poor, living in a spare small room in the garret of the Trump House in Queens (“The House” Mary calls it, the center of pathology from which no one could really escape) where he lay ill and dying for weeks when no one even called a doctor or took him to a hospital before he finally died at 42. Mary loved him, but being only 16 and infected by the family dysfunction, she accepted the family judgement that it was his own fault, that he hadn't measured up, that he had gone off on larks like being a commercial pilot and marrying a flight attendant (Mary's mother Linda) when his father had wanted him to succeed him as head of the Trump Company and keep the family business thriving as a good first son should and he couldn't make it. So he died for his alleged sins.

Mary grieves for her father now, probably thinking “if only I knew then what I know now.” All the others suffered, too, each in his or her own way. Her grandmother, Fred Sr.'s wife who was also named Mary, was chronically unhappy and suffered the misogyny of Fred Sr. The middle child of the five Trump children, Elizabeth, has been an introverted and depressed ghost. The eldest, Maryanne, succeeded in being a lawyer and a judge, but she also participated in the Trump hallmark dishonesty. She was part of the tax evasion fraud of wealth transfer in the family documented in the New York Times, and she joined the three-sib plot to defraud Mary and her brother Fritz from any semblance of a rightful inheritance. Robert, the youngest sibling, was the agent assigned by the other two after Fred died to get Mary and Fritz to sign the papers that would consent to the inheritance plan. The three Trump siblings stuck together in telling Mary and Fritz that the nearly $1 billion estate was only worth $30 million. The deluded wife of Fred declared him virtually devoid of funds in what seems perhaps to have been a gaslighting event. When Mary and Fritz delayed signing the documents, the sibling trio cut off Fritz's baby son's health insurance as he was being treated for infantile spasms, a very severe neurological disease of childhood. It was perfectly legal to do so. The lying about the value of the estate? Not so legal. As though there wasn't enough to go around. Trump Family Values. Just win, baby.

The original villain of the piece, of course, is Fred, Sr., who we learn grew up in a German-speaking family – so one would have thought that the Trumps' immigrant status should be palpable to them. Or perhaps because Fred became very wealthy, they learned the wrong lessons. He was a man out of time and maybe out of place: cold, authoritarian, wearing a three piece suit at all times and asserting control through absolute denial of the validity of feelings of others, even his wife's while she was severely ill – “You're fine, aren't you Toots?” Then she goes to the hospital for surgeries and recuperation for months on end. We don't know how Fred got to be that way, and Mary is probably in no position to know about this, and that's not part of her mission here. We just know how he was, and how his dominance forced everyone to adopt his point of view. When he finally deterioratd into dementia, it appears he received little family support. It must have been pathetic and even funny, the way Lear is funny wandering at the end, but ineffably sad. It was dog eat dog chez Trump.

Fred was the typical absent father who ran his company obsessively. The mother was in charge of raising the girls and the father the boys, but his being at work all the time limited his fathering chores, which it appears he was unsuited for, anyway. Even in this killer of a family, everyone strives for his favor. His success in business was largely from government-funded housing in the outer boroughs, Brooklyn and Queens. He got the jobs through “political connections,” the substance of which we are left to imagine. His large complexes featured impressive lobbies that bespoke luxury, but the apartments themselves were cramped and maintenance was lackadaisical. The Trump brand then was glitter outside, decrepit on the inside, and neglect after the deal is done. Fred's crucial insight was to retain ownership and carry no debt, which made them huge cash cows.

Although an effective money-maker, Fred was narrow and gauche and could never penetrate to the higher social ranks in Manhattan – he was Queens all the way. As his wealth grew, it appears he didn't know how to spend it, so accumulation itself appeared to be the purpose, and the personal control that accumulation conferred.

Fred is not the only father who envisioned his oldest son, and if not his oldest then one of the others, taking over the company and making him immortal, with nothing ever to be sold, like a shrine. When Fred Jr. dropped out of that fantasy, Donald was ready to take it up. He aped the old man, and then he entranced and gulled the old man with strutting, swagger and lies, which the old man was more than willing to gobble up and fund, even as the bailouts got bigger. But, after all, Donald did crack Manhattan as Fred Sr. had never been up to doing, got a lot of press, was a somebody, which Fred couldn't be. Fred was not the only father to let his fantasies run away with him. And Donald was not the only son to gull his old man and to try to fulfill his fantasies, to try to do what the old man would have loved to have done himself, to have cracked Manhattan and the world. The difference of Donald from others who inherited and then make themselves bigger – compare Ted Turner, for instance – is that Donald didn't really make or do anything, he just blew himself up with air and hype and tried to push it for all it was worth. It was worth a lot to Fred.

II.

This book is written with a clinical eye, which I as a pediatrician appreciate. It can't be an accident that Mary became a PhD in clinical psychology. When you are one of the victims of a toxic family, what better expertise to acquire than that of a PhD clinical psychologist, studying family dynamics and family therapy? She could not only learn to understand herself, but she could help others who find themselves lost in similar situations. Relatives of gun victims, relatives of drunk driver victims, relatives of those stricken with diseases do the same – let at least some good come of this horrible event, let's get some legislation passed, let's fund research and treatment. Good for Mary! As she helps others in her work, so she tries to help the country with this book.

Mary's way of thinking is not so different from what we pediatricians are familiar with. Mary declares her family's affliction not rare, but uncommon. That's clinician talk. When confronted with a case like Donald's, we clinicians think, what happened in the mother/child dyad, what innate characteristics of the child were at play, and what were the family dynamics that caused this monstrosity? Something caused this.

For the mother/child dyad, Mary focuses on Donald when he was two and his mother had her major illness and was effectively removed from Donald's life for a year and replaced by … nobody. Mary tells us that this is the stage of a child's life when their emotions are sensed by the intimate caregiver, reflected back to the child, and the child comes to sense what his or her emotions are, and learns how he or she can be comforted. That's what parents, and archetypically mothers, do. When Donald had nobody to mirror and comfort him, his reaction must have been to deny his feelings, she says, to be cold, and in not recognizing his own feelings he was unable to recognize anyone else's, and so became cruel. I'm a little rusty on my first year med school Erik Erikson's stages of development, but I'm willing to go along with her analysis as being at least a good part of the truth. I have to admit that I have always thought less dynamically that Donald might have had the syndrome of oppositional defiance, which doesn't specify a cause, but many assume it comes at least partially from the innate nature of the child.

But whatever the origin, these developed characteristics of Donald's, the self-centered win and don't look back, don't worry about the feelings of others, and then the bonus of grandiosity – they lit up Fred's eyes as he saw his successor. This brings in family dynamics. I was introduced to the developing field of family therapy as a pediatric resident at UC San Francisco in the 1970's. I so vividly remember my astonishment when, rather than simply meeting with individual patients, we learned to treat the family as a unit, as a system within which all the individual component parts (the people) interacted and affected each other. Meeting with the family in the room, not just individually, was key.

In that family therapy rotation I remember being confronted with an elementary school-aged boy who was being aggressive at school and disrespectful to and uncontrollable by his mother. At the meeting we saw the mother express her understandable distress, and we saw the father agreed verbally, but we could also see, when our instructors pointed it out to us, that the father's facial expressions and body language said something completely different. They said non-verbally how proud he was of his son for being a “manly” little boy. The confused boy receiving this double message looked at his Mom giving society's party line, but he was not at all unaware of his father's pride in his “spunk.” He sought to please his father. It was complicated. The father of course had his own history, and there could have been a fair amount of misogyny involved. It was a classically dysfunctional family.

A further concept we learned in family therapy was that of the “identified patient.” The family comes in with the medical complaint that relates to one family member – she won't stop eating junk, he is bullying everybody, etc. Everyone in the family sees the squeaky wheel. But what the family therapist sees is how the pathology of the family system is expressing itself in this one member. If Fred Jr. had presented to a doctor with depression and the doctor referred him for family therapy, the therapist would have called Fred Jr. the “identified patient.” The family certainly thought there was something wrong with him. Today, we all might view Donald as the identified patient. But family therapy says, yes, those are the visibly ill ones, but they are expressing the illness of the whole system.

Donald and Fred, of course, would not be caught dead in family therapy. But if they had been seen, Fred would be clearly not giving the double signals that the father of our family at UCSF did. That was minor leagues compared to Fred. Fred would be seen giving one large unambiguous signal, giving it to everyone, and everyone would be seen as trying to win his approval, or to duck and not be seen. He would brook no opposition, he of the three piece suit and imperious demeanor.

When you're caught in the situation with a family like this, there are no magic bullets. There will be some survivors like Mary – barely, it seems – but most will continue to be sociopathic as they learn to exist in the system of the family, and in time it will be gradually diluted out by marriages, changing circumstances, and new generations emerging with less direct experience. In the meanwhile, one has to hope just that it won't come to one big blowout. Lacking the ability to go back in time and nip it in the bud, one can only seek to control all the collateral damage by the sociopaths.  Mary's most plaintive sentence in the whole book is this: Donald has never been loved. But so terribly sad as that may be, everyone needs to be warned, and that is what Mary is doing.

III.

I have another memory from my first year in med school that is applicable. Our class was in the old Peter Bent Brigham Hospital auditorium on a Saturday morning, and beloved psychiatrist John C. Nemiah interviewed a patient in front of us. Under Nemiah's sensitive and friendly questioning, the patient told his florid story of how resounders had been placed in his brain, and how he got explanations of the world and orders to act through them. The statements he made had some verisimilitude to a possible reality, if you ignored that it was resounders delivering the news. After he had left, Nemiah asked us freshmen med students how we would describe the patient. Those of us headed for psychiatry took the lead, describing his paranoid ideation in detail, noting his affect, commenting on irregularities in his logic. I was impressed by their observations and expositions. Then Nemiah took charge and said, look, those are interesting and good observations, but let's just look at this guy, OK. What do you see? He's crazy! He's nuts! The shock of recognition grabbed us and we laughed hard, to the last person. Forest, said Nemiah, forest – not the trees. (He probably didn't say that, but that was his message.) I loved Nemiah.

So, our forest is the Trump family. They are totally nuts. A crazy father raised a crazy family. Just because you are rich and financially successful doesn't mean you can't be nuts. “High-functioning,” yes, incredibly able to raise money in the first generation and to spend it in the second, but nuts. A family constantly conspiring against each other, filled with terror and lies, yet reassembling at The House like clockwork for the birthdays and holidays and such. A family where the divorced spouses were induced to be part of the assemblage, until Marianne and Blaine, Robert's wife, asserted that they would no longer come if Freddie's ex-wife Linda, Mary's mother, were to continue to be included, thus exiling her. Forget Mary's feelings. “Feelings?” Good luck with that. A family where secrets and plots and illegalities were rife, where paying taxes was the ultimate sin, where the celebrated son and heir commerced in lies, damned lies, and false statistics. We can focus on the trees, which are astounding to behold, but let's take Nemiah's way and look at the forest. This is crazy town.

As to scion Donald, the self-proclaimed very stable genius, if there's one thing he isn't, it's “very stable.” But we should take the claim of genius more seriously. How could someone so unqualified, so ignorant, someone with probable dyslexia and ADHD and therefore someone who can't read well and can't concentrate well, someone so florid, so unmoored to the reality we commonly agree on, so full of constant easily-refutable lies, so totally cynical, how can such a person actually take over not only one of the two great parties of the republic, but the apparatus of state as well? How can someone whose schtick is best described as Borscht Belt fear, hate, and diminishment; whose taste is lower working class; whose vocabulary is elementary; whose greatest achievement was to be a third rate reality TV host; whose businesses were disasters, frauds, and hoaxes; whose ability to empathize seems totally absent; whose habits are publicly disreputable; whose inclinations are publicly gangsterish; who is obvious in his search for thieves and knaves to serve him – how can someone like that rise to the pinnacle of power in a well-established democracy? If that is not genius, what is?

Geniuses have their own individual ways. If there ever were a crazy genius, it is not some mad scientist making a Frankenstein monster in some home cellar, it is not an evil genius in the labs of Wuhan creating a lethal virus, it is not a James Bond villain. The crazy genius is someone who has found a way of seizing power and orchestrating destruction of government, someone who is seen by conventional society as a clownish and fraudulent would-be gangster, someone nurtured and enabled by a crazy but high-functioning family, who manages to disrupt the country and the world.

IV.

That's the forest. That's what Mary is telling us. She is saying, don't fall for his bullshit, he has always pulled this stuff, he has always blustered his way through things, he has always lied and manipulated, and he was selected for these characteristics and promoted for them and enabled for them by a very sick family with an immense amount of money. Here's how he lied, here is how cruel and acquisitive he has been, and please, people, see it for what it is. He's just doing what he has always done. You can see the end result as it appears now, but I see its long history, how the process has worked, how it came to be this way, how it has been this way for a long time, and I see how dangerous it is. America, don't fall for it.

Budd Shenkin

Time Flies

 

Time's arrow is cruel, very cruel. The very definition of relentless, don't you think? Time impaled my parents, first my mother with breast cancer at age 72, then my father at 92, finally – he had warded off many an illness until he finally said, take me off everything that is prolonging my life. Time will get me, and you, too, and then my kids, sure as shooting. Time is a relentless mother-fucker, believe me.

Not that this is a big discovery. Time is to people not as water is to fish. Fish don't know they're in water, they just swim. We, on the other hand, we all know about time all too well, even though we live our lives often ignoring it. The Capuchin monks have a museum in Rome featuring their skulls. The caption to the display says, as you are now, so we once were; as we are now, so you will be. https://archaeology-travel.com/italy/capuchin-crypt-rome/. We were there when we were in Rome, Ann and Peter and I, back in the day, when we lodged in a hotel right down the street, and I cadged a room on the top floor overlooking the whole city from a huge roof deck – as they say, never accept the first room they give you, which in this case was like a cell. We moved to a new room, same price, and victory was ours! The Eternal City at our feet. Although “eternal “ is, we know, a exaggeration.

I wrote the other day – where, on Twitter? evanescent twitter? – that we have fought against time for a long time. Pictures of animals on cave walls that last for eons, made by those hands and minds of long-ago victims of time. Not that long ago, actually, if you put it into thei perspective of the earth's being four and a half billion years old, life on earth three and a half billion years, so cave people were just yesterday in that perspective, but just as gone as that original molten ball of earth that eventually cooled and permitted us to emerge and grow.

Then, after cave paintings, I thought about the oral epic story. Gilgamesh – Gilgamesh never did that much for me. (I hear my father's voice – “Didn't impress you then, big shot?” He would say that with a loving smile, he wasn't belittling me, I was the first-born Jewish son, and I wasn't to be belittled, a burden I carried all my life, but I guess it worked, channelled me, if that's what you want, persistence works. Anyway, who am I to belittle Gilgamesh?)

Then came writing, keeping records, recording stories of wars, heroics, love poems, philosophy, thoughts, talk, imagination, all captured by the code of lines on a surface. Architecture, too, all the trappings of civilization, capturing and freezing, then being lost, becoming decrepit, superannuated, obsolescent, obsolete, forgotten, and sometimes then unearthed and resurrected. Time just keeps going.

My parents were aware of it. They took the technology of the day to freeze time as much as they could. They took eight millimeter home movies in the 1940's and 1950's. Pictures of us running under the boardwalk. “What happened to that cute little boy?” my father would wonder as he looked at me in later years. They loved us so, their loved their young family, they remembered their own childhoods which we heard about in dribs and drabs. They had some old photographic portraits with names loosely attached – that is, there were no labels, just the photos, and we were told who was who but who could remember? They were our ancestors and relatives, but they looked just like everyone else from the 19^th century, hats, dresses, mustaches, we are related to them? I guess so. That's how it works.

“You should have a hobby, Buddy,” my parents told me. I guess I was 12 or 13. We were still living in West Philadelphia, the four kids going to school just outside the city limits at Friends' Central School, so I was probably in 6^th or 7^th grade. I thought and answered, “Photography?” In no time I had all the equipment to develop negatives and prints with trays and chemicals down in the cellar, with a red light that wouldn't spoil the film and a yellow light for I forget what. I guess time has dimmed my memory.

I read about composing shots, f-stops, everything, and got pretty good. I was official photographer at my great aunt Sadye's wedding at her Rittenhouse Plaza apartment, and developed and printed the pictures of her and my new Uncle Henri the music publisher, and the overexposed eight by ten prints I produced were put under the glass top of Aunt Sadye's dresser forever. It was still there when she died at 96, lonely, asking me as a young doctor, is there a pill she could take to end it all? She was impatient in her loneliness, but her death was just a question of timing, as usual.

I am amazed at all the time and care and hopes my parents put into me. Supplying me with a hobby. I don't think I was grateful enough. I don't think I put enough back into my own kids. It's pretty hard when you're divorced.

I was in my thirties when the first camcorders appeared. I wanted one badly, I had the money, I saw the one I wanted at Eid's in North Berkeley, but I was taught to be thrifty. My soon to be wife Ann taught me to spend the money if that was what I wanted. So I bought it and got a tripod thrown in when I whined to Eid that it was expensive, but I knew its value. I remembered my parents eight millimeter movies, how they would get them out and run them sometimes and we would watch, and one time – it was still in the West Philly house – they were running it and I pointed at a cute little blond girl in a stroller, and I cried out, “There's Susie Levin!” But Susie's parents Herb and Beck were in the next room, visiting from their house a block and a half away, and Susie had died a few years ago from leukemia, decades before medicine learned how to cure it, and they could hear me, so in a moment of panic my Mom put her hand in front of the projector so the screen would go dark, and she hissed: “Shhhh!” Their pain was, of course, too great, people just can't talk about it. Just the other day I heard Peter Bogdanovich say how his mother could never talk about his brother who died at a year and a half. It never goes away, it perseveres, it is only covered up. The time up on the screen, they were good times, but not forever. It was long ago. Beck died a few years ago when she was almost a hundred, living alone near Rittenhouse Square, I think.

I started taking videos of our kids as my parents had taken movies of us. I got lost in the dancing at Play Day at Henry C. Lea Elementary School at 47^th and Spruce Streets when I was in kindergarten, and there it was on the screen, anytime we wanted to look at it. I still have it, now on a DVD. I took lots of videos, lugged that bulky camera attached to a heavy recorder strapped over my shoulder, to games and even vacations. On Lanai I remember the busboy asking, “What's that?” It was bulky. I was relentless, I put in the effort.

We would go back from Berkeley to Philly regularly. My parents were then living in their I. M. Pei house on Society Hill on Fourth and Orianna, not far from Independence Hall, in the neighborhood my father had been born in and raised in and been happy in – he remembered when there were more horses than cars, he claimed, although I don't know, he was born in 1915 and was known to exaggerate – or lie, actually, or misremember – until the depression came and his father died of a brain abscess and his mother's family's bank failed and they moved in with a relative in some apartment, went the story. But here he was with my Mom back in city center, happy, prosperous, renewed.

I was in my late thirties, I guess, and newly confident. Camcorders were still bulky, so I left mine at home and rented one in Philly – what an expenditure! We also stayed at a nearby Holiday Inn instead of bunking with my parents – what an expenditure! And then I led them to my project.

“Buddy wants to do this,” said my mother, telling my father to go along with it. It had taken me that long to break through her iron grip on organizing the family, or so it seemed. Torch-passing, maybe, as we all got older. And what I did was, I got my mother and father in their car, Dad driving and Mom in the back seat trying to direct, certainly contributing to finding the best way to our objectives, which were all the places they had ever lived in, to film them and narrate. We would go from center city where my Dad was born, to the apartment on 42^nd street where I was taken home from the hospital when I was born and where my earliest memories are – the shadows of the lights coming through the blinds as the clanging street car made its way past the apartment and I could track how the light and shadows on the walls progressed as it passed, to the house at 4931 Osage right around the corner from my mother's parents, then to the one at 422 South 47^th where I learned photography and chess and had an aquarium, to the 52^nd street squalid apartment where my mother was born (“the family manse, she narrated) and then out to 526 North Wynnewood Avenue where I went to Lower Merion High.

Then we went back home to Society Hill, and I don't know if it was that day or another, it might have been the next day, when I videotaped Mom and Dad in the TV room talking about old times and my father was standing up remembering when a patient, a relative or someone prominent, had been sent specially to Dad to operate on his back, I think it was. It was some kind of a tough operation. He was assisted in the operation by a resident from South America who had pustular acne, and he contaminated the op site with a bacterium that the elementary antibiotics they had at the time couldn't cure. Nowadays, of course, it wouldn't be a great problem, but the time for great antibiotics had not yet arrived. My Dad said, “I made rounds on him every day. It took him such a long time to die.”

“Don't, Henry,” my mother begged. But he had recounted it, and all the anguish that went with it. I have it all on tape. Not that I look at it. But I sent it to my siblings and I think they watched it, not that we talk about it, just one or two comments once or twice.

Back home in Berkeley I taped it when we told the older four kids that a new one was on the way, to their wonder. I taped it when we told them it was to be a boy and the three boys were thrilled and Sara, not so much. We taped Brian and Nicky and Allie on their skateboards and on their bikes, and Peter at his Little League games. Then eventually we just stopped taping, although we shouldn't have, when kids get older you just stop taping. Then came digital cameras that made taping easier, then I-phones when it's a true snap, and the kids had kids and they do it with their kids, of course.

And now it's 2020 – it should be the year of perfects eyesight but instead it's the year of COVID-19, shut up stores and staying home, waiting for COVID to disappear and for Trump to disappear as well. They will, for sure. It's only a matter of time. Waiting them out. In the end, Trump's right, everything goes away.

But with all this recording of events, freezing them in time with ever greater verisimilitude as the technology leaps forward, somewhere along the line we have neglected to take videos of me, just as we didn't take videos of my father when he got older, nor of my mother when she got sick and the good treatments for breast cancer hadn't arrived yet. But who would take them? Allie lives in Oxford with his own family, I was estranged from Nick for many years and now we're back together but his family lives in Marin and probably I'll get to see them in the future when COVID recedes in time, and Peter is not one to memorialize. And Sara my step-daughter has her own family and her own father. Maybe I'll figure out how to tape myself. Can't be that hard. I guess each nuclear family tapes itself, is the way it usually works.

So, like everyone else at this time, we wait. We have fewer events to mark it's passage, it just keeps flowing regularly on its own. We have our pursuits and our daily routines that are now more pronounced than exceptional events, I study my French and pursue writing projects and take walks for exercise, we have our meals to enjoy, our crows and squirrels to watch, the sun setting earlier each day. We just had our house painted and it's beautiful, best paint job ever. I was careful to take before and after pictures because if you're not careful and the new paint is already on, you can't go back and get the before picture. Do it then or you never will. And the new kitchen floor and appliances from two years ago are great, too. Change is good.

Actually, there's no alternative.

Budd Shenkin

A Stunning Majority, A Massive Crisis, An Historic Opportunity

 

I believe that the Democrats will probably run the table in November, taking the Presidency by a landslide, increasing their majority in the House, and taking the Senate by about 54-46. Who knows, but that's what I think. The election will constitute a massive rejection of Trump personally, and Trumpism, and the Republican party as it is now constituted. Not only will the united Democrats have complete control, but their Republican opposition will be divided and thus even less able to obstruct than the numbers will indicate.

They will take over in the midst of a huge, mishandled, dangerous, ongoing pandemic health crisis, and in the midst of the associated huge, dangerous, ongoing economic crisis. These two singular crises will take the major part of the attention of the public and the top administration. That is where the drama will be.

At the same time, however, the crises that Trump had precipitated even before the pandemic will still be there, ready to solve. These Trumpian crises are of two sorts. One is Trumpian policies – the tax policies, the destruction he has caused throughout the government agencies in their objectives as well as their ability simply to function. The other is the Trumpian trampling of the laws and norms of how the government does its business. To make a medical analogy, you might think of these two separate areas as the bones and the muscles of government. The bones would be the laws and norms, the stable structure necessary for the muscles to attach to and to operate. The muscles would be the policies themselves.

(I have discussed this in three previous posts focusing the the laws and norms – the bones, if you will – on Post Trump Reform, Post Trump Reforms Executive Summary, and Post Trump Reforms David Frum Commentary, with comments on David Frum's excellent book, Trumpocalypse. I have also discussed one specific important suggested reform that refers back to the paper that David Levine and I wrote recommending that the power of the presidential pardon be constitutionally amended to require that each pardon receive the co-signature of the Speaker of the House.)

So you have to wonder, if the Democrats take over as I have outlined, or something close to that, would the necessity of concentrating on COVID-19 and the attendant recession/depression completely suppress and delay all the other necessary actions of post Trump reforms? After all, you might think, their hands and the congress's will be more than full.

Maybe so. That will certainly be the argument of the disorganized rump Trumpian/Republican minority. But I have a different view. I am optimistic that the Democrats will find it possible to walk the COVID-19 and economic support walk, and at the same time to chew the gum of post Trumpian Reforms. And in fact, with COVID-19 and economic support at center stage, I would posit that, (switching metaphors here!) like a magician who has focused the audience's attention on his right hand doing the pandemic/economic juggling, the Dems could push the post Trumpian Reforms even faster and more completely than if everyone's attention were on them.

You never know until you get there, but it's possible. But, it will only be possible if the Democrats are prepared. It's all in the preparation. You have to rehearse the hell out of that left hand, or the chewing of the gum, take your pick of metaphors. If you're not ready for the opportunity, you won't be able to take advantage of it.

So here is what I'm suggesting. I'm suggesting that the Democrats construct a detailed battle plan right now. Even if the plan never survives the battle intact, you still have to have it ready so you can act with the knowledge of what you have planned. What are your major steps and how are you going to accomplish them?

I would divide them up into policies and laws/norms, muscle and bone. I won't deal with the muscle here and now, but first would probably have to be personnel; I would have them ready. Then there would have to be all the policies and rules and regulations that have been changed – just change them back and make them better – Build Back Better, the man said. Then, as the Republicans squawked about the cost of the economic support program, I would reverse the Trump tax cuts and say, you're right, we need the money, and guess how we're going to get some of it.

For the laws/norms, the bones of government, I think David Frum hit it on the nose. I would start with getting rid of the filibuster first thing, then vote in DC as a state before they can say Jack Robinson. As Frum reasons succinctly, just do it, you can do it with simple majority votes in both houses and a presidential signature. They'll never know what hit them.

I'm not sure what the professional Democrats would plan to do next, but there would have to be a list. I would take the Frum tactical line and just get it done. Invite the opposition in, allow cooperation and amendments – but not obstruction. If they howl, excoriate them. Respond – no more obstruction! No more emasculation of the legislative branch! But whatever, the crisis atmosphere and the rare Democratic predominance should not to be wasted.

I would start the planning, slowly and quietly, but bringing in the major players inside and outside of government, right now. Have your list ready. And have your playbook ready on how you are going to educate the nation to what you are doing. (Learn from the great missed opportunity and cautionary tale of the Obama administration – how to sell it. Personally, I would put Donnie Deutsch on the case, and the Lincoln Project people, and James Carville, but that's personal taste.)

You've got to be ready. This will be your chance. As my wife told me when I got Stanford's offer to buy my practice, as she very wisely advised me, and as she directed me, let me say now to the Democrats – Don't fuck it up!

Budd Shenkin

Opening Elementary Schools Might Make Sense In Covid Time

The original post is this note from Dr. Hoeg.  Her reasoning, while sound at the time, might be faulty, in that the New York Times reports that children have been now shown to harbor large loads of the virus in their nasal mucosa - see here


From Tracy Hoeg MD PHD: (UC Davis)

I wanted to give an update on the research regarding COVID in children. 

I should back up briefly and state that I am a physician with a PhD in Epidemiology who became very interested in this topic when a colleague and friend of mine, Jennifer Kasten, MD MSc, wrote a systematic review of COVID epidemiology in children (https://www.facebook.com/jenniferkastenmd/posts/128898328763114) and found kids 12 and under *might be viral "dead ends", meaning they can get COVID but can't transmit to anyone else. This really captured my interest because this would make COVID very different from most respiratory viruses we know. Then in a physician's group dedicated to school opening, a physician researcher published a document for the group in which said she could identify 0 (zero) cases of certain transmission from children under 12 in the scientific literature and since that time Dr. Rutherford, UCSF Epidemiologist, has also been public about elementary-aged children being a "one way street" for infection - they get it but don't appear to transmit it, much, if at all. (UCSF Grand Rounds lectures are now available on YouTube for those interested in hearing him).

Last month, I did my own summary of the data (https://www.facebook.com/tracy.hoeg/posts/10219217323357158) and found evidence of the following:

*Very limited transmission if any from children ages 12 and under to either other children or adults

*Children appeared to be at least 10 times more likely to die of influenza than Covid and are more likely to be struck by lightning (I rechecked the CDC website today 7/13 and they are still reporting 3 deaths in children under 18 due to confirmed COVID; for comparison, there have been 185 deaths due to influenza in this population in the 2019/2020 season. If anyone has an updated death count in the pediatric population due to COVID, please share).

*Countries that reopened elementary schools as a first step in their country's reopening did not see an uptick in cases (these include numerous European and Asian countries, some of which are displayed in Figure 4. Reopenings not causing and uptick in cases is consistent with children not being a major vector for the disease. Figure 3 shows age of the source of the cases of COVID in Holland, with none ages 18 and under in their study, as just an example of these data. 

What have we learned in the last month?

1. We now have a generally accepted mechanism for younger children getting milder disease and transmitting significantly less than adults, which is paucity of ACE2 receptors in the respiratory tract compared with adults (this is the receptor SARS COV2 uses to enter the cells of the body). This could explain why children get COVID less, have milder disease (lower viral load) and are less contagious (if contagious at all). Yet another way COVID is unlike typical influenza! https://jamanetwork.com/journals/jama/fullarticle/2766524

(Figure 2)

2. Consistent with this was the study showing lower viral load (lower amount of the virus) in children up to age 18. (Figure 1). The original non-peer reviewed print of this article from Drosten et al was reanalyzed as per UCSF Grand Rounds and does indeed show significantly lower viral load in children as seen in image 1. 

3. This is great news for teachers and children, because not only are children significantly less likely to transmit COVID, but IF they do, the dose of the "inoculum" will be expected to be lower and there is mounting evidence (though inconclusive at this point) that the lower the dose of the virus you get, the less severe your disease will be if you even get symptoms at all (https://www.reliasmedia.com/blogs/2-hicprevent/post/146456-Public-Masking-Could-Save-Lives). This may be why Denmark and Norway were able to reopen elementary schools without any mask wearing in children (or adults for that matter!). Now if there IS mask wearing in the US by either children, adults or both, that would make both transmission even less likely and possibly the severity of the disease will be less if it does occur (interesting non peer-reviewed study showing inverse correlation between mask-wearing and mortality rate: https://www.medrxiv.org/content/10.1101/2020.06.22.20137745v2)

4. I am sensing many of your are STILL skeptical we can safely open elementary schools in the US. Well, thankfully we have really good data from the YMCA childcare for essential workers in the US, which has been providing childcare throughout the pandemic (our kids go there) and was even open in NYC at the height of the outbreak and they have had 0/>40,000 kids (ages 14 and under) contract COVID. They have also not had any outbreaks, though a few staff at different sites tested positive (presumably contracted from another adult per the above data) and quarantined so no more than 1 positive case a just a limited number of sites. Adults wear masks, kids don't, temperature checks at the door, each kid has a small "cohort" of kids they do everything with. More details can be seen in this article, but it shows that WE CAN DO THIS SAFELY in the US - even in areas hit severely by the virus and with truly minimal resources. https://www.npr.org/2020/06/24/882316641/what-parents-can-learn-from-child-care-centers-that-stayed-open-during-lockdowns 

Edit: The small cohorts in children may actually not be necessary and the data I am using to support this is guidelines for return to school in Holland in quotes below and from their Ministry of Health Website (https://www.rivm.nl/en/novel-coronavirus-covid-19/children-and-covid-19). This model has worked for them:

"Children up to and including 12 years of age do not have to keep 1.5 metres apart from each other and from adults. This also applies to childcare and primary education.

Young people aged 13 until 18 years old (i.e. 17 years old and younger) do not have to stay 1.5 metres apart from each other. In secondary schools, this applies to all pupils, regardless of their age."

--I also want to briefly address the many "clickbaity" articles in the popular press lately about school and day care outbreaks. Specifically I will mention the school outbreaks in Israel where there were some infections in high school aged children but the "outbreaks" in the elementary schools were among adults only. Also, if you carefully look at the reports of day care outbreaks in our country, most appear to be involving staff that infect each other and, if kids are affected they are infected by the adults and are asymptomatic/have mild disease. I challenge you all to look at the articles coming from the popular press with the above data in mind and you will be surprised in the elementary age group that the adults appear to be the ones responsible for the outbreaks (though it is hard to get all of the info from those articles) and the ones who are severely affected by the disease.

--What are the bottom lines?

1. Kids 13-14 and below (likely around puberty) do not appear to be driving the spread of COVID. They rarely (one can never say never) transmit the disease. Tracing the source case with 100% certainty can be very challenging, but the data overall indicate pediatric transmission to be quite rare compared with adults.

2. Kids up to 18 years of age tend to get mild disease if any symptoms and death in this age group is less likely than getting hit by lightning. 

3. In school settings, adults can and will give to adults and kids, so teachers need to be socially distancing while at work. Adults also should be wearing masks and getting tested and staying home if they have symptoms. 

4. Data and guidelines from Holland suggest distancing among children <19 and="" as="" be="" been="" children="" countries="" div="" economy.="" even="" first="" has="" in="" it="" masks.="" may="" necessary.="" not="" of="" opened="" out="" pointed="" reopening="" scandinavia="" schools="" should="" step="" successful="" that="" the="" their="" these="" wearing="" without="">

5. I have previously discussed the many downsides of not having kids in school in person this fall: further entrenching socioeconomic disparities, job loss for parents who can't afford childcare worsening poverty and neglect, abuse of children (which will be underreported), lack of support for children with special needs, anxiety, depression and lack of physical activity and peer relationships in children. The list goes on and on. But I want this post to focus more on the science of the disease so it can inform our public policy decisions.

6. I hope the above data are reassuring. The more we know, the better we can tackle and live with this disease.

Edit: Now that this post has been shared hundreds of times (never imagined this), I want to say first of all, that I in no way am intending to detract from the seriousness of COVID-19. It is imperative our country get this disease under control -by social distancing, closing indoor businesses which are not essential, wearing masks, etc, but the above data at least suggest to me that children are not driving the pandemic; adults are. And I also want to say that a lot of what I shared above was recently discussed in the UCSF combined Medicine and Pediatric Grand Rounds lecture (an inspiration for me to write this to get this scientific info to the public). I encourage anyone interested in the above data to watch this recording of the Grand Rounds : https://www.youtube.com/watch?v=yh9gmca6o_A&feature=youtu.be&fbclid=IwAR2HH3myAdjOBmebb23iI2DWPSkdYrEp2niYa_KRiwWStxrqN5f6JNxXPD4

And this article about the above UCSF physicians' stances on reopening schools and transmission in children: https://missionlocal.org/2020/05/ucsf-medical-grand-rounds-the-doctor-is-ready-to-send-children-back-to-school-with-care/

I welcome any data or questions you have. The science about COVID in pediatrics is evolving and we don't have all the answers (far from it), but I hope people can use the above data to help them make informed decisions about children's activities and school openings. 

Now in my OPINION- elementary school is an essential service of a country. All other first world countries prioritized opening their elementary schools BEFORE their economies. When one considers the number of couples or single parents who are essential workers, or now working again in the US, with kids too young to watch themselves - I ask you- where will they go if not to school? And will the alternative be better?  These children with either be 1. in school, 2. in a day care (IF their parents are privileged enough to afford this) or 3. neglected/potentially left alone at home and not learning and without their usual resources. It is our job together as American people to figure out what is in the best interest of all our children (regardless of socioeconomic status) - they are truly the future of our country and figuring how to open schools safely is infinitely more important than reopening Disney World (WHY is this open??). I hope we can use the above data and strategies of other countries (as well as our own YMCA daycares!) that have successfully managed this pandemic to guide us. Having NO plan for how to most safely open our elementary schools is not an acceptable modus operandi for our country.

*********************************************************

Edit to add new data:

7/16: In Germany, a study of over 2,000 children: "Scientists from Dresden Technical University said they believe children may act as a “brake” on chains of infection." https://news.yahoo.com/german-study-finds-no-evidence-164704005.html

7/16: Study performed by the Swedish and Finish Ministries of Health "closure or not of schools had no measurable direct impact on the number of laboratory confirmed cases in school-aged children in Finland or Sweden. The negative effects of closing schools must be weighed against the positive indirect effects it might have on the mitigation of the covid-19 pandemic." https://www.folkhalsomyndigheten.se/contentassets/c1b78bffbfde4a7899eb0d8ffdb57b09/covid-19-school-aged-children.pdf

Two Things I Was Thinking

Memory is a funny thing.

When we get older, some of us wish we could remember more.

And some of us wish we could remember less.

I guess either.  Or both.

I feel lucky to be alive.

I'll miss it when I'm not.

Budd Shenkin

My Anti-Trump Ad

What was he told and when was he told it?

Starting in December of last year, the intelligence agencies and the CDC started alerting Donald Trump to the impending Corona virus epidemic. They knew what was brewing, no matter what China or the WHO were saying or were not saying. Even though Trump had disbanded the pandemic alert and pandemic response team, even though Trump had, very unwisely and against advice, removed Americans from on the ground surveillance of Chinese viruses, still, our intelligence services knew.

They tried to tell the President. They tried to brief him. They sent him warning messages. They included the warnings in the Presidential daily briefings which the president does not read, but which officials try to read to him, as they try to point him in the right direction.

Instead, the President didn't read the messages, didn't listen to the warnings, and ignored the impending danger..

When cases started to appear, officials tried to warn him again. They tried to get him to act, to get testing materials – but he rejected their advice. He turned down the tests from WHO that other countries accepted and used. He didn't give the hurry up order to CDC to get our own testing in order. CDC under the leadership of his personally chosen commissioner failed miserably to produce tests. When universities and companies wanted to develop and use the tests to detect where the disease was and to take steps to stop it in its tracks, Trump's administration stopped them from doing it.

Without tests, for long months as people were infected and died, we were prevented from stopping the infection because we couldn't test to find out who had it, and where they were. Other countries like South Korea, Taiwan, New Zealand, and Denmark knew just where the infection was and who had it, and they held their countries deaths to very low levels. Under Trump, the United States has been the biggest failure in containing the virus in the entire developed world. He has been the world's biggest loser, which means that our people have had more infections and more deaths per capita than anyone else.

When Trump was urged to get American industry to produce and stockpile ventilators and protective gear to keep healthcare workers and others safe, he refused to do it. Instead he turned to his son-in-law, Jared Kushner, who had convinced him that he could import and distribute everything necessary on his own. He failed, although he was able to let giant contracts to his friends, who couldn't come through, but did manage to go to the bank.

Trump failed at the start, and he continues to fail to meet every challenge that the corona virus presents to us, so the United States' pandemic spread is the worst in the Western world. We have more cases and more deaths per capita than virtually any other advanced country.

It's his fault.

The main job the President has is to keep Americans safe.

Some people hate Donald Trump. Other people love him. But one thing we can all agree on. Donald Trump is really bad at his job.

Post Trump Reforms - David Frum Weighs In

When I heard that David Frum had a new book coming out, Trumpocalypse:Restoring American Democracy, I was excited. I like Frum, he's very smart, regularly has original ideas, has a nice sense of humor, and he's interested in just what I am – Post-Trump Reform. So I preordered and read it right away. And sure enough, he has an acute analysis of Trumpism, an acute analysis of our current troubles, and some ideas that I hadn't thought of. Although I have to say, without being too competitive with a very smart guy who does this for a living and has done so for decades, I've had some ideas that he hasn't thought of. (Especially reforming the presidential power of the pardon.)

I agree with the bulk of Frum's analysis, which is not far from my own. We both agree that post-Trump reforms are likely, comparing the post-Trump environment to that of post-Watergate. He says: “Democracy is tested by its ability to deliver security, prosperity, and justice. Relatively modest reforms to the US system could improve all those outcomes. This is not to negate the value of bigger ideas: changes to the voting system, changes to the campaign-finance system. But those things are hard to do.”

While he has some specific suggestions for changes, in general, he hopes that Americans will come to their senses after Trump, and that the new victorious forces will seek reconciliation rather than revenge, except for the leaders who will deserve opprobrium and often appropriate punishment. For two good summaries of what he says, check the book reviews in the WaPo and the NYT.

Although he doesn't dwell on it, it's interesting to look at the reforms he does offer. Let me recall the six tools and the eight problems I identify in my basic post, keeping in mind that one of the tasks of reform will be to turn some of the former norms into new law.

The six tools:

• Constitutional amendment
• New Legislation
• Presidential executive action
• New interpretation or resuscitation of existing congressional power
• Reassertion of norms or declaration of new norms
• Efforts to affect public opinion

The eight problems:

Problem #1 – Attacks on oversight

Problem #2 – Attacks on fair electoral processes

Problem #3 – Abusive extension of presidential powers

Problem #4 – Department of Justice has come under complete control of President

Problem #5 – Corruption and conflicts of interest are rife

Problem #6 – Extensive inattention and incompetence in directing basic governmental functions

Problem #7 – A coarse, mendacious, thuggish, racist, cynical and dictatorial demeanor and tone

Problem #8 – Population of the United States widely ignorant of governmental processes and concepts

Here are Frum's observations and suggestions as they apply to these problems.

#1 – Attacks on oversight. Frum takes this on on page 37. “The Trump years demonstrated the very great extent to which presidential cooperation with the law is voluntary, especially if he or she retains a sufficient blocking vote in Congress.” But then he says there really isn't much we can do about it, that enforcing subpoenas is very difficult, and “even outright lying to Congress can prove exceptionally difficult to punish.” Then, “...there is no 'Congress' anymore; there are only the two parties in Congress.” And then, “The system that protects all of us has failed because the protectors of that system have failed to protect it for us. Democracy does not fly on autopilot.”

Frum doesn't offer a ready remedy in law, although it's clear he wishes Congress had more backbone and independence. As I detail in my post, I think the Congress could and should be more assertive. You can't leave oversight to norms, you need law and muscle.

#2 – The electoral process. Frum spends a great deal of attention on this. Although he doesn't mention it, the great Yale political scientist Robert Dahl predicted that the Connecticut Compromise (two senators per state and the electoral college, both favoring small states power) and the undemocratic elements of the constitution would lead increasingly to trouble. Frum gives statistics that show a gathering skew of these elements – particularly the increasing frequency of electing a president with a minority of votes - and how the skew plus filibuster rules plus gerrymandering ensure continued minority rule and governmental stasis. His fixes are:

• Nuke the filibuster. The filibuster enables 16% of Americans (small states count as much as large states in the senate) to block action by 84%. Just vote it down with a Democratic majority.
• Adopt a modern voting rights act. He includes issuing tamper-proof voter ID for free to all citizens, aqnd making fair and equal the location of voting installations, voting technology, and waiting times at the booths.
• Deter gerrymandering. Here Frum is quite innovative. He says: assume the Democrats win preponderantly. Then offer Republicans two maps of voting districts, one the way the Republicans would draw one if they were in power, and the other one done fairly. He has no way then of ensuring that the next set done 10 years later would be fair if the Republicans win, and seems to count on the moral virtue of reciprocity. Ingenious, but I'd reject it. First pass a statute for independent boards to draw districts in all states, and then set the districts.
• Statehood for the District of Columbia. Now, that's a surprise! He points out that this can be done easily by a simple majority of the House and Senate and a presidential signature. This would help redress the structural strength of the preponderance of small state Republicans. Pretty good move, I'd say. He said in a radio interview that he wouldn't do the same for Puerto Rico because of a substantial independence movement there, which I understand, but it seems to me a quick referendum in Puerto Rico could change that decision quickly. My hesitation would be more about the nature of a nation; language is important to carry culture, and Puerto Rico's language is Spanish.

#3 Abusive extension of presidential power. I think his hope here is that better people will be elected president. I have several suggestions here, including that the constitution be modified to require the presidential pardon to be cosigned by the Speaker of the House. That one would probably be dismissed by Frum as too long-term, but then again, if Trump really goes wild with it as expected, I would contend that it might not be so long-term at all. It could sweep the country like the wind.

#4 Department of Justice repair. Frum recognizes the importance of this problem and proposes that the assistant attorney general for the Criminal Division be changed from a political to a career job. He is deterred from seeking a fully nonpolitical criminal justice system at the federal level because of the bureaucratic constraint – career bureaucrats are not paid enough to attract the very best, and to change the pay structure of DOJ would wreck havoc with the rest of the bureaucracy.

I see his point. In fact, the point is applicable throughout the government, and the quality of government standards of work reflect it. It might be a good idea to start with DOJ, make it a hybrid of regular bureaucratic structure for regular staff, and make the top professional staff above supergrade (GS18) with the expectation that they would elect to stay for long periods of time, and make them dismissible by combined action of the White House and the congress. Then other governmental units could be looked at for a similar structure. But, this would take time. For the moment, some serious personnel housecleaning and restaffing would be necessary. Or, as I suggest in my post, find a completely new way to insulate the DOJ. This comes under the category of bringing norms into legislation.

#5 – Corruption. Frum suggests as I do that tax return transparency be mandated, with more extensive, explicit, and modern financial statements. He compares the bank mandate to “know your customer,” which seems like a valid comparison. We are on the same page here.

#6 Poor direction of governmental functions. Anne Applebaum calls this “a three-year assault on professionalism, loyalty, competence, and patriotism.” Frum sees this, too, of course, but his solution is find a better president, which is hard to argue with. My suggestions bear on increasing transparency and putting Congress on record as approving or disapproving current operations.

#7 Thuggish demeanor and tone. Frum certainly has an exquisite distaste for this vile aspect of Trump, but once again, he thinks Americans simply have to come to their senses. He's right, they do. My idea is that they need help to do so, which would be helped by extensive education in civics.

#8 Population ignorance of governmental processes and concepts. Frum doesn't deal with this. I think it requires a major effort of public education in the schools with three years of civics required.

I liked the book. Frum is smart and an excellent writer. His ideas on #2, the electoral process, are quite good. I would add those to our list of possible solutions to these important problems. Likewise on his suggestion on #4, how to fix DOJ. I think his ideas about how people should appreciate more what good government is like is right on, although I don't think he's got great ideas about how to get there. His analysis of the current situation is penetrating, better than he is on solutions. Read it to your profit.

Budd Shenkin