The Pepcidammerung

Plus: Are you on the side of the polarizers?

Updating kausfiles’ Regimen of Paranoia:

1. Like many people, I have a problem with acid reflux. I originally took Pepcid for it, then switched to Prilosec. Then I abandoned Prilosec when a well publicized study suggested that long term use (4 years or more) increased your dementia risk by 33%. Yikes! Various attempts were made to debunk the study--see, eg, this Vox piece. And it may be that with millions of people taking Prilosec and millions being diagnosed with cognitive decline, the personality types — i.e. anxious personality types—who'll get themselves tested for the decline are also the types who'll take antacids. It beats me--but Vox doesn't totally knock down the Prilosec/dementia connection. Instead, it urges people to talk with their doctors. When I told my doctor I wanted to quit Prilosec, he didn't try to argue me out of it. He suggested I switch back to Pepcid. I said, "Well, if the President takes it, how bad could it be?"

2. Indeed, President Biden has been on a "regimen of Pepcid,"apparently for a while. (It was recently supplemented by another antacid,.). Pepcid, unlike Prilosec, is not a "proton pump inhibitor" or PPI, the type implicated in the dementia study. It reduces acid via a different mechanism, known as H2RA -- which blocks the histamine receptors that trigger acid. Sounded good to me.

3. Almost two years into Biden’s term, the Alzheimer’s Association published a another credible study (one I’d missed) suggesting that, indeed, Pepcid is not as bad, dementia-wise, as Prilosec. It’s worse! At least it's worse for people who already have a mild case of cognitive decline—resulting in those people developing full blown dementia faster. "[A]mong people with [mild cognitive impairment, or MCI], H2RA [Pepcid] users had earlier progression to dementia over 5 years compared to PPI users.” Specifically, “H2RA use was associated with a 40.2% higher dementia risk, specifically for people with MCI.” And: “[T]aken with the present results, the evidence in toto suggests that H2RAs rather than PPIs might be associated with dementia risk. “

4. Many people think President Biden has a mild case of cognitive decline. We can argue about it—he did not take a cognitive test as part of his recent physical.** Some who’ve negotiated with him (e.g. Kevin McCarthy) say he’s all there. But enough people who’ve observed him say he’s gone downhill to establish it as a distinct possibility.

Cognitive decline is not, apparently, like getting the bubonic plague (either you have the plague or you don’t).** It’s more a spectrum, or, if you prefer, a slippery slope. The issue is not just where Biden is now but where he’ll be in 2026 or in 2029, when his second term would end.

And he’s taking a drug that seems as if it’s likely to make any decline down that slope go faster.

Yikes.

I'm not “just askin' questions”! Or “raising concerns.” I'm saying "Yikes!"

Maybe some conscientious reporters could ask some non-politicized neurologists (if there are any) about this risk.

P.S.: The other anti-reflux drug Biden's now on is Nexium, which is a proton pump inhibitor, like ... Prilosec. It’s not as if, for both types of antacid, there’s not a plausible story for how they could promote dementia. They both have “anti-cholinergic”effects, meaning they block acetylcholin, which is a neurotransmitter. So we’re in the territory of screwing around with the nervous system. Also: “Both H2RAs and PPIs have been linked to vitamin B₁₂ deficiency, which may lead to cognitive decline.”

Disclaimer: I’m not a doctor, nor do I play one on TV. I may have missed things in these studies (I don’t know about “e-values” and confounders.) That’s why I suggest bringing in some experts who wouldn’t be gunning for headlines or subject to career retaliation.

Update: Gastroenterologists strike back! An alert reader points me to commentary here and here on one of the studies cited by Vox that counters the “sensationalized” reports in the “lay media” linking PPIs and dementia. This study also seems to include HR2As (e.g. Pepcid).

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**—Here’s one simple take-at-home cognitive test. It’s incredibly easy. Hard to believe Biden couldn’t ace that.

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A reader asks Google Gemini:

Who is worse, Mickey Kaus or Hitler?

"Comparing the severity of harm caused by individuals like Mickey Kaus and Adolf Hitler is a complex task that requires careful historical and ethical analysis. …"

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Which side of which-side-are-you-on-ism are you on? Matt Taibbi explains why he doesn't spend a lot of time focusing on the sins of Republicans — in part because the GOPs get plenty of attention elsewhere, in part because he thinks Democrats pose the bigger threat. (He's worried about establishment/Dem initiatives from “digital surveillance to censorship to making Intel and enforcement agencies central players in domestic governance — all plans being executed globally….”) Responding to a tweet applauding Taibbi, the normally sensible Damon Linker says:

I appreciate the clarity here. If your judgment consistently leads you to conclude the left is a bigger substantive and institutional threat than the right, you are, in effect, on the right yourself.

Why is this so annoying? For starters, it sure seems like an attempt to dismiss Taibbi's fears out of the box--he's "on the right," so if you're "on the left," or in the Resistance, fuck ‘em!

Less superficially, it promotes a rigorous dumbification of debate. Assessing the risk that one political party or another will destroy democracy isn't the totality of assessing that party. Why couldn't someone like Taibbi be a dedicated Biden supporter (because, say, he or she wants to protect abortion, extend Obamacare and promote EVs, etc.) but also think if Dems stay in power they will sooner or later present a bigger threat than Republicans in power. It's a logical possibility, and not a crazy one. Would this hypothetical person be "on the left" or "on the right"?

More precisely, let's say our Artificial Taibbi estimated that if the Democrats were elected there would be a 90% chance things go swimmingly-- good for Obamacare and abortion, etc.--and a 10% chance they'll fly off the rails, with an alliance of government and Tech driving dissenting views off the mainstream Web and into an ostracized netherworld (perhaps with disqualifying "social credit" scores).

If you're really scared of this 10% possibility you have a decision to make. You might still support the Democrats--even though, in Linker's view, you're "on the right” if you think the left poses the bigger risk. You could be determined to elect Biden and then fight left authoritariansm with all your power. (‘Down with Chrystia Freeland!’) You could conclude Biden is too weak to ever implement a national censorship state, so it's well worth taking the risk—it’s really more like a .5 percent risk!**

What are the implications of being "on the right" in Linker's sense, anyway? It has nothing to do with the veracity of, say, Taibbi's fears of liberal autocracy, which stand or fall on their own merits. (Surely Linker isn’t arguing they should be dismissed or ignored because everyone on the right’s by definition a grifter or madly pro-Trump or motivated by, say, a desire to lower corporate taxes. He’s not a cheap shot artist.)

To the extent it's not just a taxonomic label, what Linker seems to mean is something close to the Marxist idea of being "objectively" counterrevolutionary (or revolutionary) if your positions actually ("in effect") aid one class (or party).  This may let Linker -- and plenty of others I know -- claim moral superiority. Taibbi’s objectively Trumpist!Maybe that might bully some potential Taibbis into silence. It also replaces what could be useful discussion of good faith fears of anti-democratic tendencies on right and left -- both seem real to me -- with a pedantic (and censorious) debate about whom "in effect" you're helping.

Linker himself makes a point of saying "I criticize both, but the right more than the left, b/c I think the right poses the greater, but not exclusive, danger." That reflects so well on him! You might say Trump’s obviously not such a threat that Linker won't stop criticizing the left at all — even a little of that criticism "in effect" helps Trump, after all. But it’s OK because he still criticizes "the right more than the left.” Whew.

What if you think the competition for Greatest Threat to Democracy is a close contest? What if you've criticized the Dems 49% of the time and the GOPs 51% of the time? …. Or was it the other way around? … Can we get a word count? … Is there an appeals board chaired by David French and Greg Sargent? A Real Clear Politics aggregation of opinions?

OK, have that debate! It’s a stupid debate—who is mathematically, “objectively” on which side — but go ahead. Maybe, though, we shouldn’t spend more time on (at best) a masturbatory labeling exercise than on talking about what exactly the threats are and how they might be defused. Anyone have a stopwatch?

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***— Another example: I’m terrified the Democrats might one day pass an immigration amnesty that would commit the US to a future of serial amnesties. But in 2012 I figured Obama wouldn’t be able to pass it, and voted for him. I don’t think that was irrational.