Thursday, May 9, 2024

The Healthy Vaccinee Effect - How Did It Impact COVID-19 Statistics?

A recent study from the Czech Republic has added to our understanding of the impact and effectiveness of COVID-19 vaccines and their relationship with the "healthy vaccinee effect".  

  

The healthy vaccinee effect also known as the healthy vaccine bias is observed when better health among a vaccinated population results in a vaccine appearing to be more effective than it is.  The term was originally applied to influenza vaccine research by Jennifer Nelson in 2005:

 


...which found that the reduction in risk of death from influenza in vaccinated American seniors was related to preferential receipt of the influenza vaccine by relatively healthy seniors.  Here's a quote from the summary of the study:  

 

"In this study, the reductions in risk observed in the before influenza period suggest the presence of bias due to preferential receipt of vaccine by relatively healthy seniors."


Other studies in Canada, Sweden, Germany, Spain and a 40 nation analysis have also researched healthy vaccinee effects for influenza vaccines over the past twenty years. 

  

In the aforementioned Czech Republic study of the COVID-19 vaccines:



...the authors analyzed two data sets from two Czech health insurance companies consisting of a population of approximately 2.2 million people, representing more than one-fifth of the nation's population.  They examined the validity of claims of the healthy vaccinee effect by analyzing the association between all-cause mortality and COVID-19 vaccination status in subjects 60 years of age and older.  Each age group in the study was stratified according to their vaccination status; unvaccinated vs individuals vaccinated less than four weeks vs. more than four weeks from doses 1, 2, 3 and 4 or more doses of a COVID-19 vaccine.

 

When considering the raw data alone, it would appear that there is a higher level of all-cause mortality among the vaccinated seniors aged 60 and older which suggests that vaccination works remarkably well at preventing death.  That said, the authors note that the data shows that of the deaths over the study period, 37,000 of the 269,000 all-cause deaths (14 percent) were COVID-19 related.  In fact, during a low COVID period between June 2021 and September 2021, almost no COVID-related deaths were recorded in the Czech Republic (0.3 percent to be precise) meaning that almost all of the deaths during that period were non-COVID-related.  Here's a quote from the study:

 

"When comparing the two largest groups in that period, i.e., unvaccinated and those with the completed primary course, the unvaccinated population was more than twice as likely to die as the population with the completed primary course. This apparent “vaccine efficacy” in a period when no COVID was present is likely an artifact of the HVE (healthy vaccinated effect).

 

During the high COVID period from October 2021 to May 2021, there were almost 10,000 COVID-19-related deaths.  The vaccine effectiveness in preventing COVID-related deaths should have lead to an increase in the ratio of unvaccinated to vaccinated all-cause mortality.  In fact, the exact opposite happened; the all-cause mortality in the chart with a completed primary course more than doubled compared to the low-COVID period and the all-cause mortality of the unvaccinated chart rose by only one-third.  

 

The authors' conclusions are as follows with my bolds:

 

"The results of the presented analysis revealed several peculiar patterns of the relationship between all-cause mortality and vaccination status. The presented data obviate that vaccination status has a profound association with all-cause mortality, which goes far beyond the possible protective effect against COVID-related death, especially in the low-COVID periods. Using a simple model, we argue that this pattern can be, to a large degree, attributed to the healthy vaccinee effect....

 

...to the best of our knowledge, the presented study provides the best and most robust illustration of the healthy vaccinee effect in COVID-19 vaccination so far. The implications are huge—based on our results, we propose that the evaluation of the baseline frailty between vaccinated and unvaccinated populations (in our case, the differences observed in the low-COVID periods) should be taken into account when evaluating vaccine effectiveness in observation studies....

 

On two independent datasets, we demonstrated a paradoxical pattern of strong association between COVID vaccination status and all-cause mortality, even in periods when almost no COVID-related deaths were present in the population. Vaccinated individuals (especially those shortly after vaccination) exhibit much lower all-cause mortality than the unvaccinated, even in low-COVID periods. This pattern cannot be explained by the true effectiveness of the vaccines in preventing COVID-related deaths. We have demonstrated that the observed association can be explained by the healthy vaccinee effect (a bias in which individuals of poorer health have a lower probability of taking up the vaccine/its further dose) and present a very simple model of health vaccinee effect, which well replicates the pattern observed in the real data."

 

I would strongly recommend that you read the study if you wish to better understand how the researchers came to their conclusions about the impact of the healthy vaccinee effect on the apparent effectiveness of the COVID-19 vaccines.

  

So, the next time that you hear a public health official tout the numerical advantages of vaccinations against the prevention of disease, perhaps you should consider the impact of healthy vaccinee effect on the efficacy statistics that are being touted by governments and their partners in crime, Big Pharma.


Saturday, May 4, 2024

Did Benjamin Netanyahu Scuttle an Early Deal for the Hostages?

In a recent edition of the Times of Israel, I found this article:

 

 

The article outlines the actions taken by Haim Rubinstein, a media advisor who previously worked for former Member of the Knesset, Ofer Shelah and as a member of the Yesh Atid political party's media team for four elections, immediately after the Hama attacks on Israel on October 7, 2023.  

  

According to Rubinstein, he met with the families of the hostages on October 8th, and ultimately, he became the cofounder of the Hostages and Missing Families Forum:

 

 

The Hostages and Missing Families Forum focuses on bringing all of the hostages back to their families and "offers the families holistic medical and emotional support as well as professional assistance, and advances the ongoing efforts locally, regionally and globally". Members of the Forum include the family members and friends of the hostages as well as top security, law, media and diplomacy experts who are volunteering their time to aid in the recovery of the missing Israelis.  The group notes that they are using diplomatic and legal channels to raise public awareness about the hostage crisis.  The aforementioned Haim Rubinstein was the group's original spokesman and announced that he was stepping down as spokesman for the group in early March 2023 to spend more time with his family and because of what he felt was political interference in the Forum, taking on the role of strategic advisor:

 

Let's go back to the recent story in the Times of Israel.  In the April 26th edition of the Times as I provided above, Rubinstein is interviewed about his experiences over the past six months.  Here are some interesting exchanges with my bolds throughout:

 

Question - Did you work with Gal Hirsch or with the Prime Minister’s Office? (On October 8, Prime Minister Benjamin Netanyahu appointed Hirsch to act as the coordinator between the families and the government. Rubinstein contends that, at the time, Hirsch’s team didn’t have comprehensive information regarding the number of hostages.)

 

Answer - Gal Hirsch only began functioning after two or three weeks. Until then, there was no one to talk to. I don’t know what his contribution was. As far as I can tell, he just held the microphone in meetings with the families. He told them they shouldn’t hold protests [to push for their loved ones’ release].

 

You need to understand that Netanyahu set up Hirsch’s team because the Prime Minister’s Office didn’t want there to be an external body criticizing the government for its conduct surrounding the hostages.

 

Question - Did you feel like the government was ignoring you?

 

Answer - Absolutely. No representative of the government or the IDF had updated the families of the hostages that the IDF was beginning its ground offensive in the Gaza Strip. We couldn’t understand how it could be that the families weren’t getting updated on the ramifications this could have for them.

 

Question - How did you deal with this?

 

Answer - On that day, October 26, I called on the families to come to Hostages Square in Tel Aviv. At the assembly, we announced that the prime minister and the defense minister must meet the families, but there was no response to that from Netanyahu’s or Yoav Gallant’s offices.

 

So we said that if we didn’t get an immediate response, the families would camp outside the Kirya IDF headquarters in Tel Aviv.

 

After that, Gallant promised in a statement to meet the families the next day. We told him we weren’t willing to wait. That evening, Netanyahu’s office announced that he would meet the families’ representatives.

 

Here is the key exchange:

 

Question - What was the atmosphere like? (at the aforementioned meeting with Netanyahu)

 

Answer - We left the meeting very disappointed because Netanyahu talked about dismantling Hamas as the goal of the war. He didn’t promise anything regarding the demand to return the hostages. He merely said a military operation in Gaza was needed to serve as leverage for the hostages’ release.

 

We later found out that Hamas had offered on October 9 or 10 to release all the civilian hostages in exchange for the IDF not entering the Strip, but the government rejected the offer.

 

Rubinstein also notes that the first hostage deal took place 53 days after the beginning of the war but that the second deal has taken over 200 days to complete for the following reason:

 

"The main reason is the prime minister’s refusal.... There is no doubt that Netanyahu is preventing a deal. Netanyahu knows that if he goes to elections at this time he won’t be able to form a new government, and he is motivated by cold political considerations."

 

Rubinstein states that he believes that the moment the hostages are released, far-right members of the coalition government Finance Minister Bezalel Smotrich and National Security Minister Itamar Ben Gvir will claim that the price paid for the release of the hostages was too high, thus collapsing Netanyahu's current coalition government.

 

Think about this for a moment.  According to Haim Rubinstein, Benjamin Netanyahu chose political survival over making a very quick deal to free all of the hostages just days after they were taken by Hamas.  Surely Washington must have been aware of this and, if not, why not?   One would have to wonder why President Biden and his minions are choosing to back Israel's murder of over 34,000 Palestinian civilians and supply Israel with billions of dollars worth of weapons to fight this war if, indeed, the war was not necessary in the first place....unless Israel just wants to eliminate Gaza and expand its own boundaries yet again and members of Congress don't want to alienate their backers in Big Defense.


But you won't hear this in the North American or European mainstream media, will you?


Friday, May 3, 2024

The Antisemitism Awareness Act - Criminalizing and Punishing Antisemitism in the American Education System

The House of Representatives in the United States recently passed House Resolution H.R. 6090, an act...

 

"To provide for the consideration of a definition of antisemitism set forth by the International Holocaust Remembrance Alliance for the enforcement of Federal antidiscrimination laws concerning education programs or activities, and for other purposes."

  

H.R. 6090 is also known as the Antisemitism Awareness Act of 2023.

 

Here is the entire text of the bill:

 


On May 1, 2024 the bill was passed by the House in a vote of 320 yeas to 91 nays which broke down by Party as follows:

 


If you follow this link, my American readers can see how their Representative voted.


The definition of antisemitism used in the bill was that definition created and used by the International Holocaust Remembrance Alliance (IHRA), and, if the bill becomes law, it will be codified in Title VI of the Civil Rights Act of 1964 which bars discrimination based on shared ancestry, national origin or ethnic characteristics.  

 

For those of you that aren't aware of the IHRA, it is an intergovernmental organization with 35 member nations which was founded in 1998 to address challenges related to the Holocaust and the genocide of the Roma.   Here are the member nations:





Here are the observer nations:

 

 

Now, let's get to the important stuff.  Here is IHRA's adopted non-legally binding working definition of antisemitism which was adopted on May 26, 2016:

 

"Antisemitism is a certain perception of Jews, which may be expressed as hatred toward Jews. Rhetorical and physical manifestations of antisemitism are directed toward Jewish or non-Jewish individuals and/or their property, toward Jewish community institutions and religious facilities.”

 

The IHRA goes on to give contemporary examples of antisemitism in public life, schools, the media, the workplace and the religious sphere:

 

1.) Calling for, aiding, or justifying the killing or harming of Jews in the name of a radical ideology or an extremist view of religion.


2.) Making mendacious, dehumanizing, demonizing, or stereotypical allegations about Jews as such or the power of Jews as collective — such as, especially but not exclusively, the myth about a world Jewish conspiracy or of Jews controlling the media, economy, government or other societal institutions.


3.) Accusing Jews as a people of being responsible for real or imagined wrongdoing committed by a single Jewish person or group, or even for acts committed by non-Jews.


4.) Denying the fact, scope, mechanisms (e.g. gas chambers) or intentionality of the genocide of the Jewish people at the hands of National Socialist Germany and its supporters and accomplices during World War II (the Holocaust).


5.) Accusing the Jews as a people, or Israel as a state, of inventing or exaggerating the Holocaust.


6.) Accusing Jewish citizens of being more loyal to Israel, or to the alleged priorities of Jews worldwide, than to the interests of their own nations.


7.) Denying the Jewish people their right to self-determination, e.g., by claiming that the existence of a State of Israel is a racist endeavor.


8.) Applying double standards by requiring of it a behavior not expected or demanded of any other democratic nation.


9.) Using the symbols and images associated with classic antisemitism (e.g., claims of Jews killing Jesus or blood libel) to characterize Israel or Israelis.


10.) Drawing comparisons of contemporary Israeli policy to that of the Nazis.


11.) Holding Jews collectively responsible for actions of the state of Israel.


The IHRA states that antisemitism is NOT limited to the aforementioned list of forbidden actions or beliefs.


So, given that H.R. 6090 clearly states that it adopted the IRHA's definition of antisemitism as the foundation of the bill, does that mean that all of these actions could potentially be part of the new addition to the Civil Rights Act of 1964?


As you can see, particularly given the recent actions of Israel in the Gaza, it's pretty easy to be accused of antisemitism when you compare this photo of Gaza which appears on the United Nations website:


...to this photo of Warsaw in 1945 after the German Army destroyed the city:


...or, under the IHRA's definition, is that considered antisemitism?


Interestingly, the IHRA claims that their ultimate goal is a world without genocide, rather ironic given current actions in the Middle East.

 

The focus of the bill is on the supposed rise in antisemitism in the United States and how it is impacting Jewish students in K-12 schools, colleges and universities.  This bill will make it easier for the Department of Education to determine if antisemitism is present and:

 

"In reviewing, investigating, or deciding whether there has been a violation of title VI of the Civil Rights Act of 1964 on the basis of race, color, or national origin, based on an individual’s actual or perceived shared Jewish ancestry or Jewish ethnic characteristics, the Department of Education shall take into consideration the definition of antisemitism as part of the Department’s assessment of whether the practice was motivated by antisemitic intent."

 

This bill, if passed into law, has the potential to allow the Department of Education to restrict federal funding and other resources to post-secondary institutions that appear to be allowing anti-Semitic activities on their campuses.  Does this mean that administrators will now take actions against any perception that antisemitic activities are taking place under their watch for fear of losing funding?

 

The American Civil Liberties Union (ACLU) has weighed in with this:

 

"The American Civil Liberties Union strongly condemns the House of Representatives for passing H.R. 6090, the Antisemitism Awareness Act, which threatens to censor political speech critical of Israel on college campuses under the guise of addressing antisemitism.

 

The House’s approval of this misguided and harmful bill is a direct attack on the First Amendment,” said Christopher Anders, director of ACLU’s Democracy and Technology Policy Division. “Addressing rising antisemitism is critically important, but sacrificing American’s free speech rights is not the way to solve that problem. This bill would throw the full weight of the federal government behind an effort to stifle criticism of Israel and risks politicizing the enforcement of federal civil rights statutes precisely when their robust protections are most needed. The Senate must block this bill that undermines First Amendment protections before it’s too late.”


The bill directs the Department of Education to consider an overbroad definition of antisemitism that encompasses protected political speech when investigating allegations of discrimination under Title VI of the Civil Rights Act. The ACLU has warned this could pressure colleges and universities to restrict student and faculty speech critical of the Israeli government and its military operations out of fear of the college losing federal funding."


Isn't it interesting to see the influence that Israel has had on American politics particularly given Israel's ongoing war against Hamas and Congressional support for its best friend in the Middle East?


Let's close with this from AIPAC, the one of the most powerful lobby groups in Washington that just happens to be pro-Israel:



Thursday, May 2, 2024

Prepping - A Growth Industry in America

This article on Reuters back in March 2024 caught my attention:

 


Here is a quote about the Survival and Prepper Show which was held in Longmont, Colorado:

 

"The diversification of prepping was clear last weekend at the Survival & Prepper show at the fairgrounds in Boulder County, a liberal district which President Joe Biden won in 2020 by nearly 57 percentage points over Trump. Over 2,700 people paid $10 each to attend the show, organizers said, and attendees were varied."


Here's why the author believes that there has been a notable increase in the number of American preppers:

 

"Much of that growth is from minorities and people considered left-of-center politically, whose sense of insecurity was heightened by Donald Trump's 2016 election, the COVID-19 pandemic, more frequent extreme weather and the 2020 racial justice protests following the murder of George Floyd."


Here is a video taken at the show:

 


Research by Dr. Christopher Ellis, a serving member of the United States military who has a Doctorate from Cornell University and completed his PhD thesis entitled "Are You Ready For It?"



...has thoroughly researched America's prepper community in an attempt to understand the phenomenon and how it has changed over the past few years.

 

In an article posted on The Prepared, Dr. Ellis provides us with some statistics showing the growth in the preparedness community (aka Resilient Citizens) in the United States.  He analyzes data from FEMA's National Household Survey which has been conducted annually since 2013.  FEMA's survey measures preparedness of the American public across the entire community.  From the 2020 survey, Dr. Ellis found the following:

 

1.) The number of people who can handle >31 days of self-reliance grew 50% over the 2017-20 period.


2.) The 20 million US preppers mark has solidly been crossed.  If you use the broader definition of a prepper as someone who can handle at least two weeks of disruption, the number gets even higher.


3.) That means around 7% of all US households were actively working on self-reliance in ’19-20, solidly increasing from 2% to 3% then 5% in recent years.  10% is only a matter of time.


4.) While the “basic preppers” segment was consistently growing year over year before Covid, the “advanced preppers” segment had been flat or even shrank a little — but that trend reversed in 2020, showing that many people saw the need to go beyond the basics in response to world events.


5.) Rural households are still more likely than urbanites to prep, but we continue to see strong growth among city dwellers.


6.) Perhaps most surprising: the trend in recent years was that preppers were getting younger. But that trend reversed in 2020, with the average age actually increasing a little to 52.6.  The number of younger preppers still grew — 25-34 year olds are still the largest segment on The Prepared — but there was even more growth among the older crowd during this period.


If we look at the latest data from the 2023 FEMA National Household Survey (which analyzes data from a survey conducted from February 1, 2023 to March 14, 2023) we find the following:

 

 

There has been a significant increase in the percentage of American adults who believe that they are prepared for a disaster since 2017, however, the percentage in 2023 is down from a peak of 59 percent in 2019 just prior to the pandemic which sent shockwaves through the prepper/prepper-adjacent community.

 

When comparing 2022 to 2023, the survey found that a larger portion of the public felt that they were prepared for a disaster:

 

 

The survey found that 57 percent of adult Americans took three or more actions to prepare for a disaster or emergency in the past year:


 

I found it interesting that 48 percent of Americans either assembled or updated their emergency supplies, up very significantly from 33 percent in 2022.

  

A demographic analysis of resilient citizens shows that 51 percent have a high school diploma or higher education, 52 percent have an annual income of $25,000 or more and 39 percent are aged 60 or older.  Socioeconomically disadvantaged people are also substantial less likely to take higher cost preparedness actions as shown here:

 

I'm not terribly surprised by the growth in the prepper community over the past decade given the growth in crime and political polarization, a number of severe weather events, the fragility of the electricity grid, the significant growth in inflation and the response to the COVID-19 pandemic which provided us with first hand experience with supply chain issues.  While most of us would not consider ourselves to be preppers in the pejorative sense that is often attached to the preparedness community, having a supply of goods necessary to wait out an emergency is simply smart planning.  Concrete-lined bunkers are optional.


Thursday, April 18, 2024

Payments to America's Physicians - A Potential Conflict of Interest

A recent Research Letter published in The Journal of the American Medical Association or JAMA provides us with insight regarding the functioning of the American medical system, particularly, the relationship between physicians and Big Pharma.  In the article, the authors examined data from the federal government's Open Payment platform which records payments to physicians from the health care industry, focusing on physicians in specialty practices.  Open Payments was established under the Physician Payments Sunshine Act in August 2013 in an effort to ensure that patients would have the ability to discern whether financial conflicts of interest may influence physicans' prescribing histories.  Data for physicians are available in a searchable database by either physician name or hospital and, over the past two years includes payments to physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, anesthesiologist assistants and certified nurse midwives. Payments include but are not limited to research, meals, speaking fees, travel, entertainment, education, grants, charitable donations, honoraria and gifts noting that there is an absence of data on certain types of payments like free drug samples..  

  

For 2022 alone (the latest year for which data is available), industry made 14.11 million payments totalling $12.58 billion US to physicians as shown here:

 



Going back to the study as a whole, the authors found that between 2013 and 2022, 85,087,744 payments were made by industry to 826,313 of 1,445,944 eligible physicians across 39 specialties with the median payment of $48 per physician.  The highest annual total value was $1.60 billion in 2019 and the lowest was $863.93 million in 2020.  Let's look at some details:

 

1.) Highest sum of payments by specialty:

 

- orthopaedic surgeons - $1.36 billion (31,620 recipients)

 

- neurologists/psychiatrists - $1.32 billion (58,688 recipients)

 

- cardiologists - $1.29 billion (33,074 recipients)

 

- hematologists/oncologists - $825.8 million (17,025 recipients)

 

- general internal medicine - $588.2 million (97,542 recipients) 

 

Payments were highly skewed with the payments to median physicians ranging from $0 to $2339 compared to $194,933 for the top 0.1 percent of hospitalists and $4,826,944 for the top 0.1 percent of orthopaedic surgeons.

 

2.) Highest sum of payments by drug:

 

- Zarelto - $176.34 million

 

- Elequis - $102.62 million

 

- Humira - $100.17 million

 

Other drugs associated with high payments include Invokana, Jardiance, Farxiga, Dupixent, Botox and Keytruda. 

 

3.) Highest sum of payments by medical device:

 

- da Vinci Surgical System - $307.52 million

 

- Mako SmartRobotics - $50.13 million

 

- CoreValve Evolut - $44.79 million

 

Other devices with high payments include Natrelle Implants, Impella, Sapien 3 and Arthrex Devices.

  

During the pandemic, it became quite obvious that many physicians had very close relationships with the medical industry, in particular, the pharmaceutical arm of the business.    It is quite apparent that the health care industry directs payments of various types to physicians to influence their practices and preferences; by directing payments to physicians and other medical professionals, the health care industry is anticipating greater profits.  After all, they aren't making billions of dollars of payments to their customers without expecting a significant return on their "investments".  Unfortunately, these investments have the potential to create conflicts of interest with some physicians potentially making life and death decisions for their patients based on the influence of their benefactors.


Sunday, April 14, 2024

Comparing the Military Strength of Israel and Iran

With outright hostilities between long-term enemies Iran and Israel now in full bloom, I thought that it would be an interesting exercise to compare the military capabilities of both nations.  For the purposes of this posting, I will be using data supplied by Global Firepower.

  

Let's look at some key military metrics:

 

1.) Manpower - 

 

a.) Total Population - Israel - 9,043,387  Iran - 87,590,873

 

b.) Available Manpower - Israel - 3,798,223  Iran - 49,050,889

 

c.) Fit-for-Service - Israel - 3,156,142  Iran - 41,167,710

 

d.) Active Personnel - Israel - 170,000  Iran - 610,000

 

e.) Reserve Personnel - Israel - 465,000  Iran - 350,000

 

f.) Annual Military Age - Israel - 126,607  Iran - 1,401,454

 

When it comes to manpower, Iran is clearly ahead of Israel, particularly when it comes to the number of citizens that are fit-for-service and those who are reaching military age on an annual basis.

 

2.) Airpower - 

 

a.) Total Aircraft - Israel - 612  Iran - 551

 

b.) Fighter Aircraft - Israel - 241 Iran - 186

 

c.) Dedicated Attack Aircraft - Israel - 39  Iran - 23

 

d.) Helicopters - Israel - 146  Iran - 129

 

e.) Attack Helicopters - Israel - 48 Iran - 13

 

3.) Land Power - 

 

a.) Tanks - Israel - 1,370 Iran - 1,996

 

b.) Armoured Vehicles - Israel - 43,407 Iran - 65,765

 

c.) Self-propelled Artillery - Israel - 650 Iran - 580

 

d.) Mobil Rocket Projectors - Israel - 150 Iran - 775

 

4.) Naval Power - 

 

a.) Fleet Strength - Israel - 67 Iran - 101

 

b.) Submarines - Israel - 5  Iran - 19

 

c.) Frigates - Israel - 0  Iran - 7

 

d.) Corvettes - Israel - 7 Iran - 3

 

e.) Patrol Vessels - Israel 45 Iran - 21

 

There is another key aspect of Iran's strength that Israel does not share; its massive oil reserves.  Iran produces 3.45 million barrels of oil per day compared to none for Israel and consumes 1.935 million barrels of oil per day compared to 235,000 barrels per day for Israel.  This leaves Israel vulnerable to fuel shortages should a long-term military operation take place.  Israel does have 12.7 million barrels of oil reserves however this is dwarfed by Iran's 210 billion barrels of oil reserves, putting it in third place in the world.  When it comes to natural gas, Israel is once again dwarfed by Iran which has the second largest natural gas reserves in the world compared to Israel which ranks at number 41 and has the third largest natural gas production in the world compared to Israel which ranks at number 40.  

 

Iran also has the largest and most diverse missile arsenal in the Middle East many of which are capable of carrying nuclear payloads.  Here is a table showing Iran's missiles that are most likely to be used for conventional strikes against high-value targets or as a nuclear delivery system:

 


Overall, according to Global Firepower, when all aspects of each nation's economy and military inventory and considered, Israel's military ranks at number 17 out of 145 nations in the world compared to Iran which ranks at number 14.

 

When comparing the military strength of both nations, we have to keep in mind that the United States is basically an endless supplier of military equipment to Israel through long-term formal agreements thanks to a bought and sold United States Congress whereas Iran relies to a lesser extent on its growing military relationship with Russia and China.  In any case, should all-out hostilities occur, it will be a long and bloody confrontation between two well-armed nations that represent the growing divide in the global post-American hegemonic world.