Posted on | October 17, 2014 | No Comments
A special article in JAMA explores what went wrong in Dallas. It opens this way:
“The West African Ebola epidemic is a humanitarian crisis and a threat to international security.1 It is not surprising that isolated cases have emerged in Europe and North America, but a large outbreak in the United States, with its advanced health system, is unlikely. Yet the handling of the first domestically diagnosed Ebola case in Dallas, Texas, raised concerns about national public health preparedness. What were the critical health system vulnerabilities revealed in Dallas, and how can the country respond more effectively to novel diseases in a globalized world?”
For the answer: Press Here.
Posted on | October 17, 2014 | No Comments
JOINT STATEMENT FROM THE AMERICAN HOSPITAL ASSOCIATION, THE AMERICAN MEDICAL ASSOCIATION AND THE AMERICAN NURSES ASSOCIATION
As our nation’s strategy to address the Ebola virus continues to evolve, hospitals and their partners in nursing and medicine are coming together to emphasize that a solution-oriented, collaborative approach to Ebola preparedness is essential to effectively manage care of Ebola patients in the U.S. Ensuring safe care for patients, healthcare workers, and communities demands the combined efforts of inter-professional, state, and federal organizations. In addition to domestic efforts to prepare for and treat Ebola, an enhanced focus on the part of the United States and the international community to contain the outbreak in West Africa is fundamental to stopping the spread of this virus.
Hospitals, physicians, and nurses have the same goals in addressing any Ebola case: to ensure that all hospital and clinical staff are able to safely provide high-quality, appropriate, patient care. We are committed to ensuring that nurses, physicians and all frontline healthcare providers have the proper training, equipment and protocols to remain safe and provide the highest quality care for the patient. As the Centers for Disease Control and Prevention (CDC) updates the protocols and procedures involved with patient care and personal protective equipment, we will review and share updated guidance with our collective memberships as it becomes available.
Our nation’s hospitals, physician and professional nursing organizations remain in communication with one another and with our nation’s public health institutions at the local, state and national levels. We are committed to maintaining a strong collaborative effort to address this public health threat.
Posted on | October 6, 2014 | 2 Comments
Posted on | October 3, 2014 | 2 Comments
With the announcement this morning that Nancy Snyderman and her Ebola infected free lance photographer, Ashoka Mukpo, are on their way back to the states from Liberia in a private corporate jet, fundamental questions about transmission of Ebola are being raised. The current situation rings the same crisis communication alarm bells that were ringing in 2003 during the SARS crisis (which included a widespread quarantine of Toronto for a time), or more specifically when then brand new HHS secretary, Tommy Thompson, decided he could handle the face-to-face camera work for the Anthrax attack in 2001.
CDC director Tom Frieden should be concerned after watching “Morning Joe” on MSNBC this morning. On it Dr. Alexander van Tullekan, a British TV “performer doc” turned Senior Fellow from the International Institute of Humanitarian Affairs at Fordham University, raised Joe and Mika’s ears when he stated on MSNBC’s “Morning Joe” that “We’re seeing people contract the disease, not only who have touched the people, but also who have been wearing hazmat suits, or at least personal protective gear, at least in some cases.”
Dr van Tullekin is the twin brother of Chris van Tulleken, a British Infectious Disease doctor and TV personalty, best known for his lead in the BBC series, “Operation Ouch”. Together the twins were a big hit in the British series, “Medicine Men Go Wild” described this way: “Two young British doctors explore the mysterious world of tribal medicine to discover whether traditional forms of healing have anything to teach us about bodies, health and curing illness.”
When government officials start getting scooped like this, as Thompson learned in 2001, it’s time to call in the reinforcements. Adding to the confusion, van Tullekin’s suggestion that CDC reassurances that Ebola is not easily transmissible may be incorrect was juxtaposed with 1) a loose dialogue by the morning coffee clutch about the Liberian plane traveler with Ebola currently hospitalized in Texas (Should people on the plane be worried and contacted?) and 2) Dr. Snyderman, (appearing somewhat pale and tired looking) performing an on-air, close quarters interview yesterday with a taxi driver who had just transported a hyper-infected pregnant Ebola patient to the local hospital.
Clearly, things are getting out of control. The story is now driving itself, as it once did with SARS and Anthrax. Veteran NIH ID crisis communicator, Tony Fauci, appeared on NBC Nightly News, 2 days ago. Introduced by Brian Williams as “Our nation’s ‘Go-To’ physician in Bethesda”, his ability to calmly deliver information without alarming the public once again was on full display.
Suggestion to the Obama Administration:
1. Assign all future government communications on Ebola to Dr. Fauci.
2. Ask Fordham University “What’s up?”
Suggestion for NBC:
1. Take care who you showcase as your “expert” in the middle of a serious health challenge.
2. While Nancy is quarantined for the next few weeks, consider the risk/benefit of close contact “Wild West” on-air interviews until we get a better handle on the behavior of this virus.
For Health Commentary, I’m Mike Magee
Posted on | September 27, 2014 | No Comments
NOAA Environmental Visualization Laboratory High Resolution Image with more information about the graphic
In 1997, Gro Brundtland, then head of the WHO defined health as “human potential”. In doing so, she broadened the sphere of interest of health policy experts on a macro level and challenged physicians on a micro level. In essense she united for the first time patient health and planetary health.
Since that time, we have seen a continued battle and debate in the public space between the overwhelming majority of scientists who has raised the alarm over the self-reinforcing cycle of global warming, and a much smaller but highly vocal segment of the scientific community, who – often with the support of dollars from energy related corporations – have denied the challenge we and the planet face.
In an article this week in JAMA, physicians are for the first time directly challenged to educate their patients regarding the coming health risks associated with global warming. The authors review the evidence related to this impending crisis and come to this conclusion: “Evidence over the past 20 years indicates that climate change can be associated with adverse health outcomes. Health care professionals have an important role in understanding and communicating the related potential health concerns and the cobenefits from reducing greenhouse gas emissions.”
The article in part notes:
1. “Consensus is substantial that human behavior contributes to climate change: 97% of climatologists maintain that climate change is caused by human activities, particularly fossil fuel combustion and tropical deforestation.”
2. “ About half of anthropogenic greenhouse gas emissions between 1750 and 2010 occurred since 1970. The increase in greenhouse gas emissions has been greatest in the last decade (2.2% per year) compared with 1.3% per year between 1970 and 2000.5 Emissions continue to increase; 2011 emissions exceeded those in 2005 by 43%.”
3. “ Carbon dioxide from fossil fuels and industrial processes accounted for approximately 78% of the total increase from 1970-2010.”
4. “ The trend toward decarbonization (cleaner fuels) of the world’s energy since the 1970s has been reversed by increased coal combustion since 2000.”
5. “ Climate change is happening: the relationship of heat-waves, floods, and droughts along with adverse health outcomes is evident.7,8 Two broad approaches are needed to protect public health: mitigation, or major reductions in carbon emissions, corresponding to primary prevention; and adaptation, or steps to anticipate and reduce threats, corresponding to secondary prevention (or public health preparedness).”
6. Key messages for doctors and patients include:
“Heat-related disorders, including heat stress and economic consequences of reduced work capacity.”
“Respiratory disorders, including those exacerbated by fine particulate pollutants, such as asthma and allergic diseases.”
“Infectious diseases, including vectorborne diseases, such as Lyme disease, and water-borne diseases, such as childhood gastrointestinal diseases.”
“Food production, including reduced crop yields and an increase in plant diseases.”
“Mental health disorders such as post-traumatic stress disorder and depression that are associated with natural disasters.”
7. Mitigating climate change could yield health benefits:
“Economic advantages of reducing fossil fuel combustion and improving air quality, including a reduction in chronic diseases and their associated health care costs, and economic opportunities associated with development of alternative forms of energy.”
“Infrastructure improvements that reduce greenhouse emissions could also lead to increased physical activity that would be associated with a reduction in various chronic diseases.”
8. Heat related death and disability are understated: “The most direct effect of a warming planet is heat stress and associated disorders. Heat-related deaths are routinely attributed to causes such as cardiac arrest without citing temperature as the underlying factor. Thus, the actual death toll attributable to heat is greater than certified on death certificates… High-risk groups include elderly persons, those living in poverty or social isolation, and those with underlying mental illness.”
9. Global warming will continue to reduce productivity: “Using industrial and military guidelines, Dunne et al estimated that ambient heat stress has reduced global population-weighted labor capacity by 10% in summer’s peak over the past few decades. Projected reduction may double by 2050 and may be even larger in the latter half of the 21st century.”
10. Additional death and disability secondary to food scarcity, respiratory disease and waterborne disease in all age groups and traumatic, disaster related injuries is to be expected. The mental health implications of these stressors are currently being underreported.
How can health professionals help?
“ Effective communication may shift knowledge, attitudes, and behavior toward reducing the risks of climate change. Research indicates several principles of effective climate communication that closely resemble those used in health. Themes include 2-way communication, gearing messages to the audience, limiting use of fear-based messages, issuing simple lucid messages repeated often from trusted sources, and making health-promoting choices easy and appealing.”
“Health may be a compelling frame for communication about climate change, reflecting views that change threatens health. Although further research is needed to define the role of health in climate communication, practical communication resources are becoming available, implying an important role for health care professionals.”
For Health Commentary, I’m Mike Magee
Posted on | September 16, 2014 | No Comments
This morning I was sipping my coffee as I reviewed the latest news in the New York Times on my iPad. And, of course, the Top News was depressing – ISIS, Ray Rice, Ebola and so on. So I found my way to the video section and looked around a bit.
I ended up taking a careful look at three entries. Having spent some time in media, and judged more than a few medical media award contests, I have a certain approach to these things which includes a non-judgmental quick viewing followed by a second review that more critically deconstructs.
The three pieces I focused on all fell into the broad science and technology education bucket, and all arguably had a connection to either the human patient or planetary patient or both. The shortest was 2:04 and the longest 6:36. One used a standard, broadcast-tested, interview style backed up by B-roll and liberal use of ambient sound. A second relied on simple, stylized moving graphs. And a third utilized visually stunning and highly creative paper cut-out constructs brought to life through manual animation and stop action photography.
Despite the difference in styles, all three were highly successful in holding the viewers attention, delivering complex messages, and tying those messages to future action. All three had the benefit of a musical score, though only one used an original score that was credited. All three had clearly taken care in their choices for voice-overs or on screen commentators. And all three demonstarted extraordinary discipline in limiting word count and labelling, allowing the pictures and the voices and the music to largely guide the reader.
The 3:04 standard broadcast piece, “Formula E, Carbon Free” was created by Jonah M. Kessel. But the real star of the show was a young Chinese racing driver, Ho-Pin Tung, representing “China Racing” and a generation of young tech-savy global leaders with a passion for technology-aided advances in the human condition. Oh, and by the way, the guy is great on camera – a terrific spokesperson for the movement.
The movement is Formula E, a series of urban, Formula 1 style racing events that kicked off in Beijing’s “Olympic City” on September 13, 2014, and will be traveling to nine other cities around the world over the next 12 months. In a little over 3 minutes, the viewer comes to understand that these high performance vehicles are electric and run on batteries; are intended to both entertain and act as laboratories for green development; and that the future is just around the corner.
As the visually appealing Ho-Pin Tung says in perfect English with just a few well-chosen words: ““As in the past, racing has always been proven to be a laboratory, a development center for new technologies needing to be developed for general use in cars. This series is going to only accelerate this. It won’t just accelerate the development, but also the interest of people in electric cars.” He goes on to explain that the low carbon footprint of the event allows it to be staged in center city settings, where pollution is extremely problematic and solutions are imperative.
Finally, the piece uses two black text boxes with white print to catch your attention. Neither one preaches. The first says, “Formula E race cars reach 60 m.p.h. in less than three seconds and have a top speed of about 140 m.p.h.” And the second, “The Formula E championship will continue on to nine cities across the world over the next year.” Take-away? “Stay tuned for the next installment.”
The next piece, “How It Happens: El Nino” is a 2:04 moving graphic narrated by Henry Fountain and produced by Aaron Byrd, Henry Fountain and Ben Laffin. It is a simple, attractive, well-designed and effective short lesson on how weather happens and how these forces impact our lives, and potentially our health. With comforting narration, and simple music to fill the dead space, all eyes are on the graphics which are so simple, clear and concise that they require little labeling. As a result, the imagery is clean, uncomplicated and easy to digest. We learn in a little over two minutes what El Nino is; that it causes dramatic weather effects around the globe; that there are Pacific Trade winds that push ocean water along and, in doing so, push warm water out and allow cold water to rise to the surface; that warm surface waters increase moisture in the air and promote monsoons; that sometimes the Trade winds stop (we’re not sure why) and the direction of the changes reverse; and that this can cause warmer winters in our Northwest like the one that created the snow-less Winter Olympics in Vancouver in 2010.”
And, with the help of extraordinary instructional design, they do this in 2:04 without the viewer feeling rushed.
Last, but certainly not least, is “Animated Life: Seeing The Invisible”, a 6:36 highly visual, puppeteer-driven tour de force. Using paper cut-outs, with visible animation aids in the form of wires and navigating sticks, with or without moving cinematic painted backdrops, all made more lush by the original score of Sarah Lipstate, this piece introduces us to 17th century scientist Antonie van Leeuwenhoek, who with the aid of homemade microscopes, discovered microbes. Beginning with stingers of bees and legs of louse, and advancing to pond scum alive with miraculous creatures 1000 times smaller than the scientist had ever before visualized, we are escorted through history. Along the way, we learn, for example about the luminescent Vibrio Harveyi. As narrator Bonnie Bassler from Princeton voice-over explains, “We discovered that bacteria can communicate using a molecular language. We used to think that social behaviors were the purvue of higher organisms. What we now understand is that the bacteria were probably the first organisms on this earth to ever communicate with one another.”
In each of these cases, there is a request stated or implied. We understand that we are invited to attend a Formula E race “in a city near you”. It’ll be exciting, and fun, and it’s a worthy movement that could help our planet. We’ll also be on the look-out for El Nino. What weather surprises are in store for you and your neighbors this year? Stay tuned. And finally, we are all under the microscope. As Bonnie Bassler gently intones, “We’re driven by our ignorance and driven by the idea that the world must be more complex than what we understand right now. And that’s enough inspiration to do an experiment.”
For Health Commentary, I’m Mike Magee.
Posted on | September 11, 2014 | No Comments
Each year, the memories of 9/11 offer the opportunity to reflect on the principles that guide our human populations in the direction of good and evil. Several years after the event, I delivered an address that laid out a philosophy of leadership grounded in lessons learned that day. Here is the address.keep looking »