HealthCommentary

Exploring Human Potential

Thanks and Remembrance: The Polio Volunteers.

Posted on | November 24, 2020 | 6 Comments

With my sister, Pat – “Polio Volunteer.”

Mike Magee

With vaccines and new leadership now on the horizon, it’s useful to acknowledge that this is not our first pandemic. Of course there was the 1918 flu, but before that – and for many years  after – there was polio.

Two years into his first term as President, in 1934, FDR hosted his first “Birthday Ball” and raised one million dollars for his Georgia Warm Springs Foundation – the site he returned to again and again for rehabilitation after contracting the debilitating disease.

He continued the yearly events and four years later in 1938, he broadened the effort creating the National Foundation for Infantile Paralysis (NFIP). To this mix, FDR added two additional resources – great management and celebrity support.

Management came in the form of Basil O’Connor, attorney and close friend of the President. Their friendship predated FDR’s polio and included O’Connor serving as his legal adviser and for a brief period of time as his partner in the practice of law. He would serve loyally in that capacity for more than three decades.

O’Connor’s first order of business was to set up an organizational structure with reach across the country to support services and fundraising. Ultimately, 3100 chapters would be established and $233 million distributed in patient services for children with polio by 1955.

Much of that funding came from a unique idea first presented by radio personality and FDR supporter, Eddie Cantor. Singer, dancer and comedian, he went by the label “Apostle of Pep”, and matched energy level with FDR, stride for stride. At the time Cantor became involved in the Foundation, he had just completed a term as the president of the Screen Actors Guild. In that capacity, he was very familiar with a radio series and accompanying theater newsreel programs titled, “The March of Time”.

Narrated by radio pioneer Fred Smith, and funded by TIME magazine, the program was the first of its kind “dramatized news format” complete with sound effects and music. In January, 1938, Cantor went on his regular radio show and announced the “March of Dimes”, a take-off on the popular newsreel show name. He asked his viewers, young and old, to mail a dime to the President to help beat polio. His many celebrity friends chimed in, amplifying the name and the message, and the “March of Dimes” brand was born. Nearly 3 million dimes arrived at the White House with that first drive, raising 268,000 dollars in change.

Jonas Salk was recruited to the University of Pittsburg in 1947. In 1948, he received a grant from the National Foundation for Infantile Paralysis (NFIP) to identify the various types of polio. But Salk’s goals were much more expansive. He intended to develop the first successful vaccine for the disease and devoted the next seven years to that effort.

Fully funded by the NFIP at $7,500,000, and therefore requiring no need to be distracted by fund raising, Salk initiated a trial on 15,000 children in Allegheny County, Pennsylvania in 1953. The decision to stay close to home vastly simplified the logistics and avoided extra red tape. It didn’t hurt that he also tested himself, his wife and his children or that he achieved startling results on his first try out. Blood drawn from his subjects revealed antibody levels to polio that were 4 to 16 times the levels in non-treated children. These results were reported out in the Journal of the American Medical Association on March 25, 1953.

Following this announcement, which received worldwide attention, Salk took two additional steps that clearly demonstrated both his political and scientific prowess. First he went to Basil O’Connor at the NFIP and secured 100% funding for the largest scientific study that would ever be run in the US. In addition to securing that funding, he enlisted the vast marketing expertise and distribution system of the NFIP.

Secondly, rather than design the trials himself, at a time when scientific competitors were nipping at his heels, Salk enlisted his very popular and highly respected former mentor, Thomas Francis, to design and run the trials. Besides his scientific reputation, Francis had a distinguished record of public service having been the director of the Commission on Influenza for the Army Epidemiologic Board. By 1953, he was a renowned virologist and chair of the epidemiology department at the University of Michigan’s School of Public Health. Once Basil O’Connor with Salk chose Dr. Francis, they carefully created a firewall between themselves and the scientific trials.

Francis was fully aware of the deficiencies in the design. Did every parent clearly read the permission material? Clearly not.Was defining the trial’s purpose “to determine the effectiveness of a vaccine in preventing paralytic poliomyelitis” understating the trial’s experimental nature? What sufficed as a “valid parental signature”? Why were the terms “permission” and “human experiment” found nowhere on the consent form? Was Basil O’Connor’s letter on behalf of the NCIP that accompanied the parental materials and defined their child as having been “selected to take part in this great scientific test” overselling? And did he consciously underplay risk and deliberately transfer liability when he capitalized the words “THE VACCINE WILL BE GIVEN ONLY ON REQUEST OF THE PARENTS” in his letter?

My doctor father received a parcel post in his office in the Spring of 1954. It contained indistinguishable vials of the vaccine and placebo. He used the materials to inject the 2nd graders at our school, including my sister Pat. The event was memorialized in a front page photo in the local Hudson Dispatch of my father, needle in hand, and Pat wincing from the shot, but also proudly displaying her button and card declaring her a “Polio Pioneer”. That was Basil’s idea, as it was to give all the children who participated, including the controls who received no injections, buttons as well. In his view, no one should feel left out of this national public effort to beat the enemy – Polio.

The study remains controversial to this date with two arms – randomized and observed control. The former served the needs of scientists, while the later was felt necessary to maintain public support. In the randomized arm, 2nd graders either received the active vaccine or a placebo, and 1st and 3rd graders were left untreated and served as “controls.” In a second observed control model, all 2nd graders received the vaccine.

The end results were startling and have never been replicated since. Beginning April 26, 1954, within a year’s time, 1.8 million children in 15,000 schools in 44 states were recruited for the experiment. 300,000 health professional volunteers, including my father and the majority of the physicians in the United States, participated without pay. 750,000 of the children – all 2nd graders form public and private schools – were part of a rigorous double blind study.

It was Dr. Francis who stood up on April 12, 1955 at 10:20 AM in Rackham Lecture Hall at the University of Michigan in Ann Arbor and declared in his characteristic direct style, “The vaccine works. It is safe, effective and potent.” 

As Crisis Hits, Women in the Lead – While Compensation Lags.

Posted on | November 18, 2020 | No Comments

Mike Magee

This morning, we witnessed the unusual appearance on network television of two national leaders of the professions of Nursing and Medicine, Dr. Susan Bailey (President, AMA) and Debbie Hatmaker (Chief Nursing Officer, ANA) – both women – appearing in tandem and together, describing the nation’s condition as “very grim” and “quite stark.”

As we struggle to control a second wave of Covid-19, we are reminded once again of the nurses and doctors who place themselves at risk willingly and consistently. And while our attention over the past months has centered on emergency departments and intensive care units, it’s important to remind ourselves that our system of care (where it exists) relies heavily on a primary care base for access to both standard and emergency evaluation and treatment.

In a Medscape physician survey just released today, the financial impact of Covid-19 has been significant. As the report says, “Many physicians offices have closed or have greatly reduced their hours. Hospitals, clinics, and large groups throughout the nation are laying off staff and cutting salaries. Specialties that relied upon elective procedures have lost much or most of their business.”

During the first wave of the pandemic, physician practices reported a 55% decline in revenue and a 60% decrease in patient volume. In March of 2020 alone, 43,000 healthcare workers were laid off nationwide, and nearly 1 in 10 practices closed their doors, at least temporarily.  Picking up some of the slack, reimbursable virtual patient visits increased 225%.

The annual Medscape compensation survey was pre-Covid (October 4, 2019 – February 10, 2020), and included over 17,000 surveys in over 30 specialties. In Family Medicine, on average there was a slight $3000 raise  (from $231,000 to $234,000) over the prior year. The average time spent per week with patients was similar – 38 hours for men and 35 hours for women Family Physicians. A third of all Family Medicine doctors are now women. Yet the gender gap in salary is striking, with males earning 26% more than women.

The majority of Family Physicians (71%) now work with a team that includes either a Nurse Practitioner (NP) or Physician’s Assistant (PA). Having these teams has increased the profitability of half the practices, and had a neutral effect on 45% of their businesses.

2/3’s of Family Medicine doctors would chose the same career path again, reporting that the three top sources of their job satisfaction are: 1) Gratitude/relationships with patients, 2) Knowing I’m making the world a better place by helping others, 3) Being very good at what I do/ Finding answers, diagnoses.

ANA surveys of nurse satisfaction levels roughly mirror the same determinants. In both professions, these women and men are physically, emotionally, and spiritually exhausted.

What can we do to help them?

  1. Give Thanks: Expressing gratitude is always welcome. But perhaps the best way to express this in 2020 is to limit gatherings around Thanksgiving, What we don’t need at the moment is super-acceleration of an already bad situation.
  2. Drop the Political BS. The election is over, and going mask-less in meaningless, and dangerous. Be a good citizen. Wear your mask and a smile.
  3. Be Patient and Compliant. We’ve got vaccines on the way. But we have a few months to go. When they arrive, get vaccinated without delay.

Silver Bullets Do Not A Health System Make.

Posted on | November 10, 2020 | 3 Comments

Mike Magee

As Americans cover-up against second and third waves of Covid-19, Americans once again place their hopes and prayers on a great scientific discovery to snatch us from the flames. The latest miracle cure, a hoped for Pfizer vaccine that appears to be highly efficacious and anxiously awaits safety data, may in fact provide some emergency relief in the months ahead. But a single cure does not a health system make.

When Donald Trump expressed his cluelessness—”nobody knew that health care could be so complicated”—before a meeting of state governors in February 2017, he was exposing a pattern of both arrogance and ignorance that remains on full display.

CODE BLUE: Inside the Medical Industrial Complex was published four months later, and accurately predicted that – stressed by a health crisis like Covid-19 – our fundamentally flawed health system would buckle under the pressure. As of today, some 242,000 Americans have died, many of them needlessly.

And yet, today we witness a group of Republican Attorneys General appealing to the Supreme Court to dismantle the ACA and the protections it offers to those with pre-existing conditions including Covid-19.

At the very same time this week, our President-elect named a group of leading scientists and experts as transition advisers to help take the Biden-Harris COVID plan and convert it into an action blueprint that starts on Jan. 20, 2021.

The Biden coronavirus task force will be led by former Surgeon General Dr. Vivek Murthy and Dr. David Kessler. But what if the Supreme Court dismantles the ACA?

We would be left with a convoluted system of third-party payers, and the pretzel positions our politicians weave in and out of as they try to justify it, reform it, then un-reform it. And Republican loyalists would likely continue to find solace in telling themselves, “Well, we still have the best health care in the world.”

In point of fact, we’re not even close to having the best health care in the world. As legendary Princeton health economist Uwe Reinhardt prophetically remarked two years prior to COVID-19, “At international health care conferences, arguing that a certain proposed policy would drive some country’s system closer to the U.S. model usually is the kiss of death.”

It is at times like these that system weaknesses expose themselves. The inability to swiftly and efficiently test a population for COVID-19, share those results, and rationally plan a swift, coordinated, and effective response is a reflection of the gross inadequacies of our health care system. So is a leaky and disjointed supply system that can’t manage demand for cue tips, let alone ventilators and manpower.

In a review of CODE BLUE last year, John Rother, President and CEO of the National Coalition on Health Care wrote, “Code Blue will make you mad, but it will also make you better informed and better able to understand what we need to do as a country to fix it. I can’t think of a more persuasive book on the need for change.”

The need for change that John forecasted not only included matters of justice, planning, and equitable distribution of health care resources, but also the capacity to respond to a global public health event of the magnitude of COVID-19.

How broken must a system be when our nation can’t keep up with nations like South Korea and Italy in testing for the virus? What does our “patchwork response”, variable across states and communities, lacking any private-public planning and coordination, and absent clarity on pricing, access, eligibility and prioritization, and raft with confusion even on what protections are necessary for health care workers collecting samples, tell us about our need for a fundamental restructuring of our health care system?

God Bless Anthony Fauci, but is our system so fragile that the fate of Americans rests on a single individual having the temerity to speak truth to power in the face of executive incompetence? And how are we to reconcile a Presidential veto on testing kits months ago.

A half-century of systematic underfunding of public health, planning and prevention in deference to entrepreneurial scientists in pursuit of profit and patents over patients and families, ends here – in crisis. We will survive this “Code Blue” calamity, but we need to assure through new leadership and deliberate action by the new Biden/Harris administration that it will never happen again.

“This Is No Ordinary Time”, says Jesuit Magazine “America.”

Posted on | November 6, 2020 | 2 Comments

Mike Magee

“In ordinary times, the debate about presidential candidates can be a healthy and spirited exchange about how Catholics should approach their civic duties. But this is no ordinary time.” America

The Jesuit magazine, America, on September 20, 2020, broke its historic neutral tradition and supported Joe Biden for the Presidency. Their rationale was as much pro-America as pro-Catholic.

By this evening, all major networks will acknowledge, and most Americans will accept that President Donald Trump has lost his bid for a second term as President of the United States. This is the right decision for America, and more specifically for American Catholics.

In explaining their action, here (in part) is what the editors of America had to say:

“For our forebears, the U.S. Constitution was a vital bulwark against the kinds of political and economic oppression that prompted millions of them to flee their homelands. The liberty and protection that the Constitution guarantees are still a primary motivation for the majority of the nation’s immigrants…

“The Constitution itself is inspired by a theological worldview. Our founders believed that they were creating a form of government for a fallen world. Their true genius lay in how they accounted for the human predilection toward sin and division by creating a strict separation of powers that, paradoxically, would serve to unify the country and guard it against would-be tyrants and demagogues…

“In time, a system of extra-legal conventions took hold to further the founders’ vision, including respect for the rule of law, a vibrant, free press and civilian control of the military. Yet as important as those safeguards were and remain, the constitutional order is ultimately dependent on the character and judgment of our elected officials…

“The administration of Donald J. Trump has undermined the constitutional order to a degree unprecedented in modern American history, which prompts the editors of this review to register this unprecedented warning. The principal concern here is not with Mr. Trump’s positions on various public policies, some of which are right and some of which are wrong, but with the president’s disregard for the system of laws and customs that establish the necessary conditions for debate, decision-making and public accountability in this republic…

“Mr. Trump has subverted the rule of law …This pattern of presidential behavior is unique in American history.

“….In the election of 2020, however, Catholics face the unfortunate reality that the ostensibly pro-life presidential candidate also represents a proven threat to the constitutional order. That threat is real. As President Gerald R. Ford said upon assuming office during a moment of constitutional peril, ‘Our great republic is a government of laws and not of men.’ That means that the rule of law, the work of a vital free press, constitutional use of the military and a basic, operative respect for the separation of powers are not optional. For without those safeguards, this country will devolve into prolonged factional conflict—the outcome our founders feared most—which would mark the beginning of the end of a republican form of government.”

By tomorrow, our incoming President and Vice-President and their team will begin the hard work of preparing to address two confounding disasters – one health, the other economic. The challenges are monumental, but manageable. In addition to these, we must repair the damage to our government, rebuild trust, and rediscover our finer selves. “Liberty and protection that the Constitution guarantees are still a primary motivation“, says America Magazine. No truer words were ever spoken.

A Useful Distraction. An Hour With Gro Harlem Brundtland.

Posted on | November 5, 2020 | No Comments

VIEW INTERVIEW

Mike Magee

As each of us, in our own way, waits for the final results of the 2020 US Presidential contest, patience is demanded, and a useful distraction may be helpful. Let me recommend this 1 hour interview by UC Berkeley’s Harry Kreisler of one of my Public Health heroes, Gro Harlem Brundtland. 

I have been following the former Prime Minister of Norway since 2000, when, as Director General of the World Health Organization (1998-2003), she defined health as “twofold – goodness and fairness; goodness being the best attainable average level; and fairness, the smallest feasible differences among individuals and groups.”

In this interview, she touches on social justice, income equality, maternal fetal health, the public duty to serve if called, the increasing leadership role of women in society, her 1st political role as Minister of the Environment (not Minister of Health), cross-disciplinary cooperation, consensus building, when to hold your ground, climate change, the European Union, the destructive health impact of advertising, and pandemic management.

Get to know Gro! She will reassure you, whatever your point of view, that humans are capable of self-governance, even in a country so painfully divided as our own.

My Father – Doctor, Republican, and Catholic – would never vote for Trump in 2020!

Posted on | November 1, 2020 | 8 Comments

Mike Magee

“You know, our doctors get more money if someone dies from COVID. You know that, right?” Trump asked the crowd in Michigan last Friday, October 30, as he laid the blame for nearly a quarter million Covid deaths at the feet of our nation’s health professionals.

Susan Bailey, president of the AMA, in a same day reply, was pretty direct. “The suggestion that doctors — in the midst of a public health crisis — are overcounting COVID-19 patients or lying to line their pockets is a malicious, outrageous, and completely misguided charge.”

Trump has not only insulted my father, he has insulted my mother and their children, and our entire family. We buried my father on September 21, 1998. My sister, Sue, delivered the Eulogy, which two decades later speaks loudly in his absense, and draws a stark contrast with his modern-day critic.

Sue said:

One time before Mom and Dad were sick with their dreadful diseases, I was visiting Steve and we were talking about heroes. Steve said his hero was Dad. I asked him why. He said, “Think about it. Dad went to work every day, was out of the house early and went till late in the evening, often got called to the hospital in the middle of the night and always made rounds on the weekend…but, never complained. You never heard Daddy complain about how hard he worked.”

Dad was a man of compassion. We were all frustrated at times when we would come home from school with a story about some annoying little classmate and Dad would feel compelled to insist that we think about what that child might be living with that would make him react the way he had. Dad always thought of the other side of an issue. When I was younger I thought he did it just to tease me (he was a masterful teaser after all) but as I got older, and, certainly now, I am convinced it was because that is how he saw the world and the people in it. And, it was his compassion that helped people, and healed those who were losing their spirit for life.

All of us, while we were growing up, were stopped by people in Fort Lee who felt compelled to tell us how wonderful our father was. For me, at the time, it was an uncomfortable situation—I didn’t know them and they would be pinching my cheek and filled with emotion would say, ‘Your father is a great doctor and a great man.’ Today I would have to say I agree—He certainly was.

He was hard working. He was a man with heart. He was a gentleman. He was a busy man who did not ask much for himself. His pleasure and the only thing he really seemed to need in life was Mom. And we all knew it. His busy life, the responsibility of raising 12 children and his love for Mom meant that none of us have memories of Dad dawdling away a day with us alone, but what we do have, straight to our very core, is what it means to be devoted to someone and what it means to love someone—and we know that because of Dad and Mom. We know that when you love someone you give everything you have, and you don’t measure how much you’ve given, and you don’t measure how much you receive. Although Dad didn’t spend a lot of individual time with us, he shaped our world quietly and powerfully.

...He taught us honesty. I was a little girl when Dad first impressed upon me the importance of honesty. He related a story to me about his own childhood. He had gone to the store and when he paid the shopkeeper there was some question about the amount of change he was due. He said more, the shopkeeper was uncertain but took Dad’s word because he said, “He had never known Bill Magee to tell a lie.” He finished that story by saying to me, “There is nothing more important than honesty. People may not always like what you have to say, but if they can believe you then they will always trust you.” That was a lesson Dad taught over and over again. His personal honesty and his integrity were beyond reproach.

Dad’s final lesson for me was one that taught bravery and humility, again through his example. When Dad was diagnosed with Alzheimer’s Disease, Mom already had Cancer. Throughout the years to come I do not remember Dad talking about his disease. He must have been worried about what the future would hold. He must have been frustrated by his loss of ability. Long before he reached the stage of being unaware of his surroundings …Long before Alzheimer’s robbed him of his memories and his abilities completely, he was losing small things. He lost the ability to drive. He lost the ability to read. He couldn’t remember his children’s faces. He couldn’t participate in conversations appropriately. He couldn’t follow conversations. He couldn’t tell time. He didn’t recognize his friends. He couldn’t order food in a restaurant because he couldn’t remember what different types of food were called. He needed help in the bathroom. He couldn’t remember how to tie his shoes…All this, yet he was still aware enough to know that this was happening to him. And through it all, Dad talked about Mom, her care, her treatment, and about other things in life.

Dad was a brave man and with every personal loss he suffered he did it silently. He did it humbly. He did it with a firm faith in God and that faith shaped his life and gave him the strength to live it so well.

‘This too will pass honey,’ it was a favorite saying of Dad’s, and it often came with a gentle smile

Were my father alive today, he would never vote for Trump. He is the antithesis of all that my parents valued – honesty, hard work, compassion, integrity, humility, gentleness, kindness, respect and love for others. Trump has none of these.

My parents were life long Republicans, Catholics, conservatives. But they were wise enough to know that no policy gain – on federal funding of private schools, or limits on abortion and contraception, or lower taxes, or conservative Supreme Court Justices – would ever be enough of a rationalization to signal to an evil man like Trump that the traits he embodies are acceptable for America.

They would never vote for Trump – Never, Never, Never!

Could Bezos and Amazon Help America Build An Accessible, Affordable and Effective National Health Care System.

Posted on | October 29, 2020 | No Comments

Mike Magee

This past week I spent an hour with THCB’s Matthew Holt and Jessica DaMassa discussing everything CODE BLUE – how and why it came to be, and where it directs us as Covid-19, global warming, and rising income inequality bear down on our nation.

In the final ten minutes of the THCB Book Club interview, Jess asks me if a company like Amazon, under Jeff Bezos, could play a role in creating a long overdo high quality, affordable, and universal National Health Care system.

To be clear, we’re not talking a splintered elite solution with Jeff, and his buddies, Jamie Dimond and Warren Buffett, arms linked (and Atul Gawande “brain-childing” the affair). We’re talking a national health care system that is publicly offered, accessible to all, strategic and visionary, and governed in a manner that is not rife with conflicts of interest.

Is it possible that an uber-private entrepreneur could respond to a nation’s call-to-service and help us correct a seven decade old misconstruction? For an answer to this and other questions, check out the interview above – especially the final 10 minutes.

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