HealthCommentary

Exploring Human Potential

What Scientists And Historians Understand: No Truth, No Progress.

Posted on | February 1, 2023 | No Comments

Mike Magee

“This too will pass, honey!” That’s what my mother used to say when any of my eleven brothers and sisters or I seemed to be overwhelmed by whatever. And largely, now, three quarters of a century since my birth, she was mostly right. Whether in personal lives or the life of our nation, over a span of time, the slope has been slight, but upward.

But there are weeks, like this past one, where we are forced to witness the beating death of an innocent 29 year old black man at the hands of police in the very city where Martin Luther King was slaughtered 55 years ago, when it would be easy to lose hope. Why not, as Trumpists actively promote, just lie? Why not create “alternate facts?”

Witness Gov. Ron DeSantis. What he fails to realize, in his attempts to white wash Black History from Florida schools, is that the accurate and full disclosure and discussion of our complicated American history ultimately supports progress and optimism. This is because the record shows that we have the capacity (admittedly in very small steps) to improve ourselves and our ability to manage self-governance.

Science has a long history of opposition to politicians who oppose truth-telling. Louis Pasteur famously urged fellow scientists to “worship the spirit of criticism.” When challenged to provide a rationale for his faith in full disclosure, he replied, because “everything is fallible.”

There was another scientist of the same era who was born with an iron spine and a love for honest learning. Her mother had emigrated from Wales shortly after our Civil War. Born into a farming family on January 29,1881, Alice Evans lived to be 94. Along the way she became the first women scientist to work as a bacteriologist for the U.S. Department of Agriculture, and the founding president of the Society of American Bacteriologists (American Society for Microbiology).

Descriptions of her include an “unending intellectual curiosity, independent spirit, and unflinching integrity.” She received her education at Cornell’s College of Agriculture and at the University of Wisconsin’s College of Agriculture. After working on improving the flavor of cheddar cheese for three years, she headed to Washington D.C. to join the new federal Dairy Division. She had applied as A. Evans at the urging of her male mentors knowing the federal government had no taste for female scientists. As she was later quoted, “I was on my way to Washington where I had not wanted to go and where I was not wanted.”

Her new venue was milk, still largely unpasteurized and brimming with a range of organisms from TB to diphtheria, from typhus to strep. Their presence in dairy cows and cattle meant slaughtering a herd. Evans was no friend of the dairy lobbyists. But when she identified the Brucella bacteria as a common agent that caused bovine contagious abortion in animals and undulant fever in humans, she apparently crossed the line. As NIH historians recount, it “set off a firestorm of protest and disbelief by physicians, veterinarians, dairy industry representatives and other scientists” who “scoffed at the idea that the bacteria could cause symptoms in both animals and humans…She endured nonstop scrutiny before becoming vindicated.”

She died in 1975 in her ninth decade, outlasting most of her critics. Today she is remembered in heroic terms, not only for saving countless infants and children from milk borne deadly diseases, but also for being a source of inspiration and paving the way for many female scientists who followed in her wake.

In his Inaugural Address on January 20, 2021, President Joe Biden said, “we must reject a culture in which facts themselves are manipulated and even manufactured…Our history has been a constant struggle between the American ideal that we are all created equal and the harsh, ugly reality that racism, nativism, fear, and demonization have long torn us apart.

The battle is perennial…Victory is never assured.”

Near the end of his address, he asked rhetorically, what were the common objects of love that St. Augustine had suggested unite a multitude. His answer, “Opportunity. Security. Liberty. Dignity. Respect. Honor. And, yes, the truth.”

The truth sometimes hurts. But (as scientists and historians know) without it, progress is an impossibility. 

The “Antebellum Paradox”: Why are Native White American Males Falling Behind in Health?

Posted on | January 25, 2023 | 2 Comments

Mike Magee

I recently made the case that “Health is foundational to a functioning democracy. But health must be shared and be broadly accessible to be an effective enabler of good government.” I also suggested that the pursuit of good health is implied and imbedded in the aspirational and idealistic wording of our U.S. Constitution, and that the active pursuit of health as a nation is essential if we wish to rise to Hamilton’s challenge in Federalist #1 and prove that we are “capable of establishing good government from reflection and choice.” So why are native white males lagging behind in health?

Our progress as a nation toward health was severely hampered from the start. The reality of self-government “of the people, by the people, and for the people” applied only to 6% of inhabitants, all white male land owners at the time. Health was never voiced as a priority, though modern day critics insist it is clearly implied in the promise of “life, liberty, and the pursuit of happiness.” But what was that promise worth in the late 18th century, in a nation that allowed slavery, disenfranchised women, and slaughtered and dislocated its indigenous brothers and sisters?

In those earliest years of the birth of this nation, in the first half of the 19th century, what was the state of health for enfranchised native born white citizens of this nation? Most may presume (as I did) that the general health and standard of living over the next two hundred years, as reflected in lifespan, was a straight (if gradual) upward slope. But what I learned from a bit of digging is that uncovering the facts on mortality, fertility, migration, and population growth during those early years of our nation is a complex venture at best.

Our federal government did conduct a census every ten years, but one hundred years passed before we reliably collected vital statistics including comprehensive birth and death registration. Beginning in 1850, age, sex, race, marital status, occupation and cause of death were supposed to be collected. But an audit in those years disclosed that mortality (for example) was 40% underreported.

This was not too surprising when one considers what can go wrong with a census even on a blunt entry like death. Solitary household death left no one to report. Loss of a household lead in a large family often meant dissolution of family members. Deaths of infants or elders within 6 months tended to be reported, but after 12 months they were often forgotten. And all of this was made worse by westward migration.

The earliest life tables date back to 1790 in Massachusetts. These can not be extrapolated as representative of the colonies, or growing nation as a whole, because this small northeastern state was largely urbanized, industrialized, filled with immigrants and had lower levels of nuptiality and fertility (1/3 lower than the nation) compared to their neighbors.  

To fill in the gaps over the years, academic experts have turned to alternate data sources including family genealogies, biographical data from schools and local legislators, and height as a reflection of nutritional status and general health. By using these sources, and integrating different databases, modern day historians and economists now agree that there was “a significant increase in (native white male) mortality in the antebellum era, especially in the three decades between 1830 and 1860.” 

Termed the “antebellum paradox”, life expectancy at age 20 was six years lower in 1850 than in 1800. In fact, the nation didn’t catch up with 1800 survival rates until 1880. And the question is “why?” What happened to early American health? On average white males between 1830 and 1890 lost 1 1/2 inches in height which experts suggest may have been from a combination of deteriorating diets, early industrialization and urbanization resulting in spread of infectious diseases and traumatic injuries, rising inequality and mass populations on the move westward with the “transportation revolution” utilizing canals, steamboats, and railways.

Other factors that experts have pointed to include the congregation of young children in new public schools aiding the spread of whooping cough, diphtheria, and scarlet fever, and food shortages and elevated food prices in the 1830’s.

The United States of 1860 bore little resemblance geographically to the 1790 version of our nation. Its size had increased from 891,364 square miles to 3,021,295 square miles. Our 16 states had grown to 33 states. And the average center location of our population had now shifted 135 miles west of where it had been.

If it is difficult to quantify life expectancy for white males in the 19th century in America, it is even harder to gauge white female survival. In general, women were often ignored in public records. Their names changed with marriage, and they routinely disappear from observation during these years. What has been pieced together is that white women’s life expectancy in the mid 1880’s at age 20 trailed white males of the same age by about 2 years. This male advantage disappeared by age 35 if a woman survived to that point. 

With up to 10 maternal deaths per 1000 live births at the time, marital fertility tracked with maternal mortality. But experts believe that tuberculosis was an equal or greater contributor to death in child-bearing women, especially in rural settings. Where food was limited, men and boys were favored with meat and calories. Pregnancy and lactation were nutritional drains, weakening women’s health status and ability to withstand infectious diseases, especially tuberculosis. As for the children, 1 in 5 born alive in 1850 didn’t survive to age 1.

By 1880, the gender gap began to disappear with increased industrialization, urbanization, imposition of public health measures to create clean water and pasteurized milk as the germ theory and sanitation took hold. Women now entered the work force. In addition, fertility in 1900 was about half that in 1840.

The “antebellum paradox” suggests that the health of a nation, as reflected in life expectancy, is fungible. It also can be argued that health status is a reasonable measure of whether a society of humans is “capable of establishing good government from reflection and choice.”

Ohio State University’s Emeritus economic historian, Richard Steckel,  used to ask his students to imagine they were reborn and had to chose their place of birth based on only three of following characteristics: “access to material goods and services; health; socio-economic fluidity; education; inequality; the extent of political and religious freedom; and climate.” It is notable that health and income always scored at the top.

As for human stature in modern times, America’s native white men have stagnated, with average height essentially flat over the past 50 years. This is in contrast to European nations like Norway, Sweden and Denmark with similar genetic stock.  They are two inches taller. All of these nations have national health care systems. Specifically, all are “known for regular pre-and post-natal checkups, which are important for early childhood health.” 

As Steckel reminds us, “We know that on average, stunted growth has functional implications for longevity, cognitive development, and work capacity….it is important to know why Americans are falling behind.”

Missouri Plays Brass Knuckles With Women

Posted on | January 19, 2023 | 2 Comments

Mike Magee

A case has been made that a logical approach to reforming America’s violent and racist leanings would be to adopt the values and practices of Health Care for All. These include a commitment to compassion, understanding, and partnership; extending the linkages between individual, family, community and society; addressing fear and worry for individuals and populations; and promoting an optimistic and equitable future for all Americans. 

Nurses and doctors and pharmacists and other health professionals pledge oaths and spend years training to exhibit and practice these values in the course of providing preventive and interventional care to select Americans. Imagine the effect of delivering these many benefits in an equitable way, in all communities, with the intent of making not only Americans, but also the American culture healthy.

Or we could simply continue to accept the values exhibited by the Missouri State Legislature, where misogyny and brass knuckles have risen to the top of their legislative calendar.

In June, 2021, a Missouri News-Press editorial commented that “one vote last week might strike some as a sign that Missouri’s lawmakers could use some help with time management and prioritization.” The Republican led body had soundly passed HB 1462 which included Section 571.020 and 571.107 which read “This act repeals prohibitions on the possession and selling of brass knuckles, firearm silencers, and switchblade knives.” The same act addressed the taxpayer burden for possession of their weaponry by providing “that all sales of firearms and ammunition made in this state shall be exempt from state and local sales taxes.”

Coming off of pandemic induced limited face time, the local legislators are back to giving it their all on behalf of Missouri’s citizens, though their priority list remains pretty debatable. This week, 116 men and 43 women legislators gathered to do the state’s work in earnest. One of their first actions? Updating women legislators dress code in four sentences of a 37-page resolution. 

Democratic women, like legislator Raychel Proud, rose to object, stating, “I think we’re being quite pedantic here by making rules so petty. And what it will ultimately lead to is the disenfranchisement of folks. For example, they don’t make jackets or blazers for women who are pregnant. That can be very uncomfortable.”

Her Democratic colleague, Ashley Aune, added she was personally offended by being given the once over by her male colleagues, adding “You know what it feels like to have a bunch of men in this room looking at your top trying to decide whether it’s appropriate or not? I mean, this is ridiculous.” 

Republican State Representative Ann Kelley, who introduced the new rule, channeling her best inner “Phyllis Schlafly”, feigned confused surprise. “You would think that all you would have to do is say, ‘Dress professionally,’ and women could handle it. You would think elected officials could handle that.”

A decade earlier, fellow Missourian Schlafly said, with a polite smile, “We certainly don’t need a committee of foreigners who call themselves ‘experts’ to dictate our laws or customs.” From there it was a straight line to the Dobbs decision, to green lighting weapons of violence, and to challenging women’s autonomy.

Brass knuckles rose to prominence during the Civil War. But their symbolism, along with misogynistic and racist attacks on large segments of our population, can only be described as “deeply disturbing.” None of this would pass the muster in addressing the simple, but very basic question, “How do we make America and all Americans healthy?”

The Danger of Stroking a Tiger – Learning From Churchill and FDR

Posted on | January 12, 2023 | 6 Comments

Mike Magee

On the evening of December 29, 1940, with election to his 3rd term as President secured, FDR delivered these words as part of his sixteenth “Fireside Chat”: “There can be no appeasement with ruthlessness…No man can tame a tiger into a kitten by stroking it.”

Millions of Americans, and millions of Britains were tuned in that evening, as President Roosevelt made clear where he stood while carefully avoiding over-stepping his authority in a nation still in the grips of a combative and isolationist opposition party. 

The Germans were listening as well, and sent a different type of message as the Luftwaffe, in concert with the address, launched their largest yet raid on the financial district of London. Their “fire starter” group, KGr 100, initiated the attack with incendiary bombs that triggered fifteen hundred fires that began a conflagration ending in what some labeled the “Second Great Fire of London.”

There was nothing happenstance about the timing or methods of the attack. The night was moonless, keeping RAF fighters lacking air-to-air radar grounded. There were high winds to fan the flames that night. High explosive bombs were used to target water mains to hamper fire fighters, and the Thames was at low tide making accessing it for a water supply neigh impossible.

Combined with Roosevelt’s words, the actions of December 29, 1940, now 82 years later, highlight two truisms when confronting evil orchestrated at the hands of racist, autocratic leaders.

First, appeasement does not work. It expands the vulnerability of a majority suffering the “tyranny of the minority.”

Second, the radicalized minority will utilize any weapon available, without constraint, to maintain and expand their power.

The battle to save democracy in these modern times has not been won. As was FDR at the time of his address, we are in the early years of this deadly serious conflict, and still in catch-up mode, awakened from a self-induced slumber on January 6, 2020.

Hitler was no more an “evil genius” than was Trump. But both advantaged historic and cultural biases and grievances, leveraging them and magnifying them with deliberate lies and media manipulation. Cultures made sick by racism, systemic inequality, hopelessness, patriarchy, and violence, as it turns out, can be harnessed for great harm. But it doesn’t take a “genius.” Churchill never called Hitler a “genius.” Most often he only referred to him as “that bad man.”

The spectacle and emergence of Kevin McCarthy as Speaker of the House, and the contrasting address by Hakeem Jeffries as he handed over the gavel, represent just one more skirmish in this “War for Democracy.”  If our goal is a “healthier” America – one marked by compassion, understanding and partnership; one where fear and worry are counter-acted by touch and comfort; one where linkages between individuals, families, communities and societies are constructed to last – all signals confirm that the time is now to fight with vigor. As Churchill vowed on his first day a s Prime Minister, “I have nothing to offer but blood, toil, tears, and sweat.” At about the same time, FDR offered this encouragement, “We have no excuse for defeatism. We have every good reason for hope — hope for peace, yes, and hope for the defense of our civilization and for the building of a better civilization in the future.”

The rise of white supremacists and nationalists, theocratic and patriarchal censorship, and especially post-Dobbs attacks on women’s freedom and autonomy, are both real and substantial threats to our form of government. They indeed are minority views, but no more so than the minority in 1940 who allowed a small group of “bad men” to harness a relatively small nation of 70 million people into a force that very nearly conquered the world.

On December 7, 1941, we Americans were “awakened from our slumber” by the attack on Pearl Harbor. Churchill reached Roosevelt that night, and FDR said, “They have attacked us at Pearl Harbor. We are all in the same boat now.” A few weeks later, Churchill arrived in a battleship, docked off Chesapeake Bay in Maryland. Shuttled from there by plane, he witnessed Washington aglow, quite a contrast to his own blacked-out London. He stayed as a guest in the White House, and on Christmas Eve was asked to make a few remarks.

Here is what he said to the President’s guests, and (I suggest) to us today:
“Let the children have their night of fun and laughter. Let gifts of Father Christmas delight their play. Let us grown-ups share to the full in their unstinted pleasures before we turn again to the stern tasks and formidable year that lie before us. Resolve! – that by our sacrifice and daring , these same children shall not be robbed their inheritance and denied their right to live in a free and decent world.”

2023: A Focus on Women’s Autonomy

Posted on | December 30, 2022 | Comments Off on 2023: A Focus on Women’s Autonomy

Mike Magee

Women’s bodily autonomy, post the Dobbs case, is up for grabs as the New Year begins. The collapse of Trumpers’ Red Wave in the 2022 Mid-term election proved that women don’t take kindly to being threatened or subjugated. But historians know that the insults women face today are deeply seated in our history and take many different forms from birth to death. Case in point: The Federal Case of Terri Schiavo.

Theresa Marie Schindler was born in a Philadelphia suburb on December 3, 1963. She and her bother Richard and sister Suzanne attended local schools. Terri struggled with weight and had an eating disorder. By the time she attended Bucks County Community College, she had lost 100 pounds, and met fellow student Michael Schiavo in 1982. They were married two years later, and moved to Florida in 1986, in part to be closer to Terri’s parents. Her husband Michael was a restaurant manager and Terri worked for an insurance company.

Terri apparently continued to struggle with her eating disorder, a condition left undiscovered when she sought evaluation for infertility. On February 25, 1990, she collapsed in the lobby of their apartment in St. Petersburg, Florida. Her husband discovered her face down and unconscious, and called 911. She was resuscitated and intubated by paramedics.

On admission to the local hospital, Humana Northside, she was determined to have had a cardiac arrest brought on by a cardiac arrhythmia caused by hypokalemia with a blood potassium of 2.0 mEq’L (normal 3.5 – 5.0 mEq/L).

Her condition stabilized, but her mental status never improved. She had no “Living Will” or Advanced Directive. Michael received a court order making him legal guardian and director of future medical decisions related to his wife on June 18, 1990. After thorough examinations and diagnostic studies directed by specialists, two physicians independently declared her in a “permanent vegetative state.” A gastric feeding tube was surgically placed to provide regular nutritional feedings.

During the first year or two after Terri’s arrest, her parents and husband maintained cordial relationships. They initially supported intense rehabilitation. Nine months after the injury, Michael accompanied his wife to the University of California in San Francisco, for three months of experimental nerve stimulation treatments. She showed no improvement, and when they returned, Michael admitted her to a Rehabilitation Center in Bradenton, Florida, and subsequently to a Skilled Care facility.

In 1992, Michael Schiavo sued Terri’s gynecologist for missing a diagnosis of bulimia, claiming this error contributed to her cardiac arrest. He ultimately received  $2.0 million in damages to cover injuries and cost of permanent care. There was disagreement at that time between Terri’s husband and her parents over legal guardianship and access to the funds. The parents wanted him to sign over legal guardianship and encouraged him to “go on with his life.” They also suggested some distribution of the court award to assist in the care of their daughter. Michael refused.

When she developed a urinary tract infection in mid-1993, he signed a “Do Not Resuscitate” (DNR) order on her behalf.

By 1998, relations between Michael and his in-laws had further deteriorated. He refused their appeals to divorce their daughter and relinquish control. In May, 1998, Michael filed a petition to remove the feeding tube, providing some evidence that his wife would not have wanted to continue to live this way. The Court appointed a secondary legal guardian who agreed that Terri was in a “permanent vegetative state”, but that Michael, as inheritor of the remains of the legal settlement should his wife die, also had a conflict of interest. The legal advocate also noted that the parents were conflicted as well, and recommended not removing the tube.

The case went to Court and a decision to remove the tube was upheld in Florida Second District Court of Appeal in February 2000. After multiple legal maneuvers, the tube was finally removed on April 24, 2001. The Schindlers charged Michael Schiavo with perjury, and a judge ordered the tube reinserted 2 days later. The Schindlers claimed new treatments were now available, which triggered more experts, more testing, and more court dates. Finally, on September 17, 2003, a frustrated presiding Judge George Greer declared the actions of the Schindlers “an attempt to re-litigate the entire case”, and ordered the feeding tube to be removed for a second time, which it was on October 15, 2003.

By now, the case had entered the public reign, with the Schindlers joined by their son, Bobby. Together they engaged anti-abortion Operation Rescue /Right to Life extremist Randall Terry in their campaign. The Republican Party offered their support as well. Still none would have predicted that the Florida legislature in emergency session would grant then Gov. Jeb Bush (filled with Presidential aspirations), the authority to intervene in the case. Citing the new “Terri’s Law”, Bush assumed authority for Terri’s medical decisions and ordered the feeding tube reinserted for a third time which it was. In the meantime the ACLU lined up with Terri’s husband. On May 5, 2004, “Terri’s Law” was declared unconstitutional.

Before a permanent solution was reached, the United States Congress held hearings on the case, and then President George W. Bush brokered a compromise transferring the case to Federal Courts. The Federal Court agreed with prior State Court Appeals. Terri Schiavo’s feeding tube was removed a final time on March 24, 2005. She died at a Pinellas Park hospice on March 31,2005.

The Republican party suffered two political casualties by injecting itself into the case. The first was the career of Senator Mel Martinez (R-FL). He was damaged irreparably when his top aide Brian Darling’s memo in the middle of the controversy went public. Commenting on the case, it read, “This is an important moral issue, and the pro-life base will be excited…This is a great political issue, because Senator Nelson of Florida has already refused to become a co-sponsor and this is a tough issue for Democrats.”

A second casualty was the future political career of doctor turned politician, Senator Bill Frist, who had Presidential ambitions but couldn’t resist weighing in as a physician. Breaking an unspoken code of ethics for the profession, without every seeing the patient, he challenged the decision to remove Terri’s feeding tube, proclaiming on broadcast television,  “I question it based on a review of the video footage which I spent an hour or so looking at last night in my office.”

Terri Schiavo’s father, Robert, died of heart failure on August 31, 2009. His mother Mary, and her brother Bobby and sister Suzanne, went on to establish Terri Schiavo Life & Hope Network. Their guest of honor at their First Annual Fundraising Gala in 2013 was Sarah Palin who once again asserted that Advanced Directives and Living Wills were constructs designed to support “Death Panels.”

The case spanned 15 years, and was rejected by the Supreme Court for a hearing four times. Hijacked by political opportunists and Right-to-Life activists, it rode the poor health and disability of one unfortunate woman literally into her grave with devastating consequences for all concerned. Dobbs has charted the same familiar path. However, this time, 33 years after Terri Schiavo found her autonomy mortally compromised,  many thousands of women enter the New Year at similar risk.

2023 could be “The Year of Participatory Democracy.”

First, Extirpate Trump. Then Begin the Nation Anew With Health.

Posted on | December 20, 2022 | 5 Comments

Mike Magee

“The Right to Health Care and the U.S. Constitution.” On the surface, it sounds like a straight forward topic – a simple presentation. But a gentle scratch at the surface reveals a controversy that literally dates back 250 years and more. Is it a “right”, a “privilege”, or simply a “necessity?”

I’m not a lawyer or Constitutional scholar. But I do know health care, its’ history, and its’ many strengths and weaknesses. What does our Constitution have to do with health care?  The answer: That depends on how broadly you define “health.”

Before we were ever a nation, there existed a 300 year period of war and conquest, of genocide and superstition masquerading as science, of promises made and promises broken in the Americas. The naive fledgling nation that declared its independence in 1776, knew that what they were attempting was a long shot. As Alexander Hamilton wrote in the first Federalist paper, the pressing question was “… whether societies of men are really capable or not, of establishing good government from reflection and choice, or whether they are forever destined to depend, for their political constitutions, on accident and force.” It was, and is, an open question.

One hundred and seventy years after our Declaration of Independence, General George Marshall raised the same question when charged with rebuilding the destroyed societies of vanquished enemies, Germany and Japan, from ashes. Where should he begin? In 1946, he decided to begin by establishing national health plans in each of those nations. He believed that by creating services that emphasized safety and security; handing out compassion, understanding and partnership in liberal amounts; reinforcing bonds between individuals, families and their communities; and processing a populations collective fears and worries day in and day out; the occupying forces might be able to establish a level of trust and tranquility necessary to secure the foundations of a thriving and lasting democracy. It was, if you will, a “nation building” plan, The Marshall Plan. And it worked.

General George Washington’s moment in history  when assigned to lead the Continental Army on June 15, 1775 was quite different. He had no such insights. He had his hands full assuring our immediate survival. Governance and representation, rights and privileges, checks and balances – these were issues decidedly on the table for him and the other Founding Fathers in 1776. Health of the population was not. Nowhere in those early years will you find an essay titled “How do we make America healthy?”

Arguably, the aristocratic leaders of this fledgling nation (the 6% allowed to vote) spent much of their time doing just the opposite – figuring out how to subjugate women and harm a large portion of their fellow humankind, most notably indigenous natives and enslaved Africans. Had there been a broad goal of creating an equitable healthy population from the beginning, our Founding Fathers would have been forced into a “Truth and Reconciliation” process of our own – an impossibility most historians believe if the goal was uniting these 13 distinctly separate colonies.

We went with the “United States” as it was, as it still is. Trump and his Republican  admirers are simply residual damage, evidence of the persistence of unhealthy and discriminatory behaviors, and proof positive that “life, liberty and the pursuit of happiness” is quite impossible without good health. 

Health is foundational to a functioning democracy. Health is recognized by most throughout the world as a fundamental right, intertwined with our economic, social, and political systems. But health must be shared and be broadly accessible to be an effective enabler of good government.

Our Constitution is aspirational and idealistic – a “living document.”  We have the opportunity to actively pursue a healthy America. It is within our grasp to improve on the Founders vision and demonstrate to Hamilton, in modern times, that we are “capable of establishing good government from reflection and choice.” 

The choice of Health Care for All is a basic and foundational component for a thriving democracy. Understanding the Constitution and our nearly 250 years of relevant case law has been an eye opener for me. I thought I really understood the history of health care in America. But viewing it through a legal lens (even before the Dobbs case) has only reinforced my belief that we together, as Americans, deserve better. We have a right to share a healthy culture, live lives of promise and productivity and personal autonomy, and secure a bright future in this country we love. 

Ignoring health has brought American culture to its knees, allowing weak values, fear, and ignorance to make Trump possible. We shouldn’t require any more proof than this. Surgical extirpation of this malignancy is underway. But that will only bring us back to neutral.

How will we finally make our American culture healthy? General George Marshall would say, “Begin with health. It is a necessity.”

Abigail Adams Message To Clarence Thomas

Posted on | December 13, 2022 | 6 Comments

Mike Magee

“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

This striking and sweeping statement of values, the Preamble to our Constitution, was anything but reassuring to the wives, mothers, sisters and daughters of the Founding Fathers. Abigail Adams well represented many of them in her letter to John Adams in March, 1776, when she wrote:

“Remember the Ladies, and be more generous and favorable to them than your ancestors. Do not put such unlimited power into the hands of the Husbands. Remember all Men would be tyrants if they could. If particular care and attention is not paid to the Ladies we are determined to foment a Rebellion and will not hold ourselves bound by any Laws in which we have no voice or Representation.”

Her concern and advocacy for “particular care and attention” reflected a sense of urgency and vulnerability that women faced, and in many respects continue to face until today, as a result of financial dependency, physical and mental abuse, and the complex health needs that accompany pregnancy, birth, and care of small infants.

The U.S. Constitution is anything but static. In some cases, the establishment of justice, or the unraveling of injustice may take more than a century. And as we learned in the recent Dobbs case, if the Supreme Court chooses, it may reverse long-standing precedents, and dial the legal clock back a century overnight. 

Roe v. Wade was a judicious and medically sound solution to a complex problem. Perfection was not the goal. But in the end, most agreed that allowing women and their physicians to negotiate these highly personalized and individualized decisions by adjusting the state’s role to the reality of the 1st, 2nd, and 3rd trimester made good sense. But getting physicians to step forward and engage the issue was neither simple nor swift.

In July, 1933, McCall’s magazine published one of hundreds of ads that year for contraceptive products. This one was paid for by Lysol feminine hygiene. It pulled punches, using coded messages, and suggesting that the very next pregnancy might finally push a women over the edge, and that would indeed be a “travesty.” The ad read: 

The most frequent eternal triangle:
A HUSBAND…A WIFE…and her FEARS

Few marriages would flounder around in a maze of misunderstanding and unhappiness if more wives knew and practiced regular marriage hygiene. Without it, some minor physical irregularity plants in a women’s mind the fear of a major crisis. Let so devastating a fear recur again and again, and the most gracious wife turns into a nerve-ridden, irritable travesty of herself.

Birth control had by then become a huge and unregulated business. As one report noted, “Capitalizing on American’s desire to limit family size in an era of economic hardship, pharmaceutical firms, rubber manufacturers, mail-order houses, and fly-by-night peddlers launched a successful campaign to persuade women and men to eschew natural methods for commercial devices whose efficacy could be ‘scientifically proven’. . . with the industry’s annual sales exceeding $250 million, Fortune pronounced birth control one of the most prosperous new businesses of the decade.”

This was a decided shift from the Roaring 20’s when coded messaging was the rule rather than the exception, and the AMA maintained a respectful, self-protective distance from the controversy. 

As one report described, this was “…an era when the American Medical Association did not consider contraception part of medicine . . .The goal of the birth control movement in the 1920s and 1930s was to take power away from the commercial advertiser and place it in the hands of the physician.”

For Margaret Sanger, medicalizing women’s autonomy over birth decisions was essential. Having highly respected and politically powerful physicians as allies in the struggle provided much needed shielding nationwide. Sanger’s efforts to expand women’s health services, especially to immigrants fleeing the war clouds settling over Europe, demanded partnerships with physicians. But physicians were leery when it came to going public in support of birth control. Even noted academic supporters feared being accused of advertising birth control for profit which was distinctly outlawed under the AMA code of ethics.

By 1937, however, the AMA felt the winds of change blowing. FDR already knew a war was coming and that availability of contraception would be a critical factor in avoiding outbreaks of venereal disease among the troops as the nation had experienced in WW I. On the morning of June 9, 1937, the nation awoke to front page headlines in the top two columns of the New York Times that read “Birth Control Is Accepted By American Medical Body: Association Backs Doctors in Use of ‘Legal Rights’ on Contraceptive Advice.”

The body of the article explained that the association’s house of delegates – defined as “the supreme court of American medicine” – adopted two recommendations dealing with the issue. First, “that the American Medical Association investigate the various forms of contraception with a view to disseminating authoritative information on the subject to the medical profession”, and second, “that the association promote the teaching of proper methods of birth control in the medical schools.”

Labeling the action as “another landmark in the annals of American medicine,” they offered perspective noting that “For many years all efforts to gain official status for birth control, as a legitimate part of medical practice, have been bitterly fought and successfully blocked by powerful groups, religious and otherwise, within the ranks of American medicine.”

In the very next paragraph, the Times article asserted that, with this issue now out of the way, the delegates were focused on “the most important problem facing American medicine today – whether to give official recognition to the principle that  “the health of the people is the direct concern of the government, and that a national health policy directed to all groups of the population be formulated…Whatever the outcome, every one here realizes that organized medicine in America now stands at the crossroads and that it can no longer champion the status quo as it has done in the past.”

Roughly three decades later, on June 7, 1965, in a 7 to 2 decision titled Griswold v. Connecticut, authored by Justice William O. Douglas, the Supreme Court issued a 7–2 decision and struck down Connecticut’s last state law banning the sale and advertising of  contraceptives.

In the Majority Opinion, Douglas wrote: “Would we allow the police to search the sacred precincts of marital bedrooms for telltale signs of the use of contraceptives? The very idea is repulsive to the notions of privacy surrounding the marriage relationship.”

Griswold v. Connecticut became one of the most referenced landmark cases in history. All Americans now had their “sexual privacy” protected from government intrusion. As a result, a series of cases were successfully built on top of this precedent setting ruling. These included:

Eisenstadt v. Baird (1972) – Contraceptives for Single Adults.
Roe v. Wade(1973) – Abortion Legal in Non-viable Fetus.
Lawrence v. Texas (2003) – Texas Anti-Sodomy Law Unconstitutional.
Obergefell v. Hodges (2015) – Same Sex Marriage Legal.

When the Dobbs decision that effectively reversed Roe v. Wade was handed down, Justice Clarence Thomas in a concurrence statement wrote, “…in future cases, we should reconsider all of this Court’s substantive due process precedents, including GriswoldLawrence, and Obergefell.”

In a Clarence Thomas world, historic precedent and scientific progress be damned. Bodily autonomy is a product of the state. Health is a luxury, doled out in small measure only to those who toe the religious party line. Abigail Adams words resound: “Remember all Men would be tyrants if they could.”

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