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Exploring Human Potential

“We Give People Light, and They Will Find The Way.”

Posted on | October 26, 2020 | No Comments

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Mike Magee

In the Jennifer Hudson/Black Eyed Peas campaign video remixing “Where is the Love?”, Joe Biden mirrors the famous words of Civil Rights legend Ella Baker, “Give people light and they will find the way.” Health care reform in America is now the path we must travel to uncover our own “exceptionalism.”

Health care, fundamental to rebuilding a nation and its culture from scrap, was what drove the military’s decision under the Marshall Plan. In the re-build of Germany and Japan, we elected to start with a health plan – in part because we recognized that all other social determinants – housing, nutrition, education, clean air and water, safety and security – would be enhanced in the process leading to a tradition that could support stable democracies.

This is essentially the same challenge we as a country (having wandered so far off course as to elect Trump) are faced with today. Changing culture, as health professionals know, is a tall order. It is about compassion, understanding and partnerships. It is about healing, providing health, and keeping individuals, families and communities whole. And – most importantly – it is about managing population-wide fear, worry and anxiety.

What we are asking of the people, and the people caring for the people, is to change their historic culture (one built on self-interest, hyper-competitiveness, and distrust of good government). This is a tall order – something that parents, pastors, politicians and physicians equally recognize. Things evolve, and difficult things take time. But what happens if you run out of time, if the threats of delay or incrementalism create risks that outweigh or negate rewards. If global warming reaches a point of no return or a pandemic spirals out of control? What then?

“What then” usually involves some middle path, one that emphasizes self-determination but not self-destruction. In the case of health reform, this is the argument for provision of a public plan (similar to Medicare) as a voluntary option that is available to all comers. In the response will be revealed next steps in health reform.

If we choose to go this route however, the mischief makers who spent a decade undermining the Affordable Care Act must be effectively sidelined from the start. The essentials? The public plan must be open to all. Insurance must be a requirement and mandated as such with penalties. Medicaid expansion (in combination with the new public offering) must be required in all states without exception (including the 12 current hold-outs). And a complete benefit package as delineated in the ACA must be required (no skimpy substitutes). In other words, the public offering must be muscular, nationwide, and easily accessible to all comers.

At the same time, we must disabuse ourselves of any notion that a cultural shift with health care as the leading edge will be simple or easy. We need only recall those post-WWII Marshall Plan years to remember that, as we were building out national health systems for our vanquished enemies, the AMA, Pharmaceutical Manufacturers Association, and allies simultaneously branded Truman a “socialist” and dispatched his plan for national health care as “socialized medicine.” Power, profit, and persistence prevailed. It took nearly two more decades to move the dial on Medicare and Medicaid.

What we witnessed this past week during the final debate, the “60 Minute” Leslie Stahl interview, and Jake Tapper’s skillful extraction from Mark Meadows that “We are not going to control the pandemic”, was a grim reminder of how far protectors of the status quo are willing to go. All this while the Covid-19 infected camps of Trump and Pence continued to unleash fear and worry, and fuel hatred and resentment. It is not a pretty picture.

But putting that aside, it is useful to acknowledge what our former military leaders stated as Germany and Japan sought to rise from the ashes in 1945. “We start with health care because it is an anecdote to fear, worry, and hatred.” Using the same logic, our distressed American culture will benefit greatly from universal health care. We start anew. And given a bit of patience, and some wiggle room to choose a better future, we might be surprised to learn that we are a bit more “exceptional” than we might at first appear.

Catholic Leaders – Can We All Agree On This?

Posted on | October 22, 2020 | 1 Comment

Mike Magee

My college roomate wrote me yesterday. We graduated from LeMoyne College, a Jesuit run institution in Syracuse, NY in 1969. Our four years together during the height of the Vietnam war were consumed with issues of social justice led by LeMoyne faculty including Daniel Berrigan, S.J.. 

My roomate wrote, “It breaks my heart to keep hearing about the hundreds of children being kept in cages by our government. And now we are informed that there are more than 500 who can’t be returned to their parents because the government did not keep good records. So what can we do?”

This issue is especially disturbing as our Presidential election arrives with a Catholic candidate on the ballot, and the assured Supreme Court confirmation of conservative Catholic Amy Conan Barrett just days away.

Last month, NPR’s Labor and Education reporter Tom Gjelten wrote: “If Amy Coney Barrett is confirmed as the new Supreme Court justice, she will be one of six Catholics on the bench. She would be joined by an Episcopalian who was raised as a Catholic. and two Jewish justices…Never before has the Court been so dominated by one religious denomination…Whether such a concern will be discussed, however, is another matter entirely… Not all Catholic justices think alike. Sonia Sotomayor and Clarence Thomas, both Catholic, are ideological opposites.”

Jesuit senior analyst for Religion News Services, Thomas Reese, S.J., noted at the time that “Catholics tend to pick and choose which parts of Catholic teaching have an impact on their political views.” And this is true. But on some things, we should all agree – including the protection of children.

For health professionals, committed to healing, providing health, and keeping families and communities whole, the many actions of President Trump are deeply offensive on multiple levels – but none more than the deliberate separation of immigrant children from their parents. 

Chicago’s Catholic Bishop Cardinal Bernardin addressed a gathering of AMA members shortly before he died in 1996 and made the case that health was integral to human potential and that doctors and nurses and all health professionals played a pivotal role in assuring the survival of a caring society.

Bernardin’s guiding philosophy was a “consistent ethic of life.” In addressing health leaders, he said, “To defend human life is to protect the human person … the core reality in Catholic moral thought…Attitude is the place to root an ethic of life…We cannot urge a compassionate society and vigorous public policy to protect the rights of the unborn and then argue that compassion and significant public programs on behalf of the needy undermine the moral fiber of the society or are beyond the proper scope of governmental responsibility.”

The images of children, forcibly separated from their desperate parents, would have been unthinkable to the Cardinal as he approached his death in Chicago two decades ago. “The dignity and value of human persons is a basic value …. [L]et it be said that the energizing vision of healthcare must be this commitment to the dignity of human persons.” Those were his words then.

“How will each of us bear witness now?” That is what my roomate was asking this week. His suggestion was to use the agency of Catholic churches in the Americas to identify parents of these children and then connect them to the 500 plus children that Trump kidnapped from their parents.

“ I have written to the Pope and asked him to have the churches in Latin America ask that any person whose child is being held here contact the church and then they can send the info to American bishops who can then get the information to the many volunteer lawyers who are trying to get these kids back home. If you think this is a viable idea please join me and send his Holiness a message.”

Pope Francis has no personal email address but does have a Twitter account @Pontifex. You can also write him a letter today at:

His Holiness, Pope Francis
Apostolic Palace
00120 Vatican City

His Holiness, Pope Francis
Saint Martha House
00120 Città del Vaticano, Vatican City

In both cases, be sure to have the correct postage.

Thanks!

ACA – A Ticking Time Bomb For Republicans.

Posted on | October 20, 2020 | 2 Comments

Mike Magee

Watching the Amy Conan Barrett hearings last week, I couldn’t help but wonder who exactly was running the Republican Death Star at the moment.

Specifically the Supreme Court candidate’s vulnerability based on an outspoken disdain for the ACA seemed to release a quiet, below-the-surface, Democratic  scream “Go ahead. Make our day!”

For nearly a decade the Republican party has done everything within its power to kill President Obama’s signature legislation, always promising but never delivering an alternative. And all along the way, they have succeeded in emphasizing the pieces of the bill that Americans in large majorities favor.

In the process, they’ve alienated not only those who believe health care is a right rather than a privilege, and those who support protections for pre-existing conditions, but also those against deceptive skimpy health insurance, those who believe transgender Americans deserve care guarantees, those who demand access to affordable drugs, those who have their adult children covered on their family plan, those opposed to cuts in coverage of contraceptives, and those in favor of federal funding of Planned Parenthood clinics.

No surprise then that Nancy Pelosi, on the first day of the Barrett hearings, went straight to the mic and said, “The president is rushing to make some kind of a decision because … Nov. 10 is when the arguments begin on the Affordable Care Act…He doesn’t want to crush the virus. He wants to crush the Affordable Care Act.”

What the House Speaker was referring to was California v. Texas. As Kaiser Health News Washington correspondent, Julie Rovner, recently wrote, “With the death of Ruth Bader Ginsburg, the ACA’s future is in doubt.”

That’s because California v. Texas, set for presentation to the Supreme Court in just a few weeks, is seeking clarity on a challenge by Texas led Republican attorneys general (AGs) to declare the ACA unconstitutional based on a weak technicality. The California refers to 21 Democratic (AGs) led by California, and Barrett when confirmed could be the deciding vote.

But charter members of the Medical-Industrial Complex (MIC) aren’t lining up with Mitch McConnell. America’s Health Insurance Plan (AHIP), the lobbying arm for the big insurance companies, says a Trump win here would cast “a long shadow of uncertainty over ACA-based investments and denies health insurance providers, states, individuals, and other stakeholders of much needed clarity.”

The AARP, with its own proprietary Part D pharmaceutical plan, says a bad decision here “plunges millions of Americans into an abyss of prolonged uncertainty because they do not know if they will lose access to life-sustaining health care coverage and consumer protections.”

The American Hospital Association, the Catholic Health Association of the United States, and the Association of American Medical Colleges issued a joint warning that a Trump/McConnell victory here could  “have serious, perhaps irreparable, consequences for hospitals and the patients they serve.”

Why would charter members of the MIC be spurred to such progressive, public-spirited action against their very own free-market allies?

The answer lies in the “What if?” What if Republicans actions in the Supreme Court on November 10th succeed in throwing American health care into full-throttled chaos in the middle of a pandemic now slated to result in 400,000 plus American casualties as we enter 2021…and Joe Biden wins control of the executive and legislative branches of government?

One scenario: Inside the White House on January 21, 2021, Biden takes a good hard look at the ACA, and at a new batch of Republican-led “nickel and dime” legal challenges that proceed unabated (with tacit support from the health care lobby status quo), and says, “Screw it. I’m going Medicare for All.”

Nature Magazine: Trump has taken an axe to our Democracy.

Posted on | October 15, 2020 | No Comments

Mike Magee

A month ago, I catalogued the actions of the editorial boards of Scientific American and Science in their historic endorsements of Joe Biden for President.

This week Nature magazine goes one step further in expressing regret for their statement of tolerance in 2016 when they wrote, “US democracy was designed with safeguards intended to protect against excesses.” Four years later? This mea culpa: “How wrong we turned out to be.”

Their opening paragraph sets the record straight:

“No US president in recent history has so relentlessly attacked and undermined so many valuable institutions, from science agencies to the media, the courts, the Department of Justice — and even the electoral system. Trump claims to put ‘America First’. But in his response to the pandemic, Trump has put himself first, not America.”

They catalog a list of grievances. First at home:

“On the domestic front, one of this administration’s most dangerous legacies will be its shameful record of interference in health and science agencies — thus undermining public trust in the very institutions that are essential to keeping people safe.”

And around the world:

“Challenges such as ending the COVID-19 pandemic, tackling global warming and halting the proliferation and threat of nuclear weapons are global, and urgent. They will not be overcome without the collective efforts of the nation states and international institutions that the Trump administration has sought to undermine.”

On the pandemic:

“Trump has lied about the dangers posed by the virus and has encouraged people to protest against policies intended to slow its transmission. The result, if not the goal, has been to downplay the greatest crisis the country — and the world — has faced in at least half a century…These actions have had devastating consequences.”

On the environment:

“…under the Trump administration, the EPA has withered as its scientists have been ignored by the senior leadership. Those at the top of the agency have worked to roll back or weaken more than 80 rules and regulations controlling a spectrum of pollutants, from greenhouse gases to mercury and sulfur dioxide.

On discrimination and hatred:

“Trump has also promoted nationalism, isolationism and xenophobia — including tacitly supporting white-supremacist groups. The administration has rewritten immigration policies, beginning in 2017 with a controversial travel ban on people from seven countries, including five Muslim-majority states.

On destruction of our Democracy:

“Donald Trump has taken an axe to a system that was intended to safeguard and protect citizens when leaders go astray. He has become an icon for those who seek to sow hatred and division, not only in the United States, but in other countries, too.”

The cure:

“Joe Biden must be given an opportunity to restore trust in truth, in evidence, in science and in other institutions of democracy, heal a divided nation, and begin the urgent task of rebuilding the United States’ reputation in the world.”

I agree.

“The Magnitude of this Failure is Astonishing.” – The NEJM Cluster.

Posted on | October 8, 2020 | 6 Comments

Mike Magee

“Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy.” …and that’s just the first paragraph.

From the last paragraph: “Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences. Our leaders have largely claimed immunity for their actions…When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.”

Who is speaking here? The New York Times, the Washington Post, The Atlantic?

None of the above. This editorial, signed by 34 high-profile physicians and scientists, states “The magnitude of this failure is astonishing.” Individually they are science luminaries. But what is more consequential is the platform they inhabit. They are the editors of the world renowned New England Journal of Medicine.

Here are their names and titles:

Editor-in-Chief
Eric J. Rubin, M.D., Ph.D.

Executive Editor
Mary Beth Hamel, M.D., M.P.H.

Deputy Editor
Lindsey R. Baden, M.D.

Deputy Editor
Julie R. Ingelfinger, M.D.

Deputy Editor
John A. Jarcho, M.D.

Deputy Editor
Dan L. Longo, M.D.

Deputy Editor
Elizabeth G. Phimister, Ph.D.

Deputy Editor
Allan H. Ropper, M.D.

Deputy Editor
Caren G. Solomon, M.D., M.P.H.

Deputy Editor
Darren B. Taichman, M.D., Ph.D.

Associate Editor
Arnold M. Epstein, M.D., M.A.

Associate Editor
Guadalupe Garcia-Tsao, M.D.

Associate Editor
Ellen M. Gravallese, M.D.

Associate Editor
Michael F. Greene, M.D.

Associate Editor
John F. Keaney, Jr., M.D.

Associate Editor
Clifford J. Rosen, M.D.

Associate Editor
Gary Wong, M.D., F.R.C.P.C.

Associate Editor
Rui‑Ping Xiao, M.D., Ph.D.

Executive Managing Editor
Stephen Morrissey, Ph.D.

Statistical Consultants
Ralph B. D’Agostino, Sr., Ph.D., Constantine Gatsonis, Ph.D., David Harrington, Ph.D., Joseph W. Hogan, Sc.D., David J. Hunter, M.B., B.S., M.P.H., Sc.D., Sharon‑Lise T. Normand, Ph.D.

Perspective Editor
Debra Malina, Ph.D.

National Correspondent
Lisa S. Rosenbaum, M.D.

International Correspondent
Charlotte J. Haug, M.D., Ph.D.

CME Editor
Carla S. Rothaus, M.D.

Images Editor
Chana A. Sacks, M.D.

Editors-at-Large
Joseph Loscalzo, M.D., Ph.D., Richard P. Wenzel, M.D., M.Sc.

Editorial Fellows
Jehan F. Chowdhury, D.O., Siri R. Kadire, M.D

In taking this action, they join others in declaring outright independence from Trump and his Republican enablers. They are preceded by the leadership of two other prominent science publications.  In its 175-year history, Scientific American had never endorsed a US presidential candidate – until last month when they chose Joe Biden. One week earlier, H. Holden Thorp, the spicy new editor of Science, penned an editorial titled “Trump Lied About Science.”

Actions like these are not taken lightly. They can undermine well-established and hard-earned reputations for independence. They can create enemies in high places. They can have financial consequences.

This NEJM cluster, in its own way, is as significant as the Rose Garden/Covid cluster that Trump personally ignited. Both actions have captured our attention. Both actions united individuals of like mind. And both have real-life consequences that no longer can be ignored.

The History of Presidential Health, Succession, and the 25th Amendment in 15 slides.

Posted on | October 5, 2020 | No Comments

Mike Magee

DOWNLOAD SLIDE DECK PDF

In 2019 I taught a course at the President’s College at the University of Hartford titled “The President’s Health and the 25th Amendment.” The questions raised then are now prescient and include:

1. What is the 25th Amendment?
2. How do you define “inability” and who defines it?
3. Has Presidential “inability” been a problem in the past?
4. What is the role of the White House physician?
5. What is his/her responsibility to the nation?
6. Is a Presidential candidate required to release medical records?
7. Have White House doctors lied to the public in the past?
8. Have Presidents lied about their health?

In this abbreviated format, here are 15 selected slides from that course with brief commentary.

Slide 1. The first commentary in our Constitution did not appear until 1787. This was not simply an oversight on the part of our Founding Fathers. Rather it reflected that the issue would be thorny and complicated – as it has remained to this day. In the statement, the position of Vice President is established, and (in the case of inability of the President) his duties “devolve on the Vice President” until the Congress identifies who should take the President’s place.

Slide 2. Over the next roughly half century, the issue of succession surfaces twice. In 1792, five years after the Constitutional Convention, Congress establishes that the line of succession after the Vice-President will be first to the leader of the Senate and then to the leader of the House of Representatives. When President William Henry Harrison dies in office from Typhus 49 years later, his Vice President, John Tyler”, has a local judge swear him in as “President.”  John Quincy Adams is outraged by this precedent setting move since most believed he was only entitled to serve for an interim period as “Acting President.”

Slide 3. Historically, turnover in the Executive Office has been relatively common in our history requiring frequent succession. Violence and disease have been the common instigators of these crises.

Slide 4. Formal discussions regarding how best to legislatively manage succession have often followed these acute crises. On July 2, 1881, James Garfield was shot. Though incapacitated, he (and his supporters) refused to relinquish control of the government for the next 80 days until he died. When Chester Arthur, his VP assumed the Presidency, he directed the Legislature to reconsider the issue of succession. In 1886, they passed the Succession Act. It created a line of successors in the Cabinet should a President and Vice President become disabled. The successor would be titled “Acting President.” The issue of defining “inability” and who could determine “inability” was left unaddressed.

Slide 5. President Woodrow Wilson is often cited as the prime example of Presidential abuse when faced with incapacity. During his second term, exhausted from campaign efforts in support of passage of the League of Nations, Wilson suffered a stroke on October 2, 1919. For the next 15 months, Wilson’s 2nd wife, Edith Wilson, his long time Chief of Staff, Joe Tumulty, and White House Dr. Gary Grayson entered into a conspiracy to run the government and cover up his incapacity. The VP would not confront the issue fearing he’d be accused of opportunism. When the Secretary of State, Robert Lansing, finally surfaced the problem, he was fired. Wilson had to be convinced not to run for a 3rd term. He died on March 4, 1921.

Slide 6. White House doctors through history have routinely lied about the President’s health. Wilson’s doctor was not an outlier. FDR’s doctor, Admiral Ross McIntire, actively hid FDR’s progressive and eventually fatal Congestive Heart Failure for over a year before he died in office. This included penning a rosy portrayal of the President’s health in Collier’s magazine, titled, “Unconquerable Spirit” 2 months before he died.

Slide 7. In the middle of the Cold War, on September 24, 1955, President Eisenhower suffered a massive heart attack that confined him for months out West until he could be transported back to his home in Gettysburg, PA. He reportedly insisted on waiting until he was capable of walking unaided up the airplane stairs for a photo op. The Democratic Congress at the time asked for hearings to clarify succession issues. In 1958, rather than submit to legislative changes, Eisenhower penned a letter to Nixon, authorizing a temporary and reversible transfer of power were he to declare “inability” to govern.

Slide 8. At the time, Congress raised, and Eisenhower partly addressed the issue in his letter to Nixon.

Slide 9. Senator Frederick Payne (R, ME) had this response in 1958. The key issue he said was “Who will determine ‘inability’?”

Slide 10. Attorney General Robert F. Kennedy commented directly on the role of the Vice-President in declaring “inability” if a President is unable to do so himself. After JFK is assassinated, LBJ seeks clarity on the issue of succession. A junior senator from Indiana agrees to head up a Congressional committee to explore the need for a Constitutional Amendment. Few believe it will amount to much.

Slide 11. Since 1788, there have been 11,000 proposed Amendments to the Constitution. Only 27 to date have succeeded and 10 of these were contained in the original Bill of Rights. Ratification of an Amendment requires support from 2/3 of both Houses of Congress, and approval by ¾’s of the states. On January 23, 1967, the 25th Amendment was ratified.

Slide 12.  During Nixon’s second term, the 25th Amendment gets a work out. VP Spiro Agnew resigns in disgrace. Gerald Ford is appointed by President Nixon. Nixon resigns and Ford assumes the Presidency. Ford appoints Rockefeller as his VP.

Slide 13. During his Presidency, Ronald Reagan ignores the 25th Amendment after an assassination attempt. His PR people create an inaccurate and deceptive heroic narrative for public consumption to cover-up the seriousness of his condition. Returning a “hero” to address both Houses of Congress helps Reagan pass his “trickle down” tax cut which is partially reversed one year later.

Slide 14.  When Reagan undergoes general surgery for colon cancer, he transfers power temporarily to George H. W. Bush, but specifically notes that he is not invoking the 25th Amendment. Late in his second term, the First Lady, and White House staff (including the White House doctors) cover-up Reagan’s declining mental status. George H. Bush is the first to formally invoke the 25th Amendment when under anaesthesia to Dick Cheney.

Slide 15. In 1992, twenty-five years after its passage, Birch Bayh and Fordham University Dean of the Law School, John D. Feerick (both of whom were involved in creating the original language for the 25th Amendment in 1967), co-chair a committee to re-examine the Amendment, and recommend any necessary changes. They conclude it should be left as is, deciding that the issue of both “inability” and “transfer of power” is primarily a political decision, and that transferring the power to override the result’s of the body politics vote to a medical committee, the Supreme Court, or other expert body, would create more problems than it would solve. They also reinforced their faith in Section 4 of the 25th Amendment – a succession scheme empowering the Cabinet and the Vice-President to appeal to Congress to remove an “inable” President who refuses to leave.

Pfizer CEO Should Distance Himself From Trump.

Posted on | October 1, 2020 | 2 Comments

Mike Magee

The executive team on the 18th floor at 42nd and 2nd Avenue had to be shifting in their seats a bit on Tuesday night as they heard the President of the United States assure the American public that Pfizer will very soon (maybe even in October) come to the rescue with a miraculous Covid-19 vaccine.

It’s been a heady two months for Pfizer’s new CEO, Albert Bourla. A veterinarian from Greece who spent 27 years working his way up the corporate ladder, he’s in the middle of a barnyard mess that is not of his making.

Two months ago, he teamed up with Germany-based BioNTech and landed a $1.95 billion deal with the US government. That contract is contingent on him finding a safe and effective vaccine and can deliver 100 million doses as promised (with 500 million more to follow).

With such happy news, why is Mr. Bourla increasingly sweating under the Primetime spotlight?

It’s likely because of the company he’s been forced to keep. As Trump former henchman Michael Cohen warned Congress on February 27, 2019. “I did the same thing that you’re doing now” and you will eventually “suffer the same consequences that I’m suffering.”

Increasingly Bourla finds himself out on the limb – a situation that became more tenuous during this week’s debate. First, Pfizer is some distance (months not days) away from completing phase three studies which have at least as good a chance of failing as succeeding. Second, if the vaccine is submitted for approval, it will have to survive a fully transparent and very public FDA review. Third, since Trump is a chronic liar who has displaced real science experts, it’s unlikely that the public will respond with open-armed trust even with an approval.

Bourla and the other PhRMA execs signaled as much when they sent out a joint release in September pledging not to cut corners on safety. Why did Bourla feel this was necessary? He told the Washington Post, “People are confused. Right now, they don’t know who to believe and what to believe. And we felt that, as this debate was peaking, we had to go out and say that we are going to stand with science. And we had to make it clear that if there are pressures, we are going to honor our legacy, and we are going to do whatever it takes to deliver a product that is safe and effective.”

He may not want to hit that “Pfizer’s legacy” too hard. As recounted in “Code Blue: Inside the Medical Industrial Complex”, the Pfizer “rap sheet” over six decades, from controversial experiments on children with meningitis in Nigeria to a $2.3 billion fine for massive over-marketing, is not exactly the kind of “legacy” worth defending in public.

The point being for Bourla, you’ve been warned. Aggressively maintain your distance from Trump, and listen to the advice of your fellow Greek, Aristotle, who said, “Moral excellence comes about as a result of habit. We become just by doing just acts, temperate by doing temperate acts, brave by doing brave acts.”

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