HealthCommentary

Exploring Human Potential

The WHO’s “Triple Billion” Project

Posted on | May 7, 2019 | No Comments

World Health Organization

Mike Magee

The WHO just released in most recent 5 year strategic plan. The plan in anchored in three “billion” labeled goals:

  1. Increase the number of glabal citizens with universal health coverage.
  2. Protecting 1 billion more citizens during health emergencies.
  3. Ensuring health and well-being for 1 billion more citizens.

To reach these onjectives, the WHO have outlined 10 Critical factors contributing to the planets global burden of disease. They are:

  1. Air Pollution and Climate Change
  2. Non-communicable Diseases like diabetes, cancer and heart disease.
  3. Prevent an Influenza Pandemic.
  4. Address 1.6 billion who survive in “fragile settings” due to drought, famine, conflict, and forced migration.
  5. Delay the emergence of antimicrobial resistance.
  6. Address Ebola and other high-threat pathogens.
  7. Enhance and extend reliable primary care networks.
  8. Ensure mass population wide vaccination.
  9. Address the 390 million mosquito borne infections due to Dengue Fever each year.
  10.  Extend prophylaxis and early treatment of HIV.

These challenges are amplified by the growing levels of isolationism, hostility toward at-risk migrating populations, intolerance and hatred – home grown and otherwise. In short, the issue is human behavior not lagging science. We humans have created the crisis. Health care is built on three pillars – compassion, understanding, and partnership. Vulnerable populations are calling out in quiet desperation – “Give us more of that!”  

“Going Up In Air” – Tobacco Strikes (again)

Posted on | May 3, 2019 | No Comments

Mike Magee

In chapter 8 (“Masters of Manipulation”) of my soon to be released (Grove Atlantic/June 4, 2019) book, CODE BLUE: Inside the Medical Industrial Complex, I trace the history of Big Tobacco’s complicit relationship with health care, and how unscrupulous marketers from opioid king Arthur Sackler, to stress racketeer Hans Selye, to ADHD opportunist Leandro Panizzon, whose wife Rita lent her name to the generic redo amphetamine “Ritalin”, followed the tobacco marketing playbook letter for letter.

This week the Ad Agency, Crispin Porter Bogusky, helped launch “Quit Big Tobacco”, asking marketing companies to voluntarily pledge not to work for the tobacco industry. But if you think the issue is about cigarettes, you’d be wrong. It’s about vaping, which is growing in leaps and bounds.

As Ad Exec Alex Bogusky points out, vaping is Big Tobacco in disguise. In his words, among the offenders are “Altria, which owns Philip Morris, the maker of Marlboro cigarettes, yet also holds 35 percent of the vaping giant Juul; Reynolds American, which owns Vuse; and Imperial Tobacco, which owns Blu.”

The recent statistics are alarming:

1. Among high school students vaping increased 80% from 2017 to 2018, with over 2 million middle and high school users..

2. A Juul “pod” has more nicotine than an entire pack of cigarettes. Juul controls 3/4 of the child market.

3. Vape liquid additives form carcinogenic compounds on combustion.

4. Juul store signage is deliberately placed at children’s eye ;levels.

5. Boardroom stated goal for vaping: “nicotine addiction no matter the vehicle.”

Courageous Ad giants are beginning to speak up. A few samples:

Madalene Milano: Partner, GMMB

“It’s kids — that’s the tipping point. It’s the manipulation of kids and getting kids hooked, who replace their adult smokers who die.”

Robin Koval: CEO & President, Truth Initiative

“The advertising and public relations community has a critical and urgent choice to make in the face of an e-cigarette epidemic among youth. Work for the tobacco industry to legitimize and spread its deception. Or be a force for good by refusing to help place a generation at risk for a lifetime of addiction.”

Katie Dain: CEO, NCD Alliance

“Tobacco use is one of the main risk factors for a number of #NCDs, including cancer, lung diseases & cardiovascular diseases. The NCD Alliance puts its mission first in everything we do. We do not work with any company that supports Big Tobacco.”

Jimmie Stone: Chief Creative Officer, Edelman NY

“We’re entering into a behavioral marketing era. The way you behave is your marketing. Not any longer can you build marketing with what you say, but with what you do.”

So far 175 individuals from the Ad and PR world have signed the pledge to Quit Big Tobacco. Join them HERE.

A Message for Apple’s “Top 5” Health Leaders

Posted on | April 25, 2019 | No Comments

Mike Magee

This week, STAT News led with the headline, “5 names to know at Apple: the people leading its move into health care.” For those following the consumer health space, this was one more bit of bait to attract and catch tech-savvy readers with hints of success that have circulated for nearly two decades.

Google famously played in this health space, and then very publically bowed out in 2011. The problem then, and arguably now, is confusion around “health” and “health care” in America. As I outline in CODE BLUE: Inside the Medical Industrial Complex”, the U.S. took a right turn after the war, when every other developed nation (including two we fully funded – Germany and Japan) went left and embraced universal and national health care as a human right for their citizens.

As a result of that decision, we released health care to entrepreneurs and profiteers and drank the Coolaid believing that defeating disease was synonymous with providing health. In the eight decades that followed, pharmaceuticals, diagnostics, and devices pushed common sense public health to the periphery, leaving America the only nation to spend more on health care than all other social services combined.

So it’s not surprising that tech companies attempting to integrate with US health care are a bit confused. Are they partners in this mess, cost-effective reformers, or competitors?

Some simple advice, first provided some 13 years ago, ask the basic question, “How do we make America and Americans healthy?”

Is it through “wearable” diagnostics? Will AliveCor’s medical grade EKG device lead to a healthy and productive nation or reverse the downward trend in life expectancy in our nation?

Will portability of data, or consumer controlled collection, or “wrist time” instant distribution and sharing of data place a dent in a hyper-competive society with crumbling infrastructure, environmental degradation, poor nutrition, crumbling schools, poor air and water, and population wide anxiety?

Apple’s “Top 5” – and Cerner, athenahealth and eClinicalWorks – should be looking at where we’re going, not where we have been. Legendary Health IT leader Don Detmer said as much to Congress in 2006 with these words, “While it is the undoubted world leader in high technology clinical care and biomedical research, the US healthcare system is an incredibly fragmented mix of very large and very small players – a conglomeration of 21st century medical science and cottage-industry business practices, and too often characterized by uneven access, delivery and outcomes.”

If there is a transformative role for technology (and one that might be profitable) in the health care space, it lies at the nexus of integrated lifespan planning and strengthened bonds between individual/family/clinician and community. Efficiency, universality and solidarity are the deliverables Apple’s “top 5” should be targeting.

Here’s a short video from 2006 worth a viewing:

VIEW

Running a Health Care System: As Natural As Mother’s Milk?

Posted on | April 9, 2019 | No Comments

Mike Magee

The latest recorded U.S. birth rate dropped for the second year in a row, down 3% from the prior year. In 2017, there were just under 4 million births, 500,000 fewer than in 2007. Even though there has been a 7% increase in women 20 to 39, women are delaying child birth. Over the past 10 years, women in their 30’s are now having more babies than women in their 20’s.

If you look at US health care outcomes, women can hardly be criticized for being cautious. Moms giving birth in the U.S. are three times as likely to die in the process as moms in Canada or the U.K. But that’s not the worst of it. For every woman who does die, 70 more (an estimated 50,000 moms) come close to dying.

The Obama administration recognized that lack of access to health insurance was a large factor, and targeted women for coverage. As a result, uninsured women under age 65 dropped from 20% to 11% overall, and for poor women uninsured declined from 34% to 18%.

For all interested in national health reform in the U.S., the measures of maternal-fetal health, safety, and care should be ground zero. That our performance – in 3rd world ratings for morbidity and mortality of both mothers and children – reflects the total absence of a national health plan let alone a national health system should be a national scandal.

We fail on every measure, even those most believe are our strong suits – like medical research. Case in point: Is the breast milk we’re feeding our children safe? This is the question raised in a New England Journal of Medicine article this week. It notes that 8 in 10 American women breast feed (at in least in part) during the first six months of their children’s lives. But we also know that over half (over 1.5 million lactating women) take one or more prescription drugs during that period. And these mothers often ask, is the milk safe?

You would think their doctors would know, but they don’t. After two decades of badgering, in 2006, the National Library of Medicine created a voluntary database called LactMed. Twelve years later, in 2018, there were 1408 products in the database. But only 2% had strong, evidence based data to support conclusions of safety.

This was consistent with an FDA analysis of 575 drugs in 2018 which included data on human lactation in only 15%. Research on breast-feeding, lactation, and breast milk garnered only .3% of the NIH budget in 2017. If you want to rise quickly in academic medicine, cancer or diabetes research if a far more lucrative and productive pathway.

But what if you’re a new mom trying to do right by your baby, and you’re on anti-hypertensive meds, is that OK? We don’t know. How about if you’re having trouble getting your milk to come in, and your doctor tells you to take the GI drug, metoclopramide, said to have an off-label benefit of increasing milk supply. Is that safe for your baby? We don’t know.

Bottom line is, when it comes to running a health care system, our priorities are all screwed up. And as health industry profiteers pursue their wildest genomic dreams, moms are left to wonder why they always seem to get the short end of the stick. I mean really – Is this any way to run a health care system?

Michael Bennet’s “Medicare-Xtra” = “Capitalism + Compassion”.

Posted on | April 3, 2019 | No Comments

Mike Magee

On July 30, 1965, President Lyndon B. Johnson signed into law “Medicare,” a national insurance plan for all Americans over 65. He did so in front of former President Truman, who 20 years earlier had proposed a national health plan for all Americans, and for his trouble was labeled by the AMA as the future father of “socialized medicine.”

For Truman, there was a double irony that day in 1965. First of all, the signing was occurring at around the same time as our neighbor to the north was signing their own national health plan, also called “Medicare”, but there’s covered all Canadian citizens, not just the elderly.

The second incongruity was that Truman was fully aware that in 1945, as he was being tarred and feathered as unpatriotic by taxpayers for having the gall to suggest that health care was a human right, those very same citizens were unknowingly funding the creation of national health plans as democracy stabilizers in our two primary vanquished enemies – Germany and Japan – as part of the US taxpayer supported Marshall Plan.

Fast forward more than a half century, and we’re still trying to correct the error, and make Medicare available to all citizens. For nearly all Democrats, and for many Republicans, as I’ve stated, the focus now is on “for all”. Arguably we’ve not quite evolved as a culture or society to embrace the notion of “all for one, and one for all.” That would require not only universality but a sense of solidarity, which goes against several hundred years of ultra-competitive capitalism. But what if we were to shoot for “Capitalism Plus” with the (+) being compassion?

Our Medicare continues to have very high satisfaction scores among citizens over 65. So theoretically, it shouldn’t have to be forced on anyone. That’s why, this week, potential Presidential candidate, Sen. Michael Bennet (D-Colo.), along with former VP candidate, Sen. Tim Caine (D-VA), suggested that pull vs. push was the way to go.

Their “Medicare-X” would allow anyone who chooses, to buy into Medicare. You like your employer insurance, with diminishing benefits and ever increasing deductibles and co-pays? Terrific, keep it! But if you would prefer the public plan with maternity benefits and mental health, with prevention and safeguards for pre-existing conditions, join the team.

Sen. Bennett says, “I see this as an attempt, a good-faith attempt, to try to address the gaps we have in our current health care system. It is an attempt to move us toward universal coverage. Everybody in America should be insured. I think every single Democrat sees that view and I hope over time Republicans in Washington will share that view as well.”

And he may be right. Presidential candidates Sens. Cory Booker (D-N.J.) and Kamala Harris (D-Calif.), have signed on to the plan. But as I lay out in “Code Blue: Inside the Medical Industrial Complex”, the key to a healthy America is re-establishing appropriate checks and balances, eliminating insurance gaming of the system, reference pricing pharmaceuticals and outlawing DTC advertising, and addressing physicians prescribing behaviors which can only generously be labeled “sloppy.”

Consider these latest figures on Adverse Drug Events (ADE):

● 5 million older adults sought medical attention for ADEs in 2018

● 42% of older adults take 5 or more prescription medications

● There was a 300% increase in polypharmacy over 20 years

● 750 hospitalizations every day due to ADEs in older adults

● $62 billion in unnecessary hospitalizations over 10 years

● 150,000 premature deaths in next 10 years due to ADEs

Michael Bennett is on the right track. He’s done his homework and knows his history. What is left is to make “Medicare-X”, “Medicare X-tra” by embracing three additional principles:

1. Less is more. Insurance Simplicity = Savings and Enhanced Quality and Performance. 16 health workers for ever physician – that’s ridiculous.

2. Health = Full Human Potential (not the elimination of disease). Innovative Research is great, but it is no substitute for national health planning and public health programming.

3. The Public Option must eliminate Medical Industrial Complex profiteering. It hurts our nation and our citizens in equal measure. Reinsert appropriate checks and balances.

Who named “Ritalin?”

Posted on | March 28, 2019 | 1 Comment

Rita and Leandro Panizzon

Mike Magee

Last week our “somewhat-less-than-excellent” American culture took an extra Trumpian hit. But this had nothing to do with gender abuse, or separating innocent children from their desperate parents, or even moves to knock 20 million Americans off their ACA enabled health insurance.

No this latest offense involved celebrities and the super-rich bribing their children’s pathways into elite colleges. While many expressed surprise and bewilderment, I was not among them. The reason can be found in chapter 8 of “Code Blue: Inside the Medical Industrial Complex” (Grove Atlantic/June 4, 2019).

In that chapter, I disclose how some parents, in concert with local teachers and compliant physicians, placed their young children on Ritalin and Adderall to improve their performance on standardized tests.

According to the American Psychological Association, attention deficit hyperactivity disorder (ADHD) affects 5 percent of America’s youngsters, though nearly 15 percent of high-school-age boys have been labeled with the condition. Yet no blood test or imaging study is available to confirm the diagnosis; there’s just a weakly validated 39-question yes-or-no survey that’s distributed far and wide in pediatricians’ offices, through the media, and through public and private schools nationwide.

When the diagnosis is broken down by gender, demographics, and geography, the distribution of ADHD becomes even more mystifying and disturbing. Rates can double and triple in areas, most notably Arkansas, Kentucky,Louisiana, and Tennessee, where schools promote the diagnosis and local physicians are willing to play along and prescribe.

Meanwhile, the Centers for Disease Control and Prevention reports that among poor and disadvantaged two- to five-year-olds who carry the diagnosis of ADHD, more than 75 percent are placed on drugs, while only half ever receive “any form of psychological services.”

Encouraged by a million-dollar grant from CIBA pharmaceuticals(originally Chemical Industries Basel) in 1989, Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD), with 34,000 members in 640 chapters, currently trumpets, on its website, the “12 amazing superpowers” associated with hyperactivity.

According to CHADD, medicated juveniles multitask with a “laser focus” and score high on tests, a result no parent or teacher would object to. In 2012 comedian Stephen Colbert critically labeled the behavior “meducation.”

The problem is that even when these pills deliver short-term, positive results, they short circuit the child’s development of strategies that can provide long-term solutions and success in adulthood. And as one might predict, anything in our culture that promises a quicker route to academic success is an invitation for illicit use.

For the whole story on the ADHD scam, you’ll need to read Code Blue, available for pre-order at www.codeblue.online. In the meantime, I’ll leave you with one fascinating tidbit to use at your next social gathering:

Q. Who invented the name Ritalin? 

A. The drug, Methylphenamine hydrochloride – an updated formulation of pre-WWII drug, Dexedrine – was created by CIBA chemist, Leandro Panizzon in 1956. His wife, Marguerite, was a tennis enthusiast looking for that extra oomph. Her nickname, Rita, provided the brand name—Ritalin. Although the company initially marketed the drug—with a 5,000 percent markup—for the treatment of depression and fatigue, in time it pivoted to a novel marketing pitch to therapists and counselors. These clinicians, CIBA said, should give the drug to their patients before a session because it could “help psychiatric patients talk in as little as 5 minutes.”

The Roots of Compassion – Dr. Ralph Snyderman and The 14th Dalai Lama

Posted on | March 21, 2019 | No Comments

Ralph Synderman MD and 14th Dalai Lama

Mike Magee

The issue of “doctor burnout” is front and center at the moment. It’s not a particularly new issue. I grappled with it way back in 1980, with soul-searching sessions at the Massachusetts Medical Society at the time. The focus then was on inadequate reimbursement, but the real issues were fear, depression, and isolation.

At the core of these debates are three elements: the caring professionals, the patients, and the system within which they encounter each other.

In 1999, working with social scientists, I set out to define what this encounter entailed, labeled then the “patient-physician relationship”. In a three month structured survey of both doctors and patients in the U.S., Canada, U.K., Germany, South Africa and Japan, I discovered surprising unanimity across geographies and between those receiving care and those delivering it. More than 90% of individuals surveyed said that the patient-physician relationship was three things – compassion, understanding and partnership.

Defining what the relationship was proved easier than nailing down what ails it at any moment in history.

Ralph Snyderman MD, Past-President of the AAMC and Chancellor Emeritus of Duke Medical Center took the unusual step last year to visit the 14th Dalai Lama in India and explore what it takes to ignite compassion in health care. In a joint publication, Dr. Snyderman describes the Dalai Lama’s insights including:

1. “Compassion is a deep inborne emotion and the source of true happiness.”

2. “Compassion is an inherent trait, but it does not necessarily maintain its focus and intensity in a world with so many factors suppressing it.”

3. “An essential component of compassion is the feeling of interconnectedness with others, which naturally leads to engagement—a critical component of effective health care.”

Twenty years ago, I asked a simple question: “Are we choosing the right individuals for medical school – ones that could deliver compassion, understanding and partnership – along with knowledge, judgement, and required skills? We tested 188 physicians from across the nation that hospital CEO’s had identified as “role models” for physicians using a highly validated Psychological Profile tool called NEO-PIR to identify scores on 20 different personality traits. One of those traits was “arrogance”, scoring low in our “best doctors” but present in more than trace amounts in 1/3 of our incoming class of students.

So first insight: We could do better in our medical student selection process by deliberatly attempting to rejecting arrogant students and selecting compassionate ones.

 Our second insight: Repeat testing of medical students and residents appeared to indicate that their capacity for compassion began to decline in the third year of medical school and continued downward through their years of residency. Conclusion: We could do better in designing training that did not systematically dehumanize future physicians.

Our third insight: Engaged and informed patients make better doctors. Expanding the time and quality of interaction expanded physician responsiveness, engagement and resilience.

Our final insight: Health system design inequities matter. Physicians and nurses are trained to take all comers without prejudice, no questions asked. The fundamentals of compassion, understanding and partnership don’t function very well in a dog-eat-dog environment where substanial portions of our citizenry are uninsured or underinsured; where major social determinants of health are largely ignored; where time devoted to patients is less than time devoted to billers; and where focus on patient care is substantially undervalued compared to profiteering research.

Compassion takes time and focus. Health systems that are equitable, accessible, and above all simple give the patient-professional relationship the opportunity to advance understanding and true partnership. Universality, solidarity, and compassion are one in the same.

Dr. Snyderman and the 14th Dalai Lama, Tensin Gyato, leave us with this challenge: “We must focus not only on developing the best scientifically driven care but also on creating delivery models that facilitate compassion, making them more personalized to the needs and capabilities of the patient and, hence, more cost-effective and humane than our current fragmented approach to care.”

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