HealthCommentary

Exploring Human Potential

WSJ Denialists: “Same Climate Report, Different Day.”

Posted on | August 12, 2021 | No Comments

Mike Magee

This past weeks scary Climate Report raised alarm bells with good reason around the world. What’s not surprising is that the editorial page of the Wall Street Journal has not changed its tune. Holman W. Jenkins, Jr.’s headlined, “Same Climate Report, Different Day.”  In some ways, he’s right – the finding (the News in the report) is actually not new.

In 1997, Gro Brundtland, then head of the WHO defined health as “human potential”. In doing so, she broadened the sphere of interest of health policy experts on a macro level and challenged physicians on a micro level. In essence she united for the first time patient health and planetary health.

Since that time, we have seen a continued battle and debate in the public space between the overwhelming majority of scientists who has raised the alarm over the self-reinforcing cycle of global warming, and a much smaller but highly vocal segment of the scientific community, who – often with the support of dollars from energy related corporations – have denied the challenge we and the planet face.

Exactly 7 years ago, in an article in JAMA, physicians for the first time were directly challenged to educate their patients regarding the coming health risks associated with global warming.  The authors reviewed the evidence related to this impending crisis and come to this conclusion: “Evidence over the past 20 years indicates that climate change can be associated with adverse health outcomes. Health care professionals have an important role in understanding and communicating the related potential health concerns and the co-benefits from reducing greenhouse gas emissions.”

The article in part noted:

1. “Consensus is substantial that human behavior contributes to climate change: 97% of climatologists maintain that climate change is caused by human activities, particularly fossil fuel combustion and tropical deforestation.”

2. “About half of anthropogenic greenhouse gas emissions between 1750 and 2010 occurred since 1970. The increase in greenhouse gas emissions has been greatest in the last decade (2.2% per year) compared with 1.3% per year between 1970 and 2000.5 Emissions continue to increase; 2011 emissions exceeded those in 2005 by 43%.”

3. “Carbon dioxide from fossil fuels and industrial processes accounted for approximately 78% of the total increase from 1970-2010.”

4. “The trend toward decarbonization (cleaner fuels) of the world’s energy since the 1970s has been reversed by increased coal combustion since 2000.”

5. “Climate change is happening: the relationship of heat-waves, floods, and droughts along with adverse health outcomes is evident. Two broad approaches are needed to protect public health: mitigation, or major reductions in carbon emissions, corresponding to primary prevention; and adaptation, or steps to anticipate and reduce threats, corresponding to secondary prevention (or public health preparedness).”

6. Key health risks noted  for doctors and patients included:

“Heat-related disorders, including heat stress and economic consequences of reduced work capacity.”

“Respiratory disorders, including those exacerbated by fine particulate pollutants, such as asthma and allergic diseases.”

“Infectious diseases, including vector borne diseases, such as Lyme disease, and water-borne diseases, such as childhood gastrointestinal diseases.”

“Food production, including reduced crop yields and an increase in plant diseases.”

“Mental health disorders such as post-traumatic stress disorder and depression that are associated with natural disasters.”

7. Mitigating climate change could yield health benefits:

“Economic advantages of reducing fossil fuel combustion and improving air quality, including a reduction in chronic diseases and their associated health care costs, and economic opportunities associated with development of alternative forms of energy.”

“Infrastructure improvements that reduce greenhouse emissions could also lead to increased physical activity that would be associated with a reduction in various chronic diseases.”

8. Heat related death and disability said the author, have been understated: “The most direct effect of a warming planet is heat stress and associated disorders. Heat-related deaths are routinely attributed to causes such as cardiac arrest without citing temperature as the underlying factor. Thus, the actual death toll attributable to heat is greater than certified on death certificates.”

9. Global warming will continue to reduce productivity: “Using industrial and military guidelines, Dunne et al estimated that ambient heat stress has reduced global population-weighted labor capacity by 10% in summer’s peak over the past few decades. Projected reduction may double by 2050 and may be even larger in the latter half of the 21st century.”

10. Additional death and disability secondary to food scarcity, respiratory disease and waterborne disease in all age groups and traumatic, disaster related injuries is to be expected. The mental health implications of these stressors are currently being underreported.

How can health professionals help?

“ Effective communication may shift knowledge, attitudes, and behavior toward reducing the risks of climate change. Research indicates several principles of effective climate communication that closely resemble those used in health. Themes include 2-way communication, gearing messages to the audience, limiting use of fear-based messages,  issuing simple lucid messages repeated often from trusted sources, and making health-promoting choices easy and appealing.”

“Health may be a compelling frame for communication about climate change, reflecting views that change threatens health. Although further research is needed to define the role of health in climate communication, practical communication resources are becoming available, implying an important role for health care professionals.”

The WSJ’s Jenkins writes, “Corporate management has nothing material to add.” The 2014 JAMA article suggests that health professionals do.

Celebrate The Good!

Posted on | August 5, 2021 | 4 Comments

Mike Magee

A week ago, I came across this photo on Linkedin posted as part of a message from Mary Bardin, a Senior Services Manager at Sunbeam House Services, an Irish firm from Bray, County Wicklow.

I shared her post, and added the words, “Celebrate the good!”

In the week that followed, 49 others “liked” my post, which is my equivalent of “going viral.” As I watched those numbers climb, three questions emerged. First, who were the two people in this photo with missing left forearms, and how did they come to connect? Second, what caused me and others to react positively to this image? Three, does this image carry a message for Americans, some hidden instruction how to manage our current reality?

1) Who are they?

In the summer of 2017, Colleen and Miles Tidd were told that their third child would be born without a left forearm. Colleen later reported that she cried at first, but not for long. They had two other children, girls age 2 and 12, to consider. In preparation for their son Joseph’s birth, they reached out to an advocacy organization, “Lucky Fin”, for information and support. The name derives from the 2003 Disney classic, “Finding Nemo”, and its’ animated star clownfish, Nemo. He was born with one short fin, the result of a barracuda attack that killed his mother and sister, and cracked his egg while he was still in development. The little fish was left with an over-protective father who, out of fear, tried to limit his future. Nemo resisted and found his strength and purpose, in part, by redefining what other sea creatures saw in him. They saw a unfortunate fish with an abnormally shortened limb. He saw adventure ahead, powered by his “lucky fin.”

This was just the kind of messaging Molly Stapelman was looking for in 2007 when her healthy baby girl, Ryan, was born with “her right hand stunted, her palm small and no fingers except a tiny thumb.” Three years later, she launched “Lucky Fin” stating that, “A child being born with a limb difference is not tragic. It’s extremely important to show our children how capable & wonderfully made they are. If we treat them as flawed or limited that is who they will believe themselves to be- and that would be the tragedy.”

Colleen and Mike Tidd, in turn, discovered Molly’s organization, and with the encouragement of Joseph’s sisters, who loved the Disney movie, reinforced the hidden power of his own “lucky fin.” His parents took the personal campaign one step further. They began to document their son’s adventures on an Instagram page called “tiddbit_outta_hand.”

Carson Pickett, the soccer star, has her own story. She was born in 1994 near Jacksonville, Florida, with a missing left forearm, nearly identical to Joseph (nicknamed Joe-Joe) Tidd. Her parents, Treasure and Mike, were former college sports stars, committed to expanding rather than limiting their daughter’s horizons. Carson’s mantra became, “Control what you can control”, her own variation of Nemo’s famous, “Just keep swimming.” At age five, her father introduced her to soccer and she never looked back. She was a standout at Florida State University, and was drafted by the National Women’s Soccer League team, Seattle Reign. In 2018, she was part of a three-person trade to the NWSL’s Orlando Pride.

Colleen and Mike Tidd immediately took notice. Joe-Joe and Carson were both born in Florida, loved soccer, were athletic, and had partially formed left arms. Their limb defects placed them among 2,250 U.S. babies born each year with the condition. By the time their photo was taken in April, 2019, Joe-Joe was 21 months old and had taken to wearing a purple Pride jersey with Carson’s #16 on the back.

2) What’s in an image?

The famous photo was taken by Joe-Joe’s mother at a home game in 2019 when Carson jogged over to the family after hearing their cheers. As reported, “She repeatedly tapped her arm against his as he shrieked with glee.” After the game, the two spent time in the locker room playing their version of peekaboo – pulling up their shirt sleeve to expose their left arms. As Colleen recounted, “It took a minute for him to realize, ‘Wow, we’ve got the same arms,’ and then he just giggled. You could see it hit him, and then they were best friends after that…She’s like me.”

When they arrived home, Colleen posted the photo on “tidbit_outta_hand”. Why? She said, “It’s just showing that he might be unique, but he’s no different than anyone else. He’s going to be able to accomplish it all.”

Since then, that photo has touched many others, especially those isolated by the pandemic, or caught in the throes of America’s political upheaval. For all of them, Nemo’s “Just keep swimming”, or Carson’s “Control what you can control”, or Joe-Joe’s ecstatic response to “Reach out and touch”, speak of persistence, resilience, endurance, common humanity – and yes, goodness.

3) What is the message for us?

The emotional journey of the past few years has touched all Americans. Fear and worry have had a corrosive effect on our society, and isolation added fuel to the fire. But challenges also carry with them enlightenment. Joe-Joe’s father Miles said it best. “Carson knelt down next to Joseph and showed him her arm. It was this instant bond we can’t begin to understand.”

A human connection can be very powerful and healing. For Miles and his wife that connection extended to Carson’s parents, Treasure and Mike Pickett. Their advice: Never allow the words, “I can’t.” Carson added, “People might not treat you the right way or they may stare at you. But the way that you treat people is going to go way further than anything else.”

The image has a power all its own. Renewing contact in the middle of the pandemic’s Delta variant surge isn’t easy. Keep swimming. Fighting intentional waves of deliberate misinformation designed to sow division and distrust is discouraging. Control what you can control. Deliberate efforts to disenfranchise or deny or destroy other human beings is disheartening. Celebrate the good and embrace the future.

You never know. The greater good may be just around the corner. Ask Carson Pickett. She’s 27 now, and her Orlando team was sidelined when several members tested positive for Covid, eliminating them from playoff’s. Around the same time, there was a knock on her door, with a package containing an easy entry shoe with a wrap-around strap closure in lieu of laces. The Phantom GT Academy FlyEase was her shoe – literally.

She had teamed up with Nike, and this shoe held special meaning. She recalled “I saw my younger self. I looked at it and it almost brought me to tears because it’s just awesome to see something that would’ve really helped me when I was younger. ”

You never know. “Ever since I got to the pros and seeing how many amazing messages I get sent about how I inspire people, some who aren’t even soccer players,” she said. “[Seeing that] just showed me that I can do so much more than just be a good soccer player, and that I could advocate for something much bigger than soccer.”

Health Care Needs A Hero.

Posted on | July 27, 2021 | 2 Comments

Mike Magee

Health care needs its heroes.

I came to that conclusion this week through a round about route.

First I read Maureen Dowd’s interview entitled “Dara Khosrowshahi, Dad of Silicon Valley”, in which she, with some affection, gives the reader a look behind the scenes at the personal life of the current Uber CEO. At one point, Dowd shares her conversation with Dara’s 20 year old daughter, Chloe, a Brown student, who wants us to know her father was a seriously good dad. In support of this belief, she reports that “When she was little, her father – a fan of Joseph Campbell…would concoct children’s stories set in faraway kingdoms…”

This, of course, forced me to acknowledge that I didn’t know who Joseph Campbell was. Bill Moyers came to the rescue. His June 21, 1988 interview titled “Joseph Campbell and the Power of Myth — ‘The Hero’s Adventure’”, begins with a clip from Star Wars where Darth Vader says to Luke, “Join me, and I will complete your training.” And Luke replies, “I’ll never join you!” Darth Vader then laments, “If you only knew the power of the dark side.” Moyers asked Campbell to comment.

JOSEPH CAMPBELL: He (Darth Vader) isn’t thinking, or living in terms of humanity, he’s living in terms of a system. And this is the threat to our lives; we all face it, we all operate in our society in relation to a system. Now, is the system going to eat you up and relieve you of your humanity, or are you going to be able to use the system to human purposes.

BILL MOYERS: So perhaps the hero lurks in each one of us, when we don’t know it.

By then, I was aware that Joseph Campbell, who died in 1987 at the age 83, was a professor of literature and comparative mythology at Sarah Lawrence College. His famous 1949 book, “The Hero With a Thousand Faces” made the case that, despite varying cultures and religions, the hero’s story of departure, initiation, and return, is remarkably consistent and defines “the hero’s quest.” His knowledge of this quest gained him a large following that included George Lucas who was a close friend and has said that Star Wars was largely influenced by Campbell’s scholarship.

Whether health care or technology, unfettered capitalism is more than adept at breeding predatory systems that beg for redemption. Author Emily Chang spoke to this predilection in her 2018 book, “Brotopia”, describing Silicon Valley types as “secretive, orgiastic, and dark.” Dara Kharowshaki’s CEO predecessor at Uber, Travis Kalanick, was labeled one of the worst. When Dara took over, New York Times technology expert, Mike Issac asked in 2019, “Can this rational, charming chief without the edge, ego or cult following of wacky founders succeed in today’s insane economy?”

But Dara’s journey across and within Uber seems to be guided by his inner “Joseph Campbell.” Departure, Initiation, Return. He appears to be mid-stream in challenging his own system. Not naming Mark Zuckerberg, he mused, “I think, just like Uber, some of them grew up too fast and some of them didn’t take responsibility for their power and I think now they’re being called to reckon… I think the age of ‘I built a platform, I’m not responsible,’ that time is over. And now the question is, what does the responsibility look like? Defining it and putting guard rails around it, I think that’s a healthy thing.”

Health care if anything is more complex than Silicon Valley. Deeply segmented but fundamentally opaque and collusive, the Medical Industrial Complex controls 1/5 of the economy with power literally over life and death decision-making. With its share of heroes – from every day doctors and nurses to unassuming scientists birthing “just-in-time” cures – the system also has breed some first class villains of the likes of Arthur Sackler, Martin Shkreli, and Elizabeth Holmes.

Health care, for all its pure and idealized mythology, has descended into the belly of the capitalist beast. Its vaulted training institutions have captured and breed many of our nations finest, only to trap them in a compromised and conflicted “Initiation” phase, from which they never “Return.” As Dara told Dowd, “sometimes the system ‘works too well’: I think capitalism has its claws in our democratic societies in ways that has allowed it to overly optimize for its benefit.”

Health Care needs to be certain that its young and developing heroes, who depart from their civilian lives, to be initiated into a life of service and sacrifice, are not captured by “the dark side.”

Those who train doctors and nurses and health professionals, who lead research and discovery, who administer health care institutions, need to understand the fundamental challenge in “the hero’s quest.” As Joseph Campbell stated “Is the system going to eat you up and relieve you of your humanity, or are you going to be able to use the system to human purposes?”

Confronting “Health Care Royalists.”

Posted on | July 19, 2021 | 6 Comments

Mike Magee

Earlier this month President Biden signed a far-reaching executive order intended to fuel social and economic reform, and in the process created a potential super-highway sized corridor for programs like universal healthcare. In the President’s view, the enemy of the common man in pursuit of a “fair deal” is not lack of competition, but “favoritism.”

To understand the far-reaching implications of this subtle shift in emphasis, let’s review a bit of history. It is easy to forget that this nation was the byproduct of British induced tyranny and economic favoritism. In 1773, citizens of Boston decided they had had enough, and dumped a shipment of tea, owned by the British East India Company, into the Boston Harbor. This action was more an act of practical necessity than politics. The company was simply one of many “favorites” (organizations and individuals) that “got along by going along” with their British controllers. In lacking a free hand to compete in a free market, the horizons for our budding patriots and their families were indefinitely curtailed.

Large power differentials not only threatened them as individuals but also the proper functioning of the new representative government that would emerge after the American Revolution. Let’s recall that only white male property owners over 21 (excluding Catholics and Jews) had the right to vote at our nation’s inception.

Over the following two centuries, power imbalances have taken on a number of forms. For example, during the industrial revolution, corporate mega-powers earned the designation “trusts”, and the enmity of legislators like Senator John Sherman of Ohio, who as Chairman of the Senate Republican Conference, led the enactment of the Sherman Antitrust Act of 1890.

He defined a “trust” as a group of businesses that collude or merge to form a monopoly. As University of California historian Nelson Lichtenstein recently noted, to Sen. Sherman, J.D. Rockefeller, the head of Standard Oil, was no better than a monarch. “If we will not endure a king as political power, we should not endure a king over the production, transportation and sale of any of the necessities of life”, he said.   The law itself stated “[e]very contract, combination in the form of trust or otherwise, or conspiracy, in restraint of trade or commerce among the several States, or with foreign nations, is declared to be illegal.”

In the middle of the Great Depression, FDR also focused on financial favoritism as the source of the common man’s misery. Branding the powerful as “economic royalists”, he saw political corruption and worker exploitation as human foibles, and government regulation as an essential safeguard against our inborn tendencies toward greed and avarice.

Note the shift in emphasis. To FDR, the problem was not simply a structural lack of competition in our capitalist society, but also the absence of adequate regulation and oversight of humans who, in the pursuit of power and favoritism, levied harm and discrimination against each other.

By the time Ronald Reagan assumed the presidency, mass movement of people, data, and products had created a global marketplace. This new emphasis on “global competitiveness” provided moral cover for a twenty-year campaign of deregulation that spanned Republican and Democratic administrations. Now worldwide competition ruled the reign, ultimately descending to Trumpian reductionism where you were either a “winner” or a “loser.”

As corporate profits soared, wages and benefits for workers were slashed, and the gap between rich and poor soared. Over the past forty years, CEO pay increased by over 1000%, while the typical worker’s wage inched up by a meager 10%. Our favored 1%, supported by an army of state and federal lobbyists, argued that the solution to a widening power differential was more unfettered capitalism. That was until the COVID 19 pandemic arrived on our shores.

Strangely enough, the pandemic became an equalizer, a truth-teller, and a social experiment on a grand scale. All Americans sheltered at home for 18 months, and to varying degrees reflected on their purpose and priorities.

As an equalizer, the virus was “democratic”, showing little preference. All were vulnerable. The poor and minorities were slightly more at risk. But so were the elderly, those with chronic disease, and those ignorant enough to politically posture and deliberately place themselves at risk.

As a truth teller, the pandemic exposed the lack of national health planning, a limited capacity to handle a national health emergency, vulnerable and exposed health care workers, and enormous geographic variability in the quality of our health services. Our inadequate health system lay naked and exposed.

Finally, as a social experiment, for the first time in recent memory, our government provided direct relief and resources to our citizens themselves rather than “trickling down” relief through the hands of powerful intermediaries. Citizens found themselves part of the “favored” class. Fears of inappropriate use proved ill founded. The relief sustained our economy. Every day citizens’ purchases were wise and restrained. Debt was paid down and savings expanded.

Biden’s executive order, including 72 initiatives that impact health care, technology, transportation, agriculture and the environment, seeks to expand economic equality, not so much by injecting competition that can be manipulated and compromised by those who wield the power in our society, but by interacting simply and directly with America’s 99%.

Take just one initiative – the direction to allow over-the-counter sale of hearing aids. Traditionally defined, this move injects competition. But combined with expansion of Medicare benefits, the move entrusts every day people with the power to care properly for family and loved ones.

Which brings me to Universal Health Care. As I document in my book, “Code Blue: Inside the Medical Industrial Complex” (Grove/2020), America threw all its’ health care eggs into a profiteering capitalist basket over 70 years ago, leaving behind huge swaths of our citizenry, progressively diminished as the Health Sector profiteers cornered rough 1/5 of our GDP.

With the aid of new information technologies, and coordinated lobbying in a largely deregulated society, the Medical Industrial Complex followed the Standard Oil playbook, creating virtual horizontal and vertical integrated networks that were both collusive and monopolistic. Pharmacy Benefit Management (PBM) programs were but one example, opaquely moving data, pills and money, as their lobbyists secured the right to share hidden kickbacks among themselves.

President Biden’s actions last week weaken the hold of “competition” as a cure all for this nation’s economic injustice and inequity. By stating that “Capitalism without competition isn’t capitalism. It’s exploitation.” our President is inching the debate forward. Exploitation subtly suggests it is now our time to confront modern-day “economic royalists.”

What Biden needs to do now is double-down on the provision of direct benefits to our citizens themselves. As the pandemic has demonstrated, they can be trusted with this power to use our resources wisely without the help of powerful intermediaries. Extending a public health care option as a “favored” gesture to the 99%, would be a wise next step, and would send a clear message to “Health Care Royalists” that their reign of coercive terror may soon be coming to an end.

Who Will Write Tomorrow’s American Story? A Hamiltonian Perspective on COVID 19.

Posted on | July 12, 2021 | 2 Comments

Mike Magee MD

“In countries where there is great private wealth much may be effected by the voluntary contributions of patriotic individuals, but in a community situated like that of the United States, the public purse must supply the deficiency of private resource. In what can it be so useful as in prompting and improving the efforts of industry?”

Those were the words of Alexander Hamilton published on December 5, 1791 in his “Report on the Subject of Manufactures.” He was making the case for an activist federal government with the capacity to support a fledgling nation and its leaders long enough to allow economic independence from foreign competitors.

Today’s “foreign force” of course is not any one nation but rather a microbe, gearing up for a fourth attack on our shores with Delta and Lambda variants. This invader has already reeked havoc with our economy, knocking off nearly 2% of our GDP, as the nation and the majority of its workers experienced a period of voluntary lockdown.

Our leaders followed Hamilton’s advise and threw the full economic weight of our federal government into a dramatic and direct response. Seeing the threat as akin to a national disaster, money was placed expansively and directly into the waiting hands of our citizens, debtors were temporarily forgiven, foreclosures and evictions were halted, and all but the most essential workers sheltered in place.

Millions of citizens were asked to work remotely or differently (including school children and their teachers) or to not work at all – made possible by the government temporarily serving as their paymaster and keeping them afloat.

As we awake from this economic coma, many of our citizens are reflecting on their previously out-of-balance lives, their hyper-competitiveness, their under-valued or dead-end jobs, and acknowledging their remarkable capacity to survive, and even thrive, in a very different social arrangement.

If our nation is experiencing a trauma-induced existential awakening, it is certainly understandable. America has lost over 600,000 of our own in the past 18 months, more people per capita than almost all comparator nations in Europe and Asia. This has included not just the frail elderly, but also those under 65. In the disastrous wake of this tragedy, 40% of our population reports new pandemic related anxiety and depression.

A quarter of our citizens avoided needed medical care during this lockdown. For example, screening PAP smears dropped by 80%. And so, Americans chronic burden of disease, already twice that of most nations in the world, has expanded once again. There will be an additional price to be paid for that.

The Kaiser Family Foundation’s most recent Health System Dashboard lists COVID-19 as our third leading cause of death, inching out deaths from prescription opioid overdoses. Year to date spending on provider health services through 2020 dropped 2%, but pharmaceutical profits, driven by exorbitant pricing, actually increased, bringing health sector declines overall down by -.5% compared to overall GDP declines of -1.8%. The net effect? The percentage of our GDP devoted to health care in the U.S. actually grew during the pandemic – a startling fact since our citizens already pay roughly twice as much per capita as most comparator nations around the world for health care.

In the “pause”, other nations have been soul-searching as well. A common theme has been work. Two of the most popular discussions include remote work from home and the four day work week. These discussions were already well underway pre-pandemic in Germany, Spain, New Zealand, Iceland and beyond. But now, they are cropping up in U.S. corporations like PepsiCo and Verizon as Human Resource departments grapple with scarce or reluctant employees, and consider paid time off, flexible work schedules and remote work arrangements.

In some ways, we remain the nation that Hamilton described in 1791. We have been unable to come fully to grip with our racist past, and have used both our state and federal governments – not to provide economic room for our citizens to survive foreign competitors – but rather to maintain the status-quo advantages of home-grown “haves” over “have-nots.”

On the surface, Red vs. Blue America seem ill prepared to start anew, to learn from and progress off the back-end of this historic pandemic.

Americans have had a year and a half to reflect and think about work and life, priorities and the future. Our discomfort with the current arrangement is palpable. Is this the America we want?

As Lin-Manuel Miranda, author of Hamilton: The Revolution,  wrote, “History is entirely created by the person who writes the story.” Tomorrow’s story of America is now being written by us.

What if we managed to spread our nation’s resources more equitably? What if we eliminated “non-real work” and allowed remote work as the rule rather than the exception. What if health care and early childcare programs were universal, and not tied to one’s job? What if technologic innovation was employed to advance equity and justice? What if we decided that making our lives better was the goal instead of just maximizing our GDP.

Wouldn’t that be a better way to live?

 

 

 

 

 

July 4, 2021 – Sharing The Truth In Red, White, and Blue.

Posted on | July 4, 2021 | 3 Comments

Mike Magee

Four years ago, on July 4th, as we came to grip with Trumpism, I wrote a piece titled “A Nation At Risk This 4th of July.”

At the time, I noted the fact that the US was the only developed nation in the world that spent more on Health Care than all other Social Services combined according to a 2015 Commonwealth Fund study. This regressive achievement remains true today, reinforced by pandemic induced revelations of lack of capacity to plan and execute for national health emergencies.

Besides reflecting our distorted financial and ethical priorities, and the natural end point of a profit-driven free enterprise health care system, Covid graphically continues to expose our nation’s vulnerability, as most Republican led states intentionally politicize preventive strategies and vaccinations.

Our inability to come to grips with a 1947 decision to throw our weight behind private profiteering health insurance has crowded out all other US priorities and threatens our economy. A simple shift to consolidate back room insurance functions (not the management or delivery of care) could trim 15% off the US health care bill immediately. But more than this, it would allow us to develop for the first time an integrated plan to assure a more healthy America.

Under such a plan, medical schools could integrate social mission into health professional education as Fitzhugh Mullan had suggested before his untimely death. Also in the positive column, regressive policies such as those proposed by Trump EPA chief Scott Pruit, now recognized in the new Biden era as economically dangerous and ethically disastrous, could be integrated into health planning.

As we wait for the US populace to catch up with this new administration (in much the same way as 1970 America’s Nixon supporters took 19 months to finally come to grips with the fact that their President was both corrupt and unwell), we all need to continue to expose the truth in words and graphics. As we do this, we need to shore up the weaknesses in our governance, revealed so obviously on January 6th, and in the halls of Republican state legislatures to this day.

Paul Voosen, Earth and Planetary Science journalist for Science magazine in the June 30, 2017 issue of Science depicted the loss in state and county GDP as a result of the predicted impact of global warming. Four years later, regressive policies meant to undermine the sacred right to vote in our democracy in these very same states, led by Trump’s most loyal supporters, punctuates that this July 4th much remains to be done to fulfill America’s promise.

As Frank Rich predicted four years ago in a New York magazine cover story, “How A Presidency Ends”, Trump is ultimately arriving at the same end point as Richard Nixon. Rich perhaps foresaw the January 6th Insurrection when he prophesized Trump’s demise, writing “Between now and then, there will be lulls in the downward trajectory, …and many shocks and surprises.” 

We have a new President, and challenges from health care, to the environment, to tumbling infrastructure and more. But none of these amount to more than the many obstacles Americans have overcome in our 245 years as a nation.

We shall survive, and may even thrive as equitable, fair, joyful and wise. But only if patriotic Americans continue to doggedly and respectfully pursue, display and share the truth in red, white and blue.

Happy July 4th!

Health Tech – Part II: The Risk of Under-Powering The Vision.

Posted on | July 3, 2021 | No Comments

Mike Magee

Few can disagree that, in the fog of the Covid 19 pandemic, health technology entrepreneurs have been on a tear. In the first year of Covid’s isolation induced new reality, digital health companies experienced a $21.6 billion investment boost, double that of the prior year, and four times 2016 funding.

By year two, the investment community exhibited some signs of self-restraint by raising a few open ended questions. For example, in early 2021, Deloitte & Touche led a Future of Health panel at the J.P. Morgan Healthcare conference, reporting that “panelists suggested that entrepreneurs need to go beyond products that simply improve processes or solve existing problems.”

Panelists predicted that virtual health delivery services will expand; consumers will demand greater involvement including expansion of home diagnostics; and investment driven mergers and acquistions will explode – all of which has proven to be true.

Adding push to shove, Deloitte added this final nudge: “Entrepreneurs who define new markets, dominate them with a strategy people can understand, and extract value will likely be the most successful.” Recent surveys also reveal that only 1 in 5 health care executives are satisfied with their health tech solutions.

Forty years ago, in the early beginnings of Health Tech, words similar to those above triggered cautionary tones from traditionalists. For example, Dr. John A. Benson, Jr., then President of the Board of Internal Medicine, stated “There is a groundswell in American medicine, this desire to encourage more ethical and humanistic concerns in physicians. After the technological progress that medicine made in the 60’s and 70’s, this is a swing of the pendulum back to the fact that we are doctors, and that we can do a lot better than we are doing now.”

He accurately described the mood then, and for most of the 20th century, of academic clinicians toward technology, a complex love-hate relationship that has rejoiced and cheered on progress, while struggling to accept and master change in a manner that would avoid driving a wedge between academicians, clinicians and patients.

In the lead up to the 2005 White House Conference on Aging, the National Commission on Quality Long Term Care attempted to bridge that gap.

As the chair of their technology sub-committee, I wrote the report, “Fully Leveraging Technology to Transform Health Care.” I asked then, “How might technology be applied to re-engineer homes for health and assure maximum connectivity to support aging citizens as part of the multigenerational family, the community and a preventive oriented health delivery system?”

This insight, that the technology should not be limited only to fourth and fifth generation Americans, but rather, in an integral way, be applied to assist as well the three generations below them – their children, grandchildren, and great-grandchildren – reinforces the concept of technology applications as both assistive and transformational.

Such a vision focuses on healthy bodies and health minds. It assists memory as well as mobility. It harnesses software and hardware to not only improve individual quality of life, but to also advantage family, community and societal goals.

Independence also implies responsibility centered on individuals and their networks of support including family, friends and caring professionals. As citizens we have differing capabilities and needs, and these change as we age. We must help each other. But to do so efficiently, we must advantage virtual connectivity and a full range of technologic applications that unlock our fullest individual and collective human potential.7

The revolutionary strength of modern information and scientific technologies is that “they ignore geography.” In so doing they allow us to reorient and connect beyond the limits of a range of barriers whether they be physical, social, financial or political. The danger is not in over-reaching but in under-reaching.

Where are the “killer applications” that would allow lifespan planning to move us ahead of the disease curve? How can we target technologic advances in health to first reach our citizens most at risk? How do we, in powering the health technology revolution, broaden our social contract to include universal health insurance? How do we unite the technology, entertainment, and financial sectors (previously locked out of the health care space) with the traditional health care power players, and incentivize them to work together to create a truly preventive and holistic health delivery system that is equitable, just, efficient, and uniformly reliable? How can each citizen play a role in ongoing research and innovation, and help define lifelong learning and behavioral modification as part of good citizenship? What can corporate America do to advance health in the broadest sense of the word, and in “doing good,” do well financially, serving Main Street as it serves Wall Street?

Technologies can enable, operate, connect, instruct and assist. But to do so logically and efficiently they must conform to a vision that is both generalizable and customizable. Technology offers the flexibility and fluidity to pursue health, independence, mobility, financial security, social engagement and cognition in hundreds of thousands of uniquely different environments simultaneously, while also pursuing a single unified and collectively committed vision for our nation.

In 2005, the Commission reported stated, “Technology has the power to assist us in healing, providing health and keeping our nation and global family whole. But it’s capacity to deliver on this promise is dependent on a vision for health that is both broad and inclusive.”

In 2021, academic medical leaders and health technology investors may find common ground in asking the question, “How does my support for this proposed technology project make America and all Americans healthy?”

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