HealthCommentary

Exploring Human Potential

We Must All Swim Together for Cross-Racial Solidarity.

Posted on | February 18, 2021 | 3 Comments

Source: Penguin Random House

Mike Magee

“…honest self-examination is a critically important step to better understanding ourselves, to heal old wounds, and to take corrective actions to address ongoing societal harms.”

These were not the words of a member of Congress in the wake of the January 6 insurrection, nor the incantations of a religious leader appealing to a congregation of worshipers. They were the words this week of James L. Madura MD, the CEO of the American Medical Association in Chicago, IL.

They mirrored the final words in “CODE BLUE: Inside the Medical Industrial Complex”: “In the Declaration of Independence, our nation’s founders proclaimed that equality was self-evident. Nearly 250 years later, what has become equally self-evident is that there is no equality without reasonable access to health care, and that universal insurance coverage is the only system that truly can provide access that is reasonable.”

Dr. Madura was announcing the retirement of the bust of Dr. Nathan Davis who since 1845 has proudly carried the moniker, “father of the AMA.” The organization that he was instrumental in launching, however, had a rocky start.

According to Madura, “Dr. Davis’s answer for maintaining the AMA as a national organization was to explicitly exclude women and Black physicians from representation in our House of Delegates, thus appeasing many state and local medical societies who barred all but white men from their membership…Sadly, this would remain AMA policy for nearly a century, until race- and gender-based discrimination was officially outlawed by the Civil Right Act of 1964.”

His statement comes at a time when white supremacy and domestic terrorism is front and center after four years of relentless encouragement by Donald Trump. But its origins arose during a different Republican administration.

In the new millennium, there was renewed focus within academic medicine on health disparities. Madura states that “In 2008, the AMA concluded a three-year study on the racial divide in organized medicine and publicly apologized for our organization’s past discriminatory practices against Black physicians. The AMA’s apology was never intended to be the final word on the subject of race for our organization. In fact, the AMA called it ‘a modest first step toward healing and reconciliation.’”

Madura likely agrees with Bill Moyers who believes the problem runs deep and is at the core of America’s fatal flaw. Moyers says, “We’ve invested the word ‘democracy,’ with so much sacred aura. But we never really have had a real democracy.”

Author Heather McGhee, whose new book, THE SUM OF US: What Racism Costs Everyone, and How We Can Prosper Together” was just released, couldn’t agree more. As she says, “I think we really do have a secular religion in America, this idea that the powerful have to ask us for their permission to rule, right? The founders left holes in the bedrock of that revolutionary idea in order to make room for slavery and racial subjugation. And time and time again, with every generation, there has been a concerted effort to keep chipping away, to keep democracy, which in this country, would be a multiracial democracy, from taking root.”

McGhee literally illustrates her point on the book cover. There you’ll find a 1950 style illustration of a white child jumping off a diving board into a swimming pool, as a black child steps on a ladder on her way out. Inside the cover, McGhee reveals that when anti-segregation laws took hold in the U.S., over 2000 thousand communities, not only in the South but in the North as well, drained or filled in these public pools financed by tax dollars, rather than comply with integration. In recounting the story to Bill Moyers, he replies, “That happened, I regret to tell you, in my hometown.”

Heather McGhee is a descendent of slaves. Her great-grandparents and grandparents were part of the great migration north, worked in the steel mills, and settled in Madura’s city, Chicago. What the two have in common today is optimism and activism.

In removing Nathan Davis from his throne, Dr. Madura signals that it is time for this nation to grow up, swim in the same pool, and leave the “zero sum” game behind.

McGhee couldn’t agree more. “Racism has a cost for everyone. And its primary function in our society has been to grease the wheels for a machine of greed that has impoverished almost everyone…racial division as a tool wielded by those who are the most wealthy, the most powerful, and the most self-interested, is something that breaks down potential coalitions between people who have common struggle. It makes us demonize one another when, in fact, we should be linking arms to improve all of our lives…when we can create cross-racial solidarity, we can all benefit.”

The Seeds To Plant Now to Assure Vaccine Success.

Posted on | February 10, 2021 | No Comments

Mike Magee

In the wake of Pearl Harbor, FDR found our nation ill prepared for war. He lacked manpower and tools. In response, he took deliberative action with the support of Congress, drafting soldiers and redirecting supply chains toward weapons of war. Compliance was requested, then demanded. Those industries that served, including Pfizer with penicillin production, benefited in the short and long-term.

FDR not only harnessed the power of industry and science, and ramped up the military, but also asked every family and every community to participate in the war effort. Community volunteering soared, and sacrifice for the public good was the rule, not the exception.

One idea was “victory gardens”, planted in back yards,  to allow stressed food manufacturers the ability to focus on meeting the demand to “feed the troops.”  These gardens in 1943 provided 1/3 of all the vegetables consumed in the states that year.

President Biden now finds himself in a similar predicament – the need to redirect our vast industrial productive capacity while mobilizing our citizens to both support and participate in vaccination efforts.

Our President and his team understand that interventional and privatized high science is of little avail if that science (in this case vaccines) is unable – by limited supply or logistic ineptitude or the absence of public trust – to find it’s way efficiently and quickly into the arms of our citizens.

Shortages of vaccine supply clearly have placed the emphasis on equitable distribution. But in the end, the secondary unintended negative impact has been profound. A legitimate desire to prioritize diverse and vulnerable populations, and protect our hospitals from being overwhelmed by sick and dying patients, has been translated into an anemic response that is overly medicalized and militarized.

In the push toward equity and over-concern with group gatherings, many states have relied on complex computer based scheduling and stadium like drive-up sites previously used as testing locations.

The emergence of potentially lethal strains has now made it clear that we are in a race. We need to get to herd immunity before the new virus strains have enough leisure time to become even more deadly. This means a major shift toward simple, local, walk-up mass immunization as we did for polio vaccination in the 1950s.

Public health leaders are rightly proud of their well-intentioned algorithms to assure equitable distribution of limited vaccine supply. Their military partners should be recognized as well for maintaining an orderly flow of vehicles and supply and approved individuals with minimal wastage of limited vaccine. But complexity carries its own inequities and is ill suited to the wartime challenge we now face.

What is now more than obvious is that we need a simple vast political campaign to reach a population 10-fold larger in 1/10th the time. This requires three elements:

1. Use of local, neighborhood vaccination sites. Schools are a logical local brick and mortar choice because they are viewed as a community resource, are accessible in every community across America, and have been proven safe even during the pandemic as the Nov. 3rd voting proved out.

2. Our campaign must reinforce vaccine acceptance. The best way to accomplish this is to include parents of school children (doctors, nurses, firefighters, police, EMTs) as volunteer providers of the injections. This was instrumental in the polio campaign. Their inclusion is not about manpower so much, but rather as a signal that this is a community-wide and community-based effort enjoys strong family and community support.

3. Demand must now drive supply. That is to say that the Pfizer’s of the world must voluntarily or through the Biden Administration’s use of the Defense Production Act extend patent utilization to partners to massively expand production overnight.

The value of organized participation – whether it be Pfizer penicillin or “victory gardens” in 1943 –  extended well beyond pills and food. The true value was the sense of inclusion and solidarity, the singularity of focus on speed, sacrifice, and success. We face a similar challenge, and with President Biden, must rise to the occasion.

Join Me, Wednesday, May 5th. “The Constitution and the Right to Health Care.”

Posted on | February 1, 2021 | No Comments

Mike Magee MD

May 5th seems far into the future with the pandemic still raging, distressing images of insurrection and a 2nd Impeachment fresh and current, and relief checks “in the mail.” But Spring is coming!

So I hope you’ll reserve May 5, 2021, from 1:30 to 3:00 PM, for a fascinating online lecture: “The Constitution and Your ‘Right’ to Health Care.” Best of all, the $20 fee helps support the lifelong learning programs at the University of Hartford. These virtual programs are open to all comers and are an invaluable resource to help combat the isolation, fear and worry that has affected all of our citizens.

This 90-minute slide lecture explores the recent political history and legal controversy surrounding attempts to establish universal health coverage in America. “Is health care a right?” viewed within the context of the Bill of Rights and especially the 9th and 10th Amendments? What are the legal arguments advanced over the past decade to challenge the Affordable Care Act (Obamacare)? And does the Covid-19 pandemic make it more or less likely that “Medicare for All” will pass legal muster in the future?

Join me for this stimulating interactive session, including time for audience participation, and contribute $20 to a great cause. You can register online HERE. (See path to registration below)

If you have thoughts or questions in the lead up to the lecture, send them along to me at mmagee@hartford.edu. Thanks!

Mass Vaccination – We’ve Been There Before.

Posted on | January 30, 2021 | No Comments

Bill Magee MD, 1954

Mike Magee

Children of this era, decades from now, will recall a pandemic and their experiences with vaccines, in the same manner as citizens of my age recall the polio vaccine campaigns in the 1950’s.

While my generation was less informed on the science than our counterparts today, we had three advantages:

  1. National administrative leadership of vaccines and their distribution.
  2. A focus on mass immunization rather than preferential individualized encounters.
  3. A unified community school-based (vs. hospital or pharmacy based) campaign, fully engaging local families and their physicians in validating the safety and efficacy of a vaccine, and immunizing the general public.

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

O’Connor did not have an NIH or CDC to direct his efforts. He took charge himself, setting up an organizational structure with reach across the country to support services and fundraising. Ultimately, 3100 chapters would be established and $233 million distributed in patient services for children with polio by 1955.

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

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

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

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

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

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

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

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

Justice Is A Complicated Affair, Dr. Barrasso.

Posted on | January 28, 2021 | 4 Comments

Mike Magee

Dr. John Barrasso, 1996, source/Spencer Books

“We’re better than this” is the common refrain heard from many political leaders following the deadly assault on our democracy on January 6th. Are we really?

One year ago, my physician friend, Senator John Barrasso, famously said, “The time for political stunts is over. The Senate had a fair trial and clear acquittal. Republicans stayed true to the Constitution. Now the Senate gets back to work for the American people.” How did that work out for you, John?

This has been a week of empty appeals for blind appeasement and shifting of blame in the interest of “bringing our country together.” But as Senator Barrasso’s former colleagues in Medicine learned on their first day of Medical School, the only way to face bad news is to confront it, share it honestly with your patient and family, and together agree on the best curative course of action.

Justice is a complicated affair. A quick review of medical history is instructive – specifically Germany in 1945 and South Africa in 1995.

In sorting through the legacy of Hitler’s regime in Germany, the Allied forces established the International Military Tribunal.  One of the series of trials, opened on November 19, 1945 in the Palace of Justice in Nuremberg, delved into egregious examples of medical criminality, including Nazi experimentation on human subjects. These trials are often cited as an example of “retributive justice.” Of 23 defendants, 7 were hanged, 7 acquitted, and the rest given sentences of from 10 years to life in prison.

These judgments were conducted under the direction of U.S. judges and prosecutors and fully compliant with U.S. standards of criminal procedure. Yet another 25 years would pass before any of the 10 agreed-upon medical ethics research standards were integrated into US trial law.

Legal scholars such as Michelle Miller at Cornell Law School attribute this lapse to the self-regarding biases of leaders within the Medical Industrial Complex. As Jay Katz, a physician and professor of law at Yale wrote in 1992 of the Nuremberg directives, “It was a good code for barbarians, but an unnecessary code for ordinary physician-scientists.”In other words, it was assumed that American medicine’s noble professionalism was adequate to ensure appropriate ethical standards.

Adding to the irony, at the very same moment that the leaders of the Medical Industrial Complex were rejecting President’s Truman’s 1946 call for a national health plan as “socialized medicine”, our military under the Marshall Plan was fast at work creating highly successful national health plans for our two main vanquished archenemies, Germany and Japan. We were willing to allocate precious taxpayer resources to assure this expression of “restorative justice.”

An analysis of the German and Japanese programs made some years later by the Rand Corporation summed up the Marshall Plan’s rationale: “Nation-building efforts cannot be successful unless adequate attention is paid to the health of the population. The health status of those living in the country has a direct impact on the nation’s construction and development, and history teaches us it can be a tool in capturing goodwill of the nation’s residents.”

A similar restorative approach was utilized in South Africa in 1995. Nelson Mandela’s Truth and Reconciliation Commission conducted over 1000 public hearings on their road to a free democracy, offering amnesty to those who publicly admitted past crimes of sectarian violence and asked for forgiveness. Less recognized, Mandela simultaneously instituted fundamental social service reform, including free primary level public health care for all in 1996 serviced in over 350 newly constructed health clinics by 1997.

The crimes of Donald Trump, his followers and enablers, are now fully exposed. Their failures include the mismanagement of the Covid-19 pandemic, certain to claim more than a half million Americans by April, 2021. As with Germany in 1945, and South Africa in 1995, these crimes involve racism, disinformation, and erosion of public trust. They are egregious, deep-seated, and likely not self-corrective.

To address them, and move our nation forward, we must openly and honestly embrace both retributive and restorative justice. Impeachment of Donald Trump, criminal investigations of his legislative and civilian co-conspirators, and movement toward universal health care in America are now important next steps if we truly wish to “bring our nation together.”

MLK (1967) to Biden (2021).

Posted on | January 21, 2021 | No Comments

(a caution) “We are now faced with the fact, my friends, that tomorrow is today. We are confronted with the fierce urgency of now. In this unfolding conundrum of life and history, there is such a thing as being too late. Procrastination is still the thief of time. Life often leaves us standing bare, naked, and dejected with a lost opportunity. The tide in the affairs of men does not remain at flood — it ebbs.”

(a challenge) “This is the calling of the sons of God, and our brothers wait eagerly for our response. Shall we say the odds are too great? Shall we tell them the struggle is too hard? Will our message be that the forces of American life militate against their arrival as full men, and we send our deepest regrets? Or will there be another message — of longing, of hope, of solidarity with their yearnings, of commitment to their cause, whatever the cost?”

(and a choice) “The choice is ours, and though we might prefer it otherwise, we must choose in this crucial moment of human history…If we will but make the right choice, we will be able to speed up the day, all over America and all over the world, when justice will roll down like waters, and righteousness like a mighty stream.” 

Latest State COVID Cases/Deaths/Vaccine Rates

Posted on | January 21, 2021 | No Comments

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Data Source: Washington Post, 1/20/21

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