HealthCommentary

Exploring Human Potential

What A Difference A Year Can Make.

Posted on | May 3, 2020 | 4 Comments

Mike Magee

What a difference a year, and a global pandemic, can make. In this self-enforced pause, there is a great deal of self-reflection going on.

Back in 2019, Michael Bloomberg, looking for support in New Hampshire declared about Medicare-for-all proposals, “I think we could never afford that. We are talking about trillions of dollars… [that] would bankrupt us for a long time.” And fellow billionaire candidate at the time, Howard Schultz added, “That’s not correct. That’s not American.”

Today, with the health care system visibly tilting and scrambling, and policy loyalists and lobbyists for the Medical-Industrial Complex praying for “silver bullets” while searching for “silver linings”, the terra firma beneath their feet is shifting.

At the time though, neither man made the connection between large-scale health reform’s potential savings (pegged to save 15% of our $4 trillion annual spend according to health economists) and the thoughtful application of these newly captured resources to all U.S. citizens without discrimination.

Bloomberg’s own 2017 Health System Efficiency Ratings listed the U.S. 50th out of 55, trailed only by Jordan, Columbia, Azerbaijan, Brazil, Russia. Yet he seemed unable to connect addressing waste with future affordability.

Schultz was similarly short sighted. While acknowledging that the manmade opioid epidemic, mental health crises, and income inequality are “systemic problems” and at levels “the likes of which we have not had in a long time”, he failed to connect the cause (a remarkably dysfunctional and inequitable health care system) with these effects.

“Universal health care” is an end point goal that reinforces the principle that health is a human right rather than a privilege for the most entitled. It is an expression of national solidarity and reflects a shift in our culture. That is to say, it is the exact opposite of what we are experiencing now – a level of disorder and dysfunction that threatens life and limb, paralyzes our economy, and all with no concrete end in sight.

The reality today is identical to what it was one year ago: The U.S. has no government-directed, national health planning apparatus. Service levels and reimbursement vary widely across an endless array of private and public offerings that have devolved into a “free-for-all.” Our profit-driven, scientific research community continues to divert resources from health planning and patient care, and our insurance system harbors an enormous number of health system middlemen profiteers to support “non-real” work (16 positions for every one physician – half with no clinical role).

What we do have are $4 trillion already committed (albeit badly misallocated), a remarkable array of educational institutions, a dedicated network of public health schools and practitioners, under-utilized nurses and pharmacists, and a testing ground of 50 different states. These remarkable, yet undervalued and under appreciated resources, are the true bright spots in this pandemic.

The full impact of spiraling health care costs and their secondary effects—including stagnant wages, income inequality, a lack of job mobility, high rates of medical bankruptcy, the closure of rural hospitals, an inability to invest in infrastructure repairs, and our exploding national debt – remains to be calculated as the covid-19 dust eventually settles.

But let us be clear – there is another way. We could have the courage and the will to reapply our more than ample health care assets and reject this insanely reactive and helter-skelter status quo. We could vote in change on a large scale.  We could elect leaders willing to honestly address a simple, long overdue question that is at the very center of this pandemic: “How do we make Americans healthy?”

Public Health, The Media, and The Performance of Deborah Birx.

Posted on | April 28, 2020 | 8 Comments

Mike Magee

Imagine there was a time in our living memory when a Washington Post reporter and a woman public health official shared a mutual passion – the health and welfare of Americans. 

Imagine this woman was steely in her determination, but shy and refused the spotlight. And imagine that those lined up against her were both powerful and aggressive, and were on record of having attempted – dozens of times – to get her fired.

Imagine now that she woke up one morning, and picked up her Washington Post in the driveway, walked back to the kitchen table, filled her coffee cup, and read the headline, “Heroine Keeps Bad Drug Off Market.”

And as she reads on, “This is the story of how the skepticism and stubbornness of a Government physician prevented what could have been an appalling American tragedy. The story is not one of inspired prophecies nor of dramatic research breakthroughs.”

“She saw her duty in sternly simple terms, and she carried it out, living the while with insinuations that she was a bureaucratic nitpicker, unreasonable – even, she said, stupid. That such attributes could have been ascribed to her is, by her own acknowledgement, not surprising, considering all of the circumstances.”

“What she did was refuse to be hurried into approving an application for a new drug. She regarded its safety as unproven.”

This is not the story of Dr. Deborah Birx. Her’s is a different story. Faced with wild claims of an errant President that hydroxychloroquine showed promise of curing covid-19, she remained self-sidelined, even after studies demonstrated no efficacy and established that cardiac fatalities were an associated risk of the therapy.

Birx is also the government scientist who allowed herself to acquiesce to her embattled President and appear Saturday evening on FOX News, and in response to the host’s question , “Do you think the media in this country has been fair throughout this pandemic?”, responded, “I think the media is very slicey and dicey about how they put sentences together in order to create headlines.”

And she is the doctor who, 12 hour’s later, appeared on Jake Tapper’s CNN Sunday program and was questioned about the President’s suggestion that ingesting or injecting disinfectants might be helpful. Asked “As a doctor, doesn’t that bother you that you have to even spend any time discussing this?”, she defended her bosses remarks as “musings”. And then said, “It bothers me that this is still in the news cycle, because I think we’re missing the bigger pieces of what we need to be doing as an American people to continue to protect one another.  As a scientist and a public health official and a researcher, sometimes I worry that we don’t get the information to the American people that they need when we continue to bring up something that was from Thursday night.”

The other Public Health doctor, received the President’s Award for Distinguished Civilian Service on August 7, 1962, in acknowledgement of her strength and personal fortitude which protected thousands of children from thalidomide, and lead to the passage of the Kefauver-Harris Amendment that required drugs be proven to be not only safe, but effective. Her name was Frances Oldham Kelsey, and she worked for the FDA for thirty more years, and died at age 101.

She remained friends for life with Morton Mintz, the Washington Post reporter, who broke the thalidomide story. Their values were well aligned as this salute to him by his colleague, Colman McCarthy, on Morton’s retirement in 1988, suggests.

“Mintz regularly wrote stories after reading thousands of pages of trial transcript, court exhibits and pre- and post-trial proceedings. Were he less a shelf rat and more a show horse, Mintz might be better known. But not better respected. His stories had reach because his commitments had depth.”

Dr. Birx is not Dr. Kelsey. But the Washington Post and New York Times have many reporters who, in their journalistic service to our nation, emulate Morton Mintz, and who must continue to make him proud. He is 98 and lives in Washington, DC.

Earth Day 2020 – 25 Important Facts About Water

Posted on | April 22, 2020 | No Comments

Mike Magee

World Water Day, April 22, 2020, celebrated at the United Nations, drew a wide range of interested and engaged professionals. But surprisingly, the health care professionals remain under-represented.  How much do doctors, nurses and other health professionals know about water?

Here are “25 Facts Every Health Professional Should Know About Water”:

1. Water is essential to all life.

2. Oceans, surface water and ground water are interconnected and interdependent.

3. Most of the Earth’s water (99%+) is not fresh, not accessible, or neither fresh nor accessible.

4. Humans need 2.3 liters of water on average per day to survive. Humans’ average daily diet however derives from an investment of 3,000 liters of water.

5. Agriculture is the leading consumer of water worldwide, consuming 70% of our fresh water.

6. Irrigated fields have 400% greater food yield than rain-fed fields. By 2030, 70% of the world’s grain crop will come from irrigated fields.

7. Currently 27% of fish consumed by humans is “grown” through aquaculture. China alone is responsible for 70% of the “crop.”

8. Industry is the second leading consumer of fresh water, consuming 22% of our total supply worldwide.

9. Water is essential for all forms of energy generation worldwide.

10. Global hydropower currently provides about 20% of our energy worldwide.

11. Supplies of safe, fresh water are declining and global population is increasing. In the past 100 years our population has tripled, and water consumption has increased six-fold.

12. Water scarcity is increasingly common. 3.4 billion global citizens will live in water-scarce areas by 2025.

13. One-sixth (17%) of humans lack fresh, safe water and two-fifths (40%) lack adequate sanitation.

14. Investment in water and sanitation has a 34-fold return on investment.

15. Watershed catch basins cover 45% of Earth’s land and support 60% of our global population.

16. 145 nations share a catch basin with another nation.

17. Urban environments, usually associated with catch basin areas, continue to grow and will house 60% of our population by 2025.

18. Safety and security of urban populations are fundamentally dependent on wise water management.

19. Surface water in the developing world is the dumping ground for 70% of industrial waste and 90% of local raw sewage.

20. Water-related diseases account for 25% of all deaths worldwide and 50% of all hospitalized patients.

21. Water-related disasters between 1990 and 2000 claimed over half a million lives. Most could have been prevented by Integrated Water Resource Management and Disaster Preparedness.

22. Global warming is a significant contributor to water scarcity and water disasters.

23. Integrated Water Resource Management (IWRM) is organized at the catchment level, proactively balancing infrastructure development, allocations of water and mitigation of risk.

24. IWRM has social, political and economic dimensions that directly impact human health, poverty levels and gender equality.

25. IWRM requires reliable data and careful valuation of water as a resource. Identifying true cost of provisions of safe water and sanitation is essential for financing and creating sustainable and reliable infrastructure.

For more in depth exploration: Healthy Waters: What Every Health Professional Should Know About Water. HERE

Could Covid-19 Be Leveraged As A Change Agent?

Posted on | April 21, 2020 | 4 Comments

Source: WHO

Mike Magee

As the weeks and months of the Covid-19 pandemic pass by, it is increasingly obvious that it is both an economic and a public health crisis. These two major forces appear on the surface to be opposing each other. But the reality is that solutions for both could be harmonized by movement toward a national health care system.

The failure of our health care system should, by now, be patently obvious to all.

Our faith in free enterprise and capitalism to “win the war” on disease (and supposedly leave “health” in its wake) dates back to the immediate post – WWII era. Over the years we’ve doubled down on this historically poor decision again and again, breeding profiteers, colluders, and promoters – but not much health for America.

Covid-19 has revealed that American health care is rigid and inflexible when confronted with an unexpected crisis. The historic intermingling of health and business has yielded a long list of side-effects including: academic medicine’s rush for NIH grants, sellable patents, DTC advertising and AMA profiteering database sales, industry’s relentless assault on checks and balances engineered by ever expanding government relations programs, and government’s open door policy toward scientists with well known conflicts of interest.

All spell success for the Medical-Industrial Complex, but treat patients as pawns. The winning argument for a restructuring of our healthcare system and the movement toward public health insurance options is both economic and ethical. Universal coverage is necessary not simply because it’s a human right (which it is), but because risk must be shared by all equitably to make insurance work.

A healthy population is more productive, more likely to be educated, more mobile and willing to take risk, more likely to get married and have children, less likely to be involved in crime, violence, or injury, and less likely to panic during a health care crisis. And all of this saves money.

When Warren Buffett said that “Medical costs are the tapeworm of American economic competitiveness”, he knew what he was talking about. But to responsibly transition ourselves out of this mess requires two things: 1) a vision/strategic plan, 2) the capacity to retrain and redirect excess non-clinical health care workers from reactive health delivery to proactive and preventive social services.

On the vision front, studies clearly indicate that consolidating administrative back-office management of insurance sales, benefit management, and claims payments could immediately shave 15% off our national health care bill. But getting there is not as easy as uttering the magic phrase, “Medicare-for-all”. But opening up coverage now, with so many suddenly unemployed and without insurance, is a no-brainer. The American public in large majorities already favored moving in this direction, and that was before paychecks and health coverage began to disappear en masse in tandem.

Clearly, we are facing worker displacement on a scale similar to the Great Depression. Why not seize this as an opportunity to embrace workforce transitioning? Currently, there are 16 additional health care workers for every one physician in America.  Approximately half of these are non-clinicians uninvolved in any direct patient care. You can find a list of some the jobs, along with average salary and educational requirements HERE. The American Academy of Professional Coders is now nearly 200,000 strong with average salary approaching $50,000 a year.

Health care now includes 11% of all workers compared to 8% in 2000. Since the country’s near financial collapse in 2007, 35% of the job growth has been in health care, fueled by aging demographics and the expansion of Medicaid under the ACA. More than 1/2 of the nearly $4 trillion spent on health care in the U.S. goes to wages.

Opening up a public option to all would trigger a shift toward prevention, public health planning, and investment in expanding our societal safety net including social health determinats like safety and security, nutrition, education, clean environments, and transportation.

Where might we begin. A logical starting point would be to deconstruct enterprises which primarily service direct patient care needs from those engaged in speculative scientific discovery for profit. These are radically different entities. Step two would be to integrate direct patient care with the continuum of social services. Plan for health, not disease.

Finally, we need to reposition this pandemic as an economic and public health opportunity. We need to be bold. We need to make change our friend.

Covid-19: A Wake-Up Call For Those Not Yet Woke.

Posted on | April 16, 2020 | No Comments

Mike Magee

Exactly one year ago, I penned a piece for Matthew Holt’s The Health Care Blog titled, “All For One, One For All.”

In laying out our vulnerability, I wrote:

“The U.S. has no  government-directed, national health planning apparatus. Service levels and reimbursement vary widely across an endless array of private and public offerings that have devolved into a ‘free-for-all.’ Our profit-driven, scientific research community regularly diverts resources from health planning and patient care, and our insurance system harbors an enormous number of health system middlemen to support ‘non-real’ work (16 positions for every one physician – half with no clinical role).”

Back then, THCB member, William Palmer MD, presciently replied:

“We have worked our way into a truly difficult cul de sac. There are now so many stakeholders, all making nice incomes, that the political will to change the system seems nearly impossible to gain. I think some of us are hoping for some extraneous catastrophic event to save the system.”

This week, one year later, I replied to Dr. Palmer:
“You were way ahead of the game, and certainly on the mark one year ago, in looking toward the possibility of an “extraneous catastrophe.” Covid-19 is already in the process of changing scope of practice, type of employment, standards of coverage, and the future of employer based insurance. Who could have predicted? But you did!”

Responding to the same article a year ago, Craig A.T. Jones wrote:

“The only way to extend Medicare to everyone is to dramatically reduce benefits which has two problems (1) the over 65 crowd will scream bloody murder that you have ruined the healthcare quality they were counting on (2) providers–doctors, nurses, hospitals would all have to get by with MUCH less $$ per patient which would be a shock to the system to say the least.”

This week, now one year later,  I replied:

“It’s fascinating to read this now, 1 year later. Your remarks laying out the challenges and obstacles are right on. Of course, the disruption of a pandemic to the institutions and the people who work in them is profound. The movement of physicians from private practice to employed status (with income give-backs and enforced insurance coverage rules for example), could markedly affect the trajectory of health care costs and the pace of transformation toward a national and universal care system – and, none of this could have been anticipated one year ago. And yet, here we are.”

In retrospect, as these postings support, our current dilemma was predictable. The “perfect storm” clouds had been gathering for awhile. They included the absence of national health planning; extreme profiteering and collusion within the health sectors; and a President who has more than made the case for a need to apply the 25th Amendment.

Covid-19 is a wake-up call for those not yet “woke.” But one year ago, at the publication of “Code Blue: Inside the Medical Industrial Complex”, I wrote in “All For One, One For All”:

“For far too long, our leaders have focused on how to make American corporations wealthy. But let us be clear – there is another way. We could have the courage and the will to reapply our more than ample health care assets and reject the status quo. We could vote in change on a large scale.  We could elect leaders willing to honestly address a simple, long overdue question “How do we make Americans healthy?”

It’s never too late. Let us begin.

Who Is The Real Batwoman, and Can She Defeat The Forces of Evil?

Posted on | April 13, 2020 | 2 Comments

Shi Zheng-Li releases bat after capture and testing.

Mike Magee

According to experienced phraseologists, “bats in the belfry” should resonate on multiple levels with Americans currently confronting covid-19. They say: “Bats are, of course, the erratically flying mammals and ‘belfries’ are bell towers, sometimes found at the top of churches. ‘Bats in the belfry’ refers to someone who acts as though he has bats careering around his topmost part, that is, his head.”

Living under the threat of a deadly and suffocating virus, combined with economic destruction and acute, total and immediate human isolation is certainly enough to drive any of us crazy. But add to this the central and mysterious role of bats themselves and we’re into uncharted territory.

Arguably, no one knows more about this disease and bats role in it then Shi Zheng-Li, leading bat virologist at the high security Chinese Academy of Sciences Key Laboratory of Special Pathogens and Biosafety, Wuhan Institute of Virology.

At 7 P.M. on December 30,2019, she received an emergency call to inform her that two patients with atypical pneumonia and respiratory failure had just been admitted to a Wuhan hospital and both were infected with a new coronavirus. Her greatest fear, that the virus had somehow escaped from her vast collection of bat coronaviruses storied in her high-security lab, was soon proven wrong by genomic analysis. But she knew right then that death and destruction were on her doorstep.

For the past 16 years, Dr. Zheng-Li has led the expeditions into China’s caves to capture and collect blood, urine and feces from bats in an attempt to stay one step ahead of the next viral pandemic. In the process, most of her focus has been on coronavirus, the virus whose spiked receptors create the appearance of a crown (corona). The history of this microbe variety is not great. This would be the sixth bat borne disaster in the past 25 years. The others included Hendra in 1994, Nipah in 1998, SARS in 2002, MERS (Middle East respiratory syndrome) in 2012, and Ebola in 2014.

While bats can be positive contributors – they eat insects and pollinate plants – they seem ideal vectors for pandemics. Consider the following qualities:

1. They can live for 30 years or more.

2. They are incredible reproducers and are extremely diverse, constituting 25% of all mammal species on the planet.

3. They like living in crowds in dark, moist places.

4. They produce vast amounts of bat guano teaming with microorganisms.

5. They fly, carrying diseases for long distances.

In the three months following Dr. Zheng-Li’s engagement, she pretty much confirmed what she had already predicted in 2018 peer reviewd publications  including  MDPI’s Viruses and 2019 in Nature’s Reviews of Microbiology – that a global pandemic from a novel coronavirus was a near-term certainty.

First, the virus was hatched in a bat – specifically the RaTG13 or Rhinolopus affinis, a horseshoe bat that generated a near identical covid-19 virus back in 2013. Its’ full genome was published recently by Penn State virologist Maciej Boni.

Second, the dreaded wet markets of China, criticized by the WHO and all responsible health agencies, that sell eatable wild animals, were not the originators of covid-19. At most, they are middlemen, incubators and multipliers of the organism. Some bad news here – seems domestic livestock, like pork can serve a similar purpose.

Third, a bigger issue may be the tie in between our treatment of the planetary patient and our future on Mother Earth. Global warming already is causing profound ecosystem alterations. And that’s without behaviors outlined recently in Scientific America: “With growing human populations increasingly encroaching on wildlife habitats, with unprecedented changes in land use, with wildlife and livestock transported across countries and their products around the world, and with a sharp increase in both domestic and international travel, new disease outbreaks of pandemic scale are a near mathematical certainty.”

Shi Zheng-Li is the real Batwoman, and she is in a death battle with the forces of evil. Liars and science deniers beware!

Passover, Easter, and the Pandemic – Common Themes?

Posted on | April 12, 2020 | 4 Comments

Mike Magee

Two years ago, Rabbi Daniel F. Polish wrote an article in the Jesuit magazine America titled, “Easter and Passover have more in common than you think.”

Rabbi Daniel F. Polish

In the final summary paragraph, he writes:

“Pesach (or Passover) and Pascha (or Easter), beneath their manifest historical and theological content, can be seen as the human reaction to the liberation from the harsh confinement of winter to the verdant restoration of life and promise that all of us feel as we experience the bursting buds and radiant colors, the soft air and beautiful scents that mark the beginning of the new season. And more, both holidays are joined at their core in finding us rejoicing in the defeat of death and the gift of life restored.”

In the body of the article, Polish makes the case for common themes including:

Liberation: From Egyptian slavery for Jews, and from sin for Christians.

Messianic aspirations: “Next year in Jerusalem” for Jews, and the risen Christ for Christians.

Rebirth: Return to ancestral land for Jews, and the rebirth of the Son of God for Christians.

The timing of these most sacred holidays presses down on all Americans today, isolated and separated, brave and fearful, discouraged but hopeful in the face of this pandemic.

Emotions are raw, self-reflection abundant, the future uncertain. But what is certain is that the same issues drug up by the pandemic are at the core of Pesach and Pascha – life and death have center stage.

Here are my reflections:

Death is not popular but it is inevitable. The only question is whether it is part of our lineage or something stolen away in the night. Death is not our choice in time or place. But life can be lived with death included. Those who never contribute never live fully. Their lives are like a series of small deaths, death to potential, death to promise, death to exploration. Life deserves to be lived each day, considering the unpredictability of death. That death is at the end should not be feared as much as a halted life at the beginning. Life is a continuum – being, doing, doing without. Things wear out. They break or get broken by events beyond our understanding. Life is short. But the art of living is long. When we change, there is a sadness for what we leave behind, but a joy as well for what lies ahead. It’s a trade-off. Losing a love along the way, that is the pain, depopulation, a hole in your world. Can it ever be filled? Perhaps not, but is that not a tribute to the one who’s gone, to the memory of the one whose pleasures made? No time to fret. No need to rush it. Death will stop for you so why watch out, or dwell on it. A better rest, and well-deserved, a joining ‘wither thou goest’ are in your future too.

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With thanks and attribution to Ruth 1:16-17, Charles Dickens, Emily Dickinson, Jean Paul Richter, Edna St. Vincent Millay, Alphonse de Lamartine, Anatole’ France, John Morley, John Henry Cardinal Newman, Eleanor Roosevelt, Joan Baez, and Hippocrates.

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