HealthCommentary

Exploring Human Potential

Confronting Presidential Out-ertia.

Posted on | March 23, 2020 | 6 Comments

Source

Mike Magee

“All change of matter has an external cause. (Every body remains in its state of rest or motion in the same direction and with the same velocity, if not compelled by an external cause to forsake this state.) … This mechanical law can only be called the law of inertia (lex inertiæ) Immanuel Kant, 1786

_____________________________________________________________________________

In the March 23, 2020 COVID-19 Washington Press Briefing, President Trump signaled his active intent to break through his self-imposed inertia and embrace opening markets while closing out American lives. In the process he has taken inertia and morphed its evil twin, out-ertia. What should medical leaders like Tony Fauci do now?

____________________________________________________________________________

Inertia describes the tendency for physical objects and human beings to resist change. If you want something to move, or to stop moving, or to shift direction, you must apply force whether through gravity, friction, or contact.

Isaac Newton defined inertia as his first law of his Laws of Motion in 1687 in his Philosophiae Naturalis Principia Mathematica. But the word “inertia” was first introduced in scholarly fashion 60 years earlier by Johannes Kepler in his Epitome Astronomiae Copernicanae, deriving the word from the Latin word for “idleness” or “laziness.”

The phrases “dig in your heels” or ‘denial and routine were her two best friends” reflect human tendency to embrace existing habits and ideas. Most of the time, this proves harmless and with some patience evolves with time. But in moments of great environmental change, whether by global warming or COVID-19, inertia can prove to be dangerous and fatal.

This truth is magnified by those in power. Indecision and poor judgement are a deadly combination. It matters little whether the man in control fails to recognize change or fails to react to it – the outcome is the same.

History tells us that failures of inertia are more commonly exhibited by those directly involved at the center of a crisis. They readily exhibit a bias toward the status quo, hanging by a thread to the old ways. Clarity often arrives first through witnesses on the periphery with greater perspective.

Breaking the rules requires mental courage. This is especially true at the beginning. After the first push, there is momentum. But it has to be a real push, not a feign, nor a wink and a nod. Gentle corrections of Presidential fabrications, false promises, and misdirections are not a course changing push. You’d have to say, “If you lie one more time in my presence, I will walk off the stage and quit.”

Dr. Fauci needs to insure his availability to the public to speak truth to power. That’s the only way to confront Presidential out-ertia. Trump has signaled his intent. There is no “hidden agenda.” It is present and clear, and there is no Presidential regret. Time for Medicine, Nursing, and all Health Professionals to rise to or fall from the challenge.

David Brooks on COVID-19 Response: Beware of Dread.

Posted on | March 17, 2020 | 5 Comments

PBS Newshour

Mike Magee

On March 12th, New York Times columnist David Brooks indulged in a moment of existential reflection when he wrote, “Frank Snowden, the Yale historian who wrote ‘Epidemics and Society,’ argues that pandemics hold up a mirror to society and force us to ask basic questions: What is possible imminent death trying to tell us? Where is God in all this? What’s our responsibility to one another?”

Three days later, he discarded metaphysics and just couldn’t take it anymore. On PBS News, he let loose with this:
“I feel a deep sense of anger that our government has responded so badly. Frankly, this is what happens when you elect a sociopath as president, who doesn’t care, (and) who’s treated this whole thing for the past month as if it’s about him.”

Likely Snowden’s book with its crushing insights put Brooks over the edge. Here are a few nuggets from a recent New Yorker interview of the author:

Historically, epidemics have “shaped politics, crushed revolutions, and entrenched racial and economic discrimination.”

“Epidemic diseases are not random events that afflict societies capriciously and without warning. On the contrary, every society produces its own specific vulnerabilities … it’s structure, its standard of living, and its political priorities.”

Epidemics are a category of disease that seem to hold up the mirror to human beings as to who we really are.”

“Epidemics also, as we’re seeing now, have tremendous effects on social and political stability. They’ve determined the outcomes of wars, and they also are likely to be part of the start of wars sometimes.”

“The way we respond very much depends on our values, our commitments, and our sense of being part of the human race.”

“The health of the most vulnerable people among us is a determining factor for the health of all of us.”

“To have officials in the White House saying, ‘Oh, its nothing more than a common cold, we’ve got it under control,’ when they have nothing under control, as far as I can see, and they’ve put people in charge who don’t even believe in science.”

Even as David Brooks awoke, Republican leaders have slept on, or offered weak bromides like Marco Rubio’s plea that we not “spend all our time taking political shots”, as if Susan Collins was right when she said President Trump had “learned his lesson.” No, he hasn’t.

His words – serious one day, flippant the next – mean nothing.  Actions – only verifiable actions – count now. They must be real, rational, and responsible. And so is David Brooks warning, “Dread overwhelms the normal bonds of human affection.”

A “CODE BLUE” Moment – Crisis In A Broken Health Care System.

Posted on | March 12, 2020 | 2 Comments

Source: WSJ/JASON REDMOND/REUTERS
Visiting Nursing Home family member quarantined in Seattle area.

Mike Magee

In the opening pages of “CODE BLUE: Inside the Medical Industrial Complex”, I wrote:

 “When Donald Trump expressed his cluelessness—’nobody knew that health care could be so complicated’—before a meeting of state governors in February 2017, he was exposing a pattern of both arrogance and ignorance that is now on full display.

Most Americans awaken today forced to acknowledge the absurdity of our convoluted system of third-party payers, and the pretzel positions our politicians weave in and out of as they try to justify it, reform it, then un-reform it. Congressional loyalists continue to find solace in telling themselves, “Well, we still have the best health care in the world.”

In point of fact, we’re not even close to having the best health care in the world. As legendary Princeton health economist Uwe Reinhardt prophetically remarked two years prior to COVID-19, “At international health care conferences, arguing that a certain proposed policy would drive some country’s system closer to the U.S. model usually is the kiss of death.”

It is at times of crises like these that system weaknesses expose themselves. The inability to swiftly and efficiently test a population for COVID-19, share those results, and rationally plan a swift, coordinated, and effective response is a reflection of the gross inadequacies of our health care system. So is a leaky and disjointed supply system that can’t manage demand for cue tips, let alone ventilators.

In a review of CODE BLUE last year, John Rother, President and CEO of the National Coalition on Health Care wrote, “Code Blue will make you mad, but it will also make you better informed and better able to understand what we need to do as a country to fix it. I can’t think of a more persuasive book on the need for change.”

The need for change that John forecasted not only included matters of justice, planning, and equitable distribution of health care resources, but also the capacity to respond to a global public health event of the magnitude of COVID-19.

How broken must a system be when our nation can’t keep up with nations like South Korea and Italy in testing for the virus? What does our “patchwork response”, variable across states and communities, lacking any private-public planning and coordination, and absent clarity on pricing, access, eligibility and prioritization, and raft with confusion even on what protections are necessary for health care workers collecting samples, tell us about our need for a fundamental restructuring of our health care system?

God Bless Anthony Fauci, but is our system so fragile that the fate of Americans rests on a single individual having the temerity to speak truth to power in the face of executive incompetence? And how are we to reconcile a Presidential veto on testing kits months ago. And the solution now? The President turns to his son-in-law’s family for advise on what to do next.

A half-century of systematic underfunding of public health, planning and prevention in deference to entrepreneurial scientists in pursuit of profit and patents over patients and families, ends here – in crisis. We will survive this “Code Blue” calamity, but we need to assure through new leadership and deliberate action that it will never happen again.

For now:

  1. Self-isolate the family.
  2. Test if you can.
  3. Trust and believe in each other.
  4. Ignore Trump and Pence. Trust your state leaders for now.
  5. Vote with your head, not your heart (or your gut), in the next cycle.

For All Health Professionals Now: “Connect the ‘DOTS’, Dump the ‘Hunch’ “

Posted on | March 9, 2020 | No Comments

Mike Magee

There isn’t a health professional (or financial professional for that matter) out there who didn’t shake her head last week when Dr. Trump expressed his “hunch” about Covid-19. Crises and panic breed in an environment of ignorance, loose lips, and misshaped priorities. “Hunches” make all responsible leaders shutter.

Britain’s Adam Kucharski’s new book, “The Rules of Contagion”, recounting the mathematics of 1918 Pandemic, makes clear the critical roles of scholarship and leadership during a health crisis.

Rather than “a hunch”, he explains “DOTS.” As Joe Biden would say, “Here’s the deal.” The critical question we face today, as circuit breakers shut down our markets, and “South by Southwest” (a festival critical to the Austin, Texas livelihoods of thousands since 1987) is cancelled, is: “How worried should we be about infection from Covid-19?”

As Kucharski explains, the answer to that question is packaged in a number – R, for reproductive rate. But to calculate R,  you must know four other numbers signified by the acronym, “DOTS.”

“D” is for “duration”, that is, how long someone is infectious. It appears that with this virus, the answer is one to two weeks.

“O” is for “opportunity”, that is, the number of people an infected person comes in contact with during the period that they are actively infectious. “Social distancing”, self-isolation, eliminating hand shaking are all limits placed on opportunity.

“T” is for “transmission probability”, that is, the chance that the virus will pass from one human to the next during an interaction. For Covid-19, transmission seems most common in close-knit communities, and large gathering situations.

“S” is for “susceptibility”, that is the likelihood that the virus will find a welcoming environment in the contact individual. If and when we develop a vaccine, susceptibility would go way down. So far, children appear least susceptible to this virus. In contrast, the old and frail in some cases appear to have fatality rates in the range of 10%.

“D” x “O” x “T” x “S”  =  “R”

If  we are to bring this pandemic under control, we have to decrease “R” or the reproductive rate to less than one. What the means is that you can’t pass the virus on to more than one person, otherwise the numbers, and population vulnerability continue to explode exponentially.

For all health professionals listening: “No hunches now, just the facts – clear, calm, and consistent!”

The Mask – When Not To Cover Up and Why.

Posted on | March 5, 2020 | 1 Comment

Mike Magee

If you want to know what American consumers are obsessing on these days, just check out Amazon searches. There you will discover that the tag “N95 mask” has had more than a million hits over the past month.

It seems we have transferred all of our fears, and hopes of protecting ourselves and loved ones from COVID 19, to some form of this iconic, to the point that health professionals in hospitals and outpatient settings are nervous about their own dwindling supplies.

Obvious missteps and trust gaps related to our President and his administration haven’t been helpful. Health professionals in and out of government, through various communication work-arounds, have tried to settle things down – sometimes clumsily. For example, Surgeon General Jerome Adams tweet “Seriously people- STOP BUYING MASKS!” felt a bit like it had come out of the Mick Mulvaney “GET OVER IT!” school of crisis communication.

That said, masks can be a bit confusing, and that comes from someone who spent more than a few years wearing one as part of his daily stints in operating rooms. So here are the quick facts:

1. Two types of masks: There are a) surgical masks that fit loosely and prevent transmission through large droplets emitted by sneezing or coughing; and b) respirator masks that fit tightly, requiring sizing and adjusting, and can prevent transmission of smaller microorganisms like the ones that cause measles and chickenpox.

2. Who should make priority use of a mask?  Two types of people: a) Health care workers who are in frequent contact with infected individuals; and b) patients with symptoms of respiratory infection, and suspect or proven COVID 19 patients.

3. If not masks, than what? The basics are now essential:

a) Frequent hand washing. Soap and water for 20 seconds is very effective, more so than hand sanitizers.

b) Stop touching your face – that’s harder than it sounds, but quite essential.

c) Keep surfaces at home and at work clean and sanitary.

d) Avoid  close contact with sick individuals – challenging during the flu season.

e) Isolate yourself if you are sick. Stay put – close to home and limit non-essential travel.

Last piece of advice for doctors, nurses and other health professionals who are charged not only with caring for all of us, but also help all Americans process their fear and worry during these worrisome times. Deliver equal measures of knowledge and reassurance.

Coronavirus – an Opportunity to Pursue Global Health, Societal Justice, and Progress.

Posted on | February 25, 2020 | No Comments

Mike Magee

The emergence of the novel coronavirus, and its evolution into a pandemic threat, are sending shock waves across the globe. The discussions between government, academics, non-governmental organizations and industry reflect the common belief that no one sector can address such a complex challenge in isolation. 

The rapid advance of technology and human migration have accelerated globalization, regionalization and the rate of change in social institutions while virtually disintegrating geographic boundaries.  Success in forming stable and productive cross-sector relationships will largely determine the extent to which we are able to ensure global health, societal justice and progress.

Without new cooperative approaches, we find ourselves at cross-purposes and at risk. For paradoxically, expanding the flow of information and creating the expectation, and in time the reality of free and equal access to knowledge, has placed the spot light on glaring inequalities and human needs that are no longer politically tenable.   

Human health requires optimistic leaders with the expertise and willingness to commit, and a reservoir of good will among the players to support both innovation and implementation of the common vision, structural integration, joint governance and ongoing civic engagement.

Human health requires accurate information and baseline data that clearly define the challenges and serve as a foundation for future reasonable outcomes.  It is not enough to marshal human resources.  There must be an established organizational capacity, processes, and oversight to ensure that the human effort translates into a highly coordinate and effective service result.

Human health also demands long-term sustainability. A lack of clarity undermines operational execution, measurement, communications, and long term planning.  The prejudice should always be toward early organization and prevention, health consumerism and relationship based care, elimination of health disparities, and an integrated vision of health as the leading edge of development.

The obstacles to success in combating coronavirus are a microcosm of global health challenges writ large. These include absence of top level leadership, basic disagreements on the fundamental scientific underpinnings, absence of strong prevention programming, hidden political agendas, exclusion of key sectors, and failure to identify a key issue and address it proactively.

Government, business, academics and non-governmental organizations are increasingly overlapping in the areas of social purpose. Addressing coronavirus effectively is both a challenge and an opportunity.  The ability to significantly organize their varied and often complimentary skills and resources could significantly benefit societies worldwide.

Young, Liberal, Silicon Savvy – Why did they join Juul?

Posted on | February 7, 2020 | 4 Comments

Mike Magee

In late 2018, young tech-savvy future entrepreneurs streamed into the offices of e-cigarette start-up Juul. Four thousand strong, they were attracted by the $38 billion valuation and the promise of stock sharing in the high-flying techie new business with moral cover – a mission to make cigarette smoking obsolete. At their Christmas party in the San Francisco Giants baseball stadium, all agreed, morale couldn’t be higher.

Nine months later, their vaulted CEO, Kevin Burns, formerly of Chobani, stepped down. Valuation had sunk by over 2/3s to $12 billion, leaving those sign-up stock bonuses highly devalued, and 16% of the staff were fired as the new CEO pledged to cut $1 billion. What happened?

Reality bit! Juul was a 2017 spin off from cannabis vape manufacturer Pax Labs. CEO Burns engineered aggressive expansion into Europe and Asia, sold a 1/3 stake to tobacco giant Altria, and embraced teen friendly marketing tactics and flavored pods. The latter delivered in more ways than one.

Yes, 1 in 4 high schoolers are now hooked on nicotine (1 pod has as much nicotine as a pack of cigarettes, and a 4 pod pack costs $15.99). But in return for massive profits, Juul is now public enemy #1 in the eyes of concerned parents, school boards and progressive legislators.

Juul has now pulled its ads and their most popular flavors off the market. But that’s not the worst of it. Over 50% of employees are tied up in an all-hands-on-deck effort to deliver to the FDA a “pre-marketing tobacco application” (PMTA) due May 12th that will expose ingredients, components, manufacturing processes, and health and environmental impacts of their product. As one anonymous employee posted, “We’re going to get the PMTA or die trying! Lol…do we have a plan b? No.”

The executive team has a Plan B – Hire former FDA Officials. That includes former lead toxicologist at the agency’s Center for Tobacco Products, Roxana Weil, and FDA tobacco inspector, Gabriel Muniz, who signed up recently as director of regulatory compliance.

It isn’t as if we weren’t warned. Back in 2018, Jonathan Winickoff, former chair of the American Academy of Pediatrics Tobacco Consortium, said: “Juul is already a massive public health disaster.” But others saw addicted adults, not kids as the real problem. David Abrams, former director of the Office of Behavioral and Social Sciences Research at the NIH, commented blithely “It changes your heart rate a little bit. The AAP is doing its job. And we should be protective of kids. But there are adult lives at stake, too.”

A recent executive order has put a temporary federal ban on flavored vaping products. But health advocates note that the pronouncement is filled with intentional loopholes. The West Coast workforce is predominantly Silicon savvy, young, liberal, and have one foot out the door. As one employee put it, “To be sort of beholden to Trump and Republicans for the existence of our industry is disheartening.”  

« go backkeep looking »
Show Buttons
Hide Buttons