Giving Thanks to Women, and Children, and Lives Filled With Promise.

Posted on | November 20, 2023 | No Comments

Mike Magee

As Thanksgiving Day approaches, let’s give thanks for women, and children, and lives filled with promise.

One President who understood the power of promise more than many others was FDR. When he structured up “a series of programs, public work projects, financial reforms and regulations…”, he memorably packaged the plan under the label, “The New Deal.”

With a heavy dose of humility and learned wisdom, he rose again eleven years later, on January 11, 1944, fifteen months before his death, and delivered the State of the Union Address as a Fireside Chat from the Oval Office in the White House.

His words once again were clear and ever lasting. He stated that the original Bill of Rights was “inadequate to assure us equality in the pursuit of happiness.” One of the missing elements, he affirmed was a national health care system.

“Necessitous men are not free men.” The nation needed, he said, “a second Bill of Rights under which a new basis of security and prosperity can be established for all—regardless of station, race, or creed.”

Harvard-trained moral philosopher Susan Neiman PhD recalled those words recently in calling for “a commitment to universalism over tribalism, a firm distinction between justice and power, and a belief in the possibility of progress.”

She also recalled the work product of Eleanor Roosevelt who guided the creation of the UN’s “Universal Declaration of Human Rights” which she herself admits is to this day “a declaration that remains aspirational.” Signed by 150 nations, it remains the most translated document in the world.

Embedded in the declaration is a broad and inclusive definition of health. It reads “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

The Roosevelts’ definition of “health” continues to guide the work of the March of Dimes , whose latest report on maternal and childhood health in America is disturbing, and sends an arrow through the heart of Article 25 in the Declaration which reads:

“Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.”

As the March of Dimes reported, “the U.S. remains among the most dangerous developed nations for childbirth with early data from the CDC showing a 3% increase in infant mortality in 2022.” 10.4% of babies last year were born prematurely before 37 weeks gestation. Compare that with the U.K. (7.6%), Italy (6.8%), or Japan (5%). To make matters worse, U.S. numbers reveal remarkable racial disparity with 14.6% of Black babies born prematurely compared to 9.4% of White babies.

As for mothers health in the post-Dobbs era, the report states that “maternal deaths are on the rise, with the rate doubling between 2018 to 2021 from 17.4 to 32.9 deaths per 100,000 live births.”

Susan Neiman sees the problem as deeply embedded in America’s culture and politics where guideposts and philosophical values are being dismantled. Cast in this light, the failed U.S. health care system is systematically broken and highly discriminatory at best.

For Neiman, the vacuum left by an erosion of justice is always filled with power – and specifically, power over someone. As the March of Dimes report so well illustrates, the targets of this power play are clear. They are women, children, and people of color in America. They deserve more than our thanks this Thanksgiving. They deserve unimpeded and complete access to health services, and to their doctors and nurses throughout the land.

The True Color of Tribalism – an orange sash, a green flag, a red MAGA hat…and a fragmented health care system.

Posted on | November 17, 2023 | No Comments

Mike Magee

As Thanksgiving Day approaches, let’s give thanks for the study of history, in part because it reminds us that Trumpian words like “vermin” have been used before and serve to alert the human race that we have entered the danger zone.

One President who understood the power of words more than many others was FDR. When he structured up “a series of programs, public work projects, financial reforms and regulations…to provide support for farmers, the unemployed, youth and the elderly”, he memorably packaged the plan under the label, “The New Deal.”

Seizing alliteration in 1933, he further defined his new policies as the “3 R’s – Relief, Recovery, Reform”, promising “…action, and action now.”

“Necessitous men are not free men. People who are hungry and out of a job are the stuff of which dictatorships are made,” he said, proposing “a second Bill of Rights under which a new basis of security and prosperity can be established for all—regardless of station, race, or creed.” Those were FDR’s words that day.

In proposing this radical cultural shift, he was forecasting the words of Harvard-trained philosopher Susan Neiman PhD in her recent book, “Left Is Not Woke” celebrating a democracy that valued “a commitment to universalism over tribalism, a firm distinction between justice and power, and a belief in the possibility of progress.” Adding, “All these ideas are connected.”

It is not surprising that Dr. Neiman highlights the work product of Eleanor Roosevelt who guided the creation of the UN’s “Universal Declaration of Human Rights” which she herself admits is to this day “a declaration that remains aspirational.” Signed by 150 nations, and the most translated document in the world, not a single country has created a society that assures all the rights enumerated.

This Thanksgiving Day, I will encourage my children, and grandchildren and guests to read aloud the 30 short Articles in the Declaration. Embedded in the declaration is a broad and inclusive definition of health. It reads “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

I am motivated to take this action, not simple because the health of our democracy and others around the globe are under attack by Trump, and Putin, and their followers; nor only for the intentionally destructive behaviors of some of our elected officials; nor just as a reaction to the willingness of some leaders to undercut women’s autonomy and their rightful access to health professionals when medical danger is knocking at their doors.

Rather, I am driven to this action by last week’s March of Dimes report on maternal fetal health in America, and its incongruity with the second paragraph of Article 25 in the Declaration which reads:

“Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.”

As for mothers heath in the post Dobbs era, the report states that “maternal deaths are on the rise, with the rate doubling between 2018 to 2021 from 17.4 to 32.9 deaths per 100,000 live births.”

Fintan O’Toole, the Leonard L. Milberg Professor of Irish Letters at Princeton, in a recent review of Susan Neiman’s book, suggested that results such as these are “rather intimate catastrophes” … and “the starkest manifestation of a tribalized society.”

Such societies, and by inference our own, go well beyond “political partisanship.” As O’Toole explains, “Tribalism spills beyond the strictly political arena into parallel assumptions about history, geography, economics, and, of course, religion… neither side in this (typically binary) contest truly accepts the legitimacy of an electoral defeat. Being outvoted is understood not as a disappointment but as an existential threat.”

O’Toole, as an expert on “The Troubles” in Northern Ireland, knows the landscape, and is raising alarms. “The throwback now feels like a foretelling,” he says. As he sees it, “the Troubles are now—and not in a good way—everybody’s trouble. There are, in the United States and Europe, powerful forms of mass political identity that do not ‘adequately manifest’ themselves in loyalty to the institutions, laws, and values that make a democratic state possible…. suffering deepens the sense of victimhood… Self-harm and self-pity form a feedback loop of endlessly renewable political energy. And this perpetual motion machine is also driven by revenge.”

“The true colors of a community’s life may be a dazzling mosaic, but tribalism makes them monochrome: an orange sash, a green flag, a red MAGA hat.”

As a moral philosopher, Susan Neiman clearly channels an earlier Eleanor Roosevelt when she highlights the abandonment of philosophical values including “a commitment to universalism over tribalism, a firm distinction between justice and power, and a belief in the possibility of progress.” Cast in this light, the failed U.S. health care system is easily cast as “tribalistic” at best.

Of course, as O’Toole points out, tribalism is also accompanied by heavy doses of self-victimization. Trump’s White Nationalist followers believe they are being “tyrannized by poor immigrants and nonwhite people demanding to be treated as equals.” But as O’Toole points out, “The power of self-pity is that it does not require actual oppression—if you always travel first-class, being stuck in economy will make you feel very sorry for yourself.”

Neiman’s major point is that the vacuum left by an erosion of justice is always filled with power – and specifically, power over someone. As the March of Dimes report so well illustrates, that “someone” for Trump and followers, for whom (as O’Toole suggests) “the only truth is the eternal binary of friend and enemy,” and “politics, like war is a matter of the most extreme and intense antagonisms,” the enemies are clear. They are women and people of color in America.

Category: Uncategorized
Tags: 2023 march of dimes report > Eleanor Roosevelt > FDR > Fintan O'Toole > ledft is not woke > nazi language > Susan neiman > the new deal > tribalized society > trump > universal declaration of human rights > vermin

The Way Men Ought To Behave – According to TikToc.

Posted on | November 14, 2023 | 2 Comments

Mike Magee

The juxtapositioning of Tuesday’s New York Times headlines was disturbing. The first “Why Does This Bride Look So Mad?”, was followed by “An ‘Unsettling’ Drop in Life Expectancy in Men.”

The “reluctant bride” referred to in the first article is (by now) an estimated 175 years old if the intended bride was 18 in the painting. The painting itself was the work of artist, Auguste Toulmouche, in 1866. The original title was “The Hesitant Fiancee.” Its’ current fame has a much shorter timeline – 2 weeks to be exact. That’s when it began to appear on TikTok, hosted as a statement of disgust and outrage by mostly young females in opposition to “sexist scolding.”

The painting displays a soon-to-be bride, attended by three friends, all well appointed in opulent dress, with obvious emotional distress. The bride’s face is frozen somewhere between disgust and outrage. Two supplicants are attempting to calm her, with limited success, by hand-holding and kisses on the forehead. The third is distracted, examining her own image in a mirror.

Temple University Art Professor, Theresa Dolan, PhD, offered this description to The New York Times Style and Pop Culture reporter Callie Holtermann: “You don’t often get this in 19th-century painting — this kind of independent streak. She’s actually showing the emotion of not wanting to get married to the person that her obviously wealthy family has picked out. What Toulmouche does so successfully is get into the psyche of the woman.”

Since its recent appearance on social media, modern women have been setting the image to music (“a dramatic section of Giuseppe Verdi’s Requiem”). and adding their own captions, including: “Literally me when I’m right,”“You’re overreacting,” “You should smile more,” “Ugh, do I really have to go through with this,” “Don’t be mean,” and “Mean wasn’t even in the room with us but I can go get him and bring him in.”

Turning the page, the second article feels somehow connected to the first, and not in a good way. It’s written by the Times Sex, Gender, and Science reporter Azeen Ghorayshi, and begins with, “The gap in life expectancy between men and women in the United States grew to its widest in nearly 30 years, driven mainly by more men dying of Covid and drug overdoses, according to a new study in the journal JAMA Internal Medicine.”

The facts are clear: Life expectancy of men at birth is now approximately six years less than women. This reinforces a several decades old trend, and one that is gaining steam. General life expectancy, independent of gender, has declined from 78.8 years in 2019 to 76.1 in 2022. Placed in perspective, most developed nations like the UK, Japan, Korea, and Italy are above 80 years. Our women come close to that at 79.1 years, but they are dragged down by men who now register a depressing 73.2 years. That’s a 5.9 year gender gap.

Dr. Brandon Yan was the lead in this Harvard School gf Public Health Study, and his explanation for the results are discomforting. He identifies Covid-19 as one “preventable cause,” and adds that “The opioid epidemic, mental health, and chronic metabolic disease are certainly front and center in the data.”

But taking a systematic long range view, he speaks directly to policy makers with these words:

“We have a health care system that is very advanced in treating illnesses and advanced disease. But for the most part … it is not very good when it comes to preventative care…There’s a substantial socio-cultural norms component to this data as well in terms of the ways that society views masculinity and the way that men ought to behave. That has profound effects on care-seeking behaviors.”

“The way men ought to behave.” Hummm…sounds like a caption for a TikToK painting.

Category: Uncategorized
Tags: Auguste Toulmouche > Azeen Ghorayshi > Brandon Yan > Callie Holtermann > Harvard School of Public Health > Life Expectanct in US > The Hesitant Fiancee > Theresa Dolan > TikToK painting

Courage Has A Face. Her Name Is Hadley.

Posted on | November 8, 2023 | Comments Off on Courage Has A Face. Her Name Is Hadley.

Mike Magee

“Don’t call me a saint,” said founder of the early 1930’s Catholic Workers Movement, Dorothy Day. “I don’t want to be dismissed that easily.” Oddly enough, says Jesuit writer, James Martin, “That quote is probably the biggest obstacle to her canonization…Given that quote, would Dorothy really want to be canonized?”

Today’s election results were a sliver of bright light in what has been a rather dark period. But it is at times like this that quiet heroes emerge. If courage has a face, this morning, as results across the land show a sweeping victory for Democrats, and specifically those advancing the cause of women’s autonomy in managing their own health decisions with their doctors, it belongs to a young woman from Kentucky named Hadley.

In the final weeks of the Kentucky governor’s race, as Politico reported, Andy Beshear gave voice to the woman who directly addressed his opponent on camera. “Anyone who believes there should be no exceptions for rape and incest could never understand what it’s like to stand in my shoes. This is to you, Daniel Cameron. To tell a 12-year-old girl she must have the baby of her stepfather who raped her is unthinkable.”

Absorbing the results of yesterday’s elections with the rest of us are Governor Chris Christie, Governor Ron DeSantis, Ambassador Nikki Haley, Vivek Ramaswamy, and Senator Tim Scott who will take the stage this evening in Miami at the 3rd Republican Primary Debate. No doubt they are surrounded this morning by consultants trying to figure out how best to spin this issue. As Dobbs has played out in states like Kansas, Ohio, Kentucky, Wisconsin and beyond, political scientists are likely reminding their students that in politics, “Sometimes when you win, you lose.”

Court packing on a federal level, and even more importantly by Republican leaders on the state level, has tipped the power of our nation toward minority rule, allowing repugnant leaders to seize control of our legal system. That power has been used over the past decade to allow passage of laws that attack existing rights such as women’s power and autonomy over their own bodies, or construct barriers that obstruct the popular will of the people. Examples include promoting extreme gerrymandering and voter suppression, dead ending the Dream Act, or allowing citizen access to weapons of war and a permitless gun-carry law in Florida.

Understandably, citizens have wondered, “Will our Democracy die?” Hadley’s courageous decision reflects a stubborn and determined stance, by her and many others throughout this land, assuring the answer is, “No. Not on my watch!”

Her image and words will be lasting for three major reasons. They prove that:

A healthy Democracy requires participation and engagement of citizens.
Freedom and autonomy, including access to health professionals, is sacred and personal.
Women will not accept second class citizenship.

Trump no doubt remains unaware that he has lost everything. Many of his most ardent supporters, including Leonard Leo, the mastermind behind the court packing scheme that brought us the Dobbs decision, remain firmly in a state of denial. But even they must admit this morning, as they stare into Hadley’s eyes, and listen to her steady voice, that they have met their match. And she is a young woman who’s message is clear, “Enough is enough!”

Likely channeling another woman’s spirit from a century ago, Hadley’s courage (listen here) was more human than super-human. As Dorothy Day quietly proclaimed, “Don’t call me a saint. I don’t want to be dismissed that easily.”

Category: Uncategorized
Tags: Andy Beshear > democratic victory > Dorothy Dasy > Hadley > Kansas > kentucky > Leonard Leo > ohio > republican 3rd debate > trump > wisconsin > womens autonomy > Womens Rights

Picking Up The “Single Payer” Baton From Ady Barkan.

Posted on | November 2, 2023 | 2 Comments

Mike Magee

The Politico headline in 2019 declared dramatically, “The Most Powerful Activist in America is Dying.” This week, 4 1/2 years later, their prophecy came true, as activist Ady Barkan succumbed at age 39 to ALS leaving behind his vibrant wife, English professor, Rachael King, and two small children, Carl, 8, and Willow,4.

His journey, as one of the nation’s leading activists for a single-payer health care system began, not coincidentally, with his diagnosis of A.L.S. in 2016, 4 months after the birth of his first child. His address at the 2020 Democratic National Convention fully exposed his condition to a national audience.

His mechanized words that day were direct, “Hello, America. My name is Ady Barkan, and I am speaking to you through this computer voice because I have been paralyzed by a mysterious illness called A.L.S. Like so many of you, I have experienced the ways our health care system is fundamentally broken: enormous costs, denied claims, dehumanizing treatment when we are most in need.”

With remarkable self-awareness, he told New York Times reporter, Tim Arango, “That’s the paradox of my situation. As my voice has gotten weaker, more people have heard my message. As I lost the ability to walk, more people have followed in my footsteps.”

His was a shared sacrifice, laced with stubborn and very public persistence, under the banner, “Be A Hero.” His passing on November 1, 2023, was bracketed that day by a piece by veteran Healthy Policy guru, and columnist for KFF Health News, Julie Rovner, that certainly would have made Ady smile. In the Washington Post newsletter, Health 202, it read, “The AMA flirts with a big change: Embracing single payer health care.”

The commentary that followed included this, “That leftward shift in political outlook is showing up not just in the AMA, but in medicine as a whole. As the physician population has become younger, more female and less White, doctors (and other college graduates in medicine) have moved from being a reliable Republican constituency to a more reliable Democratic one.”

Ironically, the AMA’s lead journal, JAMA, last week reinforced the need for simplification with an article by luminary KFF health policy pros, Larry Levitt and Drew Altman, titled “Complexity in the US Health Care System Is the Enemy of Access and Affordability.” They wrote, “Health care simplification does not necessarily resonate in the same way as rallying cries for universal coverage or lower health care prices, but simplifying the system would address a problem that is frustrating for patients and is a barrier to accessible and affordable care.”

My friend and colleague at The Health Care Blog, THCB, Kim Bellard took off on the article, writing, “Health insurance is the target in this case, and it is a fair target, but I’d argue that you could pick almost any part of the healthcare system with similar results. Our healthcare system is perfect example of a Rube Goldberg machine, which Merriam Webster defines as ‘accomplishing by complex means what seemingly could be done simply.’ Boy howdy.”

A bit further on, Kim comments, “If we had a magic wand, we could remake our healthcare system into something much simpler, much more effective, and much less expensive. Unfortunately, we not only don’t have such a magic wand, we don’t even agree on what that system should look like. We’ve gotten so used to the complex that we can no longer see the simple.”

As Kim suggests, status quo is hard to crack. But change has been in the air for some time. A KFF supported 2017 survey of 1,033 US physicians by Merritt Hawkins revealed a plurality of physicians favored moving on to a single payer system. Why? The survey suggested four factors:

1. Physicians are seeking “clarity and stability”. They believe “single payer” will reduce “distractions.”

2. There is a generational shift underway. “Younger doctors are more accepting.”

3. Physicians have become resigned that “we are drifting toward a single payer system” – so let’s get on with it.

4. There is a philosophical change occurring that increasingly embraces the societal value of universal coverage.

Around the same time American Public Health Association published a proposal drafted by the Physicians for a National Health Program which currently boasts more than 25,000 physician and medical student members. That proposal echoed some of the five points – universality, single administration, local delivery, health planning, and inclusive transparency – I advanced in 2019 in CODE BLUE: Inside America’s Medical Industrial Complex.

Kim, Julie, Larry, and Drew are right in pointing a finger at complexity. But what Ady understood, more perhaps than any others having waged the good activist fight as a progressive soldier, was that the challenge was greater than that. The challenge was cultural.

That realization was what drove the military’s decision under the Marshall Plan. In the re-build of Germany and Japan, we elected to start with a health plan – in part because we recognized that all other social determinants – housing, nutrition, education, clean air and water, safety and security – would be enhanced in the process leading to a tradition that could support stable democracies. This is essentially the same challenge we as a country (having wandered so far off course as to elect Trump) are facing today.

Changing culture, as health professionals know, is a tall order. It is about compassion, understanding and partnerships. It is about healing, providing health, and keeping individuals, families and communities whole. And – most importantly – it is about managing population-wide fear, worry and anxiety.

What we are asking of the people, and the people caring for the people, is to change their historic culture (one built on self-interest, hyper-competitiveness, and distrust of good government). This is a tall order – something that parents, pastors, politicians and physicians equally recognize. Things evolve, and difficult things take time.

Ady Barkan has run out of time. He has left it to us to complete the task of achieving health care for all through a single payor system.

Category: Uncategorized
Tags: Ady Barton > Code Blue > Drew Altman > Julie Rovner > KFF News > Kim Bellard > Larry Levitt > Physicians for a National Health Plan > PNHP > THCB > The Health Care Blog > Tim Arango

“Some Like It Hot.” – An Old Disease Arrives Anew.

Posted on | October 25, 2023 | 2 Comments

Mike Magee

Naomi Orestes PhD, Professor of the History of Science at Harvard, didn’t mince words as she placed our predicament in context when she said, “If you know your Greek tragedies you know power, hubris, and tragedy go hand in hand. If we don’t address the harmful aspects of human activities, most obviously disruptive climate change, we are headed for tragedy.”

At the time, as a member of the Anthropocene Workgroup, she and a group of international climate scientists were focused on defining and measuring nine “planetary boundaries,” environmental indicators of planetary health. At the top of the list was Climate Change because, one way or another, it negatively impacts the other eight measures.

Not the least of these “human perturbations” is the effect of global warming on access to clean, safe water, and the impact of violent weather cycles and rising sea levels on concentrated urban populations along coastal waters.

A less recognized, but historically well documented threat, is exposure to migrating vectors of disease as they contact unprepared human populations beyond their traditional camping grounds. The threat of avian flu among migratory birds has been well covered. Equally, over the past decade, North America has seen a range of novel infections, especially along our southern borders, from dengue, to chikungunya, to Zika.

The southern United States and its coastal populations are firmly in the cross-hairs. Their seas are rising at an alarming rate, and fouling fresh water supply with invasive sea water. Their soaring temperatures are only exceeded by record setting atmospheric river rainfalls and flooding events, and their “extreme poverty throughout Texas and the Gulf Coast states, where inadequate or low-quality housing, absent or broken window screens, and a pervasive dumping of tires in poor neighborhoods,” as reported in this weeks New England Journal of Medicine, assures a reemergence of one of this countries most significant, but now long forgotten killer diseases.

In 1853, the disease killed 11,000 in New Orleans, some 10% of the population. Twenty-five years later, it overwhelmed Mississippi Valley cities killing 20,000. Its latest major foray in the United States was in 1905 with 1000 deaths. Its’ absence over the past century is credited to public health and structural and engineering advances. But that was then, and this is now.

The disease is Yellow Fever, and red lights are blinking in a range of southern coastal cities from Galveston, TX, to Mobile, AL, to New Orleans, LA and Tampa, FL.. Experts say they may soon be in the same boat as Brazil was between 2016 and 2019 when it experienced a threefold increase in the historic prevalence of the disease among its population.

Public Health sleuths have uncovered that the 1878 epidemic in the Mississippi Valley was triggered by an El Nino spike the year prior. The warmer and wetter conditions are believed to have supported a large increase in Aedis aegypti mosquitos, the vector for the Yellow Fever virus.

Are we prepared? Recent experience in fighting Dengue fever in the southern states is not encouraging, with WHO chief scientist Jeremy Farrar warning that Dengue might soon “take off” absent better mosquito eradication and screening prevention. U.S. Public Health experts say a Dengue foothold is nearly secured and the disease is fast on its way to becoming endemic in southern coastal states.

As for Yellow Fever, there is an effective vaccine, but it is also associated with rare but serious side effects. Antivaccine activism post-Covid would be a significant barrier now say experts. Adding to the challenge, no Yellow Fever vaccine is currently available from the U.S. Strategic National Stockpile. Mosquito surveillance programs are currently marginal, and response capabilities for mass vaccination in affected areas are severely limited.

The Anthropocene Workgroup is fully aware of these human instigated crises. In the prior Holocene Epoch of 11,700, we prided ourselves with being able to co-exist with other lifeforms and in equilibrium with a healthy planet. But beginning in 1950, the new Anthropocene Epoch has aggressively chipped away at planetary health, disrupting stabilizing cycles, and critically raising the temperature and acidity of oceans that cover and buffer 70% of the planet.

The return of Aedes aegypti, and the Yellow Fever virus it carries, is a dramatic harbinger of additional challenges to come if we are unable to limit “human perturbations” of our planetary cycles.

Category: Uncategorized
Tags: anthropocene epoch > anthropocene working group > chikungunya > dengue > global warming > halocene epoch > Yellow Fever > Zika

Agents of Democracy

Posted on | October 19, 2023 | Comments Off on Agents of Democracy

Mike Magee

In the Age of “Doomscrolling,” Doctors and Nurses Need To Stay Focused On Their Primary Mission.

Exactly 1 year ago, mental health experts alerted the medical world to their version of an assessment scale for yet another new condition – “doomscrolling.”

As defined in the article, “Constant exposure to negative news on social media and news feeds could take the form of ‘doomscrolling’ which is commonly defined as a habit of scrolling through social media and news feeds where users obsessively seek for depressing and negative information.”

No one can deny a range of legitimate concerns. Faced with continued background noise from the pandemic, add global warming, renegade AI, and the Republican Congress. And now, the devastating attacks on Israel and growing instability in the Middle East. It is no wonder that we can’t turn off the Instagram feed.

With real challenges like these, our troubled world needs her doctors and nurses to stay focused more than ever on their primary professional missions – managing health and wellness, sickness and disease, fear and worry, and yes, now “doomscrolling.”

John J. Patrick PhD, in his book Understanding Democracy, lists the ideals of democracy to include “civility, honesty, charity, compassion, courage, loyalty, patriotism, and self restraint.” The 4.2 million registered nurses and 1 million doctors in America are agents of democracy.

Regrettably, they are already being drawn away from patients by three powerful forces.

Corporate Dislocation – To assure maximum reimbursement, doctors and nurses are routinely asked to prioritize time and contact with data over time and access to patients.
Health Technology and AI Substitution – Rather than engineering solutions to expand real-time patient contact, most innovations are further distancing patients from healthcare professionals.
Legislative Intrusion – Complex medical decisions, long entrusted to the patient-health professional relationship to negotiate, are being transferred to ultra-conservative legislators.

We live under a constitutional and representative democracy, as do two-thirds of our fellow citizens in over 100 nations around the world. The health of these democracies varies widely. The case for democracy emphasizes its capacity to enhance dignity and self-worth, promote well-being, advance equal opportunity, protect equal rights, advance economic productivity, promote peace and order, resolve conflicts peacefully, hold rulers accountable, and achieve legitimacy through community based action.

One of the challenges of democracy is to find the right balance in pursuing “the common good” which has dual (and often competing) arms. One arm is communitarian well-being and the other, individual well-being. Blending personal and public interests is complex. In health, one might argue, this tension has led to our dual system – one, largely profit driven, interventional and science discovery based, and the other largely public, preventive and focused on communitarian public health.

Both nursing and medicine have embraced professionalism, and launched new graduates by voicing “oaths” or promises to themselves, their colleagues, and our society as a whole. These lists of promises or pledges, their language and priority ordering, helps reveal both the history and intent of these noble professions.

Of course, the most famous oath in Medicine is the Hippocratic Oath reaching back some 2000 years to Greece. In pledging to a grouping of ancient deities, it recognized that interventions should “do no harm,” and that confidentiality was paramount.

By 1964, this oath was sufficiently out of date that many medical schools embraced an updated version written by Louis Lasagna, MD. The oath includes a communitarian connector: “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.”

The Penn State College of Medicine’s Oath in 2022 offered a counter-balance by giving top billing to the patient, with the oath to the patients, not to Greek gods: “By all that I hold highest, I promise my patients competence, integrity, candor, personal commitment to their best interest, compassion, and absolute discretion, and confidentiality within the law.”

The Geneva based World Medical Association, in the shadow of the Nuremberg Trials, provided a list of pledges in their 1946 Declaration of Geneva in order of appearance including:

the service of humanity
patents first
patient autonomy and dignity
respect for human life
absence of bias or prejudice on any basis
commitment to patient privacy
guided by professional conscience and dignity
honor the noble traditions of the profession
respect and gratitude to teachers, colleagues and students
share knowledge to advance health care
commit to personal health and well-being
never violate human rights.

Nursing has also relied on professional Oaths. The first was the Nightingale Pledge, created in 1893 by the Farrand Training School for Nurses and named after Florence Nightingale. It is believed to be based on the Hippocratic Oath, and was modernized in 1935. In the 1950’s, the American Nurses Association (ANA), created a formal Code of Ethics, including Nursing’s 9 Provisions (or Pledges) committing to: compassion and respect, patient-focus, advocacy, active decision making, self-health, ethical environment, scholarly pursuit, collaborative teamwork, professional integrity and social justice.

As health professionals, we need to be laser focused during these troubled times on our patients. Doctors and nurses, day in and day out, by managing fear and worry, reinforcing community and family bonds, and championing hopefulness, guard against a true “doomsday scenario” – the destruction of our Democracy from within. The patient is our primary concern, and deserves our full professional attention.