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The “Antebellum Paradox”: What is it and why it matters.

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BY MIKE MAGEE

I recently made the case that “Health is foundational to a functioning democracy. But health must be shared and be broadly accessible to be an effective enabler of good government.” I also suggested that the pursuit of good health is implied and imbedded in the aspirational and idealistic wording of our U.S. Constitution, and that the active pursuit of health as a nation is essential if we wish to rise to Hamilton’s challenge in Federalist #1 and prove that we are “capable of establishing good government from reflection and choice.” So why are native white males lagging behind in health?

Our progress as a nation toward health was severely hampered from the start. The reality of self-government “of the people, by the people, and for the people” applied only to 6% of inhabitants, all white male land owners at the time. Health was never voiced as a priority, though modern day critics insist it is clearly implied in the promise of “life, liberty, and the pursuit of happiness.” But what was that promise worth in the late 18th century, in a nation that allowed slavery, disenfranchised women, and slaughtered and dislocated its indigenous brothers and sisters?

In those earliest years of the birth of this nation, in the first half of the 19th century, what was the state of health for enfranchised native born white citizens of this nation? Most may presume (as I did) that the general health and standard of living over the next two hundred years, as reflected in lifespan, was a straight (if gradual) upward slope. But what I learned from a bit of digging is that uncovering the facts on mortality, fertility, migration, and population growth during those early years of our nation is a complex venture at best.

Our federal government did conduct a census every ten years, but one hundred years passed before we reliably collected vital statistics including comprehensive birth and death registration. Beginning in 1850, age, sex, race, marital status, occupation and cause of death were supposed to be collected. But an audit in those years disclosed that mortality (for example) was 40% underreported.

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The Danger of Stroking a Tiger

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By MIKE MAGEE

On the evening of December 29, 1940, with election to his 3rd term as President secured, FDR delivered these words as part of his sixteenth “Fireside Chat”: “There can no appeasement with ruthlessness…No man can tame a tiger into a kitten by stroking it.”

Millions of Americans, and millions of Britons were tuned in that evening, as President Roosevelt made clear where he stood while carefully avoiding over-stepping his authority in a nation still in the grips of a combative and isolationist opposition party.

The Germans were listening as well and sent a different type of message as the Luftwaffe, in concert with the address, launched their largest yet raid on the financial district of London. Their “fire starter” group, KGr 100, initiated the attack with incendiary bombs that triggered fifteen hundred fires that began a conflagration ending in what some labeled the “Second Great Fire of London.”

There was nothing happenstance about the timing or methods of the attack. The night was moonless, keeping RAF fighters lacking air-to-air radar grounded. There were high winds to fan the flames that night. High explosive bombs were used to target water mains to hamper fire fighters, and the Thames was at low tide making accessing it for a water supply neigh impossible.

Combined with Roosevelt’s words, the actions of December 29, 1940, now 82 years later, highlight two truisms when confronting evil orchestrated at the hands of racist, autocratic leaders.

First, appeasement does not work. It expands the vulnerability of a majority suffering the “tyranny of the minority.”

Second, the radicalized minority will utilize any weapon available, without constraint, to maintain and expand their power.

The battle to save democracy in these modern times has not been won. As was FDR at the time of his address, we are in the early years of this deadly serious conflict, and still in catch-up mode, awakened from a self-induced slumber on January 6, 2020.

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The Constitution, Health, and Culture in America

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By MIKE MAGEE

“The Right to Health Care and the U.S. Constitution.” On the surface, it sounds like a straightforward topic – a simple presentation. But a gentle scratch at the surface reveals a controversy that literally dates back 250 years and more. Is it a “right”, a “privilege”, or simply a “necessity?”

I’m not a lawyer or Constitutional scholar. But I do know health care, its history, and its many strengths and weaknesses. What does our Constitution have to do with health care? The answer: That depends on how broadly you define “health.”

Before we were ever a nation, there existed a 300 year period of war and conquest, of genocide and superstition masquerading as science, of promises made and promises broken in the Americas. The naive fledgling nation that declared its independence in 1776, knew that what they were attempting was a long shot. As Alexander Hamilton wrote in the first Federalist paper, the pressing question was “… whether societies of men are really capable or not, of establishing good government from reflection and choice, or whether they are forever destined to depend, for their political constitutions, on accident and force.” It was, and is, an open question.

One hundred and seventy years after our Declaration of Independence, General George Marshall raised the same question when charged with rebuilding the destroyed societies of vanquished enemies, Germany and Japan, from ashes. Where should he begin? In 1946, he decided to begin by establishing national health plans in each of those nations. He believed that by creating services that emphasized safety and security; handed out compassion, understanding and partnership in liberal amounts; reinforced bonds between individuals, families and their communities; and processed a population’s collective fears and worries day in and day out, would help establish a level of trust and tranquility necessary to secure the foundations of a thriving and lasting democracy. It was, if you will, a “nation building” plan, The Marshall Plan.

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“All Men Would Be Tyrants.” History Reverberates!

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By MIKE MAGEE

“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

This striking and sweeping statement of values, the Preamble to our Constitution, was anything but reassuring to the wives, mothers, sisters and daughters of the Founding Fathers. Abigail Adams well represented many of them in her letter to John Adams in March, 1776, when she wrote:

“Remember the Ladies, and be more generous and favorable to them than your ancestors. Do not put such unlimited power into the hands of the Husbands. Remember all Men would be tyrants if they could. If particular care and attention is not paid to the Ladies we are determined to foment a Rebellion and will not hold ourselves bound by any Laws in which we have no voice or Representation.”

Her concern and advocacy for “particular care and attention” reflected a sense of urgency and vulnerability that women faced, and in many respects continue to face until today, as a result of financial dependency, physical and mental abuse, and the complex health needs that accompany pregnancy, birth, and care of small infants.

The U.S. Constitution is anything but static. In some cases, the establishment of justice, or the unraveling of injustice may take more than a century. And as we learned in the recent Dobbs case, if the Supreme Court chooses, it may reverse long-standing precedents, and dial the legal clock back a century overnight.

Roe v. Wade was a judicious and medically sound solution to a complex problem. Perfection was not the goal. But in the end, most agreed that allowing women and their physicians to negotiate these highly personalized and individualized decisions by adjusting the state’s role to the reality of the 1st, 2nd, and 3rd trimester made good sense. But getting physicians to step forward and engage the issue was neither simple nor swift.

In July, 1933, McCall’s magazine published one of hundreds of ads that year for contraceptive products. This one was paid for by Lysol feminine hygiene. It pulled punches, using coded messages, and suggesting that the very next pregnancy might finally push a women over the edge, and that would indeed be a “travesty.”

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THCB Gang Episode 111, Thursday December 22

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It’s the Christmas special THCB Gang where we reviewed the year! Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday December 22 were privacy expert Deven McGraw (@healthprivacy), fierce patient activist Casey Quinlan (@MightyCasey); Jennifer Benz (@Jenbenz); and medical historian Mike Magee (@drmikemagee). And then in our end of year tradition a few other gang members dropped in towards the end.

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

As Balwani and Holmes Head To Jail…Will Others in Health Tech Follow?

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by MIKE MAGEE

This week’s headlines seemingly closed a chapter on the story of medical research criminality in America. Ramesh “Sunny” Balwani, former president and COO of Theranos was sentenced to 13 years in prison for fraud. That’s 2 years more than his former business and romantic partner, Elizabeth Holmes.

White crime criminal defense attorney for all things science tech, Michael Weinstein, took the opportunity to trumpet out a confident message that crime doesn’t pay in Medicine with these words, “It clearly sends a signal to Silicon Valley that puffery and fraud and misrepresentation will be prosecuted, there will be consequences and the end result is potentially decades in prison.”

The smooth talking fraudsters played a good hand for years, buoyed by a Board, asleep at the $9 billion valuation wheel, with the likes of George Shultz, Henry Kissinger, Rupert Murdoch and Larry Ellison. But attorney Weinstein and all associated with Health Tech entrepreneurship would do well to read again a classic piece of health journalism from fifty-six years ago.

On June 16, 1966, the New England Journal of Medicine published an article titled “Ethics and Clinical Research.” Written by a highly respected Harvard physician, Henry K. Beecher, the head of anesthesiology at Massachusetts General Hospital, the article referred to “troubling charges” that had grown out of “troubling practices” at “leading medical schools, university hospitals, private hospitals, governmental military departments (the Army, the Navy and the Air Force), governmental institutes (the National Institutes of Health), Veterans Administration hospitals and industry.”

Beecher then reviewed 50 distinct contemporary American clinical studies with ethical violations judged by standards at Beecher’s own Massachusetts General Hospital.

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“True, True, and Unrelated” in the age of “Product Placement/Embedded Marketing.”

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BY MIKE MAGEE

This is “high grandparenting season” at our home when you go “The Extra Mile.” That means it is possible on certain days on or between Thanksgiving and New Year’s Day to find up to 20 children and grandchildren under our roof. With my wife one of ten, and me, one of twelve, we are no strangers to chaos. Our kids believe we feed off it, and maybe they’re right.

With over 150 years under our collective belts, we two are – if nothing else – optimistic, resilient, and somewhat wiser then we were in our early years. For example, we know that the mere temporal or geographic approximation of two incidents or events does not necessarily prove cause and effect. 

That point was reinforced the morning after Thanksgiving when our 11 year old granddaughter informed me that the basement toilet was clogged. She then provided a thumbnail sketch of the events the night before after we had bailed early – the toilet overflowed (nobody knows how or why), a frantic search for a plunger failed even though all were enlisted in the effort, and eventually everyone retired satisfied that the now unusable toilet was quiescent.

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When Push Comes to Shove: The AMA v. Dobbs. Part 2.

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BY MIKE MAGEE

On November 8, 2022, five days after the 2022 Midterm elections, the AMA raised its voice in opposition to Republican efforts to promote second class citizenship for women by exerting public control over them and their doctors intensely private reproductive decisions. At the same time they sprinkled candidates on both sides of the aisle with AMA PAC money, raising questions whether their love of women includes active engagement or just passive advocacy.

Trump and his now MAGAGA (“Make America Great and Glorious Again”) movement has now returned to center stage. With the help of Senate Majority leader McConnell, Christian Conservatives had packed the Supreme Court with Justices committed to over-turning Roe v. Wade. And they did just that.

On June 24, 2022, a Supreme Court, dominated by five conservative Catholic-born Justices, in what experts declared “a historic and far-reaching decision,” Dobbs v. Jackson Women’s Health Organization, scuttled the half-century old right to abortion law, Roe v. Wade, writing that it had been “egregiously wrong,” “exceptionally weak” and “an abuse of judicial authority.”

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When Push Comes to Shove: The AMA v. Dobbs. Part 1.

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BY MIKE MAGEE

Should anyone present know of any reason that this couple should not be joined in holy matrimony, speak now or forever hold your peace.”     Book of Common Prayer, Church of England, 1549

Last evening Trump rose from the ashes and declared it was time to “Make America Great and Glorious Again” (MAGAGA).

This past week, five days after the Midterm elections, AMA President, Jack Resnick, Jr., MD, raised his voice from the podium at the AMA Interim Meeting in Hawaii with the AMA’s own version of a call to action:

“But make no mistake, when politicians insert themselves in our exam rooms to interfere with the patient-physician relationship, when they politicize deeply personal health decisions, or criminalize evidence-based care, we will not back down…I never imagined colleagues would find themselves tracking down hospital attorneys before performing urgent abortions, when minutes count … asking if a 30% chance of maternal death, or impending renal failure, meet the criteria for the state’s exemptions … or whether they must wait a while longer, until their pregnant patient gets even sicker…Enough is enough. We cannot allow physicians or our patients to become pawns in these lies.”

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