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Health Care Needs A Hero

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By MIKE MAGEE

Health care needs its heroes.

I came to that conclusion this week through a roundabout route.

First I read Maureen Dowd’s interview entitled “Dara Khosrowshahi, Dad of Silicon Valley”, in which she, with some affection, gives the reader a look behind the scenes at the personal life of the current Uber CEO. At one point, Dowd shares her conversation with Dara’s 20-year-old daughter, Chloe, a Brown student, who wants us to know her father was a seriously good dad. In support of this belief, she reports that “When she was little, her father – a fan of Joseph Campbell…would concoct children’s stories set in faraway kingdoms…”

This, of course, forced me to acknowledge that I didn’t know who Joseph Campbell was. Bill Moyers came to the rescue. His June 21, 1988 interview titled “Joseph Campbell and the Power of Myth — ‘The Hero’s Adventure’”, begins with a clip from Star Wars where Darth Vader says to Luke, “Join me, and I will complete your training.” And Luke replies, “I’ll never join you!” Darth Vader then laments, “If you only knew the power of the dark side.” Moyers asked Campbell to comment.

JOSEPH CAMPBELL: He (Darth Vader) isn’t thinking, or living in terms of humanity, he’s living in terms of a system. And this is the threat to our lives; we all face it, we all operate in our society in relation to a system. Now, is the system going to eat you up and relieve you of your humanity, or are you going to be able to use the system to human purposes.

BILL MOYERS: So perhaps the hero lurks in each one of us, when we don’t know it.

By then, I was aware that Joseph Campbell, who died in 1987 at the age 83, was a professor of literature and comparative mythology at Sarah Lawrence College. His famous 1949 book,  “The Hero With a Thousand Faces” made the case that, despite varying cultures and religions, the hero’s story of departure, initiation, and return, is remarkably consistent and defines “the hero’s quest.” His knowledge of this quest gained him a large following that included George Lucas who was a close friend and has said that Star Wars was largely influenced by Campbell’s scholarship.

Whether health care or technology, unfettered capitalism is more than adept at breeding predatory systems that beg for redemption.  Author Emily Chang spoke to this predilection in her 2018 book, “Brotopia”, describing Silicon Valley types as “secretive, orgiastic, and dark.” Dara Kharowshaki’s  CEO predecessor at Uber, Travis Kalanick, was labeled one of the worst. When Dara took over, New York Times technology expert, Mike Issac asked in 2019, “Can this rational, charming chief without the edge, ego, or cult following of wacky founders succeed in today’s insane economy?”

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Biden Should Extend a “Public Option” as a Message to “Health Care Royalists”

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By MIKE MAGEE

In this world of political theatrics, with Democratic legislators from Texas forced into exodus to preserve voters’ rights, and Tucker Carlson rantings about Rep. Eric Swalwell riding shirtless on a camel in Qatar streaming relentlessly, Americans can be excused if they missed a substantive and historic news event last week.

On Friday, July 9th, President Biden signed a far-reaching executive order intended to fuel social and economic reform, and in the process created a potential super-highway sized corridor for programs like universal healthcare. In the President’s view, the enemy of the common man in pursuit of a “fair deal” is not lack of competition but “favoritism.”

To understand the far-reaching implications of this subtle shift in emphasis, let’s review a bit of history. It is easy to forget that this nation was the byproduct of British induced tyranny and economic favoritism. In 1773, citizens of Boston decided they had had enough, and dumped a shipment of tea, owned by the British East India Company, into the Boston Harbor. This action was more an act of practical necessity than politics. The company was simply one of many “favorites” (organizations and individuals) that “got along by going along” with their British controllers.  In lacking a free hand to compete in a free market, the horizons for our budding patriots and their families were indefinitely curtailed.

Large power differentials not only threatened them as individuals but also the proper functioning of the new representative government that would emerge after the American Revolution. Let’s recall that only white male property owners over 21(excluding Catholics and Jews) had the right to vote at our nation’s inception.

Over the following two centuries, power imbalances have taken on a number of forms. For example, during the industrial revolution, corporate mega-powers earned the designation “trusts”, and the enmity of legislators like Senator John Sherman of Ohio, who as Chairman of the Senate Republican Conference, led the enactment of the Sherman Antitrust Act of 1890.

He defined a “trust” as a group of businesses that collude or merge to form a monopoly. To Sen. Sherman, J.D. Rockefeller, the head of Standard Oil, was no better than a monarch. “If we will not endure a king as political power, we should not endure a king over the production, transportation and sale of any of the necessities of life”, he said.   The law itself stated “[e]very contract, combination in the form of trust or otherwise, or conspiracy, in restraint of trade or commerce among the several States, or with foreign nations, is declared to be illegal.”

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THCB Gang Episode 62 – Thurs July 15, 1pm PT- 4pm ET

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Episode 62 of “The THCB Gang” will be live-streamed on Thursday, June 17th at 1pm PT -4PM ET. Matthew Holt (@boltyboy) will be joined by regulars futurist Jeff Goldsmith; policy expert consultant/author Rosemarie Day (@Rosemarie_Day1); Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune); and medical historian Mike Magee (@drmikemagee).

If you’d rather listen, the “audio only” version it is preserved as a weekly podcast available on our iTunes & Spotify channels a day or so after the episode — Matthew Holt

A Hamiltonian View of Post-Pandemic America

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By MIKE MAGEE

“In countries where there is great private wealth much may be effected by the voluntary contributions of patriotic individuals, but in a community situated like that of the United States, the public purse must supply the deficiency of private resource. In what can it be so useful as in prompting and improving the efforts of industry?”

Those were the words of Alexander Hamilton published on December 5, 1791 in his “Report on the Subject of Manufactures.” He was making the case for an activist federal government with the capacity to support a fledgling nation and its leaders long enough to allow economic independence from foreign competitors.

Today’s “foreign force” of course is not any one nation but rather a microbe, gearing up for a fourth attack on our shores with Delta and Lambda variants. This invader has already wreaked havoc with our economy, knocking off nearly 2% of our GDP, as the nation and the majority of its workers experienced a period of voluntary lockdown.

Our leaders followed Hamilton’s advice and threw the full economic weight of our federal government into a dramatic and direct response. Seeing the threat as akin to a national disaster, money was placed expansively and directly into the waiting hands of our citizens, debtors were temporarily forgiven, foreclosures and evictions were halted, and all but the most essential workers sheltered in place.

Millions of citizens were asked to work remotely or differently (including school children and their teachers) or to not work at all – made possible by the government temporarily serving as their paymaster and keeping them afloat.

As we awake from this economic coma, many of our citizens are reflecting on their previously out-of-balance lives, their hyper-competitiveness, their under-valued or dead-end jobs, and acknowledging their remarkable capacity to survive, and even thrive, in a very different social arrangement.

If our nation is experiencing a trauma-induced existential awakening, it is certainly understandable. America has lost over 600,000 of our own in the past 18 months, more people per capita than almost all comparator nations in Europe and Asia. This has included not just the frail elderly, but also those under 65. In the disastrous wake of this tragedy, 40% of our population reports new pandemic-related anxiety and depression.

A quarter of our citizens avoided needed medical care during this lockdown. For example, screening PAP smears dropped by 80%. And so, Americans’ chronic burden of disease, already twice that of most nations in the world, has expanded once again. There will be an additional price to be paid for that.

The Kaiser Family Foundation’s most recent Health System Dashboard lists COVID-19 as our third leading cause of death, inching out deaths from prescription opioid overdoses. Year-to-date spending on provider health services through 2020 dropped 2%, but pharmaceutical profits, driven by exorbitant pricing, actually increased, bringing health sector declines overall down by -.5% compared to overall GDP declines of -1.8%. The net effect? The percentage of our GDP devoted to health care in the U.S. actually grew during the pandemic – a startling fact since our citizens already pay roughly twice as much per capita as most comparator nations around the world for health care.

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Health Tech: Part II –Powering Up The Vision

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By MIKE MAGEE

Few can disagree that, in the fog of the Covid 19 pandemic, health technology entrepreneurs have been on a tear. In the first year of Covid’s isolation induced new reality, digital health companies experienced a $21.6 billion investment boost, double that of the prior year, and four times 2016 funding.

By year two, the investment community exhibited some signs of self-restraint by raising a few open ended questions. For example, in early 2021, Deloitte & Touche led a Future of Health panel at the J.P. Morgan Healthcare conference, reporting that “panelists suggested that entrepreneurs need to go beyond products that simply improve processes or solve existing problems.”

Panelists predicted that virtual health delivery services will expand; consumers will demand greater involvement including expansion of  home diagnostics; and investment driven mergers and acquistions will explode – all of which has proven to be true.

Adding push to shove, Deloitte added this final nudge: “Entrepreneurs who define new markets, dominate them with a strategy people can understand, and extract value will likely be the most successful.”

Forty years ago, in the early beginnings of Health Tech, words similar to those above triggered cautionary tones from traditionalists. For example,  Dr. John A. Benson, Jr., then President of the Board of Internal Medicine, stated “There is a groundswell in American medicine, this desire to encourage more ethical and humanistic concerns in physicians. After the technological progress that medicine made in the 60’s and 70’s, this is a swing of the pendulum back to the fact that we are doctors, and that we can do a lot better than we are doing now.”

He accurately described the mood then, and for most of the 20th century, of academic clinicians toward technology, a complex love-hate relationship that has rejoiced and cheered on progress, while struggling to accept and master change in a manner that would avoid driving a wedge between academicians, clinicians and patients.

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Health Tech, Part I: Where We Are Going, Not Just How Fast We Can Get There

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By MIKE MAGEE

What will be the lasting impact of the Covid 19 pandemic?

We still don’t know the answer to that question in full. But one thing that can be said with some certainty is that it has strengthened the hand of Big Tech and all things virtual. Consider the fact that within the Biden White House administration, 13 senior aides have Big Tech resumes with time spent in firms like Google, Facebook, Twitter, Apple, Amazon, Microsoft and more.

This pandemic-induced scrape with mortality has instigated widely varied responses ranging from existential re-awakenings to explosive entrepreneurship.

In health care for example, health tech start-up’s are altering research, education, care delivery and coordination, data mining, patient privacy and financing.

As we know well from health care, intermingling profit, policy and politics can eventually lead to conflict and recrimination. The current controversy over NIH indirect funding of Shi Zengli’s Wuhan “gain-of-function” viral research through Peter Daszak’s New York based EcoHealth Alliance is a case in point.

But we’ve been there before. In the 1990s, James M. Wilson received a PhD and an MD degree from the University of Michigan, then completed an internal medicine residency at Massachusetts General Hospital and a postdoctoral fellowship at MIT. By 1997, he was one of the leading stars in the new gene-therapy movement, directing his own research institute at the University of Pennsylvania.

The institute focused on adjusting the genes of children born with a hereditary disease called ornithine transcarbamylase deficiency (OTD), which prevents the normal removal of ammonia in the body. Wilson’s experimental technique involved genetic engineering, splicing therapeutic genes into supposedly harmless viruses that, once injected into the body, could carry their payload to defective cells and repair the genetic errors.

Dr. Wilson was attempting to determine the maximum dose of genetically modified material that could be safely injected into affected youngsters. He had enlisted 18 participants, including a teenager named Jesse Gelsinger who had a version of the genetic disease in which some of his liver cells carried the genetic abnormality but other cells were entirely normal. Those who have the full-blown disorder die in early childhood. But with his mosaic, Jesse most of the time felt well, as long as he continued to take 32 pills a day.

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THCB Gang Episode 57 – Thurs June 10

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Episode 57 of “The THCB Gang” will be live on Thursday, June 10, 1pm PT 4pm ET. Matthew Holt (@boltyboy) will joined by regulars: medical historian Mike Magee (@drmikemagee), THCB regular writer Kim Bellard (@kimbbellard) and futurist Ian Morrison (@seccurve). And we have a special guest, health care equity analyst at Hedgeye, Emily Evans (@HedgeyeEEvans)

You might guess that the latest meme stock Clover Health (CLOV) might make an appearance! But that won’t be all!

The video is below. If you’d rather listen, the audio is preserved as a weekly podcast available on Fridays on our iTunes  & Spotify channels

U.S. Science Embrace of Wuhan “Gain-Of-Function” Viral Research Proved A Slippery Slope

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By MIKE MAGEE

The truth hurts.

Eighteen months into a disaster that has claimed 3.5 million lives around the globe, the truth is seeping out. Human error likely caused the Covid pandemic, and America’s Medical-Industrial Complex was right in the middle of it.

Signs of a “great awakening” have emerged from various corners in the month of May.

On May 14, UNC’s top virologist, Ralph Baric, who worked closely with Wuhan chief virologist and batwoman extraordinare, Shi Zhengli, signed on with 17 other scientists to a Science editorial that demanded a reexamination of Covid’s causality writing “theories of accidental release from a lab and zoonotic spillover both remain viable.”

On May 26, Francis Collins, head of the NIH, which funded in part Zhengli’s risky bat virus research (more on that in a moment), admitted to Congressional investigators that “we cannot exclude the possibility of some kind of a lab accident.”

And on June 3rd, on MSNBC’s Morning Joe, the ever-present Tony Fauci advised all who would listen “to keep an open mind.” What he would like us to open our minds to is not a Chinese run weaponized microbe conspiracy, but simply scientific recklessness and human error.

It’s now well established that three Wuhan virology scientists were hospitalized in the Fall of 2019 with Covid. But the initial report from the Wuhan Municipal Health Commission, China, of this cluster of cases of pneumonia was only released on the last day of 2019.

It took only 50 more days for the tight knit group of global research virologists to get their act together and pen a Lancet editorial in which they stated “We stand together to strongly condemn conspiracy theories suggesting that COVID-19 does not have a natural origin,” and that they  “overwhelmingly conclude that this coronavirus originated in wildlife.”

Their coordinator-in-chief was one Peter Daszak, chartered power broker within the U.S. Medical Industrial Complex and president of New York based EcoHealth Alliance which was a major funder of Shi Zhengli’s work in Wuhan.

Daszak is known for adopting militarized terms in the battle against global infectious diseases. In 2020 he wrote in the New York Times, “Pandemics are like terrorist attacks: We know roughly where they originate and what’s responsible for them, but we don’t know exactly when the next one will happen. They need to be handled the same way — by identifying all possible sources and dismantling those before the next pandemic strikes.”

Daszak’s argument that risks involved in Shi Zhengli’s Wuhan bat viruses were justified as defensive and preventive was convincing enough to the NIH and the Department of Defense that his EcoHealth Alliance was funded from 2013 to 2020 (contracts, grants, subgrants) to the tune of well over $100 million – $39 million from Pentagon /DOD funds, $65 million from USAID/State Dept., and  $20 million from HHS/NIH/CDC.

As veteran Science reporter Nicholas Wade deciphered in a classic article in Science – The Wire, “For 20 years, mostly beneath the public’s attention, they had been playing a dangerous game. In their laboratories they routinely created viruses more dangerous than those that exist in nature. They argued they could do so safely, and that by getting ahead of nature they could predict and prevent natural “spillovers,” the cross-over of viruses from an animal host to people. If SARS2 had indeed escaped from such a laboratory experiment, a savage blowback could be expected, and the storm of public indignation would affect virologists everywhere, not just in China.”

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Secular Stagnation – An Economic Argument for Universal Health Care Now

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By MIKE MAGEE

John Maynard Keynes, the famous British economist, was born and raised in Cambridge, England, and taught at King’s College.  He died in 1946. He is widely recognized today as the father of Keynesian economics that promoted a predominantly private sector driven, market economy, with an activist government sector hanging in the wings ready to assume center stage during emergencies.

Declines in demand pointed to recession. Irrationally exuberant spending  signaled inflationary increases in pricing, eroding the value of your money. Under these conditions, Keynes encouraged the government and central bank to adjust fiscal and monetary policy to dampen the highs and lows of the business cycles.

Keynesian economics were popularized in America in the 1930’s by a University of Minnesota economist who would go on to become Chairman of Economics at Harvard. For this, he is often referred to as “The American Keynes”, and was highlighted this week in the New York Times by Nobel economist, Paul Krugman, for his association with another tagline, “Secular Stagnation.”

When that economist, Alvin Hansen, first described the condition, he was working on FDR’s Social Security Plan. He defined it as “persistent spending weakness even in the face of very low inflation.”  Krugman’s modern-day description?  “What we’re looking at here is a world awash in savings with nowhere to go.”

Krugman is not the only economist sounding the alarm. Larry Summers, Harvard economist and Treasury Secretary under Bill Clinton, recently wrote, “The relevance of economic theories depends on context.” On the top of his list of current environmental concerns restricting investment and growth is the strong belief that the number of available workers is in steep decline.

Just days ago the CDC added fuel to the fire when they reported a 2020 birth rate in the U.S. of 55.8 births per 1,000 women ages 15 to 44. That was 4% lower than in 2019, and the lowest recorded rate since we started collecting these numbers in 1909. Our lower birthrate is further aggravated by declines in numbers of immigrants and a flattening of the movement of women into the workforce. Add to this the general aging of our population. To put it in perspective, Americans over 80 now outnumber Americans 2 and under.

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THCB Gang Episode 54, Thursday May 13

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Episode 54 of “The THCB Gang” was held on Thursday, May 13. Matthew Holt (@boltyboy) was joined by regulars: policy expert consultant/author Rosemarie Day (@Rosemarie_Day1); medical historian Mike Magee (@drmikemagee), THCB regular writer Kim Bellard (@kimbbellard) employer health expert Jennifer Benz (@jenbenz); and WTF Health host & Health IT girl Jessica DaMassa (@jessdamassa).

The topic ended up looking at the role of employers in dealing with inequality in health care, and whether the digitally enabled primary care navigation organizations could help. A great discussion!

Then video is below. If you’d rather listen, the audio is preserved as a weekly podcast available on our iTunes  & Spotify channels.

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