Tag: Mike Magee

Orange, Green, and Red – The Colors of Tribalism

Nov 20, 2023

BY 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 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.”

When his enemies began to coalesce against him in 1936, he chose his words carefully in the public defense. Seizing the largest venue he could find at the time –Madison Square Garden – he stood tall and erect, supported by heavy leg braces, and declared defiantly, “They are unanimous in their hate for me – and I welcome their hatred.”

With a heavy dose of humility and learned wisdom, he rose again eight 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.

TikTok on the Gender Gap

Nov 14, 2023

By MIKE MAGEE

The juxta-positioning 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 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 an 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, examine her own image in a mirror.

Temple University Art Professor, Theresa Dolan, 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.

The Voice of Democracy is Young and Female

Nov 10, 2023

By 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?”

This week’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 the elections with the rest of us are Governor Chris Christie, Governor Ron DeSantis, Ambassador Nikki Haley, Vivek Ramaswamy, and Senator Tim Scott who took the stage last Wednesday evening in Miami at the 3rd Republican Primary Debate. No doubt they are surrounded 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 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 she and many others throughout this land, to assure 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, 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.”

Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex.

Will the AMA Support A Move Toward Single Payer Health Care?

Nov 8, 2023

By 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,7, and Willow,3.

His journey, as one of the nation’s leading activists for a single-payer health care system began, not coincidentally, began with his diagnosis of A.L.S. in 2016, 4 months after the birth of his first child. His speech at the 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.”

Three years later, 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 passage 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 follows includes 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 write, “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 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:

The “Green Pope” Loves Science and Is Cautious of AI

Oct 11, 2023

By MIKE MAGEE

By all accounts, they were mutually supportive. He was three years older and the chief scientific adviser to the world’s most powerful religious leader. The Scientific American called him “the greatest scientist of all time,” and not because he won the Nobel Prize in Chemistry a decade earlier for explaining the nuts and bolts of ozone formation. It was his blunt truthfulness and ecological advocacy that earned the organization’s respect.

Paul Crutzan is no longer alive. He died on February 4, 2021 in Mainz, Germany at the age of 87. What attracted the 86 year old “Green Pope” to Paul were three factors that were lauded at his death in the Proceedings of the National Academy of Sciences (PNAS) – “the disruptive advancement of science, the inspiring communication of science, and the responsible operationalization of science.”

It didn’t hurt that Crutzan was pleasant – or as the The Royal Society in its obituary simply described him: “a warm hearted person and a brilliant scientist.”

In 2015, he was Pope Francis’s right arm when the Catholic leader, who had purposefully chosen the name of the Patron Saint of Ecology as his own, was briefed on the Anthropocene Epoch. Crutzen had christened the label five years earlier to brand a post-human planet that was not faring well.

Crutzen was one of 74 scientists from 27 nations and Taiwan who formed the elite Pontifical Academy of Sciences in 2015. Those selected were a Who’s Who of the world’s scientific All-Stars including 14 Nobel recipients, and notables like Microbiologist Werner Arber, physicist Michael Heller, geneticist Beatrice Mintz, biochemist Maxine Singer, and astronomer Martin Rees.

On May 24, 2015, they delivered their climate conclusions to the Pope, face to face. The Pope heard these words, “We have a collection of experts from around the world who are concerned about climate change. The changes are already happening and getting worse, and the worst consequences will be felt by the world’s 3 billion poor people.”

The next month, with his release of the encyclical on the environment, Laudato Si’, Pope Francis began by embracing science, with these words, “I am well aware that in the areas of politics and philosophy there are those who firmly reject the idea of a Creator, or consider it irrelevant, and consequently dismiss as irrational the rich contribution which religions can make towards an integral ecology and the full development of humanity. Others view religions simply as a subculture to be tolerated. Nonetheless, science and religion, with their distinctive approaches to understanding reality, can enter into an intense dialogue fruitful for both.”

Further along, he celebrates scientific progress with these remarks, “We are the beneficiaries of two centuries of enormous waves of change: steam engines, railways, the telegraph, electricity, automobiles, aeroplanes, chemical industries, modern medicine, information technology and, more recently, the digital revolution, robotics, biotechnologies and nanotechnologies. It is right to rejoice in these advances and to be excited by the immense possibilities which they continue to open up before us”

But then comes the hammer: “Any technical solution which science claims to offer will be powerless to solve the serious problems of our world if humanity loses its compass, if we lose sight of the great motivations which make it possible for us to live in harmony, to make sacrifices and to treat others well.”

We’re All In The Hot Seat Now.

Oct 4, 2023

BY MIKE MAGEE

It’s not that easy living in the “Big Easy” these days and co-existing with a world dominated by water concerns. When Times-Picayune gossip columnist Betty Guillaud (as the folklore goes) “coined New Orleans’ undisputed nickname” in the 1960’s, it was a lifestyle eponym meant to favorably contrast life in “The Big Easy” with hard living in “The Big Apple.”

That was well before August 23, 2004, when the levies failed to hold back the Gulf waters, and 1,392 souls perished leaving two names to last in infamy – Katrina and Brownie, of “Brownie, you’re doing a heck of a job” fame.

Now it’s not as if it’s been all smooth sailing for New York City and water. I mean, look at the history. When the British overran the Dutch in 1667, one of the first priorities was to dig the first public well and include a marvelous technologic attachment – a hand pump. That was in front of an old fort at Bowling Green, near Battery Park.

But by the early 1700s, the absence of a sewage system and saltwater intrusion from the Hudson and East Rivers, plus a crushing population explosion, had foiled the clean water supply. The solution – temporary at best – haul in fresh groundwater, in limited quantities, from Brooklyn.

“PictureWhat” ??? Super-Human Poison Ivy. What’s Going On?

Sep 20, 2023

By MIKE MAGEE

Connecticut loves its’ trees. And no town in Connecticut loves its’ trees more than West Hartford, CT. The town borders include an elaborate interconnected reservoir system that does double duty as a focal point for a wide range of nature paths for walkers, runners and cyclists.

While walking one path yesterday, I came a tree with the healthiest upward advancing vine I had ever seen. My “PictureThis” app took no time to identify the plant. To my surprise, it was Toxicodendron radicans, known commonly as Poison Ivy.

The description didn’t pull punches. It read, “In pop culture, poison ivy is a symbol of an obnoxious weed because, despite its unthreatening looks, it gives a highly unpleasant contact rash to the unfortunate person who touches it.” And even that doesn’t quite capture the plants negative notoriety.

Its’ pain and itch inducing chemical oil covers every inch of the plant, and is toxic to 80% of humans. It was discovered by Japanese chemist Rikō Majima in the lacquer tree and named urushiol (Japanese for lacquer) in 1922. It is a derivative of catechol, an organic compound with the molecular formula C₆H₆O₂.

But the giant vine this week was nothing like the creeping little three leaf plant most children have be taught to avoid. This was a giant – a very different aggressor worth investigating. Its leaves were impossibly large and its vine straight and thick, and its vitality unhampered by a need to support elaborate roots or bark.

Others have noticed it too including “Pesky Pete” who has made a good living removing the invader from properties in Massachusetts and southern New Hampshire. And recently business has been booming. This is because the plant, which up to this year has never appeared in the region before May 10th, suddenly appeared this year on April 23rd.

This was no surprise to Bill Schlesinger, resident of Maine and Durham, NC. Officially, he is “William H. Schlesinger … one of the nation’s leading ecologists and earth scientists …a member of the National Academy of Sciences, …has served as dean of the Nicholas School of the Environment at Duke…”

Turns out Bill was in the lead on a six year project termed the “DukeUniversity Free-Air CO2 Enrichment Experiment” between 2000 and 2006 when the results were published. They had been following tree declines in the Duke Forest where predatory vines had played a major role. They decided to encircle and isolate six giant forest plots and pump them full of CO2, and then catalogue the effects.

Their 2006 publication revealed that:

CO2 enrichment increased T. radicans photosynthesis by 77%
Increased the efficiency of plant water usage by 51%
Stimulated the growth of poison ivy during the five growing seasons ambient plants
Annual growth increase of 149% in elevated CO2 compared to ambient plants.
Notably larger than the 31% average increase in biomass observed for woody plants

Poison Ivy was the fastest grower of them all in the experimental CO2 forests. Bill’s collaborator, Jacqueline E. Mohan, carried the work further as head of the Harvard Forest project in Massachusetts. They reported out results, not on CO2 soil, but warmed soil. They heated the upper layer of soil by 9 degrees. Her response to the findings was surprisingly down-to-earth. She said, “My heavens to Betsy, it’s taking off. Poison ivy takes off more than any tree species, more than any shrub species.”

Mohan and coworkers made it clear at the time that this was not great news for 8 out of 10 Americans who are sensitive to poison ivy. Not only did global warming and carbon footprints accelerate growth in the plant by 70% in its leaf size and biomass, but additional experiments revealed that these environmental enablers increased the amount of urushiol in the plant

As Duke was building those first towers to isolate their experimental forests in 2000, the International Geosphere-Biosphere Program was holding its annual meeting in Mexico. A Working Group subsequently focused on defining planetary boundaries (PB) that would assure both planetary and human health.

Nine years later, the group published “A Safe Operating Space For Humanity” in Nature. In it they proposed nine “planetary boundaries” to gauge “the continued development of human societies and the maintenance of the Earth system(ES) in a resilient and accommodating state.” In their view, measuring and ongoing monitoring of these boundaries would provide “a science-based analysis of the risk of human perturbations” that might “destabilize the Earth’s Systems (ES) on a planetary scale.” The work was updated in 2015.

The first Planetary Boundary listed was Global Warming with two measures, atmospheric CO2 and air and water temperature. As for human perturbation, as the picture above well illustrates, you can add super-human poison ivy to the list of unintended consequences.

Mike Magee MD is a Medical Historian and regular THCB contributor. He is the author of CODE BLUE: Inside the Medical-Industrial Complex (Grove/2020)

“The Greatest Scientist of All Time” says Scientific American. Who is it?

Sep 11, 2023

BY MIKE MAGEE

When it comes to our earthly survival as a human species, words are often under-powered and off-the-mark. Clearer concepts, definitions and terms are required for clarity. Here are five terms that are useful and worth remembering:

Planetary Boundaries
Earth Systems
Human Perturbations
Planetary Scale Destabilization
Holocene Epoch vs. Anthropogenic Epoch

These terms all tie back to a single source – a child of World War II, only seven when his home in Amsterdam was overrun by Nazis. His father was a waiter, his mother a cook in a local hospital. He’d later recall with a shudder the Fall of 1944, the beginning of “hongerwinter” (winter of famine) which he blamed for stunting his growth and contributing to his short stature. The event also exposed him to death for the first time, losing several classmates to starvation and frozen temperatures that winter.

There were no early signs of brilliance. He attended a technical school and prepared for a life in construction. He met a Finnish girl, Terttu when he was 25, and they settled in a small town 200 km north of Stockholm. It was his wife who recognized his potential first, pointing him toward a newspaper ad for a job as a programmer at the Stockholm University’s Meterorologic Institute (MISU). No matter that he had no experience in computer programming. They moved to Stockholm. He worked and they both took college courses. By age 30, with sponsorship from the world’s expert on acid rain and first chairman of the Intergovernmental Panel on Climate Change (Bert Bolin), he received a master’s degree in meteorology. Five years later, after focusing on stratospheric chemistry, he earned his doctorate.

Has Sensemaking Collapsed When It Comes To U.S. Healthcare?

Sep 5, 2023

By MIKE MAGEE

This past week my wife and I were at a family event to celebrate my brother-in-law’s 70th birthday. Our extended family has more than a few doctors. A physician nephew who had read CODE BLUE and had a strong interest in health policy asked if I felt I (and others) were too hard on doctors. My response was yes, but that it was intentional and came with the territory. Combining scientific, sometimes life and death expertise, with high-touch compassion, understanding and partnership has always been a “big ask” but that was what we and others had signed up for as “health professionals.”

But can a health professional be “professional” in a fundamentally misaligned health system? And, if not, does a health professional have a responsibility to engage in an effort to reform and transform the system to behave professionally?

Professionals are generally members of a vocation with special training, highly educated, enjoy special trust and work autonomy, abide by strict moral and ethical obligations, and in return are generally self-regulating. Their academic training is expected to reliably provide those they serve with special skills, judgement, and services. When they deliver, society responds with confidence and trust and durable long-term relationships.

My nephew and many of his contemporaries have come to believe that this is neigh impossible under the current heavily corporatized, profit driven, inequitable, under-insured, and widely inaccessible system. They have begun to voice that being an ethical and competent professional in an unprofessional system is not possible, and not their fault.

System redesign guru, W. Edward Deming, the father of Quality Control Management, and the man credited with assisting the Japanese in transforming their auto industry, had this to say about transformation in 1993: “The prevailing style of management must undergo transformation. A system cannot understand itself. The transformation requires a view from outside…The individual, once transformed, will: set an example; be a good listener, but will not compromise; continually teach other people; and help people to pull away from their current practices and beliefs and move into the new philosophy without a feeling of guilt about the past.”

Six years later Don Berwick MD, Emeritus President of the Institute For Healthcare Improvement and now Harvard Health Policy professor, delivered a classic speech, “Escape Fire: Lessons for the Future of Health Care”, sponsored by the Commonwealth Foundation. In it Don recounted the events surrounding the tragic fire at Mann Gulch, Montana which claimed the lives of 13 “smokejumpers” on August 5, 1949. He reviewed the lessons learned in a system analysis by Professor Karl E. Weick of the University of Michigan, in his paper titled,“The Collapse of Sensemaking in Organizations: The Mann Gulch Disaster.”

Berwick explained, “Sensemaking is the process through which the fluid, multilayered world is given order, within which people can orient themselves, find purpose, and take effective action. Weick is a postmodern thinker. He believes that there is little or no preexisting sense of organization in the world—that is, no order that comes before the definition of order. Organizations don’t discover sense, they create it…In groups of interdependent people, organizations create sense out of possible chaos. Organizations unravel when sensemaking collapses, when they can no longer supply meaning, when they cling to interpretations that no longer work.”

Now roughly a quarter century ago, Berwick concluded, “I love medicine. I love the purpose of our work. But we are unraveling, I think…Sense is collapsing… We need to face reality…Why did it take the Mann Gulch crew so long to realize they were in trouble? The soundest explanation is not that the threat was too small to see; it is that it was too big. Some problems are too overwhelming to name. I now think that that is where we have come in health care; I have been radicalized.”

Clearly the visions we have been using are under-powered, and we seem to be heading in the wrong direction with information technology and AI fully prepared to make permanent a system that is moving patients to despair and doctors to early retirement. What are the questions my nephew and his health policy colleagues should be asking now?

1. How do we make America and all Americans healthy?

2. What is our national health care plan, and who is in charge?

3. How do we balance national and state responsibilities?

4. How do we maintain balanced humanistic and scientific care, and preserve patient and health professional autonomy over complex life and death decision making?

5. How do we advance healthy behaviors while providing high touch access to health professionals for acute and moderate issues?

6. How do we use information technology and AI to expand human and social, rather than just financial, capital?

7. How do we prioritize investment in human contact between patients and health professionals over wealth enhancement and brick and mortar expansions?

8. How do we put a smile (independent of money) back on the faces of doctors, nurses and patients?

9. How do we separate hospital and physician profit driven research from direct patient care?

10. How do we move to geographic annual budgeting of comprehensive care and eliminate individual billing/reimbursement operations?

Mike Magee M.D. is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside the Medical-Industrial Complex (Grove/2020).

The One Question FOX News Moderators Should Ask Tonight

Aug 30, 2023

Editor Note: This article was published a week after the Republican Party Primary debate

BY MIKE MAGEE

This evening, the Republican Party will sponsor their first Primary Debate. It will be historic in featuring the absence of their lead contender for the 2024 Presidential campaign, a candidate who appears committed to the destruction of their own political party

Events over the past year clearly have confirmed that we are a “work in progress” even as we stubbornly affirm our good intentions to create a society committed to “life, liberty, and the pursuit of happiness.”

With the Dobbs’ decision, our Supreme Court has unleashed long-abandoned regressive state laws designed to reinforce selective patriarchy and undermine the stability and confidence of America’s women and families. As a result, our nation’s health professionals, and the patients they care for, potentially find themselves “on the wrong side of the law.”

Three months ago, our former President decided to deliver a message to North Carolina Republican supporters claiming that he was engaged in the “final battle” with “corrupt” forces, most especially the “Deep State” that was “out to get him.” This is the same state that politically birthed Mark Meadows, former Congressman from the 11th District of North Carolina, a position he resigned to become Trump’s Chief of Staff on March 21, 2020. That ultimately landed him a position on the roster of 19 individuals indicted by District Attorney Fani Willis on RICO charges for conspiracy and racketeering.