Miscarriage & Justices

Posted on | September 18, 2024 | 2 Comments

Mike Magee

“What did they know, and when did they know it?”

These are the questions Americans have become accustomed to asking of their leaders, dating back to Nixon and extending to Trump, and all Presidents in between. But now the same questions have surfaced, to the extreme discomfort of conservative Justices, as death and destruction of lives begins to mount in the wake of the Dobbs decision.

As predicted, graphic cases of young women bleeding out in parking lots after being refused life-saving acute care for miscarriage in 14 states across the nation are being documented and described. These stories are not only affecting the lives of couples across the land, but also threatening the “political lives” of downstream Republicans facing an upcoming election.

The responsible  Supreme Court Justices (Alito, Thomas, Gorsuch, Kavanaugh, and Barrett) and their legions of Ivy League clerks had scoured the literature far and wide before making the decision to eliminate women’s reproductive freedom in the U.S. and inflict lasting harm to their life-saving relationships with their local doctors.

Their review had to include Blue Cross & Blue Shield’s timely publication, “Trends in Pregnancy and Childbirth Complications in the U.S.” That report, surveying over 1000 pregnant women ages 18 to 44 in April, 2020, was, in part, designed to understand the impact the Covid epidemic had had on prenatal care nationwide. But what it revealed was that pregnancy complications were up 16% over prior years, in part due to “social barriers such as availability of appointments, lack of transportation or nearby providers.”

A comparison of 1.8 million pregnancies in 2014 versus 2018  demonstrated a severely compromised women’s health support system. 14% did not receive prenatal care in their first trimester, and 34% missed scheduled prenatal visits with 1 in 4 of these suffering complications in pregnancy. The BC/BS summary “underscores the importance of focusing on the health of pregnant women in America, especially as health conditions increase in this population…”

The Conservative Justices were forewarned.  Yet they still elected to throw fuel on a maternal health system which was already in flames. They were also aware of a 2021 study that confirmed that miscarriage was 43% more likely in Black women than in their white counterparts.

On May 2, 2022, Justice Alito and his allies engineered the release of a draft of a majority opinion in part to freeze attempts by Chief Justice Roberts to secure a compromise.  The leaked document  labeled Roe v. Wade “egregiously wrong from the start.”  As predicted, the ruling spawned chaos.  When 14 Red states established total bans on all abortions,  miscarrying women seeking help in ER’s literally had to fight for their lives. Their doctors were criminalized. Was this an abortion gone bad?

A miscarriage, or pregnancy loss before 20 completed weeks, is not an uncommon affair. Approximately 15% of pregnancies end in miscarriage, mainly the result of chromosomal or genetic abnormalities. That amounts to some 540,000 women in crisis, which most believe is under counted. 80% of miscarriages occur in the first 13 weeks of pregnancy.

25% of pregnant women experience some vaginal bleeding in the first trimester. For most (6 in 10) this is self-limiting and they go on to deliver a healthy baby. But for 4 in 10 (or 10% who present with bleeding) they go on to miscarry. All pregnant women who experience vaginal bleeding in early pregnancy need to have a medical examination. Doctors and midwifes check blood work, perform a physical examination, and do an ultrasound examination. 

Most pregnancy loss (95%+) occurs before 20 weeks gestation. If miscarriage occurs before 13 weeks, there is a good chance of clearing the blood clots and uterine tissue with medication and no surgical intervention. But if bleeding is severe, or the loss is occurring beyond 13 weeks, dilation and curettage (D&C) is both necessary and at times life saving. Under anesthesia, the cervix is dilated and any remaining pregnancy-related tissue is gently scraped and suctioned from inside the uterus. Patients are then closely monitored for several weeks for any evidence of continued bleeding or infection.

What did the Justices  know, and when did they know it?

1. They knew that Miscarriages were a medical emergency and exceedingly common.
2. They knew that 80% occur during the first trimester, and that existing state abortion laws on the books would restrict access to acute life-saving treatments in 14 states.
3. They knew that pregnancy loss was far more common in non-whites and in rural underserved communities.
4. They knew that the medical community opposed overturning Roe v. Wade in overwhelming majorities, and predicted maternal loss of life if the Justices proceeded.
5. They read, two years after their deadly decision, the Commonwealth Report which stated , “The United States continues to have the highest rate of maternal deaths of any high-income nation, despite a decline since the COVID-19 pandemic. And within the U.S., the rate is by far the highest for Black women. Most of these deaths — over 80 percent — are likely preventable.”

They knew all this, and they did it anyway.

AI and The Future of American Medicine

Posted on | September 13, 2024 | Comments Off on AI and The Future of American Medicine

Mike Magee MD

(This paper is provided Open Source as a public service. It may be republished and distributed with proper attribution. Reading Time: 30 minutes.)

 

The history of Medicine has always involved a clash between the human need for compassion, understanding, and partnership, and the rigors of scientific discovery and advancing technology. At the interface of these two forces are human societies that struggle to remain forward looking and hopeful while managing complex human relations. It is a conflict in many ways, to hold fear and worry at bay while imagining better futures for individuals, families, communities and societies, that challenges leaders pursuing peace and prosperity.

The question has always been “How can science and technology improve health without undermining humans freedom of choice and rights to self-determination.” . . . (Continue reading.)

Political Jiu-Jitsu: Trump As A Liability to Deep State Republicans

Posted on | September 12, 2024 | Comments Off on Political Jiu-Jitsu: Trump As A Liability to Deep State Republicans

Mike Magee

Funny think about that Project 2025’s  “Mandate for Leadership.” Trump declared in this week’s  debate, “I know nothing about it.” But in addition to the vast majority of authors and editors of the document having served in the prior Trump administration, the former President’s name is mentioned in the 887 page document over 300 times. 

Described by Pulitzer Prize winning economics columnist, Carlos Lozada, the work itself is an “off-the-shelf governing plan.” It’s packed with conservative fan favorites, not simply “militarizing the southern border” and reversing what they call “climate fanaticism”, but especially placing DEI (diversity, equity, inclusion) efforts in the waste bin, banning abortion nationally, and pushing deregulation and tax cuts for the richy rich.

None of that is surprising if you’ve run into these characters on K street and beyond. This is who they are, and largely who they have always been. Over the years, I’ve bumped elbows with them in Washington and in corporate C-suites galore. What makes this effort a bit unique is, of course, the presence of a cooperative headliner who will clearly endorse “the elevation of religious beliefs in government affairs” and actively diminish “the powers of Congress and the Judiciary.”

This is political jiu-jitsu practiced at its highest level. Rather than dismantling the “deep state,” these operators are fast at work “capturing the administrative state” for their own self-serving purposes.

Understanding jiu-jitsu takes one a long way toward understanding the Heritage Foundation and Federalist Society’s puppet masters. The word “Jū” means “gentle, soft, supple, flexible, pliable, or yielding.” It’s companion, “jutsu” is the “art or technique.” Combine the two, and you have the ”yielding-art.” The intent in bodily (or political) combat is to harness an opponent’s power against himself, rather that confronting him directly.

Political jiu-jitsu may be deceptive and confusing in the absence of visible weaponry, but it is anything but gentle. In the physical version, you are instructed in joint locks and chokeholds of course, but also biting, hair pulling, and gouging. Kevin Roberts, the President of the Heritage Foundation and editor of Project 2025, is a master of the political version. While he and Trump outwardly employed a “nothing to see here” stance, demographic realities were cued up in the document. The solution to the growing minority status for Republicans? “Voter efficiency” and a rigged census. Or in the Project’s words: “Strong political leadership is needed to increase efficiency and align the Census Bureau’s mission with conservative principles.”

Roberts’ language is soft, but its impact hard indeed. In the introduction he suggests that the Declaration of Independence’s words “pursuit of happiness” were better understood to be “the pursuit of blessedness” while providing corporations a market free hand “to flourish.” Career civil servants are recast as “holdovers” without “moral legitimacy.” And the Justice Department suffers this put-down – “a bloated bureaucracy with a critical core of personnel who are infatuated with the perpetuation of a radical liberal agenda.”

Majority rules and demographic changes being what they may, alternative facts and voter suppression have been added to the tools of “political jiu-jitsu” artists. But Kelly Anne Conway was nowhere to be seen this week, and their headliner was long-winded, boring, and tired. As for voter integrity, the Democrats are fully funded and lawyered up. Finally, good Republicans everywhere have begun to recognize that towing the MAGA line much further puts their down-ballot hopes in the direct line of fire.  Those 300 mentions are beginning to look like a liability instead of an asset.

Project 2025: Cheat Sheet for Tonight’s Debate.

Posted on | September 9, 2024 | Comments Off on Project 2025: Cheat Sheet for Tonight’s Debate.

Mike Magee

Donald Trump says he’s never heard of Project 2025. Denials aside, expect the term Project 2025 to come up multiple times in this evening’s debate. But you are less likely to hear the name Kevin Roberts. He’s been president of the Heritage Foundation, and the voice for Project 2025 until it became too hot to handle and Trump publicly threw him and the controversial 900 page document overboard.

But few loyalists deny that both Roberts and the Project’s policy objectives will be front and center if a 2nd Trump presidency were to prevail. Like Leo Leonard, the Chairman of the Board of the Federalist Society that engineered a conservative takeover of the Supreme Court, the Grand Old Party is rich in these shadowy figures. They are content to wield power behind the scenes, and work doggedly, sometimes for decades, to achieve their policy objectives.

As a result, the public is largely unaware of the full story. For example, you are probably unaware that Project 2025’s predecessor was the 7th edition of the Heritage Foundation’s “Mandate for Leadership” released in the lead up to the 2016 election. 64% of its policy proposals were embraced by Trump in the first year of his presidency.

And you may be surprised to learn that 8 out 10 of the contributors to Project 2025 were members of Triump’s administration – including conservative fan favorites like Homeland Security Secretary Ken Cucinelli, adviser to the president Peter Navarro, Defense Secretary Chris Miller, and OMB head Russel Voight.

Off course, when you are dealing with a 900 page tome, its not surprising that most Americans get lost in the weeds and lose interest. So financial guru, Steve Rattner, has helped out by directing you to a few pages:

Page 326: Title I funding is a rural and red state favorites that has to go. It is a major funder of public schools in low income areas, and has supported the growth of charter schools. Nationwide projections suggested a 6% loss of teachers effecting nearly 3 million students. In some states like Louisiana, the projections are more dire with 12% of teachers left unemployed.

Page 337:  Look for monthly payments for student debt for those who never gained their diplomas to rise from $78 dollars per month to $308 dollars per month. Biden’s proposed Student Loan Forgiveness would be a goner.

Page 365 & 440: Few are aware that the Inflation Reduction Act is mainly intended to aid our nation’s shift to renewable clean energy. And most agree it has been very successful, and has had a side benefit of helping to curb inflation. Other Biden legislation is targeted for destruction as well including the government’s ability to negotiate drug prices, and successful implementation of the Bipartisan Infrastructure Law.

Page 458: 63% of all abortions now are first trimester medication abortions using mifepristone. As a result, the need for surgical abortions has declined from 1.5 million to just .4 million in the past year. Project 2025 asks that the FDA ban the use of mifepristone.

Page 468:  If you’re low income and live in Wisconsin, hold onto you hat. This proposal places a lifetime cap on enrollment in the Medicaid program. This would result in 41% of Wisconsin enrollees losing their Medicaid benefits. Nationwide, 19 million of the 95 million Medicaid enrollees (that’s 5% of our population) would lose their health insurance coverage.

Page 482: Get ready for “familial in-home child care” because Project 2025 has Head Start, another popular program especially in rural counties and red states, up for the chopping block.

Page 524: Civil service employees enjoy a range of protections to prevent politically motivated threats to their ongoing employment. Project 2025 has identified 50,000 civil servants for reclassification as political appointees. This would greatly expand Trump’s executive power were he to be elected, essentially creating the “deep state” he’s been warning us all about.

Page 696:  Here you’ll find the promise to condense seven tax brackets down to two – 15% and 30%. That would insure lower tax rates for the rich, and higher taxes for our lower-income citizens. The richy rich well remember Trump’s cutting their corporate taxes from 35% to just 21%. Project 2025 says Trump will double down and lower corporate rates further.

And of course there’s more.  And you won’t hear Trump quoting chapter and verse of Project 2025 tonight. So what’s the point? It’s this. Regardless of the debate performance of these two candidates this evening, keep in mind that whether it be the Federalist Society or the Heritage Foundation, they have been working for at least two decades to achieve a theocratic autocracy – and they’ve gotten pretty damn close. They can smell victory.

So it is not enough to simply reject Trump. We can not limp to the finish line. To neutralize the Kevin Roberts and the Leo Leonard’s of our world, Republicans up and down the ballot (even the good ones) must be soundly rejected. The message must clear to reset our democracy. If you threaten our freedoms, as you have with women’s reproductive rights, you will never again successfully run for elective office in America.

A Healthy Educated Labor Force Is The Key To Economic Prosperity.

Posted on | September 2, 2024 | Comments Off on A Healthy Educated Labor Force Is The Key To Economic Prosperity.

Mike Magee

Another Labor Day has come and gone. But support for the Labor Movement, and the focus on housing, health services, and economic mobility are front and center for the Harris-Walz ticket as Tuesday, November 5th approaches. 

As Dora Costa PhD, Professor of Economics at UCLA puts it:  

“Health improvements were not a precondition for modern economic growth. The gains to health are largest when the economy has moved from ‘brawn’ to ‘brains’ because this is when the wage returns to education are high, leading the healthy to obtain more education. More education may improve use of health knowledge, producing a virtuous cycle.”

Information technology is clearly making its mark as well. As one report put it, “Recent advances in artificial intelligence and robotics have generated a robust debate about the future of work. An analogous debate occurred in the late nineteenth century when mechanization first transformed manufacturing.”

The National Bureau of Economic Research (NBER) recently stated, “The story of nineteenth century development in the United States is one of dynamic tension between extensive growth as the country was settled by more people, bringing more land and resources into production, and the intensive growth from enhancing the productivity of specific locations.”

At the turn of the 20th century, industrialization and urbanization were mutually reinforcing trends. The first industrial revolution was “predominantly rural” with 83% of the 1800 labor force involved with agriculture, producing goods for personal, and at times local market consumption. The few products that were exported far and wide at the time – cotton and tobacco – relied on slave labor to be profitable.

The U.S. population was scarcely 5 million in 1800, occupying 860,000 square miles – that’s roughly 6 humans per square mile. Concentrations of humans were few and far between in this vast new world. In 1800, only 33 communities had populations of 2,500 or more individuals, representing 6% of our total population at the time. Transportation into and out of these centers mainly utilized waterways including the Eastern seaboard and internal waterways as much as possible. This was in recognition that roads were primitive and shipping goods by horse and wagon was slow (a horse could generally travel 25 miles a day), and expensive (wagon shipment in 1816 added several days and cost 70 cents per ton mile.)

At least as important was the creation of a national rail network that had begun in 1840. This transformed market networks, increasing both supply and demand. The presence of rail transport decreased the cost of shipping by 80% seemingly overnight, and incentivized urbanization.

But by 1900, the U.S. labor force was only 40% agricultural. Four in 10 Americans now lived in cities with 2,500 or more inhabitants, and 25% of Americans lived in the growing nation’s 100 largest cities. The rivers and streams drove water wheels and later turbine engines. But this dependency lessened with the invention of the steam engine. Coal and wood powered burners could then create steam (multiplying the power of water several times) to drive engines. The choices for population centers now had widened.

Within a short period of time, self-reliant home manufacturing couldn’t compete with urban “machine labor.” Those machines were now powered not by waterpower but “inanimate power” (steam and eventually electricity). Mechanized factories were filled with newly arrived immigrants and freed slaves engaged in the “Great Migration” northward. As numbers of factory workforce grew, so did specialization of tasks and occupation titles. The net effect was quicker production (7 times quicker than none-machine labor).

Even before the information revolution, the internet, telemedicine, and pandemic driven nesting, all of these 20th century trends had begun to flatten. The linkages between transportation, urbanization, and market supply were being delinked. Why? 

According to the experts, “Over the twentieth century new forces emerged that decoupled manufacturing and cities. The spread of automobiles, trucks, and good roads, the adoption of electrical power, and the mechanization of farming are thought to have encouraged the decentralization of manufacturing activity.”

What can we learn from all this in 2024?

First, innovation and technology stoke change, and nothing is permanent.

Second, markets shape human preferences, and vice versa.

Third, in the end, equal access to education and health services is critical to long term economic prosperity. When it comes to the human species, a healthy well-educated workforce fuels innovation, growth, and opportunity for all. Happy Labor Day!

What Are the Harris-Walz Health Policy Team Reading?

Posted on | August 26, 2024 | 4 Comments

Mike Magee

Clearly the Harris-Walz ticket has been doing their homework. Last week, this book was spotted on one prominent thought-leader’s pile: “Human Evolutionary Demography.”  It’s a 780-page academic Tour de force led by veteran scientist Oskar Burger, leader of the Max Planck Institute for Demographic Research and the Laboratory of Evolutionary Biodemography.

That’s the Institute founded in 1917 in Berlin. Their first director? Albert Einstein. These days, its researchers work (in an age of “alternate facts”) to separate justified belief from opinion. Their major focus is on “categories of thought, proof, and experience” at the crossroads of “science and ambient cultures.”

This is the field of Human Evolutionary Demography, a blending of natural science with social science. Demographers study populations and explore how humans behave, organize and thrive focusing heavily on birth, migration, and aging. 

This has been a year of just that in American politics. First, the fallout of the Dobbs decision caught Republicans with their electoral pants down in reproductive freedom referendums in Kansas, Michigan, Kentucky and Vermont. Southern migration of Democrats to former red states like Michigan, Arizona, Georgia, and North Carolina have turned them various shades of purple. And this summer, octogenarian candidates from both parties have been all the rage, literally.

Up until July 21, 2024. the race for the Presidency was between two aging candidates with visible mental and physical disabilities. The victor was destined to a term of office that would extend into his 80’s. 

The emergence of Kamala Harris as the Democratic nominee was a reflection of the electorates growing discomfort with turning a blind eye to the realities of aging. It also suggested that Americans, especially Gen X’ers, have grown tired of Boomer dominance in the lives of an increasingly multi-cultural America – tired as well of growing income disparity, attacks on reproductive freedom, and declining life expectancy in America.

But why the sudden interest in “Human Evolutionary Demography?” The answer lies in the numbers. Back in 2012 Oskar Burger studied Swedes and noted that in 1800 their life expectancy was 32 years. They gained an additional 20 years in the century that followed, and 30 more years by 2000. 

What stumped Burger was not the gains over these two hundred years. Instead he focused on the question, “Why did it take the human race so long to progress?” The bottom line is this, we left chimpanzees behind in the evolutionary dust some 6.6 million years ago. We limped along, not faring very well, for all but the last 200 years. In the past century, a moment in time spanning just 4 of our historic 8000 plus human generations, we took off. This period coincided with rapid scientific and technologic advances, cleaner air and water, greater nutritional support, improved education and housing, expanded public health related governmental policy, and establishment of a safety net for our most vulnerable citizens.

But in the past decade, growth in U.S. life expectancy has all but stalled. For the first time, we actually saw declines each year from 2014 to 2019. For the decade just past, the numbers improved by less than 1/2 of 1 %. When first studied, declines were blamed on losses in working age adults due to trauma, addiction, suicide or “deaths of despair.” 

But recent studies reveal losses due to poor maternal/fetal care, especially in red states, and made worse by fallout of the Dobbs decision. A second complicator has been losses starting at age 65 from complications of cardiovascular disease and diabetes, made worse by obesity and poor health care follow-up.

This has led the Max Planck Institute to issue an alert to U.S. health experts: “Our findings suggest that the U.S. faces a ‘double jeopardy’ from both midlife and old-age mortality trends, with the latter being more severe.” 

Women’s reproductive advocates say it’s really a “triple jeopardy” demanding grass roots advocacy focused on access today, and political victory up and down the ballot in November. In their words, “Today, and every day, we work to ensure that every patient who seeks sexual and reproductive health care can access it, and to build a just world that includes nationwide access to abortion for all — no matter what.”

If this is true, a careful read of “Human Evolutionary Demography” could direct a 3-prong health policy approach for the Harris-Walz campaign:

1. Expanded safety net to address “deaths of despair.”
2. Expansion of the ACC toward Universal Health Insurance to address burden of chronic diseases.
3. Federal guarantees of reproductive freedom.

Dobbs’ Created “Moral Distress” – Country Responds “We’re Not Going Back!”

Posted on | August 7, 2024 | 2 Comments

Mike Magee

When Andrew Jameton, a Nursing Professor at the Department of Mental Health and Community Nursing at UCSFin 1984  published “Nursing Practice: The Ethical Issues”, the term “Moral Distress” was a novel term in clinical health care. It focused primarily on “care that they were expected to provide but ethically opposed.”

Over the past four decades, the definition has expanded and now encompasses the “inability to provide the care that one feels morally compelled to provide.”  Beyond its’ impact on individual health professionals, it has growing health policy implications, explosively reverberating in the wake of the recent Dobbs decision. 

There are approximately 1600 health care facilities nationwide that provide abortion care in the U.S. In the wake of the Dobbs decision overturning Roe v. Wade 14 states have near complete bans on all abortions and this reproductive care is severely restricted in an additional 11 states “with few or no exceptions for maternal health or life endangerment.”

The impact of these rulings has created not only a moral dilemma for health professionals, but also intense legal jeopardy. As one Tennessee Obstetrician recently put it, “There are weeks when I commit multiple felonies.”

There now exists a validated psychometric tool to measure the mental health impact of the Supreme Court’s actions called the Moral Distress Thermometer.(MDT) Experts recently surveyed 310 practicing clinicians involved in women’s reproductive health care, with a focus on comparing moral distress in those from restricted versus unrestricted states. What they reported in JAMA was that those in restricted vs. protected states had scores on the MDT that were more than double their comparators.

As one might expect, high scores on the MDT also correlate with higher rates of job burnout and attrition. This means lower rates of abortion care, but also a smaller maternal health workforce overall. This is in states that had already been lagging behind in access to obstetrical and reproductive health care in general. Clinical shortages are expected to rise in the months approaching an historic Presidential election.

Project 2025’s agenda for future women in America is much more expansive and aggressive than restriction of abortion alone. Trump’s denials aside, his selection of JD Vance as a running mate signals an intent to thoroughly engage in restriction of women’s reproductive rights in allegiance with a Supreme Court that appears equally committed. 

With that in mind, the massive response to the Harris-Walz ticket appears to be offering a response that appears to be go well beyond simple “weird” labeling. Those words are a promise to each other, “We’re not going back.”

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