Why “Medicare for All” Could Appeal to White Swing Voters.

Posted on | July 12, 2022 | Comments Off on Why “Medicare for All” Could Appeal to White Swing Voters.

Mike Magee

“There’s common ground there—not the warm belonging of full creedal agreement, perhaps, but a place, even a welcoming place, where we can stand together.”    Ian Marcus Corbin, Research Fellow, Harvard Medical School

Most Americans would love to believe this statement. But political reality intervenes. A March, 2022 Pew Research Center analysis found our two major parties to be “farther apart ideologically today than at any time in the past 50 years.” 

Take, for example, Presidential hopefuls, Florida Gov. Ron DeSantis and Sen. Marco Rubio (R-Fla.). They see political pay dirt on the jagged peaks of America’s culture wars with the governor taking on Disney for defending LGBTQ employees by introducing the his “Stop W.O.K.E. Act“, while Rubio goes one step further with his “No Tax Breaks for Radical Corporate Activism Act”.

In academic circles, you increasingly find references to “what’s the matter with…debates.” The phrase derives from a 2004 book “What’s the Matter with Kansas?”  written by historian Thomas Frank, which spent 18 weeks on the New York Times Bestseller List. 

In the book, Frank detailed the transformation of Kansas from a “hotbed of left-wing populism” to a center of “anti-elitist conservatism in the United States” and exposed the state’s remarkable capacity to vote against its own economic self-interests. 

The title itself originated in an August 15, 1896 editorial in the the Kansas Emporia Gazette. It was written by a political leader, William Allen White, who charged that the state’s slippage into economic stagnation (compared to neighboring states) was the result of overly aggressive progressive policies which unduly restricted small business. William McKinley, in his 1896 run for the Presidency, picked up on the theme, distributing hundreds of thousands of copies of the editorial as part of his campaign.

In modern times, selected academics argue that working-class social conservatives have abandoned the Democratic New Deal political coalition and landed on the rocky knolls of Republican shores mired in conservative ideology and buffeted by religion laced cultural gale-force winds.

Others, like Vanderbilt political scientist Larry Bartels, challenged these assumptions. As he summarized in 2005: “Has the white working class abandoned the Democratic Party? No. White voters in the bottom third of the income distribution have actually become more reliably Democratic in presidential elections over the past half-century, while middle- and upper-income white voters have trended Republican.”

A recent publication by two political scientists – Herbert P. Kitschelt from Duke and Philipp Rehm from Ohio State – says no one should be surprised by what happened in 2016, because it was a long time in the making. 

What makes white Americans vote the way they do, they say, lies at the cross-roads of economics and education. Using a four quadrant analysis graph, they tracked white voters presidential preferences from 1952 to 2016 in four groups – I. Low Education/Low Income, II. Low Education/High Income, III. High Education/Low Income, IV. High Education/High Income.

Primary Source

Using a version of this graph, they concluded that that there has been a “polarity reversal…the New Deal core constituencies of the two main US parties—low-education/low-income voters for the Democrats and high-education/high-income voters for the Republicans—have become swing groups; the former swing groups are the parties’ new core constituencies (high-education/low-income voters for the Democrats and low-education/high-income voters for the Republicans).”

Specifically they believe that:

1. The Democratic Party is being abandoned by lower education/higher income white voters. (Think small business men/local Chambers of Commerce), while higher education/higher income are slowly moving to neutral “swing” status.
2. Lower income workers are also segregating based on education. Those white voters with little income or education are moving away from Democrats to neutrality – “drifting into right-wing politics” and exploring militarizing “social governance, racism and xenophobia.” In contrast, low income, high education whites are securely now in Democratic territory.

What does all this mean? It appears that, as we have transformed from an industrial society to a knowledge society, the traditional New Deal core groups (Dem- LE/LI; Rep- HE/HI) that anchored the two parties have become swing groups filled with divided, volatile “independents” up for grabs.

How do you reach these new swing voters? Is there anything programmatic that might enjoy the support of large numbers of swing voters? 

How about those Big Education/High Income individuals. In 2020, 68% of the S&P 1500 CEO’s were Republicans in a National Bureau of Economic Research study. What might the government offer the workers that labor in their charge?

How about those Low Education/Low Income individuals. Many manage to rise to intermediate incomes, only to fall back when faced with predatory debt often associated with a family illness or tragedy.

Programmatic solutions that would unite us need to appeal on multiple levels to members of swing quadrants. One concrete example would be “Medicare for All.” It would free the HE/HI CEO’s of managing employee health care while trying to run their companies. It would also assist LE/LI strivers by reinforcing health and productivity, avoiding crippling medical debt, and creating new job opportunities.

So, in fact, as Dr. Corbin suggests, “There’s common ground…a welcoming place, where we can stand together.” Programs and services that create jobs, reinforce community linkages, and equitably promote compassion, understanding and opportunity are political pay dirt. Democrats and Republicans would help themselves, and help America, by seeking “common ground” under the banner of  “Medicare-for-All.”

Mike Magee’s Advice To The AMA On Reversal of Roe v. Wade.

Posted on | June 27, 2022 | 10 Comments

Mike Magee

Stable, civic societies are built upon human trust and confidence. If you were forced to rebuild a society, leveled by warfare and devastation, where would you begin? This is the question the U.S. Army faced at the close of WW II, specifically when it came to rebuilding Germany and Japan, hopefully into stable democracies. The Marshall Plan answered the question above, and its success in choosing health services as a starting point was well documented by many in the years to come, including the RAND Corporation. Their summary in 2007 said in part, “Nation-building efforts cannot be successful unless adequate attention is paid to the health of the population.” 

They began with services for women and children, the very location that a splinter of politicians and Supreme Court Justices has targeted, replacing entrusted doctors with partisan bureaucrats in an approach so obviously flawed that it forced a course correction a half century ago in the form of Roe v. Wade.

The practice of Medicine is complex. Ideally it requires knowledge, skills, supportive infrastructure, proximity and presence. But most of all, it requires trust, especially in moments of urgency, with lives at stake, when an individual, and family, and community are all on high alert. When time is of the essence, and especially if one or more people are trying to make the right decision for two, rather than one life, decisions are impossibly personal and complex.

This was widely recognized by most physicians, including those most devout and conservative nationwide in the troubling years leading up to Roe v. Wade. As recently as 1968, the membership of the Christian Medical Society refused to endorse a proclamation that labeled abortion as sinful.  In 1971, America’s leading conservative religious organization, the Southern Baptist Convention, went on record as encouraging its members “to work for legislation that would allow the possibility of abortion under such conditions as rape, incest, clear evidence of severe fetal deformity, and carefully ascertained evidence of the likelihood of damage to the emotional, mental, and physical health of the mother.” In 1973, both the Southern Baptist Convention and the Christian Medical Society chose not to actively oppose the Supreme Court ruling against a Texas law prohibiting abortion known as Roe v. Wade, and reaffirmed that position in 1974 and 1976.

What they recognized was that the nation’s social capital, its political stability and security, relied heavily on the compassion, understanding and partnership engendered in the patient-physician relationship. As most doctors saw it, what possible good could come from putting politicians in the middle of such complicated, emotion-ridden, and highly personal decisions?

The American Medical Association’s prepared reaction to the June 24, 2022, reversal to Roe v. Wade was direct and immediate. They labeled the decision “an egregious allowance of government intrusion into the medical examination room, a direct attack on the practice of medicine and the patient-physician relationship…” Their president, Jack Resneck Jr. M.D. went further to say, “…the AMA condemns the high court’s interpretation in this case. We will always have physicians’ backs and defend the practice of medicine, we will fight to protect the patient-physician relationship..” But what exactly does that mean?

Approaching 75, and a lifelong member of the American Medical Association, I expect I know the AMA, its history as well as its strengths and weaknesses, about as well as anyone. Aside from having deep personal relationships with many of the Board of Trustees over the years (some of whom quietly continue to contact me for advice), I have studied the evolution of the patient-physician relationship in six countries over a span of forty years.

Those who know me well, and who have pushed back against my critique of the organization, know that my intentions are honorable, and that the alarms that I sound reflect my belief that, for our profession to survive as noble, self-governing, and committed above all to the patients who allow us to care for them, we must have a national organization with reach into every American town and city, and official representation in every state, and every specialty.

My concern today, despite the strong messaging from Chicago, is that the AMA and its membership have not fully absorbed that this is a “mission-critical” moment in the organization’s history. It is also an opportunity to purposefully flex its muscles, expand its membership, and reinforce its priorities. The strong words, without actions to back them up, I believe, will permanently seal the AMA’s fate, and challenge Medicine’s status as a “profession.”

Here are five actions that I believe the AMA should take immediately to make it clear that physicians stand united with our patients, in partnership with nurses and other health professionals, and that the actions of last week can not and will not stand.

1. The AMA should pull all financial support for all Republican candidates through the 2022 elections.
2. The AMA should actively encourage physician “civil disobedience” where appropriate to protect the health and well being of all women, regardless of age, race, sexual identity, religion, or economic status.
3. The AMA should convene, under the auspices of its’ General Counsel, Andra K. Heller, a formal strategy meeting with the legal counsels of all state and specialty medical societies to formulate an aggressive legal approach to minimize the damage of the recent Supreme Court action.
4. The AMA should actively promote AMA volunteers to help provide a full range of women’s health care services at federal institutions and on federal land, and stand up information sites that coordinate travel and expenses should inter-state travel be required for care access.
5. The AMA should immediately make clear that any restriction of prescribing authority of medications in support of women’s health care, including contraceptive medications and devices, and Plan B treatments will result in a coordinated nationwide disruption of health services.

Why, After 200 Years, Is Haiti This Impoverished?

Posted on | June 23, 2022 | 2 Comments

Mike Magee

This Spring, at the President’s College at the University of Hartford, I taught a timely course titled, “The History of Epidemics in America.” By way of introduction, I stated that “Epidemics are social, political, philosophical, medical and above all ecological. They are also narratives – with a beginning, middle and end, and a range of heroes and villains, both human and microbial.”

One of the narratives, which sadly has had no end, is the French colonization of Saint-Dominque (now Haiti), western neighbor of the then Spanish controlled Dominican Republic, which together comprised the island of Hispaniola.

Columbus arrived on the island in 1492. Documents suggest he was greeted peacefully by the native Taino tribe which numbered some 60,000. By 1548, the numbers had plummeted with less than 500 of the indigenous tribe surviving. What had happened? The arrival of Columbus and others, and their subsequent movement back and forth between the Old World and the New World led to an unprecedented exchange of plants, manufactured goods and raw materials, tools and technologies, ideas, and microbes.

In the pursuit of wealth, traders and merchants, with financial inducements by their governments, clear cut and developed large plantation farming of cash crops like sugar, tobacco and wheat for export. These crops demand huge workforces for planting and harvesting under brutal and dangerous conditions.

The explorer’s plan was to enslave the natives they encountered as indentured servants and maintain a system of forced labor. To assist the effort, they also imported large numbers of domesticated animals from Europe including horses, cows, pigs, goats and sheep. At the time, the only domestic animals on the island were llamas and alpaca. But the animals carried with them a wide range of infectious diseases including smallpox, chickenpox, measles, mumps and typhus.

Over hundreds of years, the Europeans had developed immunities to these diseases. But the native Americans were immunologically naïve. By some estimates, 90% of the indigenous population in South and North America perished. Beyond the human tragedy, their demise created an enormous shortage of labor on the plantations. The solution chosen by the English, Spanish, Portuguese and French conquerors was to begin large scale importation of African slaves.

Between 1785 and 1790, nearly 40 percent of human cargo of African slaves crossing the Atlantic listed Saint-Dominque as their destination. The French by then possessed eight thousand plantations producing sugar, coffee, cotton, tobacco, indigo and cacao. These were established by clear-cutting forests under the most brutal conditions, explaining why the average lifespan of the enslaved population was just 5 years.

As Yale historian Frank Snowden recently described: “It was said that an acre of land on a Saint-Domingue plantation yielded more wealth than an acre anywhere else on earth. At the same time, the same area enclosed what many regarded the highest concentration of human misery…Men and women who had recently arrived in chains did not regard slavery as natural or permanent.” Those in control however were deeply committed to the status quo for a region whose capital city was called the “Paris of the Antilles.”

What the slaves lacked in freedom, they partially made up in determined defiance and natural immunity as the labored in insect infested fields. One was a mosquito that is the vector of choice for the Flavivirus that causes Yellow Fever. A competitor, the Anopheles mosquito, transmits the protozoa, Plasmodium, that causes malaria. African slaves who had survived these endemic diseases in their homelands often arrived as carriers with the Flavivirus and Plasmodium in their blood, protected from the diseases deadly effects by natural immunity.

By the end of the 18th century, revolution was in full swing in the future Haiti led by the dynamic Toussant Louverture, known popularly as “The Black Sparticus.” Out of the ashes of the French Revolution and the guillotining of Louis XVI and Marie Antoinette in 1794, Napoleon had risen to power in a military takeover of the country. While waging war and skirmishes on his own continent, he watched the colonies closely, both as a source of fabulous wealth, but also with significant holdings in North America which included 828,000 squares miles, containing what would become the middle third of the United States.

He saw in Louverture a direct competitor, and also a potential massive regional destabilizer. If slavery went down in Saint-Domingue, France’s slave colonies in Guadeloupe, Martinique, Reunion, and Guiana would also likely collapse. With British and U.S. endorsement, Napoleon took action in 1801, deploying  an armada of 65 ships to the region led by his brother-in-law, General Charles Leclerc.

The arrival in February was met, at the direction of Louverture, by surprising non-engagement. The “Black Sparticus” was aware that his African former slaves were largely immune to Malaria and Yellow Fever, and that the Europeans were not. He therefore decided to wait for the summer insect infestation to decimate the French troops. The epidemic that engulfed them eventually killed over 50,000 soldiers (90% from Yellow Fever), including Leclerc on November 2, 1802.

In the wake of the defeat, Saint-Dominque formally declared its independence in 1804, a half-century before the Civil War and decades before slavery was outlawed in Britain. As for Napoleon, the loss of Saint-Domingue eliminated his forward base for staging additional North American conquests. In his eyes, these far away lands were now “indefensible liabilities.” In 1803, he sold it all – all 828,000 square miles – for $15 million dollars or 4 cents an acre. That land, which would eventually be segmented into 15 new states, was largely the property of native Americans.

This story should have a happy ending. But it does not. The reasons why have been shrouded by the American and French governments for over two centuries, and only recently exposed in a 2022 landmark investigative study published recently in the New York Times.

What happened to Haiti to account for its impoverished state and an economy only 1/6 the size of its mirror neighbor, the Dominican Republic? To uncover the truth, Times reporters spent several years combing thru dusty archives in three nations to reveal the deeply hidden truth for Haiti’s current impoverished reality.

The story picks up 21 years after its independence, when a new armada of French ships packing 500 cannons appeared off the coast of Haiti on July 3, 1825 with an ultimatum.  American lawmakers, between 1804 and 1825,  had refused to acknowledge the freed slaves nationhood for obvious reasons. Georgia Senator John Berrien at the time said that official recognition would “introduce a moral contagion.”

The ultimatum of newly installed French ruler, Charles X, was clear – pay a ransom of 150 million francs as reparation for the losses of former French slave holders on the island or your ports and trade with France and America will be blockaded as “an enemy of France.” By scale, the financial demand was enormous, twice what Napoleon had been paid for the Louisiana Purchase, but only 1/77 its size in square miles. This then was  Haiti’s “double debt.” As one local leader described, “The slaves fought for our independence. To make them pay for that independence again, it was setting up another form of slavery.”

The price for peace was now clear, to be delivered in 5 payments. But as the New York Times uncovered, to cover just the first payment, it had to empty its national treasury and travel to Paris to secure a bank loan. The bank collective, which included the Rothschilds and was fronted by Credit Industriel et Commercial (the financier of the Eiffel Tower) were more than happy to advance 30 million francs, while pocketing a 6 million transaction fee, leaving Saint-Dominque in the red to the tune of 156 million plus interest. Between 1825 and 1957, international debt consumed approximately 1/5 of the suffering nation’s annual revenue. During the same time the Eiffel Tower’s bankers grew into one of Europe’s largest financial conglomerates.

It took another half-century for Haiti to pay the debt down to 12 million francs, funded by taxes raised from coffee producers. In the meantime, the impoverished nation and its population descended  into what one observer called “the most foul smelling, dirty, and consequently fever-stricken city in the world.” 

The U.S. military takeover, beginning in 1915 and extending to 1934, was by all accounts devastating.  Secretary of State Robert Lansing justified our nation’s actions in 1918 stating,  “The African race are devoid of any capacity for political organization.” The list of offenses was long including “a puppet government, dissolved parliament at gunpoint, entrenched segregation, forced Haitians to build roads for no pay, killed protesters and rewrote the nation’s Constitution, enabling foreigners to own property for the first time since independence.”

During this period, the Haitian people were once again asked to pick up the bill. But this time , the payments went to U.S. bankers, most notably the National City Bank of New York, the predecessor of Citigroup, draining 1/4 of their annual revenue for  over ten years.

What followed was mass corruption, dictatorships, graft, resources diverted to the military, environmental degradation, and social turmoil. The 1998 World Bank report catalogued the misery. “The staggering level of poverty in Haiti is… shocking. Life expectancy is only 57 years compared to the Latin American average of 69. Less than half of the population is literate. Only about one child in five of secondary-school age actually attends secondary school. Health conditions are similarly poor; vaccination coverage for children, for example, is only about 25 percent. Only about one-fourth of the population has access to safe water. In short, the overwhelming majority of the Haitian population are living in deplorable conditions of extreme poverty.”

According to the Times investigators, the U.S. and France are still pulling the strings. On February 29,2004, the U.S. orchestrated a forced exile of Haiti President Jean-Bertrand Aristide who was engaged in a public “restitution campaign.”. A former Catholic priest, he had loudly lobbied for France’s repayment of the 1825 ransom which he valued at over $15 billion (confirmed by New York Times financial consultants).

From his exile, Aristide circled the loop and raised up Saint-Dominque’s “Black Spartacus” from the dead. Quoting Toussaint Louverture, who himself had been abducted by French soldiers in 1802 at the signing of a peace agreement, he said, “In overthrowing me, you have done no more than cut down the trunk of the tree of Black liberty in Saint-Domingue. It will spring back from the roots, for they are numerous and deep.”

As for the question that has troubled many of us: “Why after 200 years, is Haiti this impoverished?”

His response: “We were condemned to live in poverty — not just poverty, but misery. An abject misery tied to 1825.”

June 9, 1954 – The Day America Slayed The Dragon.

Posted on | June 21, 2022 | Comments Off on June 9, 1954 – The Day America Slayed The Dragon.

VIEW HERE

Mike Magee

If you plan on tuning in to the 4th session of the January 6 Congressional hearings at 1 PM EST today, do yourself an enormous favor. Commit five minutes this morning to view a 5 minute online video of a Congressional  hearing which is a Master class in “How to slay a dragon.”

The clip does not feature John Dean and his reading of a 245-page prepared summary on June 25, 1973 where he recounts advising Nixon of “a cancer on the presidency.” Nor is it a cameo of surprise witness, Alexander Butterfield, on July 16, 1973, revealing that the President maintained a taping system in the Oval Office.

No. This is from an earlier time. The date is June 9, 1954. This was over a year after Wisconsin Republican Senator Joseph R. McCarthy had assumed the chairmanship of the Senate Permanent Subcommittee on Investigations. The history shows that he had  “rocketed to public attention in 1950 with his allegations that hundreds of Communists had infiltrated the State Department and other federal agencies.” Clearly a psychopath, he escaped control of moderating voices, biting off ever larger targets, including now the U.S. Army.

“Judge, jury, prosecutor, castigator, and press agent, all in one”, was how Harvard law dean Ervin Griswold described him. In 1954, McCarthy accused the army of “lax security at its top-secret army facilities” which he claimed were infiltrated by communists. The army responded by hiring veteran Boston lawyer Joseph Welch to defend itself.

As documentarians reported, “Mothers who never watched TV during the day were glued to watching the Army-McCarthy hearings.” McCarthy’s right-hand chief council that day was none other than Trump’s most favored personal bro-lawyer Roy Marcus Cohn. Pragmatic, ruthless, and evil to the core, Cohn’s career was launched by McCarthy, and his tainted touch destroyed lives and weakened the U.S. government for three more decades, straight up to the moment of his death from HIV/AIDS in 1986.

In this 5-minute summation of the televised events of June 9, 1954, you are allowed to witness an historic takedown of McCarthy by Welch (with Cohn as witness) – the “slaying of the dragon” that finally destroyed McCarthy once and for all. Cohn had reached an agreement with Welch that McCarthy would avoid attacking one particular Army service man as a communist if Welch remained civil. But Welch had laid a trap, and purposefully needled McCarthy into loosing his temper, and on camera, violating the agreement and “attacking the good lad”, who an outraged Welch tearfully defended in his historic and well-prepared retort.

As historian Thomas Doherty recalls, “It was as if the entire country had been waiting for somebody to finally say this line, ‘Have you no sense of decency.’” To which Jelani Cobb adds, “At the end of it, all the illusions, the comfortable illusions that McCarthy had cultivated about himself, had effectively been dispelled.”

Watch Welch pounce on his victim. Watch Cohn wince as his dragon is slain. Liz Cheney has likely viewed these 5 minutes more than once.

Patients Are Piling Up Credit Card Debt – Doctors, Hospitals, CVS*, and Other Grifters.

Posted on | June 20, 2022 | Comments Off on Patients Are Piling Up Credit Card Debt – Doctors, Hospitals, CVS*, and Other Grifters.

The Medical-Industrial Complex is swarming with grifters. This is to be expected when you build a purposefully complex system designed to advance profitability for small and large players alike. The $4T operation bankrolling 1 in 5 American workers is, in large part, a hidden economy, one built by professional tricksters, designed by Fortune 100 firms with mountains of lobbyists, but reinforced as well by friendly doctors and hospitals engaged in petty and small scale swindling who justify their predatory actions as entrepreneurial, innovative, and purposeful means of necessary financial survival.

When lobbyists for high-priced stakeholders get called before Congress, as they did on March 29, 2022 before the House Committee on Oversight and Reform, they make it sound like Americans should embrace the privilege of being screwed over by MIC elite. But as former Kaiser Permanente CEO, George Halvorson, recently reminded, “People are getting bankrupted when they get care, even if they have insurance.”

It’s enough to draw a person back to the early 1950’s when Arthur Sackler helped launch the Medical-Industrial Complex. In fact, our modern day willingness to mask health care cruelty in high-minded language and miscarry  justice is extreme enough to draw one back to June 9, 1954, when Boston attorney, Joseph Welch, hired by the U.S. Army to defend it against accusations of Communist infiltration, said to Sen. Joe McCarthy, “Little did I dream that you could be so reckless and so cruel…You’ve done enough. Have you, sir, no sense of decency at long last?”

Halvorson and others seem to be reaching a similar boiling point, ready to utter to controllers and apologists of the MIC – “Have you not done enough?”

The most recent tipping point comes in the form of a June 16, 2022 KFF poll revealing that more than 100 million Americans, including 41% of all adults, carry significant medical debt, much of it out-of-sight, carried on personal credit cards. Hospitals and doctors have been tapping into the patients cards for payments, leaving patients tapped out, with high interest plastic debt. 1 in 8 now owe more than $10,000, which nearly 20% say they will never be able to pay off.

The problem is accelerating as health insurers have pushed skimpy plans with deductibles that can legally reach $8,700 a year per individual. As I documented with Tenet Health Care Systems and their Conifer Collection System in 2018, the debt business has bailed out poor hospital practices and medical group mismanagement more than once. Now four years later, 58% of collection agency listed debt is medical in nature. One in 10 of the desperate debtors owe money to family members, and collective medical debt now tops $195 billion as of 2019.

As if it couldn’t get worse, the debt (as one might expect) is not spread evenly. Southern states are over-represented due to poor insurance protection laws, lack of Medicaid expansion, and greater presence of chronic disease in their populations. Medical debt is 50% more common in Blacks, and 35% more common in Hispanics, than in whites. If you live in an unhealthy county (measured by high rates of chronic diseases), 1 in 4 have medical debt, compared to 1 in 10 in healthy counties.

Of course, if you are unhealthy in the U.S., you are also in the cross-hairs of direct-to-consumer drug advertising. The practice of pushing medications through TV ads is only allowed in one other nation in the world. 

More than 1 in 3 Americans will fill those prescriptions at CVS, where whistleblower, Alexandra Miller used to work. What is she blowing her whistle about? According to STAT’s uber-pharma investigative reporter, Ed Silverman, her lawsuit contends that “Starting in 2015, CVS allegedly coordinated an effort that relied not only on its SilverScript (Medicare Part D) subsidiary, but also its Caremark pharmacy benefit manager (PBM) and its chain of CVS retail pharmacies to prevent consumers from obtaining low-cost generics because the company profited from making only higher-priced brand-name medicines available to its customers….”

 The kickback scheme involved CVS Health’s Part D plan sponsor, SilverScript; its pharmacy benefit manager, CVS Caremark, and CVS Pharmacies with hidden rewards flowing back and forth as patients credit card debt skyrocketed. As America proceeds headlong into a recession, and the economy becomes bedridden, the ghost of Arthur Sackler is rising from its gilded crypt and whispering, “It is your own health care system that is making you sick and broke.”

As The Bird Flies (and the planet burns)…So Does The Risk of Infectious Disease Grow.

Posted on | June 14, 2022 | 2 Comments

Mike Magee

A study eight years ago, published in Nature, was titled “Study revives bird origin for 1918 flu pandemic.” The study, which analyzed more than 80,000 gene sequences from flu viruses from humans., birds, horses, pigs, and bats, concluded the 1918 pandemic disaster “probably sprang from North American domestic and wild birds, not from the mixing of human and swine viruses.”

The search for origin in pandemics is not simply an esoteric academic exercise. It is practical, pragmatic, and hopefully preventive. The origin of our very own pandemic, now in its third year and claiming more than 1 million American lives, remains up in the air. Whether occurring “naturally” from an animal reservoir, or the progeny of an experimental lab engaged in U.S. funded “gain-of-function” research, we may never know. What we do know is that viruses move at the speed of light, or more accurately, at the speed of birds.

When Tippi Hedren and Rod Taylor headed indoors at Bodega Bay, California in a high-speed attempted escape from sudden violent bird attacks in the Alfred Hitchcock 1963 natural horror-thriller film, The Birds, it was beaks not bugs they were trying to avoid. But sixty years later, we may all soon find ourselves nodding in agreement with the Library of Congress which declared Hitchcock’s work to be “culturally, historically, and aesthetically significant.” Tourists on the national mall two weeks ago would agree. They discovered a dozen dead mallard ducklings in the national Reflecting Pool. Vets quickly determined the cause – avian flu virus.

Last month’s Nature publication, written by science journalist Brittney J. Miller, titled “Why unprecedented bird flu outbreaks sweeping the world are concerning scientists,” raised the alarm. As she writes “Mass infections in wild birds pose a significant risk to vulnerable species, are hard to contain and increase the opportunity for the virus to spill over into people.”

In the past 9 months, an H5N1 bird flu strain has ignited 3,000 outbreaks in domestic poultry populations across the globe – from Europe, Asia, Africa, and North America. Local governments have limited the damage by destroying (culling) over 77 million birds. But these chickens and turkeys don’t fly commercial, so how did their virus spread?

The answer lies in the dead bodies of another 400,000 wild birds, mostly water fowl, involved in another 2,600 outbreaks in 2022. So far, the virus doesn’t seem to like humans much. Only two human cases (one in the U.K. and another in the U.S.) have been flagged. But spillover, say experts, is inevitable with spread at this rate. A WHO representative says, “These viruses are like ticking time bombs. Occasional infections are not an issue – it’s the gradual gaining of function of these viruses” that’s makes everyone nervous.

Since 1996, wild birds have been in the cross-hairs. Back then, a pathogenic H5N1 bird flu appeared in geese in Asia. Within 5 years, it was all over Europe and Africa. Five years later, widespread mass deaths of wild birds appeared tracked back to the original geese. Within another 10 years, a worrying trend evolved. A strain throughout North America appeared that infected a range of wild birds but didn’t always kill them. For example, mallard ducks were routinely infected, but only 10% died. While good for the ducks, their survival fueled continued spread and reengineering through mutation of the virus.

As you might imagine, it’s not as easy to track and monitor wild birds as well as cooped up chickens. Nor is killing them in masse once infected a reasonable, or achievable option. From the wild bird’s perspective, these are not the best of times. If you are a ruddy turnstone or a resident duck on the Delaware Bay, things are heating up in more ways than one. 

Global warming is affecting the timing of horseshoe crab spawning season at the Delaware Bay. 

The northern Arctic migration (with a stopover at the Delaware Bay) of the ruddy turnstone (which feeds on the crab) has been prolonged as a result. Many of these birds are bird flu carriers. The longer they hang around, the more they infect the local water fowl residents – especially, ducks, swans, geese, shorebirds, and waders. On top of this, when the ruddy turnstone and other migrators reach the Arctic, they are staying longer thanks to moderating temperatures and ice melting. Scientists have concluded that “these conditions support maximal transmissions (of viruses) across wild water birds.”

Climate change not only leads to northward shifts, but expanded species diversity, accompanied by shorter migratory routes. Both spell greater mixing and exchange of viruses across avian species. Spring migrations are now taking place earlier, with age classes, species and flyways significantly altered. Extreme climatic events, more common in an age of “global weirding” of weather, are also more common. For example, a cold clip near the Caspian Sea in 2006 triggered a mass exodus of swan, which unleashed an H5N1 viral outbreak in domestic birds across Western Europe.

What ecologists are saying is that “A1 viruses have co-evolved with migratory waterfowl over millions of years and have survived and withstood many eras of climatic turbulence… An increase in the proportion and number of birds over-wintering in the subarctic areas may result in very high densities of birds competing for the limited feed resources available. This could potentially enhance interspecies virus transmission, involve a larger spectrum of avian host species or alter the virus transmissibility, both to wild birds and domestic poultry.”

As more and more Canadian geese set up permanent domicile in the grassy wonderlands of suburban America, they and their wild avian friends are increasingly settled in, crowding together in a new world, permanently residing in intimate contact with humans. The shrill alarms set off by environmental scientists have now been joined and reinforced by an increasingly alarmed global infectious disease community.

“Replacement Theory” from the BMJ

Posted on | June 8, 2022 | Comments Off on “Replacement Theory” from the BMJ

White Americans are dying (being “replaced”) at an alarming rate in Republican-led states since 2008? What’s the story?

Mike Magee

Source: BMJ: June 7, 2022

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“As I’ve said before, I believe Dr. Ladapo is an anti-science quack who doesn’t belong anywhere near our state’s Surgeon General office, let alone running it. But now that he’s been confirmed, it’s my sincere hope that he and Governor DeSantis choose to focus on saving lives and preventing unnecessary illness instead of continuing their absurd promotion of conspiracy theories and opposition to proven public health measures — but I’m not going to hold my breath.”

If you identified these as the words of former governor, and now Congressman Charlie Crisp, currently running to retake the office he once held, you’d be wrong. These are the words of another state Democrat who is running a distant 2nd in the Democratic primary battle set for this summer.

Her name is Nikki Fried, Florida’s Agricultural Commissioner, and the only Democrat in his Cabinet. This is not the first time she’s tangled with DeSantis over Joseph Ladapo. She vigorously opposed his nomination in October, 2021, citing among other deficits promoting Covid misinformation, discriminating against Black farmers, and refusing to wear a mask at the request of State Senator Tina Policy who was undergoing chemotherapy for breast cancer.

By all accounts, the health department that Dr. Ladapo is supposed to be surgeon generaling is a mess. An investigative report in this week’s Tampa Bay News, found that in the past seven months as Covid variant cases topped 80,000 per week in the state, public health officials failed to report back positive tests to nearly a quarter of those infected, and failed to include 3,000 cases of COVID-19 deaths in the states mortality stats. During this same period, Ladapo, who earned his reputation for incompetence as a Trump sycophant, recommended that the state’s health departments cease all COVID contact tracing.

It would be comforting to imagine that politically motivated medical malfeasance is restricted to this one state, but a comprehensive article published this week in the BMJ, tracking U.S. health data from 2001 to 2019, finds that politics does indeed affect your health.

In a prior study published in JAMA the authors had established that there was a growing gap in morbidity and mortality between rural and urban areas in the U.S. As a follow-up, the lead author decided to explore whether county level political leadership affiliation positively correlated with poor medical outcomes.

In an article this week, the author, Haider J. Warraich, an assistant professor at Harvard Medical School, stated, “Regardless of whether we looked at urban or rural areas, people living in areas with Republican political preferences were more likely to die prematurely than those in areas with Democratic political preferences. There was no single cause of death driving this lethal wedge: The death rate due to all 10 of the most common causes of death has widened between Republican and Democratic areas… Based on statistical testing, the gap in mortality appeared to particularly widen after 2008, which corresponds to the passage of the Affordable Care Act in 2010, a major part of which was Medicaid expansion.”

As expected, the poorest performing areas coincided with those under the control of Republican governors who refused to accept federally subsidized expansion of Medicaid services for their citizens.

While DeSantis and his fellow governors fan the flames of “replacement theory” and gratefully accept the unwavering support of the Trump base, they may want to focus on this surprise finding in the BMJ data – The “fourfold growth in the gap in death rates between white residents of Democratic and Republican areas seems to be driving most of the overall expanding chasm between Democratic and Republican areas.”

In 2005, I gave a speech at the Library of Congress that caused a stir. Its title was “Health is Political.” Dr. Warraich’s work adds concrete data in support of the argument. As he recently wrote, “In an ideal world, public health would be independent of politics. Yet recent events in the U.S., such as the Supreme Court’s impending repeal of Roe v. Wade, the spike in gun violence across the country, and the stark partisan divide on the response to the Covid-19 pandemic, are putting public health on a collision course with politics. Although this may seem like a new phenomenon, American politics has been creating a deep fissure in the health of Americans over the past two decades.”

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