Santa’s Message on Health – 2021

Posted on | December 20, 2021 | 4 Comments

Mike Magee

When I first posted “Santa’s Letter” four years ago, these three of our ten grandchildren were believers, Trump was in power, and immigrant children were literally dying in cages on our southern border. The words written then, by our youngest of four children and her husband, were much needed reassurance.

Our challenges in 2021 are different but no less significant and disorienting. The ongoing pandemic, a climate crisis now visible enough to be difficult to deny, and real threats to our form of government coming from within rather than from outside our borders simply head the list.

And yet – there is still a Santa Claus for true believers. And as he says above, believing in magic, family, laughter, yourself – these are not “luxuries,” but rather essentials to a healthy human existence. Read along with me:

“Dear Quinn, Luca and Charlotte,
Thank you for believing in my magic. I hope you will always believe in magic. 
Believe in the magic of family. There are times you will stumble, but your family will always be by your side. 
Believe in the magic of laughter. It will keep you whole. 
Believe in yourselves because I believe in you. 
Take care of each other.
Love always,
Santa”

This coming year will be a critical challenge for all Americans. How will the American family respond? How do we make America healthy again? I cling to Santa’s final words – “Take care of each other.”

Here is what that means to me as a health professional.

Eisenhower to Biden on Health Care: “Enlarge the Problem.”

Posted on | December 16, 2021 | 2 Comments

Mike Magee

My good friend, Kim Bellard, in a piece published in Medium titled “The Eisenhower Principle”, shines a light on this genuine American hero’s seminal military, political and management insight – “If a problem cannot be solved, enlarge it.”

In Kim’s astute health care analysis, he notes “We’ve learned only half of Eisenhower’s adage: we’ve got the letting the problem get bigger part down, but we’ve forgotten the part about how/when to come up with solutions.”

In the spirit of uncovering solutions, it is worthwhile to retrace Eisenhower’s steps, supported by his own commentary, in the decade that followed WW II.

Section 1: The Chance For Peace.

The  “Chance For Peace” speech was delivered on April 16, 1953, shortly after Stalin’s unexpected death. In the speech, Eisenhower stated:

“Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed…This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children. The cost of one modern heavy bomber is this: a modern brick school in more than 30 cities. It is two electric power plants, each serving a town of 60,000 population. It is two fine, fully equipped hospitals. It is some fifty miles of concrete pavement. We pay for a single fighter with a half-million bushels of wheat. We pay for a single destroyer with new homes that could have housed more than 8,000 people…This is not a way of life at all, in any true sense. Under the cloud of threatening war, it is humanity hanging from a cross of iron.”

For those who actively criticized President Biden’s unilateral disengagement from Afghanistan, consider the anti-war stance of our nation’s most decorated general. As President, in foreign affairs, he demonstrated enormous restraint, even as his supporters questioned his decisions. For example, he did not take any advantage when Stalin died unexpectedly in 1953, and he resisted being drawn into Indochina in 1954 when the French departed, electing to “wage peace” rather than engage in another war. Similarly, in 1956, when Hungry was invaded by the Soviets, he chose (at least publicly) to stand down. In the midst of the Cold War, he envisioned a negotiated truce with the Soviets on nuclear weapons, a long range goal that was eventually scuttled near the end of his second term by the shooting down of an American U-2 spy plane over Soviet territory. He did take definitive action on two occasions, in 1955 and 1956, when he believed American interests were at risk. In the first case, when Communist Chinese appeared ready to attack Taiwan, he seeked and gained Congressional approval to use force “if necessary to assure the security” of Taiwan. The Chinese backed off. A year later, when the United Arab Republic seized the Suez Canal, and Israel invaded Egypt, American allies, Britain and France, were ready to enter the fray, which would likely ignite a broader conflagration. Eisenhower immediately involved the UN and all parties were forced to stand-down. Crisis averted.

Section 2: The Pivot.

While Communism and the Cold War must be managed, Eisenhower had strong ambitions for his domestic agenda which he labeled “the middle way” to domestic prosperity. This included balancing the budget, building up America’s highway infrastructure, and continuing the New Deal commitments – a decision that more than raised the eyebrows of the Republican Old Guard. He extended insurance coverage through Social Security and bumped the minimum wage from .75 cents an hour to 1$ an hour. For passage he relied on Democrats to support key legislation.

Believing “what was good for business was good for the nation”, he stacked his Cabinet with successful millionaire businessmen including Secretary of Defense Charles E. Wilson (General Motors CEO), Secretary of the Treasury George M. Humphrey (M.A. Hanna Steel Company), and Secretary of the Air Force Harold E. Talbott (a director in both TWA and Douglas Aircraft Company). He saw this as simply a common sense, pragmatic approach. Would Americans rather he choose “some failure…or a successful businessman,” he asked.  Clearly the new president intended to be activist in the domestic arena, and signaled this early to the business community with corporate tax cuts. Prosperity and expansion of the middle class were his key objectives.

Seven months before his heart attack, on January 31, 1955, Eisenhower delivered his “Special Message To Congress Recommending A Health Program.” This needs to be appreciated in the context of what had occurred over the past twenty years in the health insurance arena. When FDR declined to use political capital required to pass Social Security legislation to advance health insurance in 1937, opposition was abundant. The American Medical Association was fully engaged and pulled out all the stops. This included an FDR lunch with famous neurosurgeon Harvey Cushing, Roosevelt’s son’s father-in-law, the day before FDR’s announced decision to delay action. Into the resultant void came the non-profit Blue Cross and Blue Shield plans.  For-profit companies watched from afar through the 1930s. Once profitability was clear, they streamed in behind the Blues, so that by the time the country was prepared for post World War II expansion, the private insurance infrastructure was firmly in place.

In the early years of the war, the economy super-heated and caps were placed on employee salaries to prevent inflation. Employers, competing for scarce workers, began to layer on benefits, including health insurance. By 1949, the government ruled that benefits were part of the negotiated wage package, and five years later, the IRS exempted employer-provided health benefits from income tax. Coincident with this, labor and management dueled over the issue. In 1949, the United Auto Workers Toledo local began a drive to create a regional pension plan that would spread risk across many auto industry suppliers. The reasoning was that even if your particular company went bankrupt, your benefits would be safe because they came from a regional pool, not directly from your employer. Business owners and large employers disagreed with the concept. They felt that collectivization threatened the free market and business owners’ autonomy. In the United States a year later, Eisenhower’s future Secretary of Defense, Charlie Wilson, then president of General Motors, began offering GM workers health care benefits and a pension. The offer was more defensive than beneficent. In the single decade between 1940 and 1950, the number of Americans covered by employer-sponsored health care increased from 21 million to 142 million.

The opening paragraph of Eisenhower’s 1955 Special Message on Health Care reads, “ Because the strength of our nation is in its people, their good health is a proper national concern; healthy Americans live more rewarding, more productive and happier lives.”

Section 3: Tipping His Hat To Truman.

By now, President Eisenhower clearly had determined that health care deserved to be at the center of his domestic agenda.  His second paragraph in the 1955 State of The Union address focused on chronic disease. “Deaths from infectious diseases have diminished. During the past year, important progress has been made in dealing with such diseases as rheumatic fever, high blood pressure, poliomyelitis and tuberculosis. Intensified research has produced more knowledge than ever before about the scourges of heart disease and cancer.”

Two paragraphs later, he highlighted President Truman’s accomplishments noting the 1947 Hospital Survey and Construction Act (known also as the Hill-Burton Act) as a critical achievement that had greatly expanded America’s caring capacity. It provided federal funding in support of communities advancing local hospital construction to expand access throughout the country to 4.5 hospital beds per 1000 citizens. In return for the grants, hospitals had to commit to non discriminatory behavior based on race, creed, color or national origin; agree to provide a “reasonable volume” of free care to needy residents (though “reasonable volume” was not defined for another twenty years); and the community had to demonstrate the long term economic viability of the hospital construction that was to be funded.

Eisenhower then acknowledged the 83rd Congress’s expansion of this law saying, “The 1954 amendments to the Hospital Survey and Construction Act opened another new chapter in the national drive for better health. Under these amendments, further provision was made to help build health care facilities for the chronically ill; to aid in the construction of nursing and convalescent homes; to provide for more diagnostic and treatment centers for patients who do not need hospital care; and to help make centers available for the rehabilitation of the disabled.”

And yet,  Eisenhower said clearly in 1955, we can do more. In his words, “These achievements represent a major gain for the immediate and future welfare of countless Americans – in the health of both mind and body. Recent advances do not, however, represent our full capacity to wage war on illness and disability throughout the land. As a nation, we are doing less than now lies within our power to reduce the impact of disease. Many of our fellow Americans cannot afford to pay the costs of medical care when it is needed, and they are not protected by adequate health insurance. Too frequently the local hospitals, clinics, or nursing homes required for the prevention, diagnosis and treatment of disease either do not exist or are badly out of date. Finally, there are critical shortages of the trained personnel required to study, prevent, treat and control disease.”

Section 4: The Solutions.

Eisenhower then laid out a long list of recommendations that read remarkably progressive for it’s day. It includes:

Lower the Cost of Care: Expanding the numbers covered by health insurance and the scope of benefits with a special focus on protection against catastrophic costs, coverage for the disabled and those in rural areas, and coverage for low income Americans.

Health Facility Construction: Improved access to funding mechanisms with federally backed support for privately funded construction loans to health care facilities.

Health Manpower: Grants to support expanded training of nurses and public health specialists including those focused on mental health.

Expansion of Public Health Programming: Expanded grants for the Public Health service, the Children’s Bureau of the Social Security Administration, and the Food and Drug Administration.

Environmental Health: Expanded research on air pollution control, and water purity.

Mental Health: Increased funding for training of mental health professionals, expansion and improvement of mental health facilities, and strategies to manage mental health in the community rather than in large institutional settings.

International Health: Stronger support of the World Health Organization (WHO). His positioning for support was new for the day. As he said, “For half of mankind, disease and disability are a normal condition of life. This incalculable burden not only causes poverty and distress, and impedes economic development, but provides a fertile field for the spread of communism.”

These were not simply words for Eisenhower, they were backed up by organizational action that he had taken in 1953.

On April 11, 1953, the president provided his signature of approval and HEW was created. Within its’ umbrella were sheltered Social Security providing 70 million Americans with $4 billion annually on the back of proceeds from a $19 billion dollar trust fund; the Public Health Service and its’ new National Institute of Health (NIH) and National Cancer Institute (NCI); the Office of Education overseeing national education policy; the Food and Drug Administration; The Office of Vocational Rehabilitation; the Children’s Bureau; the American Printing House for the Blind; the Columbia Institute for the Deaf; and St. Elizabeth’s Hospital for the Mentally Ill.

In a bipartisan slight of hand, Eisenhower appointed Democratic Texan, Oveta Culp Hobby, as HEW’s first Secretary. She had been a strong Eisenhower supporter in 1952. He backed her up by appointing Nelson Rockefeller the under-secretary. Rockefeller accepted the role against the advice of his handlers who felt it was beneath him to be the number two. But as he stated, “I’m responsible for creating this baby. I have a responsibility for seeing to it that it succeeds.”

Section 5: In Summary – Eisenhower Gets The Final Word.

In his contemporary review, Kim Bellard reflects, “Yet still the outlines of a solution continue to elude us. It seems there is no health problem so big that we can’t turn it into a political issue, not even a pandemic.”

But in shining a light on this remarkable American, Bellard reminds us that Biden is on the right path in promoting peace time oriented spending priorities, confronting the enemies of truth, and believing that the health of Americans is the critical determinant in the economic and political future of our American democracy.

Eisenhower had no second thoughts about the wisdom of such investment. As health care expenditures hit $4.1 trillion this week, controlling 1/5 of our GDP, Eisenhower would likely advise President Biden to “lean in” to the problem, expose the liars and haters, and do the right thing.

Our former President gets the final word:  “I believe that the social gains achieved by the people of the United States, whether they were enacted by a Republican or a Democratic administration, are not only here to stay but are to be improved and expanded…Anyone who says it is my purpose to cut down Social Security, unemployment insurance, to leave the ill and aged destitute, is lying. Should any political party attempt to abolish social security, unemployment insurance, and eliminate labor laws and farm programs, you would not hear of that party again in our political history.”

The Terri Schiavo Case: A Cautionary Tale For Justices Who Want to Play Doctor.

Posted on | December 12, 2021 | 2 Comments

Mike Magee

For the Justices on the Supreme Court considering allowing the government to “muscle out” the patient-physician relationship in the Mississippi abortion case (Dobbs v. Jackson Women’s Health Organization), the question each should be asking is, “What possibly could go wrong if we remove doctors from delicate life and death decisions?”

For historic precedent and an answer to this question, they need only review the Terri Schiavo case. For those interested in a full summary, it was provided as part of my Fall, 2021 course, “The Right to Health Care and the U.S. Constitution” at the President’s College of the University of Hartford.

Here’s a quick summary and timeline of the case:

•Theresa Marie Schindler was born in a Philadelphia suburb on December 3, 1963. She and her bother Richard and sister Suzanne attended local schools. Terri struggled with weight and had an eating disorder.

•Terri married her husband, Michael in 1984 and moved to Florida to be close to her parents. Terri apparently continued to struggle with her eating disorder, a condition left undiscovered when she sought evaluation for infertility.

•On February 25, 1990, she collapsed in the lobby of their apartment in St. Petersburg, Florida. She was 26 years old. She was resuscitated, and taken to the local hospital, Humana Northside, where she was determined to have had a cardiac arrest brought on by a cardiac arrhythmia caused by hypokalemia with a blood potassium of 2.0 mEq’L (normal 3.5 – 5.0 mEq/L).

•Michael received a court order on June 18, 1990 making him legal guardian and director of future medical decisions related to his wife. Two physicians independently declared her in a “permanent vegetative state.” A gastric feeding tube was surgically placed to provide regular nutritional feedings.

•When she developed a urinary tract infection in mid-1993, he signed a Do Not Resuscitate (DNR) order on her behalf.

•In May, 1998, Michael filed a petition to remove the feeding tube, providing some evidence that his wife would not have wanted to continue to live this way. He refused her parents request that he divorce his wife and hand over decisions, and money garnered from a successful malpractice suit for ongoing care of Terri.

•The parents challenged the removal of the feeding tube that her doctors supported. The case went to Court and a decision to remove the tube was upheld in Florida Second District Court of Appeal in February 2000. After multiple legal maneuvers, the tube was finally removed on April 24, 2001. Terri was now 37 years old.

•The Schindler’s charged Michael Schiavo with perjury, and a judge ordered the tube reinserted 2 days later.

•Claims and counter-claims ate up two more years. On September 17, 2003, as Terri approached her 40th birthday, a frustrated presiding Judge George Greer declared the actions of the Schindler parents was “an attempt to re-litigate the entire case”, and ordered the feeding tube to be removed for a second time, which it was on October 15, 2003.

•With encouragement from Republican operatives in Florida, the Schindler’s joined by their son, Bobby, engaged anti-abortion Operation Rescue/Right to Life extremist Randall Terry in a very public campaign with daily demonstrations at the care facility.

•The Florida legislature in emergency session granted then Gov. Jeb Bush (filled with Presidential aspirations), the authority to intervene in the case. Citing the new “Terri’s Law”, Bush ordered the feeding tube surgically reinserted for the third time.

• In the meantime the ACLU lined up with Terri’s husband. On May 5, 2004, “Terri’s Law” was declared unconstitutional.

•Senator Mel Martinez’s (R-FL) political career was damaged irreparably when he called for federal government intervention in the case. His top aide, Brian Darling’s memo went public. Commenting on the case, it read, “This is an important moral issue, and the pro-life base will be excited…This is a great political issue, because Senator Nelson of Florida has already refused to become a co-sponsor and this is a tough issue for Democrats.”

•A second Republican casualty was the future political career of doctor turned politician, Senator Bill Frist, who had Presidential aspirations but couldn’t resist weighing in as a physician. Breaking an unspoken code of ethics for the medical profession, without every seeing the patient, he challenged the decision to remove Terri’s feeding tube, proclaiming on the floor of the Senate on March 17, 2005,  “I question it based on a review of the video footage which I spent an hour or so looking at last night in my office.”

•The United States Congress held hearings on the case, and then President George W. Bush brokered a compromise transferring the case to Federal Courts. The Federal Court agreed with prior State Court Appeals.

•Terri Schiavo’s feeding tube was removed a final time on March 24, 2005. She died at a Pinellas Park hospice on March 31, 2005.

_____________________________________________________________

The case spanned 15 years, and was rejected by the Supreme Court for a hearing four times. Hijacked from doctors and patients by political opportunists and Right-to-Life activists, it rode the poor health and disability of one unfortunate woman literally into her grave with devastating consequences for all concerned.

Note To AMA: Reversing Roe v. Wade Threatens the Patient-Physician Relationship and Societal Trust in Doctors.

Posted on | December 9, 2021 | 1 Comment

Mike Magee

“Should anyone present know of any reason that this couple should not be joined in holy matrimony, speak now or forever hold your peace.”

The admonition above first appeared in the marriage liturgy section of the Book of Common Prayer in 1549 that laid out Church of England guidelines for worship leaders at the time.

Three hundred years later, Charles Dickens said his piece in the opening lines of the Tale of Two Cities. “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, …”

Dickens was exposing an unhappy union on a grand scale – the contrasting realities and uneasy coexistence of human prosperity and despair, class warfare where joy and hope seem incapable of overcoming suffering and anguish.

A century and half after Dickens shined a light on two cities – London and Paris – and dipped into themes like income inequality and political chaos, our own nation served up its own Dickenesque character in the form of a plucky 44 year old self-promoter, born in 1964 in Sandpoint, Idaho. Her name was Sarah Palin.

Her unlikely rise from Mayor of Wasilla, Alaska (population 11,562) to John McCain’s choice for Vice President of the United States on August 29, 2008, has been well documented elsewhere. What has been less well recognized is that the behaviors and tactics she exhibited helped inform Trump and whet his appetite for politics years before he threw his hat into the Presidential ring.

Palin was crude, flamboyant, and lied with ease. She was unfazed when lampooned, calm and supremely confident as she displayed instincts for the political jugular. Most important, even in the face of withering criticism, she never ever backed down, and her people (soon to be Trump’s) loved her for that.

Let’s take just one example – Palin’s “death panels.”

Sarah Palin invented “death panels” out of thin air, much as Trump invented “The Big Lie” of voter fraud. At the time her claim first appeared in a Facebook post in August, 2009, many of us were busy promoting “Living Wills”, “Advanced Directives” and end-of -life discussions, and never thought she would be taken seriously, even though there was a past history to this distortion.

We thought her laughable antics would fall flat. They were totally and wildly inaccurate.  Her claims that elders across America had much to fear were panned and exposed for what they were – a pack of lies.

Here’s a sampling collected and published by American Medical News at the time :

End-of-life discussions are useful
“In truth, there are no “death panels” in the proposed legislation to overhaul the health care system. HR 3200, the main proposal in the U.S. House, makes periodic, voluntary end-of-life discussions with your doctor a covered expense under Medicare (Sec. 1233). In truth, Republicans supported such discussions in Medicare proposals when George W. Bush was president. That’s it. No euthanasia, no arbitrary decisions about who should live or die, no mandatory anything.” Miami Herald, Aug. 20, 2009

Distortions doom end-of-life counseling
“This is not a proud moment in American politics. Financing beneficiaries’ optional consultations about a range of end-of-life care is a good idea. Families need it. Patients benefit. But a well-orchestrated rumor campaign ensured this element of the plan could not survive.” Seattle Times, Aug. 16, 2009

Stop distortion: There’s no “death panel”
“End-of-life care is a difficult issue, but one Americans should discuss — with family members, attorneys and doctors. Especially doctors. They will likely be involved in end-of-life care, if it becomes necessary. They should be compensated for consulting with patients on the issue. That is what the House legislation strives to allow: consultation. It’s not about death panels. It’s about planning, which is important for individual patients and the health-care system as a whole.”
Des Moines (Iowa) Register, Aug. 14, 2009

In truth, health professionals made a huge mistake in believing that logic, knowledge, and well-established professional practice would easily counteract Palin’s irresponsible actions. Their collective voice was weak. They largely “held their peace” in order to keep the peace.

A simple check of top Google searches at the time (with “death panels” beating all comers) should have forecast what happened next. The fact that the bill wouldn’t require patients to receive counseling sessions, nor would it require a doctor to offer one didn’t matter. Nor that it simply modified Section 1861(s) of the Social Security Act, defining what services Medicare will pay for and allowing a patient receiving an end of life counseling session from a doctor or health care practitioner, to have Medicare pay for it.  No matter it earned Politifact’s “Lie of the Year.” Within weeks, the proposed coverage was gone.

Palin’s intrusion into well-established medical terrain did not receive an adequate and sustained counter-punch from health professionals and their societies around the country. And once the public endorsed Palin’s lie, it was difficult to reverse.

The 2012 lackluster performance of traditional Republicans Mitt Romney and Paul Ryan provided the ideal foil for the full-blown high octane “Palinesque” takeover of the party in 2016. Trump had been toying and experimenting and learning the game of politics as part of a Brand-extension strategy. In 2011, during a Conservative Political Action Committee address when he first admitted to considering a run for President, he tried out the Obama “birther” claim.  To John McCain’s campaign director, Steve Schmidt, his choice of Palin for VP had unleashed Trumpism. As he said of Palin in 2020, “She is the first of a generation of politicians who live in a post-truth environment. She was, and there’s no polite way to say it, but a serial liar.”

What Trump understood in 2011 was that Palin’s only mistake was being a woman and not lying enough.

A quick examination of the map of our United States, color coded for regressive legislation and tactics to disenfranchise women and children, people of color, the poor and the vulnerable, well illustrates that we too are a tale of two cities.

Attacks on women’s rights are the underpinning of current and future assaults on democracy. With women’s rights comes trust in physicians (and the patient-physician relationship) to help negotiate the individual and complex choices that come with child bearing.

On September 21, 2021, the AMA with 25 other medical organizations filed an amicus brief in opposition to the restrictive Mississippi abortion law, Dobbs v. Jackson Women’s Health Organization.  On  October 12, 2021, 19 medical societies, with the AMA in the lead, filed  an amicus brief in U.S. v. Texas, the abortion vigilante law signed by Gov. Greg Abbott. But in the court of public opinion, there has been minimal investment of time and resources by these same medical associations over the past two months considering all that is at stake in the upcoming Supreme Court decision.

As the Supreme Court deliberates the future of Roe v. Wade, health professionals and their societies should not make the same mistake they did in 2009 on “death panels.”

“Speak now or forever hold your peace.”

 

For A Nation Gripped In Fear, The Solution is Positive Leadership.

Posted on | December 3, 2021 | 4 Comments

Mike Magee

I wonder these days, “What are my fellow Americans thinking?” Not knowing the answer, I thought I might share with you what’s on my mind as the nation absorbs everything from Omicron variants to Roe v. Wade teetering on the cliff.

My reflections have centered on the issue of change, how it affects people, communities and societies.

In our lifetime, we have witnessed the emergence of the Internet and HIV, of globalization and overnight delivery, of bubbles and bursts in our stock market, of the genomic revolution and the aging revolution. We have witnessed our health care system creak under the weight of a pandemic, and borne witness to an ongoing attempt to overthrow our democratic form of government. We are heavily armed, are always prepared for war, but show little desire for peace. State legislatures across the land work diligently to minimize the number of votes from people of color, and members of our Supreme Court, with straight faces, seem to suggest that carrying a child for 9 months and then giving it away is no big deal.

We are in the grip of change. Change is one of the few human experiences that supports two dramatically opposed human emotions.  On the one hand, change is fear and on the other, change is exploration.  And while you can support both emotions simultaneously, you can only do so for a short period of time before the tension created between the two forces you to choose one or the other.

If you choose fear, the natural tendency is to retrench, retreat, wall yourself off in the hope that the world will return to what feels normal and safe.  If you choose exploration, your mind moves ahead of the change, envisioning a better way, a way out – dreaming, imagining how best to arrive at that new destination.

At times like these, leadership really matters. Negative leaders embrace fear, using it as a currency to mobilize and organize populations and achieve short-term regressive goals.  In contrast, positive leaders are explorers who use a compelling value-centered vision as currency. Through role modeling and the strength of new ideas, they draw people in as they work through the challenges and shape an environment consistent with their long-term vision.

Negative leaders retrench and divide; positive leaders connect across the divide.  Negative leaders segregate; positive leaders aggregate. Negative leaders build walls.  Positive leaders build  “islands of common stewardship.”

On these islands, one consistently finds qualities like openness, inclusiveness, cultural sensitivity, justice, opportunity for all, goodness and fairness.

On this island people speak a common language grounded in shared values and a unified vision for the future.  They share as well common tools including lifelong learning, new technologies, curiosity, introspection and an active social conscience.

On this island exist formative relationships, that is, as I care for you, you form me as a human being.  And on this island there is a rich supply of renewable capital – human capital, financial capital, social capital, and cultural capital – the equity captured between individuals committed to each other’s success and to the concept of cooperative productivity.

I am concerned that we are giving way to fear for a number of reasons?

First, fear is currency for negative leaders.  In an environment overwhelmed with fear, negative leaders find fertile ground for their divisive messages, and once in control, fan those fears to advance their goals.

Second, fear has distinct mental health implications.  Threats to our democracy, reinforced by rotating cycles of pandemic isolation, have expanded the number and severity of violence, addiction, and mental illness.

Third, fear accumulates and discriminates.  My post-9/11 studies on fear levels in New York City revealed that vulnerable populations already primed for discrimination or abuse including blacks, Hispanics, and women had the highest levels of persistent fear.

Fourth, fear is fundamentally regressive in that it blocks imagination, innovation, and risk taking.  In short, it robs us of our dreams and hopes for a bright future.

How do we combat fear?

Begin by identifying, nurturing, mentoring and advancing positive leaders.  That means voting for people who lead with vision rather than fear.

For parents, community leaders, and teachers, identify promising young minds early in their lives and support their advancement and success.

For children and young adults, identify one or more positive mentors to guide your future, and ask their permission to turn to them from time to time to provide you with guidance, wisdom, and advice.

For all Americans, pursue balance.

Skills, aptitude and ambition assure success on a superficial level, but not happiness.  Happiness evolves from a life well spent, from enduring relationships, and from persistent and sometimes stubborn adherence to the values that have formed you.

Never stay silent in the face of evil or injustice.  Your silence will forever entrap you and define you as passive, vulnerable and insecure.  Better to have the courage and take the risk of speaking up and standing out.

Persist and endure.  Face challenges with realism and without procrastination. The brain magnifies fear. Every issue we will face can be managed as long as we do not give up.  Persist, and endure. When your head hits the pillow, transfer the power to a Higher Power.  Then take a fresh look in the morning. Things always look better in the morning. You are much stronger than you think.

Honor judgment over decisiveness.  We have somehow in our culture come to value rapid decision making in the extreme.  But as a surgeon, I learned early in my life that if you operated on the person who didn’t need the operation, and didn’t operate on the one who did need the operation, the outcomes would be disastrous even though you had been decisive.  It is not about being decisive.  It’s about using good judgment.

My final advice? Find an island of common stewardship to live on.  And if you cannot find one, create one around yourself.

People are basically good, but they are not perfect.

People are basically kind, but when afraid can act unpredictably.

People are basically loving, but when misled can respond with hatred.

People are people.

In every organization I have been in – and for better or worse I have been in many – there are roughly 10% saints, 10% sinners, and 80% in between.  And what determines which way the 80% go are two things.

First, who is leading them.

Second, what is going on in the environment at the time.

Of the two, the most important by far is who is leading them.  For if they are led by a positive leader, they not only have a visible role model embodying values and behaviors worth developing, but also have an individual committed to shaping the environment in a manner that supports positive values and behaviors, and a constructive vision for our collective future.

Omicron and Evolutionary Biology: A Greek Tragedy in the Making.

Posted on | November 29, 2021 | Comments Off on Omicron and Evolutionary Biology: A Greek Tragedy in the Making.

Mike Magee

“Many still see Alpha and Delta as being as bad as things are ever going to get. It would be wise to consider them as steps on a possible trajectory that may challenge our public health response further.”
       Aris Katzourakis, Evolutionary Biologist, University of Oxford., August, 2021

The prophetic words above were shared just three months ago in a Science review article on Covid variants. Now we’ll have to deal with Omicron, and (who knows) Pi in the wings somewhere.

Let’s review the Covid mutants:

Alpha – A variant first detected in Kent, UK with 50% more transmissibility than the original and has spread widely.

Beta – Originating in South Africa and the first to show a mutation that partially provided evasion of the human immune system, but may have also made it less infectious.

Gamma – First detected in Brazil with rapid spread throughout South America.

Delta – First seen in India with 50% more transmissibility than the Alpha variant, and now the dominant variant in America and around the world.

Omicron – Labelled by the WHO “a variant of concern” because it has 32 mutations of the original Covid spike protein that drives transmissability.  The Omicron warning: “There could be future surges of Covid-19, which could have severe consequences.”

The silver lining: Our ability to track and identify mutating viruses in real time is now extraordinary. Well over 2 million Covid genomes have been cataloged and published. But describing the “anatomy” of the virus is miles away from understanding the functional significance of their codes, or the various biochemical instructions they may instruct.

These deeper questions are in the realm of evolutionary biologists who are currently experiencing sleepless nights. Their prior nightmare? “What comes after Delta?” No need to wonder any longer. It’s “Omicron.”

As we await scientific analysis to catch up on the new variant, what we already know is that Delta’s genetic mutation, P681R, affected a spot on the virus spike that cuts through protein chains and sped up human cell entry 1000 times. The speed lit a fuse under colony growth, which in turn allowed the virus’s spread to other unsuspecting human contacts before any immune response generated symptoms appeared. Of course the state of being asymptomatic didn’t last for long. Speedy virus multiplication rates accelerated the microbes movement from upper airways to lower airways.

Will Omicron be a killer? First a few basics.

1. A virus’s survival, and threat to us, relies on three factors:

a)Infectiousness, b) Virulence, c) Immune Evasion.

But these factors can as easily play against each other as for each other. Natural or vaccine induced immunity slows down infectiousness and potential virulence. But (by narrowing a virus’s options for survival) it also creates a Darwinian reward for any mutant that figures out the Rubik’s Cube solution to becoming “invisible” to the human immune system. According to Rockefeller University virologists, such a change requires the coalescence of 20 independent random changes in the genome. Bottom line: Random escape is a tall order. But Omicron already is housing a boatload of mutations on the infective spike. And with Delta having  burned through a sizable portion of its potential future victims, Omicron stands expectantly in the wings.

2. Viruses depend on us. But we no longer look or act as we did in 2019. 4.3 billion citizens (56% of the global population) worldwide have had at least one dose of the vaccine, and hundreds of millions of others have survived the infection. The virus each day is increasingly pressured to find its next human victim. One way out is to figure a way past our immune defenses provided by prior infection or vaccination.

So this is a cyclical game, likely to go on for some time. If we global citizens played our vaccination cards better, the virus would have had fewer turns in the game, and the appearance of Omicron would have been less likely. But here we are.

So here are five take-away facts:

• The longer we allow Covid to stick around, the worse this could get.
• The majority of the messy replication mistakes are inconsequential, but there are occasional windfalls that rise to Greek alphabet mythical status. Omicron is likely one of them.
• Delta’s critical weakness – it leaves behind high antibody titers that limit its future.
• Give the virus more time, or access to compromised hosts, and anything can happen. Viruses are constantly rolling the evolutionary dice.
• Mutations hurt us by increasing transmissibility/virulence or immune evasion. The good news is there is some evidence that an immune escaping Covid might not be efficiently transmissible any more.

Leaders who still politicize this virus are not only ignorant of evolutionary biology, they are playing with fire – and with our human lives.

Whatever it takes, we need to force this virus into a corner . That means a worldwide vaccination push. Otherwise, we run the risk of becoming a Greek tragedy ourselves.

#IgnoreDeSantics

Giving Thanks for Principled Leaders.

Posted on | November 23, 2021 | 2 Comments

Mike Magee

This Thanksgiving, more than most, our country finds itself reaching for guidance and direction. Join me in giving thanks for principled leaders.
______________________________________________

The principles most people aspire to live by come quite naturally to mind because they simply feel right, or sound right to the majority. We make choices – good over evil, love over hate, gentleness over cruelty.

Individuals, families, and societies fight over principles, some say because it is simpler than living up to those principles. We equate certain virtues with success – sincerity, justice, chastity, humility, and industry. But whether this is true is more about how we define success (long-term vs. short-term, ourselves vs. others, material vs. spiritual).

Whose success are we talking about, the principled or the unprincipled?

Principled people seem to feel comfortable in their own skin.

Principled people do not seem to surround themselves with unprincipled people.

Principled people are viewed as valuable rather than successful.

Principled people are self-directed from within.  The measure of their principles can be taken by where they spend their time and the objects they pursue.

Principles provide the direction and the pathway to a worthy destination.

 

Additional Readings:

“Intelligence is derived from two words – inter and legere – inter meaning ‘between’ and legere meaning ‘to choose’. An intelligent person, therefore, is one who has learned ‘to choose between’. He knows that good is better than evil, that confidence should supersede fear, that love is superior to hate, that gentleness is better than cruelty, forbearance than intolerance, compassion than arrogance, and that truth has more virtue than ignorance.”   J. Martin Klotsche

“It is often easier to fight for principles than to live up to them.”
Adlai Stevenson

“Thirteen virtues necessary for true success: temperance, silence, order, resolution, frugality, industry, sincerity, justice, moderation, cleanliness, tranquility, chastity, and humility.”
Benjamin Franklin

“Beware all enterprises that require new clothes.”
Henry David Thoreau

“Who lies for you will lie against you.”  
Bosnian proverb

“Try not to become a man of success, but rather a man of value.”
Albert Einstein

“Doing what’s right isn’t the problem. It’s knowing what’s right.”
Lyndon B. Johnson

“We trust, sir, that God is on our side. It is more important to know that we are on God’s side.”
Abraham Lincoln

“The man who grasps principles can successfully select his own methods. The man who tries methods, ignoring principles, is sure to have trouble.”
Ralph Waldo Emerson

“If we are facing in the right direction, all we have to do is keep on walking.”
Ancient Buddhist Proverb

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Happy Thanksgiving to all!

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