HealthCommentary

Exploring Human Potential

What Comes After Delta?

Posted on | August 25, 2021 | 2 Comments

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.

In my Jesuit high school, we were offered only one science course – chemistry. I took it in my Senior year and did pretty well. In contrast, I took four years of Latin, and three years of Greek, as part of the school’s Greek Honors tract.

Little did I know that Covid would create a pathologic convergence of sorts six decades later. 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.

Our ability to track and identify mutating viruses in real time is now extraordinary. 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 recurrent nightmare? “What comes after Delta?”

What they know already 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 leading to hospitalization rates that are twice as common as they were in the original Covid.

What’s next in the Greek alphabet? 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 under the current system, with Delta transmissibility likely to eventually burn through most of its potential future victims, such a change would be richly rewarded.

2. Viruses depend on us. But we no longer look or act as we did in 2019. Two billion citizens 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 play our vaccination cards right, the virus has fewer turns in the game, and is less likely to draw the cards it needs to evade our human defenses.

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.
  • 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.

A guy like Ron DeSantis is not only ignorant of evolutionary biology, he’s playing with fire – and with our human lives. This cannot go unchallenged. Whatever it takes, we need to force this virus into a corner. Otherwise, we run the risk of becoming a Greek tragedy ourselves.

A Long Awaited “Moment of Truth” For FDR and President Biden.

Posted on | August 22, 2021 | 1 Comment

Mike Magee

A word is dead
When it is said,
Some say.

I say it just
Begins to live
That day.

Emily Dickinson

Arguably, no President better understood the power of the word then FDR. When he structured up “a series of programs, public work projects, financial reforms and regulations…to provide support for farmers, the unemployed, youth and the elderly”, he memorably packaged the plan under the label, “The New Deal.”

Seizing alliteration in 1933, he further defined his new policies as the “3 R’s – Relief, Recovery, Reform”, promising “…action, and action now.”

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

As he aged and his general health declined, his will to serve and honor his commitment to serve the American people only grew. With a heavy dose of humility and learned wisdom, he rose again on January 11, 1944, fifteen months before his death, and delivered the State of the Union Address as a Fireside Chat from the Oval Office in the White House. His words once again were clear and ever lasting. He stated that the original Bill of Rights was “inadequate to assure us equality in the pursuit of happiness.”

Powerful words, in their messaging and meaning, survive the ages. Consider these words from that day 77 years ago:

“We have come to a clear realization of the fact that true individual freedom cannot exist without economic security and independence.”

 “Necessitous men are not free men.  People who are hungry and out of a job are the stuff of which dictatorships are made.”

 “In our day these economic truths have become accepted as self-evident. We have accepted, so to speak, a second Bill of Rights under which a new basis of security and prosperity can be established for all—regardless of station, race, or creed.”

 “It is our duty now to begin to lay the plans and determine the strategy for the winning of a lasting peace and the establishment of an American standard of living higher than ever before known.”

“We cannot be content, no matter how high that general standard of living may be, if some fraction of our people—whether it be one-third or one-fifth or one-tenth—is ill-fed, ill-clothed, ill-housed, and insecure.”

“This Republic had its beginning, and grew to its present strength, under the protection of certain inalienable political rights…As our nation has grown in size and stature, however—as our industrial economy expanded—these political rights proved inadequate to assure us equality in the pursuit of happiness.”

In proposing this radical cultural shift, with war still waging across the globe but the tide clearly turning in the direction of the Allies, he defined those rights in black and white:

  • The right to a useful and remunerative job in the industries or shops or farms or mines of the nation;

 

  • The right to earn enough to provide adequate food and clothing and recreation;

 

  • The right of every farmer to raise and sell his products at a return which will give him and his family a decent living;

 

  • The right of every businessman, large and small, to trade in an atmosphere of freedom from unfair competition and domination by monopolies at home or abroad;

 

  • The right of every family to a decent home;

 

  • The right to adequate medical care and the opportunity to achieve and enjoy good health;

 

  • The right to adequate protection from the economic fears of old age, sickness, accident, and unemployment;

 

  • The right to a good education.

FDR loved America and all Americans. He rests in peace, but his words – and the promise they enshrine – have never died. They remain unfulfilled, their meaning and import reinforced on January 6, 2021 and beyond by the actions of insurrectionists, and anti-vaxxers, and political opportunists whose latest gambit is to sacrifice school children on an altar of profit and privilege.

President Biden shows signs of greatness, but must take care not to come up short – in voting rights, in national health care, in global warming. When dealing with determined and malevolent foes, words must be chosen carefully and delivered with absolute clarity.

“They are unanimous in their hate for me – and I welcome their hatred.”

Those were FDR’s words in 1936. Determined and deliberate. Defiant and dramatic. In defense of Democracy. This is the long awaited moment of truth for FDR, and President Biden.

The Unhealthy Leadership of Governor DeSantis.

Posted on | August 21, 2021 | 1 Comment

Mike Magee

On March 25, 1966,  Rev. Martin Luther King Jr. said, “Of all the forms of inequality, injustice in health care is the most shocking and inhuman…”

This week, my niece in Orlando, Florida, sent her 8-year old son, masked, back to public school. He has a history of severe allergies, including several anaphylactic episodes requiring emergency respiratory intervention. His class included a voluntary mix of masked and unmasked children. He now has a 105 degree fever and has tested positive for the Delta variant of Covid.

His crisis, and those of countless other children in Republican led states, now lies clearly on their governors’ shoulders. It also suggests, as with voting rights, that we can no longer allow health planning and delivery to be captured entities of the states rights crowd. Dying children are just not acceptable in a civilized society.

The impassioned and illogical pleas of leaders like Florida Gov. Ron DeSantis are literally as old as this nation. As with many controversies in human endeavor, the easiest way to decipher history and meaning is often “to follow the money.” Such was the case in the battle between state and federal rights. This battle engaged early and often, with Thomas Jefferson and Alexander Hamilton on opposite sides of the spectrum.

Soon after the 1788 ratification of the U. S. Constitution, Washington’s Secretary of the Treasury, Hamilton, suggested a federal bank to manage debt and currency. Jefferson, then Secretary of State, opposed it for fear of a federal power grab. Regardless, in 1791, Congress created the First Bank of the United States with a 20-year charter.

When the charter ran out in 1811, it wasn’t renewed. But then the War of 1812 intervened, and in 1816 the Second Bank of the United States was created with the Federal government holding 20% of the equity. The divide reinforced the divide of two political parties – the Federalist Party and the Democratic-Republican Party whose members were committed to undermining the bank.

The battle came to a head when, in 1818, Maryland’s state legislature levied a $15,000 annual tax on all non-state banks. There was only one – the Second Bank of the United States, which refused to pay. The suit rose to the Supreme Court with Maryland claiming the right to tax based on their reading of the 10th Amendment claiming state protection against extension of non-enumerated rights to the Federal government.

The landmark 1819 case – McCulloch v. Maryland, defined the scope of the U.S. Congress’s legislative power and how it relates to the powers of American state legislatures. In ruling against Maryland, Chief Justice Marshall argued that:

“Let the end be legitimate, let it be within the scope of the constitution, and all means which are appropriate, which are plainly adapted to that end, which are not prohibited, but consist with the letter and spirit of the constitution, are constitutional.”

 It was the people who ratified the Constitution and thus the people, not the states, who are sovereign.

One hundred and thirty years later, on December 10, 1948, the newly formed United Nations, adopted the Universal Declaration of Human Rights. That day, Eleanor Roosevelt spoke for America, stating: “Where after all do human rights begin? In small places close to home…Unless these rights have meaning there, they have little meaning anywhere.”

Of the rights enumerated and endorsed that day was included Article 25: Right to An Adequate Standard of Living. It read:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control”, and “Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.”

Professors like Jonathan Mann, director of the Health and Human Rights Center at Harvard School of Public Health, have added political heft to the debate. He agreed with a 2000 UN statement that “Health is a fundamental human right indispensable for the exercise of other human rights.” Why? He gives three reasons.

Political: “Health policies, programs, and practices have an affirmative impact on human rights, especially when state power is considered in the realm of public health.”

Discrimination: “Human rights violations have health impacts.”

A Propitious Cycle: “Protection and promotion of human rights and health are linked fundamentally in a dynamic relationship.”

What is somewhat remarkable is not what Professor Mann said, but rather how long it has taken to make its’ way from the streets of America to the ivy halls of academic, and now back again.

Covid, and its mutants and their enablers like DeSantis, are now part of our history. We the people, not the states, are sovereign. We must have the vote. We must protect our children. And we must have a national health plan based on science and truth.

Afghanistan, Covid, the Delta Variant …and Fear Management as a Public Health Emergency.

Posted on | August 17, 2021 | 3 Comments

Mike Magee

In the past two decades, all manners of catastrophe have managed to land on our laps at the intersection of science, public policy, and information technology. Transparency and truth are the keys to unlocking lasting solutions. But in the meantime, there is a pressing need to manage fear.

The U.S. evacuation from Afghanistan this week has simply added fuel to the fire. People are scared. And when people are scared, they not only make bad decisions, but they also make themselves sick.

It wasn’t too long ago that I tackled this very issue. The source point for the fear was different then: 9/11. I was charged to study fear levels in New Yorkers 30 months after 9/11 and again 4 years after 9/11.

The first study of 1,000 New Yorkers , 30 months post 9/11, disclosed high fear levels, especially with respect to using mass transit, and high residual levels of mental illness. It also noted that, while citizens were more vigilant, they did not see themselves in a position to contribute to a response to color coded warnings. In short, they absorbed the fear, but had little outlet for a constructive response. Four years post-9/11, fears over terrorism remained prevalent among New York City residents.

The suffering from mental ailments persisted as well. Thirty-five percent reported personally suffering depression, anxiety, or mental illness as a result of the 9/11 attacks. Fifty-two percent of those originally affected said they were still suffering from mental ailments. Of those who personally suffered, women, Hispanics and African Americans were disproportionately affected.

Our citizens reaction to Covid, and now the Delta variant, mirrors these findings.

Here is what I believe needs to be done:

1. Fear Management must become a core responsibility of those involved in Covid disaster response.

2. A mental health professional with strong public health credentials should be an active team member on local, state, and national levels.

3. All Covid recovery plans should include short, medium and long-term plans to manage fear and its mental health fallout.

4. Covid disaster communication plans, both proactive and reactive, should be rigorously focus tested to assess mental health impacts.

5. A comprehensive national public/private multi-media communication program to address residual fear head on and reinforce social confidence and trust in vaccines should be developed and launched.

What we must now recognize is that current fear left unaddressed and reinforced by frequent warnings and Delta induced flashbacks will not go away. It will persist, especially in the most vulnerable, and eat away at the fabric of society, eroding public confidence and trust in science and health professionals.

President Biden is doing his part, but he cannot do it alone. We together absorbed the fear. Together we must now confront and rid ourselves of it.

WSJ Denialists: “Same Climate Report, Different Day.”

Posted on | August 12, 2021 | Comments Off on WSJ Denialists: “Same Climate Report, Different Day.”

Mike Magee

This past weeks scary Climate Report raised alarm bells with good reason around the world. What’s not surprising is that the editorial page of the Wall Street Journal has not changed its tune. Holman W. Jenkins, Jr.’s headlined, “Same Climate Report, Different Day.”  In some ways, he’s right – the finding (the News in the report) is actually not new.

In 1997, Gro Brundtland, then head of the WHO defined health as “human potential”. In doing so, she broadened the sphere of interest of health policy experts on a macro level and challenged physicians on a micro level. In essence she united for the first time patient health and planetary health.

Since that time, we have seen a continued battle and debate in the public space between the overwhelming majority of scientists who has raised the alarm over the self-reinforcing cycle of global warming, and a much smaller but highly vocal segment of the scientific community, who – often with the support of dollars from energy related corporations – have denied the challenge we and the planet face.

Exactly 7 years ago, in an article in JAMA, physicians for the first time were directly challenged to educate their patients regarding the coming health risks associated with global warming.  The authors reviewed the evidence related to this impending crisis and come to this conclusion: “Evidence over the past 20 years indicates that climate change can be associated with adverse health outcomes. Health care professionals have an important role in understanding and communicating the related potential health concerns and the co-benefits from reducing greenhouse gas emissions.”

The article in part noted:

1. “Consensus is substantial that human behavior contributes to climate change: 97% of climatologists maintain that climate change is caused by human activities, particularly fossil fuel combustion and tropical deforestation.”

2. “About half of anthropogenic greenhouse gas emissions between 1750 and 2010 occurred since 1970. The increase in greenhouse gas emissions has been greatest in the last decade (2.2% per year) compared with 1.3% per year between 1970 and 2000.5 Emissions continue to increase; 2011 emissions exceeded those in 2005 by 43%.”

3. “Carbon dioxide from fossil fuels and industrial processes accounted for approximately 78% of the total increase from 1970-2010.”

4. “The trend toward decarbonization (cleaner fuels) of the world’s energy since the 1970s has been reversed by increased coal combustion since 2000.”

5. “Climate change is happening: the relationship of heat-waves, floods, and droughts along with adverse health outcomes is evident. Two broad approaches are needed to protect public health: mitigation, or major reductions in carbon emissions, corresponding to primary prevention; and adaptation, or steps to anticipate and reduce threats, corresponding to secondary prevention (or public health preparedness).”

6. Key health risks noted  for doctors and patients included:

“Heat-related disorders, including heat stress and economic consequences of reduced work capacity.”

“Respiratory disorders, including those exacerbated by fine particulate pollutants, such as asthma and allergic diseases.”

“Infectious diseases, including vector borne diseases, such as Lyme disease, and water-borne diseases, such as childhood gastrointestinal diseases.”

“Food production, including reduced crop yields and an increase in plant diseases.”

“Mental health disorders such as post-traumatic stress disorder and depression that are associated with natural disasters.”

7. Mitigating climate change could yield health benefits:

“Economic advantages of reducing fossil fuel combustion and improving air quality, including a reduction in chronic diseases and their associated health care costs, and economic opportunities associated with development of alternative forms of energy.”

“Infrastructure improvements that reduce greenhouse emissions could also lead to increased physical activity that would be associated with a reduction in various chronic diseases.”

8. Heat related death and disability said the author, have been understated: “The most direct effect of a warming planet is heat stress and associated disorders. Heat-related deaths are routinely attributed to causes such as cardiac arrest without citing temperature as the underlying factor. Thus, the actual death toll attributable to heat is greater than certified on death certificates.”

9. Global warming will continue to reduce productivity: “Using industrial and military guidelines, Dunne et al estimated that ambient heat stress has reduced global population-weighted labor capacity by 10% in summer’s peak over the past few decades. Projected reduction may double by 2050 and may be even larger in the latter half of the 21st century.”

10. Additional death and disability secondary to food scarcity, respiratory disease and waterborne disease in all age groups and traumatic, disaster related injuries is to be expected. The mental health implications of these stressors are currently being underreported.

How can health professionals help?

“ Effective communication may shift knowledge, attitudes, and behavior toward reducing the risks of climate change. Research indicates several principles of effective climate communication that closely resemble those used in health. Themes include 2-way communication, gearing messages to the audience, limiting use of fear-based messages,  issuing simple lucid messages repeated often from trusted sources, and making health-promoting choices easy and appealing.”

“Health may be a compelling frame for communication about climate change, reflecting views that change threatens health. Although further research is needed to define the role of health in climate communication, practical communication resources are becoming available, implying an important role for health care professionals.”

The WSJ’s Jenkins writes, “Corporate management has nothing material to add.” The 2014 JAMA article suggests that health professionals do.

Celebrate The Good!

Posted on | August 5, 2021 | 4 Comments

Mike Magee

A week ago, I came across this photo on Linkedin posted as part of a message from Mary Bardin, a Senior Services Manager at Sunbeam House Services, an Irish firm from Bray, County Wicklow.

I shared her post, and added the words, “Celebrate the good!”

In the week that followed, 49 others “liked” my post, which is my equivalent of “going viral.” As I watched those numbers climb, three questions emerged. First, who were the two people in this photo with missing left forearms, and how did they come to connect? Second, what caused me and others to react positively to this image? Three, does this image carry a message for Americans, some hidden instruction how to manage our current reality?

1) Who are they?

In the summer of 2017, Colleen and Miles Tidd were told that their third child would be born without a left forearm. Colleen later reported that she cried at first, but not for long. They had two other children, girls age 2 and 12, to consider. In preparation for their son Joseph’s birth, they reached out to an advocacy organization, “Lucky Fin”, for information and support. The name derives from the 2003 Disney classic, “Finding Nemo”, and its’ animated star clownfish, Nemo. He was born with one short fin, the result of a barracuda attack that killed his mother and sister, and cracked his egg while he was still in development. The little fish was left with an over-protective father who, out of fear, tried to limit his future. Nemo resisted and found his strength and purpose, in part, by redefining what other sea creatures saw in him. They saw a unfortunate fish with an abnormally shortened limb. He saw adventure ahead, powered by his “lucky fin.”

This was just the kind of messaging Molly Stapelman was looking for in 2007 when her healthy baby girl, Ryan, was born with “her right hand stunted, her palm small and no fingers except a tiny thumb.” Three years later, she launched “Lucky Fin” stating that, “A child being born with a limb difference is not tragic. It’s extremely important to show our children how capable & wonderfully made they are. If we treat them as flawed or limited that is who they will believe themselves to be- and that would be the tragedy.”

Colleen and Mike Tidd, in turn, discovered Molly’s organization, and with the encouragement of Joseph’s sisters, who loved the Disney movie, reinforced the hidden power of his own “lucky fin.” His parents took the personal campaign one step further. They began to document their son’s adventures on an Instagram page called “tiddbit_outta_hand.”

Carson Pickett, the soccer star, has her own story. She was born in 1994 near Jacksonville, Florida, with a missing left forearm, nearly identical to Joseph (nicknamed Joe-Joe) Tidd. Her parents, Treasure and Mike, were former college sports stars, committed to expanding rather than limiting their daughter’s horizons. Carson’s mantra became, “Control what you can control”, her own variation of Nemo’s famous, “Just keep swimming.” At age five, her father introduced her to soccer and she never looked back. She was a standout at Florida State University, and was drafted by the National Women’s Soccer League team, Seattle Reign. In 2018, she was part of a three-person trade to the NWSL’s Orlando Pride.

Colleen and Mike Tidd immediately took notice. Joe-Joe and Carson were both born in Florida, loved soccer, were athletic, and had partially formed left arms. Their limb defects placed them among 2,250 U.S. babies born each year with the condition. By the time their photo was taken in April, 2019, Joe-Joe was 21 months old and had taken to wearing a purple Pride jersey with Carson’s #16 on the back.

2) What’s in an image?

The famous photo was taken by Joe-Joe’s mother at a home game in 2019 when Carson jogged over to the family after hearing their cheers. As reported, “She repeatedly tapped her arm against his as he shrieked with glee.” After the game, the two spent time in the locker room playing their version of peekaboo – pulling up their shirt sleeve to expose their left arms. As Colleen recounted, “It took a minute for him to realize, ‘Wow, we’ve got the same arms,’ and then he just giggled. You could see it hit him, and then they were best friends after that…She’s like me.”

When they arrived home, Colleen posted the photo on “tidbit_outta_hand”. Why? She said, “It’s just showing that he might be unique, but he’s no different than anyone else. He’s going to be able to accomplish it all.”

Since then, that photo has touched many others, especially those isolated by the pandemic, or caught in the throes of America’s political upheaval. For all of them, Nemo’s “Just keep swimming”, or Carson’s “Control what you can control”, or Joe-Joe’s ecstatic response to “Reach out and touch”, speak of persistence, resilience, endurance, common humanity – and yes, goodness.

3) What is the message for us?

The emotional journey of the past few years has touched all Americans. Fear and worry have had a corrosive effect on our society, and isolation added fuel to the fire. But challenges also carry with them enlightenment. Joe-Joe’s father Miles said it best. “Carson knelt down next to Joseph and showed him her arm. It was this instant bond we can’t begin to understand.”

A human connection can be very powerful and healing. For Miles and his wife that connection extended to Carson’s parents, Treasure and Mike Pickett. Their advice: Never allow the words, “I can’t.” Carson added, “People might not treat you the right way or they may stare at you. But the way that you treat people is going to go way further than anything else.”

The image has a power all its own. Renewing contact in the middle of the pandemic’s Delta variant surge isn’t easy. Keep swimming. Fighting intentional waves of deliberate misinformation designed to sow division and distrust is discouraging. Control what you can control. Deliberate efforts to disenfranchise or deny or destroy other human beings is disheartening. Celebrate the good and embrace the future.

You never know. The greater good may be just around the corner. Ask Carson Pickett. She’s 27 now, and her Orlando team was sidelined when several members tested positive for Covid, eliminating them from playoff’s. Around the same time, there was a knock on her door, with a package containing an easy entry shoe with a wrap-around strap closure in lieu of laces. The Phantom GT Academy FlyEase was her shoe – literally.

She had teamed up with Nike, and this shoe held special meaning. She recalled “I saw my younger self. I looked at it and it almost brought me to tears because it’s just awesome to see something that would’ve really helped me when I was younger. ”

You never know. “Ever since I got to the pros and seeing how many amazing messages I get sent about how I inspire people, some who aren’t even soccer players,” she said. “[Seeing that] just showed me that I can do so much more than just be a good soccer player, and that I could advocate for something much bigger than soccer.”

Health Care Needs A Hero.

Posted on | July 27, 2021 | 2 Comments

Mike Magee

Health care needs its heroes.

I came to that conclusion this week through a round about route.

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

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

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

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

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

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

But Dara’s journey across and within Uber seems to be guided by his inner “Joseph Campbell.” Departure, Initiation, Return. He appears to be mid-stream in challenging his own system. Not naming Mark Zuckerberg, he mused, “I think, just like Uber, some of them grew up too fast and some of them didn’t take responsibility for their power and I think now they’re being called to reckon… I think the age of ‘I built a platform, I’m not responsible,’ that time is over. And now the question is, what does the responsibility look like? Defining it and putting guard rails around it, I think that’s a healthy thing.”

Health care if anything is more complex than Silicon Valley. Deeply segmented but fundamentally opaque and collusive, the Medical Industrial Complex controls 1/5 of the economy with power literally over life and death decision-making. With its share of heroes – from every day doctors and nurses to unassuming scientists birthing “just-in-time” cures – the system also has breed some first class villains of the likes of Arthur Sackler, Martin Shkreli, and Elizabeth Holmes.

Health care, for all its pure and idealized mythology, has descended into the belly of the capitalist beast. Its vaulted training institutions have captured and breed many of our nations finest, only to trap them in a compromised and conflicted “Initiation” phase, from which they never “Return.” As Dara told Dowd, “sometimes the system ‘works too well’: I think capitalism has its claws in our democratic societies in ways that has allowed it to overly optimize for its benefit.”

Health Care needs to be certain that its young and developing heroes, who depart from their civilian lives, to be initiated into a life of service and sacrifice, are not captured by “the dark side.”

Those who train doctors and nurses and health professionals, who lead research and discovery, who administer health care institutions, need to understand the fundamental challenge in “the hero’s quest.” As Joseph Campbell stated “Is the system going to eat you up and relieve you of your humanity, or are you going to be able to use the system to human purposes?”

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