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

_____________________________________________

Happy Thanksgiving to all!

Health Insecurity and the Survival of American Democracy

Posted on | November 16, 2021 | Comments Off on Health Insecurity and the Survival of American Democracy

Mike Magee

Social Epidemiology, is a branch of epidemiology that concentrates on the impact of the various social determinants of health on the citizens of a nation. This field of study lives at the intersection of health care services, political science , the law, and history.

What makes this field of study so timely and relevant at the moment is the linkages it exposes between health and the construction or destruction of a functional democracy .

This was familiar territory for Eleanor Roosevelt. She spent the greater part of World War II creating what she labeled in 1948 “Humanity’s Magna Carta” – aka the “Universal Declaration of Human Rights (UDHR.)”

Embedded in the declaration was a broad and inclusive definition of health. It reads “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The Marshall Plan, for reconstruction of war torn Germany and Japan, embodied these principles, and successfully established stable democracies by funding national health plans in these nations as a first priority.

Although our nation signed the UDHR, it carried no legal obligations or consequences. In fact, the U.S. medical establishment’s bias was  to embrace a far narrower definition of health – one that targeted disease as enemy #1. They believed that in defeating disease, health would be left in its wake.

In contrast, neighboring Canada took the UDHR to heart, and as a starting point asked themselves, “How do we make Canada and all Canadians healthy?” Where our nation embraced profiteering and entrepreneurship, leaving no room for solidarity, Canada embraced the tools of social justice and population health.

By 1966, the U.S. had passed Medicare providing health insurance to all citizens over 65 years of age. Canada, that same year passed their program (also called “Medicare”) which covered all Canadian citizens.

The United Nations, in the same year published their “International Covenant on Economic, Social and Cultural Rights” (ICESCR). Article 12 was explicit. It reads:

1.The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for:

“the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child”;

“the improvement of all aspects of environmental and industrial hygiene”;

“the prevention, treatment and control of epidemic, endemic, occupational and other diseases”;

“the creation of conditions which would assure to all medical service and medical attention in the event of sickness.”

The U.N.’s idealism was tempered by realism. They highlighted what is called a “reasonableness standard” using the tag phrase “highest attainable standard” as a goal for each nation to pursue. They recognized as well that a nation’s cultural, economic and social conditions would evolve, affecting the speed with which certain goals designed to meet basic human needs, such as food, shelter, education, health care, and gainful employment, could be met.

In 2005, I gave a speech to a group of international leaders at the Library of Congress titled “Why health is political.” It focused on the social context of health, power politics, and the domain of law. At the time, more than 70 nations had ratified ICESCR, Article 12. In doing so, they pledged to avoid retrogressive measures, reject discriminatory policies, hold unhealthy polluters at bay, and establish proactive planning to address health disasters. The U.S. was (and remains today) missing in action. Then and now, we remain the only industrialized country in the world without a plan for universal health coverage.

FDR had slated health security to be part of his “Second Bill of Rights”, but died in 1944. The AMA and Pharmaceutical Manufacturers Association (PMA) then short-circuited the effort by successfully labeling Truman as a representative of the “Moscow party line.”

The challenges today remain much the same. The American culture lacks a communal identity, favors individualism and tribalism, has a weak labor movement, distrusts its own government, and often treats its own Constitution as an exercise in semantics.

ICESCR, Article 12, celebrates human rights as universal, indivisible, interdependent, and interrelated. Where our tradition is individualistic and transactional, their philosophy is holistic, and commits to addressing human needs in order to break the bondage of fear and want that can dominate in uncaring or ineffectual authoritarian societies.

The UDHR was a universal declaration of the General Assembly of the United Nations that created no technical binding legal obligations on its signatories.

In contrast, the ICESCR is a covenant– “a treaty which, under the rules of international law, creates legal obligations on all states that ratify it.” It was published on December 16, 1966. President Carter did finally sign the covenant on October 5, 1977, but elected not to pass it on to the Senate which must give its “advice and consent” before the U.S. can ratify any treaty.

As of 2021, over 170 nations have ratified the covenant. The United States is not one of them.

The Value of the “Right” to Health Depends On The Definition of “Health.”

Posted on | November 8, 2021 | 2 Comments

Mike Magee

In my course this Fall at the University of Hartford, titled “The Right to Health Care and the U.S. Constitution”, we have concentrated on the power of words, of precedent, and the range of interests with which health has been encumbered over several hundred years.

The topic has been an eye-opener. On the most basic level, it is already clear that the value of this “right” depends heavily on your definition of “health.”

We’ve highlighted three definitions worth sharing here.

The first is attributed to Eleanor Roosevelt. In 1948, as lead for the United Nations Declaration of Human Rights, she defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” She also made clear at the time that each of us, as responsible citizens, bore a level of personal responsibility for our own health. By virtue of the choices we make, and the behaviors we exhibit, we raise or lower the chances of being “healthy.”

The second voice highlighted was also a woman. She is a physician from Norway, born on April 20, 1939 in Oslo, the daughter of a physician and politician. She received her Medical Degree from the University of Oslo and went on to earn a Masters in Public Health at Harvard. She served three separate terms as Norway’s Prime Minister, never having fewer than 8 women in her 18-member cabinet. Her name is Gro Brundtland. In 1998, she was confirmed as director general of the World Health Organization (WHO).

In one of her first WHO directives in 1998, she took on the definition of health which she described as “Part Goodness and Part Fairness.” She went on to explain,

“Goodness in the sense that our professionals are well trained and qualified; our institutions well outfitted and safe; our processes engineered to perfection; our teamwork a reflection of training and excellent communication.”

“ Fairness in the sense that these skills and capabilities are fairly and equitably distributed to the broadest population possible.”

The third featured definer of heath was a Catholic Cardinal from Chicago during those early Brundtland years. His name was Joseph Bernardin. He had terminal cancer and was ultra-focused on health delivery when he addressed the Annual Meeting of the American Medical Association. He said, “There are four words in the English language that have common English roots. They are heal, health, whole, and holy. To heal in the modern world, you must provide health. But to provide health, you must keep the individual, the family, the community and society whole. And if you can do all that, that is a holy thing.”

As the Earth and its inhabitants entered the new millennium, it was clear that the delivery of health care – whether local, national or global – was a complex human endeavor. Even if you declared it a “universal right” as the UN and the WHO did, you would still need responsive programs, trained professionals, equal access, continuity of care, funding, compassion, understanding, and partnership. And even these would not be enough without forward planning, anticipation, scientific discovery and reliable funding.

When the Covid-19 pandemic hit, it rapidly revealed the cost of lack of U.S. planning, investment and capacity. Specifically, the complex supply chain, including materials, human capital, and science failed. More alarming than these however was the damage and confusion that flowed directly from flawed leadership at the top. What Trump revealed was that trust, truth, and integrity were critical elements when it came to health delivery.

Weaknesses in this regard have been with us since the birth of this nation. But they have never quite been called out with such penetrating clarity as they were by Rev. Martin Luther King Jr., when he addressed the crowd at the Poor People’s Campaign on March 25, 1966, and said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

As I said to my students, we could learn a great deal by pondering whether Dr. King was right, and if so, why? At the time, President Lyndon Baines Johnson was struggling to make real his “Great Society.” The three-prong “Martyr’s Cause (as he labeled his efforts to honor JFK’s death), included implementation of The Civil Rights Act, The War on Poverty, and Medicare. All three, integrated and interdependent, were necessary if justice was to prevail as promised in the U.S. Constitution.

Mark and Sheryl’s “Meta”-Mania.

Posted on | October 29, 2021 | 1 Comment

Mike Magee

At the 2010 World Economic Forum, marketing powerhouse Fleishman-Hillard reported that “3 out of 5 chief executives believe their corporate brand and reputation represent more than 40% of their company’s market capitalization.”

But what happens when your brand becomes synonymous with misbehavior, dishonesty, deceit, and deception? For C-suites behind the management curve, or ones ethically compromised, choice number one is to abandon the brand. But timing is critical.

Take Mark Zuckerberg’s announcement this week that Facebook is now “Meta.” As reported in Forbes, “Mark Bayer, president of Bayer Strategic Consulting, noted that, ‘A name change now—when Facebook is under intense scrutiny—reinforces the perception the company is trying to elude responsibility for its lengthening list of misdeeds. Even if disconnected from the current crisis, the name change will be seen as a clumsy PR move. It’s a gift for comedy writers everywhere.’ ”

Zuckerberg on the record comments this week didn’t exactly chart new ground. He timidly contended that “Over time, I hope that we are seen as a metaverse company. I want to anchor our work and our identity on what we’re building towards.”

Metaverse? The term was coined in 1992 by writer Neal Stephenson in his dystopian novel Snow Crash.  It is an invented word (the prefix “meta” meaning beyond and “universe”) to a vision of how “a virtual reality-based internet might evolve in the near future.”

“Metaverse” is all the rage today, referenced by the leaders not only of Facebook, but also Microsoft, and Apple, and many other inhabitors of virtual worlds and augmented reality. The land of imaginary 3D spaces has grown at breakneck speed over the past three decades, and that was before the self-imposed isolation of a worldwide pandemic.

In rebranding Facebook “Meta”, Zuckerberg is banking on futurists who say that the metaverse remains a future-facing concept that has not yet approached its full potential. But everyone from gamers to academics say it is gaining ground fast, and igniting a cultural tug of war.

Zuckerberg is far from the only enthusiat. Jason Warnke of giant consulting firm Accenture sees the “metaverse” as a power enhancer and multiplier. He says “…we believe we now have the opportunity to bring our people together in ways never before possible in the physical world.”

Not so fast, says Esther O’Callahan, the Gen-X founder of the online recruitment firm Hundo, who must feel just a bit violated this week. She says the term is“… owned by young people who care more about community than profit and use it for the good of the real and virtual world. And if that sounds ludicrously naive and optimistic about it – I am and I’m not sorry!”

Karinna Nobbs, CEO of The Dematerialized, envisions the coming metaverse as a societal builder referring to it as “the next significant third space.” In doing so, she is appropriating a term made famous by sociologist Ray Oldenburg in his 1989 book, “The Great Good Place”. In it, the author advocates for investment in public spaces, outside of home and work that encourage congregation, civic engagement and relationship building. Karinna sees her virtual company as a “third space” to converge and nurture the emerging digital fashion ecosystem.”

Not surprisingly, many health entrepreneurs must be viewing Zuckerberg’s Meta-mania with concern. They have been all over the metaverse as well, with new ventures attracting investor demand, selling marginal moves in telemedicine, robotics, behavioral health, consumer wearables and the like.

Deloitte & Touche LLP report that digital health investment has quadrupled in the past four years, including $21.6 billion in 2020. They see health tech invasion of the metaverse as “a prescription for disruption by a growing base of health technology investors armed with funding from special-purpose acquisition companies (SPACs).” Investors are literally betting on an idea since SPACS go public without any existing business operations. They play to profit, not to disrupt.

Of course, so does Facebook, manipulating algorithms to juice up profitability, even as they have disrupted what had previously appeared to be a rather stable form of government, democracy.

Rebranding might distract, and even excite some Facebook fans. But it is no more likely to be a successful rebranding strategy than Phillip Morris’s morphing into Altria while simultaneously targeting with e-cigarettes the same crowd that got Mark and Sheryl into so much trouble – teens.

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