Health Tech – Part II: The Risk of Under-Powering The Vision.

Posted on | July 3, 2021 | Comments Off on Health Tech – Part II: The Risk of Under-Powering The Vision.

Mike Magee

Few can disagree that, in the fog of the Covid 19 pandemic, health technology entrepreneurs have been on a tear. In the first year of Covid’s isolation induced new reality, digital health companies experienced a $21.6 billion investment boost, double that of the prior year, and four times 2016 funding.

By year two, the investment community exhibited some signs of self-restraint by raising a few open ended questions. For example, in early 2021, Deloitte & Touche led a Future of Health panel at the J.P. Morgan Healthcare conference, reporting that “panelists suggested that entrepreneurs need to go beyond products that simply improve processes or solve existing problems.”

Panelists predicted that virtual health delivery services will expand; consumers will demand greater involvement including expansion of home diagnostics; and investment driven mergers and acquistions will explode – all of which has proven to be true.

Adding push to shove, Deloitte added this final nudge: “Entrepreneurs who define new markets, dominate them with a strategy people can understand, and extract value will likely be the most successful.” Recent surveys also reveal that only 1 in 5 health care executives are satisfied with their health tech solutions.

Forty years ago, in the early beginnings of Health Tech, words similar to those above triggered cautionary tones from traditionalists. For example, Dr. John A. Benson, Jr., then President of the Board of Internal Medicine, stated “There is a groundswell in American medicine, this desire to encourage more ethical and humanistic concerns in physicians. After the technological progress that medicine made in the 60’s and 70’s, this is a swing of the pendulum back to the fact that we are doctors, and that we can do a lot better than we are doing now.”

He accurately described the mood then, and for most of the 20th century, of academic clinicians toward technology, a complex love-hate relationship that has rejoiced and cheered on progress, while struggling to accept and master change in a manner that would avoid driving a wedge between academicians, clinicians and patients.

In the lead up to the 2005 White House Conference on Aging, the National Commission on Quality Long Term Care attempted to bridge that gap.

As the chair of their technology sub-committee, I wrote the report, “Fully Leveraging Technology to Transform Health Care.” I asked then, “How might technology be applied to re-engineer homes for health and assure maximum connectivity to support aging citizens as part of the multigenerational family, the community and a preventive oriented health delivery system?”

This insight, that the technology should not be limited only to fourth and fifth generation Americans, but rather, in an integral way, be applied to assist as well the three generations below them – their children, grandchildren, and great-grandchildren – reinforces the concept of technology applications as both assistive and transformational.

Such a vision focuses on healthy bodies and health minds. It assists memory as well as mobility. It harnesses software and hardware to not only improve individual quality of life, but to also advantage family, community and societal goals.

Independence also implies responsibility centered on individuals and their networks of support including family, friends and caring professionals. As citizens we have differing capabilities and needs, and these change as we age. We must help each other. But to do so efficiently, we must advantage virtual connectivity and a full range of technologic applications that unlock our fullest individual and collective human potential.⁷

The revolutionary strength of modern information and scientific technologies is that “they ignore geography.” In so doing they allow us to reorient and connect beyond the limits of a range of barriers whether they be physical, social, financial or political. The danger is not in over-reaching but in under-reaching.

Where are the “killer applications” that would allow lifespan planning to move us ahead of the disease curve? How can we target technologic advances in health to first reach our citizens most at risk? How do we, in powering the health technology revolution, broaden our social contract to include universal health insurance? How do we unite the technology, entertainment, and financial sectors (previously locked out of the health care space) with the traditional health care power players, and incentivize them to work together to create a truly preventive and holistic health delivery system that is equitable, just, efficient, and uniformly reliable? How can each citizen play a role in ongoing research and innovation, and help define lifelong learning and behavioral modification as part of good citizenship? What can corporate America do to advance health in the broadest sense of the word, and in “doing good,” do well financially, serving Main Street as it serves Wall Street?

Technologies can enable, operate, connect, instruct and assist. But to do so logically and efficiently they must conform to a vision that is both generalizable and customizable. Technology offers the flexibility and fluidity to pursue health, independence, mobility, financial security, social engagement and cognition in hundreds of thousands of uniquely different environments simultaneously, while also pursuing a single unified and collectively committed vision for our nation.

In 2005, the Commission reported stated, “Technology has the power to assist us in healing, providing health and keeping our nation and global family whole. But it’s capacity to deliver on this promise is dependent on a vision for health that is both broad and inclusive.”

In 2021, academic medical leaders and health technology investors may find common ground in asking the question, “How does my support for this proposed technology project make America and all Americans healthy?”

Is Health Tech Firing On Too Many Cylinders?

Posted on | June 23, 2021 | 1 Comment

Mike Magee

What will be the lasting impact of the Covid 19 pandemic?

We still don’t know the answer to that question in full. But one thing that can be said with some certainty is that it has strengthened the hand of Big Tech and all things virtual. Consider the fact that within the Biden White House administration, 13 senior aides have Big Tech resumes with time spent in firms like Google, Facebook, Twitter, Apple, Amazon, Microsoft and more.

This pandemic-induced scrape with mortality has instigated widely varied responses ranging from existential re-awakenings to explosive entrepreneurship.

In health care for example, health tech start-up’s are altering research, education, care delivery and coordination, data mining, patient privacy and financing.

As we know well from health care, intermingling profit, policy and politics can eventually lead to conflict and recrimination. The current controversy over NIH indirect funding of Shi Zengli’s Wuhan “gain-of-function” viral research through Peter Daszak’s New York based EcoHealth Alliance is a case in point.

But we’ve been there before. In the 1990s, James M. Wilson received a PhD and an MD degree from the University of Michigan, then completed an internal medicine residency at Massachusetts General Hospital and a postdoctoral fellowship at MIT. By 1997, he was one of the leading stars in the new gene-therapy movement, directing his own research institute at the University of Pennsylvania.

The institute focused on adjusting the genes of children born with a hereditary disease called ornithine transcarbamylase deficiency (OTD), which prevents the normal removal of ammonia in the body. Wilson’s experimental technique involved genetic engineering, splicing therapeutic genes into supposedly harmless viruses that, once injected into the body, could carry their payload to defective cells and repair the genetic errors.

Dr. Wilson was attempting to determine the maximum dose of genetically modified material that could be safely injected into affected youngsters. He had enlisted 18 participants, including a teenager named Jesse Gelsinger who had a version of the genetic disease in which some of his liver cells carried the genetic abnormality but other cells were entirely normal. Those who have the full-blown disorder die in early childhood. But with his mosaic, Jesse most of the time felt well, as long as he continued to take 32 pills a day.

Jesse and his parents heard about the experiments in nearby Philadelphia and were anxious to help those less fortunate who had the full-blown disease. When he arrived at the clinic on September 13, 1999, to begin the study, his blood ammonia levels were above normal, which in and of itself should have blocked his participation. Nonetheless, Wilson’s team infused Jessie’s bloodstream with 38 trillion colonies of a virus carrying genes engineered to reprogram his cells. Eight hours later, Jesse’s fever hit 104.5 degrees. Two days later he was brain-dead.

The patent for the technique of genetic modification being studied was owned by a company called Genovo, cofounded by the above mentioned James M. Wilson, the institute director. Wilson owned a 30 percent stake valued at over $30 million, and the University of Pennsylvania, which under the rules of the National Institutes of Health, was responsible for ethical oversight of the research protocol design and execution, was a hidden investor. The informed consent Jesse had signed made no mention of Wilson’s financial conflict of interest, or the university’s, or the fact that some of the prior 17 participants had suffered significant liver inflammation, or that three laboratory monkeys had died from massive inflammatory immune responses to injections of the very same agent.

But the perverse financial incentives and conflicts of interest that led to such risk-taking went further up the academic food chain. Dr. Bill Kelley, an accomplished and aggressive medical researcher from the University of Michigan, had assumed the top post at the University of Pennsylvania in the early 1990s. Kelley’s goal was to achieve dominance in a crowded and competitive local medical market that included six medical schools. The age of genomics was just gaining steam, and Kelley wanted Penn to lead the way and share the rewards. His rapid expansion and heavy investment in technology and personnel had resulted in a reported $198 million loss by the University of Pennsylvania’s health system in fiscal year 1999. No doubt Kelley harbored hopes that Penn’s investment in Dr. Wilson’s gene company, bolstered by NIH grants and private investors, might help balance the books. Jesse Gelsinger’s death ended not only that research but Bill Kelley’s tenure as well.

The point being that regulatory boundaries, full transparency, and self-imposed brakes on profit-infused exuberance protect researchers, the public, and society overall. As Big Tech’s romance with Big Health flowers and blooms, our leaders need to step back and consider where we are going, and not just how fast we can get there.

Coming Next: Health Tech – Part II: Are We Under-Powering The Vision?

American Science’s “Odd Couple” – Dr.’s Koop and Fauci.

Posted on | June 8, 2021 | 2 Comments

The following 5-part series is excerpted from an as yet unpublished history of 20th Century medicine in the United States by Mike Magee MD.

PART I: The Conversion of C. Everett Koop

On the day after Ronald Reagan’s election, Christian conservative Jerry Falwell was euphoric. As he said, “I knew that we would have some impact on the national elections, but I had no idea that it would be this great.”(1)

One other big personality who saw, in Reagan’s win, a win of his own was C. Everett Koop. Carl Anderson, a Catholic aide to North Carolina Senator Jesse Helms, had informally approached him that fall to explore in earnest his willingness to accept the nomination as Surgeon General of the United States.

For Chick, the timing was perfect. At 64 1/2, he saw his days in the operating theatre at Children’s Hospital in Philadelphia as numbered. He was filled with a sense of mission that energized him, and his wife, Betty, was encouraging him to pursue the new role. In his customary fashion, Chick did his homework, gauging his supporters and his opponents. (2) Among the former, in addition to Jesse Helms and Strom Thurmond, there was the conservative Catholic Henry Hyde of Illinois. Regrettably on the negative side of the ledger sat the American Medical Association, which saw him as unpredictable and were already on record as supporting University of Texas vice chancellor of Health Affairs, Edward Brandt Jr.

The opposition of the AMA should have been an early warning signal. But Chick, hard-nosed, direct, and science driven, was also something of a dreamer, a Don Quixote optimist, prone to a romantic vision of the world and his role in it. His governor in Pennsylvania, Richard Schweiker, the lead candidate to head up Reagan’s Department of Health and Human Services, split the difference. Edward Brandt would be made the Assistant Secretary of the department, and Koop would be nominated for Surgeon General.(3)

If Chick thought that this compromise had resolved the issue, he was soon surprised as an avalanche of opposition to his nomination rapidly congealed.(4) Anticipating speedy approval, he had taken leave of his position in Philadelphia, resigned from the Boards of several Christian Conservative organizations, and taken up residency in Washington. He knew that the AMA had approached the White House through the back door and was encouraging them to drop him, but he felt that issue had already been decided. He knew as well that his past publications and activism as writing and traveling tour partner to uber conservative minister Francis Schaefer ensured the opposition of Planned Parenthood, the National Organization of Women, and the National Gay Alliance. But when the American Public Health Association (APHA) came out in full-throated opposition – that was a surprise. In the past 100 years, they had never before formally opposed a nominee for this post.(2)

For the dignified surgeon and conservative Presbyterian, who was used to professional adulation, and believed that he had led a conscience driven, moral and upstanding life, in the service of his fellow Americans, the APHA move was a slap in the face. But that was nothing compared to what he read on the editorial page of the New York Times when he opened his paper on April 9, 1981. There, in black and white, was the lead editorial with a blaring title – “Dr. Unqualified”.(5) In the editorial, they acknowledged in the first line that he had a “fine reputation as a pediatric surgeon” but found him “not deserving” of the role of Surgeon General. The charge that he had no “significant experience in the field of public health” wasn’t a big surprise, especially since the APHA had torched him. But the attack that followed, cued up by the supposition that his “attractiveness to the Administration must lie elsewhere” had to bring a grimace to his stately face.

Answering their own query, the editors said, “That ‘elsewhere’ may be his anti-abortion crusade. Two years earlier, he and Francis Schaefer had toured 20 cities with a film whose message was that abortion led inexorably to euthanasia for the elderly. And he has described amniocentesis, a procedure used to detect congenital disorders like Down’s syndrome and Tay-Sachs disease in fetuses, as ‘a search-and destroy mission.’”

Pending approval, Schweiker put Koop on the payroll as his assistant. The months dragged on, and Koop, encouraged to stay under the radar screen, focused on establishing as many relationships as possible. The people he met were surprised, as they had always been throughout his life. The severe physical package did not reflect the accessible and generous individual within. Chick would later reflect, “Out of those tough months, I made a number of very important friends in HHS who believed in me, believed I was being given a raw deal, who did think I was credible, who did think I had an idea and the ability to do something with it.”(6)

In October, 1981, while testifying before Congress, he surprised his audience when he stated clearly, “It is not my intent to use any government post as a pulpit for theology”.(6) Apparently, his Christian conservative backers thought this was simply a matter of political slight of hand. But for the Democratic leaders, like Henry Waxman and Ted Kennedy, this was a turning point. In November, the Senate confirmed him with a vote of 68 to 24, and on January 21, 1982, more than a year after the battle had engaged, C. Everett Koop was sworn in as the 13th Surgeon General of the United States.(7)

Next: PART II – A Communications Genius Rides Tobacco To Success.

References: On request.

________________________________________________________________________________

The U.S. Medical Industrial Complex Had a Role In The Wuhan Covid Catastrophe.

Posted on | June 3, 2021 | 2 Comments

Mike Magee

The truth hurts.

Eighteen months into a disaster that has claimed 3.5 million lives around the globe, the truth is seeping out. Human error likely caused the Covid pandemic, and America’s Medical-Industrial Complex was right in the middle of it.

Signs of a “great awakening” have emerged from various corners in the month of May.

On May 14, UNC’s top virologist, Ralph Baric, who worked closely with Wuhan chief virologist and batwoman extraordinare, Shi Zhengli, signed on with 17 other scientists to a Science editorial that demanded a reexamination of Covid’s causality writing “theories of accidental release from a lab and zoonotic spillover both remain viable.”

On May 26, Francis Collins, head of the NIH, which funded in part Zhengli’s risky bat virus research (more on that in a moment), admitted to Congressional investigators that “we cannot exclude the possibility of some kind of a lab accident.”

And on June 3rd, on MSNBC’s Morning Joe, the ever-present Tony Fauci advised all who would listen “to keep an open mind.” What he would like us to open our minds to is not a Chinese run weaponized microbe conspiracy, but simply scientific recklessness and human error.

It’s now well established that three Wuhan virology scientists were hospitalized in the Fall of 2019 with Covid. But the initial report from the Wuhan Municipal Health Commission, China, of this cluster of cases of pneumonia was only released on the last day of 2019.

It took only 50 more days for the tight knit group of global research virologists to get their act together and pen a Lancet editorial in which they stated “We stand together to strongly condemn conspiracy theories suggesting that COVID-19 does not have a natural origin,” and that they  “overwhelmingly conclude that this coronavirus originated in wildlife.”

Their coordinator-in-chief was one Peter Daszak, chartered power broker within the U.S. Medical Industrial Complex and president of New York based EcoHealth Alliance which was a major funder of Shi Zhengli’s work in Wuhan.

Daszak is known for adopting militarized terms in the battle against global infectious diseases. In 2020 he wrote in the New York Times, “Pandemics are like terrorist attacks: We know roughly where they originate and what’s responsible for them, but we don’t know exactly when the next one will happen. They need to be handled the same way — by identifying all possible sources and dismantling those before the next pandemic strikes.”

Daszak’s argument that risks involved in Shi Zhengli’s Wuhan bat virus research were justified as defensive and preventive was convincing enough to the NIH and the Department of Defense that his EcoHealth Alliance was funded from 2013 to 2020 (contracts, grants, subgrants) to the tune of well over $100 million – $39 million from Pentagon /DOD funds, $65 million from USAID/State Dept., and  $20 million from HHS/NIH/CDC.

As veteran Science reporter Nicholas Wade deciphered in a classic article in Science – The Wire, “For 20 years, mostly beneath the public’s attention, they had been playing a dangerous game. In their laboratories they routinely created viruses more dangerous than those that exist in nature. They argued they could do so safely, and that by getting ahead of nature they could predict and prevent natural ‘spillovers,’ the cross-over of viruses from an animal host to people. If SARS2 had indeed escaped from such a laboratory experiment, a savage blowback could be expected, and the storm of public indignation would affect virologists everywhere, not just in China.”

The EcoHealth Alliance’s connection to Wuhan, and Daszak’s connection to Shi Zhengli was somewhat insulated by a UNC virologist named Ralph Baric. Zhengli and Baric had teamed up in November, 2015 to manipulated the crucial spike protein of the SARS1 virus creating “chimera” – possessing genetic material from two different viral strains. At the time, other scientists were sounding alarms including Pasteur Institute’s Simon Wain-Hobson who wrote “If the virus escaped, nobody could predict the trajectory.”

The risky experiments, termed “gain-of-function” studies, were justified as super-secure, safe, predictive, and preventive. Shi returned to her labs in 2018 and 2019 with grant funding from Fauci’s National Institute of Allergy and Infectious Disease.

Nicholas Wade read the grant proposal and somewhat alarmingly concluded that Shi was creating chimeric viruses with a range of human infectivity as measured in genetically altered “humanized” mice. In essence, she was assisting the virus in discovering “the best combination of coronavirus backbone and spike protein for infecting human cells.”

When you see pictures of scientists in space suits clumsily attempting to complete experiments, that is maximum safety – BSL4. As it turns out, Shi’s experiments on “gain-of-function” were conducted in part two rungs down the safety ladder at BSL2– , the safety level equivalent to a dentist’s office.

On January 15th of this year, the State Department fessed up releasing this statement, “The U.S. government has reason to believe that several researchers inside the WIV became sick in autumn 2019, before the first identified case of the outbreak, with symptoms consistent with both COVID-19 and common seasonal illnesses.”

It is not as if the Medical Industrial Complex was not warned. Seven years earlier, a group of concerned scientists called the Cambridge Working Group issued this statement: “Accident risks with newly created ‘potential pandemic pathogens’ raise grave new concerns. Laboratory creation of highly transmissible, novel strains of dangerous viruses, especially but not limited to influenza, poses substantially increased risks. An accidental infection in such a setting could trigger outbreaks that would be difficult or impossible to control.”

As Nicholas Wade’s investigation lays out in detail, while absolute proof remains to be uncovered, the overwhelming and rising mountain of evidence points to human error supported on a national scale. As Wade sees it, “The US government shares a strange common interest with the Chinese authorities: neither is keen on drawing attention to the fact that Dr. Shi’s coronavirus work was funded by the US National Institutes of Health.”

As Fauci stated this week, “We need to keep an open mind.” This apparently extends in both directions. His National Institute of Allergy and Infectious Disease, as recently as August, 2020, awarded $82 million to establish the Centers for Research in Emerging Infectious Diseases to ten principal investigators. Peter Daszak is #3 on the list.

Is Paranoia in American Politics Diagnosable?

Posted on | May 26, 2021 | Comments Off on Is Paranoia in American Politics Diagnosable?

Mike Magee

“The Presidency should not be used as a platform for proving one’s manhood ..”

“Inwardly he is a frightened person who sees himself as weak and threatened by strong virile power around him . . .”

 “Since his nomination I find myself increasingly thinking of the early 1930s…”

 “Unconsciously he seems to want to destroy himself.  He has a good start, for he has already destroyed the Republican party . . .”

At first glance, the remarks above appear to have been made about Donald Trump. In fact, they are part of written survey responses to a September, 1964, Fact Magazine survey sent to 12,300 psychiatrists asking, “Do you believe that Barry Goldwater is psychologically fit to serve as President of the United States?” Of the 2400 responses, half replied “No.”

That was a bridge too far for the American Psychiatric Association, which in 1973 adopted Section 7.3 in their Ethics Rules which states, “[I]t is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement”

That rule held until Donald Trump descended his Trump Tower spiral staircase in 2016. As he approached a possible second term, the nation’s mental health professionals were in full revolt. For example, the June, 2018 article appearing in The Journal of the American Academy of Psychiatry and Law was titled “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President.”

In the age of Marjorie Greene, mass paranoia and open insurrection, we Americans may be excused if it appears that our national experiment in self-governance is coming apart at the seams. It is also natural to give way to the notion that what we are experiencing is uniquely different, and therefore poses a greater risk than we’ve encountered in the past.

Under such moments of self-inflicted crises of conscience, history often comes to the rescue. Let me introduce you to a young boy, born in Chowan County, North Carolina, in 1899. Raised by devout Baptists, and homeschooled by his mother until age 10, when he entered high school.

He was self-described in later years as “a gifted child”, a rabid and early anti-communist, and an “insufferable” advocate of Christian conversion. He was also a graduate of the U.S. Naval Academy and Harvard Law School.

You may not have ever heard of him, but certainly know him by his products if you were a child of the ‘50’s or 60’s. He created Sugar Daddies, Sugar Babies, Junior Mints and Pom Poms. He also created the John Birch Society.

When he took early retirement at the age of 50, Robert W. Welch, Jr. was already a wealthy man. He could well afford to focus on rescuing the souls of Americans for whom he apparently held deep contempt, describing them as ignorant and ill-informed, and therefore in danger of being converted by communists who he found hidden in every crack and around every corner.

His earliest foray into electoral politics, a run for Lieutenant Governor of Massachusetts in 1950, ended poorly. But it did allow him to get close to the 1952 Republican candidate for President, Robert A. Taft, the champion of “Fortress America” and smearer of internationalism in the form of NATO and the United Nations.

Taft of course lost. But in the wings, Welch embraced another like-minded cold warrior, Senator Joe McCarthy, who was running for re-election in Wisconsin, who happily agreed to accept donations from the retired candy striper. McCarthy of course went down in ashes.

But Welch more than picked up the mantle when McCarthy succumbed to alcohol and opioid addiction on May 2, 1957. One year later, he convened a group of like-minded conspiracists for a two-day session in Indianapolis, Indiana. On the agenda was a discussion of the life of one relatively unknown World War II soldier who had been the subject of Welch’s first book in 1954, a biography of the “first casualty of World War III.” The book’s title was The Life of John Birch.

Welch shared a common passage with Birch. Beyond their military experience, both grew up in the deep “Jim Crow” south (Welch in North Carolina, Birch in Georgia), both intellectually gifted, both products of missionary oriented Baptist parents, and early radicalized with equal measures of paranoia and hyperbole. A classmate at Mercer University, an affiliate of Georgia Baptist, later recalled that “He was always an angry young man, always a zealot, felt he was called to defend the faith, and he alone knew what it was.”

What made Birch Welch’s hero however was that he died at the hands of Chinese Communists in Xuzhou, Jiangsu, China, as a member of the Army’s fledgling intelligence service on August 25, 1945, seven days before Japan officially surrendered. Jimmy Doolittle, US ARMY WWII pilot extraordinaire, said of this man others made a hero posthumously, “I feel sure he would not have approved.” While Birch may have preferred to remain anonymous, Welch chose to elevate him. By 1960, Birch was the face of a hard-right, anti-communist organization with a staff of 28, and approaching 100,000 members.

Members kept busy writing letters of protest. For example, when supporters of the U.N. created a four part documentary television series celebrating the United Nations, Xerox, their primary sponsor, received 51,279 letters of protest from John Birch Society members. The Society’s president at the time said “We hate to see a corporation of this country promote the U.N. when we know that it is an instrument of the Soviet Communist conspiracy.” They also actively opposed the civil rights movement, and lined up to help secure the candidacy of Barry Goldwater for President in 1964.

Columbia University’s Pulitzer Prize Winning Professor of History,Richard Hofstadter, labeled the unique political approach of Welch, and Goldwater, and all the rest leading up to Trump as “The Paranoid Style in American Politics.” As he wrote in 1964, “I call it the paranoid style simply because no other word adequately evokes the sense of heated exaggeration, suspiciousness, and conspiratorial fantasy that I have in mind.”

In fleshing out his theory, Hofstadter recounts a 1951 speech by McCarthy in which he states, “This must be the product of a great conspiracy on a scale so immense as to dwarf any previous such venture in the history of man. A conspiracy of infamy so black that, which it is finally exposed, its principals shall be forever deserving of the maledictions of all honest men.”

Later in the article, Hofstadler comes eerily close to defining our current predicament with this: “Perhaps the central situation conducive to the diffusion of the paranoid tendency is a confrontation of opposed interests which are (or are felt to be) totally irreconcilable, and thus by nature not susceptible to the normal political processes of bargain and compromise. The situation becomes worse when the representatives of a particular social interest—perhaps because of the very unrealistic and unrealizable nature of its demands—are shut out of the political process. Having no access to political bargaining or the making of decisions, they find their original conception that the world of power is sinister and malicious fully confirmed.”

Finally, there are these words, which certainly must resonate with the many psychiatrists who felt compelled to break their own “Goldwater Rule” as a patriotic gesture in defense of their nation against Trump and his enablers. Hofstadler writes, “We are all sufferers from history, but the paranoid is a double sufferer, since he is afflicted not only by the real world, with the rest of us, but by his fantasies as well.”

Is Universal Health Care An Economic Tool Whose Time Has Come?

Posted on | May 19, 2021 | 6 Comments

Mike Magee

John Maynard Keynes, the famous British economist, was born and raised in Cambridge, England, and taught at King’s College. He died in 1946. He is widely recognized today as the father of Keynesian economics that promoted a predominantly private sector driven, market economy, with an activist government sector hanging in the wings ready to assume center stage during emergencies.

Declines in demand pointed to recession. Irrationally exuberant spending signaled inflationary increases in pricing, eroding the value of your money. Under these conditions, Keynes encouraged the government and central bank to adjust fiscal and monetary policy to dampen the highs and lows of the business cycles.

Keynesian economics were popularized in America in the 1930’s by a University of Minnesota economist who would go on to become Chairman of Economics at Harvard. For this, he is often referred to as “The American Keynes”, and was highlighted this week in the New York Times by Nobel economist, Paul Krugman, for his association with another tagline, “Secular Stagnation.”

When that economist, Alvin Hansen, first described the condition, he was working on FDR’s Social Security Plan. He defined it as “persistent spending weakness even in the face of very low inflation.” Krugman’s modern-day description? “What we’re looking at here is a world awash in savings with nowhere to go.”

Krugman is not the only economist sounding the alarm. Larry Summers, Harvard economist and Treasury Secretary under Bill Clinton, recently wrote, “The relevance of economic theories depends on context.” On the top of his list of current environmental concerns restricting investment and growth is the strong belief that the number of available workers is in steep decline.

Just days ago the CDC added fuel to the fire when they reported a 2020 birth rate in the U.S. of 55.8 births per 1,000 women ages 15 to 44. That was 4% lower than in 2019, and the lowest recorded rate since we started collecting these numbers in 1909. Our lower birthrate is further aggravated by declines in numbers of immigrants and a flattening of the movement of women into the workforce. Add to this the general aging of our population. To put it in perspective, Americans over 80 now outnumber Americans 2 and under.

But Summers’ concerns extend well beyond worker and product line shortages. More significant in his view are two other factors. The first is low demand fueled by population stasis. As he states, “These demographic developments eliminate the demand for new capital goods to equip and house a growing workforce.” Or stated in a different way, growing families buy things – lots of things. Shrinking families do not.

The second trend that concerns him is information technology enabled efficiencies that further dampen demand. Why? Because products today work much better and for much longer. Just one example – today’s $500 iPhone has the power of a Cray supercomputer from a generation ago. And, with no end in sight, Summers says consumers will likely continue to withhold spending in anticipation of lower prices in the future.

To make matters worse, IT connectivity has also increased renting and sharing opportunities. You don’t need to own everything (or anything) yourself. There appear to be few limits on what you can share.

What Krugman and Summers agree on is that there is plenty of money in the system, and more to come, through government infusions. But growth requires participation, not sitting on the sideline. Hansen’s “secular stagnation” suggests a reluctance to invest in the immediate future. If unchecked, it can lead to a prolonged, Japan-like, period of deflation and hardship.

Krugman’s prescription is to spend, and spend big, in government-sponsored projects that draw out citizen participation, and encourage mobility, productivity, and confidence in the future. He says we need to ignore “deficit hawks”, noting that the current deficit (twice as large as in 1990) is carrying an interest payment burden only half as large as three decades ago because of persistent low interest rates.

Krugmen believes “cheap money” should be advantaged, but in a purposeful and targeted manner. What are his two top priorities?

1)   Infrastructure projects – to create immediate jobs in and for the communities they serve.

2)  Universal Health Care – to promote mobility, productivity and confidence in our combined and interdependent futures.

Alvin Hansen died at the age of 87 in 1975. Hansen’s first book, Full Recovery or Stagnation, published in 1938, was prescient in suggesting that, if employment and growth are stagnant, in an economic cycle, government intervention may be required to stimulate demand.

A few years before his death, Paul McCracken, chairman of the President’s Council of Economic Advisers under LBJ, said of Hansen: “It is certainly a statement of fact that you have influenced the nation’s thinking about economic policy more profoundly than any other economist in this century.”

Now, a half-century later, it appears that Full Recovery or Stagnation deserves a careful reread.

The Night Biden and Bernie Channeled FDR and MLK.

Posted on | May 10, 2021 | Comments Off on The Night Biden and Bernie Channeled FDR and MLK.

Mike Magee

In my research up to last week’s speech on “The Right to Health Care and the U.S. Constitution” (transcript here), I came across this Emily Dickinson poem that could easily have been a forward looking tribute to two American Presidents – one from the 20^th, the other the 21^st century.

Dickinson’s poem “A WORD is dead” is hardly longer than its title.

“A WORD is dead

When it is said,

Some say.

I say it just

Begins to live

That day.”

She certainly was on the mark when it came to President Franklin Delano Roosevelt’s signature legislation. FDR’s New Deal, extending from 1933 to 1939, ultimately came down to just three words – the 3R’s – Relief , Recovery, and Reform.

He promised “Action, and action now!”  This included a series of programs, infrastructure projects, financial reforms, a national health care program and industry regulations, protecting those he saw as particularly vulnerable including farmers, unemployed, children and the elderly.  And he wasn’t afraid to make enemies. Of Big Business, he said in a 1936 speech in Madison Square Garden, “They are unanimous in their hate for me – and I welcome their hatred.”

But he was also a political realist. And by his second term of office Justice Hughes and his Conservative dominated Supreme Court had begun to undermine his legislative successes and were threatening his signature bill- the Social Security Act. So FDR compromised, and in the face of withering criticism from the AMA, postponed his plans for national health care.

By June 11, 1944, a supremely popular 4^th term President had found his voice again, and knew the words to use as he promised a “Second Bill of Rights” stating that the original was now “inadequate to assure us equality in the pursuit of happiness.”

Turning a phrase that is as lasting as it is powerful, he said, “Necessitous men are not free men.” And in his list of economic rights that he pledged to pursue, these two appeared:

•     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;

Now, three quarters of a century later, a new President, pragmatic and opportunistic, is signaling once again that the time is right for change.

Following his recent address to Congress on April 29, 2021, President Joe Biden spent a good deal of time on the aisle in private conversation with Sen. Bernie Sanders. They’ve been talking a lot lately. In his speech he waded into health care with both feet, and found a way to link the ACA and Medicare.

President Biden said, “The Affordable Care Act has been a lifeline for millions of Americans …And the money we save, which is billions of dollars, can go to strengthening the Affordable Care Act and expand Medicare benefits without costing taxpayers an additional penny. It is within our power to do it. Let’s do it now…We’ve talked about it long enough, Democrats and Republicans. Let’s get it done this year. This is all about a simple premise: Health care should be a right, not a privilege in America.”

Those last words, as Emily Dickinson would remind, “began to live” in 2009, when first delivered by the man on the aisle, Bernie Sanders.

Earlier in his speech, Biden reflects on an image he recently observed in Florida. “One of the defining images, at least from my perspective, in this crisis has been cars lined up, cars lined up for miles (in food lines)…I don’t know about you, but I didn’t ever think I would see that in America. And all of this is through no fault of their own. No fault of their own, these people are in this position. That’s why the rescue plan is delivering food and nutrition assistance to millions of Americans facing hunger.”

Those words also  “began to live” many years earlier. On June 11, 1944, FDR said, “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.”

Roughly two decades later in 1966, Rev. Martin Luther King, Jr. mirrored the same words and linked poverty and health care, at the Poor People’s Campaign when he said, “of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Those words continued to live a half century later, appearing in a 2017 New Yorker piece penned by celebrity physician author, Atul Gawande. The words were uttered by two former neighbors of his still living in Athens, Ohio, the hardscrabble town where he grew up in the Appalachian foothills.

The first said, “basic rights include physical security, water, shelter, and health care. Meeting these basics is, he maintained, among government’s highest purposes and priorities.”

A second voice added, “I think the goal should be security – knowing that, no matter how bad things get, health shouldn’t be what you worry about.”

« go back — keep looking »

"Available Everywhere Now"
"Code Blue INDEX online"

 

  Ralph Snyderman
Prospective Health Blog
BIOGRAPHY   Meredith Magee Donnelly
Homegrown Friends
BIOGRAPHY   Eric Dishman
NIH Precision Medicine
BIOGRAPHY   Barbara Ficarra
Health in 30
BIOGRAPHY   William L. (Larry) Minnix, Jr.
Larry's Letters
BIOGRAPHY     Eric Dishman
Precision Medicine, Euthanasia, Abortion, Communism, Trillions of Dollars, Losing Freedom, and Town Hall Mobs BIOGRAPHY   Michael Millenson
Yearning for Universal Coverage Is Not Universal
BIOGRAPHY

 

 

 

 

Search

Search