Smart Politicians Are Discovering Family Caregivers.

Posted on | January 6, 2020 | 1 Comment

Mike Magee

The 2020 elections are right around the corner – and the fight for advocates and constituents among the candidates is already engaged. Seniors have always been a target. But what about their caregivers?

A new survey sheds light on the politics of this constituency. Conducted Oct. 21 to Oct. 26, 2019, by Hart Research Associates it included 1,510 adults nationwide with these findings:

• 37% Republican; 43% Democrat; 20% Independent.
• 66% provide, or previously provided, care for an older relative, stay-at-home care for a preschool child, daily care for a disabled family member.
• The caregivers estimated they spend 36 hours a week providing care. 55% are employed full-time; 69% are employed part-time.
• 56% say there are not enough caregiving professionals to take care of those in need.
• 85% of respondents are much more likely to support a candidate who support caregivers.
• 82% support a federal program that everyone pays into for caregiving services.
• And politicians – here’s the opportunity take-away: Due to caregiving responsibilities, a significant number have not voted in an election (20%), and currently feel out of the political loop.

What do politicians need to know?

1. The old three-generation family – child, parent, grandparent – is rapidly giving way to a new model that can be four and even five generations deep.
2. Roughly 25 percent of American families now rely on informal family caregivers to bridge the needs of these multi-generational families.
3. These caregivers are mostly family members, predominately third-generation women between age 45 and 65, balancing the needs of parents and grandparents with children and grandchildren.
4. As our health care system moves toward prevention and increasing reliance on family-based informal caregivers to ensure multi-generational health, it’s important that our elected officials anticipate the needs of those involved and offer timely response and intervention.
   
   

Finally, efforts to reduce disease, disability and death in frail seniors can contribute to a self-reinforcing virtuous cycle, since a decrease in the burden of these events in one person can have cascading benefits for other stressed family members. As aging experts have suggested, “Health care might indeed be more socially efficient, and more cost-effective, than is suggested by looking at individual cases alone.” 

Letting Academic Physicians Off The Hook.

Posted on | January 3, 2020 | 1 Comment

Mike Magee

In 2004, when I read Dr. Marcia Angell’s book, “The Truth About the Drug Companies: How They Deceive Us And What To Do About It”, I agreed with everything she wrote. How couldn’t I? At the time, I had a front row seat inside the largest pharmaceutical company in the world and managed a substantial external-facing portfolio that included “Medical Relations.”

But what was equally obvious to me was a glaring omission. My “front row seat” not only revealed the underbelly of Pharma coercion, but also how willing were many of the top physician leaders in both academic and organized medicine to participate.

If this was a secret, it was hiding in plain sight. In 1966, Henry Beecher couldn’t have been clearer when he wrote in the New England Journal of Medicine, “Every young man knows that he will never be promoted to a tenure post, to a professorship in a major medical school, unless he has proved himself as an investigator. If the ready availability of money for conducting research is added to this fact, one can see how great the pressures are on ambitious young physicians.”

What I knew to be true then, and what is even truer now in our modern entrepreneurial gold rush built around genomics and stem cells and personalized therapies, is that the Medical-Industrial Complex’s strangle hold on our inefficient and often ineffective health delivery system is based on an integrated career ladder that moves from academia to industry to government and back again.

As Dr. Beecher correctly noted, publications and presentations are both the admission ticket to the ground floor of medical academic success, and the escalator to a higher perch in a gilded cage brimming with direct and indirect rewards.

To sustain such a system requires a wide range of collaborators and benefactors. To succeed, one must, at times, turn a blind eye. One does not “go along” unless one “gets along”. Publications are followed by several rounds of amplification, first at CME meetings and association panels, then through NIH grants and inclusion in government or industry advisory boards, and finally with an invitation for membership within national associations, foundations and governmental science boards.

That our medical science system is chronically rigged has led to a number of charges of late. Most have involved NIH funding where the claim is that grants are over-weighted toward well-known investigators and blue-chip institutions. For example 40% of the dollars are awarded to 10% of the grantee institutions.

But what about bias in the selection for publication or for a slot at the podium of a prestigious meeting? An October 10, 2017 article in the Proceedings of the National Academy of Sciences sheds some light on these questions. The authors are luminaries in the computer science field and were asked to jury submissions for the 10th International Machinery Conference on Web Search and Data Mining (WSDM 2017). In the academic computer science world, “research typically appears first and often exclusively in conferences rather than in journals.” And WSDM 2017 is one of the largest meetings.

Historically, only 15% of submissions to the WSDM are chosen. The process involves a large group of expert reviewers who each read and grade four submissions using a system that allows them to enter “bids” which are necessary to be in the running at all for a spot. Reviewers then grade the submitted bids. Those entered and possessing the highest marks prevail.

The WSDM has always used a single-blind reviewing process. This means that the reviewers know the names and affiliations of those submitting a proposal, but the potential presenter never knows the name or affiliation of his or her reviewer. JAMA employs a single-blind review process in peer-reviewing their journal submissions. At the time the authors were beginning their WSDM 2017 deliberations, the question was raised whether the organization should move to a double-blind review. In this method authors and reviewers and their affiliates are anonymous to each other. That is reviewers must judge purely on the merits of the submission without considering the source.

The authors, Andrew Tomkins and Min Zhang, elected to design a study using the 2017 process to inform recommendations for the 2018 conference. They created two parallel reviewing processes and split reviewers. 974 were double-blind and 983 were single blind. In analyzing the results, they detected statistically significant bias as follows:

1. Single-blind reviewers who knew authors and their institutions voluntarily restricted bids. That is, they held back bidding keeping larger numbers from competing for spots on the program. In all they had 22% fewer entry bids than did their blinded counter-part reviewers.
2. Single-blind reviewers in assessing those fewer bids they had placed in the running, were significantly more likely to recommend famous authors and those from famous institutions for acceptance.

As a result, the authors recommended that WSDM 2018 move to a fully blinded review process.

Posted on | December 31, 2019 | Comments Off on

Mike Magee

December 14, 2012 seems a long time ago – 7 years and 17 days. That is when 20 young souls, age 6 and 7, were shot down in Newton, CT, a few miles from our home. Two days after the tragedy, I wrote:

“Did we as a nation do all that was possible to avoid the disaster in Newtown, CT? Clearly no. Do the issues of what we didn’t do – manage our guns, manage our mentally ill, manage our violent culture – require elaborate study? Not really. What we require is thoughtful and deliberate action. Policy defines action. Actions seek to alter or curtail human behavior – move us forward toward our finer selves in the interest of the collective good.”

Has our nation been able to overcome the destructive impulses of the NRA and pass meaningful laws to help ensure that these youngsters have not died in vain? No.

And yet, in the actions of our citizens, there is cause for hope. Since the tragedy, a group of Moms, Mayors, and Gun Survivors have coalesced. Moms Demand Action has established a chapter in every state of the country and Washington, D.C. and, along with Mayors Against Illegal Guns, Students Demand Action and the Everytown Survivor Network, it is part of Everytown for Gun Safety, the largest gun violence prevention organization in the country with nearly 6 million supporters and more than 350,000 donors. You can join the campaign here.

An investigative report in The Guardian last month revealed that “A gun is fired on a school campus in America nearly twice a week. Suicide, homicides, a police shooting, attacks on students by other students: more than once a month this past year, gunfire on American school and university campuses has turned deadly, according to a database of school gunfire incidents compiled by advocates…Since the Columbine shooting in 1999, at least 233,000 kids across 243 schools have been exposed to gun violence during school hours, a Washington Post investigation found…Experts are quick to put that number in context. Researchers found that nearly 1,300 American children aged 17 and younger die from gunshot wounds each year, and they are more likely to be killed in homes or neighborhoods than at school.”

Since Newtown, “Everytown For Gun Safety” has been tracking the shootings of youngsters in schools across America, and analyzing and mapping the events. The entire report is HERE .

I don’t believe that our legislators will have the courage to face off the NRA, and do what is right, without a countervailing political force. But with the revelation that the Russians were washing money through their organization to support conservative candidates in the U.S.; the conviction of Maria Butina (a Russian spy embedded in the NRA), and massive executive corruption with diversion of donor funds within the NRA, the organization is finally fraying at its edges.

So this first day of 2020, I encourage you to donate to Everytown, and make your town part of the movement. Begin the year right – be useful, honorable, compassionate. Live well so that you might share the wellness with others.

For Health Commentary, I’m Mike Magee

A Cure For Our Cultural Ills? We Start Anew. Health Care For All.

Posted on | December 5, 2019 | 2 Comments

Mike Magee

At a Code Blue presentation last week, questions centered on next steps in health reform – all the way vs. incremental, and not whether, but when and how fast. Health care reform in America has become a cultural issue.

Health care as fundamental to building a nation and its culture from scrap was what drove the military’s decision under the Marshall Plan. In the re-build of Germany and Japan, we elected to start with a health plan – in part because we recognized that all other social determinants – housing, nutrition, education, clean air and water, safety and security – would be enhanced in the process leading to a tradition that could support stable democracies.

This is essentially the same challenge we as a country (having wandered so far off course as to elect Trump) are faced with today. Changing culture, as health professionals know, is a tall order. It is about compassion, understanding and partnerships. It is about healing, providing health, and keeping individuals, families and communities whole. And – most importantly – it is about managing population-wide fear, worry and anxiety.

What we are asking of the people, and the people caring for the people, is to change their historic culture (one built on self-interest, hyper-competitiveness, and distrust of good government). This is a tall order – something that parents, pastors, politicians and physicians equally recognize. Things evolve, and difficult things take time. But what happens if you run out of time, if the threats of delay or incrementalism create risks that outweigh or negate rewards. What then?

What then usually involves some middle path, one that emphasizes self-determination but not self-destruction. In the case of health reform, this is the argument for provision of a public plan (similar to Medicare) as a voluntary option that is available to all comers. In the response will be revealed next steps in health reform.

If we choose to go this route however, the mischief makers who spent a decade undermining the Affordable Care Act must be effectively sidelined from the start. The essentials? The public plan must be open to all. Insurance must be a requirement and mandated as such with penalties. Medicaid expansion (in combination with the new public offering) must be required in all states without exception. And a complete benefit package as delineated in the ACA must be required (no skimpy substitutes). In other words, the public offering must be muscular, nationwide, and accessible to all comers.

At the same time, we must disabuse ourselves of any notion that a cultural shift with health care as the leading edge will be simple or easy. We need only recall those post-WWII years to remember that, as we were building out national health systems for our vanquished enemies, the AMA, PMA and allies simultaneously branded Truman a “socialist” and dispatched his plan for national health care as “socialized medicine.” Power, profit, and persistence prevailed. It took nearly two more decades to move the dial on Medicare and Medicaid.

What we witnessed this past week during the Impeachment hearings was a grim reminder of how far protectors of the status quo are willing to go. An epic struggle by those in power once again unleashed fear and worry to fuel hatred and resentment. It is not a pretty picture.

But putting that aside, it is useful to acknowledge what our former military leaders stated as Germany and Japan sought to rise from the ashes. “We start with health care because it is an anecdote to fear, worry, and hatred.” Using the same logic, our distressed American culture will benefit greatly from universal health care. We start anew. And given a bit of patience, and some wiggle room to choose a better future, we might be surprised to learn that we are a bit more “exceptional” than we might at first appear.

Kamala Gone, But “Medicare-for-All” Not Forgotten.

Posted on | December 5, 2019 | 3 Comments

MIKE MAGEE MD

As the number of Democratic contenders for the Presidency begins to dwindle, the “Medicare-for-all” debate continues to simmer. It was only ten months ago that former candidate Kamala Harris’s vocal support drew fire from not one, but two billionaire political rivals. Michael Bloomberg, looking for support in New Hampshire declared, “I think we could never afford that. We are talking about trillions of dollars… [that] would bankrupt us for a long time.” Fellow billionaire candidate Howard Schultz added, “That’s not correct. That’s not American.”

Remarkably, neither man made the connection between large-scale health reform’s potential savings (pegged to save 15% of our $4 trillion annual spend according to health economists) and the thoughtful application of these newly captured resources to all U.S. citizens without discrimination. Bloomberg’s own 2017 Health System Efficiency Ratings listed the U.S. 50th out of 55, trailed only by Jordan, Columbia, Azerbaijan, Brazil, Russia. Yet he seemed unable to connect addressing waste with future affordability.

Schultz was similarly short sighted. While acknowledging that the manmade opioid epidemic, mental health crises, and income inequality are “systemic problems” and at levels “the likes of which we have not had in a long time”, he failed to connect the cause (a remarkable dysfunctional and inequitable health care system) with these effects.

As I outline in “Code Blue: Inside the Medical Industrial Complex” (Grove Atlantic/2019), today’s greatest risk to continued progress and movement toward universal coverage and rational health planning is sloppy nomenclature.  To avoid talking past each other, we need to define the terms of this debate while agreeing on common end points.

“Universal health care” is an end point goal that reinforces the principle that health is a human right rather than a privilege for the most entitled. It is an expression of national solidarity and reflects a shift in our culture.

“Single payer” is one strategy or tactic often associated with the Canadian health care system. However, the Canadian system is not technically a “single payer” system, in that provision of insurance (set to national standards) and the delivery of the care are the responsibilities of individual provinces, not the national government. A more accurate label for their system would be “Single Oversight/Multi Plan”.

Canada has choice and also maintains an active private health insurance market that provides supplemental health care plans purchased by 70% of citizens to cover roughly 30% of health costs including optical, dental and drugs which are not covered by government plans. Private insurers in the U.S. in the future might play a similar role.

The Canadian government’s role is focused on formalized government health planning as well as insurance standards and oversight. It also outlaws DTC drug advertising and sets prices annually for all essential drugs. The national government is the guardian of universality and (often overlooked) simplicity. Providers provide. Provincial government pays. Patients concentrate on health and wellness, and are not plagued by insurance gamesmanship and endless bill bickering on the local level.

The U.S. has no such government-directed, national health planning apparatus. Service levels and reimbursement vary widely across an endless array of private and public offerings that have devolved into a “free-for-all.” Our profit-driven, scientific research community regularly diverts resources from health planning and patient care, and our insurance system harbors an enormous number of health system middlemen to support “non-real” work (16 positions for every one physician – half with no clinical role).

What we do have are $4 trillion already committed (albeit badly misallocated), a remarkable array of educational institutions, a dedicated network of public health schools and practitioners, under-utilized nurses and pharmacists, and a testing ground of 50 different states.

The true impact of spiraling health care costs and their secondary effects—including stagnant wages, income inequality, a lack of job mobility, high rates of medical bankruptcy, the closure of rural hospitals, an inability to invest in infrastructure repairs, and our growing national debt – is staggering. We are the only developed nation in the world that spends more on health care than all other social services combined.

Warren Buffett, a man who knows something about sustainable growth, said recently: “The health care problem is the number-one problem of America and of American business. . . . Medical costs are the tapeworm of American economic competitiveness.”

For far too long, our leaders have focused on how to make American corporations wealthy. But let us be clear – there is another way. We could have the courage and the will to reapply our more than ample health care assets and reject the status quo. We could vote in change on a large scale.  We could elect leaders willing to honestly address a simple, long overdue question that is at the very center of Code Blue: “How do we make Americans healthy?”

Good News on Childhood Obesity – and “Good Government.”

Posted on | December 3, 2019 | Comments Off on Good News on Childhood Obesity – and “Good Government.”

Mike Magee

As the debate over health reform wages on, it is increasingly apparent that the real underlying issue we are grappling with is the role of “good government.” Without it, as one philosopher suggested nearly four centuries ago, life is “solitary, poor, nasty, brutish, and short.”

Canada had relatively smooth sailing from the time the province of Saskatchewan first raised the question, “How can we make Canada and Canadians healthy?” in 1947, to when the country fully embraced national health care in 1966. Why? In part because of their century old national motto (and practice), adopted in the Constitution Act of 1867 which reads “Peace, Order, and Good Government.”

Yet it’s never too late to learn from our neighbors to the north, as appears to be evident in a November 22, 2019 release by the CDC, that good government does in fact make a difference, especially when it comes to health care.

At issue, obesity rates in children. What we know? “Among children aged 2-4 years enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), obesity prevalence decreased from 15.9% in 2010 to 13.9% in 2016.”

What is also known is that childhood obesity is associated with type 2 diabetes, asthma, liver disease, bullying, and poor mental health. Emphasis on nutrition, breastfeeding, and physical activity (all part of WIC) decrease the likelihood of obesity.

During the most recent 6 years studied (2010-2016), significant decreases in childhood obesity prevalence occurred in 41 of 56 WIC states or territories. The largest improvements (>3%) were in Guam, New Jersey, New Mexico, Northern Mariana Islands, Puerto Rico, Utah, and Virginia. Only three states showed significant increases. They were Alabama (0.5 percentage points), North Carolina (0.6 percentage points ), and West Virginia (2.2 percentage points).

Progress according to the CDC reflects a “good government” practice of continuous improvement in the WIC dietary offerings. According to the agency, “The revised food packages include a broader range of healthy food options; promote fruit, vegetable, and whole wheat product purchases; support breastfeeding; and give WIC state and territory agencies more flexibility to accommodate cultural food preferences.” 

Political attitudes toward government do affect the lives and health of citizens. This is glaringly obvious in these United States, where state leadership often defines federal health program availability and access. Consider the stubborn intransigence of 14 Republican governors to the adoption of ACA funded expansions of Medicaid and/or draconian work requirements that actively limit enrollment.

These and other activities that undermine “good government” contribute to the high variability of state-by-state health performance. In the 2019 Commonwealth Fund Scorecard on State Health System Performance, the top 5 performers were Hawaii, Massachusetts, Minnesota, Washington, and Connecticut. The lowest five were Mississippi, Oklahoma, Texas, Nevada, and Arkansas.

As we continue at lightening speed toward the 2020 election day of reckoning, and debates on health reform remain front and center, it’s important to remind ourselves what is really at stake. Do the majority of Americans believe in “good government” or not?

We must be “Declaration of Independence Walking.”

Posted on | November 24, 2019 | 3 Comments

Mike Magee

In the shadow of last week’s Presidential Impeachment hearings, I have been searching for a silver lining. I tell myself it is helpful our Democracy is being stress tested and our Constitutional weaknesses revealed so that we might take corrective actions in the future. I recognize that this is not Trump’s fault alone but our’s as well, having supported a culture rich in celebrity idolatry, and one tolerant of unsustainable levels of inequity. And I acknowledge we live in a land of unbridled capitalism where solidarity and good government are diminished in equal measure.

So I was heartened to see our public servants, several of whom were first generation immigrants, display their competence, professionalism and courage in support of these United States. I want to believe that they, rather than their inquisitors, represent us. I want to believe that any fair-minded viewers could see our taxpayer money well invested in these remarkable women and men, and that we now better understand the art of diplomacy when contrasted with the bare knuckle hooliganism of Guiliani and his band of thugs.

My search for goodness led me back to 2010 and the Annual ADAP Convention at the Georgetown Westin Hotel. ADAP is a non-profit committed to making HIV/AIDS drugs affordable and accessible to all in need. I was honored and pleased to receive the invitation to deliver their keynote address that year from Executive Director, Brandon Macsata, who had been responsible for my original invite nine years earlier. That invite, in turn, was the result of Brandon hearing me address John Kemp’s Disability group the prior year. “Goodness spreads, you see.”, I told myself.

Brandon asked that I reflect on the role of “advanced professionalism” and “enlightened leadership”. To prepare, I relied heavily on a book my son, Michael, had published with the University of Alabama Press in 2004, titled, “Emancipating Pragmatism: emerson, jazz, and experimental writing”. The book derived from his PhD dissertation at the University of Pennsylvania, and extensively delved into the writings of both Ralph Waldo Ellison, author of “The Invisible Man”, and his namesake, Ralph Waldo Emerson.

So what did my son Michael say in his book that was so compelling that I turned to it that day, and return to it today, in the shadow of Trump-led Republican denials?

Page 3: Quoting Emerson, “To interpret Christ, it needs a Christ…to make good the cause of freedom against slavery you must be…Declaration of Independence walking.”

Page 7: On Fake News”, “Ultimately, Emerson came to believe that ‘America’ itself was a kind of text being read, its meaning a matter of collective decision. It followed that one’s linguistic theory, one’s view of how words generate meanings, had potentially large-scale social ramifications. In suggesting that words were ‘million-faced’, Emerson came to realize, he was suggesting that social possibility was remakeable.”

Page 18: On Change and Diversity, “Emerson writes…’the philosophy we want is one of fluxions and mobility’”.

Page 19: On the American Culture and Diversity, “‘Out of the democratic principles set down on paper in the Constitution and the Bill of Rights’, Ellison says, Americans ‘were improvising themselves into a nation, scraping together a conscious culture out of various dialects, idioms, lingos, and methodologies of America’s diverse peoples and regions’”.

Page 24: On the Emerson View of the Evolution of American Language and Culture, “We forget, conveniently sometimes, that the language we speak is not English, although it is based on English. We forget that our language is such a flexible instrument because it has had so many dissonances thrown into it ….from Africa, from Mexico, from Spain, from God knows, everywhere.”

Page 25 and 28: On Creating Our History, “The jazz musician—who, Ellison says, always plays both ‘within and against the group’ — constantly reflects and redefines the ensemble in which he plays. Likewise the ensemble reflects and redefines the larger community to which it belongs….that ‘anticipatory arena where actuality and possibility, past and present, are allowed to collaborate on a history of the future.’”

This has been a momentous week. We have made progress. We are not static, not trapped, not powerless or fixed in place. But there is much left to be done. This should neither surprise nor discourage. On the final page of Michael’s book, he writes, “An emancipated pragmatism happens whenever and wherever a creative mind or community of creative minds engages in democratic symbolic action.”

Democratic – Symbolic – Action. These are more than words. They are a culture of values. Our future is being written now. VOTE.

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