Fresh New Voices: From The World of Virtual Healthcare

Posted on | September 20, 2015 | Comments Off on Fresh New Voices: From The World of Virtual Healthcare

Since 2003, we’ve been delivering weekly packets of  virtual health education. Now, twelve years after we began, the movement has become increasingly institutionalized and professional. Some of the offerings are small and some are huge. Consider the giant MOOC offerings (Massive Open Online Course) like Stanford’s 2013 course which rapidly reached an open enrollment of 160,000. By then, more than 6 million U.S. students had taken at least one course online, and 2/3 of all institutions of higher education cited online learning as critical to their future survival.

Virtual students in the best programs rate their virtual experiences highly for content, interaction, convenience, depth of learning, and exposure to the most advanced educational technologies. Students coming out of these programs, or working for the organizations that sponsor them, tend to be lifelong virtual learners and active sharers. Exploring, producing, and sharing content seems to be in their DNA.

At Health Commentary, we’re happy in a small way to be part of the movement. In celebrating its’ growth and success, we are pleased to introduce you to this week’s two guest authors who are intimately involved in the virtual healthcare education field:

Sophia Bernazzani is the community manager for MHA@GW, the masters in health administration online offered by the Milken Institute School of Public Health at the George Washington University. She’s passionate about global health, sustainability, and nutrition. Her piece is titled, “A Closer Look at Preventable Harm”. Follow her on Twitter.

Julie Sweet is an editor of healthcare information for 2U.com. She earned her bachelor’s degree at Fordham University in New York City. She has recently moved from New York to Durham, North Carolina, where she supports 2U’s Healthcare Degree programs. Her post is titled, “How Climate Change is Hurting Our Health.”

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Sophia Bernazzani

When faced with a serious medical issue, most of us think about direct outcomes. Will there be a scar? How long will it be until I can go back to work or pick up my daughter? We spend much less time considering that things could go wrong: a surgery on the wrong site, a fall in the hospital, or an infection from improperly sterilized materials. Sadly, these types of medical errors, referred to as preventable harm, affect up to 1 in 4 discharges and cause an estimated 1,000 patient deaths per day. Only heart disease and cancer kill more Americans. It would seem the solution to the preventable harm question would be easy… find a way to “prevent” the harm. Unfortunately, it is not nearly that simple.(…continue)

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Julie Sweet

Amid continued warnings about melting arctic ice and dangerous greenhouse gas emissions, a new conversation is emerging—how climate change is hurting our health. The human impact is already evident to 7 out of 10 physicians, according to a study published in the February Annals of the American Thoracic Society. The majority polled said they see the effects of climate change reflected in patients in several ways: more severe chronic disease as a result of air pollution, more allergies from exposure to plants and mold, and more injuries caused by severe weather.

“Around the world, variations in climate are affecting, in profoundly diverse ways, the air we breathe, the food we eat, and the water we drink,” wrote Dr. Maria Neira, director of the World Health Organization’s public health and environment department, in a recent commentary. “We are losing our capacity to sustain human life in good health.”

Although the world’s poor and sick are most vulnerable, every person on the planet is subject to the health effects of climate change. Here’s a look at how our hurting environment is gearing up to impact human health in the United States. (…continue) 

Microbiota: Who’s Hosting Whom?

Posted on | September 16, 2015 | Comments Off on Microbiota: Who’s Hosting Whom?

Mike Magee

If you search under “The Future of Medicine”, you’ll see that the “Microbiome” is getting a great deal of air space these days. In fact, the NIH has committed $173 million to a collaborative dive titled the Human Microbiome Project. And yet, for most of us, it’s a new enough term that we need to continue to remind ourselves just what it means. But medical researchers have already moved beyond universal theories of its’ significance in normal homeostasis and the pathogenesis of inflammation and a wide range of diseases, and are now honing in on the questions that might be answered in formal studies.

But first, the definitions with the help of David Relman in this week’s JAMA:

Microbiota – “The human microbiota is a fundamental component of what it means to be human.” The term refers to the unique and personalized collection of microorganisms that live and thrive in each of us. As Relman explains: “All animals coexist in intimate, dependent relationships with microbes. Humans are no exception. Host-associated microbes, like nearly all others on this planet, form communities in which the overall composition, structure, and function are explained by ecological processes and environmental factors. Evidence of coadaptation and mutual benefit are key features of these symbioses between hosts and their microbial communities, or microbiotas.”

Microbiome – This term refers to the the collection of genes or genetic material that are contained in each of our microbiotas. Our growing ability to rapidly and cost-effectively analyze genetic structure has now allowed investigators to begin to peer into our microbiota and deconstruct the microbiome.

What they are finding raises some pretty serious questions including “Who’s hosting whom?” As Relman explains, “A recent examination of metagenomic sequence data obtained directly from human microbiota samples at 5 body sites identified more than 3000 biosynthetic gene clusters, each predicted to produce a small molecule with biological activity. Oral and gut communities contained more of these gene clusters (roughly 1100 and 600 per site, respectively) than communities at other, less diverse sites (such as skin and urogenital tract). Some of the most common types of predicted small molecules in the human microbiome are ribosomally synthesized and posttranslationally modified peptides—including lantibiotics, bacteriocins, and thiopeptides.”

Translation – our microbiomes are anything but passive. They are remarkably active and integrated with normal metabolism, physiology and pathophysiology. As importantly, their actions and products can be manipulated. This means that they are potential drug targets, which means that profit seeking individuals and corporations are and will continue to invest time and money in figuring out how they do what they do, and how to adjust their actions to favor wellness.

Relman says we already know a fair amount. Benefits include “differentiation of host mucosa, food digestion and nutrition, regulation of metabolism, processing and detoxification of environmental chemicals, development and ongoing regulation of the immune system, and prevention of invasion and growth of pathogens.” Debits? “…disturbance and alterations of the human microbiota… are associated with a wide variety of human diseases, such as chronic periodontitis, inflammatory bowel disease, and antibiotic-associated diarrhea.”

The field itself is beginning to feel a bit like environmental science turned inward. Consider these remarks, “The current surge of interest in this topic reflects in part recent advances in DNA sequencing technology and its use in characterizing the microbial world directly from environmental samples, as well as a renewed appreciation for ecological principles, including the importance of interactions among organisms; the formation, activities, and stability of communities of microbes; and the relationships between communities and their environment.”

This seems to bring a more nuanced appreciation of the old adage, “We are what we eat”. And it also suggests a note of caution (or optimism), as we see here, “Familiarity with an individual’s microbial ecosystem stability landscape might provide an understanding of their vulnerability to destabilizing factors such as antibiotics, as well as the likelihood of restoring their ecosystem to a health-associated state, for example, using a defined personalized synthetic community and complementary set of nutrients.”

So where are we. The experts seem focused on asking the right questions. Here’s Relman’s list:

1. “What are the most effective approaches for measuring human microbial ecosystem beneficial services?”

2. “What are the most important processes and factors that determine human microbiota assembly after birth?”

3. “Do different community assembly trajectories determine health and disease later in life, and if so, how?”

4. “What are the most important determinants of microbiome stability and resilience?”

5. “How can the stability and resilience of health-associated ecosystem states be strengthened?”

6. “How can health-associated ecosystem states be restored?”

5. “How (does) the microbiome…contribute to disease?”

Stay tuned.

For HealthCommentary, I’m Mike Magee.

Mother Nature, Moore’s Law, Globalization – and Health?

Posted on | September 9, 2015 | Comments Off on Mother Nature, Moore’s Law, Globalization – and Health?

UNICEFUSA.org

Mike Magee

In the New York Times today, Thomas Friedman made the case that we are beginning to segregate nations worldwide into “worlds of order” versus “worlds of disorder”. In support of this comment, he presents the multi-border exodus from the Middle East to various nation’s of the European Union.

This I know, is not especially revelatory. But it does, of course, have health implications, especially for the young. And believe it or not, we have been making progress in worldwide childhood mortality. In fact, deaths in vulnerable kids have dropped 53% since 1990 according to a recent UNICEF report. Under-5 deaths have declined from a high of 12.7 million in 1990 to 5.9 million in 2015. Nearly half of those deaths (45%) occur in the first month of life. Putting vulnerable families in full flight, and exposed to the elements, without clean water, adequate food, and decent shelter, certainly won’t help.

Friedman has been watching mega-trends, and he is not optimistic that the world will rediscover its sanity any time soon. He cites three trends in particular as the source for future major destabilization. They are:

1. “Mother Nature -climate change, biodiversity loss and population growth in developing countries”,

2. Moore’s law: microchip power doubling every few years assuring expansion of inexpensive information technology, making it difficult for despots to control their populations,

3. Market globalization with every increasing competition for profits – witness the shifting tides of the energy sector these days,

Of course, Tom is right. Poor climate policy, a highjacked or poorly advantaged Internet, and unfettered capitalism with a few mega-winners and many, many losers, is not healthy.

But I think his insights extend beyond the developing world, and are already affecting our own shores. My contention is that bad policy decisions at this moment could significantly undermine our nation’s future health and stability.

For example a wrong-headed approach to immigration that weakens the economic stability of neighbors like Canada and Mexico simply assures an additional future illegal influx of desperate and vulnerable migrants trying to survive. We should be contributing to those nation’s successes, not trying to “wall them off”, because that will help to continue to ensure an additional buffer of sanity and stability on our northern and southern borders.

Similarly, our ignorant denial of global warming is already adversely effecting population and personal health and safety in enumerable ways. Our actions are accelerating these changes, with solutions increasingly out of reach. The great challenge here is to continue to support national energy independence without destroying our environment in the process.

Finally, there’s the special problem of unfettered capitalism. In a nation that relies on “balance of power” to check greed and ignorance – three branches of government, separation of church and state, for-profit versus not-for-profit, corporations versus government – dismantling these boundaries in the name of theoretical gains in efficiency and productivity, is beyond ill-advised.

One need only to critically examine our health delivery system – whose power players are able to manipulate regulation by passing seamlessly from government to academic to industry posts – to appreciate how easy it is to corrupt a system and its policies when unopposed by a significant countervailing force.

For HealthCommentary, I’m Mike Magee.

Why Older Men Should Swim, Not Cycle.

Posted on | September 2, 2015 | 8 Comments

Mike Magee

I live in West Hartford, CT, an affluent town with more than its’ share of Type A personalities. In a town such as this, people would rather not give in to aging, have access to a wide range of community services, and remain active.

Three cases in point are our award winning Cornerstone Aquatic Center, our indoor skating ring, and our integrated Reservoir System with its’ 30 miles of paved, and shared, walking and biking paths.

If you go to our skating ring, at any time, you are very unlikely to encounter skaters above the age of 55 – except rarely perhaps, a grandfather like me, whose love of his grandchildren is so extreme, that, with the encouragement of his wife, he ventures out on the ice with a four year dangling from either arm. But let me emphasize, this is highly unusual.

When it comes to aquatics, depending on day and time, use is far more inter-generational, from very young to very old, and heavily involves both men and women. I swim at least once a week, always the same number of laps. My goal is as much mental and spiritual, as it is physical. Mine is an emersion, similar I suppose to meditation or yoga. A video of me would show a half hour of slow-medium “crawl” – consistent, acceptable, but no one is signing me up for swim team. It is exercise, and I’m convinced does keep my upper body from completely drooping, but really, I do it because it helps put me in the right frame of mind, and makes me feel like I’ve at least accomplished something that day.
There are older, mostly male (3:1) swimmers who take it considerably more seriously than me. They wear Speedos and are racing the clock. They seem to arrive between 7:45 and 8:25 AM each day, and have a gear bag that includes hand cups, foot fins, and a wide range of toiletries. They are focused, serious, and committed.

Finally there’s the reservoir loops – some 30 miles of integrated paved trails that connect five different reservoirs, which provide a semi-natural setting for wildlife, but no access to boating, fishing, swiming, or other human activity. This is where my wife and I, each day, usually at 5 PM, weather permitting, walk for about 1 hour. The trails receive a moderate amount of use, more on weekends than on weekdays. At times you will see a three generational family walking along, laughing and talking, leisurely enjoying each others company. Rarely we’ll pass a couple our age. Infrequently we’ll see couples our children’s ages, and if so, they are working to teach a child to bike ride, or attempting to sooth a toddler trying to climb out of her stroller or catapult from the Bjorn pack.

The pathways are segregate by a vertical painted white line that separates the trail into thirds – 1/3 to the right and 2/3 to the left. Biking goes on the right, walking and jogging on the left. In theory, the system should quite simple protect the lives and limbs of most participants, except for two problems – the paths intersect with each other and also loop around the various reservoirs which creates some left/right confusion. And second, their is an oversupply of crazy type A, mostly male, mostly older (55 to 75) bike riders whose many objective appears to be to break speed records and escape the Grim Reaper. They universally overestimate their skill levels, judgement and reaction times, and underestimate the risks to themselves and all they pass along the way.

Think John Kerry, and his recent femur fracture – then multiple by 100, and insert a dizzying whirrrrring sound track, approaching blindly from behind, and you come close to our daily experience. Were this not bad enough, these aging male cyclists arrive at these protected trails by traveling the congested suburban roads shared by young and old alike. When I say they have absolute no concept of risk/benefit, I am sure you will agree.

So you will not be surprised that I was not surprised to read in the recent JAMA report that bicycle accidents are way up in the U.S. and that it’s mostly the result of older, male riders.

That report documented that over the past 15 years, injuries have risen almost 30% and resultant hospitalizations are up 120%. Those numbers were primarily driven by older males. Injuries in those over 45 during the study period, outpaced all others – up over 80%. Casual male cyclists outpace female cyclists (60%/40%). But in the sports cyclists category (think skin tight suits, pegged cycle shoes, and prostate injuring saddles) males own an 87% share.

I don’t agree with Trump on much – in fact, nothing – except perhaps this. To be speed cycling when you’re John Kerry’s age, is just plain stupid. He should take up swimming instead – with or without a Speedo- where there’s little risk of injuring himself or others.

For HealthCommentary, I’m Mike Magee

The 176 Year History Behind Today’s Attacks On Women’s Health.

Posted on | August 18, 2015 | 2 Comments

Mike Magee

In an editorial in this week’s NEJM, editors state, “We strongly support Planned Parenthood not only for its efforts to channel fetal tissue into important medical research but also for its other work as one of the country’s largest providers of health care for women, especially poor women. In 2013, the most recent year for which data are available, Planned Parenthood provided services to 2.7 million women, men, and young people during 4.6 million health center visits. At least 60% of these patients benefited from public health coverage programs such as the nation’s family-planning program (Title X) and Medicaid. At least 78% of these patients lived with incomes at or below 150% of the federal poverty level. Planned Parenthood’s services included nearly 400,000 Pap tests, nearly 500,000 breast examinations, nearly 4.5 million tests for sexually transmitted illnesses (including HIV), and treatments.The contraception services that Planned Parenthood delivers may be the single greatest effort to prevent the unwanted pregnancies that result in abortions.”

This is not the first time the organization has been enmeshed in controversy. The following is an excerpt from my soon to be published book, “Unholy Alliances”, which places current events in context, and shows that the antagonists in the struggle – conservative politicians, the Catholic Church, and others – have been engaged in this struggle for many years.

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“The war against Planned Parenthood and its’ predecessors has a rich history dating back 176 years to 1839. That was the year that Charles Goodyear was controversially credited with the discovery of vulcanized rubber. The chemical process that Goodyear stumbled on involved the introduction of heat and additives to standard rubber gum which induced new cross links and a fundamental alteration in the end product. The new material was more moldable, mechanically stronger, and all importantly, less sticky. The process involved the application of heat, thus the name “vulcanized rubber” after the Roman god of heat, Vulcan.(31)

Fortuitously for Goodyear, his discovery arrived during a twenty year period of intense interest in self-help called the Popular Health Movement beginning in 1830. One prominent figure of the day was Edward Bliss Foote who invented a device he poetically labeled the “womb veil”.(28) This rubber pessary, designed for easy insertion, was the forerunner of the modern diaphragm and cervical cap. It was actively marketed and distributed over the counter and through mail order beginning in 1863, and sold for the princely price of $6. It largely replaced a range of less sophisticated contraptions first available publicly in the 1830’s in the United States. Advertisements of the day promised that the womb veil could be “used by the female without danger of detection by the male”.(29) Interest in the device was reinforced by the actions of the AMA which first publicly opposed all abortions in 1859, followed by the actions of Connecticut, the first state to prohibit all abortions, which prior to this time were generally tolerated in the time period before “quickening” (the sensation of fetal movement by the mother).(30) “If not abortions, then contraception”, was the public mood.

Their ultimate opponent took the unlikely form of a New York City based U.S. Postal Inspector committed to stamping out vice named Anthony Comstock. His organizational vehicle was the New York Society for the Suppression of Vice created in 1873, with Anthony as both founder and chief vice hunter.(35) His efforts were supported by key leaders of the Young Men’s Christian Association (YMCA). The organizations mission was not only to hunt out vice but also to bring offenders to justice. The organization drew its powers directly from the New York state legislature which granted its agents the police authority to search, seize and arrest those who marketed, distributed or sold banned items.

Comstock’s lasting legacy however was not on the streets of New York, but rather in the halls of Congress. On March 3, 1873, he was able to harness the support of enough U.S. legislators to amend the Post Office Act to include the “Comstock Act”.(36) Multiple states followed suit creating together a host of laws collectively called the “Comstock Acts”, many of which remain unenforced on the books today. This legislation made it illegal to transmit “obscene” materials through the mail. Specifically the law declared:

“Be it enacted… That whoever, within the District of Columbia or any of the Territories of the United States…shall sell…or shall offer to sell, or to lend, or to give away, or in any manner to exhibit, or shall otherwise publish or offer to publish in any manner, or shall have in his possession, for any such purpose or purposes, an obscene book, pamphlet, paper, writing, advertisement, circular, print, picture, drawing or other representation, figure, or image on or of paper or other material, or any cast instrument, or other article of an immoral nature, or any drug or medicine, or any article whatever, for the prevention of conception, or for causing unlawful abortion, or shall advertise the same for sale, or shall write or print, or cause to be written or printed, any card, circular, book, pamphlet, advertisement, or notice of any kind, stating when, where, how, or of whom, or by what means, any of the articles in this section…can be purchased or obtained, or shall manufacture, draw, or print, or in any wise make any of such articles, shall be deemed guilty of a misdemeanor, and on conviction thereof in any court of the United States…he shall be imprisoned at hard labor in the penitentiary for not less than six months nor more than five years for each offense, or fined not less than one hundred dollars nor more than two thousand dollars, with costs of court.”(37)

The target of Comstock’s rage was not only pornography, but more specifically contraceptive equipment and reproductive health materials of the day. Sixty years later, in 1936, the Supreme Court would strike down the ban on contraceptives.(38) In addition, control of condoms would be brought under the auspices of the Food and Drug Administration as part of a national effort to control the spread of venereal diseases.(39)This allowed World War II U.S. soldiers to be supplied condoms, in contrast to their fathers who fought in World War I.(40) In 1937, the AMA also gave its stamp of approval to contraception stating “the intelligent, voluntary spacing of pregnancies may be desirable for the health and general well being of mothers and children.”(41)

As for women, by 1938, well stocked over the counter pharmacies offered over 600 brands of powders, gels, diaphragms and douches for “feminine hygiene”.(42) What all of these shared was a dual use as contraceptives with generally poor results. As for public maternal health, in 1935, the New York City Health Department catalogued an average of 5 to 10 cases of septic abortions per week.(43)

In the early years of the 20th century, however, the battle was full on between Comstock’s raiders and a new brand of aggressive women determined to control their own fates. Chief among them was Margaret Higgins Sanger, nurse and sex activist. Margaret was the sixth of eleven children born into an immigrant Catholic family that had settled in America in the wake of the Irish potato famine. Her mother, Anne Purcell Higgins, managed 18 pregnancies in 22 years, and died at age 49. Her early years were occupied with household duties and the care of younger brothers and sisters. Two older sisters financed her education which led to a Nurse Practitioner degree from White Plains Hospital in New York in 1901. The next year she married architect William Sanger and they had three children of their own.(44)

In 1911, the young family moved to New York City and Margaret took a job as a visiting nurse in the slums on the Lower East Side. After seeing the results of several botched abortions, she began to broadly distribute a wide range of how-to sex education materials as part of an organizing effort to involve the communities she served. Welcoming a confrontation, she published a monthly newsletter titled “The Woman Rebel”. If the title didn’t capture religious leaders attention, the slogan – “No Gods, No Masters” – surely did.(46) In 1914, the monthly led to accusations of violation of the Comstock laws. She fled to Canada and then to Britain to avoid arrest and remained there for a year.(47) Her husband was charged to release the published and yet to be released “Family Limitation”, a 16 page pamphlet with graphic images and descriptions of various forms of birth control. This earned him a visit from Anthony Comstock and 30 days in jail. The resultant publicity elevated both Margaret and her cause to national standing.(48)

She believed and loudly proclaimed that, each woman should be “the absolute mistress of her own body.”(49) In 1916, back in the United Staes, she opened the first birth control clinic in Brooklyn, NY, with two goals in mind. One was to limit the occurrence of dangerous back alley abortions, and the second was to help place women in a more equitable position with men by allowing them to determine whether or not to have children and how many to bear. Nine days after opening, she was arrested and went to trial in January, 1917. She was initially convicted with the judge declaring that women did not have “the right to copulate with a feeling of security that there will be no resulting conception.” But in appeal, Judge Frederick Crane spared her 30 days in the workhouse when he delivered a compromise ruling that included the statement that physicians could prescribe contraception to treat or prevent disease.(50)

Five years later, to further organize the effort, Sanger founded the American Birth Control League, and in supplying her clinic in New York, now complete with a team of all female doctors, directly challenged the Comstock Acts.(51) Sanger had reached out to a Japanese colleague to mail diaphragms and cervical caps to her physician colleague, Hannah Stone.(52) Stone not only provided care but was the Medical Director of a second entity, the Birth Control Clinical Research Bureau, which was engaged in studying, for the first time, the effectiveness of various forms of contraception. The package was intercepted by Customs officials, and Sanger was again arrested.

The case, United States v. One Package of Pessaries, narrowed the power of the Comstock Acts by deciding that the legislations intent was not “to prevent the importation, sale or carriage by mail of things which might intelligently be employed by conscientious and competent physicians for the purpose of saving life or promoting the well-being of their patients.”(53) This reinforced Judge Crane’s prior ruling.

These decisions pointed Sanger to a narrow corridor that she and her colleagues would pursue over the next 15 years. The price they paid was the “medicalization” of a movement that had begun as a “women’s rights” effort.(54) Her organization went to work defining a wide range of medical conditions that would justify the use of contraception including everything from multiparity to hypertension to tuberculosis to poor housing conditions. By the time they finished, nearly everyone qualified.

By the 1930’s, Sanger’s American Birth Control League was working hand in hand with another New York organization, the International Workers Order (IWO). This was a Jewish fraternal organization with strong Communist leanings that by 1935 had 100,000 members.(55) It provided sport and culture, and for the first time in America, prepaid medical care. The goal was to distribute the financial burden. They provided basic generalist health care services, discounted specialty care, dental care and discounted medications at 90 contracted pharmacies. In 1937 they added mass screening for syphilis and in 1939 instituted low cost chest X-rays to detect tuberculosis. That was three years after they had added a Birth Control Center in conjunction with Margaret Sanger. Over those first three years, 1200 women received service. The annual fee of $4 ($60 in today’s currency) covered all gynecologic exams, unlimited visits and all prescribed contraceptive supplies.(56)

As 1938 rolled around, Sanger’s American Birth Control League was growing in leaps and bounds. There were now 347 birth control clinics nationwide with 1/5 supported by public funds and the remainder supported by philanthropy and patient fees. The growth was fueled by a strong shift in public opinion.(57) A 1938 poll conducted by the Ladies Home Journal revealed a 79% support for birth control.(58) As impressive were the figures coming out of Sanger’s research arm. An American Birth Control League 1937 survey of 29,000 patients from 170 clinics demonstrated a 92% effectiveness of physician fitted diaphragms in conjunction with spermicidal jelly. This success contrasted with the 72% effectiveness of over-the-counter diaphragms and the 29% effectiveness of store bought douches. As for condoms, which were used by only 4% of the clients.(59) The American Birth Control League shied away from their use not because they were ineffective, but “because the woman is more likely than the man faithfully to carry out the method of control, the means may better be in her hands.”(60)

It is important to note that leaders of the American Birth Control League and the International Workers Union and others did not see Birth Control Clinics as their end game. Rather, as their experience grew with their understanding of their patients needs, they saw women’s services as part of a general move, as the IWO unabashedly proclaimed, toward “socialized medicine”.(61)

Noticeably absent from the original Social Security Act, FDR had gone so far as to organize a 1938 National Health Conference to confer with his Technical Committee on Medical Care to examine a “program of medical care…to serve the entire population.”(62) The proposals would appear in the Senate’s Wagner bill of 1939. But FDR’s unwillingness to expend political capital in the lead up to a possible war, coupled with strong AMA opposition, collapsed the effort. The AMA would be there as well in 1943 to help defeat the Wagner-Murray-Dingell bill seeking universal coverage, and FDR’s “economic bill of rights” with health care services in 1944, and Truman’s “single system “ efforts a few years later.(63)

By the time Truman made his push, America was deeply entrenched in the “Cold War” and the Iron Curtain was about to be drawn. The IWO was on a 1947 list of “subversive organizations” prepared by US Attorney General Tom Clark.(64) Senator Joe McCarthy from Wisconsin had launched “McCarthyism” in a speech in 1950, and the search for American Communists was on. In that same year, the New York superintendent of insurance declared the IWO to be “a recruiting and propaganda unit for the Communist Party”. In June, 1953, Julius Rosenberg and his wife Ethel went to the electric chair convicted of espionage. They never proved Julius to be a Communist, but he did acknowledge having an insurance policy with the IWU, which was felt to be incriminating. With fear all around, membership in the IWU rapidly declined, and in 1953, the IWO was liquidated.(65)

As for Margaret Sanger, she lived to fight another day, in part due to skillful maneuvering in 1942. After accommodating to “medicalization” and benefitting from the subsequent AMA endorsement of contraception in 1937, she felt the winds of change and renamed her Birth Control Federation of America as the Planned Parenthood Federation of America.(66) This literary power shift dropped the notion of “birth control” with its implications of struggle and replaced it with the more congenial “family planning”.

Sanger was an adept politician and fund raiser. She received extensive funding from the Rockefeller’s, but always anonymously, so as to protect the career trajectory of Nelson Rockefeller who feared public support of Sanger could lead to formal opposition to his future campaigns by the Catholic Church.(67)

The Church’s advances in the immediate post-World War II period had convinced the hierarchy that bigger was better than smaller. Their numbers were on the steep incline as soldiers returned from the war, and the Church was committed to keeping it that way. The bishops believed that family planning was mission critical and should be a Church-down affair. They would need to be well organized and would need to include Catholic doctors like my father.(68)

As the Church stayed true to it’s roots, Sanger responded in kind. She leaned back on her clinical interests and brought together philanthropist Katharine McCormick and biologist Gregory Pincus. He would use the money he received from McCormick wisely linking up with his old fiend John Rock at the Free Hospital for Women in Boston, to create the first U.S. birth control pill, Envoid (a combination of mestranol and norethynodrel), developed and distributed by G. D. Searle & Company, after its FDA approval on June 10, 1957.(69)

The Church could see this coming for a while. Way back in 1930, a Catholic doctor from the Netherlands, John Smulders, had developed the first calendarized scheme designed to avoid pregnancy.(70) His work took advantage of early discoveries in 1920 by Austrian gynecologist Theodoor van deVelde and Japanese gynecologist Kyusaku Ogino, who independently proved that ovulation occurs about 14 days before menstruation.(71) Ten years later, Smulders published his “rhythm method” which drew wide usage in Europe. In the U.S. however, it remained highly controversial, even after Leo Latz published his book, The Rhythm of Sterility and Fertility in Women, describing the method in 1932, and John Rock opened his Rhythm Clinic in Boston to teach Catholic parents the technique.(72)

The American Catholic Church and its’ leadership could easily predict the next step. As the science of maternal health and its’ natural rhythms were increasingly exposed to examination, it was only a matter of time before pharmaceutical companies and their allied physicians would figure out how to manipulate and destroy this miraculous system. Clearly, God’s rights to decide when and where to deliver His children was under attack, and the Church must defend, defend, defend. As Pope Pius XI had said in his famous Encyclical, Casti Connubi, on December 31, 1930: “…every attempt of either husband or wife in the performance of the conjugal act or in the development of its natural consequences which aims at depriving it of its inherent force and hinders the procreation of new life is immoral; and that no ‘indication’ or need can convert an act which is intrinsically immoral into a moral and lawful one.”(73)

But what to do now with science on the rise? The Church faced a choice. Embrace the new “Rhythm Method” which at least emphasized restraint and periodic abstinence, and might dampen the march toward use of horrid preventatives, paganism, and sins of the flesh; or stand strong and face the possibility of being overrun by modernity. In the end, the bishops sided with this new semi-natural method. But a vocal minority labored on, and not in silence. As late as 1948, popular preacher and radio broadcaster, Father Hugh Calkins had this to say, “Catholic couples have gone hog-wild in the abusive employment of rhythm…A method meant to be a temporary solution of a critical problem has become a way of life, a very selfish, luxury-loving, materialistic way of life. But heaven, not security, is the goal set for the babies God sends…Every couple should have the children God wants them to have.”(74)

Margaret Sanger would live and work for another decade, as founder of the International Planned Parenthood Foundation. By the time she died on September 6, 1966 at the age of 86, her Planned Parenthood Federation of America was the largest government provider of reproductive health services.(75)”

Excerpted from Unholy Alliances, (copyright/Mike Magee©2015)

For Health Commentary, I’m Mike Magee.

References:
31. Bellis M. Vulcanized rubber. Accessed 10/16/14. http://inventors.about.com/od/gstartinventors/a/CharlesGoodyear.htm

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33. Starr P. The Social Transformation of Health Care. New York: Basic Books. 182. p.53.

34. Foote, Edward Bliss (1863). Medical Common Sense; Applied to the Causes, Prevention, and Cure of Chronic Diseases and Unhappiness in Marriage. New York. p. 380. Accessed 10/16/14.
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41. Engelman PC. The History of the Birth Control Movement in America. Santa Barbara, CA: Praeger. 2011.p.169

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The Zuckerberg’s Shine a Light on Miscarriage: What Each of Us Can Do.

Posted on | August 8, 2015 | 1 Comment

Mark and Priscilla Zuckerberg

Mike Magee

This past week, Mark Zuckerberg of Facebook fame announced that he and his wife, Priscilla, are expecting a baby. At the same time, he shared this: “We’ve been trying to have a child for a couple of years and have had three miscarriages along the way.”

In doing so, he connected with millions of other parents who have experienced the loss of a child, and the often silent and life-changing aftermath of the experience. What makes the experience doubly painful for so many is the inability of family and friends to properly support couples going through the experience.

Pregnancy can be an exciting and happy time for potential parents. But when something goes wrong and miscarriage is a result, recovery can be difficult. It’s not so much the physical problems as the emotional ones. With about 1 million known miscarriages out of 6 million U.S. pregnancies each year, a startling number of expectant parents are left devastated – without knowing who to turn to or what to think. Even though most miscarriages occur before 13 weeks of pregnancy, it’s normal for the parents to have already established a deep connection to the unborn child. Friends and family members might not be able to fully understand this, so the pain and grief can be very isolating.

The March of Dimes offers this to grieving parents, “It can take a few weeks to a month or more to physically recover from a miscarriage…It may take longer to recover emotionally. You may have strong feelings of grief about the death of your baby. Grief is all the feelings you have when someone close to you dies. You may feel sad, angry, confused or alone. At times, your feelings may seem more than you can handle. You may have trouble concentrating. You may feel guilty about things that happened in your pregnancy. It’s OK for you to take time to grieve, ask your friends for support, and find special ways to remember your baby.”

On top of this, studies have found that women often blame themselves for the failed pregnancy in the immediate months after it occurs. And yet,  in the vast majority of cases, there’s nothing the parents could have done to prevent a miscarriage.

Still, out of 1 million miscarriages, approximately 15% of women suffer clinical depression and 45% experience increased anxiety. Concerns, in the form of questions, include:  Why did the pregnancy fail?  Is it likely to happen again?  How long will I grieve? Are my feelings, and those of my partner, normal?  If not, how do I get help in recovery?  To answer these questions, ACOG advises follow-up visits with a doctor and, at times, referral to a counselor.

In many cases, the grief dissipates within four months, and acceptance soon follows. But it’s important for patients to take as much time as they need to heal emotionally — even though a woman’s body may be ready to conceive again in just a month or two.

If there is any good news here, it’s that “Miscarriage is usually a one-time occurrence. Most women who miscarry go on to have a healthy pregnancy after miscarriage. Less than 5 percent of women have two consecutive miscarriages, and only 1 percent have three or more consecutive miscarriages.”

Many emotions are triggered when a baby is lost through miscarriage, and a culture of silence and misunderstanding can sometimes surround such an event.  Family and friends should educate and prepare themselves. Sometimes it’s hard to know what to say or what to do. In the past, the March of Dimes offered this advice, “While it is very difficult to find the words that might help the grieving family, it is comforting to tell them ‘I’m so sorry for your loss’ or to admit ‘I don’t know what to say.’  Letting a family know ‘I’m here for you’ or ‘I’m praying for you’ is also a help. Even tears are comforting.  Do not make comments like ‘you’ll get over it in time’ or ‘you can always have another baby.’  The parents need to grieve this loss.  Try to be sensitive to their deep loss and the fact that, while time may ease the grief, they will never get over it.”

The Zuckerberg’s sharing this week helps bring transparency to an issue that deserves our support. What can each of us do? Be available, and be ready to listen.  Help with errands and meals.  Acknowledge the baby existed and share the grief.  If parents wish, tell others for them.  And be aware that certain times – such as the baby’s due date or pregnancy loss date, will be sensitive times, marked by sadness and extra need for kindness and support.  Finally, if depression or anxiety visibly persists beyond several months, encourage additional counseling and support.

Around one million American women and their partners suffer a lost pregnancy each year. It’s regrettable that most cases are not preventable. But it’s unconscionable to allow these parents to suffer in isolation and silence, and without adequate support.

For HealthCommentary, I’m Mike Magee.

50Th Anniversary of OAA: Why Feeding Seniors Still Makes Financial Sense.

Posted on | July 31, 2015 | Comments Off on 50Th Anniversary of OAA: Why Feeding Seniors Still Makes Financial Sense.

Mike Magee

By now, most of my readers have heard that this is the 50th anniversary of Medicare and Medicaid. But some of you may be unaware that it is also the 50th anniversary of the Older Americans Act. The what?
The Older Americans Act of 1965 was signed by LBJ. Its’ goal was to secure an adequate safety net for older Americans by providing protections for equal opportunity, sufficient income in retirement, the best health services independent of economic status; adequate housing; long term care; civic, cultural, educational and recreational inclusion; self-determination; and appropriate protection against abuse.
Programmatically, this translated into nutrition and community-based services, elder rights programs, the National Family Caregiver Support Program, and health prevention strategies on a local level. In short it acknowledged for the first time that health was profoundly political. The law for the first time defined health as a collection of resources unequally distributed in society. Health’s “social determinants” such as housing, income, and employment, were critical to the accomplishment of individual, family, and community well being and were themselves politically determined. Health was recognized at the time by many throughout the world as a fundamental right; yet it was irreparably intertwined with our economic, social, and political systems.

This important law, targeted at those over 60, spoke to the interconnectedness of health.
As described in this week’s NEJM:

1. “ Nearly 13 million people receive regular OAA services, including meals, caregiver support, personal care, and transportation assistance. “

2. “Currently, more than 40% of OAA funding goes to nutrition services (Meals on Wheels), primarily meals delivered to homes or community centers. In 2014, nearly 140 million home-delivered meals and 90 million congregate meals were served.”

3. “The remaining 60% of OAA funding is spent on health-related services, including home and adult day care, support, and elder-abuse protection.”

4. “Programs are administered by the federal Administration for Community Living and local Area Agencies on Aging (AAAs) and Aging and Disability Resource Centers (ADRCs).”

5. “Recipients of daily meals also reported decreased isolation and worry about living at home. Moreover, 1 year of home delivered meals costs nearly the same as one emergency department visit and less than a 1-week nursing home stay.”

And yet few would be surprised that the funding of OAA is under constant attack. Eight years ago I stated that, “There is a growing political disconnect between those who make health policy and those most affected by health policy. While the former continue to reinforce silos and the status quo, the latter seek broad, fundamental and comprehensive reform. Such reform might include expansion of insurance coverage, realignment of financial incentives toward prevention, increased reimbursement of physicians and nurses for team coordination that includes home health managers, support for early diagnosis and screening, and expansion of education and behavioral modification for individuals and families.”

Properly feeding our elders remains a logical and defensible starting point.

For Health Commentary, I’m Mike Magee.

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