Retail Medical Clinics – The Disruptive Impact of Walmart

Posted on | July 24, 2015 | 1 Comment

Mike Magee

This week’s NEJM article on the expansion of retail clinics in the U.S. begins:

“ In a tumultuous era of change propelled by public health policies and private entrepreneurial activity, the spread of retail clinics offering basic primary care, walk-in visits, extended hours, and lower prices than a doctor’s office or emergency department is unsettling the medical profession, especially family physicians and pediatricians. Most U.S. retail clinics are owned and operated by vast corporate enterprises and staffed by advanced practice nurses and physician assistants. Although relatively few assessments have been conducted of the quality of care in such clinics, some peer-reviewed studies indicate that they deliver their circumscribed set of services at least as well as physicians’ offices do.”

The article is written by the legendary Health Policy guru, John Inglehart, who goes on to lay out the numbers surrounding the new corporate face of the retail clinic business, including the latest CVS and Walgreen figures. He also reveals that Walmart is now jumping in with both feet. As he says, “Within the past year, the corporate giant Walmart announced a new health clinic strategy. Until recently, Walmart had leased space in its superstores to a clinic operator (usually a health system), but it is letting many of these leases expire. In those clinics, nurse practitioners have delivered primary care, and Walmart has contracted with a separate company (QuadMed) to arrange for community-based physicians to provide clinic oversight consistent with state regulations. But recognizing a rapidly evolving health care landscape, Walmart has announced a new model, the “Walmart Care Clinic…”

What Inglehart does not catalogue is the vast number of American corporations that sponsor their own on-site employee health clinics. He does suggest, however, that part of Walmart’s rationale and business model includes providing care to Walmart employees. Employees pay only $4 for basic services, while outside customers pay $40 per visit. It was just a year ago that this massive corporation was being slammed in the media for its low wage scale and poor health benefits. Herein lies an in-house solution at least to the health coverage issue, which by the way, could also be a profit center with customers, and potentially a lower cost solution for other corporations who have been funding their own in-house health centers.

In 2012, I wrote that “retail pharmacy clinics deliver a good product, that ‘virtual minute clinics’ as extension arms of the retail based sites might come to your home in the future, that home care for older chronically ill patients could easily be mixed with well-care like sports physicals or strep cultures for grandchildren at home, that home health care companies should consider themselves to be ‘comprehensive virtual clinical practice’ not a pay for hire service, and that the competition (doctors’ offices and hospitals), provided uneven service if you were able to get an appointment for standard care issues.”

At that time, Christine Cassel from the American Board of Internal Medicine and Thomas Bodenheimer of UCSF had penned articles on the same topic in JAMA and the New England Journal of Medicine respectively. Dr. Bodenheimer opined on how to improve access to primary care, while Dr. Cassel reflected on the expanded use of retail clinics in pharmacy settings to address the need for improved access to care.

Dr. Bodenheimer noted that current wait times in Massachusetts for a primary care appointment were 36 days for family medicine and 48 days for internal medicine. In their words, “The reason for the access problem is an imbalance between demand for care and capacity to provide care…. One answer is for physicians to share care with an empowered health care team….In most primary care practices, non-clinician team members – registered nurses(RN’s), medical assistants, health educators, and others – are not empowered to share the care…The most significant barrier is the discomfort that many physicians feel about giving up decisions regarding preventive and chronic care, which, though seemingly routine, are often complicated by patients’ various coexistent conditions, preferences and goals…Creating teams to share the care is not an end in itself. The purpose of this practice change is to address the national demand-capacity imbalance while enhancing quality and reducing clinician stress and burnout.”

Dr. Cassel’s comments were considerably more direct. She wrote, “Easy access to medical clinics in retail settings is gaining momentum in the United States…For a working person with a sudden onset of febrile illness, the retail clinic provides a solution: the person can be seen quickly the day the problem arises and most often is able to receive a simple and straightforward evaluation and treatment or recommendation to seek specialist care if indicated…the visit would be less than $100 and the pricing would be transparent. In contrast, the same minor problem could cost hundreds of dollars for an emergency department visit…The retail clinic phenomenon could be transformative for a vast number of patients in the United States.”

What was missing three years ago was adequate informational connectivity and flow between retail clinic caregivers and primary care and hospital networks, and expanded ubiquitous presence of retail clinics nationwide.

Walmart might change that.

For Health Commenatary, I’m Mike Magee.

The President Drives the 2015 White House Conference on Aging.

Posted on | July 15, 2015 | 2 Comments

Mike Magee

If summertime is normally marked by a sleepy Washington news cycle, than 2015 will stand out for many years as a distinct anomaly. Between marriage equality, the trade agreement, the survival of the Affordable Care Act, and now the Iran agreement, it would be very easy to miss other notable events that have occurred.

One such event was the just completed 2015 White House Conference on Aging. By all accounts, the participants saw it as a major success. In addressing the gathering, President Obama set the context in noting that this year marks the 80th anniversary of the passage of Social Security and the 50th anniversary of the passage of Medicare.

Seemingly, everyone was there from Diane Nyad to Ruth Bader Ginsburg, also known, according to the President as “the Notorious R.B.G.”. That label, which drew laughter and applause, was representative of a growing respect and strong embrace of aging Americans who remain active, engaged, and contributory members in a dynamic American society.

The President took the opportunity to speak about the future of Social Security and Medicare. He said that the critics who said that the two programs were “in crisis”, were wrong. Specifically, he said, “Medicare and Social Security are not in crisis, nor have they kept us from cutting our deficits by two-thirds since I took office. Both programs are facing challenges because of the demographic trends I just talked about. And for Medicare, that means we’ve got to keep slowing the growth of health care costs, and keep building on the progress we’ve already made in the past few years.”

Speaking quite directly to health providers of all shapes and sizes in the audience, the President tied Medicare and Social Security to his controversial, and increasingly popular, signature health legislation. In his words, “Since I signed the Affordable Care Act — also known as Obamacare — (applause) — since we signed the ACA into law, we’ve extended the life of the Medicare Trust Fund by 13 years. We’re moving Medicare towards payment models that require quality of care instead of quantity of care as the measure of what you get paid, creating a different set of incentives. And that’s something that will keep older Americans healthy and Medicare healthy as well.”

As for specifics derived in part from the ACA, he listed these:

1. “We’ve extended the life of the Medicare Trust Fund by 13 years.”

2. “…we’re moving Medicare towards payment models that require quality of care instead of quantity of care as the measure of what you get paid, creating a different set of incentives.”

3. “… this law has saved over 9 million people on Medicare currently more than $15 billion on their prescriptions… Built into the Affordable Care Act, 9 million seniors have gotten significant discounts on their prescription drugs.”

4. “It’s also given nearly 40 million people on Medicare free preventive health services. And we’ve expanded the options for home- and community-based services offered by Medicaid, which means that more older Americans are able to make the same choice that my grandmother did and live independently.”

In laying out the challenges ahead, and next steps, the President sounded anything but the lame duck. Here are a few of the priorities on his “To-Do” list:

1. Clean up the nation’s retirement plans. The President wants a system that would automatically establish IRA’s for all new workers when they begin employment. He also wants to shed light on the financial industry’s “hidden fees” which explain why so many Americans retirement investments funds never to seem to grow.

2. He wants to reauthorize the Older Americans Act which coordinates aging organizations nationwide and a range of services including nutrition, job training, senior centers, caregiver support, transportation, health promotion, and benefits enrollment. It’s reauthorization ran out in 2011.

3. He wants to push harder for workplace flexibility and family leave provisions especially for family members who are serving as family caregivers.

4. He wants to expand nutritional assistance for seniors living independently.

5. He wants to update nursing home safety and quality measures, and expand prosecution for elder abuse.

In taking the time in a summer schedule that has been jammed with monumental legislative events, the President is acknowledging the critical importance and the realities of aging demographics and aging influence. The recent Gallup-Healthways Well-Being Index noted as much, reporting that those over 55 score higher that those under 55 in the survey, but those over 75 eclipse everyone.

Others have noted why this is likely the case listing contributors like “productive engagement, social connection, healthy diet, exercise/physical fitness, adequate sleep, financial management, spiritual well-being”.

For the President, he emphasized the government’s role, and in the process, his own contributions. As he put it, “So one of the best measures of a country is how it treats its older citizens. And by that measure, the United States has a lot to be proud of. Medicare, Medicaid, Social Security are some of our greatest triumphs as a nation. When Social Security was signed into law, far too many seniors were living in poverty. When Medicare was created, only a little more than half of all seniors had some form of insurance. Before Medicaid came along, families often had no help paying for nursing home costs. Today, the number of seniors in poverty has fallen dramatically. Every American over 65 has access to affordable health care. And, by the way, since the Affordable Care Act was signed into law, the uninsured rate for all Americans has fallen by about one-third. (Applause.) Just thought I’d mention that. (Applause.)”

For Health Commentary, I’m Mike Magee.

Category: aging
Tags: 2015 White House Conference on Agoing > aca > affordable care act > Medicare > Obamacare > President Obama > Social Security

Is “Amazing Grace” Mediated Through The Placebo Neurobiologic Effect?

Posted on | July 5, 2015 | 2 Comments

Source: Chronicle Augusta.com

Mike Magee

This week, Ted Kaptchuk and Franklin Miller published a seminal article in the New England Journal of Medicine titled, “Placebo Effects in Medicine”. I believe it will be remembered for many years, not for its scientific insights, which are considerable, but for its’ theologic, sociologic, and historical revelations, buried deep in its straight forward prose.

You see, the authors’ insights happened to be published within days of President Obama’s Eulogy for Reverend Clementa Pinckney in Charleston, South Carolina, a speech reflecting on the subject of grace – Amazing Grace. And in many ways, I believe Kaptchuk and Miller were covering the same ground as our President. I say this because health, the capacity to reach full human potential, requires a bias toward success, and a commitment to equal justice. And as our President said, “.. justice grows out of recognition of ourselves in each other; that my liberty depends on you being free, too… the path of grace involves an open mind. But more importantly, an open heart.”

In the battle for health, we expect and require that our physicians take on all comers, without bias; that they care for others as they would their own; that they touch and empathize, as they advise and council. Kaptchuk and Miller say, “..medicine’s goal is to heal, which can include cure, control of disease, and symptom relief or provision of comfort. When no cure is available — an inevitable occurrence at some points — medicine’s ultimate mission is to relieve unnecessary suffering. Supportive and attentive health care (preferably with effective medications, but even without) legitimately creates a ‘therapeutic bias’ in patients toward hope and an experience of relief and reprieve.”

The authors say we have minimized and undervalued the human physiology that underlies the placebo effect. They define it as the “improvements in patients’ symptoms that are attributable to their participation in the therapeutic encounter, with its rituals, symbols, and interactions… This diverse collection of signs and behaviors includes identifiable health care paraphernalia and settings, emotional and cognitive engagement with clinicians, empathic and intimate witnessing, and the laying on of hands.”

They also say that, “Placebo effects rely on complex neurobiologic mechanisms involving neurotransmitters (e.g., endorphins, cannabinoids, and dopamine) and activation of specific, quantifiable, and relevant areas of the brain…”

They ask us to remember three things about the neurobiologic workings we label the “placebo effect”.

1. “ Placebos may provide relief, they rarely cure.”

2. “Placebo effects are not just about dummy pills: the effects of symbols and clinician interactions can dramatically enhance the effectiveness of pharmaceuticals.”

3. “The psychosocial factors that promote therapeutic placebo effects also have the potential to cause adverse consequences, known as nocebo effects. Not infrequently, patients perceive side effects of medications that are actually caused by anticipation of negative effects or heightened attentiveness to normal background discomforts of daily life in the context of a new therapeutic regimen.”

What if you had a doctor who you could say, “… lived by faith, a man who believed in things not seen, a man who believed there were better days ahead off in the distance, a man of service, who persevered knowing full-well he would not receive all those things he was promised, because he believed his efforts would deliver a better life for those who followed…”

What if you were cared for by a health professional of whom was said, “… his graciousness, his smile, his reassuring baritone, his deceptive sense of humor, all qualities that helped him wear so effortlessly a heavy burden of expectation.. wise beyond his years in his speech, in his conduct, in his love, faith and purity.. he never gave up. He stayed true to his convictions. He would not grow discouraged.”

What if you were cared for by a nurse of whom was said, “She conducted himself quietly and kindly and diligently. She encouraged progress not by pushing her ideas alone but by seeking out your ideas, partnering with you to make things happen. She was full of empathy and fellow feeling, able to walk in somebody else’s shoes and see through their eyes.” Suppose that person believed that “Our calling, is not just within the walls of the congregation but the life and community in which our congregation resides.”

What is the placebo effect really, but a bias toward success, toward trust, toward health, toward hope. What if it is grace – the kind of “Amazing Grace” our President highlighted – in action? What if the “nocebo effect” is the expression of an opposite physiologic effect, one fueled by hatred, fear, prejudice, hopelessness?

What should we do with this grace, this placebo effect? The President says that God has “given us the chance where we’ve been lost to find out best selves. We may not have earned this grace with our rancor and complacency and short-sightedness and fear of each other, but we got it all the same. He gave it to us anyway. He’s once more given us grace. But it is up to us now to make the most of it, to receive it with gratitude and to prove ourselves worthy of this gift.”

The medical authors this week emphasized that symbols can ignite both the “placebo effect” and the “nocebo effect”. On this issue, our President was clear.

“For too long, we were blind to the pain that the Confederate Flag stirred into many of our citizens. It’s true a flag did not cause these murders. But as people from all walks of life, Republicans and Democrats, now acknowledge, including Governor Haley, whose recent eloquence on the subject is worthy of praise as we all have to acknowledge, the flag has always represented more than just ancestral pride. For many, black and white, that flag was a reminder of systemic oppression and racial subjugation.”

“We see that now. Removing the flag from this state’s capital would not be an act of political correctness. It would not be an insult to the valor of Confederate soldiers. It would simply be acknowledgement that the cause for which they fought, the cause of slavery, was wrong. The imposition of Jim Crow after the Civil War, the resistance to civil rights for all people was wrong.”

“It would be one step in an honest accounting of America’s history, a modest but meaningful balm for so many unhealed wounds. It would be an expression of the amazing changes that have transformed this state and this country for the better because of the work of so many people of goodwill, people of all races, striving to form a more perfect union. By taking down that flag, we express God’s grace.”

This week’s medical authors say, “…placebo effects can help explain mechanistically how clinicians can be therapeutic agents in the ways they relate to their patients in connection with, and separate from, providing effective treatment interventions.”

But isn’t that the job of all of us? Shouldn’t each of us try to exercise our internal placebo workings, our “Amazing Grace”, by, as the President said, “recognizing our common humanity, by treating every child as important, regardless of the color of their skin or the station into which they were born and to do what’s necessary to make opportunity real for every American. By doing that, we express God’s grace.”

For Health Commentary, I’m Mike Magee.

Category: health care
Tags: Amazing Grace > Charleston > Clementa Pinckney > Confederate Flag > Franklin Miller > grace > Health > health care > new england journal of medicine > nocebo effect > placebo effect > President Obama > Ted Kaptchuk

AMA Relieved

Posted on | June 25, 2015 | 2 Comments

Steven J. Stack, MD President

“The American Medical Association (AMA) is relieved that today’s Supreme Court decision will allow millions of patients to continue accessing the health care they need and deserve.

“Physicians know that the uninsured live sicker and die younger so the AMA has been a leading voice in support of expanding health insurance access to ensure patients can get the care they require.

“The subsidies upheld today help patients afford health insurance so they can see a doctor when they need one and not have to wait until a small health problem becomes a crisis. The subsidies provide patients with peace of mind that they will not risk bankruptcy should they become seriously ill or injured and experience catastrophic health care costs.

“With this case now behind us, we hope our country can move forward and continue strengthening our nation’s health care system.”

Category: healthcare reform, Uncategorized
Tags: aca > ama > King v. Burwell > Obamacare > Steven J. Stack

Scientific Literacy – Critical in a Capitalistic, Free Society.

Posted on | June 24, 2015 | Comments Off on Scientific Literacy – Critical in a Capitalistic, Free Society.

Mike Magee

This week the FDA announced that they are finally banning Trans Fats though food companies have three years to comply, which means three years to lobby for delay or repeal of the ruling.

Fundamental to the ineffectual delayed response has been purposeful confusion sown by the very organizations that invented these “foods” and portrayed them to an uncritical public as healthier than their natural alternatives.

This marketing challenge was made easier due to a rather fundamental and widespread level of illiteracy in America when it comes to basic chemistry. I tackled this issue, with respect to “Trans Fats” back in 2007, creating a video that helps explain what they are. You can view it HERE.

What are the basics you should know?

The Balanced Diet:

A balanced diet is about taking in the recommended portions of protein, carbohydrates and fats. The American Heart Association recommends that fats should make up 25% – 35% of our daily diet. The right combination of fats is critical to life. Fats are an important source of energy, they’re essential for growth and development, and they help regulate blood pressure, heart rate, blood clotting, nerve transmissions and temperature control.

What is a fat?

It’s mostly a chain of carbon and hydrogen atoms with a couple of oxygen atoms attached to the tail end. Carbon is the main player here, and because of the atomic structure of carbon, it is able to form four bonds to other structures. When you create a carbon straight chain you immediately fill 2 of the 4 spots for each carbon. That leaves two spots open.

Saturated Fat:

If you fill all the open spots with hydrogen, or saturate the structure with hydrogen, you’ve created a “saturated fat.”

Unsaturated Fat:

Dropping a couple of hydrogen atoms and using the extra spots to doubly connect two carbon atoms together creates what is called a “double bond.” Because several hydrogen spaces have been evacuated, an “unsaturated fat” has been created. If the chain has only one double bond, it is a “monounsaturated fat.” If the chain has two or more double bonds, it’s a “polyunsaturated fat.”

Trans Fat:

Now, if you take an unsaturated fat with a double bond, heat it and add hydrogen, you can change the position of the hydrogen atoms at the double bond. Usually they are both on one side of the chain, but the chemical reaction causes one hydrogen to cross over to the other side of the chain so that the hydrogen atoms now sit across from each other. We call this a “trans fat,” because “trans” means across.

History of Trans Fats:

We first started making trans fats when concerns surfaced about the health effects of saturated fats in butter. By hydrogenating vegetable oil – that is, adding hydrogen atoms to create trans fats – we discovered that liquid vegetable oil turned solid and could be sold as sticks of margarine. From the 1950s to the 1980s, we thought what we were doing was healthy. Tufts University nutrition professor Alice Lichtenstein has said that back then “anything was good if it decreased saturated fat consumption. But then studies began to question ‘trans fats’ too.”

Fats, Cholesterol, and Cardiovascular Disease:

Unsaturated fats, those with one or more double bonds, are good. They lower bad LDL cholesterol and raise good HDL cholesterol. Trans-fats, those liquid-to-solid hydrogen creations, are the evil twin. They raise LDL cholesterol and lower HDL cholesterol. Unsaturated fats lower rates of heart attack and stroke. Trans fats raise them. Saturated fats with endless straight lines of carbon and hydrogen that we worried so much about in the past? Still bad, but not as bad as trans fats. Saturated fats raise LDL and HDL, but the net overall effect is more harmful than it is good.

Take-Away:

In our capitalistic, free society, lack of scientific literacy makes us vulnerable to those who would profit at the cost of our healthy futures. We have seen this story play out in many forms – tobacco, food, energy. Profiteers first deny, then confuse, then resist, then delay. It’s a long and painful process to reverse the harm they have done. They are by no means innocent. But if there is a take-away, it is this. We are responsible for knowledge acquisition. If we are lazy; if we are distracted; if we are not dogged in the pursuit of truth; we will (as we have in the past), pay for our errors.

Knowledge must be acquired and transferred. Having trouble visualizing the chemistry above. Check out this video, and pass it on.

For Health Commentary, I’m Mike Magee.

Category: public health, Uncategorized
Tags: American Heart Association > bad health policy > fats > FDA > public health > scientific literacy > trans fats

King v. Burwell – Thursday, 10 AM. Friday’s Question For Presidential Candidates: “What’s Your Plan Now?”

Posted on | June 14, 2015 | Comments Off on King v. Burwell – Thursday, 10 AM. Friday’s Question For Presidential Candidates: “What’s Your Plan Now?”

Mike Magee

According to the official blog of the Supreme Court of the United States, this Thursday at 10 AM, we can expect some decisions coming down in the much publicized case, King v. Burwell. But while many Americans have vaguely heard of the case, few understand exactly what the case is about, and what is at stake in the ultimate decision.

In a nutshell, the case, being funded by the libertarian think tank, Competitive Enterprise Institute, claims that the Internal Revenue Service exceeded the powers granted it by Congress through the Affordable Care Act (Obamacare) when it extended subsidies to help cover federally run insurance exchanges for low income Americans. In their literal reading of the law, subsidies were allowed to be granted only by state run exchanges.

Federal exchanges come into play when individual states decline to set up their own exchanges. (So far only 16 states and the District of Columbia have set up fully independent state exchanges.) Were the challenge to carry this week, subsidies would disappear in the 34 states without a state run exchange, leaving an estimated 5 million in those states in the lurch. What’s interesting is that the insurance companies in these states would still be required to provide the insurance, but the rates for unsubsidized individuals would rise and preclude participation by many. The pool of insured would shrink, broadly undermining the ACA itself.

Collapsing the program is the goal. Opponents of ACA haven’t be shy about trumpeting this, and the chorus has blared ever louder as the Presidential campaign gains steam. And while opinions vary on the value of ACA, all agree that undermining it now would be significantly disruptive, and carry with it a political cost.

This point was highlighted in the Commonwealth Fund survey released this week on the programs growing popularity. A rather remarkable 86% of Americans covered under the ACA through the exchanges or associated expanded Medicaid programs were “very” or “somewhat” satisfied with their insurance. More specifically, 91% were satisfied with the choice of doctors in the program; 77% found it easy to find a primary care doctor through the program; and 60% were able to get an appointment with the doctor within two weeks.

A second survey released by the Urban Institute last week found that fears, registered by ACA opponents, that the new insurance exchanges would result in a wholesale collapse of employer based insurance, did not prove to be true. In fact, the percentage of employees covered with health insurance provided by their employers has remained steady at 70%.

For a presidential hopeful who is opposed to the ACA, a ruling for CEI on Thursday may be met with muted cheers. Why? Because on Friday, he or she will have to figure out what to say to the millions of disenfranchised, formerly insured American citizens, and how to answer the question certain to be posed again and again on the campaign trail, “What’s your plan now?”

For Health Commentary, I’m Mike Magee

Category: health care reform, Uncategorized
Tags: aca > affordable care act > CEI > Commonwealth Fund > health policy > health reform > King v. Burwell > Obamacare > SCOTUS > supreme court > Urban Institute.

The Microbial Threat: Why The White House Is Engaged.

Posted on | June 7, 2015 | Comments Off on The Microbial Threat: Why The White House Is Engaged.

Image Credit:Medical Daily.com

Mike Magee

Infectious diseases are all the rage these days. Bird flu and MERS outbreaks are back in the news. Hepatitis C is pervasive in the Appalachian states, tick-borne Lyme disease is heading north and coliform bacteria is finding its way onto college toothbrushes in CT. Water is being boiled in Utah, Blue Bell ice cream comes laced with Listeria, and a common cat parasite, some say, may cause brain disorders in cat owners.

It’s no wonder that the White House is concerned about degrading our disease fighting weapons and promoting a strategy to limit the emergence of antibiotic-resistant bacteria.

Infectious microbes – tiny organisms that include bacteria and viruses – are living entities with a nearly unlimited ability to adapt. Microbes reproduce approximately every 30 minutes. This event allows constant mutation, migration, and adaptation of these organisms, which are the basic building blocks for some of the world’s most virulent diseases. The new forms that survive their predators, which include antibiotics and antivirals, go on to reproduce, multiply, and thrive. Staying one step ahead of these survivors requires surveillance, testing, and the redesigning of strategies through research, development, and distribution of new medicines and vaccines.

We develop antimicrobials in order to control symptoms, to destroy organisms, and to seek to eradicate diseases. With the development of new classes of antimicrobials in the 1950s and 60s, the scientific community prematurely thought it could claim victory over microbes. In fact, in the late 1960s, Surgeon General William H. Stewart stated it was “time to close the book on infectious diseases, declare the war against pestilence won, and shift national resources to such chronic problems as cancer and heart disease”.

Yet over a half-century later, we continue to struggle with highly recognizable foes like malaria, tuberculosis and HIV, and newcomers like SARS, Bird Flu, and MERS. Five distinct threats have emerged in our evolving battle with infectious diseases:

First, the resurgence of endemic diseases, especially in the developing world.

Second, a growing link between microbes and chronic diseases.

Third, drug-resistant microbes.

Fourth, new emerging infections, and fifth, the threat of bioterrorism.

With so many sources for trouble, it’s little wonder that infectious diseases remain a dominant cause of death worldwide. At the turn of this century, infectious diseases caused 26 percent of global deaths. Four million deaths were attributed to respiratory infections; 2.8 million to HIV/AIDS; 1.8 million to diarrhea; 1.6 million to TB; and 1.3 million to malaria.

Several factors have coalesced to make this an ideal time for an emergence of infectious diseases, according to the Institute of Medicine.

The microbes themselves have demonstrated truly remarkable genetic and biologic flexibility. We’re seeing changes in our physical environment, with global warming and weather patterns being favorable to microbes. Social, political, and economic factors, compounded by war and famine, have led to a breakdown in public health measures. Human behavior and activities bring people into contact with species of animals that harbor transmittable diseases. And finally, high speed travel and the threat of terrorism have the world on edge.

Infectious diseases are a critical concern for developing nations, but they are no less active in more developed countries, especially as they associate with an explosion of chronic diseases. In fact, the role of infectious diseases in the creation of chronic diseases is becoming increasingly well defined.

Clearly, greater investment in predictive science and preventive measures will be required if further pandemics are to be avoided. The Spanish Flu Pandemic in 1918 and 1919 killed nearly 50 million people worldwide. The 1957 to 1958 Asian Flu Pandemic and the 1968 to 1969 Hong Kong Flu claimed 1 million and 700,000, respectively. The progressive reduction in the number of deaths was primarily the result of effective antibiotics that controlled secondary bacterial infections.

Today, some believe another massive flu pandemic is conceivable because of the converging elements of a “perfect storm.” These elements include, first, the possible emergence of a strain of influenza that is non-responsive to existing vaccines. Second, the association of the virus with a highly resistant secondary bacterial infection. And third, extraordinarily fast proliferation under the radar screen due to the hyper-mobility of today’s traveler’s. Consider that in 1950 we had 200 million travelers worldwide. Fifty years later, this number increased seven fold to 1.4 billion, and ten years later, those numbers continue to swell. Charles Darwin said, “It is not the strongest of the species that survives, nor the most intelligent, but the one most responsive to change.”

The White House report not only acknowledges that o manage microbes we need to change faster than they do, but also, that we need to assure that the current weapons we possess to fight infectious diseases are not foolishly degraded by improper overuse. To review their findings and action steps, go HERE.

For Health Commentary, I’m Mike Magee.