The Planetary Patient “Where the wind comes sweeping down the plain.”

Posted on | April 10, 2015 | Comments Off on The Planetary Patient “Where the wind comes sweeping down the plain.”

https://www.youtube.com/watch?v=mrDVzbeDzRk

source:https://www.youtube.com/watch?v=mrDVzbeDzRk

Mike Magee

Hugh Jackman in 1998, in the film version of the Broadway classic, Oklahoma, sings “We know we belong to the land, and the land we belong to is grand….you’re doing fine Oklahoma, Oklahoma OK.”

But as this week’s The New Yorker article, Weather Underground, suggests, not so much these days. Okie endurance and chance mythology is legendary. But as the Dust Bowl revealed in the 1930’s, burying your science head in the sand carries some serious risks. But the modern day risk isn’t tied to the Agriculture sector. It’s tied to the Energy sector.

Mary Fallin, the state’s two term Republican governor, and former two term Congresswoman, recently combined the state’s Secretary of the Environment and their Secretary of Energy positions. That tells you about all you need to know about the state’s feelings toward their current drill based economy.

The state’s Energy Resources Board says that 1 in every 5 jobs is tied to the oil and gas industry. That the rush toward fracking and natural gas has yielded wealth is indisputable. But distributing that wealth equitably is another story. A quarter of the state’s children live below the poverty level, and the state ranks 46th in overall health measures.

The mismanagement of human health in the state has now spread to the planetary patient. Up until 2008, when widespread fracking began, the state experienced 1 or 2 magnitude 3.0+ earthquakes a year. In 2009, there were 20. Five years later, they registered 585.

The United States Geological Survey has traced the problem not to fracking, which does cause earthquakes, but almost all are less than magnitude 3.o. The problem, they say “with virtual certainty”, is the result of deep, contaminated-water, disposal wells that often penetrate the Earth’s basement rock.

This effect is an “unintended consequence” of required safe disposal of mountains of brackish, chemically contaminated water, produced by the fracking process. In Oklahoma, they’re pulling up 10 barrels of the stuff for every barrel of oil retrieved. And it has to go somewhere.

Now the state does maintain the Oklahoma Geological Survey. It is part of the Oklahoma University College of Earth and Energy, sitting on the campus that also houses the ConocoPhillips School of Geology and Geophysics. Rival Oklahoma State University has a school for geology as well, the Boone Pickens School of Geology. At O.U., competing interests are balanced by their long-term university president, David Boren, a former U.S. senator. He also sits on the Board of local oil company, Continental Resources.

The people of Oklahoma are getting a bit nervous, as more and more of their homes shake to the foundations. 3639 magnitude 3.0+ quakes have been recorded now from 2009 to 2014. And what makes it worse is that, for a portion of the citizens whose houses are quivering, they don’t own the mineral rights on the very fragile land they live on. In the past, a land owner could refuse to let the drillers onto their land. But in the past few years, in some counties, those rules have been quietly changed.

In October, 2013, the U.S. Geological Survey issued a press release stating that the chances of a magnitude 5.5+ earthquake in Oklahoma had “significantly increased”. This in the state with “flowers on the prairie where the June bugs zoom, plenty of air and plenty of room; plenty of room to swing a rope, plenty of heart and plenty of hope.”

Economics can’t be denied. And health is certainly a function of social determinants, which lag poorly where poverty and income disparities rule. But of equal concern is the Planetary Patient, which in equal measures with economics, has and will continue to impact individual and population health.

For HealthCommentary, I’m Mike Magee.

Brookings Invitation

Posted on | March 30, 2015 | Comments Off on Brookings Invitation

Assessing the Affordable Care Act’s efficacy, implementation, and policy implications five years later.

Tuesday, April 14, 2015, 9:00 AM — 12:00 PM (EST)  The Brookings Institution, Falk Auditorium, 1775 Massachusetts Avenue, NW Washington, DC 20036

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The Patient Protection and Affordable Care Act, most commonly known as the Affordable Care Act (ACA), is one of the most important pieces of legislation enacted into law and implemented by the federal government in a generation. The ACA is also one of the most complex and comprehensive efforts to reform the American health care system and reduce costs. Now that the ACA is five years old, how successful has the law been in meeting its primary goals? What has been its efficacy in transforming American health care? What have been the major outcomes and unintended consequences? And what might the future hold for this law, given today’s political environment and a pending, major U.S. Supreme Court decision that could determine the ACA’s fate?

On April 14, Governance Studies at Brookings will host a forum to examine the ACA five years after its passage. This forum is the sixth annual A. Alfred Taubman Forum on Public Policy, which will convene leaders from academia, the media, and government to explore the far-reaching implications of the ACA. Discussion will focus on the law’s successes and failures as the most consequential piece of health care legislation in recent history.

9:00 AM — A new way of covering the uninsured – how the ACA has changed American health care & the reverberations to come
Moderator: Darrell West, Douglas Dillon Chair and Vice President and Director,  Governance Studies, The Brookings Institution  Andrew Slavitt, Acting Administrator, Centers for Medicare and Medicaid Services  Department of Health and Human Services

10:00 AM — Examining the ACA’s implementation, successes, and failures and efforts to modernize health care delivery
Moderator: Elaine Kamarck, Founding Director and Senior Fellow, Center for Effective Public Management, The Brookings Institution Eric Patashnik, Professor, Public Policy and Politics, University of Virginia Kavita Patel, Managing Director, Clinical Transformation, Center for Health Policy; Fellow, Economic Studies, The Brookings Institution

11:00 AM — Has the ACA succeeded in bending the health care cost curve?
Moderator: Alice Rivlin, Leonard D. Schaeffer Chair in Health Policy Studies and Director, Center for Health Policy; Senior Fellow, Economic Studies, The Brookings Institution Steven Brill, Founder, Brill Journalism Enterprises, LLC; Author, American’s Bitter Pill: Money, Politics, Back-Room Deals, and the Fight to Fix Our Broken Healthcare System Jean Moody-Williams, Deputy Director, Center for Clinical Standards and Quality, Centers for Medicare and Medicaid Services, Department of Health and Human Services

Category: Uncategorized

There is always time to choose compassion

Posted on | March 27, 2015 | Comments Off on There is always time to choose compassion

source

Meredith Magee Donnelly

There are a few moments in my life that I will cherish forever. The birth of my daughters was not a beautiful, calm experience. They were going to be born 6 weeks early, because of the anatomy of my spine the epidural wouldn’t go in, and after thirty horrific minutes of trying it was decided they were going to have to put me completely under to have the caesarean section. It was an awful moment. My husband was still in the waiting room and wasn’t going to be able to come in before they gave me the anesthesia.

It was lonely. It was sad. It was scary. But I’ll never forget the next moment. My doctor put her hands on my shoulders and came close to my face and quietly said “Meredith, I know not one thing has gone your way in this pregnancy and I am so sorry for that. I wish I could change it, but this is what we need to do for your girls.” It was 10 seconds, but those 10 seconds meant a lifetime to me.

There is always time to choose compassion. The choice is yours.

http://homegrownfriends.com/

Category: Uncategorized

Affordable Care Act. “The Sky is Falling!” No It’s Not.

Posted on | March 25, 2015 | 1 Comment

Mike Magee

Since the signing and implementation of the Affordable Care Act, with its successful provision of coverage for millions of uninsured and expansion of Medicaid in participating states, there has been a constant stream of warnings of impending disasters of various sorts.

It will break the bank! Early results show the opposite to be true.

Over utilization, fraud and waste will abound! There is no evidence of an uptick in any of these areas.

And finally, we’ll run out of doctors and their offices will be swamped by needy, super-sick patients!

On this final fear, Athena Health with the RWJ Foundation have just completed an analysis of the physician workforce demands secondary to the implementation of the Affordable Care Act. Some had warned that physician offices would be overrun by the new demand and chaos would reign. The results were far less dramatic.

The Issue:

“In the first year of the ACA’s health insurance expansion, some expected an influx of sick, newly insured patients to burden many practices across the nation. However, in 2014 there was only a very small increase in new patients while the percentage of patients with complex medical needs decreased.”

The Findings:

1. “New patient visits to primary care providers increased very slightly from 22.6% of all appointments in 2013 to 22.9% in 2014.”

2. “The percentage of visits with patients with complex medical needs decreased from 8.0% of appointments in 2013 to 7.5% in 2014.”

3. “The ACA has decreased the overall proportion of uninsured patients receiving care in physician offices, especially in Medicaid expansion states.”

4. “The number of diagnoses per patient visit also did not increase sharply compared to the previous year’s data.”

Passions aside, looks like we’re on the right track.

Category: healthcare reform, Obama Health Care Team
Tags: affordable care act > Obamacare > physician manpower > physician workforce > primary care

Sunny Days

Posted on | March 22, 2015 | Comments Off on Sunny Days

Mike Magee

So here’s my back yard with 9 days left in March. But I choose not to focus on the snow, but rather the sun – which is shinning today, and will soon lead to a short New England spring and a beautiful New England summer. But the sunny season for many has come to mean “sunfusion” – sunlight confusion. Is sun exposure good or bad? Let’s start here: Sun Beds (tanning salons) – bad.(1)

But what about everyday natural sun? On the positive side: boosts Vitamin D (may protect against diabetes, heart disease, osteoporosis and other diseases), elevates endorphins, and increases self esteem (in some). On the negative side: cancer, aging, cataracts and more. (2) Quite a divergent set of realities. No wonder we’re confused whether to seek sun or shade.
Let’s look at some basic sun facts. (3,4)

The Rays: UVA – penetrates clouds and glass, penetrates deep into skin layers (epidermis and dermis), creates wrinkles and causes skin aging, featured in tanning booths. UVB – stimulates melanin, varies with site and environment, penetrates upper layer of skin (epidermis), aids vitamin D production, can cause sun burns. (5,6)

A New Threat: Not really. But our focus has increased for good reasons. Sun worshiping and a “healthy” tan are now associated in our culture with health and wealth. We’re living longer (damage and risk are cumulative), beach wear exposes more skin surface, and today tanning parlors are big business. (2)

Reasonable Levels of Exposure: Some feel that over reaction to sun risk has caused an increase in Vitamin D deficiency. For most in the US, up to 30 minutes standard exposure 3 times a week takes care of Vitamin D, which is also available through supplements. (2,7)

The Cancers: 90% are directly linked to cumulative UV exposure. This includes basal cell and squamous cell cancers. Basal cell cancers occur mostly on the face and have a low risk of spreading. Squamous cell cancers often occur on ears, lips and temples and are more prone to spread. As for melanomas,experts say about 2/3 are directly related to UV induced genetic mutations. While only 3% of skin cancers are melanomas, they account for 75% of skin cancer deaths and are the most common cause of cancer for adults age 25 to 29. (3,4,6)

Tan Equals Protection: No. Tan equals skin damage. Melanin is sent to the upper layer of the skin to try to block UV rays. Tan does give some blocking equal to 3 SPF sun screen but skin cell DNA damage is the price you pay for this inadequate response. Tan also equals deep collagen damage which means wrinkles and visibly aging skin. (8,9)

Skin Tones: Six types ranging from freckle-faced fair to black skin face varying levels of risk according to the Skin Cancer Foundation. (2) If you are the former like me, SPF 30 should be your constant companion and you need to head for shade whenever possible. Others can get by with SPF 15. Site matters especially beaches and mountain slopes. Clearly lying on the beach all day fully exposed doesn’t make sense for anyone.

Sunscreen Confusion: FDA in 2011 published new standards for protection and terminology need upgrading. No more use of the terms “sunblock” or “waterproof”. And SPF ratings over 50 will disappear as the SPF up-coding between competitors abates. The new system will be a simple 1 to 4 rating and include UVB and UVA rays. (8,9,10)

So those are the basic facts. Hopefully that solves some of the “sunfusion”. Bottom line – moderation, common sense exposure, increased care for the very fair.

For Health Commentary, I’m Mike Magee.

References:

1. Magee M. Dangers of Tanning. Health Politics. 2006.http://www.youtube.com/watch?v=qaMv3xyIvR0&feature=channel_page

2. Beck M. Sun-Kissed or Sunburned? The Wall Street Journal. D1. April 27, 2010.http://online.wsj.com/article/SB10001424052748703465204575208011470022100.html

3. Skin Cancer Foundation. Basic Facts. http://www.skincancer.org/Skin-Cancer-Facts/

4. Skin Cancer Fact Sheet. American Academy of Dermatology. https://www.aad.org/search/?k=skin+cancer+facts

5. Skin Cancer Foundation. UV Information. http://www.skincancer.org/UV-Information/

6. Landro L. A Shade Seeker Finds New Ways To Block UV Rays. The Wall Street Journal, D1. April 27, 2010. http://www.wsj.com/articles/SB10001424052748704388304575202110726832690

7. Vitamin D Fact Sheet. American Academy of Dermatology. http://www.aad.org/media/background/factsheets/fact_vitamind.htm

8. Skin Cancer Foundation. Sunscreen. http://www.skincancer.org/Sunscreen/

9. Facts About Sunscreens. American Academy of Dermatology. http://www.aad.org/media/background/factsheets/fact_sunscreen.htm

10. FDA Announces New Requirements for OTC Sunscreens. 2012. http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/ucm258468.htm

Category: cancer, National Skin Cancer Foundation, prevention, public health
Tags: cancer > dermatology > FDA > skin care > skin safety > sun > sun screen > tanning beds > vitamin d

Status Report – 27 Months After Newtown.

Posted on | March 13, 2015 | Comments Off on Status Report – 27 Months After Newtown.

Mike Magee

December 14, 2012 seems a long time ago – 27 months ago tomorrow. That is when 20 young souls, age 6 and 7, were shot down in Newton, CT. 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.”

Was our nation 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. They are now 2 1/2 million strong and growing. They are asking each of us to “Join the campaign to expose the NRA’s state-by-state effort to gut our public safety laws.”

Since Newtown, “Everytown For Gun Safety” has been tracking the shootings of youngsters in schools across America, and analyzing and mapping the events. They have just released the findings for December 15, 2012 – December 9, 2014. To see their maps, and the entire report, go HERE .

In the meantime, here’s their quick summary:

“In the two years since the mass shooting in Newtown, Connecticut, there have been at least 94 school shootings including fatal and nonfatal assaults, suicides, and unintentional shootings — an average of nearly one a week. During the last three months alone, there were 16 school shootings including a single week in which there were five incidents in five separate states. These school shootings resulted in 45 deaths and 78 non-fatal gunshot injuries. In 32 percent of these incidents at least one person died.”

“Of the K-12 school shootings in which the shooter’s age was known, 70 percent (28 of 40 incidents) were perpetrated by minors. Among these K-12 school shootings where it was possible to determine the source of the firearm, nearly two-thirds of the shooters (10 of 16) obtained their guns from home.”

“In 35 shootings— more than a third of all incidents — at least one person was shot after an argument or confrontation escalated and a gun was on hand. Regardless of the individuals involved in a shooting or the circumstances that gave rise to it, gunfire in our schools shatters the sense of security that these institutions are meant to foster. Everyone should agree that even one school shooting is one too many.”

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. So I encourage you to have a look at Everytown, and to make your town part of the movement. Join Moms Demand Action For Gun Sense In America.

Don’t Give Up! Don’t Give In!

For Health Commentary, I’m Mike Magee

Category: EHRs, gun safety, prevention, public health, public policy, safety
Tags: child safety > gun regulation > gun safety > newtown > NRA > public health > public safety

Why Hillary Clinton’s Private Email Matters: Transparency and Health.

Posted on | March 6, 2015 | Comments Off on Why Hillary Clinton’s Private Email Matters: Transparency and Health.

Mike Magee

Hillary Clinton’s use of a private email server to avoid the transparency that was assured by the Freedom of Information Act should be of concern to all Americans, Democrats and Republicans alike. If this is true for the general public, it goes doubly for anyone concerned with improving the health of our nation.

This is because health is fundamentally political. The battles between science and religion, industry and environmentalists, protectionists and profiteers, is hard-wired into our democratic process. Debate, compromise, and hopefully wise course corrections, require consensus and agreement on the facts. Debates can go on for years before consensus is reached, as is so well illustrated with global warming. It’s messy for sure, but impossible in the absence of transparency and disclosure.

In every Administration, there are significant battles, only partially visible, being waged in and among the differing wings of government. There is no reason to believe it would be any different with a Hilliary Clinton Administration. To illustrate how contentious things can become, and how we Americans rely on the free flow of information and an active Press Corps, let’s go back to 1988, and an investigative piece by Peter Schmeisser in the New York Times on July 10, 1988 called “Pushing Cigarettes Overseas”. Here’s a paraphrased summation:

A quarter of a century ago, C. Everett Koop shocked the Tobacco Institute, the lobbying arm of Big Tobacco, with the release of a 618-page report that had reviewed 2,000 research papers, and come up with one overlying conclusion: “Tobacco is as addictive as heroin”.

”Smoking is responsible for well over 300,000 deaths annually in the United States,” Koop said on July 10, 1988. Using charts to reinforce the data, he called for a , ”a smoke-free society.”

He faced some stiff opponents, and I’m not talking about R.J.Reynolds or Jesse Helms. I’m talking about members of the federal government, most specifically, the Office of the United States Trade Representative, who were anxious to open lucrative foreign markets to American tobacco.

The Departments of Commerce and State, as well as Southern congressmen, loved the $2.5 billion annually in export revenue and especially the 76% rise in tobacco export revenue in 1987 over the prior year.

There was trouble in the air. Canada had just pulled the plug on all tobacco advertising and established the principle of using warning labels. Additionally activists in Japan (where 63% of the adult population smoked) and China (where 90% of the adult population smoked) were beginning to use wartime language to describe the American advertising assaults, saying for example that “the current clash that pits America against Asia over tobacco and trade is nothing less than a new Opium War.”

There was no question where Koop stood on the issue of exportation. During the press conference that day he said, ”I don’t think that we as citizens can continue to tolerate exporting disease, disability and death.”

With trade officials like Catherine R. Field, associate general council at the trade office, it was business as usual. ”Personally, I have no love of cigarette smoke. But we are not telling people to smoke, we are simply gaining access to an existing market,” is what she said at the time.

Over the recent years, Europe had closed their doors to advertising. But companies like Philip Morris snuck through the back door by linking name and logo to Formula 1 Grand Prix cars. That had been going on since 1972.

Public Health experts like Judith L. Mackay, then executive director of the Hong Kong Council on Smoking and Health, warned about “the cost in mortality, hospital care, or lost productivity.” Ronald M. Davis, then director of the Centers for Disease Control’s office on smoking and health, agreed with her. He went on record to say, ”My life’s work has been devoted to reducing global morbidity figures, yet in this case we are exporting an obviously hazardous agent. This kind of thing perplexes me as a Government official and frustrates me as a doctor.”

The U.S. Trade Representative and allied Big Tobacco executives had the support of the Reagan Administration, and largely shut down public HHS activities on the issue. Peter S. Allgeier, Assistant U.S. Trade Representative at the time, easily slipped the noose saying that the U.S. loosing out on China’s annual 1.3 trillion cigarette addiction was foolish because “they’re going to smoke whether the U.S. is exporting cigarettes or not.”

David Yen, then chairman of the John Tung Foundation, a Taipei public health organization, had already sent a pleading letter to Reagan asking that the U.S. not use “tobacco as a tool to solve the trade imbalance…We are happy to buy any other American products, but please, don’t push your cigarettes on us.” He was especially worked up about R.J.Reynold’s latest stealth campaign which had sponsored a famous rock band for a concert, and offered tickets which could not be bought for any amount of cash. One could only get a ticket in exchange for 5 empty Winston cigarette packs – if you threw in 5 more, you received a ticket and a souvenir sweatshirt.

Who were the Tobacco Institute’s lobbyists at the time? Former Reagan Administration heavy weights, Michael Deaver and Richard Allen, now prominent Pro-Tobacco players. In the meantime, Jesse Helms was busy sending nasty letters to various country’s Prime Ministers threatening trade tariffs. Of course, he didn’t mention that the U.S. based, Southern companies were not even using North Carolina tobacco leaves at the time. In 1984, R.J. Reynolds had inked a deal with Beijing to harvest leaves and manufacture their product in China for Chinese consumption. Same thing for the Philippines, and on and on.

This caused U.S. Congressman Charles Rose (D, NC) to complain ”The farmers lose income, as the big tobacco corporations break into the Fortune 500.” Helm’s response? ”Our tobacco farmers are experiencing the best of times, with increased quotas…” Rep. Chet Alkins (D, MA) didn’t like the tone of that. He said, that the Reagan Administration was ”sending Asians a message that their lungs are somehow more expendable than American lungs.” Striking a Senior Statesman pose, Strom Thurmond, without cracking a smile said, ”I don’t think that we should dictate to other nations what their health policy should be. . . . That would be interfering with the internal policies of a sovereign nation.”

The president of the Tobacco Institute, added patriotically, ”Tobacco is one of the very few American industries that has the ability to produce a world-class export product.”

In America, we’ve come to expect that our Press will expose characters like these and their unhealthy activities to the light of day. But this is by no means assured. It requires that all of us – including Hillary Clinton – properly balance individual privacy concerns with pressing societal needs for transparency.

For Health Commentary, I’m Mike Magee.