An Invitation To Join Mike Magee in Syracuse, This Thursday 11/13/14.

Posted on | November 11, 2014 | 4 Comments

Veterans Day Invitation from Mike Magee

This Thursday, November 13, after 45 years, I will be returning to Syracuse. The trip is in response to an invitation from my Jesuit Alma mater, LeMoyne College. I spent four snowy years there, in the shadow of Vietnam and the Berrigan Brothers, from 1965 to 1969. I added four more years, a marriage and our first child, from 1969 to 1973, attending SUNY Upstate Medical School before heading South with the family to Chapel Hill. By the time we returned to New England in 1978, the war was over, but the human toil – physical, mental, spiritual – was visible in plain sight. It still is.

On Thursday, from 4:00 to 5:15 PM, I will be addressing student, faculty and guests at the college. My subject is WW II and how it defined U.S. health care for the next half century. My guides on this “tour” are three WW II veterans – all decorated, and all influential in my personal and professional life. There is a doctor, my father; an injured soldier and patient, Bob Dole; and a maverick economist and advisor to presidents on the health professional workforce during war and peace, Eli Ginzberg. In conversations with each of them, (and with the help of a bit of research), I have pieced together this story.

Consider this an Open Invitation, for any of you in the region Thursday, to join the conversation.

Here are the details:

Location: LeMoyne College – 1419 Salt Springs Road, Syracuse, NY, 13214. (315) 445-4100.

Site: SCA 318

Time: 4-5:15pm:

A Wise Father: “One Brain is Bigger Than Both Your Hands.”

Posted on | November 9, 2014 | 1 Comment

Credit:Jabin Botsford/The New York Times

Mike Magee

So it’s Sunday – and for many Americans (130 million when it comes to “Super-Bowl Sunday”) that means football. But as one post-election commentator opined today, “Politics determines who has the power, not who has the truth”.

Discussions around the future of NFL football are just about as fractionated and passionate as our deeply entrenched two party system. But at the end of the day, in the arena of science and diagnostic health care (at least as doctors, nurses and health professionals of all stripes espouse), truth = power.

When there is an impasse between reality and denial, lawyers eventually surface. That is one of the stop gates in the management of our civil society. There is an ample supply in this country of 300 million – about a million and a quarter lawyers from which to choose. In the NFL case, one spoke up.

Back in 2002, a physician in Allegeny County, PA, shared a beer with his friend, a young “working class” lawyer with a family passion for football. Dr. Bennet Omalu was a forensic pathologist at the county’s medical-examiner’s office. The friend was Jason Luckasevic, recent graduate from law school in 2000, then gainfully employed by a firm in Pittsburgh whose motto was “Working Lawyers for Working People”. For Luckasevic, whose godfather was president of the United Steelworkers local, that felt about right.

Dr. Omalu was anxious that day to share some findings from earlier in the week. He had done an autopsy on a 50 year old man who had for the past few years exhibited eratic behavior that had complicated his family life, and for a brief period, led to his seeking shelter in his pick-up truck. To Omalu’s surprise, the brain biopsy was filled with the tangled neurons and Tau protein deposits emblematic of Alzheimer’s disease.

That first patient was Pittsbugh Steeler Hall of Fame linesman Mike Webster. Omalu drew a straight line of cause and effect that day. And Luckasevic looked for further confirmation. Over the next two years, by word of mouth and inside referral, Omalu examined the brains of five other NFL players who had suffered early deaths and had some history of behavioral changes. All five showed the same characteristic neuropathologic findings.

Seven years later, in 2011, Luckasevic filed a law suit against the N.F.L., on behalf of 75 players. That number would grow. As for Dr. Omalu, in 2005, he published his findings in the journal, Neurosurgery. The N.F.L. was not amused, sensing an existential threat. They came at the accomplished Nigerian born pathologist with all guns blazing. In their attack, they mirrored tactics reminiscent of tobacco, chemical and pharmaceutical, agribusiness, and energy companies before them who had battled regulation and liability. They led with “medical experts” on their payroll. These “physician-experts” (a collection of team doctors) lied with straight faces on camera and in depositions, and enjoyed the opportunity to publish, in equal balance, “counter-claims” in reputable medical journals and in print and broadcast media.

The human and professional toll on Omalu is painfully documented in the remarkable PBS Frontline documentary, “League of Denial: The NFL’s Concussion Crisis.”

Besides utilizing familiar New York based, crisis intervention PR firms, the NFL went after media. As occurred a half century earlier when Monsanto and other chemical companies attempted to shut down the New Yorker serial publication of Rachel Carson’s “Silent Spring”, NFL pressured Frontline and Disney to not broadcast. And to the broadcast industry’s credit, they followed the New Yorker’s early lead and held tough.

The NFL has now admitted in legal documents that they believe up to 28% of their players have or will incur significant brain injury. They have tentatively agreed to a settlement that will provide around $1 billion in damages. But their future, and the futures of their players and fans, remain at great risk.

Watching Dr. Omalu on camera, I was filled with conflicting emotions – great sadness for the pain and suffering he has endured, and great pride for his courage and fortitude in the pursuit of his patient’s welfare, even at a tremendous financial and emotional cost. He is, after all, the doctor, the scientist, we intended to be when we each began this journey.

Which brings me back to the election. This morning, I saw a photo of my good friend and fellow physician, orthopedist and Pennsylvania native, John Barrasso, walking side by side, next to incoming Majority Leader Mitch McConnell. He was providing council, as they walked toward the White House yesterday. Of late, he has stepped back from the camera, where for a brief time he had been positioned by his party as a expert voice, a physician legislator, opposing the Affordable Care Act.

Watching him, I continue to see the potential for legislative greatness. His father, and his father’s father, ran a cement and masonry business in rural Pennsylvania. He learned at his father’s knee, how to build, how to constuct lasting foundations. But his Dad had larger dreams for John and his two younger brothers. Twenty years ago, John told me his father had told him, “God gave you one brain and it’s bigger than both your hands.” I thought of that quite literally when I listened to Dr. Omalu on Frontline. What is clear to the viewer is that this Nigerian born physician honored his profession and honored the truth. And in return he confronted power, and, for that, he deserves our eternal gratitude.

For Health Commentary, I’m Mike Magee.

Category: public health
Tags: aca > bennett omalu > concussions > football > jason luckasevic > John Barrasso > Mitch McConnell > NFL > public health > sports medicine

Why Are Medical Malpractice Rates Falling?

Posted on | November 1, 2014 | 3 Comments

Mike Magee

The finding is in. Malpractice awards against physicians are falling dramatically. The only two questions are “Why?” and “What does this have to do with quality health care, if anything?”

First the numbers. The JAMA study this week found:

1. Physicians paid claims decreased from 18.6 to 9.9 paid claims per 1,000 physicians between 2002 and 2013.

2. That translates into an annual decrease of 6.3 percent for MD’s and a 5.3 percent decrease forDO’s.

3. From 2007 to 2013, median payment’s have declined to $195,000 from $218,400 or average annual decreases of 1.1 percent per year.

During the years of the Obama Presidency we have seen significant changes in physician human resources including major shifts toward organizational employment vs. private practice, increased use of team approaches to care delivery, expanded use of “intensivists” and in-house Nurse Practitioners and Physicians Assistants, widespread expansion of EMR’s, and continued focus on Quality Improvement, including financial incentive systems tied to performance.

Is that what’s going on here, and what will the future hold? Study authors share there predictions.
1. Fights Over Status-Quo Will Continue and Be Non-Productive: “Debates and disagreement about traditional tort reforms, especially damages caps, will continue in the courts, in legislatures, and on ballot initiatives… They sap political energy and divert attention from alternatives…”
2. Communication/Resolution Programs Will Grow: “AHRQ is planning to support a nationwide scale-up of the communication-and-resolution approach. To that end, the agency recently awarded a contract for the development of a communication-and-resolution program implementation toolkit and training modules.”
3. Private Settlements: “There will be greater emphasis on laws that facilitate rapid private resolutions of medical injury disputes. Presuit notification, apology, and state-facilitated mediation laws can be adopted without vitiating traditional remedies to patients, and may encourage rapid dispute resolution.”
4. Creation of Safe Harbors: “The potential for safe harbors to improve safety and reduce cost through greater standardization of care will likely also keep them in the mix of attractive policy options. In February 2014, safe harbor legislation was introduced in Congress as part of the Saving Lives, Saving Costs Act.”
5. Physician Employment + ACO’s = Better Claim Resolution: “Tighter relationships between physicians and organizations enhance organizations’ ability to affect physicians’ behavior in ways that promote safety, transparency, and early resolution of injuries. These relationships also make it sensible to unify liability insurance under a single policy offered through the organization…”
6. Watch Out For Cycles: “…the lack of volatility in liability insurance costs may not last; it is reasonable to expect another increase in insurance premiums within the next few years.”

Now to the second question – “What does this have to do with quality of care?” Well. to begin with, there’s been pretty good evidence for awhile that even though medical malpractice law was intended to address poor quality by compensating patients for injuries resulting from negligence, and making future malpractice occurrences less likely, it has never really delivered.

In theory, this law made sense. Courts provide oversight when professional oversight breaks down. Doctors and hospitals are insured and therefore assured that a claim will not lead to financial ruin. Patients show restraint. And lawyers pursue only claims that have merit. But in practice, reality does not come close to this theory.

Three well-known scholars noted in 2004, the medical malpractice system “has internal logic but falls far short of its social goals of promoting safer medicine and compensating wrongfully injured patients.”1

The biggest problem? The medical malpractice system is fundamentally adversarial and built on a culture of blame. Doctors, hospitals, insurers, and lawyers have until recently been locked in battle with each other. Patients were routinely caught in their crossfire.

As a result, the status-quo didn’t bring relief to those who deserved it. A famous study conducted in 1984, at Harvard, examined 30,000 medical records and 3,500 malpractice claims. Only two percent of the patients who had suffered from negligence filed claims. Only seventeen percent of the claims that were submitted were in any way tied to negligence.(1,3)

The second big problem was that the tort system used litigation as its lever for change, while the safety movement uses quality improvement analysis. Tort law focuses on the individual. Safety focuses on the process. The tort system’s punitive style drives information down, encouraging secrecy. The safety movement requires a collaborative approach. This encourages openness, transparency, and continuous improvement. With tort law, exposing oneself can end one’s career and harm one’s mental health. In the safety movement, contributing is career-enhancing and therapeutic.(2)

So one should not be surprised that malpractice numbers are declining. As we move to a more organized approach to care delivery – based on expanded insurance, rationale teamwork, constantly improving processes, more home-based vs. hospital-based care, greater patient and family education/empowerment, and employed vs. independent physicians – we will continue to see these numbers improve.

That is what we should expect to happen. Why? Because the weaknesses in our health delivery system were never really based on fears of malpractice – that was a cop out. They were structural. And we’re finally doing what we should have done all along.

For Health Commentary, I’m Mike Magee

References:
1.Studdert DM, Mello MM, Brennan TA. Medical malpractice. NEJM. 2004; 350: 283-292.
2.Leape LL, et al. Promoting patient safety by preventing medical error. JAMA. 1998; 280:1444-1447.
3.Robinson GO. The malpractice crisis of the 1970’s: a retrospective. Law Contempt. Probl 1986; 49:5-35.

Category: medical malpractice
Tags: medical liability > medical malpractice > quality control > quality health care > quality improvements > team based care

America’s Scientific Bipolarism – “Woe Is Me.” vs. “Yes We Can!”

Posted on | October 24, 2014 | 2 Comments

SOURCE: HHMI NEWS Videos

Mike Magee

As ISIS and Ebola “take over the world” (or at least the hearts, minds, and fears of the planet’s human inhabitants), it is easy to be drawn into a downward mental spiral. This morning’s news features an MSF doctor, just back from treating Ebola patients in Guinea, travelling on the New York subways and bowling.

Putting aside the returning physician’s choices and/or the government’s seemingly inadequate policies related to close observation of high-risk individuals returning from Ebola treatment areas, the reality is that we have significant assets, whether military or scientific, that lie just beneath the surface, hidden but emerging in this world of “just-in-time” super heroes.

Item 1: A vaccine for Ebola. It turns out there is a prototype, reported out in 2005 to be highly effective that was shelved. It was never commercially pursued. Must I tell you why? Money talks – and until this current crisis, Ebola has been commercially mute. But on the positive side, the dollars are flowing now that the developed and developing worlds are in the same stew. Add to this the military-industrial complex/Homeland Security, which over the past few years became concerned enough about the Marburg virus and Ebola as weaponry, that they began funding development of an “antidote”. Bottom line: We’re about to see some rapid fire efficacy testing of more than one Ebola vaccine, and there is no shortage of “volunteers” for this study, nor professional motivation ($$$/Nobel).

Item 2. A very cool new microscope. The inventor is Eric Betzig who won a Nobel Prize this month in chemistry – but not for this. This was a creation that emerged from the scientist’s growing frustration with existing available microscopes. He wanted to visualize living, moving cells – normal and abnormal. He has now achieved at least the ability to do this, in 3-D, on a surface level. Twenty of his video images of different cell actions have been posted by the Howard Hughes Medical Institute(HHMI). And he aspires to soon go one step further and visualize living, moving physiology from inside the cells.

He’s pretty excited about it. As he says, “Every week we have new research groups coming in, and not to pat my own back too much, but I feel a bit like Galileo — everywhere you point this thing, you’re going to learn something new.” But he’s thinking forward, even now. He says, “The eventual goal is to marry all of my work together to make a high-speed, high-resolution, low-impact tool that can look deep inside biological systems.

Other scientists must be jealous, right? Well, not so much. Case in point, Harvard biology professor, Tomas Kirchhausen, who says, “I was so impressed by the instrument and its potential capabilities that I asked if it would be possible to clone it for my own lab. And Eric generously agreed.” But adds, “ “It’s great that we could clone the microscope for my lab. But I wish we could clone Betzig, too.” Who knows. Maybe this imaging will unlock new solutions to manage the Ebola plague and others that are certain to appear in the future.

Which only goes to prove that science discovery driven by imagination and joy may be just a bit more powerful than science discovery driven by mass fear and unfettered capitalism.

For HealthCommentary, I’m Mike Magee

Category: medical research, public health
Tags: Ebola > eric betzig > HHMI > new microscope > tomas kirchhausen

Is The US Prepared For Ebola – Special JAMA Article

Posted on | October 17, 2014 | 1 Comment

A special article in JAMA explores what went wrong in Dallas. It opens this way:

“The West African Ebola epidemic is a humanitarian crisis and a threat to international security.¹ It is not surprising that isolated cases have emerged in Europe and North America, but a large outbreak in the United States, with its advanced health system, is unlikely. Yet the handling of the first domestically diagnosed Ebola case in Dallas, Texas, raised concerns about national public health preparedness. What were the critical health system vulnerabilities revealed in Dallas, and how can the country respond more effectively to novel diseases in a globalized world?”

For the answer: Press Here.

Category: Uncategorized

Joint Statement on Ebola – AMA, AHA and ANA

Posted on | October 17, 2014 | 1 Comment

JOINT STATEMENT FROM THE AMERICAN HOSPITAL ASSOCIATION, THE AMERICAN MEDICAL ASSOCIATION AND THE AMERICAN NURSES ASSOCIATION

As our nation’s strategy to address the Ebola virus continues to evolve, hospitals and their partners in nursing and medicine are coming together to emphasize that a solution-oriented, collaborative approach to Ebola preparedness is essential to effectively manage care of Ebola patients in the U.S. Ensuring safe care for patients, healthcare workers, and communities demands the combined efforts of inter-professional, state, and federal organizations. In addition to domestic efforts to prepare for and treat Ebola, an enhanced focus on the part of the United States and the international community to contain the outbreak in West Africa is fundamental to stopping the spread of this virus.

Hospitals, physicians, and nurses have the same goals in addressing any Ebola case: to ensure that all hospital and clinical staff are able to safely provide high-quality, appropriate, patient care. We are committed to ensuring that nurses, physicians and all frontline healthcare providers have the proper training, equipment and protocols to remain safe and provide the highest quality care for the patient. As the Centers for Disease Control and Prevention (CDC) updates the protocols and procedures involved with patient care and personal protective equipment, we will review and share updated guidance with our collective memberships as it becomes available.

Our nation’s hospitals, physician and professional nursing organizations remain in communication with one another and with our nation’s public health institutions at the local, state and national levels. We are committed to maintaining a strong collaborative effort to address this public health threat.

Category: Uncategorized