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The Social Science of Covid

By MIKE MAGEE

As we enter the third year of the Covid pandemic, with perhaps a partial end in sight, the weight of the debate shows signs of shifting away from genetically engineered therapies, and toward a social science search for historic context.

Renowned historian, Charles E. Rosenberg, envisioned a similar transition for the AIDS epidemic in 1989. He described its likely future course then as a “social phenomenon” with these words, “Epidemics start at a moment in time, proceed on a stage limited in space and duration, follow a plot line of increasing and revelatory tension, move to a crisis of individual and collective character, then drift toward closure.”

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THCB Gang Episode 78, Jan 13

On #THCBGang I hosted the double trouble of vaunted futurists Ian Morrison (@seccurve) & Jeff Goldsmith, and medical historian Mike Magee (@drmikemagee) for an hour of conversation and banter about the health care system, the world in politics, and whether “Don’t Look Up” is a spoof or a documentary. Really good stuff, especially from Jeff on whether Medicare pays enough to keep hospitals alive. (Spoiler alter–he doesn’t think so!)

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

“Playing Doctor” – A Cautionary Tale From Health IT Pioneers.

By MIKE MAGEE

Warner Vincent Slack, MD, a pioneer of medical informatics, was a Professor of Medicine at Harvard Medical School in the Division of Clinical Informatics. When he died in 2018 at age 85, his memoriam read:

“For over 50 years, Dr. Slack conducted pioneering research on the use of computers in the medical world and was one of the founders of medical informatics. His goal was to empower both doctors and patients by improving the communication between them.”

Followers of Dr. Slack have labored hard over the past half-century to design solutions that will strengthen rather than weaken the bonds of the patient-physician relationship. But as he suggested at multiple points throughout his career, this goal becomes exponentially more difficult if politicians are allowed to “play doctor” with citizens’ lives.

His awareness of the fallout of the Terri Schiavo “right to die” case, beginning a dozen years after his seminal publication of  “Patient Power: A Patient Oriented Value System”, likely cast a long shadow on his optimistic vision. The case spanned 15 years, as it rode the poor health and disability of one unfortunate woman literally into her grave with devastating consequences for all concerned. 

As the Supreme Court readies itself to serve up opinions in the Texas vigilante and Mississippi abortion cases, the Schiavo case remains a cautionary tale that deserves a careful review. Here’s a quick summary:

  • Theresa Marie Schindler was born in a Philadelphia suburb on December 3, 1963.
  • Terri married her husband, Michael in 1984 and moved to Florida to be close to her parents. 
  • On February 25, 1990, suffering from an eating disorder, she collapsed in the lobby of their apartment, was resuscitated, and hospitalized.
  • Her husband, Michael, was made legal guardian on June 18, 1990. Two physicians independently declared her in a “permanent vegetative state.” A gastric feeding tube was inserted.
  • In mid-1993, Michael signed a Do Not Resuscitate (DNR) order.
  • In May 1998, he filed a petition to remove the feeding tube.
  • The parents challenged the removal in court and lost. The tube was finally removed on April 24, 2001.
  • The parents charged Michael Schiavo with perjury, and a judge ordered the tube reinserted 2 days later.
  • On September 17, 2003,  the appellate judge ordered the feeding tube removed for a second time.
  • Operation Rescue/Right to Life extremist Randall Terry began daily public demonstrations at the care facility.
  • The Florida legislature passed “Terri’s Law”, allowing Gov. Jeb Bush to order the feeding tube surgically reinserted for the third time.
  • On May 5, 2004, “Terri’s Law” was declared unconstitutional.
  • Senator Mel Martinez’s (R-FL) political career was damaged irreparably when memo’s revealed he played politics with the issue.
  • Senator Bill Frist’s hopes for the presidency went up in smoke on March 17, 2005, when he declared on the Senate floor, “I question it (vegetative state) based on a review of the video footage which I spent an hour or so looking at last night in my office.”
  • President Bush transferred the case to Federal Courts. The Federal Court agreed with prior State Court Appeals.
  • Terri Schiavo’s feeding tube was removed a final time on March 24, 2005. She died at a Pinellas Park hospice on March 31, 2005.
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THCB Gang Episode 75, Dec 16

Joining Matthew Holt (@boltyboy) for an hour of topical and sometime combative conversation on what’s happening in health care and beyond were — medical historian Mike Magee (@drmikemagee); futurist Jeff Goldsmith; fierce patient activist Casey Quinlan (@MightyCasey); and policy consultant/author Rosemarie Day (@Rosemarie_Day1).

Plenty of talk about voting rights, the future of American “democracy” and much more, and we did get back to health care eventually. A great & fun, while important, conversation!

You can see the video below where it’s kept for posterity. If you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels

THCB Gang Episode 73, Dec 2 1pm PT – 4pm ET

#THCBGang is back from its Turkey day snooze! Joining Matthew Holt (@boltyboy) at 1pm PT 4pm ET Thursday for an hour of topical and sometime combative conversation on what’s happening in health care and beyond will be patient activist, author & entrepreneur Robin Farmanfarmaian (@Robinff3);  Queen of all employer benefits related issues Jennifer Benz (@Jenbenz); medical historian Mike Magee (@drmikemagee); and patient safety expert and all around wit Michael Millenson (@MLMillenson)

You can see the video below live at 1pm/4pm or it’s kept here for posterity. If you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels

Can Democracy Survive In The Absence of Health Care Security?

By MIKE MAGEE

In my course this fall at the President’s College at the University of Hartford, we began by exploring the word “right” at the intersection of health care services and the U.S. Constitution.  But where we have ended up is at the crossroads of American history, considering conflicting federal and state law, and exploring Social Epidemiology, a branch of epidemiology that concentrates on the impact of the various social determinants of health on American citizens.

What makes the course timely and relevant is that we are uncovering a linkage between health and the construction or destruction of a functional democracy at a moment in America’s history when our democracy is under direct attack.

This was familiar territory for Eleanor Roosevelt. She spent the greater part of World War II creating what she labeled in 1948 “Humanity’s Magna Carta” – aka the “Universal Declaration of Human Rights (UDHR.)”

Embedded in the declaration was a much broader definition of health. It reads “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The Marshall Plan, for reconstruction of war torn Germany and Japan, embodied these principles, and successfully established stable democracies by funding national health plans in these nations as their first priority.

Although our nation signed the UDHR, it carried no legal obligations or consequences. In fact, the U.S. medical establishment’s bias was to embrace a far narrower definition of health – one that targeted disease as enemy #1. They believed that in defeating disease, health would be left in its wake.

In contrast, neighboring Canada took the UDHR to heart, and as a starting point asked themselves, “How do we make Canada and all Canadians healthy?” Where our nation embraced profiteering and entrepreneurship, leaving no room for solidarity, Canada embraced the tools of social justice and population health.

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What is the “Right” to Health Care Worth? It Depends

By MIKE MAGEE

In my course this Fall at the University of Hartford, titled “The Right to Health Care and the U.S. Constitution”, we have concentrated on the power of words, of precedents, and the range of interests with which health has been encumbered over several hundred years.

The topic has been an eye-opener on many levels. On the most basic level, it is already clear that the value of this “right” depends heavily on your definition of “health.”

We’ve highlighted three definitions worth sharing here. 

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The “Secret Sauce” – A Comparison of TSMC and Pfizer

By MIKE MAGEE

This week’s Tom Friedman Opinion piece in the New York Times contained a title impossible to ignore: “China’s Bullying Is Becoming a Danger To The World and Itself.” The editorial has much to recommend it. But the item that caught my eye was Friedman’s full-throated endorsement of Taiwan’s “most sophisticated microchip manufacturer in the world,” Taiwan Semiconductor Manufacturing Company (TSMC).

TSMC owns 50% of the world’s microchip manufacturing market, and along with South Korea’s Samsung, is one of only two companies currently producing the ultra-small 5-nanometer chips. Next year, TSMC will take sole ownership of the lead with a 3-nanometer chip. In this field, the smaller the better. (For comparison, most of China’s output is 14 to 28 nanometers.)

U.S. Silicon Valley companies like Apple, Qualcomm, Nvidia, AMD, and recently Intel contract with TSMC rather than produce chips on their own. In addition, the key machines and chemicals necessary to produce the chips are willing supplied to TSMC by U.S. and European manufacturers. TSMC’s secret sauce, according to Friedman, is “trust.” As he writes, “Over the years, TSMC has built an amazing ecosystem of trusted partners that share their intellectual property with TSMC to build their proprietary chips.”

“Trust me” is not a phrase often associated with intellectual property. Consider, for example, Washington Post’s reporting the very same day as Friedman’s under the banner, “In secret vaccine contracts with governments, Pfizer took hard-line in the push for profit, report says.” The article reveals documents in a Public Citizen report that confirms that Pfizer has been maximizing their vaccine profits “behind a veil of strict secrecy, allowing for little public scrutiny… even as demand surges…”

As I describe in my book “Code Blue: Inside the Medical Industrial Complex” (Grove 2020), Pfizer’s focus on intellectual property as a commercial weapon has a history that extends back a half-century.

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In “Riding” Abortion, Is Greg Abbott Driving Texas Toward Divestiture?

By MIKE MAGEE

Texas Governor Greg Abbott has been on a tear lately, and his central theme appears to be “revanchism.” Faced with declining demographics, he is retaliating against enemies and newcomers alike, aligning himself with slippery politicians and vigilantes. As they say in Texas, “He’s on a first-name basis with the bottom of the deck”, and the game he’s playing appears to be “South Africa – 1950.”

The formal establishment of apartheid in South Africa occurred in 1948, though racial injustice had been baked in centuries earlier. Violence and intimidation, embedded in legislation supported by a 15% white minority, led to the creation of the African National Congress (ANC) which launched what they called their “Defiance Campaign.” By 1962, their party had been outlawed, and their dynamic leader, Nelson Mandela, was imprisoned.

And yet resistance continued to grow, inside and outside the country. Religious leaders, like Archbishop Desmond Tutu, took to the street, organizing huge, peaceful rallies. In 1976, images of Black children being attacked and killed in Soweto township during a protest spread like wildfire around the world. 176 died and thousands were injured. In response, the United Nations called on its member states to divest and impose economic sanctions. Only 2 leaders did not. (More on that in a moment.)

Minority rule, oppression, vigilantism, and disenfranchisement are eventually losing propositions as Greg Abbott is learning. A majority of 52% now say his state is moving in the wrong direction. The list of grievances is long and continues to grow. Catholic bishops decried his inhumane handling of immigrant families this year. Baptist minister Rev. Frederick Haynes III spotlighted the Republican legislature’s voter suppression law recently suggesting they were “dressing up Jim and Jane Crow in a tuxedo.” Only 39% approve of his handling of the pandemic, and many Texans find the renewed endorsement of “vigilante justice” for unfortunate women and girls seeking abortions to be a disturbing and dystopian new reality. By the way, 1 in 5 Texans lack health insurance, and Texas is one of twelve Republican-led states that continue to refuse federal offers to expand Medicaid coverage of their citizens.

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The Vaccine Brawl – A Legal Battle in Process

By MIKE MAGEE

The power to mandate vaccines was litigated and resolved over a century ago. Justice John Marshall Harlin, a favorite of current Chief Justice Roberts, penned the 7 to 2 majority opinion in 1905’s Jacobson v. Massachusetts. Its impact was epic.

In 1905, Massachusetts was one of 11 states that required compulsory vaccinations. The Rev. Henning Jacobson, a Lutheran minister, challenged the city of Cambridge, MA, which had passed a local law requiring citizens to undergo smallpox vaccination or pay a $5 fine. Jacobson and his son claimed they had previously had bad reactions to the vaccine and refused to pay the fine believing the government was denying them their due process XIV Amendment rights.

In deciding against them, Harlan wrote, “liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own [liberty]…” 

Of course, a state’s right to legislate compulsory public health measures does not require them to do so. In fact, as we have seen in Texas and Florida among others, they may decide to do just the opposite – declare life-saving mandates (for masks or vaccines) to be unlawful. At least 14 states have passed laws barring employer and school vaccine mandates and imposing penalties in Republican-controlled states already.  

So state powers are clearly a double-edged sword when it comes to health care. 

Questions anyone?

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