Readings To Consider - 3/30/21

Books and Articles worth a Review… 

Terrorism and Health Care – In early February, Brian Michael Jenkins – an expert in terrorism who serves as a Senior Advisor for the non-profit, non-partisan think tank Rand Corporation – wrote an article on the issues related to terrorism. So, you immediately will ask the question: What does this have to do with health care? More than we tend to realize. First, there are the increased warnings which have been issued by the U.S. Department of Homeland Security noting that Homegrown Violent Extremists (HVEs) inspired by foreign terrorist groups are not only targeting government officials, they are also advocating threats of violence against critical infrastructure, including the health care, electric, and telecommunications sectors. The health care threats emanate from misinformation and conspiracy theories about COVID-19.  

First, there are the obvious traumas inflicted on individuals, groups, and communities through terrorist-type activities. Pushing a 70-some elder over by running at them to knock them to the ground inflicts pain and injury on the individual and terror within the community which is targeted. Second, there is the subterranean stress that clinicians treat from individuals who show up in emergency rooms and clinics with depression, anxiety, and all manner of emotional disorders. And, third, third is the secondary infliction of all sorts on members of society that cause many to shut down, shut out or turn off one another because of disagreements and positions that oppose one another. But, it’s not just the singular issue of contrary opinions – it is the sequelae of turning anyone with positions or perspectives different from our own off completely so that engagement, discussion, or debate are buried asunder. In many respects, these three elements are infecting the nature of our society and it is painful to wake every day to yet another event driving wedges between the members of our society.

In his article, Jenkins points out that the Biden Administration has stated its intentions for implementing actions that will address the questions related to domestic violent extremism. He further notes that – as a nation – we are experience acts of violence on both the far-left and far-right extremists. I’m not serving as an apologist for the recent flurry of events from the far-right. Rather, I’m being a realist that no “extreme” side of any political debate is likely to alter the course of a country’s directions if it truly believes that it embodies a true democracy. Democracy – a priori – requires the discussion, debate and dialogue in order to succeed. And, if we don’t have a stable democracy – how will we ever solve the pressing problems of health care for all, education for younger folks and re-education for out-of-work older folks, infrastructure that allows us to engage in state-of-the-art commerce and any manner of other society needs. So, in the end, I think solving these problems DIRECTLY affects health care in ways that are profound and formidable for a society purporting to serve the people.

Jenkins’ article is very worthy of a read. It outlines very clearly that domestic terrorism is a far more pernicious affliction than international terrorism on the lives of American citizens. We need to consider his decades of experience in the field of terrorism as we try to figure out what policies to implement and/or change – for the health of the nation!

Letters from an American by Heather Cox Richardson – Several years ago, I signed up for a daily observational note from Heather Cox Richardson, a Professor with Boston College but, more importantly, an observer of the American experience. She offers on a daily basis very poignant observations and outtakes on the American experience through the lens of history, politics and the like. You will definitely want to read her March 26, 2021 thoughts on the legislation passed by the Georgia legislature and signed into law by Governor Brian Kemp (R-GA). It’s a rewind through history and how diligent we must be in today’s current climate. You can also sign up for her newsletter if – after reading her observations – you have a further inclination to be challenged on a regular basis. 

Understanding Health Care – First, there are tons of books on the market related to health care. They often devolve into the complexities with dry statistics and description of complex relationship between the various players in the health care field. I’ve recently come upon a book that includes all of that information BUT, in a very understandable way. It’s like a “users guide” to the complexities of health care, titled: “The U.S. Healthcare Ecosystem: Payers, Providers, Producers” by Lawton Robert Burns. He developed the content of the book over a number of years as a “guide through the wilderness” for his Wharton MBA students. I recommend it – even for those of us who have been involved in wilderness wanderings for a long time. BTW – I don’t get a commission…

Economic Optimism – In the midst of the pandemic, it’s refreshing to hear some potentially positive news on the economic front. Neil Irwin, a reporter for the New York Times posted an article on March 13, 2021 listing 17 Reasons to Let the Economic Optimism Begin. It is a very interesting piece and I encourage everyone to read it. The basic premise is that we’ve come through a period of rapid globalization and technology change which has reduced the bargaining power of works in rich countries resulting in a movement of goods and services production to emerging countries. Secondly, the technological revolution is not over! The pandemic has served as a massive stimulus for innovation across the board among all sectors of the economy. I agree. In fact, for health care – which in the USA represents nearly 20% of the GDP – we’ve learned the virtual care if, if, if managed and deployed properly can be as effective, if not more effective, than more traditional modes of care delivery. Given the inefficiency that we all know exists within our industry, we should expect that health care will be a substantial target on the innovation, efficiency and change list of industries.

Readings To Consider - 3/11/21

Books and Articles worth a Review… 

Mandatory Reading for All of Us – The New England Journal of Medicine as one of the premier medical journals in the world published an editorial in the January 28, 2021 issue entitled One of Us. It is mandatory reading by all of us as we consider how to make health care better.

Winter Wonder Land – Now, the following has nothing to do with health care. Well, perhaps you could stretch it and say it has to do with mental health. Enjoy the Pandas as they delight in the Winter Wonder Land of the National Zoo.

Hallelujah – Now, if you’re an advocate for reasoned thinking about the value of getting your “jab” – this is the one for you. Young Tess is the highlight of this rendition of Leonard Cohen’s Hallelujah (1984). There was an initial kerfuffle with Sony but it was quickly resolved. Pass this one along to everyone… And, if you like that one, check this other one by the Marsh Family. They’ve got talent…I’d like to become their agent…

Readings To Consider vs. The Occasional Perspective - 1/18/21

Books and Articles worth a Review… 

An Overview of Biden Administration Health Care Priorities – The mainstream media has provided some coverage on “parts” of the health care priorities articulated by the incoming Biden Administration. I thought it might be helpful to provide an outline on those priorities starting with Covid-19 and continuing on to other important considerations.

  1. Covid-19 Plan – Biden in a major speech as well as through releases has stipulated a “7-Point Plan to Beat Covid-19”. The essence of the plan is as follows:
    1. Scale up testing – the intent will be to increase the number of testing sites offering “cost-free” as well as support the development and availability of at-home/rapid testing. In addition to testing, the plan calls for mobilizing 100,000 health care workers focused on supporting state and local efforts to conduct effective contact tracing and testing of at-risk populations.
    2. Provide adequate PPE supplies – While PPE supplies are less of an issue compared to several months ago, there are still issues. The plan calls for scaling up production and to restore national stockpiles utilizing the Defense Production Act. Another key element of the plan is to facilitate/support “domestic” production to ensure American independence.
    3. Engage the federal government as a leader of the response – The intent is to have the CDC step up with clear guidelines on criteria for responding to Covid-19 in terms of: when to open/close businesses, bars, restaurants, schools, gyms and other places where groups convene. A major component of this portion of the plan is to work with Congress to provide financial relief to state governments, local school districts and other adversely affected by the pandemic along with a Corona Relief Package for individuals taking them from the new $600 package to a total of $2000 in general relief.
    4. Deploy an equitable vaccination allocation plan – $25B is to be set aside for the manufacture and distribution of FDA-approved vaccinations. The intent is to make the process “free” to the public. In addition, transparency will be a requisite focus of the information which will be distributed widely for review and critique.
    5. Set a priority on elderly and high-risk individuals (NOTE: As I approach my 70th birthday in February, I leapt with joy when I read this portion of the plan – Thank Goodness 😊) – The Administration intends to establish a Racial and Ethnic Disparities (RED) Task Force to develop recommendations for managing these populations as well as the disparities issues. The CDC will also be establishing a national Pandemic Dashboard that denotes transmission rates by zip code for use by citizens.
    6. Restore national biodefense programs – The Trump Administration discontinued many of the in-place programs designed to monitor such world-wide problems as the global Covid-19 pandemic. The incoming Administration intends to re-establish the Obama Administration’s National Security Council Directorate for Global Health Security and Biodefense.
    7. Masks, Mask, MASKS! – Biden has been clear that masks are a priority ever since he made his first speech. He intends to put forward a “national mask mandate” for the first 100 days of the new Administration (= April 30, 2021) as well as advocate that the Governors and Mayors issue similar mandates in their respective jurisdictions.
  2. Return to a Use of Science-based Management in Public Health – The Administration intends to lead with science as the driver of decisions, the reliability of FDA-approved vaccines or medications.
  3. Override Executive Orders – The Administration is expected to override many of President Trump’s executive orders that were designed to undermine the Affordable Care Act. In fact, we should expect that the Democrats will focus on generally on increasing access and improving affordability plus expanding access in medically underserved communities in rural and urban America. The public insurance option will no doubt be back on the table as a competitor to private insurance as well as being made available to those with employer-based health plans. Elements that are likely to be included are 
  • Reinstatement of affordability requirements – to ensure that waivers do not adversely impact low-income consumers.
  • Reinstate HRA funded health plan purchases – so that retirement plans are not adversely impacted through use of funds for current rather than long-term needs.
  • iii. Tighter federal regulation – to increase benchmark plan requirements and levels of financial assistance for consumers in the marketplace.
  • iv. Protect coverage of contraceptives services – to recreate these services as an “essential” benefit as defined by the ACA and to reduce religious and moral exemptions.
  • v. Reinstate Obama-era regulations that strengthen marketplace risk pools.

4. Prescription Drugs – The most important of the various initiatives under consideration will be the passage of H.R. 3 and H.R. 1425 whereby the government will be able to negotiate directly with the manufacturers of drugs on pricing. Those negotiations are likely to not only include a government price but also an inflationary ceiling rate as well.

5. Reproductive Health – The Democrats’ agenda calls for the repeal of the Hyde Amendment that bans the use of federal funds to pay for abortions – except for life endangerment, rape, or incest) as well as restoration of funding for Planned Parenthood.

6. Broadband – The new Administration is also very committed to addressing the digital divide. Through the global pandemic, most everyone has become convinced that we need to “do something” to solve the lack of broadband in certain areas of the nation. Having kids sit in cars outside of Starbuck’s to do homework and hamstringing medical care delivery due to lack of sufficient bandwidth is increasingly recognized as a major problem. Biden’s “Lifeline Program” provides about $20B in funding to support the initiative. There is actually strong bipartisan support and a bridging between the urban and rural areas on this issue. As a result, we should not be surprised if this is not part of the “infrastructure” package discussed by Congress and the Administration (NOTE: I’ve been an advocate for some time of a National Broadband Infrastructure Deployment Initiative similar to the Interstate Highway funding of the 1960’s to dramatically alter the landscape of broadband capability across the nation. Such a broadband infrastructure could not only be used for education and health care but also for local commerce, remote workers and a vast number of other activities in our evolving digital society.). A secondary issue will likely be the restoration of the Federal Communication Commission’s (FCC’s) authority to enforce net neutrality principles and prohibit blocking, throttling and/or paid prioritization by broadband providers that raise consumer prices or impact competition.

On the other side of the equation, it is my strong sense that Medicare for All will be set aside in favor of re-enactment of those portions of the ACA that were set aside by the Trump Administration. In addition, I suspect that we will see a re-emergence of a strong focus on creating value-based care delivery plans by the Biden Administration as a move toward managing costs more effectively. In the later years of the Obama Administration there was a strong focus on value-based care which was sidelined during the Trump Administration. Expect a re-focus on this model of insurance with experimentation allowed under Medicare. With the large numbers of elderly already moving into Medicare Advantage programs – growing from 12 million to 24 million members – this could very well be one of the prime movers (or, the Big Gorilla in the Room) in the coming health care environment.

Readings To Consider vs. The Occasional Perspective - 10/16/20

Books and Articles worth a Review… 

A First! – The October 7, 2020 issue of the New England Journal of Medicine provided an editorial that was a first in the 208-year history of the publication going back to its origin in 1812. “Dying in a Leadership Vacuum” 34 editors weighed in on the decision in support of the decision with Eric Rubin, MD as Editor-in-Chief explaining that the events of the Covid-19 pandemic cut across all levels of leadership from the President, to Governors and other in leadership roles throughout the nation.

Enhanced Listening So We Can Learn and Act – I have recently taken on an old interest that I put on the shelf a number of decades ago (actually a whole bunch of them) and re-energized the interest. It is writing – not just blogs but on more general issues. I have been doing all these readings about how to get in touch with your other self (hmmmm) as part of an embrace for the age I’m now entering. So, check out my new article published on Medium.com – //medium.com/@drkevin1951/the-new-requirement-42bf8d96c26a">The New Requirement: First Hear and Listen with Intent to Learn and Act. The article basically is a call for moving from the passive act of hearing auditory signals, to listening where we actually absorb what is being said to learning from the exchange with others to acting responsibly on behalf of the needs of society. It emanated from the lack of dialogue, debate and discussion that has taken an overriding grip on the American spirit. Any feedback is appreciated…

Readings and Other Considerations

Books, articles and other worthy perspectives for your a review… 

Activism in Health Care and Science – I was recently introduced to 314 Action, a group of individuals from the STEM community who founded the organization with some other grassroots supporters and political activists who believe in science.  It is an organization that is committed to electing more STEM candidates to office, advocating for evidence-based policy solutions to issues like climate change, and fighting the recent attacks on science from the political community. In essence, their action statement is to elect more leaders who will use their training as STEM professionals to influence policy-making based on facts ranging from climate change to health care to gun violence.  The efforts are not limited to Washington, D.C. and include efforts focused on local and state legislatures as well. Through their efforts, they intend to leverage their network of pro-science advocates to organize and effect change in areas where science is being maligned or disputed. As a unified STEM and pro-science community, we can combat the all-too-common attacks on basic scientific understanding. This activism cuts to the very heart of health care.  Consider their efforts as you make your choices…

JAMA Releases Top 10 Articles of the Decade – There’s so much information being disseminated these days in medicine and health care that it’s hard to stay up to speed.  The JAMA Editors culled through the ones from their journal; however, and came up with a list.  Here you go and, the downloads are free, that way you can catch up:

§  The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) – Mervyn Singer, MD, FRCP; Clifford S. Deutschman, MD, MS; Christopher Warren Seymour, MD, MSc; et al

§  2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) – Paul A. James, MD; Suzanne Oparil, MD; Barry L. Carter, PharmD; et al

§  Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial – Paulina Salminen, MD, PhD; Hannu Paajanen, MD, PhD; Tero Rautio, MD, PhD; et al

§  Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial – Jeff D. Williamson, MD, MHS; Mark A. Supiano, MD; William B. Applegate, MD, MPH; et al for the SPRINT Research GroupAudio Interview: Intensive Blood Pressure Control in Adults Aged 75 Years or Older

§  Development and Validation of a Deep Learning Algorithm for Detection of Diabetic Retinopathy in Retinal Fundus Photographs – Varun Gulshan, PhD; Lily Peng, MD, PhD; Marc Coram, PhD; et al

§  United States Health Care Reform: Progress to Date and Next Steps – Barack Obama, JD

§  Health Care Spending in the United States and Other High-Income Countries – Irene Papanicolas, PhD; Liana R. Woskie, MSc; Ashish K. Jha, MD, MPH Audio Interview: Health Care Spending in the United States and Other High-Income Countries

§  The Association Between Income and Life Expectancy in the United States, 2001-2014 – Raj Chetty, PhD; Michael Stepner, BA; Sarah Abraham, BA; et al

§  Eliminating Waste in US Health Care – Donald M. Berwick, MD, MPP; Andrew D. Hackbarth, MPhil Audio Interview: Association Between Income and Life Expectancy in the United States

§  Silencing the Science on Gun Research – Arthur L. Kellermann, MD, MPH; Frederick P. Rivara, MD, MPH

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