ISSUE 11 | VOLUME 1
DECEMBER 2020/JANUARY 2021 2020 IS THE YEAR OF CLEAR VISION FOR PHYSICIANS AND PATIENTS ALIKE
WWW.PHYSICIANOUTLOOK.COM
PUBLICATION DEDICATED SOLELY TO PHYSICIANS AND THEIR PATIENTS
Cover Art by Physician Artist Dr. Saira Rahman
MOSAIC CREATED BY MANASA MANTRAVADI, M.D. (BASED ON KYLE BRINKER’S A DA PTATION OF ROSIE THE RIVETER)
F R O M T H E P U B LIS H ER
Warp-Speed Science THE CREATION OF VISIONARY VACCINES
2
Wri t t en by Ma r l e n e Wu st- S mi t h, M . D.
020, forecasted to be “the year of clear vision,” has turned out to be many things, but clear is not an adjective that comes to mind. For the vast majority, it’s been a year filled with turbid incertitude, blind trust, solitary confinement, intense fogginess, political confusion, irrational anger, deep darkness, intense grief and visceral fear. For a lucky and blessed minority, it’s been a year of personal growth, stronger connections with family, and renewed spirituality. For me, personally, I have very much felt like an “extra” cast in an unbelievably complex sci-fi/thriller movie that I have seen before, the kind where I miss intricate details that later turn out to be very important. Life in 2020 is reminiscent of cinematic oldies but goodies like Contagion, Bird Box, The Hunger Games and 2 | D E C E M B E R 2 0 2 0 /JA N UARY 2021
Wag The Dog. The kind of movie with complicated storylines complete with surreal plot twists, conspiracy theories, heroes and villains. It is surreal to think that it has only been a year since we first heard of SARSCOV2 and its journey from bat to human. By the time we had learned of its virulent path, COVID19 had already caused a tragic loss of life as it spiraled out of control and spread outside of the landlocked capital city of the Hubei province in China. In a few short months every continent and almost every country on planet Earth has become host to this most unwelcome guest. We close out 2020, however, with a ray of sunshine and prism-like focus on a brighter future as COVID19 vaccines have been developed, studied, mass-pro-
duced and sent out for distribution. Hundreds of thousands of healthcare workers are lining up to receive a vaccine that only a year ago would have been a figment of the imagination. Never in the history of science has a vaccine or medication been released to the general public so rapidly. I am frankly overwhelmed and pleasantly surprised by the unity that I have observed amongst fellow physicians who have embraced the opportunity to get vaccinated. I was expecting that ANYTHING related to “Operation Warp Speed” with its lofty goals to bring a vaccine to the U.S. market by year’s end would be met with the usual disdain and distrust that our President seems to incite. Many of the same doctors who are now proudly displaying selfies and photos of their COVID vaccine certificate and
bandaged arms are ironically the same ones who were very skeptical about the safety of the vaccines that the President was promising. The doctors’ masked faces express a combination of giddy excitement and tear-filled relief that science has brought a potential end to this horrible pandemic. Physicians are not naive, however. We understand that the vaccine is not a cure for COVID19 itself, and that it will take a considerable amount of time and widespread population immunization before we see any effects. We are ALL holding out hope that the vaccines are a first important step to putting an end to the lockdowns and drastic changes in our ability to treat patients, travel, work, learn and socialize. Worldwide, public health officials have had to recommend and institute draconian measures in attempts to “flatten the curve” of COVID spread and mortality. We know that the unintended consequences of COVID-related public health recommendations are not benign. There are rising rates of anxiety, depression, suicide, substance abuse, food insecurity, bankruptcy, divorce, missed cancer and other health diagnoses, increased homelessness, child neglect and maltreatment, worsening childhood developmental delays and many other conditions that far outnumber the tragic loss of life being caused by COVID19. As a physician, I am elated that the general public is being educated about the importance of hand hygiene, covering their coughs, not touching their noses/ mouths to prevent spread of disease and the basics about transmission of viruses. Few people seem to understand that the majority of viruses are most easily transmitted to others days before symptoms become apparent. Even fewer people understand the importance of vaccines and how they work; all of the discussions around the COVID vaccines will be a vital tool to help those who have traditionally been vaccine-skeptic and avoidant accept the science behind vaccines that they currently may be declining. Although, I too, will soon likely be taking my own vaccine selfie with a bandage on my upper arm when I return to
work at my University Health clinic in a few weeks, I have a confession to make. I am somewhat embarrassed to admit this out loud : I am secretly relieved that I was not one of the first in line to get a COVID19 vaccine. I join a relatively small subset of physicians that are willing to be patient a little longer given the speed of the roll-out of the vaccine, and my relative personal low risk for complications from COVID19 disease. Some colleagues may accuse me of “trying to destroy the public trust in vaccination” by voicing my opinion, but the exact opposite is true. I am a staunch supporter of vaccination and will continue to remain vocal about its importance. I find that my patients are more likely to accept vaccinations when I am honest and truthful about what we know and what we don’t know. I frankly can’t wait for my own father and other elderly, atrisk relatives to get vaccinated, as they are deteriorating before my eyes from the consequences of being shut-ins. I think that ALL of our colleagues who work in emergency departments, ICU’s, operating rooms and in other high-risk fields should absolutely be prioritized as first recipients if they want to receive the vaccine(s). I think that all hospital maintenance workers should be prioritized over everyone else, as this low-income hard-working group of individuals are rarely provided with enough appropriate protective equipment as they go from one high-risk situation to another. It irks me to see hospital administrators and politicians lining up to get vaccines before those who really need them. I am not embarrassed to express my opinion that I am appreciative that I will have some time--and more science-- to be able to critically review the pros and cons of each of the COVID19 vaccines before getting one myself. I have SO many unanswered questions! Will Moderna or Pfizer’s vaccine confer the longest-lasting protection? When will we know the longterm effects (if any) of mRNA vaccines on those with autoimmune disease, or on a developing fetus? We know that mRNA does not enter the nucleus of cells, and thus should not then be capable of altering human DNA...but do we know
I am secretly relieved that I am not first in line to get a COVID19 vaccine. if there will be some unintended deleterious effects from mRNA transcribing a protein that bears similarities to the coronavirus’ spike protein? Will there be superior herd immunity from Oxford/ Astra-Zeneca’s vaccine? Is the Inovio vaccine, with its reported excellent thermostability and 5-year shelf life be the most appropriate one for outpatient use? Are the more temperature-sensitive vaccines (eg, Moderna) not going to be as effective because of temperature/storage/expiration issues? I am full of questions, and avidly scouring through research studies and pre-print papers to look for answers. Today’s answers may not be tomorrow’s, as we are living through rapidly evolving and trying times. But that is the nature of science. Crazy times call for drastic measures, and while I am glad that Operation Warp-Speed has allowed us to have a vaccine approved under the EUA for COVID19, I think we should be administering it only to those at high-risk -particularly the isolated elderly who are suffering more from social seclusion than from complications of COVID, and I believe we should be aggressively studying through trials people on whom we have very little vaccine study data. We know virtually nothing about the vaccine’s effects on those who are immune-compromised due to their underlying conditions or due to medication (eg those on steroids or on biologic agents for conditions such as arthritis, psoriasis, inflammatory bowel disease). Science takes time. Vaccination of those at highest risk should proceed, as should the development of better testing for disease and to determine who is immune. You can’t hurry love, and we shouldn’t rush science. 1 Dr. Marlene Wüst-Smith Publisher
WWW.PHYSICIANO U T LOOK . C OM | 3
AHIMSA
D R. D ES IG NED , K ID AP P ROV ED SAFE, ECO-FRIENDLY AND FUN!
WWW.AHIMSAHOME.COM
DEC E MBE R 2 0 2 0 /JA N UA RY 2 0 2 1
Table Of Contents FROM THE P U BLISHER
Warp-Speed Science By Marlene Wust-Smith, MD/p.2 VIP P SP OTLIGHT
Physician Reinvented: The Venture Capitalist By Navin Goyal, MD/p.6 Physician Reinvented: The Speaker By Lynette Charity, MD/p.8 Physician Reinvented: The Coach By Amelia Bueche, DO/p.12 BABBLINGS
The Sekhmet Writing Project 8|12: The Clutch One By Megan Babb, DO/p.14 TIME FOR YOU
Physician Hidden Talents By Billynda McAdoo, MD/p.20 Sunshine In A Bottle By Ayushi Chugh, MD/p.23 ADVOCACY IN ACTION
Direct Primary Care For The Vulnerable By David Balat/p.24 OFFICE SPACE
Making Medicine Make Sense For You By Nathan Eckel/p.26 IN TELLIGENCE ON THE MOVE
What Is Health? Obstructions And Opportunities By Amelia Bueche, DO/p.28 THE LAST WORD
COVID-19 Pandemic: A Rational Vaccine Plan By Parvez Dara, MD and Craig Wax, DO/p.30 Cover Art by Physician Artist Dr. Saira Rahman WWW.PHYSICIANO U T LOOK . C OM | 5
V IP P S P OT LIG H T
Physician Reinvented
THE VENTURE CAPITALIST Wri t t en by Navin Goyal, MD
All I wanted was to be a doctor. Growing up I had the ambition to be a physician and focused all my time and effort on getting good grades and meeting the demands of standardized tests. For extracurricular activities outside of sports, I volunteered at hospitals and made sure I did research at my undergraduate institution. I even moved to Bethesda for three months to do research at the National Institutes of Health. I made sure my medical school application included great grades, strong test scores, and experience in the medical world. This story likely sounds routine for many folks going into the field of medicine, but what seemed normal then seems monotonous and boring to me today. After I finished my anesthesiology training at the University of Chicago, I joined a private practice in Columbus and was excited for the broad responsibilities I’d face within its hospitals and 6 | D E C E M B E R 2 0 2 0 /JA N UARY 2021
ambulatory centers. Upon completing my final board exams, it was refreshing to no longer have tests or coursework to worry about. For the first time in a while, I suddenly had time to think. I had time to let my mind wander and even get a little bored. I started getting into some leisure activities like golf (which didn’t last long) and I also started reading materials that had nothing to do with medicine or anesthesiology, such as the Wall Street Journal. And it was during this time that I found myself compelled to learn about various business ventures and the stories behind people who took on great risk by founding a company. I was intrigued by people leaving their comfort zone to pursue a strong passion or purpose. I wanted to join this circle of angel investors One of the highlights of reading the Wall Street Journal daily back then was learning about the journey of a compa-
ny from inception to ultimately going public. There was mention of early investors (called “angel investors”) who had the opportunity to meet these great entrepreneurs, become inspired by their vision, and then decide they want to participate in the business venture through investment. I wanted to join this circle of angel investors. I was in a fortunate enough position at that time to have investable income and began my investing journey in real estate. While I certainly saw value in these real estate investments, I quickly realized I was not excited by them and wasn’t learning much. I then started angel investing in various early-stage companies. I got to know the founders and was inspired by the sacrifices they made and their determination to fulfill their vision. And I was honored to help pave their pathway. Then, I got an opportunity to start my entrepreneurial journey via a
P HOTO C REDIT BY N AVIN GOYA L, M .D.
healthcare company named SmileMD. SmileMD essentially brings the staff, equipment, and best practices of a hospital into office-based procedures. The idea for SmileMD came about after a couple of dentists began asking my two co-founders and I for our anesthesia services at their dental practice. As we explored the opportunity, we saw a great need for anesthesia within dentistry and the lack of a standardized solution on a larger scale. With this in mind, my two close friends and co-founders and I moved forward with SmileMD. The company initially started as a provider of anesthesia to dental clients, but very quickly we realized there was a much wider array of opportunities. Thankfully, in light of the large market opportunity before us, having two close friends as co-founders brought a level of trust that helped us all move forward successfully on the then-unknown pathway of entrepreneurship.
All three of us being anesthesiologists, we certainly knew how to take care of patients; however, we didn’t yet understand the full business aspect. This seemed less intimidating at the time since we all understood the core competency of the service we were providing, but we quickly realized we had a lot to learn. Let’s get LOUD. Not knowing the full business side of things, I reached out to the entrepreneurial community for direction. As I sought help growing SmileMD, I met many great entrepreneurs and companies who were also looking for help. At SmileMD we were fortunate enough to self-fund initially, but I met so many other ambitious founders looking for startup funding who simply could not obtain any. Recognizing this pervasive lack of early-stage funding available to entrepreneurs, I then considered
addressing this need by engaging my network to pool capital for investing in early-stage companies. With a great network of physicians who could serve as investors and a relatively new community of entrepreneurs at my disposal, one of my business partners, Darshan Vyas, and I raised a small venture fund that invested in promising early-stage companies with high growth potential. Then, in 2015 I co-founded a venture capital firm named LOUD Capital with Darshan. From that point forward, we committed ourselves to be “loud” and active investors, differentiating ourselves from historically “silent” investors who take a more passive approach. What happened next was completely unexpected. We initially started the firm as an opportunity to fulfill investor and entrepreneur demand, but it turned out we were able to provide a great deal of added value on top of capital to these entrepreneurs through our active approach. We became trusted sources of support in business development, operational improvements, marketing guidance, and more. We found this to be more demanding but also much more fulfilling, and continue to feel this way several years later, having invested in over forty companies across diverse industries. Watching several of these companies grow significantly and hit key milestones following our investment is deeply rewarding, and also bodes well for our investors to achieve strong ROI. This extensive, multifaceted experience has led me to an important realization of what physicians can do outside of the hospital. We can take our moral compass, our intentions, and our ability to learn efficiently to do impactful things for the world. We can help people in a very different way that is complementary to what a physician stands for in society. As many of our colleagues are pushing incredible advancements in science and showing courage on the front lines of COVID-19, I want physicians to know there is an even greater calling to apply our expertise in shaping society for the better. 1 WWW.PHYSICIANO U T LOOK . C OM | 7
P HOTO C REDIT BY LY N E TTE C H A RITY, M .D.
V IP P S P OT LIG H T
Physician Reinvented
THE SPEAKER Wri t t en by Lynet t e C ha ri t y, M D
I
was fired after 33 years of working as an anesthesiologist. The year was 2012. I was 60 years old. My employment termination wasn’t because of medical malpractice (I had gone through the hellfire of a lawsuit twelve years prior and had won, so it was not germane to this issue). It wasn’t due to patient complaints, either. My patients loved me, at least the ones who remembered me after their anesthesia experience. I was fired because I called the department CHIEF an idiot. Who knew you could get fired for that! Today, I can write these words with humor, but at the time I was 8 | D E C E M B E R 2 0 2 0 /JA N UARY 2021
embarrassed, ashamed and lost. Until that point, medicine had been the centerpiece of my adult life. As an English-Irish-African American woman (gotta love DNA tests) growing up in the segregated South, I was able to navigate far away from my naysayers and dream smashers to reach the blessed day when I donned that white coat. And now, that white coat persona was ingrained into the very fabric of who I was. So there I was, at a crossroads and wondering, “Should I stay or should I go?” If I’m no longer a practicing physician, I thought, Who am I?
Well, I’ve since learned that a physician will always be a physician. The skills we learned through so many years of education can never be undone. But I’ve also learned that we can be much, much more than that. Nowadays, I claim several titles. Dr. Lynette Charity, Keynote Speaker. Dr. Lynette Charity, Speaker Coach. And, of course, Lynette Charity, M.D. Laughter is the best medicine So what career does a recently fired sexagenarian anesthesiologist transition into? The first thought that popped into my head was, “I’m going to be a standup comic!”
Don’t ask me why. Several people have. All I can say is, after putting people to sleep for so many years, I was ready to wake them - and myself - up! In all seriousness, learning to laugh at ourselves is the best treatment for chronically stressed-out physicians. Comedy was my first introduction to the public speaking life and I’m thankful everyday for it. Some key lessons that I learned in comedy: 1. Have a good opening: Studies say, people form impressions within 17 seconds. On stage, within 17 seconds or less, the audience is deciding whether or not they like the comic, whether or not they will listen to the comic, trust the comic, or whether or not this would be a good time to go to the bathroom. This is also true in speaking. You will be judged as someone to listen to or someone to tune out with the first few words out of your mouth. Please don’t start with a joke you found on the internet! 2. Connect with your audience Have you watched a comic bomb? I was in Vegas to see the comedian George Wallace... and his opening act bombed. And this guy was a pro. He’d been on a lot of TV shows. But he didn’t have a connection to the audience. Research your audience just as much as you research your topic. I spoke to a dermatological society last year. I’m not a dermatologist, however I reworked my presentation to better relate to their realities. Basically “I got them!” I connected with them and their issues. 3. Diffuse the hecklers In a comedy club, people say comics have the hardest job because they have hecklers; they have people who shout out “You suck! You’re no good!” Guess what? Physicians have hecklers, too! Your colleagues and the C-Suite shout, “Your Press-Ganey scores suck! You call yourself a doctor? You ain’t no doctor!”
Comics have a technique for dealing with hecklers. When someone says something nasty, the first step is to repeat the complaint. “Let me get this straight, you think because that one patient out of so many patients that I have treated gave me a poor customer service score, that I am not a good doctor?” When we meet with difficult people it’s best to validate what they say even if you don’t agree with it so it doesn’t get to a point where things get nasty. Rather than ignore negativity, it’s really important to “affirm” what you heard. This strategy gives you time to step out of reactivity, while clarifying the point. From FREE to FEE Comedy was a great first step, but it wasn’t the end of my journey. The more I fell in love with being in front of the crowd, the more I realized that a key component was missing - the money. Unfortunately, stand up doesn’t pay the bills for most comedians. So I joined Toastmasters to learn how to speak. The first day at a Toastmaster club meeting, I timidly entered the room and found a seat close to the door, just in case. A seasoned member entered soon after me and without waiting for me to say yes, he grabbed me by the arm and sat me beside him. There was now no escape. As the meeting proceeded, he translated all the terminology. I learned a lot. The beginner program was called the Competent Communicator Series and I was volun-told to prepare to give my first speech the following week. The first speech in the series is called “The Icebreaker.” So the following week I broke the ice by sharing a 5 minute speech about me. There was a lectern in the room to which I held onto for dear life. For this first speech, you were allowed to use notes, but I was too nervous to look at them. When I finished my extemporaneous speech, two members evaluated my speech based on the criteri-
Learning to laugh at ourselves is the best treatment for chronically stressed-out physicians. on set down by Toastmasters. I received great feedback and I was finally on my way to becoming a professional speaker. Taking your first step on stage My first big crowd was at the Toastmasters’ World Championship of Public Speaking. Nervous doesn’t even begin to describe how I felt. I had mastered speaking in front of 10-20 people, but I wasn’t sure I’d be able to hold my own in front of hundreds! Prior to the competition, I wrote and rewrote my speeches. I practiced those speeches at several clubs and revised as needed after valuable feedback. I videotaped my presentations. The more I gave the speeches, the more confident I became. In 2013, I won the Area and Division contests and moved on to compete for the District Title. There was a BIG crowd in attendance. The speeches were the after-dinner dessert! I couldn’t eat a thing. Poor form to puke while speaking, I thought. When my name was called, I stood, took a deep breath, walked to the stage, looked at the crowd, smiled, another breath and began. Once I began, I was in “the zone,” confident. I won! I was confident because, I had 1. Calmed my willies 2. Identified my message 3. Personalized my presentation 4. Used storytelling effectively 5. Created a crisp final product Speaking has brought so much joy into my life. A joy I never thought was possible as a physician. It’s taken me to Malaysia and Portugal. It’s allowed me to reach thousands, from college students to Tedx listeners. It’s allowed me to find my purpose and tell my story. Now I teach others to do the same. 1 WWW.PHYSICIANO U T LOOK . C OM | 9
PADPCA is a non-profit organization of Independent Direct Primary Care physicians in Pennsylvania.
WE ARE GRATEFUL RECIPIENTS OF OUR STATE MEDICAL SOCIETY’S 1ST ANNUAL PRACTICE INNOVATION GRANT. Thank you PAMED Society! As the model grows rapidly across the country, PADPCA is informing and educating the public, medical schools, residencies, physicians, and employer groups in PA about our transformative model of healthcare delivery. DPC = Transparency + Affordability + Access + Attention + Patients + Physicians–the Middlemen
www.facebook.com/PADPCA/
www.twitter.com/padpca
P HOTO C REDIT BY BRITTN Y H OWE LL, M . D.
V IP P S P OT LIG H T
Physician Reinvented THE COACH
Wri t t en by Am el i a B u ec he, D. O.
Find your voice. Create the life you want. An amazing invitation to construct a framework of your desire and step fully into the existence you imagine. This can pose a challenge if we are not accustomed to making these decisions for ourselves. So much of success in medicine is following a predetermined path. We internalize the definition of success outlined by professional organizations and live up to the expectations of others. We are often more attuned to the voices of our families, communities, culture and colleagues than our own. Brittny Howell, MD is a vascular surgeon and business coach who helps physicians discover their own voices to fully understand their passion and pur1 2 | D E C E M B E R 2 0 2 0/JA N UARY 2021
pose, making it possible to both determine and create the lives they want. Filtering through the noise of the many voices we have spent a lifetime heeding can take time and effort. Identifying our own thoughts among those we have internalized throughout our training is a skill to be honed. Dr. Howell shares her own journey in medicine, loving the work of vascular surgery. She relates the shock and surprise she experienced when she finally heard through to her own voice and realized that despite her fascination with the physiology and pathophysiology, she no longer wanted to be the operator. Embracing this new knowing is not an easy process and it can be hard to admit to others and even to ourselves.
For a time, Dr. Howell kept this new awareness hidden but noticed that her feelings only got stronger with time. The day finally arrived when she knew it was a truth that was ready to be set free – that no one and no reaction could change her mind. With every decision we make, there is a secondary decision of supporting our own choice, which can be the more difficult step. Dr. Howell notes that it is entirely normal for there to be a sense of regret with such a significant choice that comes from stepping into this new way of knowing. Instead of reflecting on the years of education and training as time wasted, she encourages physicians to recognize that everything that has hap-
P HOTO C REDIT BY A M E LIA BU E C H E , D.O.
pened simply leads to the present moment. That creating the life we want is only possible for having experienced all aspects of our collective past. For Dr. Howell, her own realization was freeing as she relates, “for the first time ever I was truly in alignment with who I am and who I want to be.” She acknowledges this freedom was also terrifying, taking her into the unknown, which feels at times unsafe and uncomfortable. She encourages physicians to embrace all of these feelings and remember that it is from the unknown that imagination combines with intention to discover and create the life we want. Track back to your first thoughts of medicine. Whether they emerged in childhood, through a different career, at the suggestion of others or from the deepest calling of our own heart, consider that they held elements of the unknown. Notice that there have been decisions made all along the way with opportunities to support ourselves in the choices we selected. We are fully capable of listening, learning and leading ourselves into the life of our choosing. Support from coaching offers reminders of our ability and an invitation to believe in ourselves. In her work with women physicians, Dr. Howell has found strength in the collective, creating spaces of support grounded in a love of medicine, flourishing in the freedom of life lived differently for each individual. Some continue the journey in medicine with heightened purpose, passion and peace while others embrace curiosity with a rediscovered capacity to venture into business. Realize the power of finding your own, unique voice. Listen to the message that invites you to be in alignment with the person you truly are. Construct the framework that supports the existence you have always imagined. Create the life you want. Visit Brittny Howell, MD at her website www.doctorbrittny.com and start creating the life you want today! 1 WWW.PHYSICIANOU T LOOK . C OM | 13
B A B B LIN G S
Eig ht | T w e lv e: T h e Clut c
The Sekhmet Writing Project 8/12 THE CLUTCH ONE Wri t t en by D r. M ega n B a bb
N
early a year ago I had this thought, “If we as women want healthcare to be better, then we need to start being better for one another.” When I committed myself to this twelve month longitudinal writing project I had no idea that the hardest part of the process would be choosing the women I would feature. You see when I began purposefully looking around the country at the work my female colleagues were doing, I found it overwhelming the number of individuals who deserved to be recognized. All across the country, I learned about female physicians who are leading positive, productive change in academia, research, healthcare administration, and above all the way patient care is delivered. While there 1 4 | D E C E M B E R 2 0 2 0/JA N UARY 2021
are so many physician women I could have featured in this month’s edition, I decided to deviate slightly by bending my own rules and showcasing a female with her doctorate in both microbiology and immunology. For the work that she has done and continues to do is redirecting humanity towards a whole new (and safer) trajectory. Kizzmekia Corbett, P.h.D Dr. Corbett is thirty-four years old. She works for one of the most prestigious research facilities in the world: The National Institutes of Health. Her boss, none other than Dr. Tony Fauci. By all accounts, Dr. Corbett grew up as a precocious and tenacious Black girl in rural North Carolina. Her love
for academia, especially the sciences, was obvious to many who knew her. While she continued to thrive in primary and secondary school, she absolutely flourished through her undergraduate and post-graduate studies. While her academic accolades can easily speak for themselves, there are more reasons than these as to why I write about her today. Currently in America, there are two glaring data points that everyone should be aware of. The first is the representation of Black individuals in STEM careers. According to the US National Science Foundation, Black men represent 3% and Black women represent 2%1. More on this in a moment. The second is the disproportionate health outcomes existing between the Black race compared to
tch One
all other races. According to the US Department of Health and Human Services, African Americans have the highest mortality rate for all cancers combined compared with any other racial and ethnic group2. Their infant mortality rate is 11 per 1,000 deaths compared to the 4.7 per 1,000 births of Non-Hispanic Whites2. They are also 2.5x times likely to have diabetes and across the board are less likely to have access to preventive health services including routine mammograms, colonoscopies and vaccinations2 (more on this in a moment). Let’s break down the first data point. To understand the extraordinary achievement of Dr. Corbett, we must
first dive headfirst into America’s past. When Brown vs the Board of Education mandated all schools in America be integrated, like all entities controlled by white American culture, this process would prove to be far from simple. In the early 1950s, most of America’s largest cities were occupied by the white race. But two things would occur around this time that would forever change the landscape of equitable education in America. The first is the passing of the GI Bill in 1944. While the GI Bill helped pull America out of the recession that followed the Second World War by addressing key social needs like unemployment, housing, and education of America’s veterans, it also helped build the white middle class. As many Black individuals fled the outwardly racist and oppressive culture of the South, they still were met with equal amounts of racism and oppression from a similar type of culture that was able to hide these transgressions better than southern tenants. One in particular is known as the White Flight. As Black families began moving into other regions of America, shortly after, white families began leaving these city regions. This was mainly accomplished due to their privileged access to the GI Bill that pertained only to the purchase of a brand new home. This meant that property outside of city-dwelling became an affordable and cheap way to increase housing opportunities. Though the bill was not written to exclude women or minority races, studies show that directly following WWII, and both the Korean and Vietnam wars, Black veterans were disproportionately denied access to the GI Bill compared to white veterans (data based on per 1,000 individuals)3. This becomes yet another contributing force that negatively impacted the Black communities. In fact there is a direct correlation between this and the inequitable distribution of educational resources seen in these communities. This along with other factors including rapidly diminishing property values in the red-lined housing districts, exclusion of access for Black individuals to new
Since COVID-19 has disproportionately affected minority races, the importance of her work goes far beyond academics and science research. mortgage loans, decreased accessibility to funding for higher education, are all reasons as to how America’s education system has remained segregated, though decades ago it was ruled unconstitutional. The effects have been devastating, especially pertaining to generational gaps in both education and wealth among the white and Black races, gaps still very much in effect today. In the area I grew up, the academic success of its children was built on a foundation supported by white privilege. This model of education in the community ensured the success of future generations by providing more than adequate academic tools necessary for students to succeed. However simultaneously, with intent or not, this model also created a disparity towards the minority populations that it failed to recognize, thus favoring white interests above others, weakening nearby minority communities, and further widening the racial divide. Having the funds to support more teachers and staff with fewer students per class, having an overabundance of educational materials needed to teach, having free on-campus collegiate level courses with transferable units to any university after completion of high school, and having boosters available to fill financial gaps when allocated funds from the state/county fell short, are all examples of the embedded advantages my community used simply as safety nets to ensure a student’s success. In other words, measures implemented to first ensure the success of our white community, without pause or reflection to give our excess to the communities of minorities who already had less. As a teenager growing up in this world, I had no idea these safety nets even existed, let alone existed uniquely for us. WWW.PHYSICIANOU T LOOK . C OM | 15
PHOTO C REDIT BY WHITEHOUSE.GOV
This is why my success as a physician is far from extraordinary when compared side by side with Dr. Corbett’s achievement in her STEM career. For every one roadblock I encountered to obtain my graduate degree, she encountered ten. She should not be seen as the exception but as an example of how hard it is for Black individuals to achieve success in fields such as STEM. Perhaps if we did that, we could all easily trace the line of her success back to the thousands of ways Black individuals have endured oppression at the hands of the white race. Now for the second data point. Again let’s dive into America’s history. One of the many privileges white America benefits from is the centuries worth of collected medical research used today to improve overall health outcomes (for the white race more so than any other). What most white Americans fail to recognize is the very data they benefit from came at the cost of Black suffrage. Though scarcely talked about, America’s healthcare system is saturated with racism. From the care previously, and in many cases still currently delivered by healthcare providers. To the inequitable access to healthcare services. 1 6 | D E C E M B E R 2 0 2 0/JA N UARY 2021
To the lack of recognition in which social determinants of health negatively impact minority populations compared to the white. To unethical research practices which favored the participation of minority races, it becomes more work to NOT acknowledge the rampant racism in healthcare to those who are unwilling to see it. While this topic alone could take anyone years to fully understand ( I would recommend reading Medical Aparthed by Harriet A. Washington as a great introduction to this topic) I will limit this discussion specifically to unethical research practices. Perhaps the most notorious is the infamous “Tuskegee Study of Untreated Syphilis in the Black Male” funded by the United States Public Health System. This study aimed to understand the natural progression of syphilis on the human body over time. The study included 600 Black male participants and extended from 1932 to 1972. Even though in 1947 Penicillin had become the known drug of choice to treat syphilis, participants were still denied access to it as well as discouraged from seeking medical treatment outside their assigned researching physician4. While the study was meant to last only six months, it continued for a total of forty years (of which twenty-three oc-
curred after a well established treatment option was known). This study is just one example of thousands in which the consequence of unethical practices led to the rightful distrust by the Black community ofAmerica’s healthcare system. The Tuskegee Study became a symbol of [the Black race’s] mistreatment by the medical establishment, a metaphor for deceit, conspiracy, malpractice, and neglect, if not outright genocide (Corbie-Smith et al. (1999)). This is why Dr. Corbett again represents so much more than what is seen on the surface. Since COVID-19 has disproportionately affected minority races in both infection rate and disease related deaths, the importance of her work goes far beyond academics and science research. She represents a familiar face in a space that has historically been monopolized by white men. She represents an opportunity for a new relationship to forge between the healthcare system and minority races. She represents the face of our future, a face minority children can identify with. And most importantly, she will become the greatest of tipping points towards the high COVID-19 vaccination rates of minority individuals. Her work is undeniably monumental. More so, undeniably, she is monumental. She is clutch. And we should all be eternally grateful for her tenacity as I cannot even begin to imagine the obstacles she faced that the white race intentionally or unintentionally placed in her path towards success. 1 Sources: 1. https://www.nsf.gov/statistics/2017/ nsf17310/digest/occupation/overall.cfm 2. U.S. Department of Health and Human Services Office of Minority Health, “Cancer and African Americans,” available at https:// minorityhealth.hhs.gov/omh/browse. aspx?lvl=4&lvlid=16 (last accessed April 2020) 3. https://journeys.dartmouth.edu/ censushistory/2016/10/31/black-and-whiteveterans-and-the-gi-bill/ 4. https://www.cdc.gov/tuskegee/timeline.htm
SEND THE GIFT OF GRATITUDE
TO THOSE WHO DESERVE IT MOST
THE A
HEARTS
YOU
COCKTAIL,
SEND
CAN
GROCERIES,
BE
OR
REDEEMED
WHATEVER
FOR
THEY
A
COFFEE
NEED
BREAK,
RIGHT
NOW.
SENDTHANKSNOW.COM WWW.PHYSICIANOU T LOOK . C OM | 17
Publisher’s Note
Elf-On-The-Shelf-Shenanigans
T
he pandemic couldn’t stop the return of the very mischievous elf Lamont to the
McAdoo household. Anesthesiologist Billynda and veteran educator Charlie and their 2 sons sure have their hands full!! Visit www. PhysicianOutlook.com online to learn more about Lamont’s antics, as well as pages 20-21 in this issue. Dr. McAdoo’s charcuterie skills are not lost on this little guy!
- Dr. Marlene Wüst-Smith
Photo credits Billynda and Charlie McAdoo
TIM E F O R YO U
Physician Hidden Talents MASTER CHARCUTERÍE-STE
D 2 0 | D E C E M B E R 2 0 2 0/JA N UARY 2021
r. Billynda McAdoo is a busy
all artfully arranged on a serving
working anesthesiologist,
board.
wife and mother of two
She is a master “Charcuteríe-ste,”
boys, who also happens to be an artist.
who also finds time every holiday season
Her preferred canvas: her kitchen’s
to oversee the antics of her family’s mis-
wooden cutting boards. Her palette:
chievous “Elf On The Shelf,” Lamont.
an assortment of meats, cheeses,
Visit www.PhysicianOutlook.com to
artisan breads, olives, fruit, and nuts,
learn more about Lamont’s escapades. 1
Photo credits Billynda and Charlie McAdoo
Want To Build Your Lung Nodule Program? Rely on our expertise to help diagnose early and treat your patients with
lung abnormalities.
OUR PROVEN PROGRAM WILL: 1. ASSESS your current workflow and most immediate needs
2. ANALYZE your team, resources and systems
3. DEVELOP your customized program from communication to implementation
4. MEASURE the results and effectiveness for ultimate success
Are you ready to...
SAVE TIME, SAVE MONEY & SAVE LIVES? CALL (267) 500-5027 or EMAIL info@lunghealthservices.com
W W W.LU N G H E A LT H S E RV I C E S .C O M 2 2 | D E C E M B E R 2 0 2 0/JA N UARY 2021
T I ME FOR YOU
Sunshine In A Bottle Poe m b y A y us hi C hug h, M. D, N e urolog is t, Phoe nix, A Z .
Sunshine in a bottle, Like the modest, warm winter Sun. Bold rays of Hope, Pierce through the unforgiving cold. Fruits of labor, born in wee hours of daybrea k, Through countless sleepless nights, Through sweat-blood of unsung hea lers, A midst cynica l glares those skeptics ma ke. Bring on the precious Golden glow, Let it f ilter through the shadow of gray clouds. That wear down unsmiling spirits, May it recharge a ll waning energies. A s the modest, warm winter sun, Wraps like a shiny armor hug, A mother’s warm embrace, May it somehow embolden tough hearts. A s each day gets tougher than the next, we need our hearts to go on, Re-fuel us in our Ser vice, Ba lm to soothe us in our tough Ca lling. For Life doesn’t get easier, May we get stronger From the glow within, Of timely, scientif ic winter miracles, Soa k up this empowering winter Sun. 1
WWW.PHYSICIANOU T LOOK . C OM | 23
P HOTO C RE DIT BY IN GRA M IM AGE S
ADVO C AC Y IN AC TIO N
Direct Primary Care for the Vulnerable
D
Wri t t en by David Balat
irect Primary Care (DPC) is not really a new model for health care in Texas. Long before employer-based insurance (with the safety nets for the elderly and disabled, Medicare and Medicaid) became the standard, patients paid doctors for their care. There were no middlemen—only the patient and the physician, and they made the decisions. DPC seems innovative now because we have moved so far away from that model. Government regulations combined with ever-more complex insurance standards have put third-party payers in charge of the decision making. The current system frustrates not only patients, but also physicians. No health care provider wants to be second-guessed by a middleman behind a computer screen hundreds or thousands of miles from the examination room. No 2 4 | D E C E M B E R 2 0 2 0/JA N UARY 2021
doctor wants to be limited to a maximum number of minutes of facetime per patient, because human beings and their ailments are rarely so conveniently compartmentalized. And doctors and patients alike want the ability to follow up on treatments to ensure the best health outcomes possible. DPC practices seek to resolve the flaws of our current healthcare system by providing transparent pricing and strengthening the doctor-patient relationship. Direct care has gained momentum in primary care, surgery, pharmaceuticals, and dentistry. Direct care functions differently in each setting, but the central idea is that third-party payers are not involved, and prices are known before the patient sees the medical professional. It’s really simple. Patients contract with DPC practices to receive a wide
range of care at a convenient monthly price. Patients are allowed to see their doctor as often as they like for preventative, wellness, and chronic care, and certain medical tests are included in the membership fee, depending on the membership agreement. They also use telemedicine—often in the form of an app—to make reaching a health care provider as convenient as possible. State Rep. Matt Shaheen understands the value of DPC and filed House Bill 484 to make this type of service available to many of our Medicaid beneficiaries who wouldn’t normally have access to this high level of service and care. Many Medicaid patients use the emergency department (ED) for primary care and that’s an inappropriate and expensive way to provide care for non-urgent medical conditions. According to a Texas Department of State
Looking for a nonclinical career or side hustle? Looking for a nonclinical career or side hustle?
Health Services analysis of hospital emergency department data from 2018, the most frequent payer source from all avoidable ED visits in Texas was Medicaid (29.2%). Barriers to timely primary care have been associated with increases in ED utilization. Reported barriers include: • An inability to contact the office • An inability to get an appointment soon enough • Excessive wait times to see the doctor after arriving at the office • Inconvenient office hours • Lack of transportation • Lack of child care. Research from the Texas Public Policy Foundation demonstrates that DPC has shown the potential to reduce unnecessary ED utilization substantially. Clearly, DPC hits those barriers by allowing for telemedicine, flexibility and after-hours contact with staff. The case study included in the 2020 Society of Actuaries analysis reported a 40% reduction in ED visits and a 53.6% reduction in ED claims costs in the DPC group as compared with the group in traditional primary care. According to an analysis by United Health Group, the average cost of treating common primary care treatable conditions at a hospital ED ($2,032) is 12 times higher than the cost ($167) in a physician’s office. If even a portion of the inappropriate ED utilization can be reduced by including DPC as an option in Medicaid, it could have a positive fiscal impact on state budgets. But more importantly, it will allow our most vulnerable to get the care that they need when they need it. Allowing Medicaid patients access to DPC would allow patients and their families to have the peace of mind they want and need. 1 David Balat is the director of the Right on Healthcare campaign at the Texas Public Policy Foundation. This article was originally published on November 23, 2020 on The Item, https:// www.itemonline.com/opinion/direct-primary-care-for-the-vulnerable/article_049a0d998 5 5 9 - 5 15 1 - 9 d 0 a - d 5 8 c 0 8 2 0 3 3 5 4 . html?fbclid=IwAR0NvVe1cYJkFfGWPMcSrjOLRxzHTnEK_OUv3E04e7yo8S0pi9ShAztt3n4
Join our community of physicians who are at all stages of their nonclinical transition - AND who will help YOU Join our community of physicians who are at all stages of their nonclinical transition - AND who will help YOU
What stage are you in? What stage are you in?
Denying Denying 1
You don't really want to admit you need a new job.
1
But you are angry
and depressed all theto time and You don't really want admit you you're starting to suspect it's need a new job. But you are angry because of yourall current job. and depressed the time and you're starting to suspect it's because of your current job.
Wishing Wishing
You understand you are not a failure
for wanting to do something outside
2
of traditional clinical practice. But You understand you are not a failure
you still daydream starting a for wantingabout to do something outside business in the Bahamas or working of traditional clinical practice. But
2
in a cool job... like maybe about NASAstarting or you still daydream a something elseinnontraditional. business the Bahamas or working in a cool job... like maybe NASA or
Exploring Exploring 3
something else nontraditional.
You know you need a resume, an updated Linked In profile, networking
3
skills and anyou elevator You know need a pitch. resume, Oh, an yeah, and you need to know what updated Linked In profile, networking your options for jobs! skills and anare elevator pitch. But Oh, you
don't know you this yeah, andwhere you need to can knowget what information and your options areit's for so jobs! But you
Changing Changing4
overwhelming... don't know where you can get this information and it's so overwhelming...
You've narrowed your focus to 1-3
job options and you have an updated resume.
You're interviews You'vegetting narrowed your focus to 1-3
and job you need and to practice your options you have an updated behavioral interviewing skills.. resume. You're getting interviews
4
and you need to practice your behavioral interviewing skills..
New New 5 Beginning 5 Beginning
You've received one or more offers and you are celebrating your nonclinical transition, while mentoring doctors You've received one or moreother offers and in their nonclinical transitions. you are celebrating your nonclinical transition, while mentoring other doctors
in their nonclinical transitions. Come to our *live* (but virtual for you!) conference: https://www.phphysicians.com/schedule-registration-2021-what-to-consider-next/ Follow us on FB: https://www.facebook.com/phphysicians Come to our *live* (but virtual for you!) conference: Subscribe to our FREE newsletter: www.phphysicians.com https://www.phphysicians.com/schedule-registration-2021-what-to-consider-next/ Follow us on FB: https://www.facebook.com/phphysicians Subscribe to our FREE newsletter: www.phphysicians.com
For a Limited Time, use code OUTLOOKPHP to save $50 on conference registration!
For a Limited Time, use code OUTLOOKPHP to save $50 on conference registration!
For a Limited Time, use code OUTLOOKPHP to save $50 on conference registration!
O F F IC E S PAC E
Making Medicine Make Sense for You
S
Wri t t en by N a t ha n Ec k el
imple question: Why do you do what you do? I remember when medicine was completely different than it is today. Granted, I was a kid in the late 70s but my gut tells me that it was a completely different ballgame back then. My second hand experience might have seen a much more personal side of medicine than many physicians do today. My earliest memories were shadowing my father (actually working on my coloring book by the nurses’ station) while he was moonlighting in the ER at the hospital 3 towns down the road. When I made it to elementary school, my paradigm shifted because I thought it was normal to have construction crews in your basement, 2 6 | D E C E M B E R 2 0 2 0/JA N UARY 2021
turning it into a medical clinic, and to live in a bedroom, eight feet above the waiting room of that late 70s era, rural medical clinic. Apparently none of my classmates shared this experience. Indeed it was a different time. For the first 20 years of my life my father successfully fended off HMOs and managed care plans as he and his amazing staff happily served a predominantly blue collar, rural patient base. Today, as a middle aged adult, it grieves me to see how much HMOs, managed care, politicians, lawyers, and other interlopers have undermined the sacred relationship between a doctor and a patient. Especially as physicians are increasingly over-regulated and boxed-in with systems that interfere
with that relationship and the time margin needed to gain fulfillment from those interactions. My desire is to find solutions, even at the risk of being “out of the box.” If you’re willing to consider recognizing and looking beyond the perceived limits of your own box, please join me in asking yourself a few questions: 1. Systems Design: How can we solve these affronts to the patient-physician relationship from a sustainability perspective? Do physicians need to repeat similar conversations with different patients? Or could physicians’ interactions be scaled in a way that favors physicians while benefiting patients as well?
P HOTO C RE DIT BY IN GRA M IM AGE S
2. Social Learning: Is it possible to reinvent one’s patient base as a learning community or “tribe,” each having the optional opportunity to pursue their own health goals in a supportive environment? Can we acknowledge - and postpone for now - the HIPAA discussion? 3. Data Analysis: Where are the pain points? What are the key performance indicators and other metrics that point to those pain points that group practices, solo, and cash clinics, know that they are facing right now? Where are the most painful, costly, known issues that can be solved? Candidly, these ideas and ponderings are moot without your insights. My de-
sire is to hear from people just like you. People who are in the place where my father was many years ago. Whether you are a direct-pay clinician, group practice partner, hospitalist, specialist, or in the c-suite, you have something significant to share. Whatever your role, these principles can be adapted to help you step out of your box, to help you think about the practice of medicine as a system that can be optimized for the betterment of the physician-patient relationship. I hope you consider joining us for a future roundtable where we will explore real-world case studies and solutions to these issues. Look for an announcement from Physician Outlook founder, Dr. Marlene Wust-Smith, to find out more. 1
Unlock The Future Of Healthcare RESTORING THE RIGHTS OF PHYSICIANS AND THEIR PATIENTS. VISIT HPEC.IO TODAY!
WWW.PHYSICIANOU T LOOK . C OM | 27
I NT E L L I GE NC E O N TH E M OV E
What Is Health? OBSTRUCTIONS AND OPPORTUNITIES
V
Wri t t en by Am el i a B u ec he, D. O.
isions of health conjure the vibrancy of youth, strength of muscle, beauty of environment. There are preconceived notions of what health is and, perhaps more so, of what health is not. Cultural expectations can create impossible standards, excluding many from the portrait of health for their appearance, habits and circumstances well beyond individual control. The good news is, we cannot be separated from health. In the deepest moments of disease, health remains. As we transition through death, health continues. Health is the connective tissue of humanity, supporting each in their own space and offering relationship between. Defined in 1948 by the World Health Organization as “a state of com2 8 | D E C E M B E R 2 0 2 0/JA N UARY 2021
plete physical, mental and social well-being, not merely the absence of disease or infirmity,” there is progress in the picture of, and expectation for, health in medicine. Stepping beyond the simplicity (and what might be better seen as shortsightedness) of health being absence of disease, there is acknowledgement here of health beyond the body. Of the impact of the world on a person and vice versa. One of the most widely referenced quotes from Andrew Taylor Still, founder of osteopathic medicine, notes, “To find health should be the object of the doctor. Anyone can find disease.” Expansion of this concept is an invitation to see health in all things, even if but a glimmer in a sea of disease. Noticing in the countless, consistent physiologic functions the
presence of health. Honoring the capacity and desire of the person to return to a state of well-being. Seeing that health can have a wide variety of appearances and that all can be welcomed as enough. When intervention is necessary and desired, approaching with an awareness of and love for health still serves. Offering support and listening for the response of the individual – verbally, physically, emotionally – is a true engagement with health. Engaging in therapeutic measures both within the physiology and between the person and their surroundings is true dedication to health. Removing obstructions is not applicable only to the structural, mechanical, musculoskeletal impedances but also to the broader environment.
C REDIT P HYSIC IA N A RTIST DR BOU C H E R
This is the opportunity of medicine dedicated to the health of all things. To acknowledge all that contributes to the flourishing of health, and serving as a steward to enhance and encourage. To recognize all that interrupts the full expression of health, and acting as an arbiter to clear and clarify. Dr. Still reveals the ultimate potential, “When every part of the machine is correctly adjusted and in perfect harmony, health will hold dominion over the human organism by laws as natural and immutable as the laws of gravity.” The task is grand – correct adjustment for perfect harmony – but the prospect grander – health holding dominion. Sometimes we must simply, in concept if not so in action, get out of our own way.
There is much to be done within the body itself. There are endless opportunities for interruptions to the baseline of optimal health. Progress in research, expansion of knowledge, developments of intervention offer much to the world of modern medicine and the capacity for extended quality and quantity of life. None of this, however, supersedes the core of health in all of humanity. Holding space for the health that can be is where beautiful transformation occurs. If outcomes do not match expectations or follow the planned course based on previous experience or evidence, looking through the lens of health all around can offer a perspective of promise. Reflect on the reminder from AT
To find health should be the object of the doctor. Anyone can find disease. Still that, “Any variation from the health has a cause, and the cause has a location. It is the business of the osteopath to locate and remove it (the cause), doing away with disease and getting health instead.” While the integration of the musculoskeletal system and utilization of osteopathic manipulative treatment is unique in the training of D.O.s, there is invitation and opportunity for all physicians to remove obstructions to health. Time, resources, genetics, relationships, season, stress – there are myriad elements hindering health. While this can be a conduit for overwhelm, it is also a corridor for opportunity. When patients are struggling to see their own health, the physician can be a mirror. If the initial recommendation is not effective or easily implemented, the physician can serve as engineer. As hopelessness emerges, darkening any potential for resolution, the physician can hold perspective, noting that no change is required, while any can be welcomed. A lengthy list of challenges means there is not one right way forward and that is actually good news. With multiple avenues in, the odds of accessing full health increase. Testing one or multiple remains ever an option. There may very well be a singular solution. It is entirely possible for adequate improvement to be made by addressing aspects of each. Remembering that these hindrances simply impact but never eliminate health is paramount. Osteopathic medicine honors the omnipresence of health. All of medicine is invited to this approach. To see the health of all things. To notice obstructions. To acknowledge them as obstacles but not obliterations. To allow for health in all forms. To embrace opportunity to remove barriers. To engage in the work of nurturing health. To hold vision for health in all its versions, through every stage of life. 1 WWW.PHYSICIANOU T LOOK . C OM | 29
T H E LA S T WO RD
COVID-19 Pandemic A RATIONAL VACCINE PLAN
Wri t t en by C ra i g Wa x , D. O. a n d Pa rv ez D a ra , M D
“A brief history of pandemics, the human endeavor for herd immunity, and a rational plan for vaccination for those at risk.”
2
020 is the year medical history, morals, ethics and principles were overrun by politics and power, under the guise of public health policy. Koch’s postulates, principles of Lister, the history of chickenpox, all paved over by the rancor of social media. In order to move society back to normal, we must start by letting individuals be normal. In a time with so many power-hungry and political plans, we must rely on classic Hippocratic, allopathic, and osteopathic principles and practices that are time tested and proven true. Mankind has suffered the ignominy of plagues and scourges throughout history. The riddles of these illnesses take time to solve but eventually, the human 3 0 | D E C E M B E R 2 0 2 0/JA N UARY 2021
mind resolves to save itself. Thousands of years ago, smallpox showed itself in the Egyptian Empire in the 3rd century BC - mummies were found with the variola pox. The spread was slow due to the low density of the population and infrequent travel. Smallpox claimed many famous lives including Britain’s 32 year old Queen Mary II and Benjamin Franklin’s 4 year old son. President Abraham Lincoln, after the 1863 Gettysburg Address, contracted smallpox and recovered after 4 weeks of illness. Not until Edward Jenner’s astute observation in 1796 was a vaccine discovered from the milkmaid’s cowpox sore that inoculated 8-year old James Phipps. This recorded the first documented triumph against the disease. On May 8, 1980, the 33rd World Health Assembly officially declared the world free of smallpox. This freedom from smallpox was predicated on the very
low mutation rate of this poxvirus and the cowpox vaccine. Other scourges have followed including poliomyelitis that maimed President Franklin Delano Roosevelt and claimed many lives only to be tamed by the Salk vaccine. Although prior attempts in 1935 had disastrous results, not until 1941 was the success guaranteed. Other pandemics included measles that required the vaccination of children at a 92% level to achieve success. And we are now faced with COVID19 that has spread terror among the world population. The striking difference between other pandemics and this one, is the rancor, manifested from an unprecedented worldwide collusion between pseudoscience and political ambition. When history is written by non-partisan historians, this will be a tale of idiots, full of sound and fury, signifying nothing: In the scheme of things,
P HOTO C RE DIT BY IN GRA M IM AGE S
a wretched offering from the crucible of time. Basic and proven concepts, such as herd immunity, are being redefined or ignored. Prior to the advent of vaccines, the actually infected survivors conferred immunity to themselves as well as to the others - the herd - by creating a firewall against the offending germ. With the advent of an efficacious vaccine, both the surviving infected individuals and the vaccinated ones serve to immunize the herd. Now the World Health Organization (WHO) seems to suggest on their website that only vaccine immunity exists, essentially erasing the long reasoned and understood herd immunity concept. Herd immunity was first recognized by A.W. Hedrich in the 1930s, who wrote about the measles epidemic in Baltimore, having found enclaves of children that were immune. The threshold of the herd
immunity stems from the transmissibility and replication rate of the virus and is bracketed between 50%-90% of the populace. The 50% target is based on a low mutation rate of the virus and low contagiousness. The higher rates are based on the latter. For instance, the seasonal influenza virus has a high mutation rate but remains seasonal and is thwarted by vaccinating the vulnerable population, the very young and the very old. Even with public education, the seasonal flu takes countless lives in the thousands and at times if extremely virulent, even more. Vaccines against the flu are predicated on the past season’s infection and have a 50% efficacy at best. Considering mumps, measles, and rubella which remain quiescent mostly because of the 91.7% vaccination rate of the 19 to 36-month-old children, since it mostly affected the young with sequel-
ae lingering in the old. Even polio, a low mutation rate poxvirus, required 100 million Americans between 1962 and 1965 (roughly 56% of the population at that time) to receive the Sabin vaccine that allowed herd immunity to occur and thus the banishment of the virus from the US soil. This virus found in the digestive tract of humans had no predilection for age. While the herd immunity threshold (HIT) varies with diseases, it is estimated at 33%-44% for influenza and 92%-95% for measles. The transmission, however, has always been due to the population density of the connected networks as evidenced by the COVID19 infection rate in the densely populated skyscrapers of New York City. The more closely packed dense networks suffer from rapid spread, while the opposite is true for thinly populated areas. Other countries offer us WWW.PHYSICIANOU T LOOK . C OM | 31
clues as to their herd immunity status and population density spreads, issues that are worth understanding. The R0 (pronounced “R naught”) is considered to be a measure of the number of cases generated by a “typical” infectious person, which depends on how individuals within a network interact with each other. R0 is the lynchpin of the herd immunity threshold calculus. Herd immunity exerts an evolutionary pressure on the virus itself and causes the virus to evolve through a mutation that results in changeable epitope (surface protein/ antigens) or antigenic drift. These antigenic drifts can and in many cases lend resistance to the vaccines. The HIT can be calculated based on the basic (viral) reproduction number or R0. A simple equation is Pc = 1- (1/R0) where Pc is the critical population at risk and R0 is the viral reproducible rate. So, an R0 of 2 will require a HIT of 50%. The scientists at the pulpit initially claimed that vaccines would be the panacea against COVID19. Unbeknownst to them, the “Operation Warp Speed” created an mRNA vaccine in record time. But as the vaccine was rolled out, the experts claimed that masks would still be necessary in spite of the vaccine as would the need for “social distancing.” With the purported 95% efficacy of the vaccine, one begins to wonder as to the motive behind those requirements. The vaccine itself has some unanswered questions. Some are being answered concurrently as only 6 anaphylactic reactions have occurred while over a million individuals have been vaccinated, and all 6 have safely resolved. Antibody-dependent enhancement (ADE), feared if reinfection occurs, is still a potential hypothesis. The incorporation of the mRNA as an intron into the human DNA also remains a theoretical possibility since this is the first mRNA vaccine approved for humans. Time will hash out these conundrums and potential longer-term side-effects. As of December 2020 we do not yet know the HIT for COVID19 because it is a novel virus that has been on the planet for only a year. There is much 3 2 | D E C E M B E R 2 0 2 0/JA N UARY 2021
left to discover and learn based on scientific evidence. How then, should we approach the vaccination process? The populace most vulnerable to COVID has always been the elderly >70 years of age with comorbid conditions, such as diabetes, obesity, hypertension, and those with suppressed immunity. Based on what we know today about the virus, the vaccine and herd immunity concepts, we should vaccinate the vulnerable first, followed by those younger but with comorbid conditions, and then those who willingly want to be vaccinated. Children have robust immune systems and thus need little in the way of vaccination, as they can eliminate the virus in a short span of a day or two without sequelae. There is also now proof of high false-positive rates in PCR testing based on high thermal cycle thresholds and a burgeoning proof of lack of transmission from asymptomatic individuals. Keeping all that in mind, a rational mind would use worthwhile strategies rather than fear-mongering and promoting a constant state of alarm for mandatory vaccinations for all. Schools should stay open and the powerful Teachers Unions should not dictate policy through lobbyists, and neither should the grifting wealthy billionaire crowd. When an eagle point of view is taken, one finds that the greed for the power of a few has trampled on the lives of the many. These few have manipulated a willing media and used them to their own ends. The vicious nature of the rhetoric and the anger directed at logical scientific skepticism has transformed into words like “deniers of the truth.” As if “truth” is only seen from a single point of view. What has unfolded during this COVID19 debacle is the lechery and grift of the rich and powerful, against the many. It is a sad testimony to human nature and human greed that flows in the veins of some. History is replete with such occurrences in the past. This pandemic and the response to it will also “go down” as another such “humans against humanity” episode in the chronicles of time signifying our turbulent past. 1
Find Your Dream Job Today REGISTER FOR FREE AT PHYSICIANOUTLOOKJOBS.COM
Al-Agba and Bernard tell a frightening story that insiders know all too well. As mega corporations push for efficiency and tout consumer focused retail services, American healthcare is being dumbed down to the point of no return. It’s a story that many media outlets are missing and one that puts you and your family’s health at real risk. JOHN IRVINE, DEDUCTIBLE MEDIA
Laced with actual patient cases, the book’s data and patterns of large corporations replacing physicians with non-physician practitioners, despite the vast difference in training is enlightening and astounding. The authors’ extensively researched book methodically lays out the problems of our changing medical care landscape and solutions to ensure quality care. MARILYN M. SINGLETON, MD, JD
A must read for patients attempting to navigate today's healthcare marketplace. BRIAN WILHELMI MD, JD, FASA
This book is a warning of what is to come if we ignore training and education. Share this book or tell others to buy it. We cannot wait to act on this.” DOUGLAS FARRAGO MD AUTHENTICMEDICINE.COM
This book exposes one of the best kept secrets in our current healthcare jungle created through the corporatization of medicine. Filled with relevant examples and anecdotes to help the reader understand the issues being addressed, this book captivated and held my interest from beginning to end. AINEL SEWELL MD
Inspiring, inciteful, and eye-opening! An in-depth and thought-provoking examination of important decisions affecting modern healthcare in America. This work should be mandatory reading for all administrators and policymakers influencing the US healthcare industry. KEVIN LASAGNA, LTC, US ARMY
A masterful job of bringing to light a rapidly growing issue of what should be great concern to all of us: the proliferation of non-physician practitioners that work predominantly inside algorithms rather than applying years of training, clinical knowledge, and experience. Instead of a patient-first mentality, we are increasingly met with the sad statement of Profits Over Patients, echoed by hospitals and health insurance companies. JOHN M. CHAMBERLAIN, MHA, LFACHE, BOARD CHAIRMAN, CITIZEN HEALTH
3 4 | D E C E M B E R 2 0 2 0/JA N UARY 2021
Publisher: Marlene Wüst-Smith, MD Editor in Chief: Alicia Roselli Managing Editor: Alejandra Suarez VP of Advertising: Pamela Ferman Director of Art and Production: Ricardo Castillo Marketing/Social Media Intern: Allison Easton, Pennsylvania State University; Eli Trimbur, Wheaton College, Contributing Authors: Megan Babb, DO; David Balat; Amelia Bueche, MD; Lynette Charity, MD; Ayushi Chugh, MD; Parvez Dara, MD; Nathan Eckel; Navin Goyal, MD; Craig Wax, DO; Cover Art: Dr. Saira Rahman (front & back); Other Art: Douna Montazer, MD; Steven Mosborg - Mosborg Exposures LLC; Manasa Mantravadi, MD (mosaic, using image created by Kyle Brinker); Amelia Bueche,DO and Billynda McAdoo, MD Published By “Physician Outlook Publishing” Editorial Policy Physician Outlook Magazine is a national magazine dedicated to empowering physicians and their patients to improve the world of medicine together. Editorial decisions are based on the editor’s judgement of the quality of the writing, the timeliness of the content and the potential interest to the readers of The Physician Outlook Magazine. The magazine may publish articles dealing with controversial issues. The views expressed herein are those of the authors and/or those interviewed and might not reflect the official policy of the magazine. Physician Outlook neither agrees nor disagrees with those ideas expressed, and no endorsement of those views should be inferred unless specifically identified as officially endorsed by the magazine. Letters to the Editor Email: aroselli@physicianoutlook.com Information on Advertising, Subscriptions, Job Board Email: hello@ physicianoutlook.com “Physician Outlook is a registered trademark” WWW.PHYSICIANOU T LOOK . C OM | 35