Monday, March 30, 2020

The Great Suppression

Interesting opinion piece from the American Institute for Economic Research appeared online framing the "Great Suppression:"

I write on Saturday morning March 28, and right now there are two contrary strains about to collide. On the one hand, you have scientists reducing their death-rate predictions further and further, lopping off zeros by the day. On the other hand, this is accompanied by appalling levels of despotism, even to the point of National Guard checkpoints at state borders and restrictions on what you can buy even at “essential” stores. This gigantic gap between emerging professional medical consensus and appalling policy ignorance is revealing as never before the practical impossibility of scientific public policy.

Then you have the cascade of unintentional and unexpected outcomes of the rush to coerce. It began with Trump’s disastrous block on flights from Europe that sent millions scrambling for tickets and led to an unspeakable crush of people standing shoulder-to-shoulder at our nations’ airports, contradicting the demand that people social distance just when the virus was revealing itself as highly contagious. The very opposite of intended results!

That’s just the beginning. I doubt seriously that the political class in this country, as low a regard I have it, set out to destroy all that we call civilized life, instantly generating millions of unemployed workers and bankrupt businesses all around, not to mention a pandemic of utter hopelessness on the part of vast swaths of the world’s population. Still, this is what they have managed to achieve. This is what their pretense of knowledge – as opposed to actual wisdom – has unleashed on the world, with incalculable human cost.

As for economics, are we talking recession? Depression? Those words indicate cyclical changes in business conditions. My friend Gene Epstein suggests another term for what we are going through. The Great Suppression. There will be months, years, and decades in which to more clearly observe the countless ways in which the supressors piled error upon error, blockage upon blockage, to add to the grotesquery.

What truly should inspire us all right now are the grocers, pharmacists, truck drivers, manufacturers, doctors and nurses, construction workers, restaurant workers, service station attendants, webmasters, volunteers of all sorts, philanthropists, and specialists in a huge variety of essential professions who keep life functioning more or less. And let us not forget the “unessential” people (it’s an incorrect and vicious term) who have innovated ways around the Great Suppression to continue to serve others, keep the rent being paid, and food on their tables. They are the means of salvation out of this mess.

The market, hobbled and bludgeoned, still loves you.

As for the politicians, Andrew Cuomo has admitted some of the error. In a much-welcome change, he has even deregulated medical services. There’s just a hint of humility and humanity embedded in these statements and actions. We need more of that, vastly more, if only to contribute to calming things down long enough to gain some perspective, and, hopefully, some eventual realization that in the “land of the free and the home of the brave” a virus should be regarded as a disease to mitigate and cure, not an excuse to bludgeon life on earth as we know it.



Anonymous said...

As we all adjust our practices, family, hospital rounds and procedure schedules to this global issue, perhaps the silver lining is these events will highlight the priceless nature of the experienced clinician. Perhaps the ABMS and especially the ABIM will realize the oppressive nature of MOC and their inexcusable monetary abuse of the very constituents they depend on to exist.

As we watch colleagues fall ill to this virus and inevitably some of us will perish from this illness can the ABMS and the ABIM leaders truly sympathize with those who actually take on call responsibilities filled to the brim with dying patients?

Have the ABMS and ABIM physician bureaucrats joined the fray? Or is their collective cowardice keeping them at home watching this spectacle from the Ivory Towers on Walnut Street?

Dr. Baron are you willing to put skin in the game and join your colleagues who are suffering for their profession? Or are you going to give yourself another salary raise?

ABIM's Cayman Hedge? said...

Protecting and being mindful of the golden parachute in lieu of protecting and serving the public?

Anonymous said...

Not a whisper about Covid 19 from the ABIM or ABFM and what to do in preparation for it before it hit our shores. Why? Baron has plenty of experience working for HHS, CMS and the CDC. The ABFM leadership over the past two decades has worked closely with the DoD helping train combat physicians for bio threats. Nada from our thought leaders at the ABMS about anything that really counts. If these folks are not part of the solution, what are they?

Anonymous said...

NQF behind a pay wall. NO guidance whatsoever that one can readily access.

Anonymous said...

The data hungry NCQA appears to not give a whit about relaxing their meaningless measures - totally useless in this crisis.

Anonymous said...

The ACP is offering little except empty words. Did I read this phrase correctly? They are offering ways to "help clinicians find joy amidst chaos".

Supporting Clinicians During the COVID-19 Pandemic - FREE
Charlene Dewey, MD, MEd; Susan Hingle, MD; Elizabeth Goelz, MD; Mark Linzer, MD

MS. Oblivious and Mr. Olivion. said...

Unprotected Beyond Burnout

The AMA has shown little insight about what was coming and what to do, it seems as Christine Sinsky their VP in charge of "physician satisfaction" was still chattering about EHR, burnout and joy on her Twitter page until almost a few days ago. Prior to that there are a few political comments about suppression of information by the current administration. Finally getting on the bandwagon about the shortage of PPE yesterday.

What has the ABMS been up to? said...

Too busy to help a nation in crisis

Too distracted with MOC money matters? Heads frozen in decades-long political posturing and clandestine lobbying that has only harmed the profession and the public? Too busy undermining physician autonomy and the well-being of patients?

Has the ABMS been too involved with private equity portfolio managers with most of the medical boards acting as agents for industry consolidation and self-dealing schemes for their own personal enrichment and control of physicians by profiting off their backs?

For the first time in 21st century history an unprecedented biological event, terrorizing the whole nation. This disastrous event is already being compared to the deadly pandemic of 1918, which came after the end of the first world war. That flu epidemic killed millions.

This pandemic comes on the heels of the repeated political distractions, which has included
several attempted political assassinations of the current president of the US. A time of utter division like at no other time in history perhaps since the 1860's.

Oddly this pandemic also come on the heels of the American Bard of Preventive Medicine being headed by a man without any medical training at all. For the first time in history we discover that the ABMS appointed a non-physician attorney with ties to private equity to be in charge of the certification and re-certification of our preventive/aerospace/population health physicians. Is the ABMS playing with fire when they sell positions to the highest bidder almost like it was an Illinois Senate seat. That person should resign immediately if not terminated and replaced with a dedicated physician, who understands population health and prevention of disease. Is this by design or just a catastrophic coincidence that epitomizes the utter corruption of the medical boards? that they hire someone with a horrific track record for health and safety of the past company he was in charge of.

This is a low time in history when the ABMS cannot find a single physician to lead an important medical board. Has the United States become so divided and perhaps politically crippled that we failed to prevent the novel corona virus from reaching our shores and spreading so profusely? Lawyers involved with growing Burger King franchises cannot understand a virus and help prevent it or lead the education of those who do have medical knowledge. None of these bureaucrats seems willing to go out and serve on the front lines.

And when this virus hit us we were woefully unprepared to contain and fight it. Physicians are unprotected. Where is the prevention and protection of our doctors/providers. It will spread profusely if there are no masks? How can we care for our population and the inflicted patients if we do not have enough equipment and the strategically necessary testing resources and medicines, and the experience/knowledge of how to effectively administer them.

In a time when the medical boards have created mistrust with repeated financial and political machinations, how can we be sure that the ABMS MB's are not just conducting themselves in the same selfish ways as before. Are they doing nothing to help out in this crisis, because they are the very same insiders who are profiting off this calamity by shorting physicians and the patient as they have been doing for decades.

Longitudinal Racketeering (An ABMS Franchise)

Gov Novella said...

Washington is planning to win the covid 19 war, but (hold on) the war against the novel corona virus is apparently not going to take place on US territory but in none other than in Venezuela.

All this, while many US states are asking sewing circles to make a few dozen homemade cotton masks to give to our doctors or for the public to wear in the streets.

The Big Lie (MOC) said...

Who do the ABMS medical specialty boards represent? They represent moneyed interests.

ABIM's blatant conflicts of interest represents a profound breach of trust for physicians and patients. Their silence on important matters is loud and clear. They are a big lie. We see this especially during moments of crisis. Research shows that the MB executives are hoarding cash and inuring themselves beyond belief. They have a track record of hiding their private investments, which they have used for their own benefit not to benefit the profession or the public.

Rebuilding Patient Trust
Richard Baron, ABIM CEO, Aspen Festival 2019

Third World Medicine Covid Containment said...

Viet Nam shows how you can contain COVID-19 with limited resources date,

"Viet Nam has had no fatalities as a result of the pandemic.
The government acted swiftly to suspend flights, shut schools and quarantine new arrivals.
More than 45 million Vietnamese have been lifted out of poverty between 2002 and 2018.
How does a nation with limited resources confront a global pandemic that has brought many developed countries’ healthcare systems to a breaking point?

That’s the challenge facing many of the world’s poorer, developing nations - including countries like Viet Nam. But while it might look like a foregone conclusion that the coronavirus outbreak would ravage such a country, Viet Nam has instead stood out as a beacon of how to do more with less.

So far, the country has 194 confirmed COVID-19 coronavirus cases, and no fatalities. Unlike other, wealthier Asian countries, Viet Nam isn’t in a position to conduct mass testing programmes. South Korea, for example, has tested 338,000 people. In Viet Nam, that number stands at just 15,637 people (figures for 20 March 2020). But by focusing on measures that are within its control, the country has won praise from the international community."

Harvard Study on Corona Virus Strategies said...

Doing the Math MOC, greed and rigid ABMS policy contributed to the current crisis

Mathematical models suggest we need more specialty and primary care physicians. We also need greater capacity in terms of emergency and critical care facilities (ready to go) in order to withstand the waves of novel lethal viruses, such as we have been experiencing.

MOC leads to fewer physicians and fewer patient contact hours. A healthcare deficit stems from mandated MOC. Coerced recertification, by whatever novel name it is called, equates to losses all around with wasted time and money. Needless morbidity and death result from unwise decisions stemming from self appointed thought leaders who generate profit for themselves the few, while they harm the many.

I call for a congressional and DoJ investigation and resolution to the problems of shortfalls and waste created by the ABMS and its member boards.

Anonymous said...

I would like to share a recently read quote that has significant meaning in these current times. It is by the owner of Time magazine, Marc Benioff. "More than ever, the truth matters. Facts matter. Values matter,... Whatever organization, business, or institution that we are a part of, we need to realize that we are not separate from the larger social issues that surround us. We have a responsibility not simply to profit, but to make the world a better place."

Fast Track to Harm? said...

Is it wise to fast track a vaccine? There are over 50 companies rushing to exert their claim.

104 Year-old Veteran Survives Corona Virus said...

Oregon veteran recovers from COVID-19, celebrates 104th birthday
William "Bill" Lapschies started showing signs of coronavirus in early March

by: Hannah Ray Lambert

Veteran celebrates his birthday and winning the battle against Covid-19 in Oregon. Says he's good for a few more.

Other good news. I heard the rates of infection in Italy and Spain were coming down.

Anonymous said...

Is it fair to ask our administrator colleagues at the ABIM, ABMS, NQF, AMA, USMLE, ACP, ACC, HRS, SCAI, ACS to join the fray?

Or should they stay at home and be excused?

AMA INT said...

AMA, "Ask Me Anything"
Bill Gates Calls for a “Digital Certificate” to Identify Who Received COVID-19 Vaccine

"Free" Debt (Physicians on Life Support) said...

Covid-19 Stimulus Bill (Who wrote the healthcare related parts?)

AMA's Ethical Guide to Healthcare Consolidation (Financial Triaging Service for Overburdened Frontline Doctors?)

AMA Covid-19 Updates

AMA Ethics Update

How the AMA Scared Us Away From Socialized Medicine (Political article with interesting quotes.)

Covid-19 may fastrack vaccination legislation and gag debate

Anonymous said...

NYC Mayor Bill Deblasio recently wrote a NY Times Opinion piece invoking the Federal Government to "Draft" physicians of all types and mandate them to work in a NYC COVID inpatient unit.

He specifically stated he did not care about the background of the physician. In his mind a podiatrist vs a dermatologist vs a plastic surgeon vs a Pulm/CC made no visible difference to him.

What he should have asked the Federal Government to do is to mandate every single MD/DO in our bureaucratic agencies to come back to clinical work. The ABIM, AMA, ABMS, ACP, ACC, ACS etc all have hundreds of well trained physicians who need to put down their pens and laptops and join the efforts in NYC, NJ, CA, WA, NoLa and beyond.

The experts in our societies and agencies need to lead by example.

AMA Covid-19 Riders? said...

The physician bureaucrats sitting at home or in their Ivory Towers should get to work on the front lines of this pandemic. But like their ABMS partners they are sitting instead with private equity partners and profiting off crises like this. Anyone who reads their financial statements can read quite plainly how they are profiting under the current circumstances. It is not "how they are helping", it is in fact that the opposite is more true. With AMA it has been duplicity for years. The anti-MOC resolution that the inner sanctum suppressed is proof of this. Instead of helping physicians and patients they are throwing out a few show crumbs and helping themselves to the buckets of money that are being passed out by this stimulus bill. Directing it toward their lucrative projects and enterprises. They AMA has been securing their future with private venture partners/private equity/shadow banks, and utilizing their own "reserve funds".

How many ways will the AMA and their "horn of plenty" partners profit from the "cornucopia" that the corona virus has created. Insurance products and services is one of them. They are hoping for membership to increase, but only if there is trust in their 'inner governance', which has failed us all in the past. The outer shell is a useless peanut.

AMA insurance product revenues were up in 2018 while membership was down. Insurance sales/revenues surpassed membership dues/revenues by several million. 39-40 million dollars in 2018 for insurance commissions/sales.

"Membership’s contribution margin decreased $3.9 million
in 2018 due to the combination of a dues revenue decline,
increased marketing efforts focused on member retention and
costs for digital marketing programs for membership."

"Publishing, Health Solutions and Insurance
Publishing, Health Solutions & Insurance results were up
$8 million in 2018. Increased royalty and digital product
revenue, advertising, site licensing and open access fees were
the major drivers."

Anonymous said...

To the credit of HRS and Andrea Russo, they have called upon the ABIM to suspend all MOC requirements in 2020. It is a good first step but more needs to be done.

Where are the physician bureaucrats during this COVID crisis? Are they joining their colleagues in the MICU or in the ER?

Where is Christine Cassel? Is she participating clinically or is she sheltering at home?

Rich Baron- are you willing to help your Philly colleagues and join the clinical fray? Would you prefer to watch from the sidelines as your city closes another academic hospital?

Balancing the Pharma Deficit said...

Repatriating the medical supply chain (from the dependency on global sources)

The Golden Spinning Wheel said...

The egregiously conflicted ABMS does not represent physicians or the public, but rather "the industry" they claim that they take no money from. This is the harsh reality. Physicians are being fleeced and herded like sheep. MOC is a testing Ponzi scheme that has been exposed along with all of the ABMS/ACGME cartel's professional medical bureaucrats who have been lining their pockets with physician fees and lucrative kickbacks from the medical industrial complex they euphemistically refer to as "industry collaborations".

The AMA never really intended to have any of the ABMS medical boards open up their "books" to an independent audit, because it might have started a precedent where they (AMA and cronies) would also have to expose their multifarious conflicted financial relationships with the "industry". So many AMA/ABMS/ACGME "administrators" pulling the wool over our eyes for decades.

The only thing wrong they thought was that they got caught in the big lie and their relationship with their stakeholders and the vast network of closely guarded and coveted moneyed interests. ProPublica needs to do a follow up on one of the greatest coverups in the history of the "quality assurance industry".

Covid 19 and ARDS protocols? said...

"Is Protocol-Driven COVID-19 Ventilation Doing More Harm Than Good?"

Plea from the trenches

Anonymous said...

The Covid virus crisis is terrible. I have not heard one story did we need credentialing for physicians especially on the front lines. I've heard that some areas want physicians to volunteer, not get paid, risk their lives and come out of retirement. None of these issues I have heard that any hospital, state or new outlet that physicians should be board certified. Hospital. Hospital CEO's hide out while front line caregivers work day and night. Hospitals are losing money. They have cut physican salaries but expect them to risk their lives. All non essential employees are being furloughed. This would include administrators . They were not needed anyway when there was not a problem.

During this time, I have not head about any ABIM/ABMS staff or doctors joining in. But they still want to get paid.

Standard Exam Dates

Coronavirus Alert Icon Coronavirus Update
August 2020 Initial Certification Exam still on - Registration open through 4/28 - Late Fees Waived

Registration will remain open through April 28, 2020 and—to give you greater flexibility during this challenging time—no late fee will be applied from April 16-28, 2020 (the previously published late registration window). No one will be able to register after April 28, 2020.

I hope that the legal issues against the ABIM/ABMS continues It would be good if some new agency such as pro publica finally investigates the MOC travesty.

Anonymous said...

Quality assurance cartel: rich sock puppets for the medical industrial/surveillance complex.

Anonymous said...

ABIM/ABMS MOC: an educational Ponzi scheme.

Anonymous said...

Happy Easter!

Anonymous said...

This applies to MOC too

"Sensitive" But Not Classified said...

US Was Concerned About Wuhan Research and Lab Safety Two Years Ago
April 16, 2020
From the UK Daily Mail, April 15, 2020

"The US State Department raised concerns over safety issues at the Wuhan research lab studying coronaviruses in animals like bats two years ago, new diplomatic cables reveal.

A US delegation led by Jamison Fouss, consul general in Wuhan, and Rick Switzer, the Beijing embassy’s counselor of environment, science, technology and health, visited the Wuhan level four biosafety lab multiple times from January to March 2018.

They voiced concern over a lack of safety protocols and the biosafety of the lab’s research on coronavirus in animals like bats and warned that if cautionary steps weren’t taken, the lab’s research could spark a SARS-like outbreak.

They sent two ‘sensitive but unclassified cables’ back to Washington, DC asking for assistance to help the lab heighten its security measures.

They warned that a lack of tight safety measures in handing the contagious viruses in the lab ‘represented a risk of a new SARS-like pandemic.’

‘During interactions with scientists at the WIV laboratory, they noted the new lab has a serious shortage of appropriately trained technicians and investigators needed to safely operate this high-containment laboratory,’ a cable dated January 19, 2018 said.

‘The cable was a warning shot. They were begging people to pay attention to what was going on,’ one US official said.

The cables argued that the United States should give the Wuhan lab further support to help control the situation, but after those messages no extra assistance was provided to those labs.

The US was not only flagged to the activities going on in that laboratory, but they were also prior financially and scientifically involved in their studies.

The WIV received assistance from the Galveston National Laboratory at the University of Texas Medical Branch and other U.S. organizations in its work.

The US National Institute of Health, a government agency, also gave a $3.7 million research grant to the WIV to carry out research on bats from caves in Yunnan, more than 1,000 miles away. Scientists have traced the sequencing of the COVID-19 genome to Yunnan, the Mail on Sunday revealed over the weekend. It’s not clear when that grant was given."

Anonymous said...

Private Fund Raisers said...

Featuring the Milken Institute, FastCures, Anthony Fauci and Carmen Puliafito

ABIM Galling and Grotesque said...

I read Medicine's House of Cards. Chilling story of ABIM's malfeasance, corruption and deceit. The ABIM/ABMS is obviously not a public servant, but a public menace. MOC really is a Ponzi scheme! Protected by a corrupt cartel of "quality assurance" organizations. It is one huge racket.

Unknown said...

Dr Wes, Could we please get a vote on the need for ABIM recertification from practicing physicians through email.

And, as a secondary question, lets ask if ABIM should be in that position vs the speciality organizations who better understand the needs of the field.

It has become a headache with all its complexities and MOC and all.