Saturday, May 11, 2024

Autobiography of Donald Harvey Marks

Donald Harvey Marks, an Autobiography


Donald Harvey Marks
(born June 27, 1949) is an American physician, scientist, author and advocate for social justice He is a husband (Diane Christine Bingham, married 1972), the proud father of three children (Brandon Ellis, Travis Dustin and Britni Kalin), and a grandfather. He had a number of major discoveries in his life, principle of which was applying the concept of cognitive engrams for interpretation of functional MRI data to human thought. (see Patents).

Family: 
Parents are Dorothy Greenberg Marks and Richard Leo Marks, of Buffalo, NY.
Marks has one brother (Stephen, deceased), one sister (Sharon), three children (Brandon Ellis, Travis Dustin and Britni Kalin) and 5 grandchildren: Connor, Lukas, Madelyn, Dylan and Rosie. I am also blessed with two wonderful daughter-in-laws Erika and Kristie, and son-in-law Mark Bentley.

Link to video Odyssey presentation on my life https://www.youtube.com/live/fwiYM-yZcsQ?si=W3nrw-VQJSDrfs8_


Early Life

Don Marks was born in Buffalo, New York in 1949. He grew up in Buffalo, Erie County, New York and in Los Angeles, California. He is a graduate of PS 66 in Buffalo, NY and of Hollywood High School (1967), Hollywood, California. He doesn't remember a lot of the details of his earlier years because he was born when he was very young.

After graduating from (now) California State University San Bernardino with a B.A. in 1972, he attended the (now) Department of Microbiology, Immunology and Human Genetics at UCLA. He received a doctorate in philosophy (Ph.D.) in 1977, on the subject of comparative immunology of graft rejection. Marks attended the David Geffin School of Medicine at the University of California in Los Angeles, and graduated in 1980 with a medical degree (M.D.). Not everyone was totally surprised that I had two doctors degrees, because some members of my family thought I was a child progeny.
He had completed Internal Medicine internship and residency at the USAF Medical Center, Keesler AFB, MS.

Don Marks is licensed to practice medicine in New Jersey. He is a Diplomat of the American Board of Internal Medicine and an Emeritus Fellow of the American College of Physicians.

Military Career

      Marks was in the Air Force ROTC and Civil Air Patrol while in high school, and served 6 years in the California Air National Guard after graduation from HS and while in undergraduate college. He attended basic training at Lack!and AFB and aircraft engine school at Sheppard AFB. He was a flight engineer on C-97 and C-130 aircraft.
     He had a military scholarship to attend medical school, and attended the Officers Candidate School Medical Indoctrination for Medical Service Officers. He also completed the Air Command and Staff College, and the Biological Warfare Courses.
     Marks was honorably discharged and is a proud third generation veteran.

Pharmaceutical Industry Career

     Marks is the former Associate Director of Clinical Research, Antibacterials of Hoffmann-LaRoche Pharmaceuticals, and the former Director of Clinical Research for adult vaccines at Aventis Pasteur Vaccines (formerly Connaught Pasteur Merieux). Research projects centered around application of antibiotics to treat Lyme disease and adult vaccines for Lyme disease and influenza.

Biotech and Neurotech Career
He was the Senior Vice President, Clinical Research and Regulatory Affairs at Emerging Technology Partners, which was the biotech division of Economic Development Partnership of Alabama. He participated in the founding and initial scientific direction for vaccine companies Vaxin Inc. (www.Vaxin.com) and Tranzyme, Inc.
He was the founder and CSO of Millennium Magnetic Technologies, MMT Neurotech, LLC http://www.MilMag.net which  commercialized his discovery of interpreting human thoughts with functional MRI.

Intellectual Property
     1) Vaccination by topical application of genetic vectors. China 98809932, November 22, 2000. D-C C Tang; D H Marks; D T Curiel; UAB Research Foundation.

     2) Noninvasive genetic immunization, expression products therefrom and uses thereof. US 6348450, February 19, 2002. De-Chu Tang, Donald H. Marks, et al.

     3) Vaccination by Topical Application of Genetic Vectors. US 06706693, March 16, 2004. De-Chu Tang, Donald H. Marks, et al.

     4) Noninvasive genetic immunization, expression products therefrom, and uses thereof. US 06716823, April 6, 2004: Tang, De-chu C.; Marks, Donald H.; Curiel, David T.; Shi, Zhongkai.

     5) Brain Function Decoding Process And System. US 7,627,370, December 1, 2009. Marks, Donald H.

6) Brain Function Decoding Process And System. Marks, Donald H. Patent application filed March 25, 2010, US Serial No. 12/731,264, claiming priority to the application filed on March 30, 2009, and assigned Serial No. 61/164,724.

Academic Affiliations

     University of Alabama at Birmingham, Clinical Assistant Professor, Division of General Internal Medicine, Department of Medicine, and also Biomedical Engineering.

     Wallace Kettering Neuroscience Institute, Kettering, OH, former visiting Research Associate.


Non-Science PUBLICATIONS

Einstein, Relativity and Relative Ethics. http://bit.ly/2HC5YEN

Jonas Salk, Polio Vaccine and Vaccinating Against Hate. My take. http://bit.ly/2HE5bDl

Personal thoughts on longevity v reputation v meaningful accomplishments. "What I have not told my family about the meaning of time." http://bit.ly/2HDQDUb

Transit States. Collected poetry of DH Marks. https://www.amazon.com/Transit-States-D-Marks-ebook/dp/B011LM9NFI

A complete listing of all of his publications can be found at www.dhmarks.blogspot.com

                              Scientific Publications 

  1. TenEyck R, Schaerdel AD, Lynett JE, Marks DH, et al: Stroma-free methemoglobin solution as an antidote for cyanide poisoning. A preliminary study. Clinical Toxicology 21(3):343-358, 1984.
  1. Marks DH, et al: Pelvic hematoma after intercourse while on chronic anticoagulation. Annals of Emergency Medicine 13:554-556, 1984.
  2. Marks DH, Patressi J, Chaudry IH: Effect of pyridoxalated stabilized stroma-free hemoglobin solution on the clearance of intravascular lipid by the reticuloendothelial system. Circulatory Shock 16:165-172, 1985
  3. Marks DH, et al: Pyridoxalated polymerized stroma-free hemoglobin solution for hemorrhagic shock in dogs. Military Med. 152(5):265-271, 1987
  4. Marks DH, et al: Antibody Response to Transfusion With Pyridoxalated glutaraldehyde-treated Hemoglobin Solution. Mil Med 152(9):473-477, 1987.
  1. Davidson IJA, Drukkerr S, Hedlund B, Marks DH et al: Deleterious Effects of Stroma-free Hemoglobin Used As Resuscitative Fluid For Rats With Ischemic Intestinal Shock. Crit Care Med 16(6):606-609, 1988.
  1. Moore GL, Marks DH, et al: Ascorbate-2-phosphate in Red Cell Preservation: Clinical Trials and Active Components. Transfusion 26(3):221-225, 1988.
  1. Marks DH, Cooper TMakovec T,et al.: Effect of Polymyxin B on in vivo hepatoxicity of hemoglobin. Mil Med 154(4):180-184, 1989.
  1. Keller, D, Koster, FT, Marks, DH et al. Safety and Immunogenicity of a Recombinant Outer Surface Protein A Lyme Vaccine. JAMA, June 8, 1994, p 1764-1768.
  1. Sigal LH, Zahradnik JM, Lavin P, Patella SJ, Bryant G, Haselby R, Hilton E, Kunkel M, Adler-Klein D, Doherty T, Evans J, Molloy PJ, Seidner AL, Sabetta JR, Simon HJ, Klempner MS, Mays J, Marks D, Malawista SE A vaccine consisting of recombinant Borrelia burgdorferi outer surface protein A to prevent Lyme disease. Recombinant Outer-Surface Protein A. Lyme Disease Vaccine Study Consortium. N Engl J Med (1998 Jul 23) 339(4):216-22.
  1. Kanesa-thasan N, Smucny JJ, Hoke CH, Marks DH, Konishi E, Kurane I, Tang DB      Vaughn DW, Mason PW, Shope RE.   Safety and immunogenicity of NYVAC-JEV and ALVAC-JEV attenuated recombinant Japanese encephalitis virus--poxvirus vaccines in vaccinia-nonimmune and vaccinia-immune humans. Vaccine (2000 Oct 15) 19(4-5):483-91.
  1. VanKampen KR, Shi Z, Gao P, Zhang J, Foster KW, Chen DT, Marks D, Elmets CA, and Tang DC. 2004. Safety and immunogenicity of adenovirus-vectored nasal and epicutaneous influenza vaccines in humans. Vaccine. 2005 Jan 11;23(8):1029-36.
  1. Marks DH, Adineh M, Gupta S: Determination of Truth from Deception Using Functional MRI and Cognitive Engrams. The Internet Journal of Radiology [peer-reviewed serial on the Internet]. 2006. Volume 5, Number 1.
  1. Marks DH, Adineh M, Wang B, Gupta S, Udupa JK. Multidimensional Representation of Concepts as Cognitive Engrams in the Human Brain. The Internet Journal of Neurology [peer-reviewed serial on the Internet]. 2007. Volume 6, Number 1.
  1. Marks DH, Adineh M, Wang B, Gupta S. Use of fMRI to Predict Psychiatric Adverse Effects of Interferon Treatment for Hepatitis C. Neuropsychiatric Disease and Treatment. 2007:3(5) 655-667.
  1. Marks DH. Cardiomyopathy Due to Ingestion of Adderall. American Journal of Therapeutics. Am J Ther. 2008 May-Jun;15(3):287-9.
  1. Marks DH. Depression Leading to Suicide As An Adverse Effect of Metoclopramide. Internet Journal of Gastroenterology [peer-reviewed serial on the Internet]. 2007. Volume 5(2).
  1. Marks DH. Dangers of OTC Herbal Supplements: Dilated Cardiomyopathy after Ingestion of TRIAC (triiodothyroacetic acid, Tiratricol). Internet Journal of Endocrinology [peer-reviewed serial on the Internet]. 2007. Volume 3(2).
  1. Marks DH and Milby J. Interferon and Risk for Drug-Seeking Behavior. Internet Journal of Pain, Symptom Control and Palliative Care [peer-reviewed serial on the Internet]. 2009, 6(2).
Simultaneously published by agreement in The International Journal of Risk and Safety in Medicine, Volume 20 (4), 2008, pp 231-240.

  1. Marks DH, Adineh M, Gupta S. MR Imaging of Drug-Induced Suicidal Ideation. Internet J Radiology [peer-reviewed serial on the Internet], 9(1). 2008. http://ispub.com/IJRA/9/1/10393
  1. Marks DH. Evaluation of Cognitive Impairment. Internet J Health. [peer-reviewed serial on the Internet]. 8(1), 2008
  2. Marks DH, Allison J, Ahmed S, Jeffers LJ, Morgan JR, Morgan PM. The Association of Race/Ethnicity, Sex, and Comorbidity with Hepatitis C Genotype 1 Treatment Response, Internet Journal of Gastroenterology [peer-reviewed serial on the Internet]. 7(2), 2008.
  3. Marks DH. Case Report: Drug Toxicity Leading to Vanishing Bile Duct Syndrome and Cholestatic Jaundice. Internet Journal of Gastroenterology [peer-reviewed serial on the Internet]. 2009, Vol 8(1).
  4. Marks DH, Valsasina P, Rocca M and Filippi M. Case Report: Documentation of Acute Neck Pain in a Patient Using Functional MR Imaging. Internet Journal of Pain, Symptom Control and Palliative Care [peer-reviewed serial on the Internet]. 2010, Vol 8(1).
  5. Marks DH. Neurologic Complications of Vaccination with Outer Surface Protein A (OspA). Int J Risk Saf Med. 2011;23(2):89-96. doi: 10.3233/JRS-2011-0527.
  6. Marks DH. Drug Utilization, Safety and Clinical Use of Actos and Avandia. Int J Risk Saf Med. 2013 Jan 1;25(1):39-51. Review
  7. D H Marks, A Yildiz, S Vural, S Levy. Face Recognition, Reversible Correlation Between fMRI and Biometrics Data. The Internet Journal of Radiology. 2017 Volume 20 Number 1.


Non-Peer Reviewed Articles
  1. Marks DH. Evaluation of Medical Causation, in Drug Injury: Liability, Analysis and Prevention, 3rd and 4th Editions, O’Donnell JT editor. L&J Publications, 2012 and 2016. 
  1. Marks DH and Middlekoop T. Accutane: Focus on Psychiatric Toxicity and Suicide, in Drug Injury: Liability, Analysis and Prevention, Second Edition, Chapter 20. O’Donnell JT editor. L&J Publications, 2005


                               Medical Fiction, under the author's name of                                                  Dimitri Markov

     "Vera Mortina" - When the patient is not the sick one! Dangerous medical fiction about violence in hospitals, so real only a doctor could have written it.. https://amzn.to/2F89yng
     Interview with the author http://bit.ly/2JkXtk5

     "The Surrogate" Greedy docs pushing false hopes in infertility business. Contemporary medical fiction by Dimitri Markov https://amzn.to/2FSzyDv
     pb http://a.co/50QyD5Y

     "BloodBird" - When the organ is not the only thing transplanted! Immortality you don't want. Dangerous medical fiction available on Amazon & Kindle https://amzn.to/2Qe2n26

     "Her Charm Was Contagious," by Dimitri Markov, on Amazon & Kindle. A dangerous doctor and a patient who just loved everyone to death. Intense medical fiction only a doctor could write. https://amzn.to/2HJinqi

Donald H. Marks

Personal credo 2021 http://bit.ly/33sJ3J6


I completed the course Build Your Own Theology in 2021.

The ending assignment was for each to create their own credo - a statement of beliefs which guide our individual actions,  which follows: 

My personal credo

  • I believe in reason, ethics, social justice,

  • in the not-all-knowing power of science, and of facts over truth,

  • that we were made in God’s image, however we see God - as a creator, as a universal force of love, or in a more classic sense. To me, Psalm 18 means that we should see ourselves as part of nature in God, and God in ourselves, in the universality of life, and of God as a life force,

  • that God reflects ourselves, and we can see our reflection in God,

  • that no one can fool God, but we can certainly fool ourselves and those we care about most, at least for some relative amount of time. 

  • that God, our universal spirit, knows our hearts, and is revealed to us as required. 

  • that great peace can come from harmonizing our lives and our ethics with the rhythm and flow of the universal spirit,

  • that in addition to the 4 classic forces in nature (strong, weak, gravity, electromagnetic), that love, forgiveness, pride and the spirit of life are also very strong and very important forces,

  • I believe that there are absolute moral rights and wrongs, without which society will simply collapse, 

  • I object to and reject moral relativism and its consequence uncertainty, because they undermine my confidence in how I see morality, norms and values.  

  • I am suspect of following dispassionate logic and adopting absolutist principles in my life, 

  • that as a moral citizen, I see that truth (ethical, moral, theological) can be relative and situational, not always absolute. Truth, not being fact, by its very subjective nature is quite relative, and I see a range of truths and an open set of beliefs. 

  • I tend to see life, morality and truth as finely nuanced, complex and relative things that generally do not respond well to absolute laws, rules that don’t change or inflexible statements, 

  • I believe that truth is relative in the human and moral realms that I live in, simple answers often don’t exist, absolute statements don’t always work, and eternal truths are hard to come by, 

  • I can not know and control everything, and I fight to accept this and just be at peace. I accept that most moral and human issues defy absolute answers.

Donald Harvey Marks

June, 2021

Some of my related writings are on my personal blog 

https://bit.ly/2RVdpP2







Jonas Salk, Polio Vaccine and Vaccinating Against Hate. The healthcare discovery that saved the lives of millions of children



Jonas Salk, Polio Vaccine and 

Vaccinating Against Hate

Donald Harvey Marks, physician scientist

Reason, ethics, health justice, 3rd generation Veteran





Can hate be successfully treated as infectious disease? In the setting of currently accepted children's public health measures, can non-traditional prevention of potentially fatal childhood illnesses yield benefits to society? 
personal blog https://bit.ly/2zbAX8N
Podcast https://bit.ly/3fKZh2l

Jonas Salk was a revered physician researcher whose team discovered a vaccine to prevent the terrible disease of paralytic polio. To many at the time, he was almost a God, a savior from the horror of polio. There is much to be learned from Dr. Salk’s life, his lasting effect on the terrible disease of polio, on bioethics, and on the impact of preventable childhood diseases in society. I will also address whether hate is a bigger killer of children than has been appreciated, and whether we should approach hate as if it is an infectious disease.

Polio is a disease of the nervous system caused by a virus, a non-living but very complex biochemical. Polio is often experienced as a flu-like intestinal illness. Symptoms can range from nausea, fever, diarrhea, and can progress to damage the nerves which cause muscles to contract, leading to its most feared component – paralysis. First recorded in 1835, polio outbreaks grew steadily more prevalent. Public health a century ago was in its infancy, and it took a long time to realize that the virus was transmitted by fecal matter and secretions of the nose and throat. Polio virus enters the victim orally, establishes itself in the intestines, and then travels to the brain or spinal cord. I suspect that many of you have never seen a case of polio and for those physicians in the group you may expect to go your whole career without ever treated one case. Every year in the United States there are a handful of breakthrough polio cases from vaccine failure always from the live vaccine. Polio is successfully eradicated from most countries in the world and only is left in a few such as Pakistan where vaccination efforts have been hindered.

During the 1914 and 1919 polio epidemics in the U.S., large numbers of individuals came down with the disease, and thousands died. The public, parents, teachers and health care workers panicked. Physicians and nurses made house-to-house searches to identify all infected persons. Children suspected of being infected were taken to hospitals and the child's family was quarantined until they were no longer potentially infectious. Sometimes parents under home quarantine could not go to their child's funeral if the child died in the hospital.

Jonas Salk was born into a time of polio plague, in New York City on October 28, 1914. His parents Daniel and Dora Salk were Ashkenazi Jews, from Russian-Jewish immigrant families, and had not received extensive formal education. Salk grew up in the Jewish immigrant culture of New York. He had two younger brothers, Herman and Lee, who became a child psychologist.

When he was 13, Jonas Salk entered Townsend Harris High School, a public school for intellectually gifted students. During that time, Ivy League schools restricted enrollment of Jews and blacks, which he did not consider at the time, and as an adult seemed to have little influence on his success. Jonas was known as a perfectionist who read everything he could lay his hands on. Students at Townsend had to cram a four-year curriculum into just three years. As a result, most dropped out or flunked out. Of the students who graduated, however, most would have the grades to enroll in City College of New York, noted for being a highly competitive college.
 “As a child,” Salk later said, “I was not interested in science. “I was merely interested in things human, the human side of nature, if you like, and I continue to be interested in that."

Salk enrolled in City College at the age of 15, from which he earned a Bachelor of Science degree in 1934. For working-class immigrant families, City College represented the apex of public higher education. Getting in was tough but tuition was free. Competition was intense, but the rules were fairly applied. No one got an advantage based on an accident of birth.

At his mother's urging, Jonas put aside aspirations of becoming a lawyer, and instead concentrated on those classes necessary for admission to medical school. However, the facilities at City College at that time were barely second rate, there were no research laboratories, and the library was inadequate. The faculty contained few noted scholars. What made the place special was the diverse student body that had fought so hard to get there, driven by their parents. From these ranks, of the 1930s and 1940s, emerged a wealth of intellectual talent, including more Nobel Prizewinners—eight—and PhD recipients than any other public college except the University of California at Berkeley.

After college, Jonas applied to and was accepted at NYU School of Medicine. NYU based its at-that-time modest reputation on famous alumni, such as Walter Reed, who helped conquer yellow fever, another devastating disease cause by a virus. Tuition was comparatively low. Better still, NYU did not discriminate against Jews and blacks, while most of the surrounding medical schools — Cornell, Columbia, University of Pennsylvania, and Yale — had rigid quotas in place against Jews and blacks. It’s hard for us today to grasp what inhibiting psychological effect quotas had on young Jews and blacks who considered applying to college and professional schools. Yale Medical School, for example, accepted 76 applicants in 1935, out of a pool of 501. Although 200 of the applicants were Jewish, only five got in. The overall odds of admission have only gotten worse, I can assure you.

During his years at NYU, Salk stood out from his peers, not just because of his continued academic prowess—he was in the Alpha Omega Alpha medical honor society. Salk also was different because he had decided he did not want to practice medicine, instead becoming absorbed in research.
"My intention was to go to medical school, and then, become a medical scientist,” Salk later reflected. “I did not intend to practice medicine, although in medical school, and in my internship, I did all the things that were necessary to qualify me in that regard. I had opportunities along the way to drop the idea of medicine and go into science,” Salk said.  “At one point at the end of my first year of medical school,” Salk continued, “I received an opportunity to spend a year in research and teaching in biochemistry, which I did. And at the end of that year, I was told that I could, if I wished, switch and get a Ph.D. in biochemistry but my preference was to stay with medicine. And, I believe that this is all linked to my original ambition, or desire, which was to be of some help to humankind, so to speak, in a larger sense than just on a one-to-one basis.” I think many of us have faced the decision of helping on a one-on-one basis, or to a larger cause in general. Helping someone we know make a car payment or giving to United Way. Helping a neighbor out of work to buy food for their children or set up an auto deduction for “Feed The Children”. Pay for a strangers dental bills or send a check to a political campaign. Direct and personal or indirect and to benefit a group or cause, difficult decisions.

Salk later focused more of his studies on bacteriology which had replaced medicine as his primary interest. The day after his graduation from medical school, Salk married Donna Lindsay, a master's candidate at the New York College of Social Work. Donna’s father, Elmer Lindsay, a wealthy Manhattan dentist, viewed Salk as a social inferior, several cuts below Donna's former suitors. Eventually, her father agreed to the marriage on two conditions: first, Salk must wait until he could be listed as an official M.D. on the wedding invitations, and second, he must improve his "rather pedestrian status" by giving himself a middle name. I think that the attitude of all of the Lindsay family cursed the Salk marriage from the start, although the decay took years to become lethal. How many of our own relationships are tainted in a subtle but insidious manner, the stain only expressing itself years later. We act surprised, but if we look deeper, we can see the causality to the final outcome. Salk's marriage produced three sons: Peter, Darrell, and Jonathan Salk, but ended years later in divorce.

After graduating from medical school, Salk began his residency at New York's Mount Sinai Hospital, where he worked in the laboratory of Dr. Francis. Few hospitals in Manhattan had the status of Mount Sinai, particularly among the city's Jews. A friend of Salk's commented, "to intern at Mr. Sinai was like playing ball for the New York Yankees ... only the top men from the nation's medical schools dared apply. Out of 250 who sought the opportunity, only a dozen were chosen," he said.

Salk quickly made his mark. Although focused mainly on research, he showed tremendous skills as a clinician and a surgeon. But it was his leadership as president of the house staff of interns and residents at Mount Sinai that best defined him to his peers. The key issue for many of them in 1939, for example, was not the fate of the hospital, but rather the future of Europe after Nazi Germany's invasion of Poland. In one instance, several interns responded by wearing badges to signify support for the Allies, but the hospital's director told them to remove them lest they upset some of the patients. The interns then took the matter to Salk, where he said that "everyone should wear the badge as an act of solidarity." One intern recalled, "Jonas was a very staunch guy. He never took a backward step on that issue or any other issue of principle between us and the hospital." The hospital administrators backed off and there was no further interference from the director.

The fight against polio really began in 1938 when the National Foundation for Infantile Paralysis, a more formal name for polio, was born. Basil O'Connor, the former law partner of President Franklin D. Roosevelt, the US's most famous polio victim, headed that foundation. That same year, the first March of Dimes fundraising program was set up, with radio networks offering free 30-second slots for promotion. Listeners were asked to send in a dime and the White House received 2,680,000 letters within days.

At the end of his medical residency, Salk began applying for permanent research positions, but he discovered that many of the jobs he desired were closed to him due to quotas on Jews, which prevailed at that time in so much of the medical research establishment. Nor could he apply at Mount Sinai as their policy prevented hiring their own interns. As a last resort, he contacted Dr. Francis for help. Salk and Francis eventually perfected a flu vaccine that was soon widely used at army bases. Salk had been responsible for discovering and isolating one of the flu strains that was included in the final vaccine.

“I have had dreams and I have had nightmares,” Salk said, “but I have conquered my nightmares because of my dreams.”

The two month stint in Dr. Francis's lab was Salk's first introduction to the world of the study of virus, and he was hooked. This was also the origin of Salk’s first controversy. Beginning around 1942, Dr. Francis and other researchers, one of whom was Salk, injected patients in an insane asylum with an experimental influenza vaccine. The group then sprayed influenza virus into the nasal cavities of these mental patients months later to check the vaccine's efficacy. It is questionable at best whether any of these patients could have adequately consented to what was being done to them, or understood why. I can assure you that this would be nearly impossible to do today in the western world, but if we judge from the context of 1942, it may seem less controversial. The 1918 flu pandemic 24 years previous was unusually deadly. 500 million people across the world were infected, and flu killed 50 to 100 million of them—three to five percent of the world's population—making it one of the deadliest natural disasters in human history

“Intuition will tell the thinking mind where to look next,” Salk said. “It is always with excitement that I wake up in the morning wondering what my intuition will toss up to me, like gifts from the sea. I work with it and rely on it. It's my partner.”

In 1947, Salk received an offer from the dean of the University of Pittsburgh School of Medicine where he could run his own lab. Salk secured grants from the Mellon family and was able to build a working virology laboratory, where he continued his research on flu vaccines.
“Nothing happens quite by chance,” Salk said. “It's a question of accretion of information and experience.” 

Paralytic poliomyelitis was, if not the most serious, easily the most frightening public health problem of the post WW2 era. The epidemics kept getting worse and its victims were usually children. In the twenty states that reported the disease back in 1916, there were 27,363 cases. New York alone had 9,023 cases of which 2,448 (28%) resulted in death, and a larger number in paralysis. However, polio did not gain national attention until 1921, when Franklin D. Roosevelt, former vice presidential candidate and soon to be governor of New York, came down with paralytic polio. At the age of 39, Roosevelt was left with severe paralysis and spent most of his presidency in a wheelchair.

As more states began recording instances of polio, the numbers of victims grew larger. Nearly 58,000 cases of polio were reported in 1952, with 3,145 people dying and 21,269 left with mild to disabling paralysis. In some parts of the country, concern assumed almost the dimensions of panic. Parents kept children home from school, avoided parks and swimming pools, and played only in small groups with the closest of friends. Cases usually increased during the summer when children were home from school. The public reaction was as to a plague, and scientists were in a frantic race to find a cure.

As the fear of polio increased each year, funds to combat it increased from $1.8 million to $67 million by 1955. Research continued during those years, but it turns out that everything scientists believed about polio at first was wrong, leading them down many blind alleys. Furthermore, most researchers were experimenting with highly dangerous live vaccines. In one test six children were killed and three left crippled.

“I pictured myself as a virus or a cancer cell,” Salk said, “and sense what it would be like.” After successful tests on laboratory animals, an experimental vaccine had to be tested on human beings. In November, 1953, at a conference in New York's Waldorf-Astoria Hotel, Salk said, "I will be personally responsible for the vaccine." He announced that his wife and three sons had been among the first volunteers to be inoculated with his vaccine. As a result of his preliminary results in 1954, when polio was destroying more American children than any other communicable disease, Salk's vaccine was ready for field testing. “There is hope in dreams, imagination, and in the courage of those who wish to make those dreams a reality,” Salk said.

With the hopes of the world upon him, Salk worked sixteen hours a day, seven days a week, for years. It had been, Salk later described, "two and a half years of drudgery and hard work." Salk said, “The reward for work well done is the opportunity to do more.” I am sure he believed that but one can only speculate on what effect this level of work had on his personal life. His first marriage ended in divorce in 1968.

The field trial set up to test the Salk vaccine was the most elaborate program of its kind in history, involving 20,000 physicians and public health officers, 64,000 school personnel, and 220,000 volunteers. Over 1,800,000 school children took part in the trial. 

“When you inoculate children with a polio vaccine, you don't sleep well for two or three months,” Salk said.

On April 12, 1955, Dr. Francis declared the vaccine to be safe and effective. The announcement was made exactly 10 years to the day after the death of President Roosevelt. Church bells rang across the country, factories observed moments of silence, synagogues and churches held prayer meetings, and parents and teachers wept. 

Salk was hailed as a miracle worker, and the day almost became a national holiday. His sole focus had been to develop a safe and effective vaccine as rapidly as possible, with no interest in personal profit. When questioned on the safety of the polio vaccine he developed, Salk said:” It is safe, and you can't get safer than safe. Still,” he also commented in reflection, “it is said, to await certainty is to await eternity.” As you may know, there are two basic types of polio vaccine. There is a live attenuated vaccine taken orally, the OPV Salk vaccine. The inactivated Sabin vaccine, which is given by injection IPV, is also available. Every year there are a handful of polio cases from live attenuated polio vaccine. There is still some discussion in the vaccine community about whether it is safer and more effective to give three OPV, three IPV or alternating IPV OPV IPV doses. And which will result in the most efficacy with the least side effects

Salk preferred not to have his career as a scientist affected by too much personal attention, as he had always tried to remain independent and private in his research and in his life. But this proved to be impossible.

Jonas Salk made scientists and journalists alike “go goofy.” As one of the only living scientists whose face was known the world over, Salk, in the public's eye, had a superstar aura. Airplane pilots would announce that he was on board, and passengers would burst into applause. Hotels routinely would upgrade him into their penthouse suites. A meal at a restaurant inevitably meant an interruption from an admirer, and scientists approached him with drop-jawed wonder, as though some of the stardust might rub off. This was not my experience when meeting a more gentle, relaxed and personable Salk, as I shall describe shortly.

For the most part, Salk was appalled at the demands as the public figure he had become and resentful of what he considered to be the invasion of his privacy. The New York Times, a few months after his vaccine announcement, wrote that "at 40, the once obscure scientist ... was lifted from his laboratory almost to the level of a folk hero." He received a Presidential citation, a score of awards, four honorary degrees, half a dozen foreign decorations, and letters from thousands of fellow citizens. His alma mater, City College of New York, gave him an honorary degree as Doctor of Laws. But "despite such very nice tributes", The New York Times wrote, "Salk is profoundly disturbed by the torrent of fame that has descended upon him.... He talks continually about getting out of the limelight and back to his laboratory... because of his genuine distaste for publicity, which he believes is inappropriate for a scientist."

Salk himself said, “The worst tragedy that could have befallen me was my success. I knew right away that I was through - cast out.”

In 1969, a year following his divorce, Salk was introduced to Francoise Gilot, a French author, artist, and former lover to Pablo Picasso. The meeting was at the home of mutual friends in La Jolla, California. Their shared appreciation of architecture, among other things, led to a brief courtship and they were married in 1970 in Paris. They remained married until Salk's death on June 23, 1995. 

During a 1980 interview Salk said, "It's as if I've been a public property ever since, having to respond to external as well as internal impulses.... It's brought me enormous gratification, opened many opportunities, but at the same time placed many burdens on me. It altered my career, my relationships with colleagues; I am a public figure, no longer one of them," he said. We can only imagine what the full extent of personal toll on him was. Yet that is the way of many who are successful, academically, in business, the arts, or otherwise. For academic wisdom is powerful, but limited and limiting. Placing all of your hopes and dreams and efforts in only one area of one’s life leaves no cushion for life’s inevitable failures.

For it is said in the Book of Ecclesiastes 9:11 "I have seen something else under the sun: The race is not to the swift or the battle to the strong, nor does food come to the wise or wealth to the brilliant or favor to the learned; but time and chance happen to them all."

"If Salk the scientist sounds austere", wrote The New York Times, "Salk the man is a person of great warmth and tremendous enthusiasm. People who meet him generally like him." This is how I personally knew Jonas Salk. Award-winning geneticist Walter Nelson-Rees called him "a renaissance scientist: brilliant, sophisticated, driven... a fantastic creature." I completely agree.

Salk had very little perceptible interest in the things that interest most people—such as making money. That is how I found Dr Salk in 1992. I spent three wonderful hours one-on-one with Dr Salk at a vaccine conference in Paris. As we talked, he was relaxed, responsive, pleasant and not at all put off. I remember that only part of our discussion related to vaccines. I asked him about the practice of medicine, research as a medical career, and how he viewed the future of vaccines. I too had taken a mostly research path in medicine, and enjoyed vaccine research. We talked about his experiences as a Jew, as a Jewish doctor, and the public perception and expectations of Jewish doctors. Growing up Jewish today is a lot different from growing up Jewish in the 50s and 60s, with their restricted country clubs, colleges and bathrooms and all the subtle discrimination, but can be just as dangerous an existence. My fondest memory is when Dr. Salk referred to me as a fellow vaccinologist.

In 1966, Salk described his "ambitious plan for the creation of a kind of Socratic academy where the supposedly alienated two cultures of science and humanism will have a favorable atmosphere for cross-fertilization." The peaceful coexistence of science and religion is very much in the spirit of modern philosophers such as Bishop John Spong. In the years after his discovery of the polio vaccine, many supporters, in particular the National Foundation, helped Salk build his dream of a research complex for the investigation of biological phenomena from cell to society. The Salk Institute for Biological Studies opened in 1963 in the San Diego neighborhood of La Jolla. Salk believed that the institution would help new and upcoming scientists along their careers as he said himself, "I thought how nice it would be if a place like this existed and I was invited to work there." This was something that Salk was deprived of early in his life, but due to his achievements, was able to provide for future scientists. “I couldn't possibly have become a member of this Salk Institute, you know, if I hadn't organized it myself,” he quipped. 

In an interview about his future hopes at the institute, Salk said, "In the end, what may have more significance is my creation of the institute and what will come out of it, because of its example as a place for excellence, a creative environment for creative minds."
Many famous researchers were associated with the Salk Institute, including Francis Crick, co-discoverer of the DNA molecule, who was a leading professor at the institute until his death in 2004.

There are many people you may have heard of who had polio, lived, but continued to suffer from polio:
President Franklin D. Roosevelt
Itzhak Perlman, one of the world's finest violinists, was permanently disabled at age four, and still plays sitting down;
Actors Donald Sutherland , Alan Alda and Lionel Barrymore
Writers Arthur C. Clarke and Robert Anton Wilson;
Actress Mia Farrow;
Singer-musicians Neil Young, David Sanborn; Dinah Shore; and Joni Mitchell;
Supreme Court Justice William O. Douglas;
Director Francis Ford Coppola;
Nuclear physicist J. Robert Oppenheimer;
Congressman James H. Scheuer.

How then are we doing almost 60 years into the availability of polio vaccine?

In 2011, there were only 650 Wild Poliovirus (WPV) cases. Most were in endemic countries such as Pakistan, Afghanistan, Chad. The polio eradication through vaccination has in general worked, as has similar approach for other lethal viruses like smallpox

“There are two types of medical specialists,” Salk said.” There are those who fight disease day and night, who assist mankind in times of despair and agony and who preside over the awesome events of life and death. Others work in the quiet detachment of the laboratory; their names are often unknown to the general public, but their research may have momentous consequences.”

Salk was considered to be the “Father of Biophilosophy,” the application of a "biological, evolutionary point of view to philosophical, cultural, social and psychological problems." As a biologist, Salk believed that science was on the frontier of tremendous new discoveries. As a philosopher, Salk thought that humanists and artists have joined the scientists to achieve an understanding of man in all his physical, mental and spiritual complexity. Such interchanges might lead, Salk hoped, to a new and important school of thinkers he designated as the bio-philosopher. 

"I think of biological knowledge as providing useful analogies for understanding human nature.... People think of biology in terms of such practical matters as drugs, but its contribution to knowledge about living systems and ourselves will in the future be equally important.... In the past epoch, man was concerned with death, high mortality; his attitudes were anti-death, anti-disease", Salk said. "In the future, his attitudes will be expressed in terms of pro-life and pro-health. The past was dominated by death control; in the future, birth control will be more important. These changes we're observing are part of a natural order and to be expected from our capacity to adapt. It's much more important to cooperate and collaborate. We are the co-authors with nature of our destiny." As you can observe, many of these issues are points of major contention today. We see parallels in the areas of population control, access to health care, voting rights, clean water, food, tolerance, violence, bigotry, war and social justice.

Jonas Salk continued to conduct research and publish books most of his life. His last years were spent searching for a vaccine against HIV, an area so far which is unsuccessful. Yet, like many of the diseases afflicting mankind, HIV is shrouded in ignorance, hatred, suspicion, and fear. Like Polio, HIV is also preventable and treatable.

At dinner one evening, a friend once mentioned to Salk that he had been reading some books and articles about Intelligent Design, and asked if he’d been following the debate. Salk started to shake his head from side to side, slammed his knife and fork onto the table, and asked, “Why do I have to choose? Why must it be one or the other? Of course evolution is real. DNA mutates, and that makes evolution one of the most powerful forces in nature. But who set evolution into motion? Can’t God have done that? I can’t stand it when the ideologues take over on something like this. Don’t ever let yourself be caught in one of these “either/or” debates, because when you finally figure it out – it’s usually a bit of both.” I think that all too often, we get caught up in the all or nothing argument, God vs a soul-less universe devoid of intrinsic meaning and value, Pro life vs Pro Choice, as if they are mutually exclusionary. Salk in my view had a clearer perspective on the compatibility of scientific reasoning and religion than either Spong or Einstein. Certainly Salk had a clearer comprehension of the relative truth of scientific facts than leading ethicists of his day.

Salk’s concept of God was internally consistent with his bio-philosophy. He thought of a bio-philosopher as "Someone who draws upon the scriptures of nature, recognizing that we are the product of the process of evolution, and understands that we have become the process itself, through the emergence and evolution of our consciousness, our awareness, our capacity to imagine and anticipate the future, and to choose from among alternatives."
Salk’s concepts are even more relevant today with our advances in the understanding of the brain and consciousness, the use of imaging to read thoughts, and the growth of the internet as a repository of human knowledge and social awareness.

Switching now to the core thesis of this article, and from Salk the bio-philosopher to public health,  what are the Major Causes of Death in the USA, how amendable are they to vaccination, and what meanings can we learn?

 Other than CV and cancer, the remainder of the top causes of death certainly are preventable. With respect to suicide, sadly, there is one suicide per day in our military.

More than three women and one man are murdered by their intimate partners in this country every day. One-third of women murdered each year are killed by intimate partners. The health-related costs of intimate partner violence exceed $5.8 billion each year. Of that amount, nearly $4.1 billion are for direct medical and mental health care services, and nearly $1.8 billion are for the indirect costs of lost productivity or wages.

Infectious Diseases – illnesses which are communicable, can be passed from person to person, and for the most part are preventable. Major infectious diseases that plague American include hepatitis, HIV, pneumonia, meningitis, DPT, pneumonia, urinary and staph infections.

Major infectious diseases afflicting children include Chickenpox & Shingles, Cold Sores (Herpes simplex), Impetigo , Measles, Rubella (German Measles), Scabies, meningitis, DPT, diarrhea. These are for the most part preventable through hygiene, medication and vaccines.
Today, what are the major causes of death in children? Not surprisingly, these depend on age group.

THE TOP THREE CAUSES OF DEATH BY AGE GROUP
0-1 years:
Developmental and genetic conditions that were present at birth
Sudden infant death syndrome (SIDS)
All conditions associated with prematurity and low birth weight
1-4 years:
Accidents
Developmental and genetic conditions that were present at birth
Cancer
5-14 years:
Accidents
Cancer
Homicide
15-24 years:
Accidents
Homicide
Suicide

Worldwide in 2010  7.6 million children died <5 year old. About half of child deaths occur in Africa. Approximately 60 countries make up 94% of under-five child deaths.

Reduction of child mortality is the fourth of the United Nations’ Millennium Development Goals.

According to UNICEF, most child deaths result from one the following five causes or a combination thereof:
acute respiratory infections
diarrhea
measles
malaria
War
malnutrition
For the state of Alabama, in 2007, there were 943 deaths in children < 18 years old
There were 84 deaths per 100,000 children. The death rate was higher in non-white than in the white population.

We can therefore see that Infectious Diseases are not among the leading causes of death for children in Alabama or in any state. Most causes of child death in Alabama, in the USA, and in the world are preventable, and we know very well how to prevent them. In fact, no research is needed, we can act now. We have programs to reduce cancer, drowning, MVA motor vehicle accidents. And yet the incidence rate per year is constant for many of these problems – our efforts would seem to not be effective.

Easily two-thirds of childhood deaths worldwide are preventable. Malnutrition and the lack of safe water and sanitation contribute to half of all these children’s deaths. Research and experience show that most of the children who die each year could be saved by low-tech, evidence-based, cost-effective measures such as vaccines, antibiotics, micronutrient supplementation, insecticide-treated bed nets, improved family care and breastfeeding practices, and oral rehydration therapy. In addition to providing vaccines and antibiotics to children, education could also be provided to mothers about how they can make simple changes to living conditions such as improving hygiene in order to increase the health of their children. Mothers who are educated will also have increased confidence in the ability to take care of their children, therefore providing a healthier relationship and environment for them.

Many societal afflictions are certainly transmissible from person to person: hate, violence, bigotry, violence, murder. Once persons are infected, these diseases pass like polio virus to infect the brain. Why not in the tradition of Salk create “vaccines” to immunize people, immunize society, immunize cultures, immunize various ethnic and religious groups against these social diseases. We have known for a long time what components are needed to go into this vaccine: love, tolerance, education, equality, and social justice. The injection will be painless, but the vaccine’s efficacy is dependent on the will of individuals, leaders and society to react.

Each of us can become in our own lives like Dr. Jonas Salk, to dedicate our lives to the prevention of death and suffering, both on an individual level and for the greater humanity, locally, and throughout the world, for our brothers and our sisters everywhere. Let us use the vaccine of peace and love to make us immune to war and hate, needless suffering, poverty and injustice.


References

Courtney Schmidt, Why violence is an infectious disease. http://www.kevinmd.com/blog/2013/04/violence-infectious-disease.html April 24th 2013

Jonas Salk. World Population and Human Values: A New Reality. Harpercollins. 1981. 

Jonas Salk and Ruth Nanda Anshen. Anatomy of Reality: Merging of Intuition and Reason. Columbia Univ Press. 1983



Additional writings by DH Marks

     What I have not told my family about the meaning of time. On this blog site

     Einstein, Relativity and Relative Ethics. On this blog site

     Collected Poetry of DH Marks, on Amazon and Kindle

Thursday, May 9, 2024

Should ALL Medical Doctors Be Required to Accept Medicare and Medicaid $$$ as a Condition of Licensure? Can the Gods be humble and care for their lowly helpless subjects?

Should Medical Doctors Be Required to Accept Medicare and Medicaid as a Condition of Licensure?





By Donald H. Marks, MD PhD, FACP   physician and scientist
Reason, ethics, health equity, 3rd generation Veteran

Medicare and Medicaid are two government programs that provide health coverage to millions of Americans. Medicare covers 67 million citizens ages 65 and over, as well as 8 million younger adults with certain chronic conditions or disabilities. Medicaid is a joint federal-state program that provides health insurance to low-income individuals and families. To date, 41 states (including DC) have adopted the Medicaid expansion, and as of June 2023, approximately 94 million persons are covered by Medicaid and Children’s Health Insurance Program CHIP.  


Having insurance coverage is not the same as having access to care,  because not all doctors accept Medicare and Medicaid patients. Are you shocked, surprised or offended? According to a survey by the American Medical Association, in 2018, 90% of physicians accept new Medicare patients, while only 72% accepted new Medicaid patients. The main reasons cited for this discrepancy are the low reimbursement rates and the high administrative burden of dealing with these programs. I have faced this very frustrating situation in my own medical practice and in my own personal life as an over 65 medical patient, turned away by a large local hospital-affiliated orthopedic surgery group which does not accept Medicare.

Interesting discussion of medical equity and access to care, on Star Trek https://youtube.com/shorts/MNbADGu_0Z0?si=e3owA2sTyhy7GliE


Some healthcare equity advocates argue that all medical doctors should be required to accept Medicare and Medicaid as a condition of their medical license. They claim that this would ensure access to quality health care for all Americans, regardless of their income or age. They also point out that medical doctors have a social responsibility to serve the public good, and that accepting government insurance is part of their professional duty.


Some opponents contend that medical doctors should have the freedom to choose their patients and their payment methods. They assert that forcing medical doctors to accept Medicare and Medicaid would violate their autonomy and their property rights. They also warn that such a mandate could reduce the supply and quality of doctors, as some would retire early, relocate to other states, or opt out of the system altogether.


Public Funding of Physician Training

All physicians in the United States receive some form of public funding during their training. This funding can come from a variety of sources, including:

  • Federal funding: The federal government provides funding for medical schools, residency programs, and other healthcare training programs through a variety of programs, such as the National Institutes of Health (NIH) and the Health Resources and Services Administration (HRSA). Another form of federal funding, which I benefited from, is military sponsorship.

  • State funding: Many state governments also provide funding for medical schools and residency programs.

  • Local funding: Some local governments also provide funding for healthcare training programs.

In addition to government funding, many physicians also receive financial assistance from private sources, such as scholarships and loans. However, even these private sources of funding often rely on government support in some way. For example, many student loans are guaranteed by the federal government.

Obligation to Accept Medicaid Patients

Because all physicians receive some form of public funding during their training, many healthcare equity advocates argue that medical doctors have an obligation to accept Medicare and Medicaid patients.

There are a number of reasons why physicians should accept Medicaid patients. First, it is a way to repay the public for the investment that was made in their training. Second, it helps to ensure that everyone has access to quality healthcare, regardless of their income. Third, it can help to reduce the burden on the uninsured healthcare system.

Challenges

There are a number of challenges that physicians face when accepting Medicaid patients. One challenge is that Medicaid reimbursement rates are often (but not always) lower than those of private insurance companies. This can make it difficult for physicians to cover the costs of providing care to Medicare/Medicaid patients.

Another challenge is that Medicaid patients often can have more complex medical needs. This can make it more time-consuming and difficult to provide care to Medicare/Medicaid patients.

While it's important to encourage healthcare providers to participate in government healthcare programs like Medicaid and Medicare, denying medical doctors a medical license solely for not accepting these programs may not be the most effective or ethical approach. Instead, it may be more effective to incentivize their participation through other means, such as matching Medicare Medicaid to BC/ BS or Kaiser rates. Here's why:

1. Ethical Considerations: Denying medical doctors a medical license based solely on their participation in specific insurance programs could be seen as discriminatory and heavy-handed. All licensed medical professionals should be treated equally, but their primary commitment should be to provide quality health care to patients, regardless of their insurance status.


2. Access to Care: Restricting access to care by revoking licenses may be counter-productive, by exacerbating the shortage of healthcare providers, especially in underserved areas. A better approach may be to encourage more doctors to accept Medicaid and Medicare patients by offering realistic reimbursement rates which also represent the cost of providing care, and lowering administrative barriers.


3. Focus on Quality of Care: Licensing should primarily ensure that medical doctors are qualified and capable of providing high-quality care. Accepting or not accepting specific insurance should not be the sole determinant of a physician's qualifications.


4. Individual Choice: Doctors often have valid reasons for not participating in government insurance programs, such as administrative burdens or low reimbursement rates. Some hold that it is essential to respect their professional judgment and provide incentives for participation rather than punitive measures.


5. Incentivize Participation: Instead of punitive measures, it may be better to create incentives for medical doctors to participate in Medicaid and Medicare. These could include improved reimbursement rates, reduced administrative burdens, or offering tax incentives for providers who accept a certain percentage of patients from these programs.


6. Patient Choice: Patients should have the freedom to choose their doctors. Forcing doctors to accept specific insurance could limit patient choice and interfere with the doctor-patient relationship, which is crucial for effective healthcare.


Of course it's crucial to encourage medical doctors to participate in Medicaid and Medicare without resorting to revoking medical licenses, although the alternative of denying access to healthcare to the sick is even more onerous, IMO. By addressing the issues that deter doctors from participating and providing incentives, we may perhaps ensure that more healthcare providers accept patients from these programs while upholding ethical standards and individual choice.


From a health equity and ethics standpoint, are medical doctors who refuse to accept Medicaid or Medicare simply greedy? 

Health equity is the principle that everyone should have a fair and just opportunity to attain their highest level of health, regardless of their income, race, ethnicity, gender, disability, or other factors that may affect their access to health care (CDC What is Health Equity? | Health Equity | CDC). By electing not to accept Medicaid or Medicare patients, even though these programs provide essential life-supporting health insurance for millions of low-income, elderly, and disabled Americans (https://www.who.int/health-topics/health-equity), those non-participating medical doctors are actively and intentionally denying patients the right to health and contribute to the health disparities that result from their unequal access to quality health care.

One might argue that doctors who refuse to accept Medicaid or Medicare are greedy because they prioritize their own financial interests over the health needs of their patients. According to a report by the Medicaid and CHIP Payment and Access Commission (MACPAC), the average Medicaid payment for 18 selected conditions was 6 percent higher than Medicare in 2012 (https://www.cdc.gov/nchhstp/healthequity/index.html ). Moreover, the average Medicaid payment for all but two of the conditions was higher than Medicare. This means that doctors who reject Medicaid patients are not only discriminating against poor and needy patients, but also losing out on potential revenue.


Another reason why doctors who refuse to accept Medicaid or Medicare might be considered greedy is that they are ignoring the social determinants of health that affect their potential patients’ well-being. Social determinants of health are the conditions in which people live, learn, work, play, and worship that influence their health risks and outcomes (https://www.cdc.gov/healthequity/whatis/index.html). These include factors such as discrimination, racism, poverty, education, employment, housing, transportation, economic status, and environment. By turning their backs on Medicaid or Medicare patients in favor of better paying patients, those doctors are failing to address the root causes of poor health and perpetuating the cycle of disadvantage and disease.

Therefore, from a health equity standpoint, doctors who refuse to accept Medicaid or Medicare could be considered greedy because they violate the principle of fairness and justice in healthcare. They also miss the opportunity to improve the health outcomes of patients and reduce the burden of preventable diseases on society.


The American College of Physicians, the internal medicine professional society to which I belong as an Emeritis Fellow, has a vision for improving healthcare access in America. ACP provides a comprehensive, interconnected set of policies for a better U.S. healthcare system for all. 


The first of ACP comprehensive recommendations is that USA should transition to universal coverage, which includes essential benefits, which I and most US citizens and healthcare providers agree. Prior US presidents, including FDR, Nixon and Clinton have agreed. 


ACP vision challenges the U.S. not to settle for the status quo, but to implement systematic health care reforms. An additional set of ACP policy papers, published in Annals of Internal Medicine, address issues related to coverage and cost of care, health care payment and delivery systems, barriers to care and social determinants of health, and more. 


Although essentially a commendable set of proposals, I look forward to ACP giving more attention to the "essentially uninsured", meaning those with unaffordable premiums, high deductibles, and poor access to providers. Not being able to afford healthcare is equivalent to not having access to healthcare. For many, it's essentially not available. In addition, if a drug is priced in a way that results in it being unaffordable, it is essentially not available to those in need, and in that sense of no efficacy. Drugs found to have no efficacy should have their approval from FDA revoked.

 

Solutions

The issue of whether medical doctors should be required to participate in Medicare and Medicaid is a complex and controversial one. It involves ethical, economic, and legal considerations that affect both doctors and patients. 


I look forward to your comments on all these issues.




References


Physicians who refuse to accept Medicaid patients breach their contract with society https://www.statnews.com/2017/12/28/medicaid-physicians-social-contract/


What is Health Equity? | Health Equity | CDC

https://www.cdc.gov/nchhstp/healthequity/index.html

https://www.cdc.gov/healthequity/whatis/index.html


Health Equity. WHO. https://www.who.int/health-topics/health-equity



Personal blog of Donald H. Marks, where one can find most of my personal and professional writings, and links to my podcases. www.DHMarks.blogspot.com


Reducing the influence of politics in healthcare. Donald H. Marks https://dhmarks.blogspot.com/2023/08/reducing-influence-of-politics-in.html


Better is Possible: ACP's Vision for the U.S. Health Care System. My comments.  https://dhmarks.blogspot.com/2020/04/httpsannalsorgaimfullarticle2759528envi.html




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