2005: “Manhattan Project for the 21st Century” – Remarks Delivered at the Bohemian Grove

Remarks as Delivered by Majority Leader Bill Frist, M.D.

“Manhattan Project for the 21st Century”

July 28, 2005

It is an honor for me to return to the Fellowship of the Grove and in this spectacular setting — the still waters, the glorious light — to share a few thoughts.  To be honest, this setting — with so much attention — is humbling.  You don’t get it as Majority Leader in the Senate.

In fact, one political pundit accurately said: “Being Majority Leader is like being a grounds keeper at a cemetery.  You have a lot of people underneath you.  But not one of them is listening.”

Like everyone else, politicians tend to look away from danger, to hope for the best, and pray that disaster will not arrive on their watch even as they sleep through it. 

This is so much a part of human nature that it often goes unchallenged. 

But we will not be able to sleep through what is likely coming soon — a front of unchecked and virulent epidemics, the potential of which should rise above your every other concern.

For what the world now faces, it has not seen even in the most harrowing episodes of the Middle Ages or the great wars of the last century.

We are unprepared for rampant epidemics.  And even worse, we haven’t taken sufficient note of the fact that though individually each might be devastating, they are susceptible of either purposeful or accidental combination, —in which case they could be devastating almost beyond imagination.

The history of pathogens advances in parallel with and is no more static than our own — with which it is always intertwined, even if at times invisibly.

Sometimes it rushes forward with great speed and breathtaking evolutionary vigor — and sometimes it rests in slow backwaters.

When, in 1967, the U.S. Surgeon General declared that we were within site of winning the war on infectious diseases, we thought the slack water would last forever.

But that war never ended other than in wishful thinking. 

*

Today more than a quarter of all deaths — 15 million each year — are due to infectious diseases.

These include 4 million from respirator infections, 3 million from HIV/AIDS, and 2 million from waterborne diseases such as cholera.  This is a continuing and intolerable holocaust that, while sparing no class, strikes hardest at the weak, the impoverished, and the young.

Three million children die every year of malaria and diarrheal diseases alone — one child every 10 seconds.

As sobering as this may be, we’ve been nonetheless in a quiescent stage of the mutability of pathogens — a hiatus from which they are now poised to break out.

When viral diseases evolve normally — such as in the typical course of the human influenza virus undergoing small changes in its antigenicity, (and killing an average of 500,000 people annually throughout the world) — it is called an antigenic drift.

When they emerge with the immense power derivative of a jump from animal to human hosts followed by mutation or recombination with a human virus — as in the influenza pandemic of 1918 – 1919 (in which 500 million people were infected and 50 million died, including half a million in the United States) — it is called an antigenic shift.

Antigenic shifts are the result of random, fortuitous, and unavoidable changes.

Human population increase, concentration, and spread, intensification of animal husbandry, and greater wealth in developing countries brings animals (both wild and domestic) into closer contact with ever larger numbers of people.

War, economic catastrophe, and natural disasters subdue active measures of public health. The unprecedented societal overuse and misuse of antibiotics build unprecedented resistance within the microbial bug universe to our even most powerful ammunition.

Travel, trade, and climate change bring into contact disparate types and strains of disease.

And as a consequence of all this, microbes evolve, mutate, and find new lives in new hosts.

*

The evidence suggests that we could be at the threshold of a major shift in the antigenicity of not merely one but several categories of pathogens — for rarely if ever have we observed among them such variety, richness, opportunities for combination, and alacrity to combine and mutate.

You read the tid bits and pieces in the news.  HIV, variant Creutzfeldt-Jakob disease (mad cow), avian influenzas such as H5N1, and SARS — all are merely the advance patrols of a great army forming out of sight — the lightning that (however silent and distant) gives rise to the dread of an approaching storm — a storm for which we … are … unprepared. 

How can that be?  How can the richest country in the world, with its great institutions, experts, and learned commissions, have failed to make every preparation — when preparation is all — for epidemics with the potential of killing off large segments of its population?

*

To see what might lie on the horizon one need only look to the relatively recent past.  I have a photograph of an emergency hospital in Kansas during the 1918 influenza pandemic.

People lie miserably on cots in an enormous barn-like room with beams of sunlight streaming through high windows.  It seems more crowded than the main floor of Grand Central Station at five o’clock on a weekday.  In this one room several hundred people are in the throes of distress.

Think of two thousand such rooms filled with a crush of men, women, and children — 500,000 in all — and imagine that the shafts of sunlight that illuminate them for us almost a century later are the last light they will ever see.

Then bury them.

That is what happened.

How would a nation so greatly moved and touched by the 3,000 dead of September 11th react to half a million dead?

*

In 1918 – 1919 the mortality rate was 3 percent, which seems merciful in comparison to the 50 percent mortality rate of today’s highly pathogenic H5N1 avian flu.  In just the last 18 months, avian flu has caused the death or destruction of over 140 million birds in 11 Asian nations.

And, most alarmingly, in 3 of those nations, H5N1 has taken the worried jump from birds to infect humans.

Should the virus shift and human-to-human transmission become sustained, imagine how many human lives avian flu will take.

How, then, would a nation greatly moved and touched by three thousand dead, react to 5 or 50 million dead?

*

And the new realities of terrorism and suicide bombers pull us one step further.  How would we react to the devastation caused by a virus or bacteria or other pathogen unleashed not by the forces of nature, but intentionally by man?

*

During the Cold War, the Soviet Union, which stockpiled 5,000 tons annually of biowarfare-engineered anthrax (resistant to 16 antibiotics), also produced massive amounts of weaponized smallpox — just as the monumental effort to immunize the world’s children came to a successful close.

It is impossible to rule out that quantities of this or other deliberately manufactured pathogens such as pneumonic plague, tularemia, or botulinum toxin may find (or may have found) their ways into the possession of terrorists such as bin Laden and Zarqawi.

Although the United States now has enough smallpox vaccine for the entire population, we haves neither the means of distribution nor the immunized personnel to administer it in a generalized outbreak.  Nor the certainty that the vaccine we have would even be relevant to a specific weaponized strain of the virus.

Hospitals and our long neglected public health infrastructure would be quickly overwhelmed.

Panic, suffering, and the spread of the disease would intensify as — because people were dead, sick, or afraid — the economy ceased to function, electrical power flickered out, and food and medical supplies failed to move.

Over months or perhaps years, scores of millions might perish, with whole families dying in their houses and no one to memorialize them or remove their corpses.  Almost without doubt, the epidemic would spread to the rest of the world, for in biological warfare an attack upon one country is an attack upon all.

Every vestige of modernity would be overturned.  The continual and illusory flirtation with immortality that is a hallmark of our scientific civilization would shatter. 

And we would find ourselves looking back upon even the most difficult times of the last century as a golden age.

*

Despite the common wisdom, humanity has not moved beyond this kind of scenario.  No — of late it has moved unnecessarily and gratuitously toward it.

Any number of known and unknown viruses — for which at present there is neither immunization nor cure — are at this very moment cooking in Asia and Africa — where they arise in hotbeds of densely intermingled human and animal populations.

We are in unexplored territory.  The brew is stewing in a new, ideal mixing vessel.  Economic and environmental changes in Asia have forced wilderness-deprived waterfowl to alight to feed amid farm animals — in newly dense populations due to recently acquired wealth and dietary expectations and in a culture in which live poultry is brought to market.

The reassortment of viral DNA as a result of this mingling is so frenzied that it is only a matter of time until the emergence of a virus unequaled in transmissibility and virulence.

The epidemiological calculus of flu is notoriously volatile due to the unknowns of rapid reassortment.  We do know now, however, we are woefully under prepared even for a virus that we can today foresee — much less for one that we cannot.

No such viruses have yet reached critical mass, or leapt from the channels imposed by their inherent limitations, environmental obstacles, and deliberate actions to contain them.

But who is to say they cannot? 

I certainly won’t.  Not with what I’ve seen.

I was in China at the height of the SARS outbreak and witnessed the government’s confused, deceptive, and miserable initial cover-up and response.  As a doctor on annual medical mission trips, I have treated patients in the Sudan and, just two weeks ago, in Tanzania.  I have seen a determined epidemic — HIV/AIDS — kill millions and hollow out entire societies on the African continent.

The evidence I have seen as doctor, scientist, and policy maker, the patterns of history, and new facts — such as rapid, voluminous, and essential travel and trade; the decline of staffed hospital beds; and a now heavily urbanized and suburbanized American population dependent as never before upon “just in time” but easily disrupted networks of services and supply — lead me to believe that such pathogens could result in the immensely high death tolls to which I have alluded.

*

Take the virus that is today the gravest threat — avian flu.

A vaccine would not become available, at best, until 6 to 9 months after the outbreak of a pandemic.  Even then, the vaccine would not be available in mass quantities.

And even then we do not know if that vaccine would work.  It’s still experimental.

So, in essence, we have no vaccine for avian flu.  Nor do we have enough of the only effective anti-viral agent Tamiflu stockpiled to treat more than one percent of our population for avian flu.  Only 10 of you could be treated.

*

It’s true that neither Avian flu nor these other viruses have yet spread geometrically — instantly and irrevocably overcoming health care systems and pulling us backward across thresholds of darkness that we long hoped we would never cross again.

And yet this they might do — either entirely on their own in nature or as a result of deliberate, purposeful human intervention.

No intelligence agency (no matter how astute) and no military (no matter how powerful and dedicated) can assure that a few technicians of middling skill using a few thousand dollars worth of readily available equipment in a small and apparently innocuous setting cannot mount a first-order biological attack.

It’s possible today to synthesize virulent pathogens from scratch, or to engineer and manufacture prions that, introduced undetectably over time into a nation’s food supply, would after a long delay afflict millions with a terrible and often fatal disease.

It’s a new world. 

Unfortunately, the permutations are so various that the research establishment as now constituted cannot set up lines of investigation to anticipate even a small proportion of them. 

But is it really reasonable to assume that anyone might resort to biological warfare?

Indeed it is.

Though Al-Qaida’s leadership has been decimated, it has declared that, “We have the right to kill four million Americans — two million of them children . . . . [and] it is our right to fight them with chemical and biological weapons.” 

It’s hardly necessary, however, to rely upon stated intent.  One need only weigh the logic of terrorism, its evolution, its absolutist convictions, and the evidence in documents and materials found in terrorist redoubts.  

And though not as initially dramatic as a nuclear blast, biological warfare is potentially far more destructive than the kind of nuclear attack feasible at the operational level of the terrorist.

And biological war is itself distressingly easy to wage.

Never have we had to fight such a battle, to protect so many people against so many threats that are so silent and so lethal.

*

So, I ask again how it is that we are so unprepared either for naturally occurring epidemics of newly emergent diseases or those that will be deliberately and purposefully induced?

I propose that we take the measure of this threat and make preparations today to engage it with the force and knowledge adequate to throw it back wherever and however it may strike.

It need not be invincible and we need not fall to our knees before it.  Means adequate to the success of a defensive plan are present in great profusion.  Whereas the approaching biological shift is gathering force like a massing army, providence has massed an army to meet it.

Having themselves expanded geometrically, the life sciences have come to the threshold of a great age, and to cross it they need only encouragement and a signal from the body politic to put their resources in play.

*

We are not without weapons in this war.  They are present in the stupendous material and intellectual wealth of the civilized world, which, despite current divisions of action and opinion, has everything to lose in common.

They are present in the great stores of science and technology amassed over thousands of years of civilization — in the many hundreds of universities, advanced research institutions, and hospitals — yes, in the United States and Europe, but also in Latin America, India, China, and dozens of other countries on six continents.

They are present in the revolution spawned by information technology and our vast, instant and interconnected ability to communicate and share information.  They are present in the private sector’s ruthless focus, which, though frequently condemned for its lack of humanity, could well be the instrument that saves us in the end.

They are present in the special temperament and brilliance of individual scientists; in the magnificent light that comes of the surprising and ingenious application of new technologies; and in the vigor, intelligence, and decency of free and unoppressed peoples.

*

So what must we do?

I propose an unprecedented effort — a “Manhattan Project for the 21st Century” — not with the goal of creating a destructive new weapon, but to defend against destruction wreaked by infectious disease and biological weapons. 

I speak of substantial increases in support for fundamental research, medical education, emergency capacity, and public health infrastructure.  I speak of an unleashing of the private sector and unprecedented collaboration between government and industry and academia.  I speak of the creation of secure stores of treatments and vaccines and vast networks of distribution.

Above all, I speak not of the creation of a forest of bureaucratic organization charts and the repetition of a hundred million Latinate words in a hundred million meetings that substitute for action, but action itself — without excuses, without exceptions — with the goal of protecting every American and the capability to help protect the people of the world.

I call for the creation of the ability to detect, identify, and model any emerging or newly emerging infection (present or future) natural or otherwise — for the ability to engineer the immunization and cure, and to manufacture, distribute, and administer what we need to get it done and to get it done in time.

*

This is a bold vision.

But it is the kind of thing that, once accomplished, is done.  And it is the kind of thing that calls out to be done — and that, if not done, will indict us forever in the eyes of history.

In diverting a portion of our vast resources to protect nothing less than our lives, the lives of our children, and the life of our civilization, many benefits other than survival would follow in train — not least the satisfaction of having done right.

If the process of scientific discovery proceeds as usually it does, we will come to understand diseases that we do not now understand and find the cures for diseases that we cannot now cure.

And, as always, disciplined and decisive action in facing an emergency can, even in the short run, compensate for its costs — by adding to the economy both a potent principle of organization and a stimulus like war, but war’s opposite in effect.

This would power the productive life of the country into new fields, transforming the information age with unexpected rapidity into the biotechnical age that is to come. 

All this, if the nation can be properly inspired in its own defense and protection — perhaps just in time.

We must open our eyes to face the single greatest threat to our safety and security today, but also to seize our greatest single opportunity.

*

And allow a conservative Senator from Tennessee (who is by nature skeptical of overzealous government action) to affirm the root conservative principle that if the life of the nation is potentially at risk, no effort should be judged too ambitious, no price too high to pay, no division too wide to breach.

I’m aware of the difficulties.  But the United States is as blessed today as it has been since its beginnings.  We are: the wealthiest, free-est, and most scientifically advanced of all societies; the first republican democracy; and the first modern state.

And although we as a nation have suffered criticism of late, we’ve been willing since our Founding, and are willing still, to pursue certain ideals.

Though not infrequently condemned from the precincts of cynicism, America has mostly left cynics in its wake — sometimes after saving them from floods that they themselves have unleashed.

Today, in the majesty of this setting, I’ve tried to impress upon you the urgency I feel in a matter concerning not only America but the world — for pandemics (whether natural or intentional) know neither borders, nor race, nor who is rich nor who is poor. 

They know only what is human, and it is this that they strike, casting aside the vain definitions that otherwise divide us.

It is my pre-eminent obligation as a public servant and my sacred duty as a physician to ask you to support the essence of this proposal.

In respect of human mortality, for the sake of your own families and children, for the honor and satisfaction of doing right, I bid you join in this effort.

*

As we celebrate as Bohemians and guests in fellowship in this magnificent and glorious space, may God preserve us all, and may our actions and foresight make us worthy of His preservation.

***

2005: Frist Calls For Manhattan Project For The 21st Century

August 3rd, 2005U.S. Senate Majority Leader William H. Frist, M.D. delivered the following lecture at the Nantucket Atheneum. The talk titled “The Manhattan Project for the 21st Century” outlined the global threat of infectious disease and bioterrorism and the need to better prepare the United States and the world to respond to epidemics and outbreaks:

Like everyone else, politicians tend to look away from danger, to hope for the best, and pray that disaster will not arrive on their watch even as they sleep through it. This is so much a part of human nature that it often goes unchallenged.

But we will not be able to sleep through what is likely coming soon — a front of unchecked and virulent epidemics, the potential of which should rise above your every other concern. For what the world now faces, it has not seen even in the most harrowing episodes of the Middle Ages or the great wars of the last century.

We are unprepared for rampant epidemics. And even worse, we haven’t taken sufficient note of the fact that though individually each might be devastating, they are susceptible of either purposeful or accidental combination, in which case they could be devastating almost beyond imagination.

The history of pathogens advances in parallel with and is no more static than our own — with which it is always intertwined, even if at times invisibly. Sometimes it rushes forward with great speed and breathtaking evolutionary vigor — and sometimes it rests in slow backwaters.

When, in 1967, the U.S. Surgeon General declared that we were within site of winning the war on infectious diseases, we thought the slack water would last forever. But that war never ended other than in wishful thinking.

Today more than a quarter of all deaths — 15 million each year — are due to infectious diseases. These include 4 million from respiratory infections, 3 million from HIV/AIDS, and 2 million from waterborne diseases such as cholera. This is a continuing and intolerable holocaust that, while sparing no class, strikes hardest at the weak, the impoverished, and the young.

Three million children die every year of malaria and diarrheal diseases alone — one child every 10 seconds. As sobering as this may be, we’ve been nonetheless in a quiescent stage of the mutability of pathogens — a hiatus from which they are now poised to break out.

When viral diseases evolve normally — such as in the typical course of the human influenza virus undergoing small changes in its antigenicity and killing an average of 500,000 people annually throughout the world — it is called an antigenic drift.

When they emerge with the immense power derivative of a jump from animal to human hosts followed by mutation or recombination with a human virus — as in the influenza pandemic of 1918 – 1919 in which 500 million people were infected and 50 million died, including half a million in the United States — it is called an antigenic shift.

Antigenic shifts are the result of random, fortuitous, and unavoidable changes.

Human population increase, concentration, and spread, intensification of animal husbandry, and greater wealth in developing countries brings animals both wild and domestic into closer contact with ever larger numbers of people.

War, economic catastrophe, and natural disasters subdue active measures of public health. The unprecedented societal overuse and misuse of antibiotics build unprecedented resistance within the microbial bug universe to our even most powerful ammunition. Travel, trade, and climate change bring into contact disparate types and strains of disease.

And as a consequence of all this, microbes evolve, mutate, and find new lives in new hosts.

*

The evidence suggests that we could be at the threshold of a major shift in the antigenicity of not merely one but several categories of pathogens — for rarely if ever have we observed among them such variety, richness, opportunities for combination, and alacrity to combine and mutate.

You read the tidbits and pieces in the news. HIV, variant Creutzfeldt-Jakob disease (mad cow), avian influenzas such as H5N1, and SARS — all are merely the advance patrols of a great army forming out of sight, the lightning that however silent and distant gives rise to the dread of an approaching storm, a storm for which we are unprepared.

How can that be? How can the richest country in the world, with its great institutions, experts, and learned commissions, have failed to make every preparation — when preparation is all — for epidemics with the potential of killing off large segments of its population?

*

To see what might lie on the horizon one need only look to the relatively recent past. I have a photograph of an emergency hospital in Kansas during the 1918 influenza pandemic. People lie miserably on cots in an enormous barn-like room with beams of sunlight streaming through high windows. It seems more crowded than the main floor of Grand Central Station at five o’clock on a weekday. In this one room several hundred people are in the throes of distress.

Think of two thousand such rooms filled with a crush of men, women, and children — 500,000 in all — and imagine that the shafts of sunlight that illuminate them for us almost a century later are the last light they will ever see. Then bury them. That is what happened. How would a nation so greatly moved and touched by the 3,000 dead of September 11th react to half a million dead?

In 1918 – 1919 the mortality rate was 3 percent, which seems merciful in comparison to the 50 percent mortality rate of today’s highly pathogenic H5N1 avian flu. In just the last 18 months, avian flu has caused the death or destruction of over 140 million birds in 11 Asian nations. And, most alarmingly, in 4 of those nations, H5N1 has taken the worried jump from birds to infect humans.

Should the virus shift and human-to-human transmission become sustained, imagine how many human lives avian flu will take. How then would a nation greatly moved and touched by three thousand dead, react to 5 or 50 million dead?

*

The new realities of terrorism and suicide bombers pull us one step further. How would we react to the devastation caused by a virus or bacteria or other pathogen unleashed not by the forces of nature, but intentionally by man?

During the Cold War, the Soviet Union, which stockpiled 5,000 tons annually of biowarfare-engineered anthrax resistant to 16 antibiotics, also produced massive amounts of weaponized smallpox — just as the monumental effort to immunize the world’s children came to a successful close.

It is impossible to rule out that quantities of this or other deliberately manufactured pathogens such as pneumonic plague, tularemia, or botulinum toxin may find or may have found their ways into the possession of terrorists such as bin Laden and Zarqawi.

Although the United States now has enough smallpox vaccine for the entire population, we have neither the means of distribution nor the immunized personnel to administer it in a generalized outbreak nor the certainty that the vaccine we have would even be relevant to a specific weaponized strain of the virus.

Hospitals and our long neglected public health infrastructure would be quickly overwhelmed. Panic, suffering, and the spread of the disease would intensify as — because people were dead, sick, or afraid — the economy ceased to function, electrical power flickered out, and food and medical supplies failed to move.

Over months or perhaps years, scores of millions might perish, with whole families dying in their houses and no one to memorialize them or remove their corpses. Almost without doubt, the epidemic would spread to the rest of the world, for in biological warfare an attack upon one country is an attack upon all.

Every vestige of modernity would be overturned. The continual and illusory flirtation with immortality that is a hallmark of our scientific civilization would shatter. And we would find ourselves looking back upon even the most difficult times of the last century as a golden age.

*

Despite the common wisdom, humanity has not moved beyond this kind of scenario. No — of late it has moved unnecessarily and gratuitously toward it.

Any number of known and unknown viruses — for which at present there is neither immunization nor cure — are at this very moment cooking in Asia and Africa — where they arise in hotbeds of densely intermingled human and animal populations.

We are in unexplored territory. The brew is stewing in a new, ideal mixing vessel. Economic and environmental changes in Asia have forced wilderness-deprived waterfowl to alight to feed amid farm animals — in newly dense populations due to recently acquired wealth and dietary expectations and in a culture in which live poultry is brought to market.

The reassortment of viral DNA as a result of this mingling is so frenzied that it is only a matter of time until the emergence of a virus unequaled in transmissibility and virulence. The epidemiological calculus of flu is notoriously volatile due to the unknowns of rapid reassortment. We do know now, however, we are woefully under prepared even for a virus that we can today foresee — much less for one that we cannot.

No such viruses have yet reached critical mass, or leapt from the channels imposed by their inherent limitations, environmental obstacles, and deliberate actions to contain them. But who is to say they cannot? I certainly won’t. Not with what I’ve seen.

I was in China at the height of the SARS outbreak and witnessed the government’s confused, deceptive, and miserable initial cover-up and response. As a doctor on annual medical mission trips, I have treated patients in the Sudan and, just two weeks ago, in Tanzania. I have seen a determined epidemic — HIV/AIDS — kill millions and hollow out entire societies on the African continent.

The evidence I have seen as doctor, scientist, and policy maker, the patterns of history, and new facts — such as rapid, voluminous, and essential travel and trade; the decline of staffed hospital beds; and a now heavily urbanized and suburbanized American population dependent as never before upon “just in time” but easily disrupted networks of services and supply — lead me to believe that such pathogens could result in the immensely high death tolls to which I have alluded.

*

Take the virus that is today the gravest threat — avian flu. A vaccine would not become available, at best, until six to nine months after the outbreak of a pandemic. Even then, the vaccine would not be available in mass quantities. And even then, we do not know if that vaccine would work. It’s still experimental.

So, in essence, we have no vaccine for avian flu. Nor do we have enough of the only effective anti-viral agent Tamiflu stockpiled to treat more than one percent of our population for avian flu.

*

It’s true that neither Avian flu nor these other viruses have yet spread geometrically — instantly and irrevocably overcoming health care systems and pulling us backward across thresholds of darkness that we long hoped we would never cross again. And yet this they might do — either entirely on their own in nature or as a result of deliberate, purposeful human intervention.

No intelligence agency, no matter how astute, and no military, no matter how powerful and dedicated, can assure that a few technicians of middling skill using a few thousand dollars worth of readily available equipment in a small and apparently innocuous setting cannot mount a first-order biological attack.

It’s possible today to synthesize virulent pathogens from scratch, or to engineer and manufacture prions that, introduced undetectably over time into a nation’s food supply, would after a long delay afflict millions with a terrible and often fatal disease. It’s a new world.

Unfortunately, the permutations are so various that the research establishment as now constituted cannot set up lines of investigation to anticipate even a small proportion of them. But is it really reasonable to assume that anyone might resort to biological warfare? Indeed it is.

Though Al-Qaida’s leadership has been decimated, it has declared that, “We have the right to kill four million Americans — two million of them children . . . . [and] it is our right to fight them with chemical and biological weapons.”

It’s hardly necessary, however, to rely upon stated intent. One need only weigh the logic of terrorism, its evolution, its absolutist convictions, and the evidence in documents and materials found in terrorist redoubts.

Though not as initially dramatic as a nuclear blast, biological warfare is potentially far more destructive than the kind of nuclear attack feasible at the operational level of the terrorist. And biological war is itself distressingly easy to wage.

Never have we had to fight such a battle, to protect so many people against so many threats that are so silent and so lethal.

*

So I ask again how it is that we are so unprepared either for naturally occurring epidemics of newly emergent diseases or those that will be deliberately and purposefully induced?

I propose that we take the measure of this threat and make preparations today to engage it with the force and knowledge adequate to throw it back wherever and however it may strike.

It need not be invincible and we need not fall to our knees before it. Means adequate to the success of a defensive plan are present in great profusion. Whereas the approaching biological shift is gathering force like a massing army, providence has massed an army to meet it.

Having themselves expanded geometrically, the life sciences have come to the threshold of a great age, and to cross it they need only encouragement and a signal from the body politic to put their resources in play.

*

We are not without weapons in this war. They are present in the stupendous material and intellectual wealth of the civilized world, which, despite current divisions of action and opinion, has everything to lose in common.

They are present in the great stores of science and technology amassed over thousands of years of civilization — in the many hundreds of universities, advanced research institutions, and hospitals — yes, in the United States and Europe, but also in Latin America, India, China, and dozens of other countries on six continents.

They are present in the revolution spawned by information technology and our vast, instant and interconnected ability to communicate and share information. They are present in the private sector’s ruthless focus, which, though frequently condemned for its lack of humanity, could well be the instrument that saves us in the end.

They are present in the special temperament and brilliance of individual scientists; in the magnificent light that comes of the surprising and ingenious application of new technologies; and in the vigor, intelligence, and decency of free and unoppressed peoples.

*

So what must we do?

I propose an unprecedented effort — a “Manhattan Project for the 21st Century” — not with the goal of creating a destructive new weapon, but to defend against destruction wreaked by infectious disease and biological weapons.

I speak of substantial increases in support for fundamental research, medical education, emergency capacity, and public health infrastructure. I speak of an unleashing of the private sector and unprecedented collaboration between government and industry and academia. I speak of the creation of secure stores of treatments and vaccines and vast networks of distribution.

Above all, I speak not of the creation of a forest of bureaucratic organization charts and the repetition of a hundred million Latinate words in a hundred million meetings that substitute for action, but action itself — without excuses, without exceptions — with the goal of protecting every American and the capability to help protect the people of the world.

I call for the creation of the ability to detect, identify, and model any emerging or newly emerging infection, present or future, natural or otherwise — for the ability to engineer the immunization and cure, and to manufacture, distribute, and administer what we need to get it done and to get it done in time.

*

This is a bold vision. But it is the kind of thing that, once accomplished, is done. And it is the kind of thing that calls out to be done — and that, if not done, will indict us forever in the eyes of history.

In diverting a portion of our vast resources to protect nothing less than our lives, the lives of our children, and the life of our civilization, many benefits other than survival would follow in train — not least the satisfaction of having done right.

If the process of scientific discovery proceeds as usually it does, we will come to understand diseases that we do not now understand and find the cures for diseases that we cannot now cure.

And, as always, disciplined and decisive action in facing an emergency can, even in the short run, compensate for its costs — by adding to the economy both a potent principle of organization and a stimulus like war, but war’s opposite in effect.

This would power the productive life of the country into new fields, transforming the information age with unexpected rapidity into the biotechnical age that is to come. All this, if the nation can be properly inspired in its own defense and protection — perhaps just in time.

We must open our eyes to face the single greatest threat to our safety and security today, but also to seize our greatest single opportunity.

*

Allow a conservative Senator from Tennessee who is by nature skeptical of overzealous government action to affirm the root conservative principle that if the life of the nation is potentially at risk, no effort should be judged too ambitious, no price too high to pay, no division too wide to breach.

I’m aware of the difficulties. But the United States is as blessed today as it has been since its beginnings. We are the wealthiest, free-est, and most scientifically advanced of all societies, the first republican democracy, and the first modern state.

And although we as a nation have suffered criticism of late, we’ve been willing since our Founding, and are willing still, to pursue certain ideals. Though not infrequently condemned from the precincts of cynicism, America has mostly left cynics in its wake — sometimes after saving them from floods that they themselves have unleashed.

Today I’ve tried to impress upon you the urgency I feel in a matter concerning not only America but the world — for pandemics whether natural or intentional know neither borders, nor race, nor who is rich nor who is poor. They know only what is human, and it is this that they strike, casting aside the vain definitions that otherwise divide us.

It is my pre-eminent obligation as a public servant and my sacred duty as a physician to ask you to support the essence of this proposal. In respect of human mortality, for the sake of your own families and children, for the honor and satisfaction of doing right, I bid you join in this effort.

May God preserve us all, and may our actions and foresight make us worthy of His preservation.
 

To Prioritize Both Student Learning and Student Health, Schools Must Work Differently This Fall | Opinion (The Hill)

BY FORMER SEN. BILL FRIST (R-TENN.) AND DAVID MANSOURI, OPINION CONTRIBUTORS

The Hill | As states and communities across the nation address the significant public health and economic impacts of the COVID-19 crisis and begin the intentional reopening of our communities, it is important to also look ahead to an important benchmark: the return to school for the nation’s 51 million Pre-K — 12 students. 

COVID-19 has created not only a devastating public health crisis but a real crisis in learning, requiring its own intensive recovery planning.

Research by the respected NWEA, a global not-for-profit educational services organization, suggests that students will return in fall 2020 with only 70 percent of the learning gains in reading compared to a typical school year. In math, students are likely to return with less than 50 percent of the typical learning gains. 

In some grades and locations, students may return nearly a full year behind what we would normally see. In high poverty schools, students are already susceptible to higher levels of summer learning loss; this pandemic will likely exacerbate existing equity gaps.

As we look ahead to school buildings reopening, state and local leaders should be focused on three major areas:

  • Planning and preparing for a very different kind of school year.
  • Investing in the innovations and technologies needed for rapid learning recovery.
  • Holding the line on proven policies and investments that advance student achievement.

Read the full article here: https://thehill.com/opinion/healthcare/498418-to-prioritize-both-student-learning-and-student-health-schools-must-work

Tennessee’s Confirmed COVID-19 Cases – A Weekly Analysis (Week of May 10th, 2020)

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  As our state begins to reopen businesses, restaurants, and lift restrictions on stay at home orders, the statistics for infection rates are vitally important. NashvilleHealth is sharing weekly tracking updates and insights based on Department of Health data.  We are also incorporating the latest figures for Davidson County from Nashville Mayor John Cooper’s office.

  • For the week of May 10, 2020 – There were a total of 2,520 new cases. Comparing to the week of May 3rd, the average cases/day are 20% higher. This could be correlated to the relaxation of restrictions concerning the virus from the previous week. For example, Davidson county is keeping more restrictions in place than other counties and the average cases/day rate dropped while Other TN Counties rose.
    • Davidson County – had a total of 514 new cases which is 12% less than last week
    • Williamson County – 30 new cases which is 36% more than last week
    • Other TN Counties – 1,976 cases which is 32% less than last week
  • There were 53 fatalities which is 61% higher than last week.
  • Hospitalizations average 22/day with a total of 155 for the week
  • Testing for this week has increased compared to last week by 20%

Data acquired from the Tennessee Department of Health Website, analyzed by Sajid Khan, SVP at Change Healthcare and a NashvilleHealth board member.

Tennessee’s Confirmed COVID-19 Cases – A Weekly Analysis (Week of May 3rd, 2020)

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  As our state begins to reopen businesses, restaurants, and lift restrictions on stay at home orders, the statistics for infection rates are vitally important. NashvilleHealth is sharing weekly tracking updates and insights based on Department of Health data.  We are also incorporating the latest figures for Davidson County from Nashville Mayor John Cooper’s office.

  • For the week of May 3, 2020 – There were a total of 2,107 new cases. Comparing to the week of April 26th, the average cases/day are 39% lower.
    • Davidson County – had a total of 585 new cases which is 8% less than last week
    • Williamson County – 22 new cases which is 42% less than last week
    • Other TN Counties – 1,500 cases which is 46% less than last week
  • There were 33 fatalities which is about the same as last week
  • Even with the influx of new cases last week, it seems that hospitalizations did not spike along with new cases. We will continue to monitor the condition of those cases.
  • Testing for this week has increased compared to last week by 3%

Read Governor Lee’s latest COVID-19 Bulletin here.

For information specific to Nashville (Davidson County) please go to asafenashville.org and for specifics regarding the reopening of Nashville see this Roadmap.

Data acquired from the Tennessee Department of Health Website, analyzed by Sajid Khan, SVP at Change Healthcare and a NashvilleHealth board member.

The US should be a leader in the global fight against Covid-19 | Opinion (CNN)

CNN | Americans are staring down an unprecedented crisis. We’ve already lost more than 71,000 of our fellow citizens. Millions of families live in fear and uncertainty every second. And large swaths of our workforce are losing their jobs each week.

Together, we face a common, invisible enemy: the novel coronavirus, Covid-19.

As two former US Senate majority leaders, we didn’t always see eye to eye during our time together in Congress, but today, we certainly agree on at least two things: America must lead the rest of the world to defeat Covid-19. And if we take our eye off the ball, China will try to exploit this crisis to its own gain.

Once again, Covid-19 has taught us that what happens around the world matters and impacts us here at home. As the number of cases climbs every time we refresh our screens, we’re learning in real time that viral threats know no borders. After starting thousands of miles away in China late last year, Covid-19 has spread to virtually every continent.

Read More Here: https://www.cnn.com/2020/05/06/opinions/covid-19-fight-against-coronavirus-us-daschle-frist/index.html?fbclid=IwAR36sePigZgn1oq6xvK_xLORiWvZmkjogwAPc2b1PMB4VXB_nq0WZK2gFVI

Tennessee’s Confirmed COVID Cases – A Daily Analysis (April 29, 2020)

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  In an effort to raise awareness about these figures and understand how our changes in behavior – including business closures, school closures, and sheltering in place for non-essential workers – are impacting infection rates, NashvilleHealth is sharing daily tracking updates and insights based on Department of Health data.  We are also incorporating the latest daily figures for Davidson County from Nashville Mayor John Cooper’s office.

State-level data as of 3pm CT on April 29th is as follows:  Tennessee confirmed COVID-19 cases increased by 314 for a total of 10,366. Hospitalizations are now at 1,013, and fatalities rose to 195. To see all of the Tennessee statistics for COVID-19 visit the state’s dashboard here.

President Trump announced this week that states should move to test 2% of their population each month. With almost 170,000 residents tested already, Tennessee has met this goal for April and is looking to continue that progress through May.

Governor Lee issued Executive Order 31 to extend the prohibition of non-emergency dental services to Wednesday, May 6, to allow more needed time for the Tennessee Dental Association, the Tennessee Dental Hygienist Association, and the Tennessee Board of Dentistry to continue their work on guidance for safe reopening and practice.

Gov. Lee also announced that close contact services, such as salons and barbershops, in 89 of Tennessee’s 95 counties will be able to reopen at limited capacity on May 6. Our Economic Recovery Group will release industry-specific guidance for those businesses before the end of this week.

Data acquired from the Tennessee Department of Health Website, analyzed by Sajid Khan, SVP at Change Healthcare and a NashvilleHealth board member.

Tennessee’s Confirmed COVID Cases – A Daily Analysis (April 25, 2020)

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  In an effort to raise awareness about these figures and understand how our changes in behavior – including business closures, school closures, and sheltering in place for non-essential workers – are impacting infection rates, NashvilleHealth is sharing daily tracking updates and insights based on Department of Health data.  We are also incorporating the latest daily figures for Davidson County from Nashville Mayor John Cooper’s office.

Here is the latest state-level data as of 3pm CT on April 25th.  Tennessee confirmed COVID-19 cases increased by 5% for a total of 9,189.  Hospitalizations are now at 821, and fatalities rose to 178.

As today is Saturday, there are no media updates from Governor Lee or Mayor Cooper.

End of week update: Average cases per day statewide increased by 47% at 347 cases per day. Total tests for the week were 50,820 which is more than double any other week in comparison. Hospitalizations per total cases is slowly dropping at a total of 9% of total cases.

Data acquired from the Tennessee Department of Health Website, analyzed by Sajid Khan, SVP at Change Healthcare and a NashvilleHealth board member.

Data acquired from Mayor John Cooper and the Davidson County Department of Health via the daily Covid-19 update.

Privatized contact tracing will help America safely reopen amid coronavirus pandemic | Opinion (The Tennessean)

THE TENNESSEAN | South Korea proved it could contain COVID-19 without a lockdown through aggressive contact tracing. That is what the U.S. must do to be successful too.

After implementing social distancing through a lockdown, but before deploying a vaccine, the single best tool we have to contain the COVID-19 pandemic is contact tracing. 

Countries that have been successful outliers in halting the virus’s spread, like South Korea, have deployed contact tracing early and extensively.

If we want to wisely reopen our state (and our nation), as quickly and safely as possible, we must aggressively implement this approach.  And for it to be successful, we must involve a public-private partnership, compensating private healthcare providers for sharing the work of public health delivery.

Read more here: https://www.tennessean.com/story/opinion/2020/04/22/coronavirus-privatize-contact-tracing-help-america-safely-reopen/3005516001/

Tennessee’s Confirmed COVID Cases – A Daily Analysis (April 22, 2020)

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  In an effort to raise awareness about these figures and understand how our changes in behavior – including business closures, school closures, and sheltering in place for non-essential workers – are impacting infection rates, NashvilleHealth is sharing daily tracking updates and insights based on Department of Health data.  We are also incorporating the latest daily figures for Davidson County from Nashville Mayor John Cooper’s office.

Here is the latest state-level data as of 3pm CT on April 22nd.  Tennessee confirmed COVID-19 cases increased by 6% for a total of 7,842.  Hospitalizations are now at 775, and fatalities rose to 166.

Gov. Lee highlighted key data points from the White House guidelines for Opening Up America Again, which highlight three key data buckets: symptoms, cases, and hospital capacity. He also reported Tennessee ranks 12th in the nation for total tests and 15th in the nation for tests per 100,000 people.

More information on Governor Lee’s daily updates can be found here.

The data for Nashville-Davidson County is current as of 9:30am CT on April 22.  The city has confirmed 1,962 cases of COVID-19, up from 1,936 on April 20, a 26-case increase. The confirmed cases range in age from 2 months to 99 years.

More information on Mayor Cooper’s daily updates can be found here.

Data acquired from the Tennessee Department of Health Website, analyzed by Sajid Khan, SVP at Change Healthcare and a NashvilleHealth board member.

Data acquired from Mayor John Cooper and the Davidson County Department of Health via the daily Covid-19 update.

What We Have Lost In Social Connections, We Can Gain In Nature (Forbes)

FORBES | What We Have Lost In Social Connections, We Can Gain In Nature

The coronavirus pandemic has stolen much from us: the company of our friends, the variety of our daily activity, the color of our social occasions, and—for too many—the stability of our livelihoods. It thrusts us into physical distancing, imposed isolation, and loneliness.

But one unexpected good fortune this crisis brings forth is the dramatic unveiling of nature as a powerful healer when isolation must be transiently the norm. Nature is the antidote to loneliness, the counter to dis-connectedness, and the haven beyond the confines of our homes. The springtime abounds with life and regeneration. What we have so painfully but dutifully (and temporarily) lost in our human social connections, we can gain in constructive solitude and wellbeing by purposefully wandering into the wonderment of the outdoors and nature.

I’m blessed that I am able to work from home and pack in a highly structured, much more efficient and more productive schedule than I had anticipated: full days of conference calls and writing and podcast generation. But my wife Tracy and I, like everyone else, are forcibly isolated from family and friends. The insidious stress slowly builds and the mind unpredictably plays confusing tricks.

Read more Forbeshttps://www.forbes.com/sites/billfrist/2020/04/22/what-we-have-lost-in-social-connections-we-can-gain-in-nature/#1af3be336bc3

Tennessee’s Confirmed COVID Cases – A Daily Analysis (April 21, 2020)

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  In an effort to raise awareness about these figures and understand how our changes in behavior – including business closures, school closures, and sheltering in place for non-essential workers – are impacting infection rates, NashvilleHealth is sharing daily tracking updates and insights based on Department of Health data.  We are also incorporating the latest daily figures for Davidson County from Nashville Mayor John Cooper’s office.

Here is the latest state-level data as of 3pm CT on April 21st.  Tennessee confirmed COVID-19 cases total 7,394.  Hospitalizations are now at 760, and fatalities rose to 157.

Governor Lee announced today that next week, 89 of Tennessee’s 95 counties will begin a phased reopening of the state’s economy as we work to bring industries like retail, restaurants, and close contact services to a safe and methodical opening. For the remaining six counties, Gov. Lee and the Economic Recovery Group are working directly with local officials and health departments in Tennessee’s major metropolitan areas (Shelby, Madison, Davidson, Hamilton, Knox, and Sullivan counties) as they plan their unique re-open strategies. Tennesseans must maintain habits like social distancing, working from home when possible, hand-washing, and utilizing cloth masks. Certain restrictions will remain in place to ensure we do this properly and safely, such as discouraging social gatherings of 10 or more and restricting visitors at nursing homes and hospitals until further notice.

More information on Governor Lee’s daily updates can be found here.

The data for Nashville-Davidson County is current as of 9:30am CT on April 21.  The city has confirmed 1,936 cases of COVID-19, up from 1,903 on April 20, a 33-case increase. The confirmed cases range in age from 2 months to 99 years. There were two additional deaths reported today, making the total death count 22.

More information on Mayor Cooper’s daily updates can be found here.

 

Tennessee’s Confirmed COVID Cases – A Daily Analysis (April 20, 2020)

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  In an effort to raise awareness about these figures and understand how our changes in behavior – including business closures, school closures, and sheltering in place for non-essential workers – are impacting infection rates, NashvilleHealth is sharing daily tracking updates and insights based on Department of Health data.  We are also incorporating the latest daily figures for Davidson County from Nashville Mayor John Cooper’s office.

Here is the latest state-level data as of 3pm CT on April 20th.  Tennessee confirmed COVID-19 cases total 7,238.  Hospitalizations now total 730, and fatalities rose to 152.

In an aggressive push to test outside of traditional symptoms, Gov. Lee announced that more than 11,000 Tennesseans received free COVID-19 tests through the weekend efforts of the Unified-Command Group. Expanded testing will continue for the next two weekends – April 25-26 and May 2-3. A full list of sites can be accessed here. In addition to drive-through sites, all rural county health departments across the state offer free COVID-19 testing 5 days a week. A full list of county health departments can be accessed here. To date, we have conducted 100,689 tests, with this weekend’s surge accounting for the largest number of tests conducted in our state over a two-day period.

  • For 17 consecutive days, we have seen only single-digit increases in the number of cases in our state.
  • Our hospitalization rate has consistently remained lower than national averages.
  • As of today, our number of recovered patients exceeds the number of active cases.

More information on Governor Lee’s daily updates can be found here.

The data for Nashville-Davidson County is current as of 9:30am CT on April 2oth.  The city has confirmed 1,903 cases of COVID-19, up from 1,751 on April 19th, a 152-case increase. The confirmed cases range in age from 2 months to 99 years. A total of 20 fatalities have been reported.

More information on Mayor Cooper’s daily updates can be found here.

Tennessee’s Confirmed COVID Cases – A Daily Analysis (April 15, 2020)

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  In an effort to raise awareness about these figures and understand how our changes in behavior – including business closures, school closures, and sheltering in place for non-essential workers – are impacting infection rates, NashvilleHealth is sharing daily tracking updates and insights based on Department of Health data.  We are also incorporating the latest daily figures for Davidson County from Nashville Mayor John Cooper’s office.

Here is the latest state-level data as of 3pm CT on April 15th.  Tennessee confirmed COVID-19 cases increased from 5,823 on Tuesday, April 14th to 6,079 on Wednesday, April 15th.  Hospitalizations are now at 663, a 5% increase from yesterday. Fatalities rose 1.22%, from 124 to 135.

Governor Lee announced today that he is recommending all schools in Tennessee remain closed for the duration of the 2019/2020 school year. The state has formed a Child Well-being Task Force to ensure at-risk children will be monitored and checked on in the interim. He also announced free COVID-19 testing will be available for any Tennessean, regardless of traditional symptoms, as the Unified-Command group ramps up an aggressive effort to expand testing capacity across the state.

The expanded testing effort launches this weekend, April 18-19, 2020, with the Tennessee National Guard popping up 15 drive-through testing sites across the state. Drive-through testing sites will also be available during the weekends of April 25-26 and May 2-3. A full list of sites can be accessed here or within the list below. In addition to drive-through sites, all rural county health departments across the state offer free COVID-19 testing 5 days a week.

The data for Nashville-Davidson County is current as of 9:30am CT on April 15.  The city has confirmed 1,492 cases of COVID-19, up from 1,457 on April 1, a 35-case increase. The confirmed cases range in age from 2 months to 94 years.

Data acquired from the Tennessee Department of Health Website, analyzed by Sajid Khan, SVP at Change Healthcare and a NashvilleHealth board member.

 

Data acquired from Mayor John Cooper and the Davidson County Department of Health via the daily Covid-19 update.

3 Ways Policymakers Could Help Our Nation’s Doctors And Nurses (TIME)

TIME | As a former heart-transplant surgeon and former U.S. Senator, I understand the frustrations many on the front lines of this pandemic are experiencing. Here are three things those doctors and nurses—dedicated but tired, anxious and feeling betrayed by government—wish policymakers would do:

First, strengthen supply chains of personal protective equipment (PPE) and diagnostic tests. We are in a battle with a cagey, deadly virus enemy, but we send our soldiers to war without armor and ammunition. The President should make the dire shortage of masks, shields, gowns and quick tests a national priority, beginning every press conference with a call to action. The tools are many; they should start with the Defense Production Act of 1950.

Second, create a single National Response Portal, conveniently accessible on a single iPad dashboard. To efficiently and wisely make life-or-death decisions in emergency situations, doctors need at their fingertips complete real-time information about the virus—where it is, how to test for it immediately, the timely return of test results, which proven treatments will work, what intensive-care-unit beds are nearby, the whereabouts of ventilators, how much disease is in the neighborhood. This virus is evolving fast. To win, we must evolve faster and smarter.

The portal, which would analyze public-health data, private-sector data, and mobility and traffic patterns, would also provide ongoing community monitoring that would speed the reopening of our schools and businesses as we relax social distancing—and again tighten it if COVID-19 begins to resurface. We’d know: Where is the enemy and where will it strike next?

Read more at TIMEhttps://time.com/5820662/bill-frist-washington-first-responders/

Tennessee’s Confirmed COVID Cases – A Daily Analysis (April 14, 2020)

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  In an effort to raise awareness about these figures and understand how our changes in behavior – including business closures, school closures, and sheltering in place for non-essential workers – are impacting infection rates, NashvilleHealth is sharing daily tracking updates and insights based on Department of Health data.  We are also incorporating the latest daily figures for Davidson County from Nashville Mayor John Cooper’s office.

Here is the latest state-level data as of 3pm CT on April 14th.  Tennessee confirmed COVID-19 cases increased from 5,610 on Monday, April 13th to 5,823 on Tuesday, April 14th.  Hospitalizations are now at 633, a 9% increase from yesterday. Fatalities rose 2.13%, from 109 to 124.

The data for Nashville-Davidson County is current as of 9:30am CT on April 14th.  The city has confirmed 1,457 cases of COVID-19, up from 1,385 on April 13, a 72-case increase.  We are still encouraged by the numbers of confirmed COVID-19 cases, but the increase today could be in part due to less people being tested over the holiday weekend. Please keep staying the course and stay at home unless going out for essential errands.

Data acquired from the Tennessee Department of Health Website, analyzed by Sajid Khan, SVP at Change Healthcare and a NashvilleHealth board member.

 

Data acquired from Mayor John Cooper and the Davidson County Department of Health via the daily Covid-19 update.

Tennessee’s Confirmed COVID Cases – A Daily Analysis (April 13, 2020)

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  In an effort to raise awareness about these figures and understand how our changes in behavior – including business closures, school closures, and sheltering in place for non-essential workers – are impacting infection rates, NashvilleHealth is sharing daily tracking updates and insights based on Department of Health data.  We are also incorporating the latest daily figures for Davidson County from Nashville Mayor John Cooper’s office.

Here is the latest state-level data as of 3pm CT on April 13th.  Tennessee confirmed COVID-19 cases increased from 5,308 on Sunday, April 12th to 5,610 on Monday, April 13th.  Hospitalizations are now at 579, a 2% increase from yesterday. Fatalities rose 1.94%, from 101 to 109.

The data for Nashville-Davidson County is current as of 9:30am CT on April 13th.  The city has confirmed 1,385 cases of COVID-19, up from 1,348 on April 12, a 37-case increase.  We are encouraged by the slowing down of the number of confirmed COVID-19 cases. This shows our curve is flattening and social distancing is working. Please keep staying the course and stay at home unless going out for essential errands.

A few important points to call out:

  • State wide average cases/day for the week of April 12th are on track to be down 8% when comparing to the week of April 5th
  • Williamson County added 4 cases to their total case count but day over day case growth remains low
  • Hospitalizations had a large influx of 54 new cases. This is the highest for the week of 4.12.2020. This may be due to people delaying going to the hospital because of the Easter holiday

Data acquired from the Tennessee Department of Health Website, analyzed by Sajid Khan, SVP at Change Healthcare and a NashvilleHealth board member.

 

Data acquired from Mayor John Cooper and the Davidson County Department of Health via the daily Covid-19 update.

A Storm for Which We Were Unprepared (Claremont Institute’s The American Mind)

Claremont Institute’s The American Mind | Senator Bill Frist saw it coming years ago.

Senator William Frist, M.D. is a nationally acclaimed heart and lung transplant surgeon and the former Majority Leader of the U.S. Senate. In 2005, during his tenure in Congress, he delivered the Marshall J. Seidman Lecture for the Department of Health Care Policy at Harvard University. In this strikingly prescient speech, he foretells the possibility of a viciously deadly pandemic and calls for action to defend against that eventuality on a vast scale. Though his warnings went unheeded, we are honored to publish his words now as part of our ongoing efforts to understand and counteract COVID-19 and its effects.

I am a physician and a surgeon who by accident of fate finds himself in the halls of power at a time of dangers for his country and the world, the most compelling of which are exactly those a physician is trained to recognize and fight. To me it seems no more natural to be a United States senator, and in my case the majority leader of the Senate, than it did to Harry Truman, who spent so many hard and unambitious years as a farmer and then found himself in such a place and at such a time as he did. And, like him, as someone who comes from the outside, and for whom the perquisites of power appear strange and irrelevant, I have asked myself what my purpose is as a public servant, what my obligations are, and what high precedents I should follow.

After some thought, I have determined my purpose, I know my duty and obligations, the precedents to honor, and why—neither history nor life itself being empty of example. Just as a surgeon must follow a purely objective course and a general must look at war with a cold and steady eye, a statesman must operate as if the world were free of emotion. And yet, to rise properly to the occasion, the surgeon must have the deepest compassion for his patient, the general must have the heart of an infantryman, and the statesman must know at every moment that the cost of his decisions is borne, often painfully, by the sovereign population he serves—all as if the world were nothing but emotion. The difficulty in this is what Churchill called the “continual stress of soul,” the rack upon which the adherents of these professions, if they meet their obligations well, will of necessity be broken.

Read More at Claremont Institute’s The American Mindhttps://americanmind.org/essays/a-storm-for-which-we-were-unprepared/

We Failed to Act on Pandemic Preparedness Before. Let’s not Make that Mistake Again. (LinkedIn)

LinkedIn | As the COVID-19 pandemic surge peaks and we begin to think about reopening our economy, our policy makers should immediately address how to prepare for the next one, for it is inevitable that a next one will occur.

I share with you my exact words from an address I gave at the National Press Club on December 8, 2005. Not because they were prescient of what was to come 15 years later, but because we as nation failed to act. Let’s not make that mistake again.

My exact words as delivered:

“But our hands are not tied. In fact, the policy implications become crystal clear. By immediately outlining and implementing a specific policy prescription, we can minimize not only the direct economic effects of a pandemic, but perhaps more significant, greatly reduce the costly indirect effects of panic, fear and paralysis.

There are 6 steps we must take. 

1. Communication

Number #1 is communicating with the public.

To allay irrational fear, communication must be the bedrock of every public policy response. Communication—of accurate, reliable, consistent information—isn’t an option—it is the antidote—the vaccine for irrational fear. (Think Katrina.) 

Failing to effectively communicate with the public—both before and during the pandemic—would be analogous to having a fire escape plan for your home, but neglecting to share the plan with your family. You don’t want your family jumping out the window when there’s a ladder under the bed. To minimize losses, you not only create an emergency plan, you tell people about it – again and again and again.”

Read More at LinkedInhttps://www.linkedin.com/pulse/we-failed-act-pandemic-preparedness-before-lets-make-bill-frist-m-d-/?trackingId=BfTPnAkRiybet%2FIJcz6kAg%3D%3D

Could Congress Vote by Zoom? (Forbes)

FORBES | The COVID-19 pandemic has rocketed the American workforce into the virtual space. Nearly any worker who can is working from home. Company boards are holding meetings and voting virtually. Physicians are seeing patients through telehealth.

What hasn’t changed? The United States Congress. Members must still travel to the floor of their Chamber to cast their vote in person, adhering to a strict dress code and a no cell phone policy. But as social distancing becomes the norm and in-person meetings have become a health hazard, why can’t Congress vote remotely?

The answer is more complex than you might think.

I spoke to my former parliamentary counselor who is working on this issue, and he said, “remote voting is probably the easy part.” Remote deliberations, such as debate and amendments are much more challenging, and “these contingencies have not yet sufficiently been thought through.”

Beyond the challenge of logistics, neither Leader Mitch McConnell nor Speaker Nancy Pelosi are keen on the idea of remote voting. As a former Senate Majority Leader, I understand how important it is to have your caucus in Washington, DC meeting and working together to move legislation. There’s a reason so many bills pass right before big holidays—keeping Members in Washington is one of the few tools leadership has to encourage cooperation and compromise. Giving that leverage up and allowing remote voting could hamstring leaders at a time when Congress is already notoriously divided.

Read more on Forbeshttps://www.forbes.com/sites/billfrist/2020/04/13/could-congress-vote-by-zoom/#522199ca6b4a

Tennessee’s Confirmed COVID Cases – A Daily Analysis (April 10 & 11, 2020)

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  In an effort to raise awareness about these figures and understand how our changes in behavior – including business closures, school closures, and sheltering in place for non-essential workers – are impacting infection rates, NashvilleHealth is sharing daily tracking updates and insights based on Department of Health data.  We are also incorporating the latest daily figures for Davidson County from Nashville Mayor John Cooper’s office.

Here is the latest state-level data as of 3pm CT on April 11th.  Tennessee confirmed COVID-19 cases increased from 4,862 on Friday, April 1oth to 5,114 on Saturday, April 11th.  Hospitalizations on Friday were 536 and rose 3% today, totaling 556. Fatalities rose 1.97%, from 98 to 101.

The data for Nashville-Davidson County is current as of 9:30am CT on April 11th.  The city has confirmed 1,256 cases of COVID-19, up from 1,224 on April 12, a 32-case increase.  We are encouraged by the slowing down of the number of confirmed COVID-19 cases. This shows our curve is flattening and social distancing is working. Please keep staying the course and stay at home unless going out for essential errands.

Mayor Cooper wanted to remind everyone about the Community Assessment Centers now open in the greater Nashville area. If you think you have symptoms or have been exposed to someone that has been diagnosed with COVID-19, please do the following:

First, call the Metro Public Health COVID-19 Information Hotline – 615-862-7777, 7 a.m-7 p.m. daily – to speak with a public health professional about your symptoms. If additional assessment is necessary, you will be directed to your provider or one of Metro’s Community Assessment Centers to be screened and, if necessary, tested for COVID-19. Centers are open at Nissan Stadium, Meharry Medical College and the former Kmart in Antioch. All centers will be open Monday, Wednesday and Friday, 9 a.m.-3 p.m. Testing is available, free of charge, for Nashville residents.

Data acquired from the Tennessee Department of Health Website, analyzed by Sajid Khan, SVP at Change Healthcare and a NashvilleHealth board member.

 

Data acquired from Mayor John Cooper and the Davidson County Department of Health via the daily Covid-19 update.

 

Our National Moment: How We Can Put Our Healthcare Heroes First (Forbes)

FORBES | As a transplant surgeon for years, we were forced to routinely make tough life and death decisions. With too few available donor hearts (limited supply) for the overwhelming number of patients waiting for a transplant (huge demand), allocation of the limited vital resource, the donor heart, left many to die within months while waiting for a heart transplant.

I’m no longer on the front line of that decision making, but today’s coronavirus pandemic similarly introduces the life and death decisions being made daily by our heroic health providers because of limited medical resources, whether it be too few ventilators or the lack of personal protective equipment for themselves.

It’s not the way it should be in American medicine today.

But because of inadequate preparation it’s the stark reality we have created for our nurses, and doctors, and caregivers, and support personnel as they fight and sacrifice on the frontlines for our safety and well-being. They are indeed our heroes.

A formidable surge in hospital admissions for COVID-19 patients is underway. Although communities across the country are successfully “flattening the curve” and spreading out the appearance of new cases across a longer span of time, it almost certainly will not be sufficient to prevent surges that will severely test clinical and hospital capacity. With 85,000 adult ICU beds available, even estimates of 960,000 to 3.8 million critically ill patients over the course of this pandemic would far outstrip our nation’s current capacity.

Read more at FORBEShttps://www.forbes.com/sites/billfrist/2020/04/08/our-national-moment-how-we-can-put-our-healthcare-heroes-first/#6b6e9fcb68db

Tennessee’s Confirmed COVID Cases – A Daily Analysis (April 2, 2020)

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  In an effort to raise awareness about these figures and understand how our changes in behavior – including business closures, school closures, and sheltering in place for non-essential workers – are impacting infection rates, NashvilleHealth is sharing daily tracking updates and insights based on Department of Health data.  We are also incorporating the latest daily figures for Davidson County from Nashville Mayor John Cooper’s office.

Here is the latest state-level data as of 3pm CT on April 2nd.  Tennessee confirmed COVID-19 cases increased from 2,683 on Wednesday, April 1st to 2,845 on Thursday, April 2nd.  Hospitalizations are now at 263, a 32% increase from yesterday. Fatalities rose 33%, from 24 to 32.

On April 2nd, Gov. Lee upgraded the statewide “safer at home” order to a “stay at home” mandate, through at least April 14.  This new order is enforceable.  Lee and his team had been tracking the level of activity our population was engaging in, and found through vehicle traffic and cell phone data that some residents were beginning to disregard the safer at home order.

The data for Nashville-Davidson County is current as of 9:30am CT on April 2.  The city has confirmed 785 cases of COVID-19, up from 673 on April 1, a 112-case increase.  We continue to stress that as testing capabilities expand, the number of confirmed COVID-19 cases will rapidly grow.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Data acquired from the Tennessee Department of Health Website, analyzed by Sajid Khan, SVP at Change Healthcare and a NashvilleHealth board member.

 

 

 

 

 

 

 

 

 

 

 

 

Source: Mayor John Cooper’s Daily Press Briefing, https://www.asafenashville.org/updates/

Tennessee’s Confirmed COVID Cases – A Daily Analysis (April 1, 2020)

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  In an effort to raise awareness about these figures and understand how our changes in behavior – including business closures, school closures, and sheltering in place for non-essential workers – are impacting infection rates, NashvilleHealth is sharing daily tracking updates and insights based on Department of Health data.  We are also incorporating the latest daily figures for Davidson County from Nashville Mayor John Cooper’s office.

Here is the latest state-level data as of 3pm CT on April 1st.  Tennessee confirmed COVID-19 cases increased from 2,239 on Tuesday, March 31 to 2,683 on Wednesday, April 1st.  We’ve seen 1,310 new cases reported since Sunday (4 days), doubling our overall total. And it’s the second day in a row that we’ve seen a day-over-day increase of over 400 cases.

Hospitalizations are now at 200, up 14% from yesterday. COVID-related fatalities increased by 1 to 24.  Tests given per day (2.2K to 5K) and net new cases per day (164 to 444) have been steadily rising since Sunday.

The data for Nashville-Davidson County is current as of 9:30am CT on April 1.  The city has confirmed 673 cases of COVID-19, up from 541 on March 31st, and 4 deaths.  The three COVID-19 Assessment Centers established by Davidson County – which had been delayed in opening due to lack of testing kits – opened the first half of this week.  With more people able to get tested in Nashville, we should begin to see the uptick in confirmed cases from this increased capability next week.

We continue to stress that as testing capabilities expand, the number of confirmed COVID-19 cases will rapidly grow.

 

 

 

 

 

 

 

 

 

Source: Mayor John Cooper’s Daily Press Briefing, https://www.asafenashville.org/updates/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Data acquired from the Tennessee Department of Health Website, analyzed by Sajid Khan, SVP at Change Healthcare and a NashvilleHealth board member.

 

Tennessee’s Confirmed COVID Cases – A Daily Analysis (March 31, 2020)

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  In an effort to raise awareness about these figures and understand how our changes in behavior – including business closures, school closures, and sheltering in place for non-essential workers – are impacting infection rates, NashvilleHealth is sharing daily tracking updates and insights based on Department of Health data.  We are also incorporating the latest daily figures for Davidson County from Nashville Mayor John Cooper’s office.

Here is the latest state-level data as of 3pm CT on March 31st.  Tennessee confirmed COVID-19 cases increased from 1834 on Monday, March 30 to 2,239 on Tuesday, March 31. That’s a 405-case increase – the largest day-over-day increase we’ve seen to date since the Health Department began tracking confirmed cases.  Hospitalizations saw an 18% increase from yesterday totaling 175 in Tennessee.  COVID-related fatalities jumped to 23, which now equal 1% of confirmed cases (2,239).

Nearly 12,000 tests have been administered in the past two days, and will monitor over the next 7 days to see what the impact this will have on confirmed cases. We continue to stress that as testing capabilities expand, the number of confirmed COVID-19 cases will rapidly grow.

Data acquired from the Tennessee Department of Health Website, analyzed by Sajid Khan, SVP at Change Healthcare and a NashvilleHealth board member.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tennessee’s Confirmed COVID Cases – A Daily Analysis (March 30, 2020)

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  In an effort to raise awareness about these figures and understand how our changes in behavior – including business closures, school closures, and sheltering in place for non-essential workers – are impacting infection rates, NashvilleHealth is sharing daily tracking updates and insights based on Department of Health data.

Going forward, we will also be incorporating the latest daily figures for Davidson County from Nashville Mayor John Cooper’s office.

Here is the latest state-level data as of 3pm CT on March 30th.  Tennessee confirmed COVID-19 cases reached 1834 on Monday, March 30, nearly a 300-case increase since Friday, March 27’s total of 1537 total cases.  There are 148 COVID-19 hospitalizations and 13 reported fatalities.  Statewide, over 23,300 tests have been administered.

The data for Nashville-Davidson County is current as of 9:30am CT on March 31st.  The city has confirmed 541 cases of COVID-19, up from 443 on March 30th.   Week over week, we’ve seen a 214% increase in confirmed cases.  We have 14 confirmed hospitalizations and 3 fatalities.  Nashville’s figures are similar to several other metro regions: Dallas, TX (549 cases), Harris County/Houston, TX (563 cases), Fulton County/Atlanta, GA (503 cases), Cuyahoga County/Cleveland, OH (493 cases), Washington, DC (495 cases), and San Diego, CA (603 cases), according to a county-level tracker from the New York Times.

We continue to stress that as testing capabilities expand, the number of confirmed COVID-19 cases will rapidly grow.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Above data acquired from the Tennessee Department of Health Website, analyzed by Sajid Khan, SVP at Change Healthcare and a NashvilleHealth board member.

 

 

Tennessee’s Confirmed COVID Cases – A Daily Analysis (March 27, 2020)

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  In an effort to raise awareness about these figures and understand how our changes in behavior – including business closures, school closures, and sheltering in place for non-essential workers – are impacting infection rates, NashvilleHealth is sharing daily tracking updates and insights based on Department of Health data.

Here is the latest data as of 3pm on March 27th.  Tennessee cases passed the 1000 mark, with an increase of 957 to 1203 confirmed COVID-19 cases over a 24-hour period.  In the past week, testing has increased dramatically, although we are seeing a several-day lag in tests being processed.  The increase in tests completed this week could mean we see a notable jump in confirmed cases next week once the results come in.  We continue to stress that as testing capabilities expand, the number of confirmed COVID-19 cases will inevitably grow.

The data continue to reflect that our confirmed cases skew towards a younger population, with more than a quarter (26%) of all TN confirmed cases in patients aged 21-30.  Only 8% of our cases have been in patients 71 and older.  Hospitalizations rose 36% from March 26 to 27, with over 100 cases or 8% of confirmed COVID-19 patients hospitalized.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Data acquired from the Tennessee Department of Health Website, analyzed by Sajid Khan, SVP at Change Healthcare and a NashvilleHealth board member.

 

Tennessee’s Confirmed COVID-19 Cases – A Daily Analysis (March 26, 2020)

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  In an effort to raise awareness about these figures and understand how our changes in behavior – including business closures, school closures, and sheltering in place for non-essential workers – are impacting infection rates, NashvilleHealth is sharing daily tracking updates and insights based on Department of Health data.

Here is the latest data as of 3pm on March 26th.  Tennessee reported cases are still trending up, with a notable day-over-day increase from 784 to 957 confirmed COVID-19 cases. Tennessee Health Commissioner Lisa Piercey explained that this larger day-over-day increase was simply reflective of the time delay in testing, not a big spike in cases.  We should expect to see a substantial increase in documented cases as testing ramps up.  For example, in Davidson County they have set up three COVID-19 assessment sites with adequate staff and PPE to test Nashvillians, but to date have not been able to open the sites because of a shortage of testing kits.  As these testing sites come online, the documented cases will inevitably rise.

The data continues to reflect that our confirmed cases skew towards a younger population, with 75% of all TN confirmed cases in patients aged 21-60.  Governor Lee acknowledged this in his daily press briefing, saying, “To the young people in Tennessee, it matters what you do out there.”  It is likely why, to date, our hospitalizations remain lower than 10%.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Data acquired from the Tennessee Department of Health Website, analyzed by NashvilleHealth Board Member Sajid Khan

Tennessee’s Confirmed COVID-19 Cases – A Daily Analysis (March 25, 2020)

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  In an effort to raise awareness about these figures and understand how our changes in behavior – including business closures, school closures, and sheltering in place for non-essential workers – are impacting infection rates, NashvilleHealth will be sharing daily tracking updates and insights based on Department of Health data.

Here is the latest data as of 3pm on March 25th.  Tennessee reported cases continue to grow, with a current total of 784 confirmed COVID-19 cases, 53 hospitalizations, and 3 deaths.   Younger Tennesseans continue to have the majority of confirmed infections, with 34% of cases in ages 21 – 30 and 22% of infections in ages 31 – 40.  We noticed that some counties are reporting higher confirmed cases than are currently being displayed on the State Department of Health’s website, and in the Governor’s daily press briefing today, Health Commissioner Dr. Lisa Piercey confirmed that,  “There is a lag in reporting… I would caution you to actually expect some local numbers to be ahead of ours, but please be reassured we will get those in our numbers.”  As testing ramps up significantly over the next two weeks, we expect to see a substantial increase in documented cases.  Many other Tennesseans probably have the virus but still have not been able to get tested.

Data acquired from the Tennessee Department of Health Website, analyzed by Sajid Khan, SVP at Change Healthcare and a NashvilleHealth board member

What We Can Learn from Tennessee’s Confirmed COVID-19 Cases – A Daily Analysis

With the coronavirus pandemic, we are in unprecedented times, with governments having to use incomplete and rapidly evolving information to determine how to best keep their people safe as well as keep local economies afloat.  I want to commend Governor Bill Lee and the Tennessee Department of Health for the steps they have taken to date to strengthen our state in the fight against COVID-19.

Every day, the Tennessee Department of Health releases figures tracking the number of confirmed COVID-19 cases in each county and statewide.  In an effort to raise awareness about these figures and understand how our changes in behavior – including business closures, school closures, and sheltering in place for non-essential workers – is impacting infection rates, NashvilleHealth will be sharing daily tracking updates and insights based on Department of Health data.

Here is the latest data as of 3pm on March 24th.  Tennessee cases continue to grow.  We are still in the beginning stages of the pandemic – this will get worse before it gets better and will be a significant burden on vulnerable populations, families, small businesses, and our healthcare professionals. We must recognize that the personal choices we make today will have a direct impact on our state and our nation’s ability to weather this pandemic.

While it is still too early to determine how much behavior changes are “flattening the curve,” so far the data suggests that the majority of documented cases in Tennessee (69%) are ages 50 and under, which means we are doing a good job protecting our seniors to date.  But it does raise the question whether younger Tennesseans are taking the pandemic as seriously as they might.

As testing ramps up significantly over the next two weeks, we expect to see a substantial increase in documented cases.   As testing and social distancing continues, we hope to provide you with an increasingly clearer picture of the impact the steps our state and our counties are taking, and what we as Volunteers can do to stem the tide of coronavirus in our communities.

Senator Bill Frist, MD

Chairman, NashvilleHealth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Data acquired from the Tennessee Department of Health Website, analyzed by Sajid Khan, SVP at Change Healthcare and a NashvilleHealth board member

We May Have 72 Hours To Address The COVID-19 Protective Equipment Shortage (FORBES)

FORBES |

I write today to describe an urgent issue that must be addressed by federal leadership in the next 72 hours. In conversations this week with two highly respected leaders representing hospitals in different parts of the country, I received the same vital message: we must organize a national effort to develop personal protective equipment (PPE), which constitutes the protective masks, face shields, gowns, gloves, and other coverings worn to protect health care personnel from contracting infections like the current novel coronavirus.

One of these health system leaders, a chief medical officer in the western United States with extensive experience responding to the past SARS and Ebola outbreaks, described to me the predicament of countless hospitals across the country. With gaps in COVID-19 testing causing patients in hospitals to wait up to five days for results, PPE is being expended by personnel caring for every individual patient waiting for a test result because the assumption must be made that they are COVID-19 positive until proven otherwise.

In fact, the majority are likely not infected and this PPE is being wasted unnecessarily due to the unusually long wait times to receive and complete testing. And with untimely testing causing patients to wait in the hospital, those who could be discharged to home, nursing facilities, and other locations are forced to wait until a negative result is confirmed. Although hospitals have postponed elective surgery to help conserve PPE, this has not been enough for the spike in demand that has been caused in this crisis.

Read More at FORBES: https://www.forbes.com/sites/billfrist/2020/03/20/a-call-for-national-leadership-to-stop-the-protective-equipment-shortage/#3b8b52722d9a

America’s public health infrastructure needs consistent funding (Roll Call)

Roll Call | As our nation confronts the COVID-19 pandemic, we have once again become aware of the critical importance of our state and local health departments. They are the backbone of our nation’s response system.

This is not a new story: Just in this century, we have confronted major infectious disease outbreaks — SARS, H1N1, MERS, Ebola, Zika and dengue. Now COVID-19. Every president, every governor and every city and county chief elected official has had to mobilize their public health systems to respond to each of these crises. These challenges seem to be occurring with greater frequency due to climate change, animal-human interaction, a growing world population and antimicrobial resistance.

But local and state leaders have responded with one hand tied behind their backs. It’s because we, as a nation, have chosen not to consistently fund a strong public health system that can quickly alert us to new problems, build resilient communities that are healthy and socially connected, and create a reserve capacity to respond to an emergency of any kind.

Read More at Roll Call: https://www.rollcall.com/2020/03/14/americas-public-health-infrastructure-needs-consistent-funding/

How Changing Tobacco Laws Can Save Thousands Of Lives, Billions Of Tax Dollars (Forbes)

FORBES | Today we have a massive and growing public health challenge that is substantially shortening the lives of millions, negatively impacting the health of our children, and adding an astounding $170 billion in health care costs to our nation annually. Unknown to most, it has been for years the leading cause of preventable death in the United States. But a new policy approach that 11 states and over 450 cities and counties have adopted is making promising inroads in this health challenge.

The challenge we are facing is tobacco and nicotine use. Smoking kills more people each year than alcohol, AIDS, car crashes, illegal drugs, murders, and suicides combined. And while the number of youth tobacco smokers had been declining for decades, it has recently plateaued and many health officials believe the explosion in vaping is to blame. Nicotine-rich e-cigarette devices were designed to help adult smokers quit, but they have increasingly attracted adolescents and children using candy and fruit flavors with devastating long-term consequences. Indeed, Rite Aid, one of the country’s biggest pharmacy chains, just announced it was discontinuing the sale of e-cigarettes and vaping products because of “the alarming statistics regarding the use… by children and teens.”

We have a solution. Research has shown that nearly 95% of adults who smoke started smoking before the age of 21. If we take steps to make it harder for youth to access these products, we can potentially prevent a whole new generation from starting this habit and becoming addicted to nicotine and tobacco in the first place. This is what Maine, Virginia, California, Oregon, Illinois, Massachusetts, New Jersey, Hawaii, Arkansas, Washington, Utah, and 450 cities and counties have done: they raised the tobacco sale age from 18 to 21. And while this is a new approach that’s just beginning to take hold, we’re already seeing promising results. In 2005, Needham, Massachusetts became the very first town to raise the tobacco sale age to 21. Within the first five years, high school smoking dropped 48%. The city of Chicago found a 36% decrease in smoking in 18-20 year olds just one year after implementation. By all accounts, this type of behavior change is a major public health achievement.

Read more at Forbes:
https://www.forbes.com/sites/billfrist/2019/04/15/how-changing-tobacco-laws-can-save-thousands-of-lives-billions-of-tax-dollars/#7e09706431d5

Most support tobacco policy changes that will save lives and tax dollars (The Tennessean)

THE TENNESSEAN | By Bill Frist, MD and Matthew Myers

As the leading cause of preventable death in Tennessee, tobacco use is shortening the lives of millions of people, affecting the health of children and adding $2.6 billion in health care costs to the state annually.  

Nearly one in four Tennesseans smoke. Centers for Disease Control and Prevention surveys show that 20.3 percent of Tennessee high school students reported using cigarettes, cigars, smokeless tobacco or electronic cigarettes at least once during the last 30 days. Based on current smoking rates, there are 125,000 kids in Tennessee today who will ultimately die from smoking, and smoking still kills more people each year than alcohol, AIDS, car crashes, illegal drugs, murders and suicides combined.

In addition, we are also facing a new epidemic of youth e-cigarette use. Nationally, use of e-cigarettes by high school students rose 78 percent in 2018, and more than 3.6 million middle and high school students used e-cigarettes.  

The good news, however, is that there are proven solutions. Over the last 20 years, states across the country have dramatically reduced tobacco use among youth by raising tobacco taxes, funding prevention programs and passing strong smoke-free laws. In the last few years, states have started raising the sales age for tobacco from 18 to 21. Research has shown that nearly 95 percent of adults who smoke started smoking before the age of 21. Raising the sale age would mean fewer teens would have access to tobacco products (including e-cigarettes) when their brains are still developing and more prone to addiction. Experts estimate that raising the tobacco sale age to 21 will, over time, reduce the smoking rate nationally by about 12 percent and smoking-related deaths by 10 percent, which translates into 223,000 fewer premature deaths, 50,000 fewer deaths from lung cancer and 4.2 million fewer years of life lost.  

Read more at The Tennessean: https://www.tennessean.com/story/opinion/2019/04/05/most-support-tobacco-policy-changes-save-lives-tax-dollars/3377168002/

Understanding The Burning Platform Of Health Care Spending Growth (Health Affairs)

HEALTH AFFAIRS | By Bill Frist, MD and Margaret Hamburg, MD

In January, we were honored to co-chair the inaugural meeting of the Health Affairs Council on Health Care Spending and Value. This diverse group of 22 health care leaders has come together to stimulate a national discussion about whether we should—and how we could—constrain what feels like runaway health care spending.

An explicit conversation about this issue has long been taboo in US health policy and politics, but with health care now consuming 17.9 percent of our gross domestic product (GDP)—up from 5 percent in 1960—that time is over. It is time for us to speak boldly and thoughtfully about the wisdom, sustainability, and return on investment of these levels of funding and examine the consequences of continuing health care cost growth along the lines of what we have seen in the past few decades.

The council’s formal charge, which will shape a three-year work plan and recommendations, is “to provide a focal point for evidence-based discussion, analysis, and action regarding what we get for our health care spending in the US, whether it is worth it, and how we might collectively take a more deliberate approach toward maximizing our investment in health care.” We want to ask tough questions, checking our allegiances and party affiliations at the door, and together, find evidence-based answers that are desperately needed to move this dialog forward. 

Read more at the Health Affairs blog:
https://www.healthaffairs.org/do/10.1377/hblog20190320.106452/full/

Tennessee’s education progress has slipped. Specific steps can turn it around (The Tennessean)

THE TENNESSEAN | By Bill Frist, MD and David Mansouri

A decade ago, the nonprofit State Collaborative for Reforming Education, or SCORE, began collaborating with Tennessee’s leaders, educators, and community and education advocates to make Tennessee one of the fastest-improving states in the nation.

Children in Tennessee today have better opportunities for success in college and career than any Tennesseans in history, and we are proud of the state’s unprecedented progress in student achievement. But as SCORE enters its second decade of service and releases our newest State of Education in Tennessee report, we want to see our students climb higher and faster.

From 2011 to 2017, Tennessee students made historic gains in national math and reading achievement, reaching as high as 34th or 35th in the nation. A few years earlier, we had been as low as 46th. Students in urban, suburban and rural areas all saw improvements. …

Read more at The Tennessean: https://www.tennessean.com/story/opinion/2019/03/11/how-to-reverse-tennessee-education-progress-declines/2919556002/

Tennessee Is Home To One Of The Deadliest National Parks In The Nation: Here’s How We Change That (Forbes)

FORBES | In Middle Tennessee, we are known for excellence in health care services, music, and economic growth. However, one distinction we would like to relinquish is being home to the national park with the highest number of suicides in the United States.

According to an analysis by Outdoor Magazine, the Natchez Trace Parkway is one of the nation’s deadliest parks with 25 suicide deaths from the Natchez Trace Parkway Bridge between January 2006 and September 2016. In recent years, the suicide rate has climbed, with five deaths in 2017 and three this past year. Suicide has become a public health crisis in my home of Williamson County, Tennessee, one that was brought to my attention by my wife Tracy through her work on the board of Centerstone. More tragedies are preventable if we act swiftly and intentionally.

Why is the Natchez Trace Parkway Bridge so deadly? The 1,572-foot-long concrete bridge only has a short, 32-inch railing barring a 155-foot drop. And since the first recorded death at the bridge in 2000, it has gained a reputation for being the “suicide” bridge. Famed country music singer-songwriter Naomi Judd, who struggled with depression, wrote in her autobiography that she contemplated ending her life by jumping from this very spot: “I knew exactly how I was going to carry out my suicide. … I would drive my car to the very center, and in one swift motion open the car door and climb over the railing. … After the 155-foot drop to State Route 96 below, it would all be over, now and forever.”

While Ms. Judd ultimately did not attempt suicide and was able to seek and receive help, 32 others have made the devastating decision to end their lives at the Natchez Trace. Now, friends and family members of these individuals are uniting as the Natchez Trace Bridge Barrier Coalition and partnering with the nationally recognized behavioral health leader Centerstone and the Tennessee Suicide Prevention Network with a singular focus: to raise the bridge railing or install a barrier to prevent future deaths. This is a cause I whole-heartedly support. And so does the science.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2019/03/07/tennessee-is-home-to-one-of-the-deadliest-national-parks-in-the-nation-heres-how-we-change-that/#58afbc387d5e

Trump’s call to end HIV is a worthy mission both at home and abroad (CNN)

CNN | In his State of the Union address, President Donald Trump brought attention to a disease that has almost disappeared from the headlines: HIV/AIDS.

He pledged to end the epidemic in the United States by 2030, setting commendable, ambitious goals for domestic prevention and treatment efforts.

I support President Trump’s pledged investment in domestic public health but believe we must also continue to build on our nation’s 15 years of global leadership in combating HIV/AIDS. Around the world, there are still nearly 37 million people living with HIV, more than 900,000 AIDS-related deaths a year and nearly 1,000 adolescent girls and young women infected with HIV every day. We can and must lead the global fight to end this pandemic.

Read more at CNN: https://www.cnn.com/2019/02/15/opinions/trumps-call-to-end-hiv-is-a-worthy-mission-frist/index.html

The Tax Credit that is History in the Re-Making (Forbes)

FORBES | At a time when our nation feels like it may be torn apart with increasing partisanship and clash of cultures, there is something all Americans share in common. We all take pride in our communities, our hometowns, the places where we were born and the places where we’ve put down roots. Part of that pride comes from a shared history, one that is preserved and told through our historic buildings, landmarks, and physical structures that are often the soul and essence of our towns and cities.

How can we best preserve and celebrate our past, while also meeting our communities’ needs for economic investment and job creation? One proven way lies with a little-known tax incentive that has been established at the federal level, and now is increasingly making a difference as states incorporate it into their tax codes. 

Read more at Forbes: https://www.forbes.com/sites/billfrist/2019/02/04/the-tax-credit-that-is-history-in-the-re-making/#18dc94911246

Why Tennessee should join 35 other states in adopting a historic tax credit (Tennessean)

THE TENNESSEAN | Earlier this week, Gov. Bill Lee made the commendable decision to direct all state agencies to find ways to improve how they serve rural Tennessee regions.

“My administration will place a high emphasis on the development and success of our rural areas,” Governor Lee said in announcing his first executive order. 

I strongly support our Governor’s committed focus, and have given thought to opportunities to move our rural towns, main streets, and downtowns forward.

What are some of the ways we can stimulate wage growth for some of our most vulnerable, improve the well-being of all our citizens, and pass along a better Tennessee to future generations?  One proven way lies with harnessing our heritage.

Incentives for historic preservation not only protect culturally significant buildings for the next generation, but also stimulate economic growth in our communities.

Read more in the Tennessean: https://www.tennessean.com/story/opinion/2019/01/25/tennessee-should-join-35-other-states-and-adopt-historic-tax-credit/2667076002/

What Andy Samberg And Sandra Oh Got Right At The Golden Globes: Vaccines Are Worth Celebrating! (Forbes)

FORBES | Last week at the Golden Globes, hosts Andy Samberg and Sandra Oh made headlines as they tried to give out free flu shots to celebrities in the audience. This surprise stunt showed famous stars looking shocked and nervous as needle-wielding nurses descended from the stage to offer vaccinations. Samberg joked, “If you are an anti-vaxxer, just put a napkin on—perhaps over—your head and we will skip you.”

This segment certainly got laughs, but perhaps more importantly it got the flu vaccine—and vaccinations in general—back into public discourse. Yes, it might be January but it’s not too late to get your flu shot. While flu season tends to peak between December and February, it can run as late as May.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2019/01/16/what-andy-samberg-and-sandra-oh-got-right-at-the-golden-globes-vaccines-are-worth-celebrating/#1d01d71ce78c

Has Childhood Obesity Become A National Security Threat? (Forbes)

FORBES | As a physician and lawmaker, I have long argued that federal global health aid improves America’s standing in the world and makes us safer by steadying unstable nations. Countries with healthy workforces have improved economic outputs, stronger family units, and are less likely to become havens for terrorists.  But what many may not realize is that the health of our population here at home also impacts our national security.  

Earlier this fall, Mission: Readiness, a group of 750 retired generals and admirals, published a new report, titled Unhealthy and Unprepared, showing that obesity is now a leading reason why 71% of young Americans are ineligible to serve in the military. This alarming trend, coupled with a decreasing number of young people interested in military service, means that our military soon may be unable to find enough recruits to protect American interests at home and abroad. And it’s already having an impact, with obesity rates cited as a major reason why the Army was not on track to meet its annual recruitment goals as of September 2018.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2018/12/19/has-childhood-obesity-become-a-national-security-threat/

Sen. Frist on Sen. Alexander’s Decision Not to Run in 2020

Senator Frist presents Senator Alexander an award from the Bipartisan Policy Center for his leadership in passing the landmark 21st Century Cures Act in 2016. 

Lamar Alexander’s unparalleled intellect, his unwavering commitment to commonsense Tennessee values, combined with his extraordinary willingness to do the hard work (he does more in a day than most do in a week!) has led to countless achievements that have improved our lives and dramatically enhanced our well-being. 

Senator Alexander has been a tireless servant for the people of Tennessee, first as Governor for eight years and now as a United States Senator for the last sixteen, in addition to serving the American people as the U.S. Secretary of Education under President George H.W. Bush. 

I am grateful to have served with him in the United States Senate and together on the Senate Committee on Health, Education, Labor and Pensions, which he so capably chairs today. He is the master of results in the Senate.   Focused always on achieving forward progress – not political posturing – Lamar has led the way in writing, crafting and passing many of our most impactful laws, including the 21st Century Cures Act to speed the next generation of cures and treatments to patients, the Every Student Succeeds Act to improve our federal education system and reform No Child Left Behind, the America COMPETES Act to invest in American innovation, and the SUPPORT for Patients and Communities Act to smartly tackle the ongoing opioid epidemic.  While Washington seems to increase in partisanship with each passing year, Lamar keeps his head down, vets and develops evidence-based solutions that will serve the American people and quietly and effectively cultivates broad support from both sides of the aisle.  He is a true statesman and a trusted, honest negotiator whose leadership in Congress has reflected the best of who we are as Americans.

15 Years Later: How Well Are We Doing Addressing AIDS (Forbes)

FORBES | This World AIDS Day, we celebrate the astounding progress made in the past 15 years! Thanks to PEPFAR— the U.S. President’s Emergency Plan for AIDS Relief—14.6 million people living with HIV (59%) have access to antiretroviral therapy. More than 2.4 million babies have been born HIV-free. Countless lives have been saved.

This progress was unthinkable when I was a surgical resident in training in the 1980s, studying the latest medical literature and tracking this mysterious new virus. On my annual medical mission trips to Africa, I saw the virus at scale. My clinics overflowed with AIDS patients. I watched the virus hollow out entire societies, taking first the most productive members at the prime of their lives — teachers, police, civil servants, mothers.

I knew there was not much a surgeon could do for a patient dying of AIDS. But in the late 1990s, I wasn’t only a surgeon. I had a new set of colleagues who wielded different tools. I shared stories and photos and data with my fellow Senators. I found allies on both sides of the aisle who grasped the scale of the problem, but also saw—with hope—an opportunity to help. Joe BidenBarbara LeeJohn KerryJesse Helms and others shared my concern.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2018/12/01/15-years-later-how-well-are-we-doing-addressing-aids/#13b1fd4b2ee5

Reading The Healthcare Tea Leaves In The 2018 Midterm Elections (Forbes)

FORBES | The November elections left us with a lot to digest—it wasn’t the decisive “blue wave” that some were predicting, but the tea leaves did tell us some interesting things about what voters believe and value, particularly when it comes to healthcare.

Interestingly, pollster Bill McInturff of Public Opinion Strategies found a notable phenomenon in exit polls: in races where Democrats won GOP seats, the number one issue was healthcare. Whereas in races where Republicans won Dem seats, the number one issue was jobs and the economy. With the Democrats decisively winning back the House, it’s clear healthcare was top of mind for many. As House Democratic Minority Leader Nancy Pelosi sees it, “Health care was on the ballot, and health care won.” It is actually quite rare in history that healthcare reaches this level of significance as a decisive issue in elections, and almost never in midterm elections.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2018/11/29/reading-the-healthcare-tea-leaves-in-the-2018-midterm-elections/#455209c8b9a3

The Latest In Blockchain In Healthcare: Top Takeaways From Distributed Health (Forbes)

FORBES | Last week I had the honor of kicking off the third annual Distributed Health conference in Nashville, which brought together leaders in healthcare as well as blockchain innovators from across the nation. All were united by the shared belief that blockchain has transformative potential for health and healthcare, with changes already underway.

Blockchain is more than a technology that has enabled the much-hyped Bitcoin. It is a transactional ledger that records the movement of anything of value—currency, records, contracts, supplies—between parties. It is unique because it is a distributed ledger, which means multiple parties can hold copies of the ledger that are continuously synched, taking out inefficiencies in the transaction process. And, most importantly, it is highly secure and generally cannot be changed without the agreement of all parties to the ledger. The Economistmagazine has called blockchain “a machine for creating trust,” allowing “people who have no particular confidence in each other [to] collaborate without having to go through a neutral central authority.”

I am particularly excited about the potential that blockchain has for the healthcare industry. 

Read more at Forbes: https://www.forbes.com/sites/billfrist/2018/11/13/the-latest-in-blockchain-in-healthcare-top-takeaways-from-distributed-health/#460224573e5a

The Future Of Healthcare Innovation And Why Government Matters (Forbes)

FORBES | Why do politics matter to health? Because government, when focused, can do incredible things to move our health forward. Here are just two examples that I was directly involved with while in the United States Senate.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2018/11/06/the-future-of-healthcare-innovation-and-why-government-matters/#f00d712192d2

Taking Root in Nashville – A New Collaborative to Green our Streets and Improve our Health

Clean air, cooler streets, safer neighborhoods, improved health – these are all things we’d like for our city of Nashville.  What do they all share in common?  They are all goals that can be achieved in part through a larger urban tree canopy – and all are central to the mission of our new collaborative effort, root nashville.

On October 3rd, I am joining with Mayor David Briley, Reverend Edwin Sanders, philanthropist Martin Brown and other community leaders to announce this innovative public-private partnership to plant 500,000 trees in Nashville by 2050.  It’s an audacious goal – and it’s one that can only be achieved with the help of business partners, developers, health and environmental organizations, community groups, and caring citizens.

As chairman of NashvilleHealth, I am heading up root nashville’s Advisory Board. I am deeply passionate about this cause as a physician who has seen firsthand how environment impacts people’s health.  Studies have repeatedly shown how proximity to trees and greenspace reduce stress and chronic health conditions like diabetes, stroke and cardiovascular disease, promote physical activity, and improve mental health and social cohesion.  A robust urban tree canopy also allows our residents to breathe easier: trees produce oxygen and absorb carbon dioxide from fuel combustion and remove or trap lung-damaging particles from the air.  That means fewer asthma attacks for our children.  And after our record-setting summer heat, Nashvillians will appreciate the fact that trees reduce air temperatures by 1 – 4 degrees which can lower cooling costs by up to $50 per year.  Furthermore, studies have shown urban areas with tree canopies have lower rates of crime.  Simply put, more trees mean a healthier, safer city.

We at root nashville hope to plant our first 5,000 trees in communities throughout Nashville by Earth Day, April 22nd, 2019 – but we need your help.  To get involved in our collaborative effort to green our city and collectively improve the health of all Nashvillians, visit rootnashville.org. You can take action by:

  • Planting a tree in your yard or on your property and register it on the root nashville website
  • Committing to watering and caring for trees in your neighborhood (“Adopt” a tree!)
  • Volunteering with root nashville through partner organizations like Hands On Nashville
  • Donating funds or in-kind resources to the campaign
  • Spreading the word about root nashville and the health benefits of trees!

The time to act to preserve and grow Nashville’s tree canopy is now. Our region is growing at an unprecedented rate, with a 45% increase in population between 2000 and 2017.  Between 2008 and 2016, Nashville’s tree canopy in urban zones fell by 15% and is behind many comparable cities across the country.  This economic boom and population explosion have led to a decline in the natural environment – but that doesn’t have to be the case.  We can make Nashville a thriving urban center with tree-lined streets, pocket parks, and greenspaces that will keep our city healthy for generations to come.  Join us at root nashville as we help our city take root!

70 Years Ago America Led The Largest Humanitarian Airlift In History: Today Would We Do The Same? (Forbes)

FORBES | In June of 1948 there was a crisis in Berlin. The Soviet Union—one of four countries tasked with redeveloping Germany after its World War II loss—set up a blockade around the capital city. By cutting off food, water, electricity, and other supplies, the Soviets expected to take over a starved Berlin and expand Soviet reach.

The Allies wouldn’t care, the Soviets reasoned. The United Kingdom, France, and the United States, the other countries committed to redeveloping Germany, certainly wouldn’t go to any trouble for the Germans trapped in West Berlin. Those countries had their own rebuilding to do. While they were busy elsewhere, the Soviets expected to push out the Allies’ presence and erase the dot of democracy.

But they were wrong.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2018/09/13/70-years-ago-america-led-the-largest-humanitarian-airlift-in-history-today-would-we-do-the-same/#693239df65fd

Fixing the opioid crisis requires the two things Congress hates most: Bipartisanship and government spending (NBC News)

NBC NEWS | Practically every community in America, and most families, are facing the still-growing opioid epidemic that is tearing at the soul of our health and wellbeing.

The Centers for Disease Control and Prevention estimates 115 Americans die each day from opioid-related overdoses, and research suggests that misuse of prescription opioids is a risk factor for heroinuse. It is thus critical that we find policy solutions that both turn the tide on opioid misuse and addiction now and make it less likely that we repeat in the long-term the same mistakes that led to the crisis.

To do so successfully, we must first fully understand the many fundamental drivers of this crisis; there is no single root cause of the epidemic, and multiple segments of society bear some responsibility.

Read more at NBC News with Tom Daschle: https://www.nbcnews.com/think/opinion/fixing-opioid-crisis-requires-two-things-congress-hates-most-bipartisanship-ncna903271

Make water a top global priority. It’s the best, cheapest way to save lives (USA Today)

USA TODAY | This summer has seen the unprecedented and simultaneous outbreak of six of eight diseases posing the greatest threats to public health, according to the World Health Organization. You’d think that after the alarmingly fast spread of Ebola in West Africa just a few years ago, we’d have learned our lesson. Instead, the health intervention that has saved more lives than any other in recorded history remains alarmingly absent in global health care. That poses an immediate and long-term danger to us all.

We call it WASH — water, sanitation and hygiene. It’s the most critical resource in my preparation for every surgical procedure I performed over my lifetime, and it is dismally deficient or nonexistent in hundreds of thousands of health care facilities around the world. Not only are we wasting billions of dollars in health care costs and lost productivity, we’re undercutting our most effective front-line defense in disease prevention and containment.  

Read more at USA Today: https://www.usatoday.com/story/opinion/2018/08/15/water-top-global-priority-best-cheapest-lifesaver-bill-frist-column/934264002/

Loneliness kills: A new public health crisis (and what we can do about it) (The Hill)

THE HILL | A little-discussed condition raises the risk of premature death by up to 50 percent—making it a health hazard at least as significant as smoking and alcohol and more so than obesity. Yet many medical professionals haven’t heard about it, and the public remains largely in the dark.

We’re talking about social isolation, a national public health crisis.

Characterized by a tiny support network and minimal interpersonal contact, it’s a circumstance often associated with older adults experiencing progressive loss. Children move away, a spouse dies, and physical deterioration makes it harder to engage in social activities. Seniors in rural areas are particularly susceptible. Geographic isolation and lack of public transportation combine to keep them alone.

Read more at The Hill: https://thehill.com/opinion/healthcare/399123-loneliness-kills-a-new-public-health-crisis-and-what-we-can-do-about-it

Murder In The Capitol: Honor The Fallen And Improve Mental Health (Forbes)

FORBES | Twenty years ago tomorrow was one of the most memorable days in my U.S. Senate career. And it haunts me still.

It doesn’t mark the anniversary of major legislation being signed or a bipartisan deal being struck. Rather, July 24, 1998, was the day our U.S. Capitol building was attacked by a mentally ill, armed individual who took the lives of two members of federal law enforcement, who daily defended lawmakers such as me, and citizens until their last breath. The images are vivid, because I was there.

On this anniversary, I reverentially reflect on the heroic sacrifices our men and women in uniform make every day. And as a physician, I’m prompted again to consider the discouraging state of mental health in America, and especially the poor care too many of those who suffer from mental illness today receive.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2018/07/23/murder-in-the-capitol-honor-the-fallen-and-improve-mental-health/#7bf2507825e3

Rural Aging: Health and Community Policy Implications for Reversing Social Isolation (Bipartisan Policy Center)

BIPARTISAN POLICY CENTER | On June 7, 2018, Tivity Health’s Donato Tramuto and I convened a roundtable at the Bipartisan Policy Center to discuss challenges and potential solutions to address a little-discussed public health crisis: social isolation and our aging population. What many don’t realize is that social isolation could be an even bigger public health threat than smoking or obesity and it could raise the risk of premature death by up to 50 percent.

Today, we’re excited to release the findings from our roundtable, which we hope will help fuel a national discussion and call to action to reverse an epidemic of loneliness.

Read the report, “Rural Aging: Health and Community Policy Implications for Reversing Social Isolation,” at the Bipartisan Policy Center: https://bipartisanpolicy.org/library/rural-aging-health-and-community-policy-implications-for-reversing-social-isolation/ 

Confirming Brett Kavanaugh Twelve Years Ago And His Prospects Today (Forbes)

FORBES | Brett Kavanaugh will make a terrific Supreme Court Justice, and I know from firsthand experience. Earlier this week, the New York Times ran a photo of me with Kavanaugh taken over 12 years ago when then-Majority Whip Mitch McConnell and I spearheaded his Senate confirmation. Seeing that photo brought me back to my time as Majority Leader — I had made it a priority to advance judicial nominees who would practice judicial restraint and interpret the law strictly and impartially. Brett Kavanaugh was one of those nominees.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2018/07/11/confirming-brett-kavanaugh-twelve-years-ago-and-his-prospects-today/#3a540ff338fa

Virtual Reality Isn’t Just For Gamers Anymore; It Will Change Your Health (Forbes)

FORBES | I’ve got one big idea that can change your health. But first some history.

Heart transplants were once rare.

When I was training to be a heart transplant surgeon at Stanford, at every opportunity I would go to the operating room to observe and study my mentor (and the “father of heart transplantation”) Dr. Norm Shumway masterfully cut out a fatally diseased heart and replace it with a strong healthy one, always amazed at that miraculous moment when it sprung back to life. Observing these rare operations was invaluable to me as a trainee, but nothing compared to that first experience of actually holding the scalpel in my own hand, making the initial, fateful incision, and deciding precisely where to place each stitch. Over time, I created the muscle memory that would allow me to safely perform heart transplants well over a hundred times in the years ahead.

It was the timeworn, slightly hyperbolic, surgical mantra, “See one, do one, teach one.” It was the best we had at the time. But is that really the best, or safest, way to learn? Or do patients deserve more?

As virtual reality (VR) software becomes more sophisticated, users are able to interact with the environment through multiple senses. Our brains and bodies begin to experience the virtual environment as real.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2018/07/10/virtual-reality-isnt-just-for-gamers-anymore-it-will-change-your-health/

Opinion: An Open Health Diplomacy Hand Works Better Than a Fist (Roll Call)

ROLL CALL | Recent headlines have been filled with stories and images of parents being separated from their children by the U.S. government. This is not what our country represents.

In fact, 15 years ago, we enacted the President’s Emergency Plan For AIDS Relief, or PEPFAR, to do quite the opposite, and the program has gone on to save the lives of millions, keep families intact, and provide support for millions of orphans, vulnerable children and their caregivers. It represents the best of America, and we can be proud of the global legacy it has created.

PEPFAR is the single largest commitment any one country has ever made to combat a disease. It has reduced mortality in some of the most vulnerable communities in Africa and elsewhere and contributed to our security at home by making a difference overseas. PEPFAR turned the tide on a global HIV/AIDS epidemic and assisted with building global partnerships and reducing national security threats. It’s been a win-win.

Read more at Roll Call: https://www.rollcall.com/news/opinion/opinion-open-health-diplomacy-hand-works-better-fist

The Senate I led put country over party. This one must do the same for Robert Mueller. (Washington Post)

WASHINGTON POST | When I retired from the U.S. Senate in 2007 as its majority leader, my parting words were a prayer for my colleagues to rise above the passions of the moment and protect the institution as a bulwark for our country’s enduring values. The Senate I served in was not devoid of partisanship, nor should it be, but my hope was that patriotism would always take priority over party.

It is with some trepidation that I offer thoughts on how the good people still serving in the Senate should address a current crisis, but staying silent is no longer an option. Special counsel Robert S. Mueller III is under assault, and that is wrong. No matter who is in the White House, we Republicans must stand up for the sanctity of our democracy and the rule of law.

Read more at The Washington Post: https://www.washingtonpost.com/opinions/the-senate-i-led-put-country-over-party-this-one-must-do-the-same-for-robert-mueller/2018/07/06/b09f0a22-8064-11e8-b660-4d0f9f0351f1_story.html

Today’s Life-Saving Ebola Vaccine Was Spurred By The 2001 Anthrax And 2004 Ricin Attacks (Forbes)

FORBES | Currently in Democratic Republic of the Congo (DRC), 25 people are suspected to have already died from Ebola in the Equateur province. Four cases have reached the provincial capital of Mbandaka, prompting fears that DRC is on the cusp of an urban epidemic.

A few years ago, in the 2014 West African Ebola epidemic, outbreaks in urban areas quickly spread to 10 countries, with a case showing up as far away as Dallas, Texas. There was no vaccine available then, and laboratory confirmation of diagnosis took three months. More than 28,600 people were infected and 11,000 died.

Thankfully, today a safe and highly effective vaccine was deployed within 10 days of the outbreak, a vaccine developed thanks to a United States anti-terrorism project that started—for me—with white powder in a Senate office.

Read the full story at Forbes.

Biden & Frist: Now is not the time to cut off AIDS funding (CNN)

CNN| Last month marked the 15th anniversary of the President’s Emergency Plan for AIDS Relief, or PEPFAR. The celebrations included an important announcement that didn’t receive enough attention: Today, 14 million people who otherwise wouldn’t have access to care are receiving lifesaving HIV treatment.

When we worked alongside President George W. Bush in 2003 to usher PEPFAR into law, that kind of outcome was almost unimaginable. AIDS was threatening to wipe out an entire generation on the continent of Africa, where only 50,000 people had access to anti-retroviral drugs.
But today, thanks to the generosity of the American people, there are millions of men, women and children for whom an HIV diagnosis is no longer a death sentence. There are 2.2 million babies born to HIV-infected mothers who are HIV-free. There are health systems in place across Africa that are equipped to manage this epidemic. There is hope.
Read more of my oped with Joe Biden at CNN.

A ‘Safer Cigarette’ Doesn’t Prevent Premature Death And May Be Tracking You (Forbes)

FORBES | When I operated on hearts and lungs every day to do my best to fix the underlying devastating and life-shortening disease, I’d always think, “If only this could be prevented.” And it can, by stopping smoking.

Ever since we recognized the health risks of smoking tobacco nearly 75 years ago, the world’s doctors, policy makers, and concerned citizens have united to prevent the nearly 6 million deaths that happen each year worldwide as a result of tobacco use. In the United States alone, one in five deaths is due to cigarette smoking, which translates to 1,300 people per day. The number is expected to rise in the coming years.

In fact, smoking is the leading cause of preventable death.

Preventable.

On this World No Tobacco Day, I urge us to keep our eye on that prize: prevention of debilitating tobacco-related illnesses, premature deaths, and the extraordinary costs to our communities and companies that ensue.

Read more at Forbes.

The five things we must to do together to end the opioids epidemic (USA Today)

USA TODAY | For the first time in history, drug overdoses are now the leading cause of death for Americans under age 50. For the first time in nearly a quarter century, U.S. life expectancy has declined, driven by diseases of despair like alcoholism and drug addiction. And for the first time in a long time, policymakers and providers are serious about trying new approaches and making a real investment in turning the tide on addiction.

The U.S. had more than 64,000 drug overdose deaths in 2016 — more people died from overdoses than those who died in motor vehicle accidents; more died than those who were killed in the 20-year Vietnam War.

It is a staggering loss of life caused by a complex epidemic. All segments of society bear responsibility: from aggressive pharmaceutical advertising with misleading information on addictive potential; to the push in the medical field, furthered by government regulation and reimbursement, to make pain a fifth vital sign; to the rise of the Mexican heroin trade that has infiltrated sleepy American towns and cities.

Solutions must be as varied as the drivers of the epidemic.

Read more at USA Today.

Yes, we can put chronic patients first and lower costs simultaneously (The Hill)

The Hill | Our health-care system can be overwhelming for those of us in the best of health. This is especially true of those living with serious and life-threatening illnesses, such as cancer or heart disease — who are juggling multiple doctors, diagnoses, treatment regimens and social stressors. Patients cycle in and out of hospitals and nursing facilities, yet 80 percent say they would rather be at home as they approach the end-of-life.

Compared to other nations, U.S. health care providers rely more heavily on medical services and procedures than providing less costly services that can help patients remain more independent and at home, but that is beginning to change.

Read more at The Hill: http://thehill.com/opinion/healthcare/387997-yes-we-can-put-chronic-patients-first-and-lower-costs-simultaneously

Medicine As Currency For Peace: How Global Health Funding Could Change The World (Forbes)

Forbes | I first met the virus as a young surgical resident in training. I read the initial 1981 report of five people in California who died of a mysterious, unnamed disease. The virus outsmarted and outran us. The first year, we watched helplessly as a few hundred people died. The next year, a few thousand, then a hundred thousand, then a million. And eventually three million people dying every year, that’s more people than died in the entire Korean and Vietnam Wars combined, every year.

I realized the scale of human suffering on my annual medical mission trips to Africa. My clinics overflowed with AIDs patients. The virus hollowed out entire societies, taking first the most productive members at the prime of their lives — teachers, police, civil servants, mothers. In Botswana, life expectancy plummeted to 39 years of age!

Yes, it was time to act. Not just to listen, not just to talk, but to act.

In 1994, I ran for the US Senate, and won. As the only doctor in the Senate, I shared my medical experiences in Africa with my Senate colleagues, so they’d understand the magnitude of destruction caused by this single virus. I brought back pictures of emaciated patients lying three to a single cot, dying of AIDS.

One afternoon in my Senate Majority Leader office, I receive a call from the Office of the President of the United States. “Could you come to a small, confidential dinner with the President in the Red Room of the White House? Please say nothing to anyone about this meeting.”

Read more at Forbes.

A Tribute to Uwe Reinhardt: Remarks at the April 21st Memorial at Princeton University Chapel

For each of the last 46 years, Uwe Reinhardt touched me like a father, a brother, a son, a friend. He walked by my side on every leg of my journey and supported me at every major turning point. These are the remarks I gave at his memorial service at Princeton on April 21 and shared with colleagues via LinkedIn. 

Fall 1971. My first exam at Princeton. It was the final exam for Uwe’s Corporate Finance class. The exam was a single assignment.

Handed a packet of financial statements for the near bankrupt American Widget Corporation, “Your job is to ‘cook the books’ in preparation for the upcoming Annual Report.”

I did my best. A week later, the graded exam books were returned. Mine had no marks, no corrections … just a single statement across the front written in red ink and huge letters … “Billy Frist, you will be the world’s greatest SHYSTER.” (I guess he was predicting my Senate career!)

I’m Bill Frist and Uwe is my mentor.

For each of the last 46 years, he touched me like a father, a brother, a son, a friend. He walked by my side on every leg of my journey and supported me at every major turning point. My last heart transplant … he was with me, in scrubs, three feet away, all night, until 4 am. My first date with Tracy, my wife … he and May lovingly holding hands next to us at Nashville’s Bluebird Café (a songwriter haven of country music), Uwe tapping out the rhythm and knowing the words to every song.

When I was in the Senate, he expertly testified before my Senate committees. After I left the Senate he, the master teacher, taught me how to teach — as we co-led a course for two semesters at the Wilson School across the street. We spoke at scores of conventions shoulder to shoulder. We traveled to South Africa to watch the World Cup. We talked under the stars, beneath the towering California redwoods, and around blazing campfires with our Bohemian Grove camp mates, who loved him so much.

Kix Brooks, of the famous country music duo of Brooks and Dunn, reflects on our time camping together: “I will never be able to sit by our fire without seeing him there with that inquisitive smile, and that joyful light in his eyes, bringing that gift of inquisition that always made me feel that what I did was so important — wanting to know everything about every country music singer that ever lived, and every song that had ever been written, when the truth was, he had learned far more about most than I will ever know. I don’t remember meeting anyone who loved country music more than he did. He was always kind enough to entertain whatever lame question I might have come up with about medical economics, but then he would spin it right back to Johnny Cash, and we would be on common ground again.”

What aspect of life did Uwe not love?

The words: inquisitive, joyful, wanting to know everything, music, kind, common ground. These are the words and the images you will hear again and again in this service — because they are the space that Uwe Reinhardt created for us.

His teaching lives with us.

Uwe was an Honorary Class Member of our class of ‘74 (as well as ‘83, ‘95, 2000). Fellow classmate Matt Singleton laughs when he recalls how Uwe, in his lecture on the “Production possibility frontier in a world of finite resources,” replaces the classical guns versus butter with, yes, marijuana versus beer.

And in Uwe’s lecture on Jimmy Ling and his conglomerate Ling Temco Vought (LTV), the issue was pumping up EPS artificially through a long series of leveraged acquisitions. Uwe referred to their products in meatpacking, sporting goods and pharmaceuticals as “meatballs, golf balls and goofballs.”

David Luther, Class of ‘74, an engineer who traded his Thermodynamics course to take Uwe’s popular course says, “I have used what I learned in that course more than any other I took in college. Uwe made seemingly complex problems easy by breaking them down to the most crucial factors to be considered. One of the most memorable was his analysis of why the Lockheed L-1011 plane could never make money for the company. With concise logic at the blackboard he showed that there was not enough demand for this plane for the standard learning curve to improve productivity to the point of profitability. After 45 years this example is still vivid.”

And then there were the colorful but critical accounts of aggressive tactics of overzealous insurance salesmen of the day who, in Uwe’s image-provoking words, “pinned down prospects and stood on their shoulders with their fancy winged tip shoes.”

Duncan Chapman says: “Such a wonderful, kind, fun and amusing campmate (Hill Billie). I loved his stories — meeting American Army soldiers during WWII in Germany, with his brother as a curious 10-year-old, his first time smoking — he vomited after two puffs on a Lucky Strike. His intelligence, wisdom and curiosity. An original, with a ready smile and laser focus…”

Uwe loved his family. Dirk, Mark and Kara would be weaved into almost every conversation. And there literally was not a talk or a speech I can remember that did not have May the central character — highlighted with unabashed affection and love and wit and admiration and respect.

Uwe taught and lived with a powerful sense of justice.

His favorite class we taught together on health policy was the one on ethical decision making. He taught accounting as a class on national morals. He consciously transformed raw data into moral imperatives.

He is, as Drew Altman of the Kaiser Family Foundation said, “the moral compass for American health care.” He attributed this sense of justice to growing up poor in a tool shed without electricity, water or money — but secure in that in Germany he and his mother had health insurance just like everyone else. A nation’s health system should reflect the values of its peoples, he would always remind us.

Uwe imaginatively captured the minds and hearts of generations of students and friends. His content was economics and policy. His style was wit and justice. His engagement was charisma and humility.

His gift to each of us is creation of a “forever space,” a space that he totally occupies, a space that is with each of us today, in this chapel, a space next to our hearts that we carry with us forever. That beautiful space inspires us each day, to do good … and to make a better world for generations to come.

 

To Whom Much is Given, Much is Expected: Why U.S. Should Lead on Global Health (TEDMED)

TEDMED | A life-changing story has been missed by the media and the general public. But it will be highlighted in the history books in future generations.

The story is that for less than 1% of our federal budget, the United States since 1990 has led the world in reducing by half those living in extreme poverty and halving the number of deaths of those suffering from AIDS, tuberculosis, and malaria. Moreover, we have cut in half the number of deaths of children under 5 through advancing vaccinations worldwide. And we have halved the number of deaths due to maternal mortality by training skilled birthing attendants and providing contraceptives for women. Our nation has forged the path with funding and infrastructure to tackle global disease, preventable deaths, and treatable illnesses to save the lives of millions.

Our legacy of global leadership was cemented in 2003 with the passage of the President’s Emergency Plan for AIDS Relief (PEPFAR), which I helped shepherd through Congress as Senate Majority Leader. PEPFAR provided an astounding $15 billion to fight AIDS across Africa and the developing world — more than any country or any President has ever committed to fight a single disease. Today, over 13 million people in developing nations receive life-saving antiretroviral treatment, compared to only 50,000 in sub-Saharan Africa when the program began.

Read more at the TEDMED blog. Watch my TEDMED talk.

Opinion | Nashville’s transit plan will improve our health (The Tennessean)

The Tennessean | Operating on a heart — opening the chest cavity, sawing through the breastbone, placing the patient on heart-lung bypass, and finally cutting into the body’s most vital muscle — is always the last resort.

As heart surgeons, we tell our patients they can avoid such drastic surgery by acting to prevent heart disease.

If Nashville’s roadways were my patient’s arteries, I’d tell her there are still preventive steps to take — but we need to act now. The alternative is to die of a heart attack or at best need painful surgery later.

Investing in a transit plan today is our preventive medicine. But if we vote down the transit plan on May 1, we are headed for total gridlock — the equivalent of a heart attack — and we will never be quite the same.

Read more at The Tennessean: https://www.tennessean.com/story/opinion/2018/04/12/nashville-transit-plan-improves-health/504696002/

Diet quality should become a core SNAP objective (The Hill)

THE HILL | As Congress considers reauthorizing SNAP as part of the 2018 Farm Bill, we believe it’s time to make nutrition a top priority for the program. First, we request that diet quality become a core SNAP objective. Specifically, we recommend eliminating sugar-sweetened beverages from the list of items that can be purchased with SNAP in addition to strengthening fruit and vegetable incentive programs. Second, strengthen SNAP-Education, which is the program’s nutrition promotion and obesity-prevention component. Third, synchronize SNAP and Medicaid at both the federal and state level. Finally, modernize program administration and better coordinate policies and data-sharing across federal programs.

Read more at The Hill.

Notes from the Road: Hadza and Clean Water

Tracy and I are in Africa for two-weeks: Tanzania, Zimbabwe, South Africa, Kenya. The trip will bring together work from Hope Through Healing Hands (global community health) and The Nature Conservancy (intersection nature and health) in conjunction with Pathfinder International (global women’s health). As chairman of Hope Through Healing Hands, I will explore how we can globally impact peoples’ well-being and health by more smartly addressing and integrating: food and nutrition; clean water by protecting sources and exploring the power of social impact water funds; sustainable agricultural practices; environment and pollution; climate change and coastal impact; maternal and reproductive health; infant mortality and child health. The expertise of The Nature Conservancy – the leading conservation organization working around the world to protect ecologically important lands and waters for nature and people – will be invaluable as we study in depth its science-based best practices in each of these areas. Internet access is intermittent, but I will share updates as I can.

What a week! We have spent the days surrounded by the unique landscapes and wildlife that are a source of pride for all Africans, and must be safeguarded as this continent rapidly urbanizes. We have traveled from a remote lakeshore town (Buhingu) in Tanzania all the way to the Serengeti, engaging in countless discussions on global health and wellbeing along the way, sharing the 13-year history of Hope Through Healing Hands operating in Africa and learning a lot about health, healing, and sustainability from local and native peoples.

With The Nature Conservancy, my goal for Hope Through Healing Hands on this trip is to observe strategies to further population health through nature conservation. This week we’ve seen increasing access to clean drinking water; preserving and implementing sustainable policies for healthy land for grazing and growing food and fish stocks; and protecting wildlife that generates tourism revenue in financially vulnerable regions.

When we left Lake Tanganyka, we traveled to the Serengeti and visited first the Maasai people, a semi-nomadic tribe in southern Kenya and northern Tanzania that lives in harmony with the land. Early this week we spent a remarkable and unforgettable day with the Hadza, an ancient tribe in Tanzania’s Great Rift Valley that is one of the few remaining full-time hunter-gatherer cultures on Earth. They are the ultimate integrator of health/well-being with their environment!

Estimated by anthropologists to have ancestors tracing back 35,000 years to the region we walked on with tribal members, the Hadza are known as much for what they don’t have as for what they do: barely any possessions, no official leaders, no calendar besides the turn of the seasons.  Their life is the land!

But as Tanzania’s population has so rapidly grown, the Hadza have seen their hunting grounds encroached upon by settlers, farmers, and illegal poachers.  For a tribe that lives almost entirely in the present, they have had to begin planning for the future so that their culture and way of life can be preserved.

The health and preservation of the natural land directly impacts the health of the Hadza people. The TNC smartly recognized this, understanding that if a new wave of conservation efforts is to succeed, it has to improve people’s wellbeing, health, and livelihoods in a tangible way.

A number of NGOs had been working with northern Tanzania residents on health, conservation, land rights, and social issues, but in 2009 the TNC aligned the separate efforts and brought together nine partners to form the Rangelands Initiative, which to date has worked with the Hadza, Datoga and Maasai tribes across 50 villages to gain legal rights to their land and thus far affects 7.4 million acres.  They share the single goal of “protecting working lands for people and nature.”  Now, not only are hundreds of thousands of acres protected from poachers and harmful development practices, the Hadza are thriving, as wildlife (a vital food source) returns to their lands, tourism and the sale of carbon offset credits provide revenue, and neighboring tribes no longer cause conflict over once-diminishing hunting territory.   First, legal rights to the land, then introduction to governance.

Just like the partnership at Tuungane, the Rangelands Initiative shows that collaboration and alignment of missions of multiple actors around a single goal is key to successful, lasting outcomes when it comes to health and wellbeing.  Health is more than just health care.  Health of people is enabled by the environment—food, water, climate, forests.

Water

Historically, Hope Through Healing Hands had focused on clean water, participating in digging wells around the world and personally surveying water projects in Mozambique. On this trip we are focusing upstream — the water source. Water-stressed cities are eager for solutions to protect source water quality and quantity. Protecting areas that supply water for downstream needs and restoring natural infrastructure (e.g., agricultural terracing) are cost-effective solutions that enhance the health and resilience of water supplies while improving livelihoods (e.g., via better agricultural yields) and population health outcomes, and building strong local support. Clear intersection of nature and health.

We saw this powerfully in the Kibera Slum in Nairobi. Kibera is a landmass the size of Central Park and contains 800,000 people. 6 to 7 people in each 10 x 10-foot structure. With only 6 water wells and open sewage, the water situation is responsible for disease and death.

But we saw the work of SHOFCO including a fascinating innovative water project that transports water from tank to tank through pipes suspended like telephone wires, guaranteeing clean water and keeping the pipelines safe from vandalism. The project we saw is just a test, but I think it has huge promise! We toured a crowded clinic that sees 700,000 patients a year giving lifesaving therapy in difficult situations. Lots of ideas for Hope Through Healing Hands.

Finally, last night, Tracy and I met with First Lady of Kenya Margaret Gakuo Kenyatta in Nairobi where she discussed health, conservation, and anti-poaching successes over last two years. Like Hope Though Healing Hands, she placed huge focus on child’s health and maternal health.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I’m Helping Found A National Health Care Movement. Let Me Tell You Why (Forbes)

FORBES | Today the United States health care system is very sick.  We have been debating health care policy fixes in America for decades but much of that time our public discussion has focused on unattainable all-or-nothing solutions. Such is the case today. With each side focused solely on their partisan version of the “cure,” we’ve lost focus on the patient. We no longer talk about health care in terms of real Americans’ daily lives, and instead approach the issue as a litmus test of a politician’s fidelity to political party and party warfare. Meanwhile, too many Americans continue to get sick without ready access to quality care. The medical bills are exorbitant, threatening financial ruin for too many families.

A new national dialogue on health care should reflect this reality: health care is personal, it’s tangible, it’s human. It’s an issue that deserves solutions, not slogans.

That’s why a diverse group of American leaders passionate and knowledgeable about health care policy, including me, are joining together to launch a new national movement. We’re calling it United States of Care, and its mission is to find those fine points on which a majority of Americans agree, to support policy solutions to address those points on a state-government level, and to educate the public on areas of health care policy that can be murky or misunderstood.

Read more at Forbes.

Notes from the Road: Tuungane Program

Tracy and I are in Africa for two-weeks: Tanzania, Zimbabwe, South Africa, Kenya. The trip will bring together work from Hope Through Healing Hands (global community health) and The Nature Conservancy (intersection nature and health) in conjunction with Pathfinder International (global women’s health). As chairman of Hope Through Healing Hands, I will explore how we can globally impact peoples’ well-being and health by more smartly addressing and integrating: food and nutrition; clean water by protecting sources and exploring the power of social impact water funds; sustainable agricultural practices; environment and pollution; climate change and coastal impact; maternal and reproductive health; infant mortality and child health. The expertise of The Nature Conservancy – the leading conservation organization working around the world to protect ecologically important lands and waters for nature and people – will be invaluable as we study in depth its science-based best practices in each of these areas. Internet access is intermittent, but I will share updates as I can.

Wednesday, January 31: We begin the day asking, “Can a program uniting Health with Nature have a synergistic impact on wellbeing?” And further, is that impact measurable and scalable? I’m here on behalf of Hope Through Healing Hands to learn the answer.

We are in the bush. We are remote, as remote as you can get in Tanzania… two bumpy, bush-plane rides west from Arusha. Obviously no cell coverage or roads. Our camp on the lake is then an hour and a half boat ride from the dirt airstrip, south on Lake Tanganyka (the world’s longest and second deepest lake).

We are here to explore a unique “experiment” program that tests the hypothesis that a specific health program integrated inextricably with a specific nature/conservation program can have a meaningful (and ultimately scalable) impact on an individual’s and community’s health and wellbeing. The Nature Conservancy and Pathfinder International sponsor the program together; I’m gathering best practices that Hope Through Healing Hands can apply.

Traveling another 2 hours north by boat we arrived at Buhingu village, now comprised of two smaller villages. We spent the day interacting with the people there, walking and learning about the impact of the Tuungane Program, the TNC and Pathfinder International partnership that works not in parallel but actually in full integration of staff and operations and facilities. The Tuungane Program focuses on:

  • Fisheries: TNC-provided fish drying racks provide a more valuable fish product to be produced and sold, with consequently higher incomes brought to the community;
  • Lake: new sustainable fishing practices conserving the most immediate natural resource for the long term
  • Water: the greatest disease burden in the village of 2,000 people comes from waterborne illnesses like amebic dysentery and giardiasis
  • Health Clinic: a minimal, primitive infrastructure. The nearest “hospital” —  more advanced but still only basic — is a 6-hour boat ride away.
  • The community health worker program: A team of impressive volunteers focuses on family planning. Pathfinder International’s major focus is family planning. Their focus on decreasing maternal deaths and healthy timing and spacing of pregnancies aligns with our work at Hope Through Healing Hands.
  • The “model home” initiatives: Introducing improved, efficient mud stoves to conserve the forests, lessen inhalation of smoke (respiratory disease), and reduce serious burn and death by fire.

I see unique aspects in the TNC/Pathfinder model:

  1. Equal partnership and full integration of two NGOs operating as a single program. Of the 10 or so team members wearing the single logo “Tuungane … creating a healthy future for people and nature” shirts, I could not tell who represented TNC and who represented PI.
  2.  Community health workers (volunteers from the community and jointly trained by both organizations) served the entry point for all communication and potential change in behavior and values.  All messaging is delivered and accepted through this powerful funnel of trust.
  3.  Outcomes. For health and well-being: Maternal deaths fell from 16 to 7  to 4 over the last two years! For nature, fish—the most valuable resource for the economy—are replenished as regulations are designed for sustainability and enforced. Forests are protected.

Notes from the Road: Africa 2018

It’s been many years since my first trip to Africa, but each trip changes me. I already know this trip will be no different.

On a Samaritan’s Purse trip in 2007

Tracy and I are here for two-weeks this time: Tanzania, Zimbabwe, South Africa, Kenya. The trip will bring together work from Hope Through Healing Hands (global community health) and The Nature Conservancy (intersection nature and health) in conjunction with Pathfinder International (global women’s health). Since 2004, Hope Through Healing Hands has invested over $2.2 million in direct funding to Africa and has sent over 60 Frist Global Health Leaders to African nations including Kenya, South Africa, and Tanzania for medical service and training.

As chairman of Hope Through Healing Hands, I will explore how Hope Through Healing Hands, consistent with our founding charter to improve the health of communities around the world, can globally impact peoples’ well-being and health by more smartly addressing and integrating: food and nutrition; clean water by protecting sources and exploring the power of social impact water funds; sustainable agricultural practices; environment and pollution; climate change and coastal impact; maternal and reproductive health; infant mortality and child health.

The expertise of The Nature Conservancy – the leading conservation organization working around the world to protect ecologically important lands and waters for nature and people – will be invaluable as we study in depth its science-based best practices in each of these areas.

Internet access is intermittent, but I will share updates as I can.

Sunday, January 28: Met for an hour with David Banks, country director for Tanzania for TNC. Presented on Hope Through Healing Hands, detailing our organization’s history in holistic aspects of health throughout Africa starting with our initial investment in Africare in 2004.  Sought feedback on possible synergies/opportunities.

Monday, January 29:  Took a 4-hour plane ride and then a 2-hour boat ride to visit the tropical mountain forests of the Greater Mahale Ecosystem (GME). The mountains rise eastward from the remote shore of Lake Tanganyika — one of the world’s largest lakes. Home to 93% of Tanzania’s chimpanzees, 250 endemic species, and some of the most vulnerable people on earth, scientists identified this region as one of the top conservation opportunities in Africa because of its rich terrestrial and freshwater diversity, intact condition, and strong probability of success.

In this spirit, over the next three days we will explore the Mahale ecosystem. The GME’s diversity and the well-being of its people are threatened by extreme poverty, a rapidly growing human population, and a lack of resources to support good planning and governance. TNC is partnering with Pathfinder International, a global reproductive health organization, on an innovative, holistic project that simultaneously addresses reproductive health care, livelihood, and natural resource management needs. Hope Through Healing Hands has liaised with Pathfinder International before, in Ethiopia, where we saw powerful examples of how healthy timing and spacing of pregnancies saves lives of women and children.

Tuesday, January 30: Mahale National Park:  Approximately two million acres in western Tanzania with western border on Lake Tanganyika, the second deepest lake (about a mile) in the world and 350 miles long. The lake holds 13 percent of all the world’s freshwater lakes combined, more than all the Great Lakes in the US.

Tuesday evening, the scientific lecture and discussion focused on a fascinating example which ties human health (schistosomiasis prevention) to conservation efforts to prevent erosion and runoff along the lake, which substantially alters the eco-habitat. Smart conservation prevents the disease, which is caused by parasitic worms. Of interest is recent scientific findings that link schistosomiasis to increased HIV/AIDS infections, emphasizing even more the value of conservation.

 

 

 

 

Fixing the wildfire funding problem starts with prevention (The Hill)

THE HILL | America’s forests are the heart and lungs of our nation. Forests clean our drinking water and trees filter the air we all need, and the work of keeping them healthy shouldn’t suffer because we must also fight wildfire disasters. Unfortunately, the U.S. Forest Service and the U.S. Department of the Interior (DOI) are often forced to choose between the two. While we use emergency funds for damages and recovery from earthquakes, floods and other disasters, we pay to fight wildfire disasters directly from the budgets of these federal agencies. In bad fire years like this one, when the budgeted amount isn’t enough, the Forest Service and DOI must take money away from the very programs that are designed to reduce wildfire risk. This only exacerbates the problem and increases the likelihood of future fires. It is time to fix how we fund wildfire disaster relief.

Read more at The Hill.

Tennessee gubernatorial candidates discuss education in forum (The Tennessean)

THE TENNESSEAN | On Tuesday night, Tennessee voters will have their first chance to hear from candidates running for governor on one of the most important topics for the future of our great state: Education. This first statewide forum featuring gubernatorial candidates from both political parties is being hosted by the State Collaborative on Reforming Education (SCORE), Belmont University, NewsChannel 5, and the USA TODAY NETWORK-Tennessee, and over 35 education and community organizations from across the educational and political spectrum have joined the effort as partners. Tennesseans all across the state will be able to watch this historic event live on television or online.

Read more at The Tennessean.

Alex Azar has the temperament, judgment, and focus to lead HHS (STAT)

STAT | The secretary of HHS is one of the most important Cabinet positions in the federal government. The department has a budget of over $1 trillion and 70,000 employees, and its programs touch nearly every American. With such an extensive reach, the HHS secretary must be experienced managing complex and large organizations; possess broad knowledge across an array of issues; and demonstrate a record of solving difficult problems. A person like this is hard to find, and the search is made even more difficult by the hyper-partisan nature of today’s politics, in which both parties too often view the other with deep suspicion. Alex Azar’s nomination as the next HHS secretary meets this high bar.

Read more at STAT.

 

Six Lessons from 50 Years of Heart Transplantation (LinkedIn Pulse)

LINKED IN | December 3rd is a historic day in modern medical history – this year marked the 50th anniversary of the world’s first heart transplant. Once considered the stuff of science fiction, this miraculous procedure now saves thousands of lives each year, with 3,191 heart transplants performed in the United States in 2016 alone. The medical miracle of heart transplantation has affected the world for so much the better. More personally, it has dramatically influenced my own journey as a clinician, medical scientist, and U.S. Senator with life lessons, and helped shape current and future holistic models of the continuum of patient care delivery.

Read more at LinkedIn.

What Tennessee Republicans and Democrats agree on: don’t smoke (The Tennessean)

THE TENNESSEAN | On December 13th the Campaign for Tobacco-Free Kids released its annual report “Broken Promises to Our Kids,” which evaluates how states address the “enormous health problems caused by tobacco use in the United States.”

One of the key metrics is funding, and I’m proud to report that – after many years of stagnant or declining funding – Tennessee has risen in the rankings, spending $6.2 million on tobacco prevention and cessation for 2018.

Governor Haslam and Health Commissioner Dreyzehner take the health and well-being of Tennesseans seriously, and have made a commendable investment in tackling what is the leading cause of preventable death in our state and nationwide

World AIDS Day — let’s work with urgency to battle this disease (The Hill)

THE HILL | The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is one of the most successful humanitarian relief efforts ever undertaken. It is directed at one of the world’s most daunting public health problems.

AIDS strikes people in the prime of their lives, shatters families and communities, orphans children, and threatens the ability of nations to develop. Bipartisan, U.S.-led efforts to address the epidemic, supported by other donor nations and the affected countries themselves, have brought health, and hope, to tens of millions of men, women and children facing AIDS.

Read more at The Hill: http://thehill.com/opinion/healthcare/362723-world-aids-day-lets-strengthen-commitments-and-work-with-urgency

Opinion: We started PEPFAR. Politicizing AIDS would be a disaster (DEVEX)

DEVEX | A decade and a half ago, we came together to bridge the political divide and address one of history’s worst public health crises. In 2002, 3.1 million people worldwide died of AIDS-related causes and 11 million children in sub-Saharan Africa had lost one or more parents to the disease. The AIDS epidemic was only getting worse; immediate action was necessary. As a progressive, Democratic congresswoman from the San Francisco Bay Area and a Republican senator from Tennessee, we were an odd pairing to tackle this emergency. But we knew that if we could find common ground, countless lives would be saved. So together, along with President George W. Bush and HIV/AIDS champions on both sides of the aisle, we created the President’s Emergency Plan for AIDS Relief, or PEPFAR, the largest legislative response to a single disease in history.

Read more at devex.

Hard Cases: Tennessee’s First Heart-Lung Transplant (Linked In)

LINKED IN | One month after Christmas, in 1987, my surgical team and I prepared for Tennessee’s first heart-lung transplant. A determined mother, desperate to live, was flying to Tennessee to receive the heart and lungs from a young woman in Nashville whose own life had ended too soon.

It was a bold step for our patient, the surgical team, and the brand new Multi-Organ Transplant Center at Vanderbilt University.

I had just left Stanford to move home to Nashville and start the Multi-Organ Transplant Center at Vanderbilt University Medical Center (VUMC), with the goal of creating a world-class transplant program. At that time, heart-lung transplants were still quite rare; fewer than 100 had been performed worldwide. It was a challenging operation that would give even the most experienced surgeon pause. Remove all the organs between the neck and the diaphragm, leaving the chest cavity bare. Transplant a donor heart and lungs. Put everything back together. The long-term prognosis of transplanted lungs was unknown.

It was a nascent field. The procedure was still considered experimental in 1987, and most insurers would not cover it. So before we could take on a heart-lung patient, several things needed to happen. First, I needed a guarantee to finance the operation. The cost of transplantation, which often totaled $100,000 or more, was one of the big social and ethical issues confronting the field at that time. We didn’t want this life-saving treatment to be available only to the very wealthy, but without insurance covering the procedure hospital systems struggled with how to absorb the hefty cost.

I had already left one program at Massachusetts General when they decided (mistakenly and shortsightedly I believed) in 1980 not to pursue heart transplantation because of the price tag. In starting the multi-organ transplant center, Vanderbilt agreed to open its doors to the patients in greatest need, not just those who could afford to pay. Eventually our center would need to pay its own way, but during those early years when insurers failed to cover the procedure – we would.

Read more at Linked In: https://www.linkedin.com/pulse/tennessees-first-heart-lung-transplant-bill-frist-m-d-/?published=t

The indispensable role of America in the world (Salt Lake Tribune)

SALT LAKE TRIBUNE |The challenges we face in the world today are different but no less severe: Chinese military activities in South China Sea, Russian aggression in Ukraine, Cyber-attacks, North Korean nuclear ambitions. But they also include softer threats ranging from unprecedented food insecurity and famines to mass migration and refugee flows to the threats of violent extremism and pandemic disease. Yet the solution to these problems still depends in large part on strong and clear U.S. leadership. And while U.S. foreign assistance is often criticized for being a large and ineffective part of the federal budget, this could not be further from the truth.

In recent years, the United States has led an unprecedented and incredibly successful global effort to combat global poverty and disease through bipartisan initiatives such as the President’s Emergency Plan for AIDS Relief (PEPFAR), the President’s Malaria Initiative (PMI) and the Feed the Future global food security program. These programs are representative of the U.S. leadership that has helped reduce the deaths of mothers and children under five worldwide by more than half since 1990. A few other U.S.-led success stories include providing HIV/AIDS treatment to more than 11.5 million Africans who otherwise faced a death sentence, reducing malaria incidence by more than 75 percent in the hardest hit countries, reducing global hunger and malnutrition by nearly 30 percent since 2000, and expanding access to life-saving vaccines to more than 500 million children around the world. The US has led these initiatives that have saved tens of millions of lives with a foreign assistance investment that represents less than 1 percent of the US federal budget.

Read more at the Salt Lake Tribune

Reach Act will save lives, continue America’s moral leadership (Knoxville News Sentinel)

KNOXVILLE NEWS SENTINEL | Nearly 15 years ago, Congress passed a historic, bipartisan bill that has since provided life-saving HIV/AIDS treatment to nearly 12 million people and reversed the spread of this devastating disease worldwide. The President’s Emergency Plan for Aids Relief, better known today as PEPFAR, has been heralded as a model for how both political parties can come together for a cause we can all support – saving lives around the globe. The bill’s passage also marked a critical step in ending preventable deaths in foreign nations and demonstrated America’s continued moral leadership on the world stage.

Now we have a chance to pass another bipartisan bill that will further America’s commitment to the least among us and save the lives of millions of mothers and kids.

The Reach Every Mother and Child Act, or Reach Act, was recently reintroduced in the Senate and will be introduced soon in the House. It focuses on expanding proven solutions to end preventable deaths of mothers and children within a generation.

Read more at Knoxville News Sentinel

Notes From The Road: Bob Marshall Log, August 2017

Notes From The Road | The Bob Marshall Wilderness Complex consists of three wilderness areas in Montana totaling over 1.5 million acres. Located in the northern Rocky Mountains along the Continental Divide, the region is as primitive as any found in the United States outside of Alaska. It’s also diverse, encompassing the dry and open Rocky Mountain Front Range on the east, and the lush and heavily timbered Swan Range and Flathead Range on the west.

As a result, it is the most ecologically complete mountain wilderness in the country. Every species of mammal indigenous to the Northern Rockies still lives in this area and adjacent Glacier National Park, except bison and woodland caribou.  Huge herds of elk, bighorn sheep, and mountain goat roam the region’s rugged peaks, big river valleys, large meadows, and vast coniferous forests. The Complex is prime Grizzly bear habitat; the population density is higher there than anywhere else in the lower 48 states.

Tracy and I had the opportunity to spend nine days in this vast national treasure last month, confirming for me—yet again—the inestimable value of our country’s wild lands.

We had no connectivity while we were there, so I jotted down notes at night and shared them (and pictures) when we returned.

“Man’s heart, away from nature, becomes hard; [the Lakota] knew that a lack of respect for growing, living things soon led to lack of respect for humans too.”
– Luther Standing Bear, Lakota Chief

Day 1.  Tracy and I showed up at Lazy P Ranch on edge of the Bob Marshall Wilderness (the 1.5-million-acre crown jewel of the American wilderness system) for all-participant dinner, followed by an enlightening discussion of conservation of public lands, and critical multi-generational role of organizations such as The Wilderness Society and The Nature Conservancy. Conversation quickly turned to those special, local individuals who actually make possible the rich experiences and journeys into pure, untouched nature, like the ranges and basins we will explore over the next 8 days. Dusty, Danelle, Gene and others have led the way. For the first time in 29 years (transplant patients, political constituents, business), I turn off ALL electronic contact. Step one to achieve connection to nature and real world around us.

Day 2. Met Pat and Nickel early in this morning.  They are strong, experienced, and loyal. They can be trusted through easy and tough times. They are the pros. They are the two horses for Tracy and me for the next seven days. And we met the 13 huge pack mules who will dependably carry our food, tents, supplies and everything else for the next 8 days. We set off on Route Creek Pass headed to Wrong Creek camp (13 miles). We soon saw our first bear. Alternating between woods and open spaces built our anticipation for the big climbs ahead. The power and grace of the mules working in harmony was the most amazing!  We are beginning to taste the wildness and feel the grandeur.  A little bit behind our motivation for the journey is caught in the words of American naturalist John Burroughs, “I go to nature to be soothed and healed, and to have my senses put in order.”  What a rich inheritance from past generations are these vast and spectacular publicly (you and me and all of us) owned lands.

Day 3. Today we get closer in touch with the wild spaces.  Big hike and a little fishing; Tracy’s hat becomes more colorful as we traverse meadows, scale hillsides and descend to and through the crystal clear creeks. Fresh drinking water from the creeks.  Sore just a bit. Long rides on horseback use tiny muscles all over the body (little ones that had no names in medical school but still ache when taken to their limits!). Mules and horses were “belled” and allowed to roam freely for forage and grazing when not working! The clanging bells in the distance become a familiar, soothing melody.

Wilderness.  Untouched by roads, or structures – just hiking and packing, with no evidence of humans.  The unspoiled nature is allowed to evolve, as it has for millions and millions of years.  Now the primitiveness is settling in, and it is calming, centering, and healthy.  Brings to mind what is behind Thoreau’s powerful words, “In wildness is the preservation of the world.”

Day 4. Out of camp at 9:30 after packing tents, first mountain goats observed high up to the left along the Chinese Wall (Swep said one was three–legged, which kept us looking).  The Chinese Wall is a thousand-foot high scarp of limestone that stretches for a dozen miles—a dramatic manifestation of the Continental Divide that we paralleled on our journey.  The Wall is the rocky playground for these agile goats.  Leisurely lunch on Pendleton blanket Tracy wisely brought and tied daily to her saddle with rain gear, as we marveled at  the long, continuous, nose to tail, pack of muscular mules calmly yet determinedly marching by us.

Further north, we come to the limestone and red shale North Wall, about 10 miles long and seemingly even more primitive. Our trail followed the foot of this towering rampart, its starkness contrasting to the wildflowers and berries and grasses in meadows at the base of the towering cliff.  I really need to learn the names and more about these berries, and flowers, and their lifecycles.

Highlight for Tracy and me: after a short hike, bravely swimming (only about 10 strokes because so cold!) in gorgeous, high mountain lake, Lake Levale, set against the backdrop of the rugged North Wall (seems like huge human faces carved into its side) and blue sky studded with journeying cumulus clouds. Arctic grayling fish were surfacing continuously, making ripples across the otherwise smooth turquoise waters. The spiritual experience is beginning to settle in. You see why the wilderness is known as Nature’s Cathedral.

Tent positioned a little too much downhill last night which continued to ball up each of us at the foot of the tent all night.  Hard to scoot uphill every hour in a sleeping bag. Will be more careful in choosing a flatter spot – even a few degrees matters!

It’s been four days without internet, TV, smartphone. The inner self is beginning to merge with the outer without all the clutter of oncoming! As Ralph Waldo Emerson wrote: “The lover of nature is he whose inward and outward senses are still truly adjusted to each other.” We, now 4 days in the wilderness, begin to feel this adjustment.  We need to make sure this environment of pure nature is preserved for generations to come.

Day 5. We are a long, long way from civilization!  Solitude and appreciation and humility as we connect with our horses and full blown nature.  Today we pass from deep gladed forests to open, steep avalanche slopes of rocks devoid of trees.  We feel the raw power of nature in these contrasts.  Most intense feat thus far – traversing Switchback Pass!  Actually we just hung on to their mane leaning as far forward as possible as our powerful horses boldly climbed the steepest and most rugged of the switchbacks, up the sheer mountain along the North Wall Trail. Talk about humbling!

As we were forewarned, today was the day we ran into a patch of bees, the horses anxiously reacting as you might expect with swarms of stinging bees, but all anticipated and taken in stride. Just keep moving when the going gets challenging! Swam in Trilobite lake which felt good and cleansing, with a belled mule joining for a drink at the edge, looking on nonchalantly.  Lots of berries along the trail today. Tracy and I share together the reverence for these awe-inspiring wild places.  “Look deep into nature, and then you will understand everything better” explained Albert Einstein.

Day 6.  “Breakfast” – every morning at 7 am, the familiar piercing shout seems to come just a little too soon and way too commanding.  We must be totally packed and ready to go before that call.  But after breakfast we have the easy part, take down the tents, while the crew pack, tie, lift and secure two heavy, heavy (as much as 200 pounds each) manties to every mule. Performed, it seemed, like a smooth surgical procedure – though so much more muscular.  Not to mix metaphors, but the whole morning prep for departure of 16 horses and 13 mules is like at grand symphony in the wilderness.

I know tying and knots — but only surgical knots. Nothing about real knots. The trip was full of “learnings” and today was knot tying. As others climbed peaks Tracy and I found solitude. Amidst breathtaking mountains and clear clean air. No roads, no devices. Just embracing nature and sounds of breezes, bumble bees, and butterflies (really). Relaxing, calming, centering. Clutter falls away. Thoughts seem a little clearer. “We need the tonic of wilderness,” reflected Thoreau.

We should actively protect this connection to nature so our great grandchildren (and theirs) can experience.  These public lands are ours and we are their custodian. Once wilderness taken away it can never be regained. It is lost forever.  Too many words from Washington today suggest that these public lands are at risk.  We need to be smarter.

Day 7.  Ten miles total ride today riding to Basin Creek. Half way we came to Gooseberry cabin, literally the only man-made structure we have seen all week. We are immersed in pure, unadulterated wilderness. No manifestations of man, road or structure anywhere, and we leave it just that way.  Tracy and I found a huge shade tree for our packed lunch that we carried each day in our horn bags (along with a lot of water) and we both nap lazily.  We had been advised to bring the best rain gear we could buy, but so far all sun. But at around 8 pm the clouds darkened. The saddles were covered and we prepared for rain.  Off to our tents for cover, pulling all our gear inside for protection, where for the next hour we were enchanted and entertained  by a huge thunderstorm with repeating flashes of lightening, heavy, recurrent rolls of thunder all around us, wind lifting our tent flies, and rain spattering against our tents. The raw power of nature speaking. Then suddenly all silent. Perfectly quiet.

Day 8.  Sun River Pass Trail.  Trace and I hang around camp today as others off to fish and hike.  Carson had given me the best pointers on chopping wood efficiently yesterday and safely (he started by saying my sandals were not safe, my pack boots much safer), so after everyone was out of camp, I chop as much wood as I could, not for a campfire because it was too dry for that, but just because I could.  Something in nature just wants you be a part. As Churchill said, “Nature will not be admired by proxy.”  I stack the wood neatly (and vertically to make it seem like a lot) as I go to measure my progress.  Tracy chops so much better than me!  Off for a hike up the trail we came in on and then through a flowing meadow to a split in the crystal clear creek for lunch – and taking the opportunity to lie on the bank  on our backs to rinse our hair (without having to get all the way in – cold water!).

A huge, fire in 1988 left miles and miles of the landscape with an otherworldly feel – only the charred trunks of the lodgepole pine were left standing, void of all branches or greenery. Undergrowth of aspen and pine are just beginning.

Day 9.   Today is our last day on the trail – 14 miles.  Billed as an “easy 14” but it seems a bit tougher, maybe because we “smelled the barn.” In and out of the woods, meadows, valleys, and hills, all is gorgeous. No grizzly bears (yes big tracks!) or mountain lions, but mule deer are common.  Even Luke, who is 14, said on a scale of 0-15, that his aches were a “4”.  Curiously but nonchalantly, he remarked agreed, thinking I was about a 7”. We pull up at a coral, the terminus of our journey.  Beef jerky, crackers, cold drinks awaited, as we loaded our saddles in trailers.  How could it be over?  We are just now becoming one with nature.  We are filled with more understanding and more humility and more fulfillment.

Einstein had it right:  “Look deep into nature and you will understand everything.”

 

 

Children’s Health Insurance Program Demands Quick, Bipartisan Passage (Forbes)

FORBES | Why would someone give up a career as a full-time surgeon to become an elected official?

It was a question I was asked time and again during my two terms in the U.S. Senate. To me, the answer was always clear: I was searching for a way to make a positive impact on the greatest number of lives.

Surgery certainly provided an avenue for helping others, but it required focusing on one patient at a time. Each time the door to the operating room closed, I never forgot that a patient’s loved ones were sitting just outside, anxiously waiting for news. I wondered if there was a way to support all of these people — both in times of crisis, and in times of security.

That is what led me to pursue public service. It’s why I spent 12 years in the Senate, including four as Senate Majority Leader, working with colleagues to champion legislation that would strengthen American families for years to come.

CHIP was a shared vision of Republicans and Democrats alike. It seems like ancient history now, but, in 1997, I joined with members from both sides of the aisle to debate health care policy forcefully but productively. Led by Senators Ted Kennedy (D-MA) and Orrin Hatch (R-UT), we crafted the CHIP language. Bipartisan action, so crucial to the health of the country and the economy, was never more important than when it came to insuring America’s children.

Now, two decades later, that progress is in jeopardy. CHIP is set to expire on September 30. If Congress doesn’t act, one out of every ten children in this country is at risk of losing health insurance.

Read more at Forbes.

Five bipartisan steps toward stabilizing our healthcare system with Andy Slavitt (Washington Post)

WASHINGTON POST | At a meeting in California this spring, we sat down with a number of insurance company chief executives who are major participants in the Affordable Care Act exchanges. They asked us to carry back a message to Washington: Put partisanship aside and end federal uncertainty about support for the ACA; otherwise, they will end up setting premiums higher than necessary or withdrawing from markets across the country.

With only weeks before the exchanges open for business again, Washington has one more chance to take clear action to bring down premiums and help millions of American families. We developed five recommendations that could stabilize the individual health insurance market.

Read more at The Washington Post.

Bill Frist and Jill Biden: A call for better health and learning (The Tennessean)

THE TENNESSEAN | At Carpenters Middle School in Blount County, exercise and reading go hand in hand.

Nearly 200 students participate in the “Pedal Power” program, spending 20 minutes a day reading a book they select while riding a recumbent bike.

Students say that when they are physically active while they learn, they notice a difference, with one sharing that before the program he “used to not focus on reading” and another explaining “I’ve been reading more.”

Blount County’s program is not an outlier.  We are increasingly learning that students’ overall well-being and their academic achievement are intrinsically linked.  In our experiences—as a physician and as an educator who has taught at the high school and college level — we both have seen firsthand that good health helps our youth prosper.

Put Out The Fire Instead Of Burning Exchanges To The Ground: Extend Cost-Sharing Reduction Payments (Forbes)

FORBES | Eight years ago, former Democratic Senator John Breaux and I wrote: “Given the acrimony that’s developed over efforts to reform our nation’s health insurance system, many Americans wonder whether true bipartisan agreement on health reform can ever be possible. In short, it can.” Back then, we watched contentious debate over what came to be known as Obamacare, and we never saw bipartisanship materialize. But in 2003 we both participated in creating and enacting the bipartisan Medicare Modernization Act that established the enormously successful Medicare Part D. Bipartisanship was alive then. We missed an opportunity eight years ago, but over the next few weeks we have another prime chance.

The healthcare (and health) of 11 million Americans hangs in the balance. This may sound like a small portion of America’s insured population, and as a percentage it is, but these are all people we know. The 6 percent of Americans who buy their insurance on the individual market are the small business people, contract workers, entrepreneurs, musicians, stay-at-home parents, job seekers, and the millions of Americans who can’t receive coverage through their employers. They are Republicans, Democrats, and Independents. Trump supporters and Hillary voters. And their ability to purchase coverage on the exchanges is in jeopardy, as mixed signals from Congress and the Administration have left insurers scrambling to decide whether to hike already costly premiums or pull out entirely—triggering the beginnings of collapse in some regions.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2017/08/03/put-out-the-fire-instead-of-burning-exchanges-to-the-ground-extend-cost-sharing-reduction-payments/#156d14a81bc9

The Science Behind How Nature Affects Your Health (Forbes)

FORBES | Have you ever wondered how experiencing nature can improve your health and your life?

Increasingly, healthcare and public health professionals are recognizing that the social determinants of health—including where we’re born, live, work, play and age—collectively have a far greater impact on our health outcomes than the healthcare delivery system. It’s estimatedthat healthcare services account for just 10% of longevity, while social and environmental factors account for twice that at 20%, genetics 30%, and individual behaviors an estimated 40% (Schroeder, NEJM, 2007). Our surroundings and how they influence our choices form the foundation for a healthy lifestyle.

What roles do nature and exposure to natural surroundings play in improving our health? We know that spending time in nature makes us feel good, but does it measurably affect our well-being?

Study after study has shown the answer is yes.

Read more at Forbes: https://www.forbes.com/sites/billfrist/2017/06/15/the-science-behind-how-nature-affects-your-health/#721d0bd015ae

For Patients With Multiple Chronic Conditions, Improving Care Will Be A Bipartisan Effort (Health Affairs Blog)

HEALTH AFFAIRS BLOG | While federal policy makers are undertaking controversial and divisive debates over the future of the Affordable Care Act, Republicans and Democrats have had a good track record of working together to improve health care delivery and payment frameworks. Most recently, the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 reformed Medicare’s physician payment system to better link payment to quality, as well as incentivize participation in models of care outside of the traditional fee-for-service system. These alternative payment models continue a history of bipartisan work in delivery system reform by shifting away from fee-for-service (FFS) and toward a more coordinated, efficient system of care. The shared goal of ensuring high-quality, high-performance, and affordable health care presents a unique opportunity for further bipartisan agreement. Building upon this goal, we should also work to advance a more patient- and family-centered approach to delivering care, especially to those with complex, high-cost health care needs.

A good place to start, and an area where policy makers have already placed an increased focus, is on developing solutions within federal health programs to improve outcomes for individuals with multiple chronic conditions and functional limitations. People with multiple chronic conditions typically use more services, such as emergency department visits, hospitalizations, and eventual need for long-term services and support, compared to those without multiple chronic conditions. For those with complex health needs and functional impairment, health care expenditures averaged $21,000 annually, more than four times the average for all US adults. This spending trajectory is unsustainable for both patients’ pocketbooks and the health care system as a whole, and the care they receive is often fragmented and confusing.

Read more at Health Affairs Blog: https://www.healthaffairs.org/do/10.1377/hblog20170601.060354/full/

Updated Nutrition Labels Can Make Us Healthier Consumers (Forbes)

FORBES | As health-minded consumers of food, I think we all deserve to know what is in the packaged food we buy.

Giving consumers information to make their own choices sounds as American as apple pie, but somehow in today’s fractured political system, it’s become a major point of contention. For the health of our families, we need to get past that.

Let’s just focus on one example, the Food and Drug Administration’s proposed revision of the iconic Nutrition Facts label. The revised label for packaged foods will be required by July 2018 for big food companies, and by July 2019 for smaller companies (those selling $10 million or less a year; they actually account for 95% of companies). Many Americans may think the Nutrition Facts label has always been on what they buy in grocery stores, but it’s only been around since the early 1990s. However, we have learned a lot about diet’s impact on our health since then.

Read more at Forbes.